A qualitative study of the barriers to utilizing healthcare services among the tribal population in Assam

Boro, Bandita; Saikia, Nandita

doi:10.1371/journal.pone.0240096

Cited by 30 publications

(27 citation statements)

References 30 publications

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“…The factors like governance, CHWs and associated determinants often played a role in the implementation of the programme and the community health workers that are key to make it a success. Previous studies have also supported our findings regarding the under-coverage of JSY scheme in some of the districts is due to unavailability of CHWs, lack of governance, and the interaction between stakeholders and CHWs [ 27 , 39 – 41 , 46 , 54 , 55 ]. Further, the major finding of this study is that the regions which were already facing high inequity in health service coverage yet again spotted with socio-spatial inequality in the JSY coverage.…”

Section: Discussionsupporting

confidence: 89%

“…Further, there is also supply-side barriers women face in accessing JSY services [ 6 ]. Women belong to a marginalized and disadvantaged community are unable to meet the required MCH services available in the public domains in India [ 29 , 32 , 34 , 39 ], although the community health workers (CHWs) are the key to improve the service coverage in the community, however, there are evidences show that CHWs are biased in providing healthcare services in the community across the social groups [ 27 , 39 , 40 ]. The literature also shows that there is a significant variation in coverage of health policy and programs interventions across the communities due to unawareness and lack of knowledge [ 5 , 20 , 34 , 41 ].…”

Section: Introductionmentioning

confidence: 99%

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Regional inequality in the Janani Suraksha Yojana coverage in India: a geo-spatial analysis

Mishra

Kumar

Srivastava

2021

Int J Equity Health

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Introduction Although India has made significant progress in institutional delivery after the implementation of the National Rural Health Mission under which the Janani Suraksha Yojana (JSY) is a sub-programme which played a vital role in the increase of institutional delivery in public facilities. Therefore, this paper aims to provide an understanding of the JSY coverage at the district level in India. Further, it tries to carve out the factors responsible for the regional disparity of JSY coverage at district levels. Methods The study used the National Family Health Survey data, which is a cross-sectional survey conducted in 2015–16, India. The sample size of this study was 148,145 women aged 15–49 years who gave last birth in the institution during 5 years preceding the survey. Bivariate and multivariate regression analysis was used to fulfill the study objectives. Additionally, Moran’s I statistics and bivariate Local Indicator for Spatial Association (LISA) maps were used to understand spatial dependence and clustering of JSY coverage. Ordinary least square, spatial lag and spatial error models were used to examine the correlates of JSY utilization. Results The value of spatial-autocorrelation for JSY was 0.71 which depicts the high dependence of the JSY coverage over districts of India. The overall coverage of JSY in India is 36.4% and it highly varied across different regions, districts, and even socioeconomic groups. The spatial error model depicts that if in a district the women with no schooling status increase by 10% then the benefits of JSY get increased by 2.3%. Similarly, if in a district the women from poor wealth quintile, it increases by 10% the benefits of JSY also increased by 4.6%. However, the coverage of JSY made greater imperative to understand it due to its clustering among districts of specific states only. Conclusion It is well reflected in the EAGs states in terms of spatial-inequality in service coverage. There is a need to universalize the JSY programme at a very individual level. And, it is required to revisit the policy strategy and the implementation plans at regional or district levels.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Regional inequality in the Janani Suraksha Yojana coverage in India: a geo-spatial analysis

Mishra

Kumar

Srivastava

2021

Int J Equity Health

View full text Add to dashboard Cite

show abstract

“…The factors like governance, CHWs and associated determinants often played a role in the implementation of the programme and the community health workers that are key to make it a success. Previous studies have also supported our findings regarding the under-coverage of JSY scheme in some of the districts is due to unavailability of CHWs, lack of governance, and the interaction between stakeholders and CHWs[34][35][36][37][38][50][51]. Further, the major finding of this study is that the regions which were already facing high inequity in health service coverage yet again spotted with sociospatial inequality in the JSY coverage.…”

supporting

confidence: 87%

Regional inequality in the Janani Suraksha Yojana coverage in India: A Geo-spatial Analysis

Mishra

Kumar

Srivastava

2020

Preprint

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IntroductionAlthough India has made significant progress in institutional delivery after the implementation of the National Rural Health Mission under which the Janani Suraksha Yojana (JSY) is a sub-programme which played a vital role in the increase of institutional delivery in public facilities. Therefore, this paper aims to provide an understanding of the JSY coverage at the district level in India. Further, it tries to carve out the factors responsible for the regional disparity of JSY coverage at district levels.MethodsThe study used the National Family Health Survey data, which is a cross-sectional survey conducted in 2015-16, India. The sample size of this study was 148,145 women aged 15-49 years who gave last birth in the institution during five years preceding the survey. Bivariate and multivariate regression analysis was used to fulfill the study objectives. Additionally, Moran’s I statistics and bivariate Local Indicator for Spatial Association (LISA) maps were used to understand spatial dependence and clustering of JSY coverage. Ordinary least square, spatial lag and spatial error models were used to examine the correlates of JSY utilization.ResultsThe value of spatial-autocorrelation for JSY was 0.71 which depicts the high dependence of the JSY coverage over districts of India. The overall coverage of JSY in India is 36.4% and it highly varied across different regions, districts, and even socioeconomic groups. The spatial error model depicts that if in a district the women with no schooling status increase by 10% then the benefits of JSY get increased by 2.3%. Similarly, if in a district the women from poor wealth quintile, it increases by 10% the benefits of JSY also increased by 4.6%. However, the coverage of JSY made greater imperative to understand it due to its clustering among districts of specific states only.ConclusionIt is well reflected in the EAGs states in terms of spatial-inequality in service coverage. There is a need to universalize the JSY programme at a very individual level. And, it is required to revisit the policy strategy and the implementation plans at regional or district levels.

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“…As per NSS (2019), majority of the Scheduled Tribes (55%) are Hindus, located in the rural areas (64%) and have the lowest likelihood of seeking healthcare among all the social groups albeit the results being statistically insignificant. Poor quality of rural health infrastructure coupled by inaccesibility have been found to be the major barriers to utilising healthcare services by the tribal population [43]. However, the role of religion needs to be explored further to analyse the factors explaining the Muslim advantage in healthcare utilisation.…”

Section: Discussionmentioning

confidence: 99%

Determinants of rural-urban differential in healthcare utilization among the elderly population in India

Banerjee

2021

BMC Public Health

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Background Population aging poses a demographic burden on a country such as India with inadequate social security systems and very low public investment in health sector. This challenge of accelerated demographic transition is coupled by the rural-urban disparity in access to healthcare services among the elderly people in India. An important objective of India’s National Health Policy (2017) is to “progressively achieve universal health coverage” which is posited upon mitigating the sub-national disparity that necessitates identifying the drivers of the disparity for targeted policy intervention. This study, therefore, makes an attempt towards the exploration of the prominent contributory factors behind the rural-urban gap in utilisation of healthcare among the older population in India. Methods The analysis has been done by using the unit level data of Social Consumption: Health (Schedule number 25.0) of the 75th round of the National sample Survey conducted during July 2017–June 2018. Two binary logistic models have been proposed to capture the crude and the adjusted association between health seeking behaviour and place of residence (rural/ urban). To compute the group differences (between rural and urban) in the rate of healthcare utilization among the elderly population in India and to decompose these differences into the major contributing factors, Fairlie’s decomposition method has been employed. Results The logistic regression models established a strong association between place of residence and likelihood of healthcare utilisation among the Indian elderly people. The results of the Fairlie’s decomposition analysis revealed considerable rural-urban inequality disfavouring the rural residents and health care utilisation was found to be 7 percentage points higher among the older population residing in urban India than their rural counterparts. Level of education and economic status, both of which are indicators of a person’s Socio-Economic Status, were the two major determinants of the existing rural-urban differential in healthcare utilisation, together explaining 41% of the existing rural-urban differential. Conclusion Public health care provisions need to be strengthened both in terms of quality and outreach by way of greater public investments in the health sector and by building advanced health infrastructure in the rural areas. Implementation of poverty alleviation programmes and ensuring social-security of the elderly are also indispensable in bringing about equity in healthcare utilisation.

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A qualitative study of the barriers to utilizing healthcare services among the tribal population in Assam

Cited by 30 publications

References 30 publications

Regional inequality in the Janani Suraksha Yojana coverage in India: a geo-spatial analysis

Regional inequality in the Janani Suraksha Yojana coverage in India: a geo-spatial analysis

Regional inequality in the Janani Suraksha Yojana coverage in India: A Geo-spatial Analysis

Determinants of rural-urban differential in healthcare utilization among the elderly population in India

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