Financial incentives in health: New evidence from India's Janani Suraksha Yojana

Abstract

This paper studies the health effects of one of the world's largest demand-side financial incentive programmes -India's Janani Suraksha Yojana. Our difference-in-difference estimates exploit heterogeneity in the implementation of the financial incentive programme across districts. We find that cash incentives to women were associated with increased uptake of maternity services but there is no strong evidence that the JSY was associated with a reduction in neonatal or early neonatal mortality. The positive effects on utilisation are larger for less educated and poorer women, and in places where the cash payment was most generous. We also find evidence of unintended consequences. The financial incentive programme was associated with a substitution away from private health providers, an increase in breastfeeding and more pregnancies. These findings demonstrate the potential for financial incentives to have unanticipated effects that may, in the case of fertility, undermine the programme's own objective of reducing mortality.

Progress in maternal and child health: how has South Asia fared?

“…These have included deployment of community health workers through non-governmental health workers in Bangladesh 21 to public sector workers such as lady health workers in Pakistan 22 or accredited social health activists (ASHA) in India. 23 There have also been large scale experiments with community engagement through women's groups 24 as well and financial incentive programmes, both conditional on recipients' health behaviour, such as India's Janani Suraksha Yojana programme supporting facility births, 25 and unconditional, such as the income support programme in Pakistan targeting women. 26 Table 2 lists the key health initiatives implemented in South Asia during the period of the millennium development goals.…”

Quality of maternity care and its determinants along the continuum in Kenya: A structural equation modeling analysis

“…For instance, the Government of India launched in 2005 one of the largest conditional cash transfer programs in the world, Janani Suraksha Yojana (JSY), to encourage expectant mothers to obtain quality obstetric services in public or accredited private facilities [10]. Despite the significant increases in institutional deliveries, there is no strong evidence to support that the JSY program has contributed to improved maternal or neonatal survival [11,12]. Experiences from other countries have also demonstrated that improvement in utilization without concomitant increase in quality of care is inadequate [13–15].…”

How equitable is the uptake of conditional cash transfers for maternity care in India? Evidence from the Janani Suraksha Yojana scheme in Odisha and Jharkhand

“…Most notably, Lim et al (2010) found JSY to have a large positive impact on the institutional delivery rate (an increase of 43–49% in the probability of women delivering in a facility), leading to important reductions in neonatal mortality (a reduction of 2.3 neonatal deaths per 1,000 live births) [10]. These large effects have, however, been questioned by Powell-Jackson et al (2015) and Joshi and Sivaram (2014) who suggested that, despite an increase in use of maternity health services, there was no effect of JSY on maternal and neonatal health due to the low quality of care provided in public facilities [11, 12]. Some studies investigating heterogeneity of the effect of JSY on use of maternity care across socioeconomic groups found that poorer, less educated women and those belonging to Scheduled Castes or Tribes (as defined by the Indian Constitution) generally benefit more from JSY [11, 13, 14].…”

“…These large effects have, however, been questioned by Powell-Jackson et al (2015) and Joshi and Sivaram (2014) who suggested that, despite an increase in use of maternity health services, there was no effect of JSY on maternal and neonatal health due to the low quality of care provided in public facilities [11, 12]. Some studies investigating heterogeneity of the effect of JSY on use of maternity care across socioeconomic groups found that poorer, less educated women and those belonging to Scheduled Castes or Tribes (as defined by the Indian Constitution) generally benefit more from JSY [11, 13, 14]. Yet, these studies do not describe and explain socioeconomic inequalities in JSY receipt in detail.…”