Understanding equity of institutional delivery in public health centre in India: An assessment using Benefit Incidence Analysis

Abstract

Background: The National Health Mission (NHM), the largest ever publicly funded health programme worldwide used over half of the national health budget in India and primarily targeted to improve maternal and child health in the country. Though increased public health investment in India has improved the health care utilization and health outcomes across geographies and socio-economic groups, little is known on equity aspect of such large scale investment. In this context, this paper examines the utilisation pattern of delivery care and equity aspect of public investment in India.Methods: Data from the recent round of National Family Health Survey (NFHS 4) conducted during 2015-16 used in the analyses. A total of 148,645 last birth delivered in an institution in a reference period of five years has been used in the analyses. The out-of-pocket (OOP) payment on delivery care is the dependent variable. Benefits Incidence Analysis (BIA), descriptive statistics, concentration index (CI), and concentration curve (CC) used in the analysis.Results: Utilization of natal care from public health centres in India is pro-poor and have a strong economic gradient. However, about 28% mothers in richest wealth quintile did not pay for delivery in public health centres compared to 16% among the poorest wealth quintile. The median OOP payments for institutional delivery from public health centre was ₹1200 for mothers belonging to the poorest wealth quintile compared to ₹2000 for mothers belonging to richest wealth quintile. Benefit incidence analyses suggests that about 17.4 % of subsidies were used among poorest, 19.3% among richest quintile and 21.9% in the middle quintile. The concentration index of institutional delivery from public health centres was -0.161 [95% Confidence Interval: -0.158, -0.165] compared to 0.296 [95% Confidence Interval: 0.289, 0.303] from private health centres.Conclusion: Utilisation of natal care services from public health centres in India is pro-poor. However, benefit-incidence analyses suggest that the use of subsidy is relatively higher among wealthier and better off mothers in India.