Unintended effects of Janani Suraksha Yojana on maternal care in India

et al. 2020

Int J Equity Health

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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 aimed to improve maternal and child health in the country. Though large scale public health investment has improved the health care utilization and health outcomes across states and socio-economic groups in India, little is known on the equity concern of NHM. In this context, this paper examines the utilization pattern and net benefit of public subsidy for institutional delivery by the level of care in India. Methods Data from the most recent round of the National Family Health Survey (NFHS 4), conducted during 2015–16, was used in the study. A total of 148,645 last birth delivered in a health centre during the 5 years preceding the survey were used for the analyses. Out-of-pocket (OOP) payment on delivery care was taken as the dependent variable and was analysed by primary care and secondary level of care. Benefits Incidence Analysis (BIA), descriptive statistics, concentration index (CI), and concentration curve (CC) were used to do the analysis. Results Institutional delivery from the public health centres in India is pro-poor and has a strong economic gradient. However, about 28% mothers from richest wealth quintile did not pay for delivery in public health centres compared to 16% among the poorest wealth quintile. Benefit incidence analyses suggests a pro-poor distribution of institutional delivery both at primary and secondary level of care. In 2015–16, at the primary level, about 32.29% of subsidies were used by the poorest, 27.22% by poorer, 20.39% by middle, 13.36% by richer and 6.73% by the richest wealth quintile. The pattern at the secondary level was similar, though the magnitude was lower. The concentration index of institutional delivery in public health centres was − 0.161 [95% CI, − 0.158, − 0.165] compared to 0.296 [95% CI, 0.289, 0.303] from private health centres. Conclusion Provision and use of public subsidy for institutional delivery in public health centres is pro-poor in India. Improving the quality of service in primary health centres is recommended to increase utilisation and reduce OOP payment for health care in India.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Understanding equity of institutional delivery in public health centre by level of care in India: an assessment using benefit incidence analysis

et al. 2020

Int J Equity Health

Self Cite

“…About half of the national health resources are invested in NHM, with the aim of achieving multiple objectives including increasing service coverage, reducing inequality in health care and health outcomes and reducing OOP payment and CHS speci cally among the poor and the disadvantaged. The priorities of these schemes are usually to bene t the economically weaker section of the population, and studies attributed to increase in maternal care utilization and improvement in health outcome to the NHM [60][61][62]. There are limited studies on the distributional aspect of public subsidy on health care utilisation in India.…”

Section: Discussionmentioning

confidence: 99%

“…Although inequality still exists, the level of inequality has reduced signi cantly across all groups in LPS [57,59,65]. Besides increasing facility based delivery, JSY has signi cantly increased contraceptive use, breastfeeding practice and post-natal check-up, all of which are closely associated with accessing public health facilities [61,63].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

Preprint

Self Cite

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 aimed to improve maternal and child health in the country. Though large scale public health investment in India has improved the health care utilization and health outcomes across states and socio-economic groups, little is known on the equity concern of NHM. In this context, this paper examines the utilization pattern and net benefit of public subsidy for institutional delivery by the level of care in India. Methods: Data from the most recent round of the National Family Health Survey (NFHS 4), conducted during 2015-16, was used in the study. A total of 148,645 last birth delivered in a health centre during the five years preceding the survey were used for the analyses. Out-of-pocket (OOP) payment on delivery care was taken as the dependent variable and was analysed by primary care and secondary level of care. Benefits Incidence Analysis (BIA), descriptive statistics, concentration index (CI), and concentration curve (CC) were used to do the analysis. Results: Institutional delivery from the public health centres in India is pro-poor and has a strong economic gradient. About 28% mothers from richest wealth quintile did not pay for delivery in public health centres compared to 16% among the poorest wealth quintile. Benefit incidence analyses suggests a pro-poor distribution of institutional delivery both at primary and secondary level of care. In 2015-16, at the primary level, about 32.29% of subsidies were used by the poorest, 27.22% by poorer, 20.39% by middle, 13.36% by richer and 6.73% by the richest wealth quintile. The pattern at the secondary level was similar, though the magnitude was lower. The concentration index of institutional delivery in public health centres was -0.161 [95% CI: -0.158, -0.165] compared to 0.296 [95% CI: 0.289, 0.303] from private health centres.Conclusion: Provision and use of public subsidy for institutional delivery in public health centres is pro-poor in India. Improving the quality of service in primary health centres is recommended to increase utilisation and reduce OOP payment for health care in India.

“…Although inequality still exists, the level of inequality has reduced and institutional delivery has increased signi cantly across all groups in LPS [52,54]. Besides increasing facility based delivery, JSY has signi cantly increased contraceptive use, breastfeeding practice and post-natal check-up which are closely associated with accessing public health facilities [55].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

Preprint

Self Cite

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.