Universalisation versus targeting in maternal and child health care provisioning: Evidence from India

To eradicate the persistent inequality in utilisation of Maternal Health Care Services (MHCS), India's Government has adopted various programmes under the National Rural Health Mission (NRHM) in 2005. The Janani Suraksha Yojana (JSY), a demand-side intervention, is one of the flagship programmes under the NRHM. Using two rounds of the nationally representative National Family Health Survey (NFHS) data collected in 2005–06 and 2015–16, respectively, we attempt to map the extent to which inequality in MHCS utilisation has changed over time across states after the implementation of NRHM; analyse whether there are differences in the patterns of inequality prevalent in the universal and targeted states; and find evidence to decide whether universalisation is more effective than targeting in reducing inequality in MHCS utilisation. We measure relative inequality and use the difference in difference technique to answer the research questions. For analysis, we have considered five outcome variables spanning across three stages of the continuum of care in maternal health. We find that relative inequality in MHCS utilisation declined across states during the period 2006–16, though in varying degrees. Universal states experienced a higher level of inequality as compared to the targeted states. However, universal states observed a higher decline in inequality over time relative to the targeted states controlling for other state-level characteristics. The study establishes that the programme implementation strategy and conditional cash transfer programmes influence the reduction of inequality in MHCS utilisation. This study makes an important contribution to the literature on public health policy and inequality in health care utilisation by highlighting the differential impact of universalisation and targeting on reducing inequality in the use of MHCS.

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Inequality in maternal health care services utilization between rich and poor has been a major policy concern in India.

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Conditional cash incentivization program for institutional delivery has helped to reduce inequality across all states.

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States have adopted either universal or targeted coverage and have experienced a varying degree of reduction in inequality.

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We use Difference-in-Difference technique to find effectiveness of universalization vis-a-vis targeting.

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Universal states experience a higher decline in inequality compared to targeted states.

Health System Competency for Maternal Health Services in Balasore District and Jaleswar Block, Balasore, Odisha, India: An Assessment

INTRODUCTION

A competent health system is of paramount importance in delivering the desired health services in a particular community.

AIM

The broad objective of this study was to assess the health system competency for the maternal health services in Balasore District and Jaleswar block of Balasore district, Odisha, India.

MATERIALS AND METHODS

A mixed method approach was adopted in order to understand the health system competency for maternal health services in the study area.

RESULTS

There was poor accessibility through road, poor electricity connection and piped water for the health care centers in the district. Even, existing Primary Health Centres (PHCs) lack ECG and X-Ray machines for proper diagnostic services which jeopardize the catering of health services. Community Health Centres (CHC) lack basic diagnostic and ambulance services making the tribal pockets inaccessible. The tribal dominated Jaleswar block shows poor performance in terms of total registered Antenatal Checkups (ANC) (only 77%). A gradual decrease in the rate of ANC, from first to fourthcheckup, was observed in the district.

CONCLUSION

Lack of public health infrastructure in general and non-compliance to Indian Public Health Standards (IPHS) in particular, affect the health of tribal women resulting in lack of interest in availing the institutional delivery services and other pertinent maternal health services.