Impact of Distance in the Provision of Maternal Health Care Services and Its Accountability in Murarai-II Block, Birbhum District

Abstract

The maternal health issue was a part of the Millennium Development Goals (MDGs, Target-5). Now it has been incorporated into Target-3 of 17 points Sustainable Development Goal-2030, declared by the United Nations, 2015. In India, about 50% of newborn deaths can be reduced by taking good care of the mother during pregnancy, childbirth and postpartum period. This requires timely, well-equipped healthcare by trained providers, along with emergency transportation for referral obstetric emergency. Governments need to ensure physicians in the rural underserved areas. The utilisation of maternal healthcare services (MHCSs) depends on both the availability and accessibility of services along with accountability.This study is based on an empirical retrospective survey, also called a historic study, to evaluate the influences of distance on the provision of maternal health services and on its accountability in Murarai-II block, Birbhum District. The major objective of the study is to identify the influence of distance on the provision and accountability of the overall MHCSs. The investigation has found that there is a strong inverse relationship (-0.75) between accessibility index and accountability score with p-value = <0.05, where the direct connectivity index seem to have no direct influence on the accountability score (as the ‘r’ is 0.56 and p-value= >0.05). Tracking of pregnant women, identification of high risk pregnancy and timely Postnatal Care (PNC) have become the dominant factors of the maternal healthcare services in the first Principal Component Analysis (PCA), explaining 49.67% of the accountability system. Overall, institutional barriers to accessibility are identified as important constraints behind lesser accountability of the services, preventing the anticipated benefit. This study highlights the critical areas where maternal healthcare services are lacking. The analysis has highlighted the importance of physical access to health services in shaping the provision of maternal healthcare services.Drawing on empirical observations of operation of public distribution system in different states of India, the paper constructs a preliminary game theoretic model. It argues that an effective public distribution must be as universal as possible, delivery mechanism of fair price shops should be reformed, they should be make them commercially viable and that special attention should be paid to PDS at times of high food inflation.

Obstacles in the Utilisation of Maternal Health Care Services in Murarai-II C.D. Block, Birbhum District, West Bengal, India

“…The aforesaid analysis unravels an amicable interpretation about the predominant position of distance in the utilisation of MHCSs. There is a strong significant impact of accessibility index on the paucity index, underserved score and obstacle score (Ghosh and Mistri, 2016). Hence, it clearly reveals the fact that distance has a negative impact on utilisation of MHCSs.…”

“…Several indicators of health status show that India is still lagging behind the global standard. It has sometimes been argued that the lacklustre performance of India in terms of health is mainly because of poor health facilities, especially at the primary level (Ghosh and Mistri, 2016;Sarma and Bhattacharyya, 2015;Hati & Majumder, 2011). Health facilities in general and hospitals in particular are facing different challenges related to their location, demand area, services and population pressure (Murad, 2007).…”

“…Pregnancy induced complication and childbirth remain major challenges to the healthcare planner, provider and policy makers in the developing part of the societies (Goland et al, 2012), and India is no exception. Most remote areas of India suffer from high maternal mortality rates (MMR) and infant mortality rates (IMR) (Bhattacharyya, 2016;Ghosh and Mistri, 2016;Sarma and Bhattacharyya, 2015). Tables 1 and 2 illustrate the state of India's MMR and IMR. Community differences in access to health facilities, the scantiness of healthcare providers and insufficient transport facilities play crucial roles for the insolvency in maternal health care system of the rural areas.…”

“…Access to healthcare is a multi-dimensional system, including the factors like-availability and acceptability (financial and geographical) (Blanford et al, 2012;Taiar et al, 2010). Proximity to the service and protecting health is the key concern for the issue of health care service system; it is to correct the "health impairments" (Akhtar & Izhar, 2010;Bhattacharyya, 2016;Ghosh and Mistri, 2016).The nature and type of terrain, road condition, location and distance of the health care centres are having greater influence to measure the degree and status of maternal healthcare services of a given area (Buor, 2002;Thaddeus & Maine, 1994;Ghosh and Mistri, 2016).Accessibility of the healthcare facilities are concerned with the ability of a population to obtain a certain set of healthcare services, which according to Penchansky & Thomas (1981) and Oliver & Mossialos (2004) can be clubbed into three categories-(a) availability, (b) affordability and (c) geography (cited in Black et al, nd.). Deteriorating roads coupled with inadequate, unaffordable transport make it impossible for the poor to access the health facilities (Mamdani & Bangser, 2004).…”

“…the Critical Morbidity Percentage then that seems to be highest in Bankura with around 7 per cent followed by Nadia, Darjeeling, Birbhum (Hati & Majumder, 2011).In order to reduce MMR and improve maternal health women need access to effective interventions and high-quality reproductive health care. Many countries have implemented programmes to expand access to interventions in order to reduce the level of unmet need for contraception, provide antenatal care during pregnancy and ensure delivery by a skilled birth attendant (World Health Organisation, 2011; see also, Bhattacharyya, 2016;Ghosh and Mistri, 2016;Sarma and Bhattacharyya, 2015).…”