Institutional delivery in India, 2004–14: unravelling the equity-enhancing contributions of the public sector

Abstract

To achieve faster and equitable improvements in maternal and child health outcomes, the government of India launched the National Rural Health Mission in 2005. This paper describes the equity-enhancing role of the public sector in increasing use of institutional delivery care services in India between 2004 and 2014. Information on 24 661 births from nationally representative survey data for 2004 and 2014 is analysed. Concentration index is computed to describe socioeconomic-rank-related relative inequalities in institutional delivery and decomposition is used to assess the contributions of public and private sectors in overall socioeconomic inequality. Multilevel logistic regression is applied to examine the changes in socioeconomic gradient between 2004 and 2014. The analysis finds that utilization of institutional delivery care in India increased from 43% in 2004 to 83% in 2014. The bulk of the increase was in public sector use (21% in 2004 to 53% in 2014) with a modest increase in private sector use (22% in 2004 to 30% in 2014). The shift from a pro-rich to pro-poor distribution of public sector use is confirmed. Decomposition analysis indicates that 51% of these reductions in socioeconomic inequality are associated with improved pro-poor distribution of public sector births. Multilevel logistic regressions confirm the disappearance of a wealth-based gradient in public sector births between 2004 and 2014. We conclude that public health investments in India have significantly contributed towards an equitable increase in the coverage of institutional delivery care. Sustained policy efforts are necessary, however, with an emphasis on education, sociocultural and geographical factors to ensure universal coverage of institutional delivery care services in India.

Regional inequality in the Janani Suraksha Yojana (JSY) coverage in India: A Geo-spatial Analysis

“…Moreover, previous literature argued that after JSY in 2005-07, the benefit was more weighted towards rural, illiterate and women from lower socio-economic strata (S. K. Gupta et al, 2012). Additioanly, it was too argued that the concentration of JSY coverage was high among women from lowe socio-economic strata because of cash incentive system of JSY (Powell-jackson et al, 2015).The use of public institutional delivery has increased many folds among the poor socio-economic women after the launch of the National Rural Health Mission (NRHM) in 2005 and it turned up as propoor programme (Joe et al, 2018). However, the gap remained the same in accessing the JSY service (Under the NRHM) by marginalized and disadvantaged women which are shown in this study as well.…”

“…Despite given efforts by international, national,and local governments and agencies, the utilization status of maternal and child health (MCH) care services is still low in many developing countries, including India (Kruk, Prescott, & Galea, 2008;Blas et al, 2008;Boerma, 2012;Heidkamp & Group, 2017;Baru et al, 2010;Lim et al, 2010;Paul, Paul, & James, 2019).Although India has made considerable progress in reducing maternal mortality through the interventions of different health policies and programs, the national rural health mission (NRHM) is one of them andactingas multi-strategic policy interventions to promote health care accessibility while reducing health inequity (Gupta, et al, 2016;Vellakkal, et al, 2017a), however, kinds of literature show that the effectiveness and efficiency of the programs are not the same across socio-economic groups and regions that led to slow, uneven and unequaldistribution of health and health care practices (Baru, et al, 2010;Borooah, et al, 2012;Lim et al, 2010;Joe, et al, 2018;Paul, S., Paul, S., & James, K. S. 2019).…”

“…Moroever, it also varies across geographic regions and states in India (Lim et al, 2010;Powell-jackson, Mazumdar, & Mills, 2015). Spatial disparity matters in the MCH services coverage and its utilization (Biradar & Singh, 2020;Joe, Perkins, Kumar, Rajpal, & Subramanian, 2018;Panda, Kumar, & Mishra, 2019). Studies show that there is a strong correlation between the proximate determinants of spatial clustering and the service coverage (Panda, Kumar, & Mishra, 2019).…”

Does engagement with frontline health workers improve maternal and child healthcare utilisation and outcomes in India?

“…Intervention through demand-side determinants and demand-side financing are well discussed and debated strategies in policy and programs to ensure equity in MCH care and outcomes [5,8,10,11,34]. However, enhancing engagement with FHWs can be just as cost-effective, results-driven and are shown to be a proven intervention for bringing equity in MCH care and outcomes [28,56].…”

Temporal decomposition of life years lived with disability in India: a growing demographic concern

“…The key finding of our research highlights a rising burden of disability on the working age groups. In the last few decades, an improvement in child health and mortality in India has directly improved the overall LE and reduced congenital and childhood disability [33,34]. This suggests that a lesser number of disabled children entered the working age group during the study decade.…”