Has the Public Health System Provided Adequate Financial Risk Protection for Child Birth Conditions – Evidences From an Eastern Indian State

Document Type : Short Communication

Authors

Indian Institute of Public Health Bhubaneswar (IIPHB), Bhubaneswar, India

Abstract

Over the years, national and sub-national governments have introduced several initiatives to improve access to maternal and child health services in India. However, financial barriers have posed major constraints. Based upon the data of National Family Health Survey (NFHS) round 4 for Odisha state, our paper examines the out-of-pocket expenditure (OOPE) borne by households for accessing maternal and child healthcare services in a low resource setting of India. We have interpreted results of NFHS-4 by drawing inferences from literature for understanding the rising OOPE in the public health system. Findings suggests that OOPE is considerably high for maternal and child health conditions in Odisha and ranks fifth, despite the coverage of 72% women under Janani Suraksha Yojana (JSY), a condition cash transfer scheme with majority utilizing the public health system. The high OOPE on child delivery raises numerous pertinent questions about the effectiveness of the public health delivery system, and thus requires financial protection in the interest of the population that accesses public health systems in the state.

Keywords

Main Subjects

References

  1. National Health Systems Resource Centre. National Health Accounts Estimates for India (2014-2015). New Delhi: Ministry of Health and Family Welfare, Government of India; 2017.
  2. van Doorslaer E, Masseria C, Koolman X. Inequalities in access to medical care by income in developed countries. CMAJ. 2006;174(2):177-183. doi:10.1503/cmaj.050584
  3. Garg CC, Karan AK. Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural-urban and state level in India. Health Policy Plan. 2009;24(2):116-128. doi:10.1093/heapol/czn046
  4. National Sample Survey Office. Key Indicators of Social Consumption in India: Health, (NSSO 71st Round, January–June 2014). Ministry of Statistics and Programme Implementation (MOSPI), Government of India (GOI); 2015.
  5. Sample Registration Survey of India 2014-2016. http://www.censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR%20Bulletin-2014-16.pdf.  
  6. Vellakkal S, Gupta A, Khan Z, et al. Has India’s national rural health mission reduced inequities in maternal health services? A pre-post repeated cross-sectional study. Health Policy Plan. 2017;32(1):79-90. doi:10.1093/heapol/czw100
  7. Government of India. National Rural Health Mission: Meeting People’s Health Needs in Rural Areas, Framework for Implementation 2005-2012. New Delhi: Ministry of Health and Family Welfare; 2016.
  8. International Institute for Population Sciences (IIPS), Macro International. National Family Health Survey (NFHS-4), 2016–2017 (Volume 1). India, Mumbai; 2017. http://rchiips.org/nfhs/pdf/NFHS4/India.pdf.  
  9. Pandey N. Perceived barriers to utilization of maternal health and child health services: qualitative insights from rural Uttar Pradesh, India. New Delhi; 2010. http://paa2011.princeton.edu/papers/111751.
  10. Kesterton AJ, Cleland J, Sloggett A, Ronsmans C. Institutional delivery in rural India: the relative importance of accessibility and economic status. BMC Pregnancy Childbirth. 2010;10:30. doi:10.1186/1471-2393-10-30
  11. Gopalan SS, Durairaj V. Addressing maternal healthcare through demand side financial incentives: experience of Janani Suraksha Yojana program in India. BMC Health Serv Res. 2012;12:319. doi:10.1186/1472-6963-12-319
  12. National Rural Health Mission. Guidelines for Janani Shishu Surakshya Karyakram. Government of India; 2011. http://nhm.gov.in/images/pdf/programmes/maternal-health/guidelines/guidelines_for_jssk.pdf.   
  13. Tripathi N, Saini SK, Prinja S. Impact of Janani Shishu Suraksha Karyakram on out-of-pocket expenditure among urban slum dwellers in northern India. Indian Pediatr. 2014;51(6):475-477.
  14. Chaudhary S, Rohilla R, Kumar V, Kumar S. Evaluation of Janani Shishu Suraksha Karyakram scheme and out of pocket expenditure in a rural area of Northern India. J Family Med Prim Care. 2017;6(3):477-481. doi:10.4103/2249-4863.222010
  15. Sharma S. Janani Shishu Suraksha Karyakaram and its repercussions on out of pocket expenditure. International Journal of Current Research. 2016;7(9):20808-20815.
  16. International Institute for Population Sciences (IIPS). National Family Health Survey-4 (NFHS-4). http://rchiips.org/NFHS/factsheet_NFHS-4.shtml.  
  17. International Institute for Population Sciences (IIPS), ORC Macro. National Family Health Survey-2 (NFHS-2), 1998–1999. India, Mumbai: IIPS; 2000.
  18. Thongkong N, van de Poel E, Roy SS, Rath S, Houweling TA. How equitable is the uptake of conditional cash transfers for maternity care in India? Evidence from the Janani Suraksha Yojana scheme in Odisha and Jharkhand. Int J Equity Health. 2017;16(1):48. doi:10.1186/s12939-017-0539-5
  19. Modugu HR, Kumar M, Kumar A, Millet C. State and sociodemographic group variation in out-of-pocket expenditure, borrowingsand Janani Suraksha Yojana (JSY) programme use forbirth deliveries in India. BMC Public Health. 2012;12:1048.  doi:10.1186/1471-2458-12-1048
  20. Mohanty SK, Srivastava A. Out-of-pocket expenditure on institutional delivery in India. Health Policy Plan. 2013;28(3):247-262. doi:10.1093/heapol/czs057
  21. Sahu KS, Bharati B. Out-of-Pocket health expenditure and sources of financing for delivery, postpartum, and neonatal health in urban slums of Bhubaneswar, Odisha, India. Indian J Public Health. 2017;61(2):67-73. doi:10.4103/ijph.IJPH_168_15
  22. Government of India. Janani Shishu Suraksha Karykram Guidelines. New Delhi: NRHM; 2011. http://rmncha.in/wp-content/uploads/guidelines_img/1487572074.pdf.    
  23. Sharma S, Bothra M. Maternal and Child Healthcare: An Analysis of Out-of-pocket Expenditure under the Janani Shishu Suraksha Karyakaram. IEG Working paper No. 366. Published 2016.
  24. Department of Health and Family Welfare, Odisha Government. Odisha Technical Management Support Team – Out of Pocket Spending on Health in Odisha – Current Status and Some Recomendations. http://www.nrhmorissa.gov.in/writereaddata/Upload/Documents/OUT%20of%20POCKET%20SPENDING%20on%20Health%20in%20ODISHA%20%E2%80%93%20CURRENT%20STATUS%20and%20SOME%20RECOMENDATIONS.pdf.  Accessed September 28, 2017. Published 2011.
  25. Concurrent Assessment of Janani Suraksha Yojana scheme in selected states of India, 2008. New Delhi: UNFPA; 2009.
  26. Sidney K, Salazar M, Marrone G, Diwan V, DeCosta A, Lindholm L. Out-of-pocket expenditures for childbirth in the context of the Janani Suraksha Yojana (JSY) cash transfer program to promote facility births: who pays and how much? Studies from Madhya Pradesh, India. Int J Equity Health. 2016;15:71. doi:10.1186/s12939-016-0362-4
  27. Lim SS, Dandona L, Hoisington JA, James SL, Hogan MC, Gakidou E. India’s Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation. Lancet. 2010;375(9730):2009-2023. doi:10.1016/s0140-6736(10)60744-1
  28. Free Drug Distribution Scheme. Odisha State Medical Corporation Limited (OSMCL) website. http://osmcl.nic.in/?q=node/231.  Assessed January 6, 2018.
  29. Department of Women and Child Development and Mission Shakti. Government of Odisha. Mamata. http://wcdodisha.gov.in/content/2/50.  Assessed January 6, 2018.
  30. National Health Mission, Ministry of Health and Family Welfare, Government of India. Janani Shishu Suraksha Karyakaram (JSSK). http://nhm.gov.in/janani-shishu-suraksha-karyakram.html. Assessed January 6, 2018.
International Journal of Health Policy and Management
Volume 8, Issue 3
March 2019
Pages 145-149

Files

History

  • Receive Date: 08 February 2018
  • Revise Date: 06 November 2018
  • Accept Date: 11 November 2018
  • First Publish Date: 01 March 2019

Share

How to cite

Statistics