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

International Journal for Equity in Health

Research

Tanja A. J. Houweling¹  Shibanand Rath²  Swati Sarbani Roy²  Ellen van de Poel³  Nattawut Thongkong⁴ 

[1] Department of Public Health, Erasmus MC Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands;Ekjut, Plot 556B, Potka, Chakradharpur, PIN: 833102, West Singhbhum, Jharkhand, India;Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands;Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands;Department of Public Health, Erasmus MC Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands;

关键词: ocioeconomic inequality;    onditional cash transfers;    aternity care;    Janani Suraksha Yojana;    India;   

DOI  :  10.1186/s12939-017-0539-5

 received in 2016-05-18, accepted in 2017-02-21,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIn 2005, the Indian Government introduced the Janani Suraksha Yojana (JSY) scheme - a conditional cash transfer program that incentivizes women to deliver in a health facility – in order to reduce maternal and neonatal mortality. Our study aimed to measure and explain socioeconomic inequality in the receipt of JSY benefits.MethodsWe used prospectively collected data on 3,682 births (in 2009–2010) from a demographic surveillance system in five districts in Jharkhand and Odisha state, India. Linear probability models were used to identify the determinants of receipt of JSY benefits. Poor-rich inequality in the receipt of JSY benefits was measured by a corrected concentration index (CI), and the most important drivers of this inequality were identified using decomposition techniques.ResultsWhile the majority of women had heard of the scheme (94% in Odisha, 85% in Jharkhand), receipt of JSY benefits was comparatively low (62% in Odisha, 20% in Jharkhand). Receipt of the benefits was highly variable by district, especially in Jharkhand, where 5% of women in Godda district received the benefits, compared with 40% of women in Ranchi district. There were substantial pro-rich inequalities in JSY receipt (CI 0.10, standard deviation (SD) 0.03 in Odisha; CI 0.18, SD 0.02 in Jharkhand) and in the institutional delivery rate (CI 0.16, SD 0.03 in Odisha; CI 0.30, SD 0.02 in Jharkhand). Delivery in a public facility was an important determinant of receipt of JSY benefits and explained a substantial part of the observed poor-rich inequalities in receipt of the benefits. Yet, even among public facility births in Jharkhand, pro-rich inequality in JSY receipt was substantial (CI 0.14, SD 0.05). This was largely explained by district-level differences in wealth and JSY receipt. Conversely, in Odisha, poorer women delivering in a government institution were at least as likely to receive JSY benefits as richer women (CI −0.05, SD 0.03).ConclusionJSY benefits were not equally distributed, favouring wealthier groups. These inequalities in turn reflected pro-rich inequalities in the institutional delivery. The JSY scheme is currently not sufficient to close the poor-rich gap in institutional delivery rate. Important barriers to institutional delivery remain to be addressed and more support is needed for low performing districts and states.

【 授权许可】

CC BY   
© The Author(s). 2017

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