Study of conditional cash transfer programme Janani Suraksha Yojana for promotion of institutional births : Studies from selected provinces of India
Background: To accelerate the coverage of skilled birth attendance, in 2005, the Indian government initiated a conditional cash transfer (CCT) programme, Janani Suraksha Yojana (JSY) that provides cash to women upon delivering in health facilities. The attempt to increase the utilization of faciliti...
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Format: | Doctoral Thesis |
Language: | English |
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Umeå universitet, Epidemiologi och global hälsa
2015
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Online Access: | http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-112844 http://nbn-resolving.de/urn:isbn:978-91-7601-393-9 |
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language |
English |
format |
Doctoral Thesis |
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topic |
Maternal health Condititonal cash transfer Inequality Referral India |
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Maternal health Condititonal cash transfer Inequality Referral India Randive, Bharat Study of conditional cash transfer programme Janani Suraksha Yojana for promotion of institutional births : Studies from selected provinces of India |
description |
Background: To accelerate the coverage of skilled birth attendance, in 2005, the Indian government initiated a conditional cash transfer (CCT) programme, Janani Suraksha Yojana (JSY) that provides cash to women upon delivering in health facilities. The attempt to increase the utilization of facilities through the JSY, given the health system’s fragile state, has raised concerns about the programme’s success at achieving its intended goal of reducing maternal mortality ratio (MMR). Aim: To understand the implementation of the CCT policy to promote institutional births in India, with a special focus on nine of India’s poorer states. Methods: Thesis uses both quantitative and qualitative methods. The changes in coverage and inequalities in institutional births in the nine states following the initiation of JSY were analysed by comparing levels before and during the programme using state and district level data. The association between the coverage of institutional births and MMR was assessed using regression analysis (I). The change in socioeconomic inequalities in institutional births was estimated using the concentration index and concentration curve, and contributions of different factors to inequalities was computed by decomposition analysis (II). The quality of referral services was studied by conducting a survey of health facilities (n=96) and post-partum women (n=1182) in three districts of Madhya Pradesh. Conditional logistic regression was used to study the association between maternal referrals and adverse birth outcomes, while spatial data for referrals were analysed using Geographical Information Systems (III). Semi-structured interviews were conducted with government and non-government stakeholders (n=11) to explore their perceptions of the JSY, and the data were analysed using a thematic framework approach (IV). Results: In five years, institutional births increased significantly from a pre-programme average of 20% to 49%. However, no significant association between district-level institutional birth proportions and MMR was found (I). The inequality in access to institutional delivery care, although reduced since the introduction of JSY, still persists. Differences in male literacy, availability of emergency obstetric care (EmOC) in public facilities and poverty explained 69% of the observed inequality. While MMR has decreased in all areas since the introduction of JSY, it has declined four times faster in the richest areas than in the poorest (II). Adjusted odds for adverse birth outcomes among those referred were twice than in those who were not referred (AOR 2.6, 95% CI 1.1-6.6). A spatial analysis of the inter-facility transfer time indicated that maternal deaths occurred despite good geographic access to EmOC facilities (III). While most health officials considered stimulus in the form of JSY money to be essential to promote institutional births, non-government stakeholders criticised JSY as an easy way of addressing basic developmental issues and emphasised the need for improvements to health services, instead. Supply-side constraints and poor care quality were cited as key challenges to programme success, also several implementation challenges were cited (IV). Conclusions: Although there was a sharp increase in coverage and a decline in institutional delivery care inequalities following the introduction of JSY, the availability of critical care is still poor. CCT programmes to increase service utilization need to be essentially supported by the provision of quality health care services, in order to achieve their intended impacts on health outcomes. |
author |
Randive, Bharat |
author_facet |
Randive, Bharat |
author_sort |
Randive, Bharat |
title |
Study of conditional cash transfer programme Janani Suraksha Yojana for promotion of institutional births : Studies from selected provinces of India |
title_short |
Study of conditional cash transfer programme Janani Suraksha Yojana for promotion of institutional births : Studies from selected provinces of India |
title_full |
Study of conditional cash transfer programme Janani Suraksha Yojana for promotion of institutional births : Studies from selected provinces of India |
title_fullStr |
Study of conditional cash transfer programme Janani Suraksha Yojana for promotion of institutional births : Studies from selected provinces of India |
title_full_unstemmed |
Study of conditional cash transfer programme Janani Suraksha Yojana for promotion of institutional births : Studies from selected provinces of India |
title_sort |
study of conditional cash transfer programme janani suraksha yojana for promotion of institutional births : studies from selected provinces of india |
publisher |
Umeå universitet, Epidemiologi och global hälsa |
publishDate |
2015 |
url |
http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-112844 http://nbn-resolving.de/urn:isbn:978-91-7601-393-9 |
work_keys_str_mv |
AT randivebharat studyofconditionalcashtransferprogrammejananisurakshayojanaforpromotionofinstitutionalbirthsstudiesfromselectedprovincesofindia |
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1718154193801314304 |
spelling |
ndltd-UPSALLA1-oai-DiVA.org-umu-1128442015-12-19T04:53:46ZStudy of conditional cash transfer programme Janani Suraksha Yojana for promotion of institutional births : Studies from selected provinces of IndiaengRandive, BharatUmeå universitet, Epidemiologi och global hälsaUmeå : Umeå universitet2015Maternal healthCondititonal cash transferInequalityReferralIndiaBackground: To accelerate the coverage of skilled birth attendance, in 2005, the Indian government initiated a conditional cash transfer (CCT) programme, Janani Suraksha Yojana (JSY) that provides cash to women upon delivering in health facilities. The attempt to increase the utilization of facilities through the JSY, given the health system’s fragile state, has raised concerns about the programme’s success at achieving its intended goal of reducing maternal mortality ratio (MMR). Aim: To understand the implementation of the CCT policy to promote institutional births in India, with a special focus on nine of India’s poorer states. Methods: Thesis uses both quantitative and qualitative methods. The changes in coverage and inequalities in institutional births in the nine states following the initiation of JSY were analysed by comparing levels before and during the programme using state and district level data. The association between the coverage of institutional births and MMR was assessed using regression analysis (I). The change in socioeconomic inequalities in institutional births was estimated using the concentration index and concentration curve, and contributions of different factors to inequalities was computed by decomposition analysis (II). The quality of referral services was studied by conducting a survey of health facilities (n=96) and post-partum women (n=1182) in three districts of Madhya Pradesh. Conditional logistic regression was used to study the association between maternal referrals and adverse birth outcomes, while spatial data for referrals were analysed using Geographical Information Systems (III). Semi-structured interviews were conducted with government and non-government stakeholders (n=11) to explore their perceptions of the JSY, and the data were analysed using a thematic framework approach (IV). Results: In five years, institutional births increased significantly from a pre-programme average of 20% to 49%. However, no significant association between district-level institutional birth proportions and MMR was found (I). The inequality in access to institutional delivery care, although reduced since the introduction of JSY, still persists. Differences in male literacy, availability of emergency obstetric care (EmOC) in public facilities and poverty explained 69% of the observed inequality. While MMR has decreased in all areas since the introduction of JSY, it has declined four times faster in the richest areas than in the poorest (II). Adjusted odds for adverse birth outcomes among those referred were twice than in those who were not referred (AOR 2.6, 95% CI 1.1-6.6). A spatial analysis of the inter-facility transfer time indicated that maternal deaths occurred despite good geographic access to EmOC facilities (III). While most health officials considered stimulus in the form of JSY money to be essential to promote institutional births, non-government stakeholders criticised JSY as an easy way of addressing basic developmental issues and emphasised the need for improvements to health services, instead. Supply-side constraints and poor care quality were cited as key challenges to programme success, also several implementation challenges were cited (IV). Conclusions: Although there was a sharp increase in coverage and a decline in institutional delivery care inequalities following the introduction of JSY, the availability of critical care is still poor. CCT programmes to increase service utilization need to be essentially supported by the provision of quality health care services, in order to achieve their intended impacts on health outcomes. Doctoral thesis, comprehensive summaryinfo:eu-repo/semantics/doctoralThesistexthttp://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-112844urn:isbn:978-91-7601-393-9Umeå University medical dissertations, 0346-6612 ; 1770application/pdfinfo:eu-repo/semantics/openAccess |