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International Journal for Equity in Health

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01-12-2020 | Public Health | Research

Understanding equity of institutional delivery in public health centre by level of care in India: an assessment using benefit incidence analysis

Authors: Sanjay K. Mohanty, Radhe Shyam Mishra, Suyash Mishra, Soumendu Sen

Published in: International Journal for Equity in Health | Issue 1/2020

Abstract

Background

The National Health Mission (NHM), the largest ever publicly funded health programme worldwide, used over half of the national health budget in India and primarily aimed to improve maternal and child health in the country. Though large scale public health investment has improved the health care utilization and health outcomes across states and socio-economic groups in India, little is known on the equity concern of NHM. In this context, this paper examines the utilization pattern and net benefit of public subsidy for institutional delivery by the level of care in India.

Methods

Data from the most recent round of the National Family Health Survey (NFHS 4), conducted during 2015–16, was used in the study. A total of 148,645 last birth delivered in a health centre during the 5 years preceding the survey were used for the analyses. Out-of-pocket (OOP) payment on delivery care was taken as the dependent variable and was analysed by primary care and secondary level of care. Benefits Incidence Analysis (BIA), descriptive statistics, concentration index (CI), and concentration curve (CC) were used to do the analysis.

Results

Institutional delivery from the public health centres in India is pro-poor and has a strong economic gradient. However, about 28% mothers from richest wealth quintile did not pay for delivery in public health centres compared to 16% among the poorest wealth quintile. Benefit incidence analyses suggests a pro-poor distribution of institutional delivery both at primary and secondary level of care. In 2015–16, at the primary level, about 32.29% of subsidies were used by the poorest, 27.22% by poorer, 20.39% by middle, 13.36% by richer and 6.73% by the richest wealth quintile. The pattern at the secondary level was similar, though the magnitude was lower. The concentration index of institutional delivery in public health centres was − 0.161 [95% CI, − 0.158, − 0.165] compared to 0.296 [95% CI, 0.289, 0.303] from private health centres.

Conclusion

Provision and use of public subsidy for institutional delivery in public health centres is pro-poor in India. Improving the quality of service in primary health centres is recommended to increase utilisation and reduce OOP payment for health care in India.

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Title: Understanding equity of institutional delivery in public health centre by level of care in India: an assessment using benefit incidence analysis
Authors: Sanjay K. Mohanty
Radhe Shyam Mishra
Suyash Mishra
Soumendu Sen
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Public Health
Care
Published in: International Journal for Equity in Health / Issue 1/2020
Electronic ISSN: 1475-9276
DOI: https://doi.org/10.1186/s12939-020-01331-z

At a glance: The STEP trials

Springer Medicine

Understanding equity of institutional delivery in public health centre by level of care in India: an assessment using benefit incidence analysis

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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