Data with Intent: A Summary of Insights Investigating Progress in Maternal and Child Health & Healthcare (Part 2)
Published on :- March 29th, 2022The fifth National Family Health Survey (NFHS-V) was conducted in 2019-20. A multi-level survey that covers all states and union territories of India, the NFHS facilitates the creation of a rich database for indicators related to healthcare systems, schemes, and region-wise performances. Among the indicators for which the survey collects data, about thirty indicators are related to maternal and neonatal child health. It is important for ecosystem actors to monitor these indicators as bases to develop their initiatives. Data with Intent by Sattva provides sharp and meaningful data insights and highlights trends that could enable ecosystem actors to take informed decisions and design effective interventions. In our first blog we covered key indicators for maternal and neonatal child health as measured in the NFHS-V and how different regions perform on these parameters. In this second part, we look into trends relating to budget allocation for various government schemes, as well as changes in out-of-pocket expenditure (OOPE) made by households across different states. Financial indicators are crucial as they offer a clear picture of the availability and quality of healthcare services in public systems. Disparities in out-of-pocket expenses among households signal a corresponding disparity in service availability for beneficiaries in the public healthcare system. Similarly, changes in budget allocations for various government schemes suggest scope for intervention by non-governmental stakeholders. These data points therefore offer a basis for informed action. Between NFHS-IV and NFHS-V, North-eastern states exhibited a major increase in average OOPE for institutional births. Sikkim, Manipur and Arunachal Pradesh reported the greatest increase in OOPE since 2015-16, with households paying more than Rs. 3000 out-of-pocket for a delivery in a public health facility. The increase is in sharp contrast to the national average – a Rs 281 decrease in out-of-pocket expenses for an institutional delivery. A worrying trend is that in states where the expenditure has increased, the magnitude is greater than the decrease in other states. One plausible explanation for the disparities in these regions could be that the cost of access increases because of the geographical conditions in this region that obstruct easy access to healthcare facilities. The difficult terrain, as well as the sparse population density makes the setting up of healthcare infrastructure challenging. High OOPE acts as a major deterrent for patients seeking institutional healthcare, and decreasing it should therefore be a priority. Such a situation indicates potential to develop hyperlocal or mobile healthcare units to cater to these areas. The Pradhan Mantri Matru Vandana Yojana (PMMVY) is a maternity benefit scheme providing conditional cash transfers to pregnant women and lactating mothers for their first live birth. Implemented under the aegis of the Integrated Child Development Scheme (ICDS), the initiative aims to impact more than 50 lakh women every year. In 2021-22, the PMVVY has been clubbed with the SAMARTHYA scheme which also includes Beti Bachao Beti Padhao, Mahila Shakti Kendra, and Gender Budgeting/Research/ Skilling/ Training programmes. The combined budget for these initiatives has increased considerably to Rs 2622 crores in 2022-23, as compared to 2016-17 allocation of Rs 634 crores to the scheme under the Indira Gandhi Matritva Sahayog Yojana (IGMSY). These trends bode well for expecting and new mothers across the country and could offset out-of-pocket expenses for institutional births to some extent. On the other hand, allocations for the Janani Suraksha Yojana (or JSY, part of the National Health Mission) have seen a marginal decline between NFHS-IV and NFHS-V. Unlike PMMVY, JSY was set up to support women from poor and marginalized groups and aimed towards promoting institutional births to reduce maternal and infant mortality among these segments. States with a lower proportion of institutional births are allotted more funds as compared to high performing states. Given that there is some overlap in the beneficiary base between JSY and PMMVY, there is potential for convergence of the two schemes. There is an urgent need to bridge regional disparities in access to maternal and perinatal care in India. Even as budgetary allocations increase, it is crucial for these to be channelised into contextually relevant interventions, especially in underserved regions, for equitable access to healthcare. Data with Intent by Sattva is dedicated to delivering you insights that help you think and act in the impact ecosystem. The next Data with Intent series explores women’s participation in the labour force, which will be summarized in our upcoming blog post. For detailed data analysis and insights on NFHS data, check out Health Indicators (NFHS) an interactive dashboard on India Data Insights (IDI).