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Has the National Health Mission Improved Utilisation of Maternal Healthcare Services in Bihar?
Based on data from the National Sample Survey Office’s surveys on healthcare, this study critically evaluates the impact of the National Health Mission on improving utilisation of maternal healthcare services in Bihar, which had very poor maternal and child health outcomes at the start of the mission. In particular, it investigates factors affecting the utilisation of maternal care services and choice of facilities between the pre- and post-NHM periods; assesses the success of the Janani Suraksha Yojana in enhancing institutional delivery, particularly in public facilities; and estimates the out-of-pocket expenditure on maternal care in the pre- and post-NHM periods and identifies factors affecting such expenditure levels.
The study was supported by a grant from Bill and Melinda Gates Foundation.
The reduction of maternal, neonatal, and under-five mortality rate and providing protection from catastrophic health expenditure are essential prerequisites to accomplish health-related targets as envisioned in the Sustainable Development Goals (SDGs) (UN 2015). In order to achieve these goals, the utilisation of maternal and child healthcare needs to be optimised and substantial investment in maternal and child health is required to protect households from impoverishment and indebtedness due to high out-of-pocket expenditure (OOPE) and catastrophic health spending (CHS) (Mohanty and Kastor 2017).
Several studies conducted on the utilisation of maternal and child healthcare during the last two decades have reported a poor state of maternal and child health in the developing countries, including India. Such countries are characterised by high maternal mortality ratio (MMR) and infant mortality rate (IMR), negligence in receiving full antenatal check-up, deficiency in skilled birth attendance during labour, and high cost of healthcare (Whitehead et al 2001; Knaul et al 2006; Ronsmans and Graham 2006; Navaneetham and Dharmalingam 2002; Thind et al 2008; Harvey et al 2004; Afsana and Rashid 2001; Levin et al 2003; Perkins et al 2009; Gabrysch and Campbell 2009). The National Rural Health Mission (NRHM) was launched in 2005 by the Government of India to improve the overall health system and maternal and child health outcomes, particularly in states that had poor health infrastructure and dismal maternal and child health indicators (MoHFW 2005). Besides, the mission intended to ensure universal access to equitable, affordable, and quality healthcare. In 2013, the government launched the overarching National Health Mission (NHM) with the NRHM and the National Urban Health Mission (NUHM) as its two submissions.
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