Rural Healthcare

In this article, we focus on the efficiency of the healthcare system at the district level for Bihar. Although relatively an economically and socially disadvantaged state, the infant mortality rate in Bihar is very close to the all-India average. We explore the reasons for the differential performance of different districts by using data envelopment analysis. The efficiency rankings from our results indicate a mix of inefficiency, inadequacy of inputs, and the presence of an optimal targeting of funds under the National Rural Health Mission to low-performing districts.

This article provides evidence on the impact of the Rashtriya Swasthya Bima Yojana on access to healthcare and financial risk protection; its coverage across selected states and whether the targeting is effective. Overall, just about 11% of households were enrolled and almost half of these households actually belonged to the non-poor category. Although the scheme has increased hospitalisation rate, we do not know if it has enabled people to access the “genuinely needed” inpatient care which they could not afford earlier or whether hospitals are inducing the demand by suggesting unnecessary inpatient care to the people. Disturbingly, it has hardly had any effects on financial protection. These evidences unequivocally indicate that targeted health insurance coupled with a healthcare delivery system dominated by private providers cannot be the means to achieve universal healthcare.

The provision of low-cost sanitary napkins to women in rural areas is not an answer to the myriad problems they face in menstrual management. Apart from the need for a mechanism for ensuring the quality of the products and reducing the environmental cost of non-reusable products, the need is for a change in the attitude towards menstruation. It is because this is a taboo topic ruled by religio-cultural conventions that rural women face not only discomfort but also problems linked to reproductive health.

Ashish Bose coined the acronym BIMARU in the early 1980s to describe the backwardness of Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh relative to the best-performing states in terms of demographic indicators. This article extends Bose's analysis to recent years to ascertain if the proposition is still valid. To retain the integrity of the original exercise, the same indicators examined by Bose have been analysed, as far as possible. It fi nds that the BIMARU states have made a lot of progress, yet they continue to be bimaru as the gap between them and the national average persists in a majority of indicators.