Abstract
Over the years, national and sub-national governments have introduced several initiatives to improve access to maternal and child health services in India. However, financial barriers have posed major constraints. Based upon the data of National Family Health Survey (NFHS) round 4 for Odisha state, our paper examines the out-of-pocket expenditure (OOPE) borne by households for accessing maternal and child healthcare services in a low resource setting of India. We have interpreted results of NFHS-4 by drawing inferences from literature for understanding the rising OOPE in the public health system. Findings suggests that OOPE is considerably high for maternal and child health conditions in Odisha and ranks fifth, despite the coverage of 72% women under Janani Suraksha Yojana (JSY), a condition cash transfer scheme with majority utilizing the public health system. The high OOPE on child delivery raises numerous pertinent questions about the effectiveness of the public health delivery system, and thus requires financial protection in the interest of the population that accesses public health systems in the state.
Highlights
In India, healthcare is largely financed through out-of-pocket expenditure (OOPE) which stands at 63% of total health expenditure.[1]
The impoverishment that impacts high OOPE on Indian households is well established in literature
Though the striking success of Janani Suraksha Yojana (JSY) scheme in the state 5 contributes to the positive growth, this success is undermined since the public health system fails to provide financial risk protection to the beneficiaries
Summary
In India, healthcare is largely financed through out-of-pocket expenditure (OOPE) which stands at 63% of total health expenditure.[1]. Though in India the public sector provides 18% of total outpatient care and 44% inpatient care,[3] wide inter-state variations in utilisation pattern exists; with exception of Assam and Odisha with higher utilization in the public health system.[4] Prominent reasons for not accessing services from public sector facilities include long waiting hours and poor quality of care among various other reasons.[4] adding to the scenario are inadequate health workforce, insufficient drug supply, and diagnostic services, notably severe in the rural areas of the country Despite such constraints, over the years, India has witnessed improvements in maternal child health indicators – especially in low performing states as Chhattisgarh, Odisha, Madhya Pradesh, Jharkhand, and Rajasthan.
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