This project will evaluate two innovative large scale, demand side maternal health programs, which aim to decrease maternal mortality by promoting institutional deliveries among poor women in India.
One program is a conditional cash transfer (JSY scheme) paid retrospectively to the woman on delivering in an institution while the other is a voucher scheme (CY scheme) paid prospectively to accredited private healthcare providers for delivery of women living in poverty. The project will evaluate the impact of each of these programs using a nonrandomised matched comparison technique.
Each of the programs will be studied with regard to
In addition, the cost effectiveness of each of the programs will be studied. The use of both qualitative and quantitative methods is planned.
An estimated 340,000 women die annually world-wide from pregnancy related complications. More than half of these deaths occur in six low-income countries and one-quarter of global maternal deaths occur in India alone making this a serious public health challenge. Skilled birth attendance and access to emergency obstetric care (EmOC) is known to reduce maternal mortality. However, the use of maternal health care services and institutional deliveries at EmOC facilities remain low throughout most of India despite continued efforts to strengthen the infrastructure, drug supply and human resource capabilities.
While these improvements are important to deliver services, they do not address many of the access to care barriers faced by the poor. Poor women continue to deliver at home, often with unskilled attendance, placing them at risk of maternal death. Indeed, maternal death is a problem closely related to poverty.
Policy makers have grappled with the problem of getting women to deliver in institutions where they can have access to skilled care at birth and complications can be managed. The two programs under study here for the first time use financial incentives in different forms to help poor women overcome barriers to accessing obstetric care in institutions. There have been no formal reports on evaluations of these programs.
This project proposes the comprehensive evaluation of these two demand side financing programs in India, to promote institutional delivery and thereby reduce maternal mortality. The MATIND project will generate evidence to facilitate decision making among policy makers and program managers who currently work with or are planning similar programs in contexts where high maternal mortality continues to be a problem.
The overall aim of this proposal is to develop methodology and apply this to assess the impact of and compare two large scale programs with different financing incentives for the promotion of institutional delivery in India.
The programs aim to reduce maternal mortality. Programs will be studied in terms of
This comprehensive evaluation will study the impact of the program on maternal mortality using secondary data analysis. Impact on other maternal and neonatal outcomes will be studied using a non-randomised matched comparison of women from primary surveys.
The project will also
The main reason for the proposed evaluation is to generate evidence on the performance and impact of these programs that is relevant to policy makers and program managers in India and other countries, who currently work with these programs or are considering initiating comparable programs in similar or different circumstances. The evidence generated by the evaluation will help policy makers decide where to implore scarce funds and resources.
It may give evidence to support the implementation of other demand side financing interventions, specifically where high maternal mortality persists and the progress towards the Millennium Development Goal (MDG) 5 is slow. This study is thus expected to contribute towards achieving MDG 5 (one of the most challenging goals thus far) through providing information on more effective and targeted program implementation.
The evaluation aims to bridge evidence gaps in the scientific literature on the performance and impact of large scale demand side financing programs for maternal health.