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Coverage and Financial Risk Protection for Institutional Delivery: How Universal Is Provision of Maternal Health Care in India?

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  • Shankar Prinja
  • Pankaj Bahuguna
  • Rakesh Gupta
  • Atul Sharma
  • Saroj Kumar Rana
  • Rajesh Kumar

Abstract

Background: India aims to achieve universal access to institutional delivery. We undertook this study to estimate the universality of institutional delivery care for pregnant women in Haryana state in India. To assess the coverage of institutional delivery, we analyze service coverage (coverage of public sector institutional delivery), population coverage (coverage among different districts and wealth quintiles of the population) and financial risk protection (catastrophic health expenditure and impoverishment as a result of out-of-pocket expenditure for delivery). Methods: We analyzed cross-sectional data collected from a randomly selected sample of 12,191 women who had delivered a child in the last one year from the date of data collection in Haryana state. Five indicators were calculated to evaluate coverage and financial risk protection for institutional delivery—proportion of public sector deliveries, out-of-pocket expenditure, percentage of women who incurred no expenses, prevalence of catastrophic expenditure for institutional delivery and incidence of impoverishment due to out-of-pocket expenditure for delivery. These indicators were calculated for the public and private sectors for 5 wealth quintiles and 21 districts of the state. Results: The coverage of institutional delivery in Haryana state was 82%, of which 65% took place in public sector facilities. Approximately 63% of the women reported no expenditure on delivery in the public sector. The mean out-of-pocket expenditures for delivery in the public and private sectors in Haryana were INR 771 (USD 14.2) and INR 12,479 (USD 229), respectively, which were catastrophic for 1.6% and 22% of households, respectively. Conclusion: Our findings suggest that there is considerably high coverage of institutional delivery care in Haryana state, with significant financial risk protection in the public sector. However, coverage and financial risk protection for institutional delivery vary substantially across districts and among different socio-economic groups and must be strengthened. The success of the public sector in providing high coverage and financial risk protection in maternal health provides encouragement for the role that the public sector can play in universalizing health care.

Suggested Citation

  • Shankar Prinja & Pankaj Bahuguna & Rakesh Gupta & Atul Sharma & Saroj Kumar Rana & Rajesh Kumar, 2015. "Coverage and Financial Risk Protection for Institutional Delivery: How Universal Is Provision of Maternal Health Care in India?," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-15, September.
    • Handle: RePEc:plo:pone00:0137315
    DOI: 10.1371/journal.pone.0137315
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    References listed on IDEAS

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    1. David McKenzie, 2005. "Measuring inequality with asset indicators," Journal of Population Economics, Springer;European Society for Population Economics, vol. 18(2), pages 229-260, June.
    2. Planning Commission, 2011. "High Level Expert Group Report on Universal Health Coverage for India," Working Papers id:4646, eSocialSciences.
    3. Rodrigo Moreno-Serra & Christopher Millett & Peter C Smith, 2011. "Towards Improved Measurement of Financial Protection in Health," PLOS Medicine, Public Library of Science, vol. 8(9), pages 1-6, September.
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    Cited by:

    1. Shankar Prinja & Atul Sharma & Ruby Nimesh & Vineeta Sharma & K Madan Gopal & Nina Badgaiyan & PVM Lakshmi & Madhu Gupta, 2021. "Impact of National Health Mission on infant mortality in India: An interrupted time series analysis," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(4), pages 1143-1152, July.
    2. Shankar Prinja & Pankaj Bahuguna & Indrani Gupta & Samik Chowdhury & Mayur Trivedi, 2019. "Role of insurance in determining utilization of healthcare and financial risk protection in India," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-16, February.
    3. Madhu Gupta & Federica Angeli & Hans Bosma & Monica Rana & Shankar Prinja & Rajesh Kumar & Onno C P van Schayck, 2016. "Effectiveness of Multiple-Strategy Community Intervention in Reducing Geographical, Socioeconomic and Gender Based Inequalities in Maternal and Child Health Outcomes in Haryana, India," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-13, March.
    4. Shankar Prinja & Akashdeep Singh Chauhan & Anup Karan & Gunjeet Kaur & Rajesh Kumar, 2017. "Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-19, February.
    5. Anshul Kastor & Sanjay K Mohanty, 2018. "Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: Do Indian households face distress health financing?," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-18, May.
    6. Rinshu Dwivedi & Jalandhar Pradhan & Ramesh Athe, 2021. "Measuring catastrophe in paying for healthcare: A comparative methodological approach by using National Sample Survey, India," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(5), pages 1887-1915, September.
    7. Geoffrey A Anderson & Lenka Ilcisin & Peter Kayima & Lenard Abesiga & Noralis Portal Benitez & Joseph Ngonzi & Mayanja Ronald & Mark G Shrime, 2017. "Out-of-pocket payment for surgery in Uganda: The rate of impoverishing and catastrophic expenditure at a government hospital," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-13, October.

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