Horizontal inequity in the utilisation of Continuum of Maternal Health care Services (CMHS) in India: an investigation of ten years of National Rural Health Mission (NRHM)

Background Continuum of Maternal Health Care Services (CMHS) has garnered attention in recent times and reducing socio-economic disparity and geographical variations in its utilisation becomes crucial from an egalitarian perspective. In this study, we estimate inequity in the utilisation of CMHS in India between 2005 and 06 and 2015-16. Methods We used two rounds of National Family Health Survey (NFHS) - 2005-06 and 2015-16 encompassing a sample size of 34,560 and 178,857 pregnant women respectively. The magnitude of horizontal inequities (HI) in the utilisation of CMHS was captured by adopting the Erreygers Corrected Concentration indices method. Need-based standardisation was conducted to disentangle the variations in the utilisation of CMHS across different wealth quintiles and state groups. Further, a decomposition analysis was undertaken to enumerate the contribution of legitimate and illegitimate factors towards health inequity. Results The study indicates that the pro-rich inequity in the utilisation of CMHS has increased by around 2 percentage points since the implementation of National Rural Health Mission (NRHM), where illegitimate factors are dominant. Decomposition analysis reveals that the contribution of access related barriers plummeted in the considered period of time. The results also indicate that mother’s education and access to media continue to remain major contributors of pro-rich inequity in India. Considering, regional variations, it is found that the percentage of pro-rich inequity in high focus group states increased by around 3% between 2005 and 06 and 2015-16. The performance of southern states of India is commendable. Conclusions Our study concludes that there exists a pro-rich inequity in the utilisation of CMHS with marked variations across state boundaries. The pro-rich inequity in India has increased between 2005 and 06 and high focus group states suffered predominantly. Decentralisation of healthcare policies and granting greater power to the states might lead to equitable distribution of CMHS.

A Review On Public Health through Rural Health Mission: Pharmacist Roles and Responsibility

For many years, the Government of India has worked hard to offer health services to people all around the country, and it remains dedicated to doing so. It has formed numerous programmes to achieve the goal of “Health for All.” As a result, in 2005, The Hon’ble Prime Minister formed the The National Rural Health Mission will provide the countries’ network with well-being administrations. The National Rural Health Mission, which went into effect in April 2005, is considered the backbone of the rural sector. They have been instilled with the belief that, as a result of their efforts, something special has appeared to assist the country dwellers in re-establishing their well-being. The National Rural Health Mission (NRHM) aims to provide rural populations, especially disadvantaged groups, with comprehensive, low-cost, and high-quality health care. Material & Method: We reviewed all of the articles published on PubMed, Scopus, BMJ, Google scholar, Nature, Web of science that were focusing on, National rural health mission services, to achieving universal health coverage (UHC). Conclusion: This study compiles a list of all social need interventions that have been described in the literature to date. National health systems around the world are reforming to meet health goals, with a focus on cost containment, universal coverage, equity in access and quality, and resource efficiency and effectiveness. The primary purpose of the mission is to establish a fully operational, community-owned, decentralised health-care delivery system with cross-sectoral integration at all levels, enabling for simultaneous action on a wide variety of health determinants such as poverty and social equity.

National rural health mission and the interstate variations in public healthcare spending in India: A study of the Indian North-Eastern states

Background/Objectives: The North-Eastern region of India comprised of eight states of which seven states come under small states and special category states. The region has a very large rural population which is highly agrarian in nature. The performances of the states in many of the health indicators have been better than most of big Indian states yet the status of health infrastructure and health accessibility in the region are still a grave concern. The study aims to find the interstate variations before and after the implementation of National Rural Health Mission (NRHM) Act of 2005, on the public health expenditure in the North-Eastern states. Methodology: The data on public health expenditure has been obtained from the State Finance Reports of the Reserve Bank of India (RBI), on population from the office of the Registrar General & Census Commission of India and the Gross State Domestic Product (GSDP) from the Directorate of Economics and Statistics of respective state governments, Central Statistics Office. The study is of twenty-six years, 1990-91 to 2015-16. The study uses the coefficient of variation to determine the extent of interstate variations. Findings: The study found that the interstate variation in public healthcare expenditure with all the eight states in the region is on a decline. Further, the study found that post NRHM, the states have equalised their proportion of health spending. Novelty/Improvement: There have been no studies to compare the interstate disparity in public health expenditure in the North-Eastern states before and after the implementation of NRHM in recent years. Keywords: Public health expenditure; interstate variations; National rural health mission; North Eastern States; India

Dissonances and disconnects: the life and times of community-based accountability in the National Rural Health Mission in Tamil Nadu, India

Background There are increasing calls for developing robust processes of community-based accountability as key components of health system strengthening. However, implementation of these processes have shown mixed results over time and geography. The Community Action for Health (CAH) project was introduced as part of India’s National Rural Health Mission (now National Health Mission) to strengthen community-based accountability through community monitoring and planning. In this study we trace the implementation process of this project from its piloting, implementation and abrupt termination in the South Indian state of Tamil Nadu. Methods We framed CAH as an innovation introduced into the health system. We use the framework on integration of innovations in complex systems developed by Atun and others. We used qualitative approaches to study the implementation. We conducted interviews among a range of individuals who were directly involved in the implementation, focusing on the policy making organizational level. Results We uncover what we have termed “dissonances” and “disconnects” at the state level among individuals with key responsibility of implementation. By dissonances we refer to the diversity of perspective on the concept of community-based accountability and its perceived role. By disconnects we refer to the lack of spaces and processes for “sense-making” in a largely hierarchically functioning system. These constructs we believe contributes significantly to making sense of the initial uptake and the subsequent abrupt termination of the project. Conclusions This study contributes to the overall field of policy implementation, especially the phase between the emergence on the policy agenda and its incorporation into the day to day functioning of a system. It focuses on the implementation of contested interventions like community-based accountability, in Low- and Middle-income country settings undergoing transitions in governance. It highlights the importance of “problematization” a dimension not included in most currently popular frameworks to study the uptake and spread of innovations in the health system. It points not only to the importance of diverse perspectives present among individuals at different positions in the organization, but equally importantly the need for spaces and process of collective sense-making to ensure that a contested policy intervention is integrated into a complex system.

The role of national rural health mission in reducing infant mortality rate in India

Purpose The purpose of this paper is to assess the role of National Rural Health Mission (NRHM) in reducing Infant Mortality in India. The study will help the government in deciding its future course of action regarding the infant mortality rate (IMR) reduction in India. Design/methodology/approach This paper adopts the interrupted time series analysis (ITSA) approach with a control group to study the role of NRHM in reducing the IMR in India. The authors examined infant mortality in rural areas of India for the level and trend change before and after the implementation of NRHM. The authors then applied a suitable ARMA model to estimate the coefficients of the regression model. From the estimated results, the study predicts the counterfactuals for both the rural IMR and urban IMR and plots the results. Findings The study found the evidence supporting the hypotheses that the NRHM has led to a reduction in the difference between urban IMR and rural IMR. The research shows that the rural IMR declined at steeper rates in the post-NRHM period (2005–2015). Originality/value None of the existing studies analyses the impact of a social scheme like NRHM on the reduction of IMR in India by applying the ITSA. The study is unique as it estimates the counterfactuals and plots the results which show the impact of NRHM on reducing IMR.