National Health Mission has improved access to facility-based childbirth among the poor: Study

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A new research study found that India’s National Health Mission (NHM) improved the use of health facility-based childbirth along with adequate ante-natal checkups (ANCs). The improvement was particularly among the poor and less educated population groups across the less-developed Indian states.

The study was conducted by researchers from the Public Health Foundation of India (PHFI), the London School of Hygiene and Tropical Medicine, and the University of Oxford also concluded that NHM helped to reduce the already existing wide gap between the rich and the poor in accessing facility-based health services. Though the inequities in the use of facility-based childbirth and ante-natal checkups favouring the rich still exist, the magnitude of the inequity steeply declined in the post-NHM periods as compared to the pre-NHM periods.

The NHM, one of the largest public health programs in the world launched in 2005 as National Rural Health Mission (NRHM), aims to strengthen the public primary healthcare system, and encourage pregnant women, particularly of low socioeconomic backgrounds, to use facility-based maternal health services.

In the post-National Rural Health Mission (NRHM) – now NHM—periods, the uptake of facility-based childbirth and ante-natal checkups increased among all socioeconomic groups, with greater increase among the lowest income and education groups.

In the 8 EAG (empowered action group) States as a whole (Bihar, Chhattisgarh, Jharkhand, MP, Orissa, Rajasthan, UP and Uttarakhand), 66% of married women delivered their child in a health facility in the post-NHM period of 2011-12, which was only 25% in 2003-04. Similarly, the uptake of minimum three times ante-natal checkups/visits increased to 58% in 2011-12 from 29% in 2003-04.

Of the low income women (bottom 33% of the income pyramid), 63% had used the facility-based childbirth and 55% had used the ante-natal checkups in 2011-12, which was 15% and 20% in 2003-04, respectively.

The study, published in the journal `Health Policy and Planning’, was based on District Level Household and Facility Surveys (DLHS) data from a sample size of nearly 1 million married women, collected in the period of before (in 1998-99, 2003–04) and after (in 2007–08 and 2011–12) the launch of the NHM.

According to the lead author of the study Dr Sukumar Vellakkal, Public Health Foundation of India (PHFI) the study findings highlight the importance of having public health programs designed specifically for the equitable inclusion of vulnerable population groups.  It also underlines the importance of strengthening the public primary healthcare system rather than adopting market-based approaches as desirable pathways for universal health coverage for India. Equally important is to address critical gaps around quality of care at the public primary healthcare facilities, he said.  

The study suggests that public health programmes in developing country settings will have larger equity impacts after its almost full implementation and widest outreach. Targeting derived populations and designing public health programs by linking maternal and child healthcare components are critical for universal access to healthcare.

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