Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA.
Lancet. 2010 Jun 5;375(9730):2009-23. doi: 10.1016/S0140-6736(10)60744-1.
In 2005, with the goal of reducing the numbers of maternal and neonatal deaths, the Government of India launched Janani Suraksha Yojana (JSY), a conditional cash transfer scheme, to incentivise women to give birth in a health facility. We independently assessed the effect of JSY on intervention coverage and health outcomes.
We used data from the nationwide district-level household surveys done in 2002-04 and 2007-09 to assess receipt of financial assistance from JSY as a function of socioeconomic and demographic characteristics; and used three analytical approaches (matching, with-versus-without comparison, and differences in differences) to assess the effect of JSY on antenatal care, in-facility births, and perinatal, neonatal, and maternal deaths.
Implementation of JSY in 2007-08 was highly variable by state-from less than 5% to 44% of women giving birth receiving cash payments from JSY. The poorest and least educated women did not always have the highest odds of receiving JSY payments. JSY had a significant effect on increasing antenatal care and in-facility births. In the matching analysis, JSY payment was associated with a reduction of 3.7 (95% CI 2.2-5.2) perinatal deaths per 1000 pregnancies and 2.3 (0.9-3.7) neonatal deaths per 1000 livebirths. In the with-versus-without comparison, the reductions were 4.1 (2.5-5.7) perinatal deaths per 1000 pregnancies and 2.4 (0.7-4.1) neonatal deaths per 1000 livebirths.
The findings of this assessment are encouraging, but they also emphasise the need for improved targeting of the poorest women and attention to quality of obstetric care in health facilities. Continued independent monitoring and evaluations are important to measure the effect of JSY as financial and political commitment to the programme intensifies.
Bill & Melinda Gates Foundation.
2005 年，印度政府启动了“母婴安全保障计划”（Janani Suraksha Yojana，简称 JSY），这是一项有条件的现金转移计划，旨在激励妇女在医疗机构分娩，以降低母婴死亡人数。我们独立评估了 JSY 对干预措施覆盖范围和健康结果的影响。
我们使用了 2002-04 年和 2007-09 年进行的全国性地区家庭调查数据，评估了 JSY 作为一项经济援助措施的发放情况，其与社会经济和人口统计学特征的关系；并使用三种分析方法（匹配、有与无对照和差异中的差异）来评估 JSY 对产前护理、机构内分娩以及围产期、新生儿和产妇死亡的影响。
2007-08 年 JSY 的实施情况因邦而异——从不到 5%到 44%的分娩妇女获得 JSY 的现金支付。最贫穷和受教育程度最低的妇女并不总是获得 JSY 支付的可能性最高。JSY 对增加产前护理和机构内分娩有显著影响。在匹配分析中，JSY 支付与每 1000 例妊娠减少 3.7（95%CI 2.2-5.2）围产期死亡和每 1000 例活产减少 2.3（0.9-3.7）新生儿死亡相关。在有与无对照的情况下，减少了每 1000 例妊娠 4.1（2.5-5.7）围产期死亡和每 1000 例活产 2.4（0.7-4.1）新生儿死亡。
这项评估的结果令人鼓舞，但也强调了需要更好地针对最贫困的妇女，并关注医疗机构中产科护理的质量。随着对该计划的财政和政治承诺的加强，继续进行独立监测和评估对于衡量 JSY 的效果非常重要。
比尔及梅琳达·盖茨基金会。
