Department of Economics, BITS Pilani K. K. Birla Goa Campus, Birla Institute of Technology and Science, Pilani, India.
Department of Economics, BITS Pilani K. K. Birla Goa Campus, Birla Institute of Technology and Science, Pilani, India; Department of Economic Sciences, Indian Institute of Technology Kanpur, Uttar Pradesh, India.
Soc Sci Med. 2021 Apr;274:113795. doi: 10.1016/j.socscimed.2021.113795. Epub 2021 Feb 23.
In the last two decades, India's central and many state governments launched several public health programs with the goal of improving maternal and child health outcomes. Many individual studies assessed the impact of these programs; however, they focused on select health programs and few specific outcomes.
This paper summarizes the literature, published during 2000-2019, investigating the impacts of public health programs on both the uptake of maternal and child health services and the related-health outcomes in India. We followed PRISMA guidelines of systematic review, and carried out a narrative synthesis of the study findings.
We found 66 relevant studies covering 11 health programs across India. Most studies had applied non-experimental study designs (n = 50), with few applying experimental (n = 1) and quasi-experimental (n = 15) designs. Most studies (n = 64) assessed the impact on the intermediate outcomes of the uptake of various health services rather on the long-term outcomes of improvement in health. Overall we found studies reporting positive impacts, however, we could not find any strong consensus emerging from these studies about the impact, partly due to differences in: outcome indicators; study designs; study population; data sets. Several studies also reported considerable beneficial impacts among low socioeconomic population groups. However, given that the outreach of the public health programs have been low across the country and population groups, we found that broader objectives of health programs remained unassessed: most studies assessed the impact on who actually participated in the program (average treatment effect on-the-treated) rather on the target population (intent-to-treat effect). Furthermore, there was dearth of research on the impacts of the state-level programs. Future research need to assess the impact of the programs on health outcomes, and on quality adjusted measures of maternal and child health services and its continuum of care.
在过去的二十年中，印度中央政府和许多邦政府推出了几项公共卫生计划，旨在改善母婴健康结果。许多单独的研究评估了这些计划的影响；然而，它们专注于选择的卫生计划和少数具体的结果。
本文总结了 2000-2019 年期间发表的文献，调查了公共卫生计划对印度母婴健康服务的利用和相关健康结果的影响。我们遵循系统评价的 PRISMA 指南，并对研究结果进行了叙述性综合。
我们发现了 66 项相关研究，涵盖了印度的 11 个卫生计划。大多数研究采用了非实验性研究设计（n=50），少数采用了实验性（n=1）和准实验性（n=15）设计。大多数研究（n=64）评估了各种卫生服务利用的中间结果的影响，而不是健康改善的长期结果。总体而言，我们发现研究报告了积极的影响，然而，我们无法从这些研究中得出关于影响的任何强烈共识，部分原因是：结果指标；研究设计；研究人群；数据集。一些研究还报告了在社会经济地位较低的人群中存在相当大的有益影响。然而，鉴于公共卫生计划在全国和人群中的覆盖面较低，我们发现健康计划的更广泛目标仍未得到评估：大多数研究评估了实际参与该计划的人的影响（受治疗者的平均治疗效果），而不是目标人群（意向治疗效果）。此外，关于州级计划的影响的研究也很少。未来的研究需要评估该计划对健康结果的影响，以及对母婴健康服务及其连续护理的质量调整措施的影响。
