Independent Research Consultant, 16/1 South Tukoganj, 201 Sukh Sheetal II, Indore, MP, 452001, India.
Department of International Health and Sustainable Development, Tulane University, School of Public Health and Tropical Medicine, New Orleans, USA.
BMC Public Health. 2022 Feb 25;22(1):394. doi: 10.1186/s12889-022-12563-9.
Since 2005, India has implemented conditional cash transfer [CCT] programs to promote the uptake of institutional delivery services [ID]. The study aims to assess changes in wealth-based inequality in the use of ID and other maternal health care services during the first decade of Janani Suraksha Yojana and related CCT programs.
Data from two Demographic and Health Surveys were used to calculate changes in service inequality from 2005 to 2015-16 in the use of three or more antenatal care [ANC] visits, ID, and postnatal care [PNC]. The changes were assessed at the national level, within high and low performing states [HPS and LPS, respectively] and within urban and rural areas of each state category. Erreygers Index [EI] and Wagstaff Index [WI], superior to concentration index, were used to gain different insights into the nature of inequality. EI is an objective measure of inequality irrespective of prevalence while WI is a combined measure of inequality and the average distribution of an indicator that puts more weight on the poor.
The results suggest that wealth-based inequalities decreased significantly at the national level. For ID, both indices showed a decline in both HPS and LPS though the change in WI in HPS was insignificant. For ANC, there was a significant decrease in inequality using both indices in HPS but not in LPS. For PNC, there was a significant decrease in inequality using both indices in HPS, and when using WI in LPS, but not when using EI in LPS.
Overall, the first decade of India's CCT programs saw an impressive reduction in EI for ID but less so for WI suggesting that the benefit of CCTs did not go disproportionately to the poor, which suggests that there is a need to reduce or eliminate the evident leakages. The improvement in uptake and inequality in ANC and PNC was not at par with ID, stressing the need to place greater focus on the continuum of care. The urban rural difference in HPS versus LPS in the changes in inequality reveals that infrastructure is important for CCTs to be more effective.
自 2005 年以来，印度实施了有条件现金转移[CCT]计划，以促进机构分娩服务[ID]的采用。本研究旨在评估在 Janani Suraksha Yojana 和相关 CCT 计划实施的第一个十年中，基于财富的 ID 和其他产妇保健服务使用方面的不平等变化。
使用两项人口与健康调查的数据，计算了 2005 年至 2015-16 年期间，在使用三次或更多次产前护理[ANC]就诊、ID 和产后护理[PNC]方面，服务不平等的变化。在国家一级、高绩效州[HPS]和低绩效州[LPS]以及每个州类别的城乡地区评估了这些变化。Erreygers 指数[EI]和 Wagstaff 指数[WI]优于集中指数，可深入了解不平等的性质。EI 是一种客观的不平等衡量标准，与流行率无关，而 WI 是一种综合衡量不平等和指标平均分布的方法，对贫困人口的权重更大。
结果表明，国家一级的财富不平等程度显著下降。对于 ID，两个指数都显示 HPS 和 LPS 的不平等程度都有所下降，尽管 HPS 中的 WI 变化不显著。对于 ANC，HPS 中两个指数都显示出不平等程度显著下降，但 LPS 中则不然。对于 PNC，HPS 中两个指数都显示出不平等程度显著下降，而 LPS 中使用 WI 时则是如此，但 LPS 中使用 EI 时则不然。
总的来说，印度 CCT 计划的第一个十年见证了 ID 的 EI 显著减少，但 WI 则减少较少，这表明 CCT 的收益并没有不成比例地流向贫困人口，这表明需要减少或消除明显的漏洞。ANC 和 PNC 的利用率和不平等性的改善与 ID 不一致，这强调需要更加关注护理的连续性。HPS 与 LPS 之间的城乡差异表明，基础设施对 CCT 更加有效非常重要。
