The impact of health interventions and programmes on mortality

Maternal mortality and morbidity continues to be high, despite the existence of national programs, for improving maternal and child health in India. Urban population of India is about 377 million, out of which 97 million are urban poor (Census 2011). Though urban India has a relatively strong health infrastructure, there is marked inequitable distribution of service availability and utilization between the rich and poor, between the settled urban population and the marginalized slum dwellers. The main objective of paper was to study the utilization of Maternal Child Healthcare services in urban slums of district Mohali, Punjab, India. Cross-sectional descriptive study was conducted and eligible women were interviewed using a semi structured questionnaire. The study clearly indicates that while the ANC utilization stands at 77%, the PNC utilization is just 23%. Home deliveries and Institutional deliveries were found to be 49% and 51% respectively, but only 4% of the home deliveries were conducted by trained SBA. JSY scheme benefit was made available to only 12% of the eligible beneficiaries. Immunisation coverage of children up to the present age was 57%. The current study revealed that utilization of healthcare services is poor in urban slums even though Healthcare facilities are available and accessible.

This paper aims to examine the net impact of ANC visits on subsequent utilization of child immunization after removing the presence of selection bias using NFHS 2005-06 data. We have used propensity score matching method with a counterfactual model. Using matched sample analysis result shows that child immunization among the groups of women who have completed 1-2 ANC visits and 3+ visits was about 13 percent and 19 percent respectively, higher than the group of women who have not made any ANC visit. Findings of nearest neighbor matching with replacement method, indicate, selection bias present in data set leads to overestimates positive effects of ANC visits. Mantel-Haenszel bounds method suggest that if around 19 percent bias would be involved in the result then also we could observe true positive effect of 1-2 ANC visits on child immunization. It indicates that antenatal clinics are the conventional platforms for educating pregnant women on the benefits of immunization.

The Government of Ghana has instituted a National Poverty Reduction Program with an initiative known as the Community-based Health Planning and Services (CHPS) as its core health development strategy. Originally launched as an experimental project of the Navrongo Health Research Centre, CHPS is currently a national initiative for shifting the focus of primary health care from clinics to communities. Four contrasting strategies of community health care were tested. In response to early evidence that community nursing could impact on survival, CHPS was launched to scale up the Navrongo community health service delivery system. The program currently functions in over 1000 villages dispersed in all 172 districts of Ghana. This paper presents a longitudinal demographic survival histories of 17,967 under age five children who were observed over the July 1993 to December 2010 period. Analysis of trends show that placing nurses in CHPS communities was associated with more pronounced mortality declines than was observed in comparison communities. Differentials show that Navrongo study areas exhibit equity relationships that are often observed elsewhere in Africa: Children whose parents are uneducated and relatively poor experience significantly higher mortality than children of the educated and less poor. Time conditional We

The study aims to examine the trends and patterns of infant and child mortality in India in the light of several programmes. In this paper, three data sources have been used namely, Sample Registration System (SRS) of India from 1971-2010; Inter-Agency Child Mortality Estimation, UNICEF, 2006; and the three rounds of the National Family Health Survey (NFHS I, II, III) conducted in the year 1992-93, 1997-98 and 2005-06 respectively. The study uses trend analysis to examine the trends and patterns and Cox-proportional hazard model to find out the determinants of infant and child mortality. The preliminary findings indicate that though there was zigzag pattern in IMR, U5MR and NMR in the beginning but from the decades of 1980s there is rapid decline in these mortalities. Various programmes have been implemented in this period of time which has profound influence on the reduction of the mortalities. It should also be noted that the reduction of mortality is not only because of the influence of one programme but, combined influence of all programmes. The Cox-proportional hazard model indicates that mother’s education and use of unsafe fuel, higher birth order and institutional delivery are significant predictors of infant mortality.

Infant mortality in rural areas of India is substantially higher than in urban areas. This study systematically assesses the role of maternal and child health (MCH) care related program factors in explaining the rural-urban gap in infant mortality during last two decades. Logistic regression was used to analyze association between maternal and child health (MCH) care related program factors and infant mortality using data from the three rounds of National Family Health Survey. Relevant socio-economic variables are adjusted in Binary logistic regression. To understand the relative contribution of different co-variates into the rural-urban gap in infant mortality, extension of the Blinder-Oaxaca decomposition technique by Fairlie was applied. Most of the rural-urban gap in infant mortality can be explained by the distributions of the co-variates in rural and urban area. The two important MCH care related program factors viz. breastfeeding and knowledge of Oral Re-hydration Solution contributed to the narrowing the gap between rural and urban infant mortality. On the other hand, the share of women using modern contraceptive methods and percentage of fully vaccinated children in the community contributed to widen the gap. The biggest part of rural disadvantage in infant mortality is attributable to underlying disadvantage in ho

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 incentivize women to give birth in healthy health facility. The main objective of this program is to ensure that each delivery is conducted in an institution and is attended by a skilled birth attendant (SBA), to minimize or prevent maternal deaths and pregnancy -related complications in women and at the same time ensure the well -being of the mother and the new-born. This paper investigates the different dimensions of Janani Suraksha Yojana and the impact of the JSY on the behavior of beneficiaries.
A total 1500 married women has interviewed and all were from the rural villages under the Community Health Centre (CHC). The findings indicate that the maximum women’s prefer to conduct their deliveries at the private hospitals because the attitude of the health personnel at the government hospital is not cordial and they have to suffer many problems to receive the benefits of the JSY. 33% respondent has given the birth of their baby at the government hospital while 61% at the private hospitals. While 83% were registered at the CHC for their health checkups during pregnancy.
Keywords: Janani Suraksha Yojana, ASHA, Community Health Centre

Improving accountability for commitments made in maternal and neonatal health has become a global priority in the race to accelerate progress on MDGs 4 and 5. At a time when tax-payers are also demanding strong, quantitative evidence that aid programmes represent value for money, new methods to attribute tangible impact to such accountability programmes are required. Conducting this type of analysis is challenging for accountability programmes. The outcomes of accountability activities are not easily quantifiable and the overall approach is still in the process of building an evidence-base.

In this article, we describe a methodology to project the number of maternal and neonatal lives saved by a programme aiming to strengthen accountability for MNH. Extensive evidence on the effectiveness of various bio-medical interventions for maternal and neonatal health has been incorporated within the Lives Saved Tool (LiST) software, developed by the Johns Hopkins School of Public Health. Our method extends the application of LiST beyond its bio-medical scope by assuming that greater accountability, through the more efficient use of health resources, causes a proportional increase in the coverage of all life-saving MNH services.

This paper examines the status of quality of delivery care services provided at public facilities in Bangladesh. Quality delivery care is an important indicator to reduce the maternal mortality rate, where as only 23% delivery take place at institution in Bangladesh. This paper is based on a study that introduced performance based incentives to facility based maternal health care team for improving quality of services. Quality of care was assessed from 2 perspectives; institutional and client. P4P interventions increased the facility’s quality of services from 54 to 77 percent. 110 in-depth interviews were conducted among the women, who have delivery experience at institution. Sample size was selected randomly from the client who received delivery care from the study facilities. Findings suggested that, quality care at the institution can increase the number of institutional delivery. Efforts must be undertaken to increase the level of quality care at institution to reduce home delivery.

The utilization of health care services by women during pregnancy and child birth is low in Nigeria, with only 35% of delivery taking place in health facility and 62 % of births take place at home. This situation not only leads to high maternal mortality in but puts Nigeria in the second position of countries with highest maternal mortality, just after India. Reduction in maternal deaths has been hindered not only by the absence of good health facilities but by socio-cultural factors prevalent within the society. This paper examined the socio-cultural factors which are least studied, especially which encourage male domination and lower status of women. Respondents consist of 458 women attending antenatal care clinic in State Hospital Ota were randomly selected and interviewed with the aid of questionnaire instrument. The data generated were analyzed using SPSS. The findings showed family type, respondent’s education, perception of cost of antenatal service, treatment place decision, husband perception of pregnancy, respondents dependency on husband for health facility visitation and service satisfaction are significant (P= .000, .023, .001, .005, .000, .000, .000) towards use of health care services by mothers. Recommendations were provided for improving maternal health delivery services in study area and beyond.

Studies on the causes of maternal mortality in India have focused on institutional deliveries, and the association of socioeconomic and demographic factors with the decline in maternal mortality has not been sufficiently investigated. By using both time series and cross-sectional data, this paper examines the factors associated with the decline in maternal mortality in India. Relative effects estimated by OLS regression analysis reveal that per capita state net domestic product (1.49611, p<0.05), poverty ratio (0.02426, p<0.05), female literacy rate (0.05905, p<0.10), infant mortality rate and total fertility rate (0.11755, p<0.05) are statistically significantly associated with the decline in the maternal mortality ratio in India. The Barro regression estimate reveals that improvements in economic and demographic conditions such as growth in state income (β=0.35020, p<0.05) and reduction in poverty (β=0.01867, p<0.01) and fertility (β=0.02598, p<0.05) have a greater association with the decline in the maternal mortality ratio in India than institutional deliveries (β=0.00305).