After a brief visit to New Delhi, I want to share some of the insights I have gleaned from maternal and child experts about the current state of maternal and child health in the vast country of India, home to about a sixth of the world’s population.
As I am sure you are aware, a few years ago (2005), the Indian Government launched a highly innovative and ambitious scheme—the Janani Suraksha Yojana scheme, which everyone refers to as JSY—to reduce maternal and newborn mortality and improve maternal and newborn health by promoting institutional delivery. Essentially, JSY is a conditional cash transfer program in which payments are given to mothers living below the poverty line and to ASHAs (Accredited Social Health Activists, female health workers who are responsible for the mother) if the mother gives birth in a public health-care facility. JSY includes delivery and post-delivery care in addition to reimbursement for any out-of-pocket expenses incurred for transport to and from the health care facility.
Much has been written about the JSY scheme and there have been some formal evaluations about its impact on maternal and neonatal mortality. However, what perhaps is most striking is how JSY has completely changed the demographics of health care in India. The Indian experts I talked to said that deliveries in health facilities have dramatically increased, by at least three times in some states, and interestingly, the proportion of public versus private health care deliveries has changed. Before JSY, for women who chose to give birth in health care facilities, about 65% of births were in the private sector and 35% in the public sector. However, as one of the aims of JSY is equity in addition to coverage, the conditional cash payments do not include the private sector. Government officials told me that since the implementation of JSY, the proportions have now flipped to 65% of births in the public sector and 35% in the private sector. This change is quite an achievement in itself.
Because of the dramatic rise in births in public health facilities, the system is understandably strained and so the focus of the Indian Government is now on the quality of health care and standards of care within health facilities (including hospitals) where the number of inpatients has greatly increased.
There is much still to do, especially in some states such as Uttar Pradesh where a large proportion of the 200 million population (about the same population as Brazil) are living below the poverty line. However, hearing more about the effects of the incredible JSY scheme from the health workers on the front line, brought home to me the importance of political will and what can happen when the government of a country is really committed to improving the health of all its people.