Is Cashless Delivery Boon or Bane? An Analysis of RMNCH Services in Odisha, India

Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: In the recent years, Government of India under the umbrella of National Health Mission (NHM) has introduced a number of schemes like JSY (Janani Surakshya Yojana) and JSSK (Janani Sishu Surakshya Karyakram) to improve maternal and child survival and promote cashless institutional delivery. Government of Odisha has also introduced MAMATA the direct cash benefit scheme. Despite constant efforts by the government for improving maternal health care services, families are still spending significant amount for delivery services at the facilities. This paper assesses the level of Out-of Pocket Expenditure (OOPE) incurred during delivery and the extent to which JSY, JSSK and MAMTA, incentives could share the financial burden.

Methodology:  The study was carried out in among 1194 women, who delivered children in the last 2 years. Descriptive statistics and a two part model are used to address above objectives. The two-part model is an analytical model in which the first step is modelling the probability of a household incurring expenditure on delivery using the logit model. In the second step, Ordinary Least Squares (OLS) regression was carried out for those who had incurred any expenditure on delivery.

Results:  The mean expenditure on normal and C-section delivery are Rs 1822/- (USD 30) and Rs. 8350/- (USD 139) respectively. Results also suggest that there is a significant difference in the level of expenditure by selected socio-economic characteristics. Though the mission of JSY and JSSK is to make delivery cashless, about 75% respondents under C-section delivery reported that, they were asked money during delivery.

Conclusion:  It is vital to promote the free and cashless delivery schemes like JSSK more effectively. Orientation to the frontline workers about the new schemes and improving awareness can make the mission possible.