Cash transfer at child birth: Women end up paying higher at 'free of cost' public facilities

Findings by two Jawaharlal Nehru University (JNU), New Delhi, scholars, Sampurna Kundu and Prof Sanghmitra Sheel Acharya, has revealed that despite the efforts of the Reproductive and Child Health Services, that provided free or nominal cost public health services, the average out of pocket expenditure (OOPE) per delivery in public health facilities has increased for many states.
Based on analysis of the National Family Heath Survey-5 data, the scholars say, while in “States like Manipur, Tripura, Mizoram and Assam, which are in the North-Eastern region, have shown increase in average OOPE per delivery in public health facilities over the past five years”, there has been a decline in West Bengal, where “the average OOPE per delivery in public health facilities is around Rs 2,700 for both urban and rural areas in West Bengal.”
As for other States, where OOPE has increased, the scholars say, it is observed that in urban areas it is higher than in rural, except for Tripura, where it is higher in rural areas. While Sampurna Kundu PhD scholar, Sanghmitra Sheel Acharya is professor at the Centre of Social Medicine and Community Health, School of Social Sciences, JNU.
The scholars say, this trend has been observed despite the fact that institutional births have increased in the past five years in public health facilities because of “improvement in the availability, accessibility and quality of public health facilities after government allotted higher budget under National Rural Health Mission (NRHM) by introducing Janani Suraksha Yojana (JSY) scheme.”

They add, “Institutional births have also increased in states like Manipur, Mizoram, Nagaland and Tripura in the North-Eastern states, where it has been mostly in the urban areas”, adding, “In West Bengal and Telangana, the increase in institutional births in public facilities has been drastic in the past five years”, mainly in the rural areas.
The scholars underline, “OOPE becomes higher when the the delivery is ceasarian in private institutions”, but latest estimates show that ceasarian delivery births in “public health facilities have increased in the last five years for almost all the States”, especially in urban areas.
Scholars underline, “The basic grounds of the conditional cash transfer by JSY will be lost if women has to pay in accessing the health services which is supposed to be free of cost. For the poor households especially will be pushed more towards poverty.”
They add, “In years to come if OOPE for reproductive health purposes continues to increase then women might deter from availing services from public health facilities despite of the cash incentive scheme.”

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