Sharp rise in out of pocket expenditure per delivery in public health facilities

By Sampurna Kundu, Prof. Sanghmitra Sheel Acharya*
Despite the efforts of the Reproductive and Child Health Services (RCH), 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.
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 5 years. On the contrary, there has been a decline for West Bengal, where it has been observed that the average OOPE per delivery in public health facilities is around Rs. 2700 for both urban and rural areas in West Bengal. For the other states where OOPE has increased, it is observed that in urban areas it is higher than in rural except for Tripura where it is higher in rural areas.

The institutional births have increased for the past 5 years in public health facilities, which is quite evident because of the improvement in the availability, accessibility and quality of public health facilities after Government had allotted higher budget under National Rural Health Mission (NRHM) by introducing Janani Suraksha Yojana (JSY) scheme. The 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. In West Bengal and Telangana, the increase in institutional births in public facilities has been drastic in the past 5 years, where it has been majorly in the rural areas.
The OOPE becomes higher when the the delivery is ceasarian in private institutions mainly. The latest estimates shows that ceasarian delivery births in public health facilities have increased in the last 5 years for almost all the states, that too mostly in the urban areas only.
In the National Health Mission (NHM) programme, the JSY and Janani Shishu Suraksha Karyakram (JSSK) are its key components where cash incentives are provided to mother for their deliveries in public health facilities for free and even treat the newborns up to one year for free. On the contrary, the latest estimates shows that the OOPE for delivery in public health facilities have increased, specially for North eastern region states. The basic grounds of the conditional cash transfer by JSY will be lost if the woman 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. 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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*Sampurna Kundu is PhD Scholar, Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, New Delhi. Sanghmitra Sheel Acharya is Professor at the Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, New Delhi