Large scale innovative pro poor programs focused on reducing maternal mortality in India: a proposal to evaluate impact.

India accounts for 20% of global maternal deaths, with 26% of her population living below the poverty line, and continues to have one of the highest maternal mortality ratios in the world. Thus progress in India (slow thus far) is a prerequisite to achieving MDG 5 by 2015. This project proposes the evaluation of two innovative large scale programs in India, which were set up to decrease maternal mortality among women living below the poverty line.

The purpose of both these state run programs is to reduce maternal deaths, by promoting institutional delivery, and by reducing access barriers to maternal healthcare for poor women. These two programs operate in two large Indian provinces. Each of these programs operates through the use of different innovative demand side financing mechanisms, which are specifically aimed at improving access for vulnerable groups. One program utilises a conditional cash transfer, paid retrospectively to women on delivering in an institution, while the other is a targeted bursary, paid prospectively to accredited healthcare providers for delivery of the woman living in poverty. All payments are made by the state.

While both programs are based on similar concepts, i.e. financial incentives for the provision and utilization of care; and the participation of the private sector – there are major differences in the socioeconomic contexts in which each program operates, including financing mechanisms, provider payment models and incentives, quantums of financial assistance, levels of private sector involvement, all of which will have a bearing on desired maternal health outcomes. No evaluations of such large scale demand side financing programs for maternal health have been carried out before. The field is fairly new, and recent scientific literature has recommended robust evaluations to fill the evidence gap with respect to the impact of such interventions. This project addresses this gap.

Another project that looks at public private demand side financing programs for maternal health in the same way as MATIND does:
Towards Millennium Dev Goal 5 - The First ‘Demand side financing’ programs to reduce maternal mortality – how have they performed?

This project covers an additional Thayi Bhagya Public Private partnership in Karnataka Province, India. It involves the Division of Global Health of the Department of Public Health Sciences at Karolinska Institutet, and the Public Health Foundation of India.

MATIND publications

Sidney K, Diwan V, El-Khatib Z, De Costa A. India’s JSY cash transfer program for maternal health: Who participates and who doesn’t – a report from Ujjain district. Reprod Health 2012;9(2).

Sidney K, de Costa A, Diwan V, Mavalankar DV, Smith H; and the MATIND study team. An evaluation of two large scale demand side financing programs for maternal health in India: the MATIND study protocol.BMC Public Health. 2012;27;12:699.

Jehan K, Sidney K, Smith H, de Costa A. Improving access to maternity services: an overview of cash transfer and voucher schemes in South Asia. Reprod Health Matters. 2012;20(39):142-54.

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