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Out-of-Pocket Spend for Deliveries in Public Hospitals Has Risen: NFHS-5

Out-of-Pocket Spend for Deliveries in Public Hospitals Has Risen: NFHS-5

Representative photo: PTI.

According to the first National Family Health Survey (NFHS-5), out-of-pocket expenditure per delivery in public health facilities has increased in the last five years in many states.

Money is a major stumbling block in accessing general health and maternity care in resource-constrained settings. In 2005, the government launched Janani Suraksha Yojana for poor and socially marginalised women – a conditional cash transfer scheme to ensure maternal healthcare at public health facilities. The Janani-Shishu Suraksha Karyakram (JSSK) followed in 2011, designed to bring down out-of-pocket expenditures incurred by pregnant women. It provided all childbirth and neonatal care at public health facilities at no cost.

Despite these interventions, many states have reported an increase in average out-of-pocket expenses per delivery in public healthcare facilities.

According to NFHS-5, only 10 states/UTs of the 22 in the data released thus far have reported a drop in the average out-of-pocket expenses per delivery in public hospitals. The average such expense in Meghalaya was more than Rs 10,000 per delivery in NFHS-4 (2015-2016), and has increased to Rs 14,581 – the highest in the country. Gujarat, on the other hand, has reported the lowest such figure among states at Rs 1,697, and Dadra and Nagar Haveli among UTs at Rs 677.

Sikkim has reported the highest increase of this figure – by Rs 4,341 per delivery. And similarly, West Bengal has shown the most improvement, with the average cost per delivery at public facilities dropping by Rs 5,236: from Rs 7,919 to Rs 2,683. Goa, Lakshadweep, Maharashtra and Telangana also reported drops.

Interestingly, there is a clear divide between India’s northeastern and western states. Goa, Maharashtra and Gujarat have all reported declines while Assam, Sikkim, Tripura, Mizoram and Meghalaya have reported steep increases. Nagaland and Manipur make for modest exceptions. In fact, except for Manipur, all northeastern states surveyed have reported an average out of pocket expense per delivery at public facilities of Rs 5,000 per delivery.

In Andhra Pradesh, Kerala, Telangana, Tripura and West Bengal, the average expense per delivery is higher in rural areas.

Himachal Pradesh reported the maximum difference of Rs 6,273 between urban and rural areas. The smallest such difference is Rs 11, in West Bengal. The difference in Bihar, Dadra and Nagar Haveli, Goa, Gujarat, Jammu and Kashmir, Karnataka, Ladakh, Maharashtra and Manipur is under Rs 1,000.

In the absence of better and/or more affordable facilities and lack of unawareness of government schemes and services, people tend towards private facilities, and are at risk of being pushed further into poverty if they’re already poor. According to India’s 2018 sustainable development goals profile, 65% of all healthcare expenses in India are out-of-pocket.

In sum, the first of the NFHS-5 data shows an alarming growth in out-of-pocket expenses that, in turn, reflects the disappointing extent to which those in need are utilising government interventions.

Bharti Singh and Abhishek Anand are research scholars and Jaydev Bhatwadekar is a postgraduate scholar, at the International Institute for Population Sciences, Mumbai.

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