Women end up paying more in “free” public facilities

By our representative
The findings of two academics Jawaharlal Nehru University (JNU), New Delhi, Sampurna Kundu and Professor Sanghmitra Sheel Acharya, revealed that despite the efforts of reproductive and child health services, which provided public health services free or at nominal cost , the average out-of-pocket expenditure (OOPE) per delivery in public health facilities has increased for many states.
Based on analysis of National Family Health Survey-5 data, researchers say, while in “states like Manipur, Tripura, Mizoram and Assam, which are in the northern region East, showed an increase in the average OOPE per delivery in public health facilities over the last five years”, there was a decline in West Bengal, where “the average OOPE per delivery in public health facilities is about Rs 2,700 for urban and rural areas of West Bengal”.
As for the other states, where the OOPE has increased, the researchers say, it is observed that in urban areas it is higher than in rural areas, except for Tripura, where it is higher in rural areas. While Sampurna Kundu PhD, Sanghmitra Sheel Acharya is a Professor at the Center for Social Medicine and Community Health, School of Social Sciences, JNU.
The researchers say this trend has been observed despite the fact that institutional births have increased over the past five years in public health facilities due to “improvements in the availability, accessibility and quality of public health facilities after the government allocated a higher budget for national rural health”. Mission (NRHM) by introducing the Janani Suraksha Yojana (JSY) program.

They add, “Institutional births have also increased in states like Manipur, Mizoram, Nagaland and Tripura in the northeastern states, where they have occurred mainly in urban areas,” adding, “In Bengal Western and Telangana, the increase in institutional births births in public facilities has been drastic in the last five years”, mainly in rural areas.
The researchers point out that “OOPE becomes higher when delivery is caesarean section in private facilities”, but the latest estimates show that caesarean births in “public health facilities have increased over the past five years in almost all states”, especially in urban areas. .
The researchers point out: “The foundations of the conditional cash transfer by JSY will be lost if women have to pay to access health services that are supposed to be free. Because poor households in particular will be pushed further into poverty.
They add, “In the coming years, if OOPE for reproductive health purposes continues to increase, women may be deterred from seeking services at public health facilities despite the cash incentive program.”

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