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Promoting Institutional Delivery through Monetary Incentive Scheme, Puducherry
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Subject Area="Access to service and coverage." Objective="To reduce the maternal mortality and infant mortality rate."
Details for Reform Option "Promoting Institutional Delivery through Monetary Incentive Scheme, Puducherry"
Summary

Background: In the 1990s, the proportion of home deliveries of children in the Union Territory of Puducherry was high and the associated delivery complications; maternal and infant mortality at the time of delivery were a matter of concern. Under the National Rural Health Mission (NRHM), there are provisions for paying INR 600 to pregnant ladies living below the poverty line in rural area and INR 500 to ladies living in urban areas for institutional deliveries. An outreach worker who facilitates the pregnant lady upto the hospital is paid INR 100 as remuneration incentive. In the Union Territory of Puducherry, the sub-centres and the primary health care centres are easily accessible and there is no need for any outreach workers like ASHA, so the incentive money supposed to be paid to ASHA is also being paid to the beneficiary mother. Activities: Auxillary Nurses Mid-wife (ANMs) have been trained in ante natal care, foetal well being, birth weight and growth monitoring of infants. They provide ante natal and immunization services to the pregnant ladies and motivate them for consulting medical officers at the nearby primary health centres. Each pregnant lady is registered with the ANM and if there is any drop out in the follow up for ante natal check ups, then home visits by ANM are carried out to explore the reasons. Medical officers examine and motivate pregnant ladies for hospital deliveries. The amount is released by the medical officer and paid to the beneficiary mother by the concerned ANM. Results: As per Rapid Household Survey- RCH Key Indicators for Puducherry/Karaikal (1998 and 2004) the institutional deliveries have increased by 3.8% (from 92.5% to 96.3%) since 1998 and there is a decrease of 5.1% ( from 7.5% to 2.4%) in home deliveries. Thus, safe deliveries have increased by 2.7% (95.0%- 97.7%) from 1998 to 2004.

Cost INR 600, Urban; INR 700, Rural; for pregnant ladies living below poverty line.
Place Union Territory of Puducherry
Time Frame Two months.
Advantages

Enhanced acceptability of ANM: It has boosted the social status of ANM and made her more acceptable and friendly in the community. Reduction in complications in deliveries: Timely diagnosis and treatment of any complication in the prenatal period helps in avoiding the complications at the time of delivery. Improved maternal health and infant survival: Enhanced accessibility to qualified opinions and medical check ups to the pregnant ladies has improved the health of pregnant ladies and hence of the infants Decrease in maternal mortality: It has also helped in reduction of maternal mortality with quality improvement in pre natal, natal and post natal health service delivery.

Challanges

Increasing trend of caesarean section: Vested interest of profit among private practitioners has resulted in an increasing trend towards caesarean section deliveries even when it is not required.

Prerequisites

Baseline demographic and epidemiological data. Refresher training of ANMs in foetal well being. Antenatal check up, counselling and immunization facilities. Availability of gynaecologists and obstetricians at primary and secondary care level health facilities Regular budget.

Who needs to be consulted

Pregnant ladies ANMs and health professionals Directorate of Health and Family Welfare Services Mission Director, NRHM

Risks

Sustainability

It is sustainable with supportive Information, Education and Communication activities and positive cooperation from the private health sector and a regular budget.

Chances of Replication

It can be replicated in similar settings.

Comments

None.

Contact

Submitted By

Dr. Anil Bhola, Research Consultant, National Institute of Medical Statistics, New Delhi, January, 2007.

Status Active
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