Global Health | MRC global maternal & child health

Project outline

Having one of the highest global rates of premature deaths and poor health among pregnant women and their new born, India and Bangladesh remain as key nations to reduce global rates of unfavourable health outcomes among women and children. Key to reducing these rates is to encourage improved coverage of health care services. Among the number of strategies used by policy-makers in both these countries – drawing on international experiences – are interventions that aim to influence women and children – particularly those from poorer households or other socially vulnerable communities – to use key health services by providing them with direct or indirect financial incentives.

In this project, we aim to investigate to what extent these incentives, either involving directly paying cash amounts or providing free services in private health facilities, are successful in improving some of the most important indicators related to improved health care services directed at pregnant women and young children. In addition, we will study the barriers impeding improved access to health services, including factors such as availability of and accessibility to health facilities; we will also consider quality of care in the health services as a potentially strong determinant of whether people choose to use the health services that are offered.

The results will help us to determine how these different barriers can be reduced so that the optimum potential of these financial incentives could be attained in these two countries. Ultimately, the data gathered will allow us to identify what likely modifications in the design of these financial incentive are required, in conjunction with supportive, positive improvements in quality of care, in order to attain improved health goals for women and children. The project builds on the collective, multidisciplinary expertise of experienced researchers brought together by a rich collaboration of Universities and research Institutes from the UK, India and Bangladesh.

The research we propose involves extensive use of available household survey data and fresh data collected through primary surveys in three Indian states (Bihar, Gujarat and Karnataka) and two divisions in Bangladesh. The surveys will cover the three most important schemes regarding financial incentives in the two countries – the Janani Suraksha Yojana (Maternity Security Scheme) and Chiranjeevi (or the Long-Life Scheme) schemes in India and the Maternal Health Voucher Scheme (MHVS) in Bangladesh. Key decision-makers in the Health Ministries in both the countries have shown a great interest in the proposed project, and intend to use the evidence generated to strengthen or review the existing interventions. By using robust, scientific approaches combined with micro-level insights from the target population, the project results will be of crucial influence in the decision-making toolkit for the health policy-makers in both India and Bangladesh.

Technical Summary: This research project aims to generate robust empirical evidence leading to the design of a new model financing mechanism that can effectively incentivise behaviours that improve health outcomes for women and children. Using India and Bangladesh as the research setting, we examine the interplay of factors related to demand for health services, socioeconomic attributes, quality of services being offered and the overarching health system characteristics that operates in a dynamic framework to determine how major demand-side financing (DSF) instruments are successful in influencing desired outcomes. We extend the research scope by aligning the objectives with recent global priorities in improving maternal and child health, which places emphasis on a wider continuum of Reproductive, Maternal, Neonatal and Child Health outcomes, as measured through key health service coverage indicators.

The research approach involves extensive use of available household survey data and fresh data collected through primary surveys in three Indian states and two divisions in Bangladesh. Among them, the surveys will cover the three most important schemes regarding financial incentives in the two countries – the Janani Suraksha Yojana (Maternity Security Scheme) and Chiranjeevi (or the Long-Life Scheme) schemes in India and the Maternal Health Voucher Scheme (MHVS) in Bangladesh. Several innovative tools such as a comprehensive module to assess quality of care combining both clinical and users’ perspectives, facility surveys, retrospective collection of event histories through surveying a cohort of women that automatically controls for variations in programme implementation over a staggered period enriches the empirical methods and strengthens the potential adaptability of the results. The researchers involved in the project are: