Barriers and prospects of India's conditional cash transfer program to promote institutional delivery care: a qualitative analysis of the supply-side perspectives
Barriers and prospects of India's conditional cash transfer program to promote institutional delivery care: a qualitative analysis of the supply-side perspectives
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DOI：
10.1186/s12913-018-2849-8
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发表时间：
2018-01-25
影响因子：
2.8
通讯作者：
Vellakkal, Sukumar
中科院分区：
文献类型：
--
作者：
Gupta, Adyya;Fledderjohann, Jasmine;Vellakkal, Sukumar
背景资料：在印度国家卫生使命团的领导下，Janani Suraksha Yojana向孕妇提供有条件的现金转移和支助服务，以便她们使用机构分娩护理设施。本研究旨在了解社区卫生工作者（ASHA）和项目官员对JSY下提供的设施的障碍和前景的看法。对有意选择的ASHA（n = 12）、村卫生和环境卫生委员会成员（n = 11）、和官员在不同层次的医疗机构（n = 27）进行了印度三个邦。数据进行了分析，主题使用ATLAS。ti software.Results：虽然JSY引发了印度孕产妇和儿童健康方面的巨大进步，有几个障碍有待解决有关i）在卫生设施提供优质护理; ii）家庭和卫生设施之间的联系;和iii）社区/家庭环境。在设施一级，受访者指出，无法治疗出生并发症是JSY吸收的障碍，导致转介到其他（主要是私人）设施。尽管根据该方案增加了对卫生基础设施的投资，但紧急产科护理设施、专家和工作人员、基本药物、诊断和必要设备的短缺仍然存在。产妇和初级保健方案的各种纵向（独立）要素之间的联系较弱，以及不考虑案件量和实际需要而向所有设施分配几乎统一的资源，也限制了提供优质保健。影响家庭与设施之间联系的障碍主要是由于多种需求与交通设施的可用性之间的不匹配，特别是在紧急情况下。关于社区/家庭的背景下，一些社会文化问题，如对阿莎的努力的咨询，特别是从老年家庭成员的阻力，往往会对人们的决定，寻求healthcare.Conclusion：在社区一级的适当干预措施，医疗服务提供者的能力建设，并采取措施，以解决潜在的结构性和系统性的障碍，需要提高机构孕产妇保健的摄取。
Background: Under the National Health Mission (NHM) of India, Janani Suraksha Yojana (JSY) offers conditional cash transfer and support services to pregnant women to use institutional delivery care facilities. This study aims to understand community health workers' (ASHAs) and program officials' perceptions regarding barriers to and prospects for the uptake of facilities offered under the JSY.Methods: Fifty in-depth interviews of a purposively selected sample of ASHAs (n = 12), members of Village Health and Sanitation Committees (n = 11), and officials at different tiers of healthcare facilities (n = 27) were conducted in three Indian states. The data were analyzed thematically using ATLAS.ti software.Results: Although the JSY has triggered considerable advancement on the Indian maternal and child health front, there are several barriers to be resolved pertaining to i) delivering quality care at health-facility; ii) linkages between home and health-facility; and iii) the community/household context. At the facility level, respondents cited an inability to treat birth complications as a barrier to JSY uptake, resulting in referrals to other (mostly private) facilities. Despite increased investment in health infrastructure under the program, shortages in emergency obstetric-care facilities, specialists and staff, essential drugs, diagnostics, and necessary equipment persisted. Weaker linkages between various vertical (standalone) elements of maternal and primary healthcare programs, and nearly uniform resource allocation to all facilities irrespective of caseloads and actual need also constrained the provision of quality healthcare. Barriers affecting the linkages between home and facility arose mainly due to the mismatch between the multiple demands and the availability of transport facilities, especially in emergency situations. Regarding community/household context, several socio-cultural issues such as resistance towards the ASHA's efforts of counselling, particularly from elderly family members, often adversely affected people's decision to seek healthcare.Conclusion: Adequate interventions at the community level, capacity building for healthcare providers, and measures to address underlying structural and systemic barriers are needed to improve the uptake of institutional maternal healthcare.