Has India's national rural health mission reduced inequities in maternal health services? A pre-post repeated cross-sectional study.
Has India's national rural health mission reduced inequities in maternal health services? A pre-post repeated cross-sectional study.
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DOI：
10.1093/heapol/czw100
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发表时间：
2017-03
影响因子：
3.2
通讯作者：
Doyle P
中科院分区：
文献类型：
--
作者：
Vellakkal S;Gupta A;Khan Z;Stuckler D;Reeves A;Ebrahim S;Bowling A;Doyle P
背景：2005年，印度启动了国家农村卫生使命，以加强初级卫生保健系统。NRHM还旨在鼓励孕妇，特别是社会经济背景较低的孕妇，利用机构孕产妇保健。我们评估了NRHM对印度高度关注（贫困）的各州在机构分娩和产前护理（ANC）方面的社会经济不平等的影响。 研究方法：使用了来自地区一级家庭和设施调查（DLHS）的数据，第1轮（1995-99）和第2轮（2000-04）来自NRHM之前的时期，第3轮（2007-08），第4轮和年度健康调查（2011-12）来自NRHM之后的时期。与财富相关和教育相关的不平等的相对指数，以及财富和教育三分位数的前后差异模型，调整产妇年龄，农村-城市，种姓，奇偶校验和国家一级的固定影响，进行了估计。 结果如下：机构交付的不平等在NRHM前第1阶段（1995-99年）和NRHM前第2阶段（2000-04年）之间有所下降，但此后在NRHM后阶段下降幅度更大。所有社会经济群体对机构交付的接受都有所增加，（1）最低和中等财富和教育三分位数的影响大于最高三分位数，（2）2011-12年NRHM后期的公平影响大于2007-08年NRHM后期的公平影响。在2007- 2008年NRHM后早期，没有发现对ANC的吸收产生积极影响;然而，在2011- 2012年NRHM后后期，大多数州的ANC吸收有相当大的增加，不公平现象有所下降。 结论：在高度关注的国家，NRHM导致孕产妇保健的增加，并减少其社会经济不平等。我们的研究表明，发展中国家的公共卫生项目在几乎全面实施和最广泛的推广之后，将产生更大的公平影响。以贫困人口为目标，通过将孕产妇和儿童保健组成部分联系起来来设计公共卫生方案，对于普及保健至关重要。
Background: In 2005, India launched the National Rural Health Mission (NRHM) to strengthen the primary healthcare system. NRHM also aims to encourage pregnant women, particularly of low socioeconomic backgrounds, to use institutional maternal healthcare. We evaluated the impacts of NRHM on socioeconomic inequities in the uptake of institutional delivery and antenatal care (ANC) across high-focus (deprived) Indian states. Methods: Data from District Level Household and Facility Surveys (DLHS) Rounds 1 (1995–99) and 2 (2000–04) from the pre-NRHM period, and Round 3 (2007–08), Round 4 and Annual Health Survey (2011–12) from post-NRHM period were used. Wealth-related and education-related relative indexes of inequality, and pre-post difference-in-differences models for wealth and education tertiles, adjusted for maternal age, rural-urban, caste, parity and state-level fixed effects, were estimated. Results: Inequities in institutional delivery declined between pre-NRHM Period 1 (1995–99) and pre-NRHM Period 2 (2000–04), but thereafter demonstrated steeper decline in post-NRHM periods. Uptake of institutional delivery increased among all socioeconomic groups, with (1) greater effects among the lowest and middle wealth and education tertiles than highest tertile, and (2) larger equity impacts in the late post-NRHM period 2011–12 than in the early post-NRHM period 2007–08. No positive impact on the uptake of ANC was found in the early post-NRHM period 2007–08; however, there was considerable increase in the uptake of, and decline in inequity, in uptake of ANC in most states in the late post-NRHM period 2011–12. Conclusion: In high-focus states, NRHM resulted in increased uptake of maternal healthcare, and decline in its socioeconomic inequity. Our study suggests that public health programs in developing country settings will have larger equity impacts after its almost full implementation and widest outreach. Targeting deprived populations and designing public health programs by linking maternal and child healthcare components are critical for universal access to healthcare.
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通讯作者：
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