Impacts of Demand Side financing Instruments on the Continuum of Care for Maternal and Child Health in India and Bangladesh

印度和孟加拉国是全球孕妇及其新生儿过早死亡和健康状况不佳比率最高的国家之一，它们仍然是降低全球妇女和儿童不良健康结局比率的关键国家。降低这些比率的关键是鼓励提高医疗保健服务的覆盖率。在这两个国家的政策制定者利用国际经验采取的许多战略中，有一种干预措施旨在通过向妇女和儿童提供直接或间接的财政奖励，影响妇女和儿童--特别是来自较贫穷家庭或其他社会弱势群体的妇女和儿童--使用关键的保健服务。在这个项目中，我们旨在调查这些激励措施在多大程度上成功地改善了与改善针对孕妇和幼儿的卫生保健服务有关的一些最重要的指标，这些激励措施无论是直接支付现金金额还是在私人卫生设施中提供免费服务。此外，我们将研究阻碍人们更好地获得卫生服务的障碍，包括卫生设施的可获得性和可及性等因素；我们还将考虑卫生服务的护理质量，作为人们是否选择使用所提供的卫生服务的潜在强有力的决定因素。结果将帮助我们确定如何减少这些不同的壁垒，以便在这两个国家实现这些财政激励的最佳潜力。最终，收集到的数据将使我们能够确定，为了实现改善妇女和儿童的健康目标，需要对这些财政奖励的设计进行哪些可能的修改，同时辅助性、积极地改善护理质量。该项目建立在经验丰富的研究人员的集体多学科专业知识的基础上，这些研究人员通过来自英国、印度和孟加拉国的大学和研究机构的丰富合作聚集在一起。我们建议的研究涉及广泛使用现有的家庭调查数据和通过在印度三个邦(比哈尔邦、古吉拉特邦和卡纳塔克邦)和孟加拉国的两个省进行初步调查收集的最新数据。调查将涵盖这两个国家关于经济激励的三个最重要的计划--印度的Janani Suraksha Yojana(产妇保障计划)和Chiranjeevi(或长寿计划)计划，以及孟加拉国的母亲医疗券计划(MHVS)。两国卫生部的主要决策者对拟议的项目表现出极大的兴趣，并打算利用所产生的证据来加强或审查现有的干预措施。通过使用强有力的科学方法，结合目标人群的微观洞察，项目成果将在印度和孟加拉国的卫生政策制定者的决策工具包中产生至关重要的影响。

Having one of the highest global rates of premature deaths and poor health among pregnant women and their newborn, 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.