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Supply-Side Barriers to Maternity-Care Provision in India: A Facility-Based Analysis

Santosh Kumar and Emily Dansereau ()
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Emily Dansereau: University of Washington

No 1406, Working Papers from Sam Houston State University, Department of Economics and International Business

Abstract: Background: Health facilities in many low- and middle-income countries face several types of barriers in delivering quality health services. Availability of resources at the facility may significantly affect the volume and quality of services. We aim to investigate the effect of supply-side determinants of delivery care in India. Methods: Facility data from the District-Level Household Survey (DLHS-3) collected in 2007-2008 were analyzed to explore the effect of supply-side factors on the volume of delivery care at Indian health facilities. A Negative Binomial regression model was fit to the data due to the count and over-dispersion property of the outcome variable (number of deliveries performed at the facility). Results: Availability of a labor room (Incidence Rate Ratio [IRR]: 1.81; 95% Confidence Interval [CI]: 1.68-1.95) and facility opening hours (IRR: 1.43; CI: 1.35-1.51) were the most significant predictors of the volume of delivery care at the health facilities. Implementation of quality measures was not associated with more deliveries. Statistically significant but very small increases in the IRR were associated with increases in the types of medical (IRR: 1.05; 95% CI: 1.01-1.08) and paramedical (IRR: 1.06; CI: 1.04-1.08) staff available, and relevant staff trainings (IRR: 1.05; CI: 1.00-1.11). The volume of deliveries was also higher if adequate beds, essential obstetric drugs, medical equipment, communications infrastructure, and electricity were available at the clinic. Findings were robust to the inclusion of a catchment area population size, and district-level controls for education, insurance, religion, wealth, and fertility. Conclusions: Our study highlights the importance of supply-side barriers to health services utilization. To meet the Millennium Development Goal of reducing maternal mortality, policymakers should make additional investment in improving the availability of infrastructure at the primary-care level, including labor rooms and hours of operation.

Date: 2014-06
New Economics Papers: this item is included in nep-hea and nep-ias
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Citations: View citations in EconPapers (4)

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