Figure 1 presents the distribution of institutional delivery by wealth quintile and type of health centres in India. The utilization of institutional delivery in public health centres declines with an increase in the economic well-being of the households. On the other hand, the economic gradient in the utilization of institutional delivery in private health centres was strong and positive. For example, among all institutional deliveries in the poorest wealth quintile, 86% were in public health centre compared to 14% in the private ones. By contrast, in the richest wealth quintile, about two-third women used private health centre for delivery care. A majority of the women from the poorest, poorer, and middle quintile availed delivery care in public health centres.
Table 1: Sample profile of the study population based on NFHS-4, 2015-16, India.
Variables
|
Percentage (%)
|
95% Confidence Interval
|
Place of residence
|
|
|
Urban
|
33.0
|
32.6-33.4
|
Rural
|
67.0
|
66.6-67.4
|
Educational Level
|
|
|
Less than 5 years
|
26.9
|
26.6-27.2
|
5 years and more
|
73.1
|
72.7-73.4
|
State type
|
|
|
Low performing states
|
48.8
|
48.4-49.2
|
High performing states
|
51.2
|
50.8-51.6
|
Social Group
|
|
|
Schedule caste / Schedule tribe
|
29.8
|
29.5-30.2
|
Other backward class
|
44.1
|
43.7-44.5
|
Others
|
26.1
|
25.7-26.4
|
Household size
|
|
|
Up to 5
|
47.5
|
47.1-47.9
|
6 and more
|
52.5
|
52.1-52.9
|
Place of Delivery
|
|
|
Public facility
|
64.7
|
64.3-65.1
|
Private facility
|
35.3
|
34.9-35.7
|
Level of care at public health centres
|
|
|
Government/Municipal, Rural Hospital
|
52.8
|
52.5-53.2
|
Sub-centre, PHC, UHC, others*
|
11.9
|
11.6-12.1
|
Number of ANC visits
|
|
|
Less than 4
|
42.5
|
42.1-42.9
|
4 and more
|
57.5
|
57.1-57.9
|
*Others include additional Urban Health Post (UHP), Urban Family Welfare Centre (UFWC), Public sector health facility
Table 1 presents the socio-demographic characteristics of the study population. About 33% (95% CI: 32.6-33.4) of the respondents resided in urban areas while 67% resides in the rural areas (95% CI: 66.6-67.4). About one-quarter of the respondents had an educational level of less than 5 years (26.9%; 95% CI: 26.6-27.2) while three-fourth of them (73.1%, 95% CI: 72.7-73.4) had more than 5 years of education. About 48.8% (95% CI: 48.4-49.2) of the respondents resides in low performing states while 51.2% (95% CI: 50.8-51.6) resided in the high performing ones. With respect to social group, 29.8% (95% CI: 29.5-30.2) of the respondents belonged to schedule caste or schedule tribe, 44.1% (95% CI: 43.7-44.5) belongs to other backward class, and 26.1% belonged to other social groups (95% CI: 25.7-26.4). About 64.7% (95% CI: 64.3-65.1) of the mothers went to public health centres for institutional delivery while, 35.2% of the respondents used private health centres (35.3%; 95% CI: 34.9-35.7). Among respondents utilizing public health centres, 52.8% (95% CI: 52.5-53.2) utilized government/municipal hospitals, rural hospitals while 11.9% (95% CI: 11.6-12.1) utilized Sub-centres, PHC, UHC, others facilities. About 42.5% (95% CI: 42.1-42.9) respondents made less than 4 ANC visit while 57.5% (95% CI: 57.1-57.9) respondents made 4 or more ANC visits.
Table 2: Percent distribution of mothers who paid and did not pay for institutional delivery by wealth quintile and type of health centres in India, 2015-16.
Wealth Quintile
|
Sub-centres, PHC, UHC & Others*
|
Government/Municipal, Rural Hospital
|
Any public health facility
|
Private health facility
|
Overall
|
Paid (%)
|
Didn't pay (%)
|
N
|
Paid (%)
|
Didn't pay (%)
|
N
|
Paid (%)
|
Didn't pay (%)
|
N
|
Paid (%)
|
Didn't pay (%)
|
N
|
Paid (%)
|
Didn't pay (%)
|
N
|
Poorest
|
79.8
|
20.2
|
5,792
|
84.4
|
15.6
|
18,726
|
83.4
|
16.6
|
24,518
|
90.8
|
9.2
|
3223
|
84.4
|
15.6
|
27,741
|
Poorer
|
76.0
|
24.0
|
5,731
|
82.1
|
17.9
|
20,904
|
80.9
|
19.1
|
26,635
|
92.6
|
7.4
|
5167
|
83.2
|
16.8
|
31,802
|
Middle
|
75.5
|
24.5
|
4,231
|
78.3
|
21.7
|
19,822
|
77.8
|
22.2
|
24,053
|
92.5
|
7.5
|
7838
|
82.3
|
17.7
|
31,891
|
Richer
|
70.8
|
29.2
|
2,511
|
76.8
|
23.2
|
16,165
|
75.9
|
24.1
|
18,676
|
91.5
|
8.6
|
11149
|
82.9
|
17.1
|
29,825
|
Richest
|
70.2
|
29.8
|
1,161
|
71.8
|
28.2
|
10,572
|
71.6
|
28.4
|
11,733
|
91.0
|
9.0
|
15653
|
84.2
|
15.9
|
27,386
|
Total
|
75.9
|
24.1
|
19,426
|
79.5
|
20.5
|
86,189
|
78.9
|
21.1
|
105615
|
91.6
|
8.5
|
43030
|
83.3
|
16.7
|
148645
|
* Any public health centre includes PHC, sub-centres, UHC & Others, government/municipal, rural hospital
Table 2 presents the percent distribution of women who availed delivery services with and without payment at private and public health centre by wealth quintile in India. About 17% of the respondents did not pay for delivery care in India, and it varies from 15.6% in the poorest wealth quintile to 17.7% in the middle wealth quintile. Among those who availed services in public health centres, the proportion of women who did not pay for delivery care increases by wealth quintile. For example, among respondents who went to primary health centres, 20% in the poorest wealth quintile did not pay for services compared to 30% in the richest wealth quintile. Similarly, among those availing services from secondary health centres, about 16% women in the poorest wealth quintile did not pay for delivery care compared to 28% in the richest wealth quintile. In case of any public health facility, about 17% of the women in poorest wealth quintile did not pay for delivery care compared to 28% in the richest wealth quintile. In the case of private health centres, the proportion of those who did not pay for institutional delivery varied from 7.4% in the poorer quintile to 9.2% in the poorest quintile.
Table 3: Utilization rate, out-of-pocket payment (OOP in US$), and benefit incidence on institutional delivery by wealth quintile and level of care in India, 2015-16.
Type of public health centre
|
Quintile
|
Number people utilizing public health service (1)
|
Utilization Rate (2)
|
Median OOP in public health service in US$ (3)
|
Median cost of service in private health centre in US$ (4)
|
Net subsidy at public health centre in US$ (5=4-3)
|
Individual Subsidy Benefit (6=5*2)
|
Benefit Incidence (7)
|
N
|
Primary: Sub-centre, PHC, UHC, & others*
|
Poorest
|
6,189
|
0.319
|
12
|
161
|
150
|
48
|
32.29
|
26241
|
Poorer
|
5,323
|
0.274
|
15
|
161
|
147
|
40
|
27.23
|
24845
|
Middle
|
3,986
|
0.205
|
15
|
161
|
147
|
30
|
20.39
|
22533
|
Richer
|
2,612
|
0.134
|
15
|
161
|
147
|
20
|
13.36
|
18983
|
Richest
|
1,316
|
0.068
|
15
|
161
|
147
|
10
|
6.73
|
13013
|
|
|
19,426
|
|
|
|
|
148
|
|
105,615
|
Secondary: Government/ Municipal, Rural Hospital
|
Poorest
|
20,052
|
0.233
|
15
|
161
|
147
|
34
|
23.63
|
26241
|
Poorer
|
19,522
|
0.227
|
18
|
161
|
144
|
33
|
22.55
|
24845
|
Middle
|
18,547
|
0.215
|
18
|
161
|
143
|
31
|
21.31
|
22533
|
Richer
|
16,371
|
0.190
|
19
|
161
|
142
|
27
|
18.72
|
18983
|
Richest
|
11,697
|
0.136
|
15
|
161
|
147
|
20
|
13.79
|
13013
|
|
|
86,189
|
|
|
|
|
144
|
|
105,615
|
Any public health centre
|
Poorest
|
26241
|
0.248
|
15
|
161
|
147
|
36
|
25.10
|
29729
|
Poorer
|
24845
|
0.235
|
16
|
161
|
145
|
34
|
23.53
|
29729
|
Middle
|
22533
|
0.213
|
18
|
161
|
144
|
31
|
21.12
|
29729
|
Richer
|
18983
|
0.180
|
18
|
161
|
144
|
26
|
17.80
|
29729
|
Richest
|
13013
|
0.123
|
15
|
161
|
147
|
18
|
12.45
|
29729
|
|
|
105,615
|
|
|
|
|
145
|
|
148,645
|
*Others include additional Primary Healthcare Centre (PHC), Urban Health Post (UHP), Urban Family Welfare Centre (UFWC), Public sector health facility; 1 US $=INR 68.22
Table 3 present the benefit incidence of the public subsidy on delivery care by wealth quintile and level of care in India. The utilization rate in primary health centres varied from 31.9% among the poorest quintile to 6.8% in the richest quintile whereas in secondary health centres, it varied from 23.3% among the poorest quintile to 13.6% in the richest quintile. In case of any public health centre, it varied from 24.8% among the poorest quintile to 12.3% among the richest quintile. By using the overall median OOP payment for service availed in private health centre as the proxy for the cost of services, the public subsidy was found to be pro-poor in each public health facility. During 2015-16, public subsidy in primary health centres was the highest for the poorest quintile (32.29%) followed by the poorer quintile (27.23%) while it was lowest for the richest quintile (6.73%). With regard to secondary health centre, the benefit of public subsidy was maximum for the poorest quintile (23.63%) followed by the poorer quintile (22.55%) while it was the lowest for the richest quintile (13.79%). Considering the quintile specific median cost of service in private health centre, the pattern of the benefit of public subsidy remained similar for primary health centres while different pattern was observed in case of secondary health centre. For instance, in case of any public health centre, the benefit of public subsidy was highest for the middle quintile (21.93%) followed by the richer quintile (21.84%) while it was the lowest for the poorest quintile (17.42%) (Appendix 1).
Table 4a: Utilization rate, out-of-pocket payment (OOP in US$), and benefit incidence by place of residence, educational attainment, states and social group in Sub-centre, PHC, UHC on institutional delivery in India, 2015-16.
PHC, Sub-centre, UHC, others*
|
Quintile
|
Number people utilizing public health service (1)
|
Utilization Rate (2)
|
Median OOP in public health service in US$ (3)
|
Median cost of service in private health centre in US$ (4)
|
Net subsidy at public health centre in US$ (5=4-3)
|
Individual Subsidy Benefit (6=5*2)
|
Benefit Incidence (7)
|
N
|
Urban
|
Poorest
|
853
|
0.343
|
14
|
191
|
177
|
61
|
34.39
|
6789
|
Poorer
|
622
|
0.250
|
15
|
191
|
176
|
44
|
24.93
|
5904
|
Middle
|
473
|
0.190
|
15
|
191
|
176
|
33
|
18.99
|
4818
|
Richer
|
303
|
0.122
|
16
|
191
|
175
|
21
|
12.10
|
3767
|
Richest
|
239
|
0.096
|
15
|
191
|
176
|
17
|
9.59
|
2794
|
|
|
2490
|
|
|
|
|
176
|
|
24072
|
Rural
|
Poorest
|
4567
|
0.270
|
12
|
147
|
135
|
36
|
27.34
|
18905
|
Poorer
|
4223
|
0.249
|
15
|
147
|
132
|
33
|
24.73
|
18214
|
Middle
|
3612
|
0.213
|
15
|
147
|
132
|
28
|
21.16
|
17163
|
Richer
|
2904
|
0.171
|
15
|
147
|
132
|
23
|
17.01
|
15421
|
Richest
|
1630
|
0.096
|
12
|
147
|
132
|
13
|
9.76
|
11840
|
|
|
16936
|
|
|
|
|
133
|
|
81543
|
LPS
|
Poorest
|
3850
|
0.284
|
12
|
142
|
130
|
37
|
28.67
|
15983
|
Poorer
|
3579
|
0.264
|
13
|
142
|
129
|
34
|
26.35
|
15565
|
Middle
|
2945
|
0.217
|
15
|
142
|
127
|
28
|
21.44
|
14638
|
Richer
|
2089
|
0.154
|
12
|
142
|
130
|
20
|
15.56
|
12929
|
Richest
|
1097
|
0.081
|
15
|
142
|
127
|
10
|
7.99
|
8767
|
|
|
13560
|
|
|
|
|
129
|
|
67882
|
HPS
|
Poorest
|
2020
|
0.344
|
15
|
180
|
166
|
57
|
34.44
|
9693
|
Poorer
|
1585
|
0.270
|
15
|
180
|
166
|
45
|
27.02
|
8925
|
Middle
|
1174
|
0.200
|
15
|
180
|
166
|
33
|
20.01
|
7925
|
Richer
|
706
|
0.120
|
15
|
180
|
166
|
20
|
12.04
|
6478
|
Richest
|
381
|
0.065
|
15
|
180
|
166
|
11
|
6.50
|
4712
|
|
|
5866
|
|
|
|
|
166
|
|
37733
|
Education less than 5 year
|
Poorest
|
1866
|
0.254
|
10
|
117
|
107
|
27
|
25.79
|
7615
|
Poorer
|
1719
|
0.234
|
13
|
117
|
104
|
24
|
23.11
|
7373
|
Middle
|
1619
|
0.221
|
12
|
117
|
105
|
23
|
22.06
|
7210
|
Richer
|
1276
|
0.174
|
13
|
117
|
104
|
18
|
17.15
|
6794
|
Richest
|
860
|
0.117
|
10
|
117
|
107
|
13
|
11.89
|
5815
|
|
|
7340
|
|
|
|
|
105
|
|
34807
|
Education more than 5 year
|
Poorest
|
4162
|
0.344
|
13
|
176
|
163
|
56
|
34.64
|
18360
|
Poorer
|
3271
|
0.271
|
15
|
176
|
161
|
44
|
26.98
|
16854
|
Middle
|
2340
|
0.194
|
15
|
176
|
161
|
31
|
19.30
|
14894
|
Richer
|
1489
|
0.123
|
15
|
176
|
161
|
20
|
12.28
|
12117
|
Richest
|
824
|
0.068
|
15
|
176
|
161
|
11
|
6.80
|
8583
|
|
|
12086
|
|
|
|
|
162
|
|
70808
|
Schedule caste / Schedule tribe
|
Poorest
|
2324
|
0.278
|
10
|
147
|
136
|
38
|
28.10
|
9553
|
Poorer
|
2143
|
0.256
|
10
|
147
|
136
|
35
|
25.91
|
9286
|
Middle
|
1856
|
0.222
|
12
|
147
|
135
|
30
|
22.20
|
8904
|
Richer
|
1345
|
0.161
|
15
|
147
|
132
|
21
|
15.74
|
8237
|
Richest
|
688
|
0.082
|
15
|
147
|
132
|
11
|
8.05
|
6633
|
|
|
8356
|
|
|
|
|
135
|
|
42613
|
Other backward class
|
Poorest
|
2338
|
0.313
|
13
|
157
|
144
|
45
|
31.60
|
10220
|
Poorer
|
1920
|
0.257
|
15
|
157
|
142
|
37
|
25.58
|
9508
|
Middle
|
1553
|
0.208
|
15
|
157
|
142
|
30
|
20.69
|
8462
|
Richer
|
1093
|
0.146
|
15
|
157
|
142
|
21
|
14.56
|
7117
|
Richest
|
562
|
0.075
|
13
|
1567
|
144
|
11
|
7.56
|
4859
|
|
|
7466
|
|
|
|
|
143
|
|
40166
|
Other
|
Poorest
|
1459
|
0.405
|
16
|
176
|
160
|
65
|
40.54
|
6247
|
Poorer
|
913
|
0.253
|
19
|
176
|
157
|
40
|
24.90
|
5615
|
Middle
|
626
|
0.174
|
15
|
176
|
161
|
28
|
17.55
|
4736
|
Richer
|
389
|
0.108
|
16
|
176
|
160
|
17
|
10.81
|
3642
|
Richest
|
217
|
0.060
|
12
|
176
|
164
|
10
|
6.20
|
2596
|
|
|
3604
|
|
|
|
|
160
|
|
22836
|
*Others include additional Primary Healthcare Centre (PHC), Urban Health Post (UHP), Urban Family Welfare Centre (UFWC), Public sector health facility; 1 US $=INR 68.22
Table 4a presents the results of the benefit incidence of institutional delivery in India by place of residence, low/high performing states, educational attainment and social group in PHCs, sub-centre, UHCs, and others public health care faculties. The distribution of public subsidy for each of the selected variables was pro-poor in nature. In urban area, the highest share of the benefit was received by women belonging to the poorest quintile (34.39%), followed by those from the poorer quintile (24.93%) while it was the lowest among women from the richest quintile (9.59%). In the case of rural areas, the share of benefit received was highest for women belonging to poorest quintile (27.34%) followed by women from the poorer quintile (24.73%) while it was the lowest among women from the richest quintile (9.76%). The utilization rate of in public health facilities in the low performing states (LPS) varied from 28.4% among women from the poorest quintile to 8.1% among women from the richest wealth quintile. On the other hand, it varied from 34.4% among those from the poorest quintile to 6.5% among women from the richest quintile in the high performing states (HPS). The share of public subsidy in LPS was highest among the women belonging to the poorest quintile (28.67%) followed by those form the poorer quintile (26.35%), while it was the lowest among the richest quintile (7.99%). In the case of HPS, the share of the benefit was the highest among the poorest quintile (34.44%) followed by poorer (27.02%), while it was the minimum among the richest quintile (6.5%). The utilization rate of public health centres among women with less than 5 years of education varied from 25.4% among those from poorest quintile to 11.7% among those from the richest quintile while, it varied from 34.4% among those from the poorest quintile to 6.8% among those from the richest quintile. The share of public subsidy for women with education less than 5 years was highest for those belonging to the poorest quintile (25.79%) followed by the poorer quintile (23.11%), while it was lowest for among women from the richest quintile (11.89%). Among mothers having more than 5 years of education, the share of public subsidy was the highest among the poorest quintile (34.64%), followed by the poorer quintile (26.98%) while it was the lowest for among the richest quintile (6.80%). The utilization pattern and net benefit from public subsidy across social groups by wealth quintile followed a similar pattern; with a higher utilization and greater benefit from seen among mothers belonging to the poorest wealth quintile compared to those from the richest wealth quintile. For example, among mothers belonging to SC/ST, 27.8% of those from the poorest quintile used public services in primary health centres compared to 8.2% of those from the richest quintile. The share of the benefit of public subsidy was also the highest among women from the poorest quintile (28.10%) followed by poorer quintile (25.91%) while it was the lowest among those from the richest quintile (8.05%).
Further, the benefit incidence was computed for women using government/municipal hospitals, rural hospitals (Table 4b) and any other public health centres (Table 4c) for delivery care. The pattern of the distribution of the share of public subsidy in these facilities was similar to that in using PHCs, sub-centres, UHCs and other health facilities; however, the magnitude of the share of the benefit was lower. For instance, in the urban area, among women from the poorest wealth quintile, the share of the benefit of public subsidy was 27.82% among those who went to government/municipal hospitals, rural hospital while it was 28.46% among those availed services from any public health facility compared to 34.39% among those availed services from Sub-centres, PHCs, UHCs, and others.
Table 4b: Utilization rate, out-of-pocket payment (OOP in US$), and Benefit Incidence by place of residence, educational attainment, states and social group in Government/Municipal, Rural Hospital on institutional delivery in India, 2015-16.
Government/ Municipal, Rural Hospital
|
Quintile
|
Number people utilizing public health service (1)
|
Utilization Rate (2)
|
Median OOP in public health service in US$ (3)
|
Median cost of service in private health centre in US$ (4)
|
Net subsidy at public health centre in US$ (5=4-3)
|
Individual Subsidy Benefit (6=5*2)
|
Benefit Incidence (7)
|
N
|
Urban
|
Poorest
|
5936
|
0.275
|
16
|
191
|
174
|
48
|
27.82
|
6789
|
Poorer
|
5282
|
0.245
|
19
|
191
|
172
|
42
|
24.34
|
5904
|
Middle
|
4345
|
0.201
|
22
|
191
|
169
|
34
|
19.68
|
4818
|
Richer
|
3464
|
0.161
|
18
|
191
|
173
|
28
|
16.10
|
3767
|
Richest
|
2555
|
0.118
|
15
|
191
|
176
|
21
|
12.07
|
2794
|
|
|
21582
|
|
|
|
|
172
|
|
24072
|
Rural
|
Poorest
|
14338
|
0.222
|
15
|
147
|
132
|
29
|
22.50
|
18905
|
Poorer
|
13991
|
0.217
|
16
|
147
|
130
|
28
|
21.71
|
18214
|
Middle
|
13551
|
0.210
|
18
|
147
|
129
|
27
|
20.79
|
17163
|
Richer
|
12517
|
0.194
|
19
|
147
|
128
|
25
|
18.99
|
15421
|
Richest
|
10210
|
0.158
|
15
|
147
|
132
|
21
|
16.01
|
11840
|
|
|
64607
|
|
|
|
|
130
|
|
81543
|
LPS
|
Poorest
|
12133
|
0.223
|
15
|
142
|
128
|
28
|
22.34
|
15983
|
Poorer
|
11986
|
0.221
|
15
|
142
|
128
|
28
|
22.06
|
15565
|
Middle
|
11693
|
0.215
|
15
|
142
|
128
|
27
|
21.53
|
14638
|
Richer
|
10840
|
0.200
|
15
|
142
|
128
|
25
|
19.96
|
12929
|
Richest
|
7670
|
0.141
|
15
|
142
|
128
|
18
|
14.12
|
8767
|
|
|
54322
|
|
|
|
|
128
|
|
67882
|
HPS
|
Poorest
|
7673
|
0.241
|
25
|
180
|
155
|
37
|
23.79
|
9693
|
Poorer
|
7340
|
0.230
|
23
|
180
|
157
|
36
|
22.97
|
8925
|
Middle
|
6751
|
0.212
|
25
|
180
|
155
|
33
|
20.93
|
7925
|
Richer
|
5772
|
0.181
|
23
|
180
|
157
|
28
|
18.12
|
6478
|
Richest
|
4331
|
0.136
|
16
|
180
|
164
|
22
|
14.19
|
4712
|
|
|
31867
|
|
|
|
|
157
|
|
37733
|
Education less than 5 years
|
Poorest
|
5749
|
0.209
|
15
|
117
|
103
|
21
|
20.93
|
7615
|
Poorer
|
5654
|
0.206
|
15
|
117
|
103
|
21
|
20.58
|
7373
|
Middle
|
5591
|
0.204
|
15
|
117
|
103
|
21
|
20.36
|
7210
|
Richer
|
5518
|
0.201
|
15
|
117
|
103
|
21
|
20.09
|
6794
|
Richest
|
4955
|
0.180
|
15
|
117
|
103
|
19
|
18.04
|
5815
|
|
|
27467
|
|
|
|
|
103
|
|
34807
|
Education more than 5 year
|
Poorest
|
14198
|
0.242
|
18
|
176
|
158
|
38
|
24.41
|
18360
|
Poorer
|
13583
|
0.231
|
21
|
176
|
155
|
36
|
22.92
|
16854
|
Middle
|
12554
|
0.214
|
22
|
176
|
154
|
33
|
20.98
|
14894
|
Richer
|
10628
|
0.181
|
19
|
176
|
157
|
28
|
18.10
|
12117
|
Richest
|
7759
|
0.132
|
15
|
176
|
161
|
21
|
13.59
|
8583
|
|
|
58722
|
|
|
|
|
157
|
|
70808
|
Schedule caste / Schedule tribe
|
Poorest
|
7229
|
0.211
|
15
|
147
|
132
|
28
|
21.34
|
9553
|
Poorer
|
7143
|
0.209
|
15
|
147
|
132
|
28
|
21.09
|
9286
|
Middle
|
7048
|
0.206
|
18
|
147
|
128
|
26
|
20.23
|
8904
|
Richer
|
6892
|
0.201
|
18
|
147
|
129
|
26
|
19.89
|
8237
|
Richest
|
5945
|
0.174
|
15
|
147
|
131
|
23
|
17.45
|
6633
|
|
|
34257
|
|
|
|
|
130
|
|
42613
|
Other backward class
|
Poorest
|
7882
|
0.241
|
15
|
157
|
142
|
34
|
24.25
|
10220
|
Poorer
|
7588
|
0.232
|
15
|
157
|
142
|
33
|
23.58
|
9508
|
Middle
|
6909
|
0.211
|
16
|
157
|
141
|
30
|
21.04
|
8462
|
Richer
|
6024
|
0.184
|
18
|
157
|
139
|
26
|
18.15
|
7117
|
Richest
|
4297
|
0.131
|
15
|
157
|
142
|
19
|
13.22
|
4859
|
|
|
32700
|
|
|
|
|
141.3
|
|
40166
|
Others
|
Poorest
|
4788
|
0.249
|
22
|
176
|
154
|
38
|
24.96
|
6247
|
Poorer
|
4702
|
0.244
|
26
|
176
|
150
|
37
|
23.92
|
5615
|
Middle
|
4110
|
0.214
|
23
|
176
|
152
|
33
|
21.26
|
4736
|
Richer
|
3253
|
0.169
|
23
|
176
|
153
|
26
|
16.91
|
3642
|
Richest
|
2379
|
0.124
|
15
|
176
|
161
|
20
|
12.96
|
2596
|
|
|
19232
|
|
|
|
|
153
|
|
22836
|
1 US $=INR 68.22
Table 4c: Utilization rate, out-of-pocket payment (OOP in US$), and Benefit incidence place of residence, educational attainment, states and social group on institutional delivery by wealth quintile in India, 2015-16.
Overall
|
Quintile
|
Number people utilizing public health service (1)
|
Utilization Rate (2)
|
Median OOP in public health service in US$ (3)
|
Median cost of service in private health centre in US$ (4)
|
Net subsidy at public health centre in US$ (5=4-3)
|
Individual Subsidy Benefit (6=5*2)
|
Benefit Incidence (7)
|
N
|
Urban
|
Poorest
|
6789
|
0.282
|
16
|
191
|
175
|
49
|
28.46
|
8461
|
Poorer
|
5904
|
0.245
|
18
|
191
|
173
|
42
|
24.46
|
8460
|
Middle
|
4818
|
0.200
|
20
|
191
|
171
|
34
|
19.69
|
8460
|
Richer
|
3767
|
0.156
|
18
|
191
|
173
|
27
|
15.61
|
8460
|
Richest
|
2794
|
0.116
|
15
|
191
|
176
|
20
|
11.77
|
8460
|
|
|
24072
|
|
|
|
|
173
|
|
42301
|
Rural
|
Poorest
|
18905
|
0.232
|
15
|
147
|
132
|
31
|
23.38
|
21269
|
Poorer
|
18214
|
0.223
|
15
|
147
|
131
|
29
|
22.40
|
21270
|
Middle
|
17163
|
0.210
|
17
|
147
|
130
|
27
|
20.92
|
21268
|
Richer
|
15421
|
0.189
|
18
|
147
|
129
|
24
|
18.65
|
21269
|
Richest
|
11840
|
0.145
|
15
|
147
|
132
|
19
|
14.64
|
21268
|
|
|
81543
|
|
|
|
|
131
|
|
106344
|
LPS
|
Poorest
|
15983
|
0.235
|
15
|
142
|
128
|
30
|
23.55
|
17852
|
Poorer
|
15565
|
0.229
|
15
|
142
|
128
|
29
|
22.93
|
17852
|
Middle
|
14638
|
0.216
|
15
|
142
|
128
|
27
|
21.56
|
17853
|
Richer
|
12929
|
0.190
|
15
|
142
|
128
|
24
|
19.05
|
17851
|
Richest
|
8767
|
0.129
|
15
|
142
|
128
|
16
|
12.92
|
17851
|
|
|
67882
|
|
|
|
|
128
|
|
89259
|
HPS
|
Poorest
|
9693
|
0.257
|
22
|
180
|
158
|
41
|
25.59
|
11878
|
Poorer
|
8925
|
0.237
|
22
|
180
|
158
|
37
|
23.57
|
11877
|
Middle
|
7925
|
0.210
|
23
|
180
|
158
|
33
|
20.83
|
11877
|
Richer
|
6478
|
0.172
|
22
|
180
|
158
|
27
|
17.11
|
11877
|
Richest
|
4712
|
0.125
|
16
|
180
|
158
|
21
|
12.90
|
11877
|
|
|
37733
|
|
|
|
|
159
|
|
59386
|
Education less than 5 years
|
Poorest
|
7615
|
0.219
|
14
|
117
|
103
|
23
|
22.0
|
8410
|
Poorer
|
7373
|
0.212
|
15
|
117
|
103
|
22
|
21.15
|
8411
|
Middle
|
7210
|
0.207
|
15
|
117
|
103
|
21
|
20.68
|
8408
|
Richer
|
6794
|
0.195
|
15
|
117
|
103
|
20
|
19.49
|
8410
|
Richest
|
5815
|
0.167
|
15
|
117
|
103
|
17
|
16.68
|
8409
|
|
|
34807
|
|
|
|
|
103
|
|
42048
|
Education more than 5 years
|
Poorest
|
18360
|
0.259
|
16
|
176
|
160
|
41
|
26.18
|
21320
|
Poorer
|
16854
|
0.238
|
18
|
176
|
158
|
37
|
23.70
|
21320
|
Middle
|
14894
|
0.210
|
21
|
176
|
155
|
33
|
20.65
|
21321
|
Richer
|
12117
|
0.171
|
18
|
176
|
158
|
27
|
17.12
|
21317
|
Richest
|
8583
|
0.121
|
15
|
176
|
161
|
20
|
12.35
|
21319
|
|
|
70808
|
|
|
|
|
158
|
|
106597
|
Schedule caste/ Schedule
|
Poorest
|
9553
|
0.224
|
13
|
147
|
133
|
30
|
22.72
|
10417
|
Poorer
|
9286
|
0.218
|
15
|
147
|
132
|
29
|
21.84
|
10417
|
Middle
|
8904
|
0.209
|
16
|
147
|
130
|
27
|
20.69
|
10417
|
Richer
|
8237
|
0.193
|
16
|
147
|
130
|
25
|
19.16
|
10417
|
Richest
|
6633
|
0.156
|
15
|
147
|
132
|
21
|
15.60
|
10417
|
|
|
42613
|
|
|
|
|
132
|
|
52085
|
Other backward class
|
Poorest
|
10220
|
0.254
|
15
|
157
|
142
|
36
|
25.55
|
12048
|
Poorer
|
9508
|
0.237
|
15
|
157
|
142
|
34
|
23.77
|
12048
|
Middle
|
8462
|
0.211
|
16
|
157
|
141
|
30
|
20.93
|
12048
|
Richer
|
7117
|
0.177
|
16
|
157
|
141
|
25
|
17.61
|
12048
|
Richest
|
4859
|
0.121
|
15
|
157
|
142
|
17
|
12.15
|
12048
|
|
|
40166
|
|
|
|
|
142
|
|
60240
|
Others
|
Poorest
|
6247
|
0.274
|
22
|
176
|
154
|
42
|
27.29
|
7264
|
Poorer
|
5615
|
0.246
|
23
|
176
|
152
|
37
|
24.29
|
7264
|
Middle
|
4736
|
0.207
|
22
|
176
|
154
|
32
|
20.69
|
7264
|
Richer
|
3642
|
0.159
|
22
|
176
|
154
|
25
|
15.91
|
7264
|
Richest
|
2596
|
0.114
|
15
|
176
|
161
|
18
|
11.83
|
7264
|
|
|
22836
|
|
|
|
|
154
|
|
36320
|
1 US $=INR 68.22
Figure 2 present the concentration curve (CC) for women who had institutional delivery at public and private health centres. The CC for women who went to public health centre is above the line of equality, indicating a pro-poor concentration of the of public health centre for delivery care services whereas CC is below the line of equality for women who went to private health centre suggesting a pro-rich concentration of the use of private health centres for delivery care services.
Table 5: Concentration index for institutional delivery by selected covariates in India, 2015-16.
|
Place of Delivery
|
|
Public
|
95% Confidence Interval
|
Private
|
95% Confidence Interval
|
Place of Residence
|
|
|
|
|
Rural
|
-0.112
|
(-0.115, -0.109)
|
0.281
|
(0.273, 0.290)
|
Urban
|
-0.209
|
(-0.218, -0.200
|
0.217
|
(0.207, 0.226)
|
State type
|
|
|
|
|
Low Performing States
|
-0.113
|
(-0.116, -0.110)
|
0.318
|
(0.309, 0.328)
|
High Performing state
|
-0.177
|
(-0.184, -0.170)
|
0.226
|
(0.217, 0.235)
|
Education
|
|
|
|
|
Less than 5 years
|
-0.063
|
(-0.067, -0.058)
|
0.24
|
(0.222, 0.258)
|
5 years and more
|
-0.177
|
(-0.182, -0.172)
|
0.258
|
(0.251, 0.265)
|
Household Size
|
|
|
|
|
Up to 5
|
-0.167
|
(-.0172, -0.162)
|
0.307
|
(-.0299, 0.315)
|
6 or more
|
-0.152
|
(-.0157, -0.147)
|
0.277
|
(-.0267, 0.287)
|
Number of ANC visits
|
|
|
|
|
Less than 4
|
-0.107
|
(-0.112, -0.102)
|
0.298
|
(0.285, 0.311)
|
4 and more
|
-0.184
|
(-0.189, -0.179)
|
0.257
|
(0.249, 0.265)
|
Adverse Birth Outcome
|
|
|
|
|
No
|
-0.166
|
(-0.170, -0.162)
|
0.302
|
(0.294, 0.310)
|
Yes
|
-0.150
|
(-0.156, -0.144)
|
0.280
|
(0.269, 0.291)
|
Overall
|
-0.161
|
(-0.165, -0.158)
|
0.296
|
(0.289, 0.303)
|
Table 5: presents the concentration index for institutional delivery by place of residence, low/high performing states, educational attainment, household size, number of ANC visits and adverse birth outcome in India by use of services in public and private health centres. For women who went to public health centres, the CI value was negative for each of the selected variable, suggesting pro-a pro-poor utilization of services while was pro-rich for those who went to private health centres. The CI values was higher for women resided in urban areas and used a public health centre (CI: -0.209) for delivery care compared to those who delivered in a private health centre (CI: -0.112). Similarly, the CI was higher for mother who used private health centres for delivery services and were from rural area (CI: 0.281) compared to those form urban areas (CI: 0.217). The CI value of was higher for women resided in an HPS (-0.177) compared to those to those resided in an LPS (-0.113). On the contrary, in the case of private health centre the CI value was higher for women who resided in an LPS (0.318) compared to those who resided in an HPS (0.226). In the terms of education the CI value was higher in the case of women who used the public health care services had more than 5 years of education (-0.177) compared to those who had having less than 5 years of education (-0.063). Similarly, In the case of private health centre too, the CI value was higher among mothers having an education of more than 5 years (0.258) compared to those having less than 5 years of education (0.240). The CI value was higher for women who made 4 or more ANC visit (-0.184) used public health services compared to those who made less than 4 ANC visit (-0.107). Conversely, in the case of private health care centres the CI value was higher for women who made less than 4 or more ANC visits (0.298) utilizing private health centres compared to those having less than 4 ANC visits (0.257). The CI value was lower for women who had an adverse birth outcome (-0.150) and used a public health facility compared to those who did not have adverse birth outcome (-0.166). Similarly, in the case of private health facilities the CI value was lower for women who had an adverse birth outcome (0.280) compared to those who did not (0.302).
Figure 3 represents the concentration index for delivery care across the states of India by public and private health facilities. The CI value for mothers who used public health centres was -0.161 and negative for all the states. In contrast, the CI value for mothers who used private health centres was 0.296 and positive for all the states. A large variation in concentration index was observed across the states for both public and private health facilities. In the case of public health facilities, the CI value was the highest in Gujarat (CI: -0.235) followed Kerala (CI: -0.234) and Telangana (CI: -0.232) and the lowest in Jammu & Kashmir (CI: -0.047) followed by Sikkim (CI: -0.066) and Himachal Pradesh (-0.067). Across private health centres, the CI value was the highest in Tripura (CI: 0.585) followed by Madhya Pradesh (0.512) and Odisha (0.487) and the lowest in Telangana (CI: 0.114), followed by Gujarat (CI: 0.127) and Andhra Pradesh (CI: 0.148)