Outreach of the programmatic components of National Health Mission in India: An inter‐ and intra‐state analysis using nationally representative data

• Published date: 01 November 2023
• Author: Abinash Singh,Sukumar Vellakkal
• Date: 01 November 2023
• DOI: http://doi.org/10.1002/pa.2883

RESEARCH ARTICLE

Outreach of the programmatic components of National Health

Mission in India: An inter- and intra-state analysis using

nationally representative data

Abinash Singh

1

| Sukumar Vellakkal

2

1

BITS Pilani KK Birla Goa Campus, Vasco, India

2

Department of Economic Sciences, Indian

Institute of Technology Kanpur, Kanpur, India

Correspondence

Sukumar Vellakkal, Department of Economic

Sciences, Indian Institute of Technology

Kanpur, Kanpur, India.

Email: vellakkal@iitk.ac.in;vellakkal@gmail.com

In 2005, India launched the NationalHealth Mission (NHM) to achieve equity in access

to primary and secondary healthcare, with special focus on maternal and child health-

care (MCH). Studies have shown that NHM has increased access to MCH services;

however, the access is still low among low socioeconomic population groups. Since

outreach among target population is crucial to improve access to MCH, we analyzed

the level and the inter- and intra-state socioeconomic inequity in the outreach in two

major NHM components: conditional cash-transfer program-JSY, and community

health workers-ASHAs and ANMs. We used administrative records and nationally rep-

resentative cross-sectional sample surveys in the early- and after the targeted full-

implementation phases of NHM, and employed descriptive and multivariate methods.

We found that the NHM had covered only less than one-half of the eligible women,

with considerable inter-state variations. For instance, in the high-focusstates in 2015–

16, the receipt of JSY benefits, ASHAs services, and ANMs services among eligible

women was 41.5%, 40.6%, and 48.8%, respectively, whereas the respective outreach

among the bottom wealth quintile was 39.8%, 45.1%, and 44.4%. However, there was

attenuation in inequity overtime, favoring the poor in the outreachof JSY benefits and

ASHAs services. Furthermore, underscoring the importance of program outreach, we

find that district with higher level of program outreach was associated with increased

uptake of MCH services among target population. Our findingsimply for implementing

policy measures for wider program outreach so that the NHM could serve as pathway

to attain universal health-care coverage for India.

KEYWORDS

community health workers, conditional cash transfer, India, maternal and child health, National

Health Mission, program outreach, socioeconomic inequity

1|INTRODUCTION

In 2005, the WHO member countries pledged to attain universal

health coverage (UHC) and had outlined several pathways, including

demand and supply side strategies to achieve equity in access to pri-

mary and secondary healthcare (WHO, 2010). Accordingly, several

low- and middle-income countries (LMICs) have been implementing

universal and comprehensive public health programs to improve

access to health services among disadvantaged population groups

(James et al., 2020; Yuan et al., 2014; Zeng et al., 2018).

India's National Health Mission (NHM), a flagship public health

program launched in 2005 by the central government in collaboration

with several state governments, has special focus on maternal and

child health (MCH) care. As pathways to attain India's UHC aspira-

tions, the program policy document states that “the NHM envisages

achievement of universal access to equitable, affordable and quality

Received: 30 January 2023 Revised: 8 June 2023 Accepted: 26 June 2023

DOI: 10.1002/pa.2883

J Public Affairs. 2023;23:e2883. wileyonlinelibrary.com/journal/pa © 2023 John Wiley & Sons, Ltd. 1of15

https://doi.org/10.1002/pa.2883