Impact of distance in the provision of maternal health care services and its accountability in murarai-ii block, Birbhum district

Abstract

The maternal health issue was a part of the Millennium Development Goals (MDGs, Target-5). Now it has been incorporated into Target-3 of 17 points Sustainable Development Goal-2030, declared by the United Nations, 2015. In India, about 50% of newborn deaths can be reduced by taking good care of the mother during pregnancy, childbirth and postpartum period. This requires timely, well-equipped healthcare by trained providers, along with emergency transportation for referral obstetric emergency. Governments need to ensure physicians in the rural underserved areas. The utilisation of maternal healthcare services (MHCSs) depends on both the availability and accessibility of services along with accountability. This study is based on an empirical retrospective survey, also called a historic study, to evaluate the influences of distance on the provision of maternal health services and on its accountability in Murarai-II block, Birbhum District. The major objective of the study is to identify the influence of distance on the provision and accountability of the overall MHCSs. The investigation has found that there is a strong inverse relationship (-0.75) between accessibility index and accountability score with p-value = <0.05, where the direct connectivity index seem to have no direct influence on the accountability score (as the 'r' is 0.56 and p-value= >0.05). Tracking of pregnant women, identification of high risk pregnancy and timely Postnatal Care (PNC) have become the dominant factors of the maternal healthcare services in the first Principal Component Analysis (PCA), explaining 49.67% of the accountability system. Overall, institutional barriers to accessibility are identified as important constraints behind lesser accountability of the services, preventing the anticipated benefit. This study highlights the critical areas where maternal healthcare services are lacking. The analysis has highlighted the importance of physical access to health services in shaping the provision of maternal healthcare services. Drawing on empirical observations of operation of public distribution system in different states of India, the paper constructs a preliminary game theoretic model. It argues that an effective public distribution must be as universal as possible, delivery mechanism of fair price shops should be reformed, they should be make them commercially viable and that special attention should be paid to PDS at times of high food inflation.