Effect of India's flagship conditional maternity benefit scheme on utilization of maternal and child health services: evidence from a statewide evaluation study.

Abstract

Background: The Pradhan Mantri Matru Vandana Yojana (PMMVY) is India's flagship Maternity Benefit Programme to improve maternal nutrition and child health. This study evaluates the functional status of the scheme, knowledge regarding the scheme and its effect on pattern of service utilization in a north Indian state.

Methods: A three-pronged mixed-methods evaluation including household survey of beneficiary and non-beneficiary women, in-depth interviews of key stakeholders (district and state level program managers, program implementers and frontline workers) and review of secondary data from the PMMVY Common Application Software and state PMMVY dashboard was done. Household survey covered 1290 women, and 70 in-depth interviews were held with eligible women, and PMMVY managerial and implementation staff. Quantitative data was analysed using SPSS version 22.0, qualitative data was analysed thematically and triangulated with quantitative results for effective analysis and conclusion. The study received ethical approval from the Institutional Review Board of IIHMR Delhi.

Results: A strong political commitment with requisite systems and resources across all levels was observed. Coverage of PMMVY was less in urban areas (53.1% as compared to overall coverage of 95.9%). Knowledge of the scheme was high among both beneficiary and non-beneficiary women (97.8% beneficiary women and 94.2% non-beneficiary women). Utilization of Maternal and Child Health (MCH) services were significantly poorer among non-beneficiary women for four antenatal check-ups (OR 0.74, 95% CI 0.55-0.99, p = 0.04), childbirth registration (OR 0.28, 95% CI 0.18-0.45, p < 0.001) and child immunization (OR 0.43, 95% CI 0.33-0.55, p < 0001). However, certain operational challenges were found related to beneficiary enrolment and use of PMMVY software, and a gap in intended and actual use of PMMVY incentive was observed (26.2% beneficiary women had spent the cash incentive on needs not related to nutrition or health).

Conclusion: Despite operational challenges, PMMVY has been effective in improving the utilization of health services like antenatal check-ups, childbirth registration and child immunization. The benefits of the scheme may be maximized by addressing those limitations in its delivery.