The Cost of Maternal Health Care Services: Antenatal,
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- Title
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The Cost of
Maternal Health Care
Services:
Antenatal, - extracted text
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The Cost of
Maternal Health Care
Services:
Antenatal, birth and postnatal
expenses in 3 Taluks in Karnataka
By
Jagrut Mahila Okkuta
**
The Cost of
Maternal Health Care
Services:
Antenatal, birth and postnatal
expenses in 3 Taluks in Karnataka
By
Jagrut Mahila Okkuta
-1-
The cost of maternal health care services by Jagrut Mahila Okkuta
(JMO). A community based ‘action-research’ to examine the expenses
that rural landless women have during pregnancy and post-delivery.
Published by:
JAGRUTI,
57, Tejaswinagar,
Dharwad 580002
www.jagruti.org
M: 9900118759
Goshyanatti,
Khanapur Taluk,
Belagavi district.
Donation: Rupees ten only
The Cost of
Maternal Health Care Services:
Antenatal, birth and postnatal expenses in 3 Taluks in Karnataka
Jagrut Mahila Okkuta
ABSTRACT
Objective: To find out how much money women in rural areas
spend during pregnancy, delivery, postnatal period and newborn
for illnesses.
Methodology: 248 women from 27 villages from Khanapur,
Belagavi and Hukkeri Taluks were interviewed using a
questionnaire. The interviews were done by members of JAGRUT
MAHILA OKKUTA - a women’s organization committed to social
justice. A one-day training to equip the women who collect the
data was done and the information from the survey sheet was put
in a tabular form for inference and analysis.
Results: All the findings and observations are presented in Table
1 along with observations.
Discussion: Expenses for health services among rural landless and
marginal farmer families can cause economic catastrophes. There
are various schemes by the central and state governments to prevent
high out-of-pocket expenditures. One such is PMMVY, a flagship
programme of the government. This study sheds light on how many
women did not benefit from PMMVY. On an average a women
spends around 7 times more in private hospitals than in government
hospitals. Below-poverty-line women should not have to spend
any money at all in a government hospital, but this rarely happens
because of the corruption that exists. In addition women from
government hospitals experience high rates of referral to private
hospitals either because the government hospitals are ill-equipped
or the government medical staff has a nexus with private hospitals.
Key Results
•
The average expenditure per woman for prenatal, natal and
postnatal care was Rs 6,772.
•
Private and government
o
The money spent at government hospitals was Rs
531 per person.
o
The amount spent at private hospitals was Rs 6,242
per person - 12 times more than a government
hospital.
Types of expenses
1. Ultrasound (scanning):
a.
Of the 89 (26%) ultrasounds done in government
hospitals, the average cost was Rs 188 (16744/89 =
188).
b. Of the 254 (74%) ultrasounds done in private hospitals,
the average cost was Rs 1203 - 6 times more than the
government. 2/3 ofthe ultrasounds occur in the private.
2. Expenses towards ambulance: Of the 248 women interviewed
190 (76%) spent on transport either as bribe (to ambulance driver)
or for hiring of a private vehicle. On an average each women
spent Rs 560. This does not include the money that the women
spend for transport for accessing ultrasound.
3. Hospital expenses: Ofthe total 248 deliveries, 189 (148 normal
+ 41 Caesareans) occurred in government hospitals and 56(16
normal +43 Caesareans) occurred in private hospitals. The
percentage ofnormal deliveries in government hospitals was 78%
compared to 28% in private hospitals.
a) GOVERNMENT HOSPITALS
l
for normal delivery every woman spent on an average
Rs 257 and
it for caesareans on an average each woman spent
Rs 1870.
b) PRIVATE HOSPITALS:
i
for each normal deliveries every woman spent on an
average Rs 3716 and
1 for caesarean every woman spent on an average
Rs 17,671.
4. Expenses for iron + folic acid: 101 (41 %)ofthe 248 have spent on
an average Rs 709/- towards buying iron + folic acid for treating and/or
preventing anemia in pregnancy and birth defects in the fetus.
5. Expenses towards newborn care : 88 (31%) of the 284 women
spent on an average Rs 3026-00 towards illness of the newborn.
TabfelxExpensestowardkultrasc und
Total number of ultrasounds done
269
In government
In private
60(26%)
167(74%)
Average expense for each
Average expense for each women
woman
Rs 1793/-(299440/167)
Rs 269/-(16150/60)
Comments:
a) 3/4,k of ultrasounds are done in private sector
b) Each ultrasounds costs Rs 1173/-, which is 6 times the daily wages (161504-299440=315590/269)
No. of women
Woman who paid money
Women who
got it free
128 (73%)
47 (27%)
Each woman spent on an average Rs 799/-
175
Expenses on average
Comments:
a) 3/4,h of women spend on ambulance and only l/4lh get it free
b) On an average each women spends 4 times the daily wages towards
ambulance services
c) This does NOT include the travel expenses for ultrasounds
Total women
interviewed
At Government Hospital 140
At Private Hospital 35
Normal 107
Caesareans 33
Normal 6
Rupees 348/
average for each
normal defivery
Rupees 2102/
average for each
caesarean
Rupees 7167/average for
normal
175
Caesareans
29
Rupees
22759/
average for
caesareans
Cbmmerts:
a)
Most normal deliveries (61%) occur in government hospitals; 18% caesareans; 3%
of normal and 17% caesareans occur in private.
b) A equal number of caesareans occur in private and government hospitals.
c) A normal defivery in private hospitals costs 20 times more than the government
d) A caesarean delivery costs 10 times more in private hospitals.
e) Private hospitals are exorbitantly costly and many times patients are referred to
private by government hospitals This indicates the URGENT necessity to strengthen
public hospital to reduce catastrophic expenses.
Total women
interviewed
175
Number of woman who
spent
26 (15%)
Rs 2522/- each woman
spent on average
Number of woman who
got it free
149 (85%)
Comments:
a) Further studies are needed to examine as to how many of anemic took
the complete treatment
b) There is a need to strengthen health education and awareness
regarding FREE anemia treatment at government hospitals during
pregnancy for healthy babies and risk reduced deliveries.
-7-
Table 5: Expenses towards newborn care
Total women
interviewed
175
Number of women who
spent
53 (30%)
Rupees 4425/- average
spent________ __________
Number of women who
did not have expenses
122 (70%)
Comments:
a) Newborn illnesses contribute a major expense.
b) Most of these are referred by government to private hospitals.
Jagrut Mahila Okkuta Demands :
The ultrasounds machine at Taluk hospital is not able to cope up with
the demand as women spend often several days waiting. This needs a
major change by having more machines made available.
All referrals from government to private hospitals need to be examined
for conflict of interest and stopped for non-medical reasons.
Rampant corruption at Taluk Hospital needs vigilance committee to
be re framed.
Table 6
Antenatal, Birth and Postnatal expenses in 3 Taluks of Karnataka, Jagnit Mahila Okkuta
Village name (no
of women)
1 Hosseti (2)
2 Gollihali (6)
3 Gundenatti (11)
Ultrasound
IN umber o times
Government Private
(no. of
women Rupee
amount)
Ambulance
expense
2-300
5-750
1-200
2-2300
4-8030
1021100
5-7700
3-1500
5-530
7-9000
9-7400
7-5000
2
1326000
1221300
1537750
6-13150
1018160
5-8300
13-11900
9-800
1-7000
5-6350
6-500
2-3000
13-4780
126000
3-150
610350
2-00
-
4 Kadatanbagevadi 5-600
(9)
5 Tolagi (13)
6 Surpur Kerwad
(Hidkal) (12)
7 Beedi (14)
10-1710
8 Handur (7)
9 Hulikotal (10)
1-100
2-1000
10 Valamikinagar
(5)____
11 Karikatti (2)
12 Chunchawad (3)
13 Chikkangroli (4)
14 Itagi (16)
-
2-800
1-200
2-200
15 Beedi Nayangar
12-1820
(14)
16 Bogur (9)
---- Q--- A—2________ 3-100
___ 17 Boranki (6)
3-620
2-2400
3-5400
4-7500
1627350
1520500
9-16600
6-6300
Delivery expenses at hospital
Government
Private
Normal Caesarean Normal Caesarean
Khanapur taluk
2-300
4-2000 5
1-2450
Expenses
for
iron+folic
acid
Newborn From
govt
care
expenses PMMV
1
0
4
1-4000-
-
-
1-25000
5-84000
6-16900
1-300
3-27600
7-23000
-
-
-
-
4
3-120000
-
-
11
212000
-
2-40000
6-19100
6-118700
5
2-45000
-
11-23350
5
1-30000
3-49000
5-6769
9-22800
6-13300
5-4500
2
3
3-00
112000
-
-
-
-
2
1-00
2-200
2-5000
-
1-10000
3-27000
-
-
1______
J______
_2______
2
11-7285
1-00
1-00
3-400
113450
8-2100
3-33000
2-84500
-
6-14000
3
6-11750
3-3400
6-1000
5-00
1-3000
115000
-
3-45500
-
-
-
1______
_2______
6-5600
6-5350
2-1900
1-200
2-300
4-5100
14-13200
-9-
3-12500
-
18 Hosalingnamatta
(3)
Kakkeri
(10)
19
20 Hindalagi (8)
21 Kasamalagi (6)
22 Mangenkoppa
(4)
23 Gastolli Daddi
(1)
TO 175
TAL
Average cost
per person
-
3-6000
-
1-00
-
-
2-95000
-
- .
2
1-500
3-2150
1-00
8-3000
-
1-5000
-
-
2
5-3000
3-600
2-3650
1018750
9-12550
4-7800
3-3000
6-1250
5-1700
3-1170
7-3730
5-1400
2-50
1-200
-
-
-
2-00
1-00
-
-
-
-
8-9800
-
-
1-1500
1-400
-
1-00
-
-
-■
-
5
1
2-first
babies
0
60-16150
167299440
1793
128-102215
10737230
348
33-69350
643000
7167
29-660000
26-65569
22759
2522
53234550
4425
5-7200
2-9250
716450
1-3000
6-29000
7-32 000
14-1089
18-294
32-1383
1
2
3
1-40000
6-27833
7-67833
15-1500
28-3134
43-4634
1659450
43-759833
10171586
269
799
2102
61
Belagaavi taluk
24 Devagiri (14)
25 Kadoli (18)
TO 32
TAL
4
7
11
14-1885
18
32-1885
6
7-214
13-214
14-871
17-314
31-1185
2
3
5
-
10-21300
10-21300
4#
4
Hukkeri taluk
26 Gutaguddi (13)
27 Basapur (28)
TO 41
TAL
Grand
total of
all three
taluks
248
7-85
11-509
18-594
27-1788
28-2485
55-4273
13-1106
28-1922
41-3028
11-336
17-370
28-706
89-16744
254305598
200-106428
14838150
-10-
3-7333
3-7333
41-76683
4-7333
21-3144
2510,477
88266327
65
A similar study titled “How affordable is child bearing in India?
An Evaluation of Maternal Healthcare Expenditure” by Pushpendra
Singh and others can be accessed at (https.7/doi.org/l0.1053/
j.nainr.2016.09.012). This used unit level records of the 71 st round of
the National Sample Survey Office (NSSO), surveyed January - June
in 2014 on the theme ‘Social Consumption: Health.’ “Results reveal
that women who gave birth to their babies in public hospitals spend
Rs. 1587 for the childbirth whereas the women who gave births to their
babies in private hospitals spend more than nine times higher money
for the delivery in rural areas (Rs. 14,777).
What’s worse is that any additional burden on the already
facing high maternal healthcare expenditure tips 46.6% women
(among those who delivered) below the poverty line. In
conclusion, there is a dire need of strengthening maternal health
services which should be readily available, accessible and
affordable to all irrespective of class-caste-region.”
This study, done by JMO, concurs with the findings
mentioned above. This study could not include the various
welfare schemes designed by the state governments because
they are so irregular and often stringed with many conditions.
This will need a separate study by itself.
Nagaravapu S, Kilaru A, Kropp N, Shridhar V undertook a
study of 320 women to understand why they had been referred to a
large, tertiary care government hospital in Bangalore (Obstetric referrals
-11-
to an urban, public hospital in South India). The study showed that
expenditure for delivery care was relatively lower compared to antenatal
care because of JSSK (a government scheme to reduce costs during
delivery). Median antenatal care expenditure was Rs 5000.11.6% of
the women reported that they did not pay anything at the government
hospital where they gave birth, while 71.3% reported that the cost was
low. However, since 59% (190) of the women surveyed possessed a
BPL card or an Antyodaya card, they should have all had free care.
*4* •'T*
-12-
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JAGRUTI
(Registration Number 189 of 98/99)
57, Sony, Tejaswinagar
Dharwad - 580 002, Karnataka
www.jagruti.org
J
1 jagruti
a partner in development
Jagruti is a registered, independent, non government
organisation (NGO) campaigning for the rights of landless,
women, disabled and other marginalised in villages of Khanapur
taluk of Belgavi district.
OBJECTIVES :
To empower and enable the marginalised.
*
To bring in a meaningful changes in the communities
especially among the marginalised by community
organising, participation and their involvement.
*
To prevent exploitation of girl child.
*
To create awareness among the marginalised regarding
their Rights.
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j
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