Table 3 Summary of major Demand side financing schemes for maternal health in India

Dr. Muthulakhsmi Reddy Maternity Benefit scheme

1987

Tamil Nadu

Financial assistance: INR18,000 /− (245 USD)

Instalments: 2

Eligibility: minimum 19 years, BPL women in the State

Conditionality: restricted for two deliveries and delivered in a government institution

This was one of the pioneering maternity benefit schemes to influence health seeking behaviour away from home care and ensure increased survival of mothers and children [29]. This scheme has been combined with PMMVY in Tamil Nadu.

Sukhibhava

1999

Andhra Pradesh

Integrated with JSY

Financial assistance: INR300 (4 USD) for first two deliveries

Bank payment: “Sukhibhava” account

This scheme provides evidence that state-level customization of JSY can benefit in addressing wide regional disparities in maternal and child health outcomes.

Janani Suraksha Yojana (JSY)

2005

Central

Eligibility: poor pregnant woman from low performing states (LPS) and high performing states (HPS). All births in LPS and upto 2 live births in HPS.

In LPS all pregnant women delivering in Government health centres or accredited private institutions are eligible.

In HPS BPL pregnant women, aged 19 years and above are eligible for cash assistance.

LPS states: Uttar Pradesh, Uttaranchal, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Orissa and Jammu and Kashmir. Rest HPS.

Financial assistance: LPS rural areas and urban areas: INR1400 (19.1 USD), INR1000 (13.6 USD)

HPS rural areas and urban areas: INR1000 (13.6 USD), INR600 (8.2 USD)

Financial incentive to ASHA workers: LPS of INR 600 (8.2 USD) in rural areas and INR 200 (2.7 USD) in urban areas.

Resulted in significant increase in ante-natal care and institutional delivery.

Associated with reduction of 3–4 perinatal deaths per 1000 pregnancies and 3 neonatal deaths per 1000 livebirths [27].

Some unintended effects report JSY beneficiaries from LPS are 12% more likely to use contraception, 8% more likely to initiate early breastfeeding and 6% more likely to get their postnatal check-up than mothers from HPS [30].

Janani Evam Bal Suraksha Yojna

2006

Bihar

Integrates cash assistance with institutional care

Eligibility: BPL women

Financial assistance: INR 1400 (19.1 USD) in rural areas and INR 1000 (13.6 USD) in urban areas paid for birth either in a government or private hospital

ASHA intervention has been effective for the employment of JBSY. It has helped in bridging gaps in the knowledge base of the target communities.

Chiranjeevi Yojana

2006

Gujarat

Eligibility: BPL women

Financial assistance: INR 200 (2.7 USD) as financial assistance+ out of pocket transport cost with INR 50 (67 cents) to the attendant.

In addition, fixed incentive for private doctors providing gynaecological services. The state pays private doctors a fixed sum of INR6000 (81.8 USD) per 100 births among eligible women living below poverty line (BPL) or belonging to scheduled tribes (ST).

An innovative scheme which increased institutional delivery and provided access to quality maternal care among the poor. Lesser maternal and new-born deaths were observed as a result of this scheme [31].

Sambhav voucher scheme

2007

Uttarakhand/ Uttar Pradesh

Voucher scheme in collaboration with USAID. Institutions are also incentivized so can women avail private facilities.

Eligibility for vouchers: Women from BPL family

Services include antenatal care, institution birth, post-natal care and family planning services.

Accredited private facilities provide services and en-cash the voucher

This is a standalone provider led scheme. Most beneficiaries claimed to have had access to quality health services under this scheme. The effectiveness of the scheme improved due to the involvement of Community Health Volunteers (CHVs). Most urban slum dwellers put their confidence in the scheme mainly due to the CHVs.

Mamata

2011

Odisha

State-sponsored conditional cash transfer maternal benefit scheme to increase utilization of maternal and child healthcare services.

Incentive: INR6000 (81.8 USD) over a period of 18 months in instalments.

Eligibility: all pregnant and lactating mothers of 19 years and above for the first two births.

Scheme successful in improving antenatal care, exclusive breast feeding, full immunization, etc.

A total number of 547,000

mothers were beneficiaries for the financial year 2017–2018 with a budget allocation of INR 3.8 billion (52 million USD).

The state is well known for

implementing maternal health and nutrition programmes [32].

Janani Shishu Suraksha Karyakram (JSSK)

2011

Central

Eligibility: All pregnant women provided with free delivery including caesarean section in public health facilities.

Entitlements: free drugs and consumables; free investigations blood transfusion if needed; free diet; and free return transport.

2014: entitlements extended to all antenatal &post-natal complications of pregnancy; and all sick new-borns and infants (up to 1 year of age).

This scheme promotes free services to pregnant women and sick neonates.

In 2019–2020, 9.2 million pregnant women were provided free medicines, 6.2 million free diet, 9.6 million free diagnostics, 3.8 million free transport. Same holds true for sick infants.

Significant increase in ante-natal care check-ups and institutional delivery in public facilities due to JSSK [33]; and improved access to level III NICU care among the poor thus reducing preterm mortality rates [34].

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)

2016

Central

Comprehensive antenatal services to pregnant women

Eligibility: 2nd and 3rd trimester women on the 9th day of every month

No. of facilities: 17,217

Private sector involvement: Prime Minister of India appeal to doctors to contribute 12 days in a year.

In the first year of launch, a total of 3,090,270 pregnant women received ANC. More than one crore antenatal check-ups have been conducted till date.

While all States/ UTs have made significant efforts to reach out to pregnant women, Rajasthan has largest number of check-ups among the Empowered Action Group States.

Includes comprehensive ANC, early identification and follow-up of high risk pregnancies. Identifying high risk pregnancies is necessary step in reducing avoidable maternal and infant deaths [35].

To detect high risk pregnancies, 84 lakh haemoglobin tests, 55 lakh HIV tests, 41 lakh tests for gestational diabetes, 33 lakh tests for syphilis and more than 15 lakh ultrasounds have been performed.

Over 5.50 lakh pregnant women were identified as high risk pregnancies and referred to a specialist or a higher health facility for appropriate care.

Pradhan Mantri Matrutva Vandan Yojana (PMMVY)

2017

Central

Implementation: Integrated Child Development Services.

Financial assistance: INR 5000 (68.2 USD) in Three Instalments for the First Live Child.

From 2017 to 2020, 1,36,80,531 beneficiaries [36]. However, this scheme is criticized for excluding women with more than 1 children.

A survey showed that only 22% pregnant and lactating women were covered under this scheme [37].