Impact of an employment guarantee scheme on utilisation of maternal healthcare services: Results from a natural experiment in India. (February 2019)

• Record Type: Journal Article
• Authors: Parmar, Divya; Banerjee, Aneesh
• Is Part Of: Social science & medicine. Volume 222(2019)
• Page Start: 285
• Page End: 293
• Publication Date: 2019-02
• Subjects: Healthcare utilisation -- Employment -- India -- Difference-in-differences -- Facility delivery -- Workfare -- Equity -- Maternal health; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2019.01.028
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: We assess the impact of India's National Rural Employment Guarantee (NREG) scheme, the world's largest workfare scheme, on healthcare utilisation – specifically maternal healthcare. The primary objective of NREG is to improve the income of rural households by guaranteeing 100 days of employment. We expect that by improving household income, thereby reducing some of the financial barriers, such as out-of-pocket payments, NREG can increase utilisation of maternal health services. Using a nationally representative household survey and a difference-in-differences approach that exploits the phased rollout of the scheme, we estimate the impact of NREG on utilisation of maternal health services: mainly deliveries at health facilities. We find that NREG did not increase overall facility deliveries, even though it led to an increase in deliveries at public facilities. There is weak evidence to suggest that deliveries at private facilities reduced due to NREG. Furthermore, sub-group analyses reveal that among poorer households, who are more likely to participate in NREG, there is a reduction in facility deliveries while home deliveries increased. Among richer households, NREG increased deliveries at public facilities. There was no impact on households belonging to marginalised castes. We conclude by discussing the possible mechanisms for these effects and its impact on equity in healthcare utilisation. Highlights: We study the impact of India's National Rural Employment Guarantee (NREG) scheme on utilisation of maternal health services. We find while NREG did not increase overall facility deliveries it increased deliveries at public facilities. Among poorer households, NREG increased home deliveries and reduced facility deliveries. Among richer households, NREG increased deliveries at public facilities.