Table 1.
Contextual factors hypothesized to affect MAPEDIR's effectiveness and indicators of their level
| State | ||||
|---|---|---|---|---|
| Contextual factor | Indicators | Rajasthan | Madhya Pradesh | West Bengal |
| Community | ||||
| Economic status | % population BPL (rural/urban) [26] | 14.3/28.1 | 29.8/39.3 | 24.2/11.2 |
| Community cohesiveness | % skilled birth attendance, by caste (SC/ST/other backward class/other) | 27.0/23.9/37.3/42.8 | 25.7/13.9/32.6/49.5 | 46.2/24.5/64.5/44.5 |
| Status of women | % female age 15-49 literacy | 39.0 | 50.0 | 64.0 |
| Civil society networks and influence | WSHGs: engagement in health activities; breadth of coverage* | Limited health activities (mostly involved in livelihood generation and micro-financing) | Assist with birth preparedness and arrange transport for normal or complicated labour; some districts | Promote MH and provide loans for medical emergencies; 300, 000+ WSHGs throughout WB |
| Public health systems | ||||
| Responsiveness and accountability | 1. % CHCs with obstetrician posted |
1. 32.2 (105/326) |
1. 5.7 (13/229) |
1. 43.2 (41/95) |
| 2. % women contacted in last 3 months by community health or nutrition worker | 2. 11.7 | 2. 16.9 | 2. 23.3 | |
| Capacity | % blocks with a PH nurse* | 0.0 (0/237 blocks) | 0.0 (0/313 blocks) | > 80% (> 348/436 blocks) |
| Governance | ||||
| Decentralization | Decentralization index score [31] | 0.35 | 0.59 | 0.75 |
| Responsiveness and accountability | % health expenditure from public resources/out-of-pocket | 30.0/70.0 | 16.6/83.4 | 21.6/78.4 |
BPL = below poverty line; CHC = community health centre; MH = maternal health; PH = public health; SC = scheduled castes; SHC = sub health centre; ST = scheduled tribes; WSHG = women's self-help group.
*UNICEF state health officers' personal communications.
26GOI Press Information Bureau: poverty estimates are based on household expenditure for essential items data collected by the National Sample Survey Organization of the Ministry of Statistics and Programme Implementation and state-specific poverty lines (rupees per capita per month): Rajasthan: 375/560; Madhya Pradesh: 328/570; West Bengal: 383/449.
31The initial decentralization measure is being revised, however, with expectation of little effect on the states' rankings (personal communication with Anoop Sadanandan).