Health Service Delivery in Punjab, India January 2014 Authors Kidus Asfaw, Mica Bumpus, Thomas Coen, Carolyn Edelstein, Alfredo López Rojas, Claudia Mendieta, Aditi Poddar, Virginia Poggio, Matthew Soursourian, David Stephan, Rosa Vidarte Advisor Professor Jeffrey S. Hammer TABLE OF CONTENTS ACKNOWLEDGEMENTS ........................................................................................................................................ III STUDENT BIOGRAPHIES........................................................................................................................................ IV EXECUTIVE SUMMARY .......................................................................................................................................... 1 HEALTH STATUS IN PUNJAB ......................................................................................................................... 2 Health Status of Punjabi Girls .............................................................................................................................................. 2 Sex-Ratio in Punjab .................................................................................................................................................................. 2 Analysis of Abortion Data in Punjab ........................................................................................................................................ 2 Stunting (Height for Age) ......................................................................................................................................................... 3 Polio Vaccination Rate ............................................................................................................................................................. 4 Breastfeeding Practices ............................................................................................................................................................ 5 Infant Mortality ...................................................................................................................................................................... 6 Neonatal Mortality ................................................................................................................................................................... 7 Child Morbidity ...................................................................................................................................................................... 8 Prevalence of Cough ................................................................................................................................................................ 8 Severe Anemia ......................................................................................................................................................................... 9 Health Issues of Punjabi Women ........................................................................................................................................ 11 Health Determinants ............................................................................................................................................................... 12 Age at First Birth .................................................................................................................................................................... 13 THE DEMAND AND SUPPLY OF HEALTH CARE SERVICES IN PUNJAB ........................................... 15 Supply of Public Health Care Delivery .............................................................................................................................. 15 Absenteeism and Vacancies in Punjabi Public Health Facilities ............................................................................................ 17 Potential Implications ............................................................................................................................................................. 17 The Demand for Health Care in Punjab ............................................................................................................................ 18 When Do People Seek Care? .................................................................................................................................................. 18 Who Seeks Care? ................................................................................................................................................................... 18 Where Do People Seek Care?................................................................................................................................................. 20 Janani Suraksha Yojana (JSY) ........................................................................................................................................... 21 RASHTRIYA SWASTHYA BIMA YOJNA (RSBY) ....................................................................................... 24 Program Overview ............................................................................................................................................................... 24 Program Implementation & Structure in Punjab .................................................................................................................... 24 Current Landscape .............................................................................................................................................................. 25 RSBY Usage .......................................................................................................................................................................... 25 Hospital Quality ..................................................................................................................................................................... 27 Patient Feedback .................................................................................................................................................................... 27 Scheme Successes in Punjab ................................................................................................................................................ 28 Scheme Challenges in Punjab.............................................................................................................................................. 29 Recommendations ................................................................................................................................................................ 33 APPENDIX .......................................................................................................................................................... 35 REFERENCES .................................................................................................................................................... 36 FIGURES Figure 1: Sex-ratio in Punjab and India .................................................................................................................................... 2 Figure 2: Stunting in Children .................................................................................................................................................. 4 Figure 3: Polio Vaccination Rate ............................................................................................................................................. 5 Figure 4: When Do Punjabi Mothers Begin Breastfeeding ...................................................................................................... 5 Figure 5: Breastfeeding Duration ............................................................................................................................................. 6 Figure 6: Infant mortality ......................................................................................................................................................... 7 Figure 7: Under-five mortality across gender and area of residence ........................................................................................ 7 Figure 8: Differences in Punjab and Indian NNM.................................................................................................................... 8 Figure 9: Differences in Punjab and Indian Morbidity ............................................................................................................. 9 Figure 10: Severe Anemia among girls and boys (%) ............................................................................................................ 10 Figure 11: Incidence of Anemia and Diabetes across wealth ................................................................................................. 11 Figure 12: Prevalence of Insurance against Wealth Score ..................................................................................................... 12 Figure 13: Explained and Unexplained Components of Female Morbidity ........................................................................... 13 Figure 14: Determinants of age at first birth and residency status ........................................................................................ 14 Figure 15: Explained and unexplained Age at First Birth ..................................................................................................... 14 Figure 16: Broad Areas of Investment Under NRHM Flexipool, 2010-2011 .......................................................................