Outreach of the programmatic components of National Health Mission in India: An inter- and intra-state analysis using nationally representative data

In 2005, India launched the National Health Mission (NHM) to achieve equity in access to primary and secondary healthcare, with special focus on maternal and child healthcare (MCH). Studies have shown that NHM has increased access to MCH services; however, the access is still low among low socioeconomic population groups. Since outreach among target population is crucial to improve access to MCH, we analyzed the level and the inter- and intra-state socioeconomic inequity in the outreach in two major NHM components: conditional cash-transfer program-JSY, and community health workers-ASHAs and ANMs. We used administrative records and nationally representative cross-sectional sample surveys in the early- and after the targeted full-implementation phases of NHM, and employed descriptive and multivariate methods. We found that the NHM had covered only less than one-half of the eligible women, with considerable inter-state variations. For instance, in the high-focus states in 2015-16, the receipt of JSY benefits, ASHAs services, and ANMs services among eligible women was 41.5%, 40.6%, and 48.8%, respectively, whereas the respective outreach among the bottom wealth quintile was 39.8%, 45.1%, and 44.4%. However, there was attenuation in inequity overtime, favoring the poor in the outreach of JSY benefits and ASHAs services. Furthermore, underscoring the importance of program outreach, we find that district with higher level of program outreach was associated with increased uptake of MCH services among target population. Our findings imply for implementing policy measures for wider program outreach so that the NHM could serve as pathway to attain universal health-care coverage for India.