Andhra Pradesh Priorities: Maternal & Child Health - Shariff

1. MATERNAL AND CHILD HEALTH
Abusaleh Shariff,
US India Policy Institute, Washington DC
and
Amit Sharma,
People Research on India’s Consumer Economy & The World Bank, New Delhi
Andhra Pradesh Priorities Conference, Vijayawada June 18-20

2. Importance and need of this study
Andhra Pradesh has improved significantly on maternal and child
survival indicators in past 10 years. But, there is room for improvement
on several indicators related to access and use of child and maternal
health services, for example:
70%
76%
65%
30%
24%
35%
EXCLUSIVE
BREASFEEDING
AT LEAST 4 ANC VISITS CHILDREN FULLY
IMMUNIZED
2015-16 (NFHS 4)

3. 1st analyzed solution
Mass media promotion and intensive counselling of breastfeeding

4. The solution
• TV advertisements to be broadcasted (aired) on different TV channels
during prime time shows
• Counselling of mothers who have just given birth or are about to give
birth by dedicated staff at health centers
• At the time of counselling, printed fliers/ pamphlets to be provided to
the mothers which contain the communication material

5. Costs
• Estimated cost of TV ads per annum – about Rs. 468
• Estimated cost of counselling of mother per annum – Rs. 174 Crore
• Estimated private cost such as travel cost, food etc. per annum
– Rs. 107 Crore
• Total estimated cost of the intervention per annum – Rs. 749 Crore

6. Benefits
• Increase in exclusive breastfeeding from 70 percent to 93 percent
• Increase in extended breastfeeding from 48 percent to 88 percent
• This will lead to:
• 5,982 fewer child deaths (0-23 month old) per year
• Reduction in U5 mortality rate from 41 to 34 per 1000 live births, and
• Avoidance of almost 40,000 years lost to disability (YLDs)
• Total estimated benefits of intervention per annum – Rs. 5,757 Crore

7. Summary
749
749
749
7,905
5,757
4,234
11
8
6
0
2
4
6
8
10
12
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
3% 5% 8%
Cost (INR Cr) Benefit (INR Cr) BCR

8. 2nd analyzed solution
Promotion, Incentivization and Supply of Immunization in Lagging Districts

9. Special Drive in Laggard Districts
Districts with Performance Less than State Average (% fully immunized)
48%
49%
59%
60%
65%
52%
51%
41%
40%
35%
SRI
POTTISRIRAMULU
NELLORE
VIZIANAGARAM SRIKAKULAM EAST GODAVARI ANDHRA PRADESH
2015-16 (NFHS 4)

10. The solution
• Promotion and provision of immunization camps for remote areas,
that incentivizes mothers to bring children for immunization
• In-kind transfers (lentils and utensils) worth Rs 685 based on a randomized
controlled study from rural Rajasthan

11. Structure of Incentives
• In-kind transfers worth Rs 685 for each full immunization.
• Based on cost estimates from a randomized controlled study of rural
Rajasthan
Components of incentive:
• 1 Kg of lentils after each completed immunization
• A set of thalis (metal utensils) as compensation to women’s wages (or
time) after full immunization

12. Costs
• Estimated cost of immunization – about Rs. 2.6 Crore
• Estimated cost of incentives – about Rs. 7.4 Crore
• Total estimated cost of intervention per annum – Rs. 10 Crore

13. Benefits
• Increase in percentage of fully immunized children in the districts to the
state average 65 percent (assumption)
• This leads to saving 219 children per year and avoiding 5,946 YLDs
• Total estimated benefits of intervention per annum – Rupees 385 Crore

14. Summary
10
10
10
463
385
329
44
37
31
0
5
10
15
20
25
30
35
40
45
50
-
100
200
300
400
500
600
700
800
3% 5% 8%
Cost (INR Cr) Benefit (INR Cr) BCR

15. 3rd analyzed solution
Conditional Cash Transfer for ANC Visits

16. Percentage pregnant women making at least 4 ANC visits
39%
76%
51%
93%
RAJASTHAN ANDHRA PRADESH INDIA KERALA (IDEAL)

17. The solution
• Provision of Rs 2000 for accessing 4 ANC visits during pregnancy
• Large incentive will boost uptake of 4 ANC services from 76 percent (Current)
to 92 percent (Kerala) of women during pregnancy (assumption)

18. Costs
• Estimated cost of incentives – about Rs. 151 Crore
• Estimated private cost (travel etc) – about Rs. 12 Crore
• Total estimated cost of intervention per annum – Rs. 163 Crore

19. Benefits
• Reduction in neonatal mortality of 6 per 1000 live births (assumption)
• This leads to saving 804 infant lives per year and averting 6,062 YLDs
• Total estimated benefits of intervention per annum – Rs. 950 Crore

20. Summary
163
163
163
1,239
950
746
8
6
5
-
1
2
3
4
5
6
7
8
-
200
400
600
800
1,000
1,200
1,400
1,600
1,800
3% 5% 8%
Cost (INR Cr) Benefit (INR Cr) BCR

21. Thank you for your time