The document analyzes three potential solutions to improve maternal and child health outcomes in Rajasthan, India. The first solution proposes mass media promotion and counseling of breastfeeding, with estimated annual costs of $1.18 billion and benefits of $9.28 billion. The second solution promotes immunization in lagging districts through incentives, with estimated annual costs of $24 million and benefits of $720 million. The third solution provides conditional cash transfers for antenatal care visits, with estimated annual costs of $241 million and benefits of $2.10 billion. All three solutions were found to have cost-benefit ratios greater than one, indicating the interventions would improve health outcomes at reasonable costs. The conclusion recommends achieving higher maternal and child

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
Rajasthan Priorities conference, Jaipur June 8-10

2. Focus Areas of Intervention
• The three focus area were identified after evaluating all India level
Multi-parameter data and according to their size and significance
levels:
• Breast Feeding Behaviour - exclusive breastfeeding
• Frequency of Antenatal Care (ANC) - Number of visits
• Fully Vaccinated Childre - All dozes of vaccinations during one year

3. Importance and need of this study
• Rajasthan 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:
• Only 58 percent of women exclusively breastfeed
• Only 39 percent of women had at least 4 antenatal care (ANC) visits during
Pregnancy
• Only 55 percent of children are fully vaccinated

4. 1st analyzed solution
Mass media promotion and intensive counselling of breastfeeding

5. Combination of Modern and Tradetional
• TV advertisements to be broadcasted (aired) on different TV channels
during prime time shows
- Learn from multi-media Anti-tobacco campaign
• 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

6. Costs
• Estimated cost of TV ads per annum – about Rs. 468
• Estimated cost of counselling of mother per annum – Rs. 323 Crore
• Estimated private cost such as travel cost, food etc. per annum
– Rs. 390 Crore
• Total estimated cost of the intervention per annum – Rs. 1,181 Crore

7. Benefits
• Increase in exclusive breastfeeding from 58 percent to 90 percent
• Increase in extended breastfeeding from 75 percent to 94 percent
• This will lead to:
• 12,628 fewer child deaths (0-23 month old) per year
• Reduction in U5 mortality rate from 51 to 43 per 1000 live births, and
• Avoidance of almost 81,000 years lost to disability (YLDs)
• Total estimated benefits of intervention per annum – Rs. 9,277 Crore

8. Total costs, total benefits and cost-benefit ratio
Discount rate
3% 5% 8%
Benefits (INR Crore) 12,774 9,277 6,796
Cost (INR Crore) 1,181 1,181 1,181
BCR 11 8 6

9. 2nd analyzed solution
Promotion, Incentivization and Supply of Immunization in Lagging Districts

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 meals) worth Rs 685 based on a randomized
controlled study from rural Rajasthan (Banerjee et al. 2010)

11. Costs
• Estimated cost of immunization – about Rs. 8 Crore
• Estimated cost of incentives – about Rs. 16 Crore
• Total estimated cost of intervention per annum – Rs. 24 Crore

12. Benefits
• Increase in percentage of fully immunized children in the districts to the
state average 55 percent (assumption)
• This leads to saving 827 children per year and avoiding 8,675 YLDs
• Total estimated benefits of intervention per annum – Rupees 720 Crore

13. Total costs, total benefits and cost-benefit ratio
Discount rate
3% 5% 8%
Benefits (INR Crore) 947 720 558
Cost (INR Crore) 24 24 24
BCR 39 30 23

14. 3rd analyzed solution
Conditional Cash Transfer for ANC Visits

15. The solution
• Rajasthan 4-ANC visits – low at 39% compared to 51% national average
• Provision of Rs 2000 for accessing 4 ANC visits during pregnancy
• Large incentive will boost uptake of 4 ANC services from 39 percent to 61
percent of women during pregnancy (assumption)

16. Costs
• Estimated cost of incentives – about Rs. 186 Crore
• Estimated private cost (travel etc) – about Rs. 55 Crore
• Total estimated cost of intervention per annum – Rs. 241 Crore

17. Benefits
• Reduction in neonatal mortality of 8 per 1000 live births (assumption)
• This leads to saving 2,764 infant lives per year and averting 13,558 YLDs
• Total estimated benefits of intervention per annum – Rs. 2,097 Crore

18. Total costs, total benefits and cost-benefit ratio
Discount rate
3% 5% 8%
Benefits (INR Crore) 2,855 2,097 1,556
Cost (INR Crore) 241 241 241
BCR 12 9 7

19. Conclusion
Although, Rajasthan is experiencing comprehensive
improvement in MCH parameters, it should aim to achieve
the relatively higher levels (ideally the level of Kerala)
Our CBR analysis presented so far suggests that this can be
achieved within a reasonable time-frame and with minimal
extra allocations.