Pay By Impact

Is outcome-based financing the right cure for maladies like high maternal mortality? Results of Utkrisht, a development impact bond launched in Rajasthan, will tell.

- Varsha Meghani

Pregnancy for women in Rajasthan comes with a significant risk of death. According to the government’s most recent data (2014-2016), 199 women die from complications for every 100,000 live births in the state. With the national average at 130, the state’s statistic is sobering. Even more so when compared to China’s 19.6 deaths per 100,000 live births recorded last year.

“What’s alarming is that most pregnancy-related deaths can easily be prevented,” says Pompy Sridhar, India director at MSD for Mothers, a $500 million global initiative focussed on ending preventable maternal mortality, by US-based pharma firm Merck.

Mindful that most maternal deaths occur due to factors such as postpartum bleeding for which there are known cures, the government of Rajasthan has been actively investing in public health care facilities. It has also been incentivising women to deliver at such centres, rather than at home. While the efforts have yielded results—the maternal mortality rate in Rajasthan has fallen by 22 percent since 2010-2012—it’s far from enough.

A quirk of law requires public health facilities in India to meet certain quality accreditation standards to get insurance reimbursements, but private health facilities aren’t held to the same standards. So the latter remain unregulated and lack standard operating procedures, explains Sridhar. With studies indicating that more than 50 percent women access health care in private facilities, rather than public ones, it was clear to MSD for Mothers that to see a reduction in maternal mortality rates, the quality of care at private hospitals had to be upped.