Maternal death inquiry and response in India - the impact of contextual factors on defining an optimal model to help meet critical maternal health policy objectives

Table 1 Contextual factors hypothesized to affect MAPEDIR's effectiveness and indicators of their level

		State
Contextual factor	Indicators	Rajasthan	Madhya Pradesh	West Bengal
Community
Economic status	% population BPL (rural/urban) [26]	14.3/28.1	29.8/39.3	24.2/11.2
Community cohesiveness	% skilled birth attendance, by caste (SC/ST/other backward class/other)	27.0/23.9/37.3/42.8	25.7/13.9/32.6/49.5	46.2/24.5/64.5/44.5
Status of women	% female age 15-49 literacy	39.0	50.0	64.0
Civil society networks and influence	WSHGs: engagement in health activities; breadth of coverage*	Limited health activities (mostly involved in livelihood generation and micro-financing)	Assist with birth preparedness and arrange transport for normal or complicated labour; some districts	Promote MH and provide loans for medical emergencies; 300, 000+ WSHGs throughout WB
Public health systems
Responsiveness and accountability	1. % CHCs with obstetrician posted	1. 32.2 (105/326)	1. 5.7 (13/229)	1. 43.2 (41/95)
	2. % women contacted in last 3 months by community health or nutrition worker	2. 11.7	2. 16.9	2. 23.3
Capacity	% blocks with a PH nurse*	0.0 (0/237 blocks)	0.0 (0/313 blocks)	> 80% (> 348/436 blocks)
Governance
Decentralization	Decentralization index score [31]	0.35	0.59	0.75
Responsiveness and accountability	% health expenditure from public resources/out-of-pocket	30.0/70.0	16.6/83.4	21.6/78.4

BPL = below poverty line; CHC = community health centre; MH = maternal health; PH = public health; SC = scheduled castes; SHC = sub health centre; ST = scheduled tribes; WSHG = women's self-help group.
*UNICEF state health officers' personal communications.
²⁶GOI Press Information Bureau: poverty estimates are based on household expenditure for essential items data collected by the National Sample Survey Organization of the Ministry of Statistics and Programme Implementation and state-specific poverty lines (rupees per capita per month): Rajasthan: 375/560; Madhya Pradesh: 328/570; West Bengal: 383/449.
³¹The initial decentralization measure is being revised, however, with expectation of little effect on the states' rankings (personal communication with Anoop Sadanandan).

ISSN: 1478-4505