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Impact of conditional cash transfer scheme (MAMATA) on the prevalent MCH care practices in rural areas of Ganjam district, Orissa: a descriptive study

Authors:
  • Great eastern medical school and hospital Srikakulam Andhra Pradesh
  • Bhima Bhoi Medical College & Hospital Balangir

Abstract and Figures

Background: RMNCH services are provided in an integrated manner to it’s beneficiaries under the premise of Primary Health Care. The utilization rates for such services have remained abysmally low and stagnated over the years. The problem lies in failure to generate a demand for such services among it’s beneficiaries. MAMATA a conditional cash transfer scheme implemented in Odisha, aims to bring around radical changes by addressing the issue of demand generation. The objectives of the study were to assess the implementation of MAMATA scheme services in the study area and to assess the impact made by the scheme in their life.Methods: The study was conducted on 200 women, who were randomly selected from the 903 pregnant women registered under Mamata Scheme from a randomly selected block of Odisha. They were then followed up for a period of 15 months.Results: Implementation of the scheme in the district was smooth, the instalments were paid regularly in most of the cases without any delay. Impact of the scheme- 98% got adequate rest during pregnancy, because of the scheme. 95% utilized the money for purchasing nutritious food and procuring medicines. The scheme has also helped develop a health seeking attitude in most of the beneficiaries (85%). 97% felt a sense of empowerment and independence compared to the past.Conclusions: The benefits of MAMATA scheme percolated beyond the boundaries of demand generation. It also brought about a sense of empowerment and independence among it’s beneficiaries.
International Journal of Community Medicine and Public Health | August 2018 | Vol 5 | Issue 8 Page 3537
International Journal of Community Medicine and Public Health
Ali SI et al. Int J Community Med Public Health. 2018 Aug;5(8):3537-3543
http://www.ijcmph.com
pISSN 2394-6032 | eISSN 2394-6040
Original Research Article
Impact of conditional cash transfer scheme (MAMATA) on the
prevalent MCH care practices in rural areas of Ganjam district,
Orissa: a descriptive study
Syed Irfan Ali1, Jarina Begum1*, Manasee Panda2
INTRODUCTION
India’s impressive economic growth in the post-
liberalisation era has been accompanied by a much
slower decline in the numbers of Maternal and Child
sufferings (IMR-37, MMR- 167).1,2 Many well-planned
programs have been designed to address this issue, but
service utilization in such programs have been abysmally
low, partly due to the unfavourable Socio-cultural
conditions prevalent in the country. Conditional benefit
schemes around the world are set up to address these
issues. MAMATA is one such scheme aiming to bring
around radical changes in maternal and child conditions.3
Launched in October 2011 it rewards pregnant and
lactating women with an incentive of Rs.5000 if they
utilize certain services during their antenatal and
postnatal periods. This partial wage compensation is
provided in form of four instalments, spread over a period
of 12 months (from 6 months of gestation period till the
infant is 9 months of age). Many questions arise about the
ABSTRACT
Background:
RMNCH services are provided in an integrated manner to it’s beneficiaries under the premise of
Primary Health Care. The utilization rates for such services have remained abysmally low and stagnated over the
years. The problem lies in failure to generate a demand for such services among it’s beneficiaries. MAMATA a
conditional cash transfer scheme implemented in Odisha, aims to bring around radical changes by addressing the
issue of demand generation. The objectives of the study were to assess the implementation of MAMATA scheme
services in the study area and to assess the impact made by the scheme in their life.
Methods:
The study was conducted on 200 women, who were randomly selected from the 903 pregnant women
registered under Mamata Scheme from a randomly selected block of Odisha. They were then followed up for a period
of 15 months.
Results:
Implementation of the scheme in the district was smooth, the instalments were paid regularly in most of the
cases without any delay. Impact of the scheme- 98% got adequate rest during pregnancy, because of the scheme. 95%
utilized the money for purchasing nutritious food and procuring medicines. The scheme has also helped develop a
health seeking attitude in most of the beneficiaries (85%). 97% felt a sense of empowerment and independence
compared to the past.
Conclusions:
The benefits of MAMATA scheme percolated beyond the boundaries of demand generation. It also
brought about a sense of empowerment and independence among it’s beneficiaries.
Keywords: Conditional cash transfer, MCH care, Conditionalities, Instalment, MAMATA scheme
Department of Community Medicine, 1NRI Institute of Medical Sciences, Sanghivalsa, Vishakhapatnam, Andhra
Pradesh, 2Balangir Medical College, Balangir, Orissa, India
Received: 17 May 2018
Revised: 27 June 2018
Accepted: 28 June 2018
*Correspondence:
Dr. Jarina Begum,
E-mail: dr.jarina @gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20183094
Ali SI et al. Int J Community Med Public Health. 2018 Aug;5(8):3537-3543
International Journal of Community Medicine and Public Health | August 2018 | Vol 5 | Issue 8 Page 3538
scheme’s implementation- can it be successfully
implemented on the platform of ICDS? The scheme is
stretched over a period of 15 months, with a gap of
several months between two consecutive instalments.
Considering this, would it develop a sense of fatigue
amongst its beneficiaries, how would they adapt to its
forced conditionalties? Will they be benefited by the
scheme and assess all the MCH services available to
them? If yes, what impact will the scheme have in their
life?
The present study is a descriptive study involving the
beneficiaries of MAMATA scheme in Kukudakhandi
block of Ganjam district which is intended to see the
impact of the scheme (MAMTA) on the current MCH
practices and perception of the beneficiaries towards the
scheme.
Objectives
To assess the implementation of MAMATA scheme
services in the study area.
To assess the impact the scheme had on it’s
beneficiaries.
METHODS
Place of study
Rural areas of Ganjam district.
Study period
2 years i.e. from October 2011 to November 2013
Study area
Out of 22 rural blocks in the district, the, Kukudakhandi
block was randomly selected for the purpose of this
study.
Study design
Community based observational study.
Details of sampling
The pregnant mothers of the block registered under
MAMATA scheme i.e. 903 constituted the study
population. Considering the long period of follow-up and
constraints of resources, a sample of 200 beneficiaries
was perceived to be adequate for the study. (20% of the
total study population i.e. 180 & an additional 10% of the
sample size i.e. 20 to account for non-response, loss of
Follow up for 15 months and abortion, still birth or infant
death). For administrative purposes, Kukudakhandi block
is divided into 7 sectors, with roughly 25 AWCs in each
sector. In order to have proper representation from all
sectors of the block, registered beneficiaries from 12
AWCs of each of 7 sectors (total of 84 AWCs) of
Kukudakhandi block were selected. They formed the
sampling frame (432) for the study. From the sample
frame of 432 beneficiaries randomly 200 pregnant
mothers were selected to constitute the sample
population, after subjecting them to the following
exclusion and inclusion criteria’s.
Inclusion criteria
Inclusion criteria were the beneficiary should be a
resident of Kukudakhandi block; she should be willing to
stay in the block for the entire period of follow-up (15
months); she should give informed consent to participate
in the study.
Exclusion criteria
Exclusion criteria were those who did not plan on staying
in the study area for the period of follow-up; those who
had abortions, still births or infant deaths during the
course of study.
They were followed up till they received their last
instalment under MAMATA scheme. The data was
collected and analysed using appropriate statistical
methods to draw conclusions.
RESULTS
At the end of the study period, all 200 pregnant and
lactating mothers and their child were alive. All of them
(100%) had fulfilled all the 20 preconditions necessary
for availing the four instalments under the scheme. Also
all of them had opted for safe delivery, even though it
was not a precondition under the scheme. There was no
attrition among the sample population. Instalments were
being paid regularly in most of the cases. Delay in
receiving of instalments were noticed in 37.5%, 25.5%,
27%,30% of the cases for 1st, 2nd, 3rd and 4th instalments
respectively (Table 1).
Table 1: Regularity of instalments (n=200).
SL
Regularity of instalment
Second
instalment
(%)
Third
instalment
(%)
Fourth
instalment
(%)
1
Paid within 1 month of usual time
149 (74.50)
146 (73.00)
140 (70.00)
2
Payment was delayed
41 (25.50)
54 (27.00)
60 (30.00)
Total
200 (100)
200 (100)
200 (100)
Ali SI et al. Int J Community Med Public Health. 2018 Aug;5(8):3537-3543
International Journal of Community Medicine and Public Health | August 2018 | Vol 5 | Issue 8 Page 3539
Table 2: Reasons for delay in payment (n=200).
SL
Reasons for delay
First
instalment
(%)
Second
instalment
(%)
Third
instalment
(%)
Fourth
instalment
(%)
1
Late fulfilment of conditionality
156 (78.00)
184 (92.00)
164 (82.00)
188 (94.00)
2
Issue of savings account by bank
146 (73.00)
0 (0)
0 (0)
0 (0)
3
Sharing of information by AWW
6 (3.00)
12 (6.00)
22 (11.00)
8 (4.00)
4
Dissemination of information at the
CDPO office
12 (6.00)
4 (2.00)
14 (7.00)
4 (2.00)
5
Delayed disbursement of payment by the
Govt
0 (0)
0 (0)
0 (0)
0 (0)
Table 3: Utilization of money from the scheme.
SL
Money utilized for
Number of beneficiaries (n=200) (%)
1
Transport to the health facility
92 (46.00)
2
In procuring medicines/ diagnostic procedures
194 (97.00)
3
For nutrition of mother and child
190 (95.00)
4
For future savings
134 (62.00)
5
Household purposes
68 (34.00)
6
Other activities
130 (65.00)
Table 4: Withdrawal of money from savings account (n=200).
Sl
Money withdrawn by
First instalment
(%)
Second instalment
(%)
Third instalment
(%)
Fourth instalment
(%)
1
Beneficiary
19 (9.50)
89 (44.50)
110 (55.00)
126 (63.00)
2
Husband
74 (37.00)
20 (10.00)
22 (11.00)
22 (11.00)
3
Others
107 (53.50)
91 (45.50)
68 (39.00)
52 (26.00)
Total
200 (100)
200 (100)
200 (100)
200 (100)
Table 5: Important messages of counselling sessions.
SL
Message
Number of beneficiaries (n=200) (%)
1
To take Adequate rest and Nutrition
194 (97.00)
2
Child rearing practices like what to do and what not to
112 (56.00)
3
To exclusively Breast feed the Child
52 (26.00)
4
Other Health issues like- Malaria, Diarrhoea, ARI prevention
190 (95.00)
5
Contraception and Breast feeding
26 (13.00)
The major reason attributed to it was delay in fulfilment
of conditionality’s on the part of beneficiary (78%, 92%,
82%, 94% for 1st, 2nd, 3rd, 4th instalments) (Table 2).
No delay was noticed in disbursement of money from the
Govt side. In depth interview of the CDPO and the
Supervisors revealed that all effort were made to avoid
any delay in payment of instalments. For monitoring and
supervision the CDPO and Supervisor randomly checked
20 cases every month. No instances of corruption either
on the part of Government officials or the ICDS staff
were noticed during the study period.
Majority of the beneficiaries utilized the money for
purchasing nutritious food (95%) and procuring
medicines or undertaking diagnostic procedures (97%)
with the money (Table 3).
Majority of cases the money from first instalment
(Rs.1500) was utilized for ultrasound of the baby (97%),
and those from the second and third instalment were
spent on procuring child’s medications or for immunizing
him with additional vaccines. A high proportion of
money was also spent on procuring complementary foods
for the child (95%). The 4th instalment was mostly saved
for future (62%).
An increasing trend of beneficiaries managing their own
account is seen in from 1st to 4th instalments (from 9.5%
to 63%) (Table 4).
Ali SI et al. Int J Community Med Public Health. 2018 Aug;5(8):3537-3543
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In majority of the counselling session’s issues concerning
maternal rest and nutrition (97%), specific diseases like
malaria, diarrhoea and ARI (95%) and healthy child
rearing practices (56%) were discussed. Key issues like
contraception and breast feeding (13%) were rarely
discussed during the counselling sessions (Table 5).
Frequent stock-out of vaccines especially the Measles
vaccine and IFA tablets was a grave concern in the block.
42.5% beneficiaries faced such problems. While about
15% of the beneficiaries sighted lack of co-operation
from their own family member and discrimination or
abuse by staff as a major problem (Table 6).
Table 6: Problems faced by beneficiaries.
Sl
Problem faced
Number of
beneficiaries
(n=200) (%)
1
Problems relating to corruption
0 (0)
2
Problems relating to
discrimination/ abuse by
health? ICDS staff
29 (14.50)
3
Health/ service centres located
far away from home
15 (7.50)
4
Problems of Irregularity in
services/ stock out of essential
items like- Vaccines, IFA
tablets etc.
85 (42.50)
5
Problems of co-operation from
own family members
34 (17.00)
Among the sample population over 80% of the
beneficiaries were uncomfortable with the mandatory
condition of having to attend Counselling sessions.
(Table 7).
Table 7: Conditions beneficiaries were uncomfortable
with.
SL
Conditionality
Number of
Beneficiaries
(n=200) (%)
1
Pregnancy registration & ANC
check up
16 (8.00)
2
To attend ANC counselling
sessions
160 (80.00)
3
To attend IYCF Counselling
Sessions
160 (80.00)
4
To breastfeed exclusively for
6 months
167 (83.50)
5
To give vitamin A first dose
37 (18.50)
6
To weigh the child regularly
29 (14.50)
As per Table 8, 72% of the study population stated that
the monetary incentive provided by the scheme helped
them in having adequate rest during pregnancy and spend
sufficient time with their infant. 97% of the study
population felts a sense of empowerment and
independence compared to the past. However all of them
felt that the money provided (RS.5000 for 12 months)
was too little and barely addressed their needs. Similarly
most of the beneficiaries (78%) and health personnel
wanted a single bulk instalment instead of four and 88%
wanted the money with-out any conditionality. All the
beneficiaries (100%) had gone for institutional deliveries.
95% of the study population now consults with the
Government health employees like Medical officer and
ANM. Compared to prior behaviour.
Table 8: Perception of the beneficiary towards scheme.
SL
Perception in regards to
Yes (n=200) (%)
No (n=200) (%)
1
Do you feel a sense of Independence and importance compared to past
194 (97.00)
6 (3.00)
2
Should there be one instalment instead of four
156 (78.00)
44 (22.00)
3
Is the money provided sufficient
0 (0)
(100)
4
Should conditionality’s be kept in the scheme
24 (12.00)
176 (88.00)
5
Are you satisfied with the Initiative
196 (98.00)
4 (2.00)
6
Did you go for safe delivery/ Institutional Delivery
200 (100)
0 (0)
7
If not for the scheme would you have still continued to work during
pregnancy and lactation
144 (72.00)
56 (28.00)
8
Do you consult ANM, AWW, MO more than before
190 (95.00)
10 (5.00)
DISCUSSION
Much of Public Health in general is arguably about MCH
and truly much about global health is about MCH. Our
current era of globalization, war, and socioeconomic
unrest has revealed public health as a worldwide concern
and a major frontier for social justice with maternal and
child health at its epicentre.4 Every year around 8 million
children die of preventable causes, and more than
350,000 women die from preventable complications
related to pregnancy and childbirth. Reaching the targets
for MDG 4 (a two-thirds reduction in under-five
mortality) and MDG 5 (a three-quarters reduction in
maternal mortality) would mean saving the lives of 4
million children and about 190,000 women in 2015
alone.5 Attaining a 75% reduction in MMR from the
levels prevalent in 1990 means an annual decline of
MMR by 5.5%. India has more than 50% of its
population below the age of 25 and more than 65% below
Ali SI et al. Int J Community Med Public Health. 2018 Aug;5(8):3537-3543
International Journal of Community Medicine and Public Health | August 2018 | Vol 5 | Issue 8 Page 3541
the age of 35, reiterating the importance of RCH services
to this country.6 Though an impressive progress has been
made in various parameters of MCH care, for a country
as diverse as India, there are several road blocks ahead in
achieving the goals of MDG 4 and 5. Special efforts were
taken by NRHM to address the crucial issue of MCH care
in the state. Being an EAG state, it receives added focus
and incentive from the Government. However the
delivery of these services to the beneficiaries face
considerable amount of road blocks leading to heightened
MMR (212 per 1 lakh live birth) and IMR (62 per 1000
live births in rural areas).7 Increasingly, maternal and
Child Health (MCH) experts are exploring ways in which
demand-side barriers (the barriers women and their
families face to seeking care) can be overcome. CCT’s
are one type of demand-side program that has been used
to overcome cost barriers. CCTs use cash transfer both as
mechanism to allow parents to provide financially for
their children needs and as incentive for the parents to
invest in their health and well-being.8
Most of the CCT programs are broad, aiming to alleviate
poverty. However, “narrow” CCT programs that
transfer cash only for the utilization of specific services-
are becoming more common; for example, India’s Janani
Suraksha Yojana (JSY) and Nepal’s Safe Delivery
Incentive Program (SDIP) specifically target MCH.9 The
JSY aims to reduce maternal and neonatal mortality
through the promotion of institutional births by providing
cash incentives to mothers on giving birth in a health
institution.10 The Government of Nepal initiated Safe
Delivery Incentive Programme (SDIP) under maternal
health financing policy on July 2005 as a cost sharing
scheme to increase access of women to safe delivery
services.11 CCT is found out to be better outcomes than
unconditional case benefit schemes.
Our study throws light on MAMATA scheme which
revealed that the Instalments were being paid regularly in
most of the cases (i.e. within the 10th of the next month
after verification of fulfilment of required conditionality’s
by ICDS staff). Beyond the obvious problem of getting a
savings account in bank which was responsible for the
majority of first instalments delay (73%), late fulfilment
of requisite conditionality’s by the beneficiary themselves
contributed to much of delays in subsequent instalments.
This highlights the fact that the existing machinery for
money distribution in MAMATA scheme is quite
efficient and whatever delays happened, could be taken
care at the level of beneficiaries themselves.
In their study “Towards universalisation of Maternity
Entitlements: An exploratory case study of the Dr.
Muthulakshmi Maternity Assistance Scheme, Tamil
Nadu” the PHRN group noted that the beneficiaries faced
no problems in getting a bank savings account. However
the issue of incentives were delayed.12 Similarly the
DMMAS scheme proposes for monetary assistance in
two instalments one before pregnancy and other after.
The study group noted that none of the beneficiary
received the first instalment before delivery. The amount
due to financial delay was paid in bulk during the second
instalment. Even there was a delay in 14% of the cases,
failure of the scheme to adhere to its regularity of paying
instalments, led to no significant changes in the nutrition
and LBW status of the beneficiaries compared to the rest
of the population.13
MAMATA provides for a partial wage compensation of
Rs.5000, to pregnant and lactating mothers. The
beneficiary is expected to use these incentives along with
the money they receive in JSY for the welfare of mother
and child. A good proportion of beneficiaries (above
95%), utilize the money for purchasing nutritious food
and procuring medicines or undertaking diagnostic
procedures, immunizing child with additional vaccines
also on procuring complementary foods for the child.
Similar observations were made by the PHRN group in
their study of utilization of services in DMMAS scheme.
The women reported that the money was mainly spent on
medical expenses (39%), savings and investment for the
child’s future (31%) and food items (29%).
Further the study revealed that in 53.5% of cases the
withdrawal of the first instalment from the bank was
usually made with the help of others (generally AWW or
ASHA). Less than 10% of the beneficiaries were able to
handle their account themselves during this period. This
coupled with the fact that only 5.5% of them had a
savings account in their name before the launch of
MAMATA and 88% of them had to face difficulty in
opening a savings account shows the existing low levels
of gender empowerment in the study area. An increasing
trend of beneficiaries managing their own account is seen
in cases of 2nd, 3rd and 4th instalments (from 9.5% to
63%). Most of them felt a sense of empowerment and up-
liftment on being able to manage their own savings
account.
Attendance of pregnant and lactating women in
counselling sessions (ANC, VHND, IYCF) is a
precondition for all of the four instalments. A disturbing
trend is seen in regards to interest of beneficiaries in
attending these sessions. In fact majority of them (over
70%) have confessed to not attending these sessions had
they not been made mandatory by the scheme.
Majority of the counselling sessions addressed issues
concerning maternal rest and nutrition (97%), and
specific diseases like malaria, diarrhoea and ARI (95%).
The issues concerning the scheme and its conditionality’s
were rarely discussed during these sessions, thereby
wasting a precious opportunity. This might be responsible
for recurring delays on the part of beneficiary to fulfil
their conditionality’s on time. Key issues like
contraception and breast feeding were rarely discussed
during the counselling sessions (13%). The repetition of
certain issues like malaria and diarrhoea too played a key
role in the disinterest and fatigue of beneficiaries towards
these sessions. The PHRN group stated that the common
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International Journal of Community Medicine and Public Health | August 2018 | Vol 5 | Issue 8 Page 3542
themes discussed during the counselling sessions of
DMMAS scheme were nutrition for the mother during
pregnancy and after childbirth. Other like breastfeeding,
rest during pregnancy, mother and child care were also
discussed frequently. However no mention was made of
wage compensation or exclusive breastfeeding during
these sessions.
Corruption was a non-issue in this scheme. MAMATA
Scheme is carried out on the platform of ICDS which is
often blamed for poor implementation and malpractices.
Given the fact that over 45 lakh rupees was disbursed
during the study period, with zero corruption and
malpractice, tells a lot about the smooth implementation
of the scheme. Similarly no evidence of corruption or
leakages were found in the DMMAS study by PHRN.
MAMATA like other Conditional Cash Transfer (CCT)
schemes is designed primarily to address the “Demand”
side of the problem. However for smooth implementation
of such programs the “Supply” side of the problems need
to be addressed as well. Frequent stock-out of vaccines
especially the Measles vaccine and IFA tablets is a grave
concern in the block. Such stock outs usually lead to
delayed fulfilment of conditionality eventually leading to
delay in getting Instalment. 42.5% beneficiaries faced
such problems. A little more effort on the part of health
officials especially AWW and ANM would effectively
prevent such problems in the future.17% of the
beneficiaries sighted lack of co-operation from their own
family member as a major problem. In most of these
cases the service centres or banks were located far away
from the beneficiary’s house and they needed someone to
accompany them.
Over 80% of the beneficiaries were uncomfortable with
the mandatory condition of having to attend Counselling
sessions. The scheme mandates the beneficiary to attend
a minimum of eight counselling sessions during the
period of twelve months. Many women faced problems
attributed to cultural barriers in fulfilling this conditions
as they are not allowed to step out of house fearing
untoward superstitions. The repeated counselling on same
topics like malaria, diarrhoea by the AWW also did not
help in arousing interest in them. Most of the
beneficiaries consider it as a waste of time. Less than
15% had problems with repeated weighing of their child.
Most of them used to weigh their child during the
immunization sessions.
Provision of counselling by home visit of a health
personnel might mitigate some of the barriers. Further
proper training of AWW and ANM in matters related to
counselling, and MAMATA Scheme is urgently required
in most of the cases.
98% of the study population welcomed the initiative of
MAMATA and stated that the monetary incentive
provided by the scheme helped them in taking adequate
rest during pregnancy and spend sufficient time with their
infant instead of worrying of joining work (72%). 97% of
the study population felts a sense of empowerment and
independence compared to the past. Most of them (97%)
were happy of the fact that they possessed their own
individual savings account and were able to manage it
independently. However almost all of them felt that the
money provided (RS.5000 for 12 months) was too little
and barely addressed their needs. National Alliance for
Maternal Health and Human Rights (NAMHHR) in their
study on utilization of MCH services under IGMSY
scheme observed the same.14 They computed that the
money provided would only provide less than a month of
rest (Roughly 25 days wages for unskilled labour at Rs
160 per day). Similarly MAMATA scheme would be able
to provide a rest of 31.25 days only.
The planning commission held a meeting on June 2nd
2010 for presentation and discussion on Dr. Muthulaksmi
maternity assistance scheme findings made by PHRN
group. It was recommended to provide a monetary
compensation equivalent to minimum wages permissible
under 6th Pay Commission and should be of universal
application, with no conditionality’s. Whether such
financial undertaking can be taken by Odisha, one of the
poorest state of India is speculated for further
consideration.
Most of the beneficiaries (78%) and health personnel
wanted a single bulk instalment instead of four with-out
any conditionality (88%). But the importance of
conditionality could be perceived by the fact that so far
all of the beneficiaries had fulfilled them although some
admit that they would not have done so had it not been
mandatory under the scheme. The conditionality’s in the
scheme is a good way of making sure that the services
offered are indeed utilized and therefore should not be
parted with.
Considering similar demands DMMAS, started paying
them in one time bulk payment of Rs. 6000 instead of 3
instalments and the results of such modifications were
drastic with beneficiaries using all of the money at once
leading to early initiation of work by them thus
diminishing the period of maternal rest- the primary aim
of the scheme. Due to this the DMMAS was again
revoked into a scheme providing monetary benefits in
three instalments (of Rs. 4000 each).
One of the objectives of the scheme was to promote
health seeking behaviour in women. This is clearly
proved by the fact that all the beneficiaries (100%) had
gone for institutional deliveries. The scheme has also
helped develop a health seeking attitude in most of the
beneficiaries (85%). In case of any ailments, these
beneficiaries now consult the Government health
employees like Medical officer and ANM for any
ailments instead of depending on quacks and private
practitioners. This is a welcome trend largely due to the
initiative of MAMATA.
Ali SI et al. Int J Community Med Public Health. 2018 Aug;5(8):3537-3543
International Journal of Community Medicine and Public Health | August 2018 | Vol 5 | Issue 8 Page 3543
CONCLUSION
Fulfilment of conditionalities with in stipulated time is
added to test their awareness of the scheme and
reluctance in fulfilling any conditionalities is also
assessed to understand the importance of conditionalities
in such scheme. All beneficiaries fulfilled their
conditionalities and received their incentives at the end of
the study. So, when compared to AHS-2011 there was a
drastic improvement especially those parameter which
were a pre-condition for incentive showed 100%
fulfilment. However not all of them were fulfilled with in
stipulated time and most beneficiaries needed to be
tracked down by AWW for fulfilling these
conditionalities. The study also points out to the
reluctance on part of beneficiary to fulfil such
conditionalities. Which as per them won’t have been
fulfilled had it not been mandatory to draw incentives. It
also shows that most beneficiaries were lured into joining
the scheme by its monetary incentives, but over a period
of time it brought about positive changes in them. The
current fund flow mechanism is quite transparent and has
blocked the pilferage. Most of the beneficiaries
welcomed the initiative of MAMATA scheme and felt a
sense of independence and importance due to this. They
felt that the scheme has enabled them to get proper rest
and spend more time with their child. The scheme seems
to have brought about a change in the health seeking
behaviour of the beneficiaries with all of them going for
institutional delivery and most of them seeking the help
of government health staff in case of ailments.
ACKNOWLEDGEMENTS
The author is very much thankful to MKCG medical
college authorities for giving permission to conduct the
study and all staff of department of Community Medicine
for their help and support. The author also extends his
sincere thanks to the CDPO, Supervisors, AWWS and the
beneficiaries of Kukudakhandi block for their co-
operation and assistance.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: The study was approved by the
Institutional Ethics Committee
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ResearchGate has not been able to resolve any citations for this publication.
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Available at: www.wcdorissa. gov.in/download/MAMATAGuideline_English
  • Mamata Scheme
MAMATA Scheme. Available at: www.wcdorissa. gov.in/download/MAMATAGuideline_English.pdf. Accessed on 5 April 2018.