Background: The National Health Mission (NHM), the largest ever publicly funded health programme worldwide, used over half of the national health budget in India and primarily aimed to improve maternal and child health in the country. Though large scale public health investment has improved the health care utilization and health outcomes across states and socio-economic groups in India, little is known on the equity concern of NHM. In this context, this paper examines the utilization pattern and net benefit of public subsidy for institutional delivery by the level of care in India. Methods: Data from the most recent round of the National Family Health Survey (NFHS 4), conducted during 2015–16, was used in the study. A total of 148,645 last birth delivered in a health centre during the 5 years preceding the survey were used for the analyses. Out-of-pocket (OOP) payment on delivery care was taken as the dependent variable and was analysed by primary care and secondary level of care. Benefits Incidence Analysis (BIA), descriptive statistics, concentration index (CI), and concentration curve (CC) were used to do the analysis. Results: Institutional delivery from the public health centres in India is pro-poor and has a strong economic gradient. However, about 28% mothers from richest wealth quintile did not pay for delivery in public health centres compared to 16% among the poorest wealth quintile. Benefit incidence analyses suggests a pro-poor distribution of institutional delivery both at primary and secondary level of care. In 2015–16, at the primary level, about 32.29% of subsidies were used by the poorest, 27.22% by poorer, 20.39% by middle, 13.36% by richer and 6.73% by the richest wealth quintile. The pattern at the secondary level was similar, though the magnitude was lower. The concentration index of institutional delivery in public health centres was − 0.161 [95% CI, − 0.158, − 0.165] compared to 0.296 [95% CI, 0.289, 0.303] from private health centres. Conclusion: Provision and use of public subsidy for institutional delivery in public health centres is pro-poor in India. Improving the quality of service in primary health centres is recommended to increase utilisation and reduce OOP payment for health care in India.

There were no estimates of the prevalence of pain and its treatment in the older population of India obtained from face-to-face interviews with a nationally representative sample. We addressed this evidence gap by using data on 63,931 individuals aged 45 years and older from the 2017/2018 Longitudinal Ageing Study in India. We identified pain from an affirmative response to the question: Are you often troubled by pain? We also identified those who reported pain that limited usual activities and who received treatment for pain. We estimated age- and sex-adjusted prevalence of pain, pain limiting usual activity and treatment, and compared these estimates across states and sociodemographic groups. We used a multivariable probit model to estimate full adjusted differences in the probability of each outcome across states and sociodemographic groups. We estimated that 36.6% (95% confidence interval [CI]: 35.3-37.8) of older adults in India were often troubled by pain and 25.2% (95% CI: 24.2-26.1) experienced pain limiting usual activity. We estimated that 73.3% (95% CI: 71.9-74.6) of those often troubled by pain and 76.4% (95% CI: 74.9-78.0) of those with pain that limited usual activity received treatment. There was large variation in each outcome across states. Fully adjusted prevalence of pain and pain limiting usual activity were higher among individuals who were female, older, less educated, rural residents, and poorer. Prevalence of treatment among those troubled by pain was lower among socially disadvantaged groups.

Disability in India is associated with increasing non-communicable diseases, rising longevity, and increasing accidents and injuries. Though studies have examined prevalence, patterns, and socioeconomic correlates of disability, no attempt has been made in estimating age of onset of disability in India. This paper investigates the economic gradient of age of onset of locomotor, visual, hearing, speech, mental retardation, mental illness, and other disabilities in India. We use nationally representative data of 106,894 disabled individuals from the 76th round of National Sample Survey (NSS), 2018. Descriptive statistics, kernel density, Kaplan-Meier survival curves, and linear regression models are used in the analysis. The disability rate in India was 2184 per 100,000 persons. The disability rate was highest for locomotor (1353) followed by hearing (296), visual (234), speech (228), mental retardation (158), and mental illness (131). Over 85% of mental retardation and 80% of speech disabilities occur at birth, while 82% of locomotor and 81% of visual disabilities occur after birth. Among those who had disability after birth, the median age for mental retardation was 2 years followed by mental illness (28 years), speech (29 years), locomotor (42 years), visual (55 years), and 56 years for hearing disability. Adjusting for socioeconomic covariates, the age of onset of locomotor and speech disabilities among the poorest individuals were 7 and 11 years earlier than the richest, respectively. The economic gradient of onset of locomotive and speech disabilities are strong. The age of onset of disability was earliest for mental retardation followed by mental illness and speech disability.

In the wake of demographic and epidemiological transition, rising life expectancy and disability has become a global, national and regional phenomenon. Though estimates of life expectancy at birth are available at regular time intervals, there are limited studies on estimates of disability-free life expectancy by gender and regions in India. Study design: Compares life expectancy of disabled and overall population by seven type of disability. Objective: This study examines the gender differential and regional disparity of disability-free life expectancy (DFLE) and Life lived with disability (LWD) among disabled in India. Methods: Data from Census of India, 2011 and abridged life table from Sample Registration System 2011 has been used. Disability-free life expectancy (DFLE) was estimated using Sullivan method. Life lived with disability was calculated for all major states included in the study by the types of disabilities. Results: In 2011, the DFLE in India was 58.1 years for males and 60.78 years for females compared to life expectancy of 66.87 years for males and 70 years for females. On average, females in India had lived more years with disability than males. Similarly, the DFLE of rural areas was 58.6 compared to 62.3 in urban areas. The DFLE was 59.26 years movement, 58.88 for mental retardation and 58.81 for mental illness. The age pattern of DFLE decreases with increasing age for both males and females. The regional variation in DFLE is large. The DFLE of males in the state of Jammu and Kashmir was 62.4 compared to 56.4 in Assam. Similarly, for females, the DFLE was 61.8 years in Gujarat and 63.1 years in Tamil Nadu. Conclusion: Though the overall life expectancy and DFLE were higher for females than for males, females lived with disability for more years than males. The DFLE was lowest for mental retardation followed by mental illness. The poorer states of India has lower DFLE compared to richer states.

Background: Identification of the disabled and providing them a disability certificate is the first step for provisioning educational, employment, and other social benefits in a welfare state. Deprivation from disability certificate deprives persons with disability (PwDs) from government policy and programme. Though studies examined the extent, variation, and pattern of disability, no attempt has been made in understanding the extent and variation of unidentified PwDs in India. The study aims to examine the variation in unidentified PwDs by type of disability, state and socio-economic correlates.Data and methods: The unit data from the 76th round (schedule 26) of Nation Sample Survey, 2018 is used in analyses. A total of 1,06,894 disabled across seven types of disabilities; any disability, locomotor, visual, hearing, speech, mental retardation, mental illness, and other disability have been analysed. Descriptive statistics and logistic regression analyses are used.Results: 7 in 10 disabled person in India don’t have a disability certificate. The percentage share of PwDs with a disability certificate varies 12% among those with hearing disability to 47% with mental retardation. Unadjusted odds ratio shows that person with hearing disability (OR=0.30 CI 0.303-0.304) are less likely to hold a disability certificate compare to locomotor disability followed by mental illness (OR=0.52 CI 0.519 0520), and visual disability (OR= 0.74 CI 0.736 0.738). Person with mental retardation are two times more likely to hold the disability certificate (OR 2.05 CI 2.046 2.047) than the visual disabled. States variation in percent share of disability certificate is found to be large. The result depicts that there remains a high variation in the access of disability certificates across states in India. Conclusion: A nationwide drive to include the unidentified disabled is recommended with documentation and inclusion in the administrative processes.