T.N. private hospitals being empaneled under MRMBS, doctors say will cause setback to Government maternity services

The Health Department has initiated the process of empanelling private hospitals under Dr. Muthulakshmi Reddy Maternity Benefit Scheme (MRMBS). The decision to extend the benefits of the scheme to eligible pregnant women availing themselves of maternity services in the empanelled private hospitals has raised apprehensions among a section of doctors and officials who argue that it could hurt the State in more than one way. Mainly, the number of deliveries in the government sector will drop in the long run, they say.

The scheme under which financial assistance was given to poor pregnant women mandated delivery at government institutions till 2017. Thereafter, the government approved extension of the scheme to those who availed themselves of free health services at private medical college hospitals. In 2018, it was co-branded with the government of India’s Pradhan Mantri Matru Vandana Yojana (PMMVY). In its present form, the scheme extends financial assistance to the tune of ₹18,000 that included two maternal nutritional kits each worth ₹2,000.

In the past few months, the Directorate of Public Health (DPH) and Preventive Medicine has tasked its officers with empanelling private hospitals under the scheme. Once the decision is implemented, eligible women who avail themselves of maternity services at empanelled private hospitals will get both financial assistance and nutritional kits. While officials say this decision is aimed at ensuring safe deliveries for pregnant women irrespective of where they are treated, a section of doctors and officials disagree.

Official sources said district officers were given a check list and told to inspect a list of private hospitals for availability of facilities. Already, some hospitals had already been empanelled and given access to the Pregnancy and Infant Cohort Monitoring and Evaluation (PICME) portal.

A number of doctors felt that this would cause a setback to maternity services in the government sector. “MRMBS is one of the reasons for a woman to choose a government facility for her delivery. Why should the government extend financial assistance to those who have the paying capacity to avail themselves of services at a private hospital? In the long run, it will definitely impact the number of deliveries in the government sector. This is a wrong decision,” a doctor pointed out.

Another official source cited a recent statement made by the Health Minister that 59% of the institutional deliveries in the State occurred in government institutions. “If the move takes off fully, there will be a shift from government facilities to private hospitals, leading to a decline in deliveries in the public health facilities. Even if we say that the place of delivery is the woman’s choice and right, such a move will end up increasing the out-of-pocket expenditure of the middle income group,” he said.

Director of Public Health T. S. Selvavinayagam said that right now, 60% of pregnant women were getting treated in the government sector, and remaining 40% in the private sector. “Not all women who go to private hospitals are rich; there are women belonging to the middle income and low income groups as well. So, we need to have a collective system. With 40% going to the private sector, we thought it was time to open up by empanelling hospitals that will ensure that they have minimum standards in place,” he said.

From the public health perspective, the safety of the mother is the prime focus rather than where she is getting treated. The aim is that there should be no maternal deaths, he added.

“While a view that this amounted to privatisation may come up, for us, reaching mothers is important, and whether government or private is multifactorial. From deliveries at home at one point in time, we moved to health sub-centres, then to Primary Health Centres, and now to hospitals. Safe delivery is important,” Dr. Selvavinayagam said.

An official said as a result of the decision, a shift may occur, leading to a dip in the utilisation of government maternity services in the long run.