Impact of Distance in the Provision of Maternal Health Care Services and Its Accountability in Murarai-II Block, Birbhum District

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Alokananda Ghosh
Biswaranjan Mistri


The maternal health issue was a part of the Millennium Development Goals (MDGs, Target-5). Now it has been incorporated into Target-3 of 17 points Sustainable Development Goal-2030, declared by the United Nations, 2015. In India, about 50% of newborn deaths can be reduced by taking good care of the mother during pregnancy, childbirth and postpartum period. This requires timely, well-equipped healthcare by trained providers, along with emergency transportation for referral obstetric emergency. Governments need to ensure physicians in the rural underserved areas. The utilisation of maternal healthcare services (MHCSs) depends on both the availability and accessibility of services along with accountability.

This study is based on an empirical retrospective survey, also called a historic study, to evaluate the influences of distance on the provision of maternal health services and on its accountability in Murarai-II block, Birbhum District. The major objective of the study is to identify the influence of distance on the provision and accountability of the overall MHCSs. The investigation has found that there is a strong inverse relationship (-0.75) between accessibility index and accountability score with p-value = <0.05, where the direct connectivity index seem to have no direct influence on the accountability score (as the ‘r’ is 0.56 and p-value= >0.05). Tracking of pregnant women, identification of high risk pregnancy and timely Postnatal Care (PNC) have become the dominant factors of the maternal healthcare services in the first Principal Component Analysis (PCA), explaining 49.67% of the accountability system. Overall, institutional barriers to accessibility are identified as important constraints behind lesser accountability of the services, preventing the anticipated benefit. This study highlights the critical areas where maternal healthcare services are lacking. The analysis has highlighted the importance of physical access to health services in shaping the provision of maternal healthcare services.

Drawing on empirical observations of operation of public distribution system in different states of India, the paper constructs a preliminary game theoretic model. It argues that an effective public distribution must be as universal as possible, delivery mechanism of fair price shops should be reformed, they should be make them commercially viable and that special attention should be paid to PDS at times of high food inflation.


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How to Cite
Ghosh, A., & Mistri, B. (2016). Impact of Distance in the Provision of Maternal Health Care Services and Its Accountability in Murarai-II Block, Birbhum District. Space and Culture, India, 4(1), 81-99.
Author Biographies

Alokananda Ghosh, The University of Burdwan, West Bengal, 713104

UGC-JRF,Department of Geography

Biswaranjan Mistri, The University of Burdwan, West Bengal, 713104

Assistant Professor, Department of Geography


Airey, T. (1989). The Impact of Road Construction on Hospital Inpatient Catchments in the Meru District of Kenya, Soc Sci Med. US National Library of Medicine. National Institute of Health, 29 (1), pp. 95-106. Retrieved from

Akhtar ,R., & Izhar, N. (2010). Global Medical Geography, Jaipur: Rawat Publication, (ISBN-81-316-0198-6).

Bevan, G.,& Charlton, J. (1987). Making Access to Healthcare More Equal: The Role of General Medical Services. British Medical Journal,295 (6601), BMJ, pp. 764-767.

Black, M., Ebener, S., Aguilar, P.N., Vidaurre, M. & Morjani, Z.E. (n d). Using GIS to Measure Physical Accessibility to Healthcare, World Health Organisation (WHO). Retrieved from GIS to measure physical accessibility to healthcare

Blanford, J.I., Kumar, S., Luo.W. & MacEachren.A.M. (2012). It’s a Long, Long Walk: Accessibility to Hospitals, Maternity and Integrated Health Centers in Niger. International Journal of Health Geographics. 11 (24). pp. 3-15.

Brinkenhoff, D. (2003). Accountability and Health Systems: Overview Framework and Strategies. Partners for Health Reform plus. Retrieved from

Buor, D. (2002). Distance as a Predominant Factor in the Utilisation of Health Services in the Kumasi Metropolis, GeoJournal, 56 (2), Springer, pp. 145-157.

Das, N.G. (2008). Statistical Methods, New Delhi. 2 : Tata McGraw-Hill Publising Company Ltd. (ISBN 10: 0-07-026351-5. 451-456).

District Statistical Handbook, Birbhum (2011). Government of West Bengal. Kolkata.

Divya, S. Tali, J.A., & Chandrashekara, B. (2014). Delineation of Primary Healthcare Services in Chamarajanagara Taluk: A Spatial Analysis. Journal of International Academic Research for Multidisciplinary. 2 (1) (ISSN: 2320-5083.494-503).

George, A. (2003). Accountability in Health Services: Transforming Relationships and Contexts. The Harvard Center for Population and Development Studies, 13 (1), pp. 1-16. Retrieved from

Hirama, M.V., Toledo, F.A.L., Junior, E.C., Costa, K.B., & Quadros, J.P. (2010). Q-Mode and R-Mode Factor Analysis in Quantitative Studies of Microfossils of the Late Quaternary in Sediments from the Brazilian Continental Margin. University of São Paulo, Oceanographic Inst., Lab. Paleoceanography of the South Atlantic (LaPAS), pp. 41-49.

Iyengar, S.D., Iyengar, K., & Gupta, V. (2009). Maternal health: A Case Study of Rajasthan. Journal of Health, Population and Nutrition. 27 (2), icddr, b. pp. 271-292. Retrieved from

Kara, F., & Egresi, I.O. (2013). Accessibility of Healthcare Institutions: A Case Study by Using GIS. International Journal of Scientific Knowledge. 3 (4). pp. 16-27. (ISSN-2305-1493). Retrived from

Kothari, C.R., & Garg, G. (2014). Research Methodology: Methods and Techniques, New Age International Publishers (ISBN: 978-81-224-3623-5).

Mamdani, M. & Bangser, M.(2004). Poor People Experiences of Health Services in Tanzinia: A Literature Review. Reproductive Health Matters (RHM), 12 (24), pp. 138-153, Retrieved from http:/

Miller, H.D. (2014). Measuring and Assigning Accountability for Healthcare Spending. Center for Healthcare Quality & Payment Reform. Retrieved from Assigning+Accountability+ Healthcare+Spending

Mondal, S.K. (2003). Health Nutrition and Morbidity: A Study of Maternal Behaviour. Development Evaluation Society of India (DESI). Bookwell Publication. New Delhi-110002, India. pp. 1-187. (ISBN:81-85040-69-9).

Monitoba Health and Healthy Living. (2009). Achieving Health System Accountability: Getting there Together. Retrieved from

Murad, A.A.( 2007). Creating a GIS Aapplication for Health Services at Jeddah City.Computers in Biology and Medicine. Elsevier Science Ltd., Great Britain. 37. doi:10.1016/j.compbiomed.879-889. Retrieved from

National Health Mission (2014).About Accredited Social Health Activist (ASHA), Ministry of Health & Family Welfare, Government of India.

Population Census of India (2011). Government of India: Office of the Registrar General & Census Commissioner, India.

Park, K., (2013). Preventive and Social Medicine. 22nd Edition. M/s Bandarsidas Bhanot Publications. Prem Nagar, Jabalpur-482001 (ISBN No. 978-93-82219-02-6).

Rana, K., Santra, S., Rafique, A., Mukherjee, A. & Sengupta, A. (2005). The Delivery of Primary Health Services: A Study in West Bengal and Jharkhand. The Pratichi Health Report: With an Introduction by Amartya Sen. Pratichi Trust. Delhi. India.110091 (ISBN 81-88297-03-8. 1-108).

Satia, J.K., Misra, M., Arora,R., & Neogi. S. (2014). Innovation in maternal health: Case study from India. New Delhi : SAGE Publication, (ISBN-978-81-321-1310-2, PB).

Saxena, H. M. (2012).Transport Geography. Jawahar Nagar, Jaipur, India: Rawat Publication, pp. 54-79, (ISBN-81-7033-945-6).

Sarkar, A. (2013). Quantitative Geography: Techniques and Presentations. Orient Blackswan (ISBN- 978 81 250 5266 1).

Singh, P.K. (8 March 2016). Because The Newly Born Deserve Better. The Statesman. Retrieved from

Taiar A. Al., Clark, A., Longenecker, J. C. & Whitty, C, J. (2010). Physical Accessibility and Utilisation of Health Services in Yemen. International Journal of Health Geographics. 9 (38), pp. 1-8. doi: 10.1186/1476-072X-9-38. Retrieved from

Thaddeus, S. & Maine, D.(1994). Too Far to Walk: Maternal Mortality in Context. Elsevier Science Ltd. ,Great Britain, 38 (8), 0277-9536/94, pp. 1091-1110.

The World Bank Health Nutrition and Population. Sector Strategy for MENA. (2013-2018). Fairness and Accountability: Engaging in Health System in the Middle East and North Africa. Retrieved from