INTEGRATING DIGITAL HEALTH AND CROSS-REGIONAL ANALYSIS IN EVALUATING BIHAR'S MATERNITY BENEFIT SCHEMES

Bihar lags on key maternal indicators despite national cash-transfer schemes. To test whether embedding a focused digital package within JSY/PMMVY delivery improves service uptake, processes, and early clinical outcomes versus a cross-state comparator, a quasi-experimental evaluation was conducted in six districts with baseline and 6–9-month follow-up among 2,400 beneficiaries and 520 workers. Difference-in-differences estimates favoured Bihar for ≥4 ANC (+12.8 pp), institutional delivery (+14.3 pp), PNC ≤48 h (+11.2 pp), and full immunisation by 12 months (+9.4 pp) (all p<0.001). Process gains were substantial, including improved scheme awareness (+17.6 pp), higher PMMVY enrollment (+10.5 pp), and shorter payment delays (−6.6 days). Early clinical changes were modest but statistically significant, with haemoglobin increasing by 0.3 g/dL and birthweight by 0.10 kg. Multilevel models yielded adjusted odds ratios of 2.34 for ANC4+, 2.67 for institutional delivery, and 2.12 for PNC ≤48 h, with approximately 39% of the total effect mediated by frontline performance in structural equation modeling. Equity analyses indicated attenuated gains among SC/ST and low-literacy groups. Integrating mHealth supports into scheme operations produced rapid, policy-relevant improvements with early clinical signals; scale-up should combine digital tools with equity safeguards and sustained follow-up to confirm durability and cost-effectiveness.