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The purpose of this paper is to assess congestion as the simultaneous occurrence of desirable health output (e.g. maternal admissions) along with undesirable output (e.g. still births (SB)), in emergency obstetric care settings of public hospitals in Tamil Nadu.

The study is based on a cross-sectional data set of 97 public hospitals collected by the statistical cell of Tamil Nadu Health Systems Project for the year 2013–2014. The study uses three inputs – beds, doctors and nurses; three desirable outputs – maternal admissions, neonatal admission and live births; and four undesirable outputs – SB, intra-uterine deaths, neonatal deaths and maternal deaths. Congestion analysis, a variant of the data envelopment analysis (DEA) method and slack analysis, has been applied to detect an excessive use of some inputs or a shortfall in some outputs across these hospitals. Furthermore, the association between congestion and some contextual factors has been examined.

On an average, the hospitals in our sample can increase the total amount of outputs by 62.8 percent by improving overall efficiency, and about 34.2 percent of this inefficiency can be attributed to congestion. Analysis of sub-samples showed that government hospitals at the taluk level have higher congestion than district headquarter hospitals. Congestion seems to decrease with greater hospital volume up to a limit; beyond that, it increases in obstetric care settings.

Hospital-based efficiency studies in the Indian context, so far, have estimated relative efficiency among hospitals using the classical DEA method, but ignoring adverse health outcomes. Congestion analysis, an advance in the DEA method, considers how much the desirable outputs can be increased as also how much undesirable outputs affect efficiency.

Persons with disabilities (PwD) are generally less likely to be employed than the general population. The paper aims to investigate whether access to assistive technologies (AT) impacts labour force participation in the disabled population.

The study utilises the nationally representative survey on disability in India conducted in 2018 through multi-stage sampling by the Ministry of Statistics and Programme Implementation (MOSPI), Government of India. The instrumental variable (IV) approach has been employed to infer causality between AT and labour market participation.

The study found that the labour force participation rate (LFPR) in India amongst the disabled population was 29% in the age group of 15–65 years in 2017–2018, as compared to 52% in the general population. Around two-thirds of the PwD respondents who were advised to acquire aid appliances acquired them, implying limited access to AT. The probability of LFPR in disabled population increases by 26.6% with access to AT particularly in urban areas.

Persistent issues such as lack of adequate amenities, poor literacy and a lack of vocational skills need to be addressed to improve labour market outcomes for the disabled population in rural areas.

Despite its role in promoting distributive justice and inclusive development, research on equity gaps in access to AT and its impact on labour market outcomes is scant. This is the first paper that provides empirical evidence on the impact of access to AT on LFPR in the context of low- and middle-income countries.