Expanding availability of safe abortion services through private sector accreditation: a case study of the Yukti Yojana program in Bihar, India

Abstract

BackgroundRecognizing the need to increase access to safe abortion services to reduce maternal mortality and morbidity, the state government of Bihar, India introduced an innovative mechanism of accrediting private health care facilities. The program, Yukti Yojana (‘a scheme for solution’), accredits eligible health facilities and supports them in providing abortion-related services free of charge to rural and low-income urban women. This paper describes implementation of Yukti Yojana.MethodsA descriptive analysis of abortion services provided under the Yukti Yojana program was conducted using four data sources: 1) assessment of accredited facilities over 6 months; 2) induced and incomplete abortion service registers; 3) client exit interviews and associated direct observation of client-provider interaction for a sample of accredited facilities; and 4) in-depth interviews with providers and key stakeholders responsible for providing or influencing abortion services. These analyses assessed characteristics of women receiving abortion services, quality of care and client satisfaction, and barriers and facilitating factors of a successful accreditation process.ResultsForty-nine private facilities were accredited during the first two years of the program, and 84 % had begun providing abortion services, in all 27,724 women were served. Overall, 53 % of beneficiaries reported holding a “Below Poverty Line” card, while 71 % had low living standard. The majority of women (n = 569) reported satisfaction (90 %) with their care, while 68 % perceived good quality of services. Having a government-led initiative was considered a key element of success, while stringent requirements for site approval, long waiting time for accreditation, complicated and delayed reimbursement process and low reimbursement fees for abortion services were identified as barriers to implementation.ConclusionsYukti Yojana provides a model for successfully involving private OB/GYNs and general physicians to deliver safe abortion services to poor women on a large scale and offers additional evidence that public-private partnerships can be used to ensure availability of high-quality maternal health services to women in low-income countries. Private facility accreditation also offers a promising solution to the limited availability of safe abortion services in low resource settings such as Bihar, India.

Experiences of private sector quality care amongst mothers, newborns, and children in low- and middle-income countries: a systematic review

“…In two studies, the authors did not specify the intervention’s success. Only four studies reporting specific interventions were assessed as being strong quality ( n = 1) [ 34 ] or moderate quality ( n = 3) [ 35 , 36 ]. Additional details of specific intervention studies appear in Additional File 1 and in the thematic analyses below.…”

Availability and distribution of safe abortion services in rural areas: a facility assessment study in Madhya Pradesh, India

“…Private facilities are required to have either a qualified gynaecologist or a doctor trained to provide abortion, as well as a functioning labour room and operating theatre. There were 49 such private facilities accredited under the Yukti program across Bihar ( 33 ); although the location of these facilities is not reported, it is very likely that most are in urban centres. Over an 18-month period 10,700 women were provided abortion care, two thirds of whom were rural ( 33 ).…”

“…There were 49 such private facilities accredited under the Yukti program across Bihar ( 33 ); although the location of these facilities is not reported, it is very likely that most are in urban centres. Over an 18-month period 10,700 women were provided abortion care, two thirds of whom were rural ( 33 ). However, in large areas of our study districts in MP (even in one whole district), there was no private facility providing abortion services; therefore, the public sector is the major provider.…”

Implementing and expanding safe abortion care: An international comparative case study of six countries

“…8 Several articles describe specific difficulties in guaranteeing equitable access to services in South Africa, Zambia, and India, and the interventions designed to address these problems. [9][10][11] Comprehensive reviews of a single country's program, including health system level implementation steps, successes, and difficulties exist for India, 12 Mexico City, 13 and South Africa, 14 but there are no comparative data to guide future program implementation. A recent five-country case study developed to inform the WHO guideline on task sharing found limited documentation of the implementation processes undertaken.…”

“…One multicountry report did offer a framework for the successful implementation of abortion services; it relied primarily on a review of published and “grey” literature although it included some interviews with key informants . Several articles describe specific difficulties in guaranteeing equitable access to services in South Africa, Zambia, and India, and the interventions designed to address these problems . Comprehensive reviews of a single country's program, including health system level implementation steps, successes, and difficulties exist for India, Mexico City, and South Africa, but there are no comparative data to guide future program implementation.…”