The State-Led Large Scale Public Private Partnership ‘Chiranjeevi Program’ to Increase Access to Institutional Delivery among Poor Women in Gujarat, India: How Has It Done? What Can We Learn?

Abstract

BackgroundMany low-middle income countries have focused on improving access to and quality of obstetric care, as part of promoting a facility based intra-partum care strategy to reduce maternal mortality. The state of Gujarat in India, implements a facility based intra-partum care program through its large for-profit private obstetric sector, under a state-led public-private-partnership, the Chiranjeevi Yojana (CY), under which the state pays accredited private obstetricians to perform deliveries for poor/tribal women. We examine CY performance, its contribution to overall trends in institutional deliveries in Gujarat over the last decade and its effect on private and public sector deliveries there.MethodsDistrict level institutional delivery data (public, private, CY), national surveys, poverty estimates, census data were used. Institutional delivery trends in Gujarat 2000–2010 are presented; including contributions of different sectors and CY. Piece-wise regression was used to study the influence of the CY program on public and private sector institutional delivery.ResultsInstitutional delivery rose from 40.7% (2001) to 89.3% (2010), driven by sharp increases in private sector deliveries. Public sector and CY contributed 25–29% and 13–16% respectively of all deliveries each year. In 2007, 860 of 2000 private obstetricians participated in CY. Since 2007, >600,000 CY deliveries occurred i.e. one-third of births in the target population. Caesareans under CY were 6%, higher than the 2% reported among poor women by the DLHS survey just before CY. CY did not influence the already rising proportion of private sector deliveries in Gujarat.ConclusionThis paper reports a state-led, fully state-funded, large-scale public-private partnership to improve poor women’s access to institutional delivery - there have been >600,000 beneficiaries. While caesarean proportions are higher under CY than before, it is uncertain if all beneficiaries who require sections receive these. Other issues to explore include quality of care, provider attrition and the relatively low coverage.

Implementation and effectiveness of free health insurance for the poor pregnant women in Tanzania: A mixed methods evaluation

“…Our finding of no programme effect on maternal health service coverage is comparable to studies of demand-side financing in India, which used a similar quasi-experimental design to our own (De Costa et al, 2014;Mohanan et al, 2014). However, studies from Bangladesh (Ahmed & Khan, 2011;Nguyen et al, 2012), Pakistan (S. Sohail Agha, 2011) and Uganda (Ekirapa-Kiracho et al, 2011) reported positive effects on antenatal, delivery and postnatal care use.…”

Assessment of facility and health worker readiness to provide quality antenatal, intrapartum and postpartum care in rural Southern Nepal

“…One example of PPP is the state led Chiranjeevi Yojana (CY) program of Gujarat state in India implemented to full scale in 2007 that used explicit performance-based subsidies to motivate private sector obstetricians to provide institutional delivery services at a defined level of quality and at an affordable cost to disadvantaged women [43]. Similar direct reimbursement to the health providers such as nurse/ANMs in accredited private birthing centers and clinics (preferably with an obstetrician) can be explored for situations when the public sector facilities capacity to provide emergency obstetric care is low [44].…”

How respectfully women are treated during difficult phase like childbirth? A primary survey of differently-managed health facilities in Odisha, India

“…A study conducted in Gujarat corroborated the findings of the present study that, after the introduction of PPP as a reformative measure through the Chiranjeevi Yojana in the healthcare, the institutional birth rose from 40.7% in 2001 to 89.3% in 2010. 21 Another study undertaken in Odisha critically examined the performance of Primary health centres (PHC) under government (PHC-GOV), NGO (PHC-NGO) and corporate (PHC-COR) and found that, there is no significant variation in the breadth and depth of services across all the three models of PHC management. The study further argued that, PHC-GOV had better accessibility, infrastructure, behaviour of doctors and availability of Note: The numbers of treated and controls refer to actual nearest neighbour.…”

“…The study was explorative in nature conducted during January to March 2016 in Odishaa high-focused state for its poor maternal health indicators in India. 8,21 Respondents were selected cross-sectionally from three differently-managed i.e. public, private and publicprivate partnership (PPP) health facilities.…”