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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?

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  • Ayesha De Costa
  • Kranti S Vora
  • Kayleigh Ryan
  • Parvathy Sankara Raman
  • Michele Santacatterina
  • Dileep Mavalankar

Abstract

Background: Many 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. Methods: District 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. Results: Institutional 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. Conclusion: This 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.

Suggested Citation

  • Ayesha De Costa & Kranti S Vora & Kayleigh Ryan & Parvathy Sankara Raman & Michele Santacatterina & Dileep Mavalankar, 2014. "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?," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-8, May.
  • Handle: RePEc:plo:pone00:0095704
    DOI: 10.1371/journal.pone.0095704
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    Cited by:

    1. Kuwawenaruwa, August & Ramsey, Kate & Binyaruka, Peter & Baraka, Jitihada & Manzi, Fatuma & Borghi, Josephine, 2019. "Implementation and effectiveness of free health insurance for the poor pregnant women in Tanzania: A mixed methods evaluation," Social Science & Medicine, Elsevier, vol. 225(C), pages 17-25.
    2. Evan Borkum & Dana Rotz & Anu Rangarajan & Swetha Sridharan & Sukhmani Sethi & Mercy Manoranjini & Lakshmi Ramakrishnan & Lalit Dandona & Rakhi Dandona & Priyanka S. Kochar & G. Anil Kumar & Priyanka , "undated". "Midline Findings from the Evaluation of the Ananya Program in Bihar," Mathematica Policy Research Reports 74ef56ababd9412b82ef906fc, Mathematica Policy Research.
    3. Benjamin M Hunter & Sean Harrison & Anayda Portela & Debra Bick, 2017. "The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-37, March.
    4. Iqbal Anwar & Herfina Y Nababan & Shabnam Mostari & Aminur Rahman & Jahangir A M Khan, 2015. "Trends and Inequities in Use of Maternal Health Care Services in Bangladesh, 1991-2011," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-14, March.

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