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Utilization of a State Run Public Private Emergency Transportation Service Exclusively for Childbirth: The Janani (Maternal) Express Program in Madhya Pradesh, India

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  • Kristi Sidney
  • Kayleigh Ryan
  • Vishal Diwan
  • Ayesha De Costa

Abstract

Background: In 2009 the state government of Madhya Pradesh, India launched an emergency obstetric transportation service, Janani Express Yojana (JEY), to support the cash transfer program that promotes institutional delivery. JEY, a large scale public private partnership, lowers geographical access barriers to facility based care. The state contracts and pays private agencies to provide emergency transportation at no cost to the user. The objective was to study (a) the utilization of JEY among women delivering in health facilities, (b) factors associated with usage, (c) the timeliness of the service. Methods: A cross sectional facility based study was conducted in facilities that carried out > ten deliveries a month. Researchers who spent five days in each facility administered a questionnaire to all women who gave birth there to elicit socio-demographic characteristics and transport related details. Results: 35% of women utilised JEY to reach a facility, however utilization varied between study districts. Uptake was highest among women from rural areas (44%), scheduled tribes (55%), and poorly educated women (40%). Living in rural areas and belonging to scheduled tribes were significant predictors for JEY usage. Almost 1/3 of JEY users (n = 104) experienced a transport related delay. Discussion: The JEY service model complements the cash transfer program by providing transport to a facility to give birth. A study of the distribution of utilization in population subgroups suggests the intervention was successful in reaching the most vulnerable population, promoting equity in access. While 1/3 of women utilized the service and it saved them money; 30% experienced significant transport related delays in reaching a facility, which is comparable to women using public transportation. Further research is needed to understand why utilization is low, to explore if there is a need for service expansion at the community level and to improve the overall time efficiency of JEY.

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  • Kristi Sidney & Kayleigh Ryan & Vishal Diwan & Ayesha De Costa, 2014. "Utilization of a State Run Public Private Emergency Transportation Service Exclusively for Childbirth: The Janani (Maternal) Express Program in Madhya Pradesh, India," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-9, May.
    • Handle: RePEc:plo:pone00:0096287
    DOI: 10.1371/journal.pone.0096287
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    1. Thaddeus, Sereen & Maine, Deborah, 1994. "Too far to walk: Maternal mortality in context," Social Science & Medicine, Elsevier, vol. 38(8), pages 1091-1110, April.
    2. Carsten Schmidt & Thomas Kohlmann, 2008. "When to use the odds ratio or the relative risk?," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 53(3), pages 165-167, June.
    3. Richard, F. & Witter, S. & De Brouwere, V., 2010. "Innovative approaches to reducing financial barriers to obstetric care in low-income countries," American Journal of Public Health, American Public Health Association, vol. 100(10), pages 1845-1852.
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    1. Ahmed Ramdan M. Alanazy & Stuart Wark & John Fraser & Amanda Nagle, 2019. "Factors Impacting Patient Outcomes Associated with Use of Emergency Medical Services Operating in Urban Versus Rural Areas: A Systematic Review," IJERPH, MDPI, vol. 16(10), pages 1-16, May.
    2. Shankar Prinja & Pankaj Bahuguna & P V M Lakshmi & Tushar Mokashi & Arun Kumar Aggarwal & Manmeet Kaur & K Rahul Reddy & Rajesh Kumar, 2014. "Evaluation of Publicly Financed and Privately Delivered Model of Emergency Referral Services for Maternal and Child Health Care in India," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-11, October.

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