De Costa, Ayesha,  Kranti S. Vora, Kayleigh Ryan, Parvathy Sankara Raman, Michele Santacatterina, and Dileep Mavalankar. “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 9, no. 5 (2014). DOI: 10.1371/journal.pone.0095704

URL: www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0095704

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.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.

In Gujarat, India, the state has implemented a public-private partnership in which the state pays private obstetricians to deliver babies for women from poor, tribal areas. De Costa et al. assess the impact of this intervention, finding that the number of deliveries in a healthcare facility improved dramatically during the time the program was in place.