The Journal of Health, Population and Nutrition
Vol. 35, No. 1, 2016, pp. 1-10
Bioline Code: hn16023
Full paper language: English
Document type: Research Article
Document available free of charge
The Journal of Health, Population and Nutrition, Vol. 35, No. 1, 2016, pp. 1-10
© Copyright 2016 - The Journal of Health, Population and Nutrition
Statewide program to promote institutional delivery in Gujarat, India: who participates and the degree of financial subsidy provided by the Chiranjeevi Yojana program|
Sidney, Kristi; Iyer, Veena; Vora, Kranti; Mavalankar, Dileep & De Costa, Ayesha
Background: The Chiranjeevi Yojana (CY) is a large public-private partnership program in Gujarat, India, under which
the state pays private sector obstetricians to provide childbirth services to poor and tribal women. The CY was initiated
statewide in 2007 because of the limited ability of the public health sector to provide emergency obstetric care and
high out-of-pocket expenditures in the private sector (where most qualified obstetricians work), creating financial
access barriers for poor women. Despite a million beneficiaries, there have been few reports studying CY, particularly
the proportion of vulnerable women being covered, the expenditures they incur in connection with childbirth, and the
level of subsidy provided to beneficiaries by the program.
Methods: Cross-sectional facility based the survey of participants in three districts of Gujarat in 2012–2013. Women
were interviewed to elicit sociodemographic characteristics, out-of-pocket expenditures, and CY program details.
Descriptive statistics, chi square, and a multivariable logistic regression were performed.
Results: Of the 901 women surveyed in 129 facilities, 150 (16 %) were CY beneficiaries; 336 and 415 delivered in
government and private facilities, respectively. Only 36 (24 %) of the 150 CY beneficiaries received a completely
cashless delivery. Median out-of-pocket for vaginal/cesarean delivery among CY beneficiaries was $7/$71. The median
degree of subsidy for women in CY who delivered vaginally/cesarean was 85/71 % compared to out-of-pocket
expenditure of $44/$208 for vaginal/cesarean delivery paid by non-program beneficiaries in the private health sector.
Conclusions: CY beneficiaries experienced a substantially subsidized childbirth compared to women who delivered in
non-accredited private facilities. However, despite the government’s efforts at increasing access to delivery services for
poor women in the private sector, uptake was low and very few women experienced a cashless delivery. While the
long-term focus remains on strengthening the public sector’s ability to provide emergency obstetric care, the CY
program is a potential means by which the state can ensure its poor mothers have access to necessary care if uptake
Maternal health; Out-of-pocket expenditures; Demand-side financing; Chiranjeevi Yojana; Public-private partnership; India
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