Effect of previous utilization and out-of-pocket expenditure on subsequent utilization of a state led public-private partnership scheme 'Chiranjeevi Yojana' to promote facility births in Gujarat, India

Autor: Kristi Sidney Annerstedt, Kranti Vora, Nishith Dholakia, Hemant Deepak Shewade, Petros Isaakidis, Dileep Mavalankar, Sandul Yasobant
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Gerontology
Adult
Gujarat
medicine.medical_specialty
Mothers
India
Public-Private Sector Partnerships
Vulnerable Populations
Health Services Accessibility
Health administration
03 medical and health sciences
symbols.namesake
0302 clinical medicine
Pregnancy
Medicine
Humans
Maternal Health Services
030212 general & internal medicine
Poisson regression
Obstetrics and Gynecology Department
Hospital
Facility birth
Home Childbirth
Retrospective Studies
030219 obstetrics & reproductive medicine
business.industry
Health Policy
Nursing research
Public health
lcsh:Public aspects of medicine
Retrospective cohort study
Chiranjeevi Yojana (CY)
lcsh:RA1-1270
Out of pocket expenditure (OOPE)
medicine.disease
Delivery
Obstetric
Public–private partnership
Utilization
Relative risk
symbols
Female
Health Facilities
Health Expenditures
business
Demography
Research Article
Zdroj: BMC Health Services Research, Vol 17, Iss 1, Pp 1-8 (2017)
BMC Health Services Research
ISSN: 1472-6963
DOI: 10.1186/s12913-017-2256-6
Popis: Background: In Gujarat, India, a state led public private partnership scheme to promote facility birth named Chiranjeevi Yojana (CY) was implemented in 2005. Institutional birth is provided free of cost at accredited private health facilities to women from socially disadvantaged groups (eligible women). CY has contributed in increasing facility birth and providing substantially subsidized (but not totally free) birth care; however, the retention of mothers in this scheme in subsequent child birth is unknown. Therefore, we conducted a study aimed to determine the effect of previous utilization of the scheme and previous out of pocket expenditure on subsequent child birth among multiparous eligible women in Gujarat.Methods: This was a retrospective cohort study of multiparous eligible women (after excluding abortions and births at public facility). A structured questionnaire was administered by trained research assistant to those with recent delivery between Jan and Jul 2013. Outcome of interest was CY utilization in subsequent child birth (Jan–Jul 2013). Explanatory variables included socio-demographic characteristics (including category of eligibility), pregnancy related characteristics in previous child birth, before Jan 2013, (including CY utilization, out of pocket expenditure) and type of child birth in subsequent birth. A poisson regression model was used to assess the association of factors with CY utilization in subsequent child birth.Results: Of 997 multiparous eligible women, 289 (29%) utilized and 708 (71%) did not utilize CY in their previous child birth. Of those who utilized CY (n = 289), 182 (63%) subsequently utilized CY and 33 (11%) gave birth at home; whereas those who did not utilize CY (n = 708) had four times higher risk (40% vs. 11%) of subsequent child birth at home. In multivariable models, previous utilization of the scheme was significantly associated with subsequent utilization (adjusted Relative Risk (aRR): 2.7; 95% CI: 2.2–3.3), however previous out of pocket expenditure was not found to be associated with retention in the CY scheme.Conclusion: Women with previous CY utilization were largely retained; therefore, steps to increase uptake of CY are expected to increase retention of mothers within CY in their subsequent child birth. To understand the reasons for subsequent child birth at home despite previous CY utilization and previous zero/minimal out of pocket expenditure, future research in the form of systematic qualitative enquiry is recommended.
Databáze: OpenAIRE
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