Utilization of the state led public private partnership program 'Chiranjeevi Yojana' to promote facility births in Gujarat, India: a cross sectional community based study
| Autor: | Sandul Yasobant, Ayesha De Costa, Kranti Vora, Dileep Mavalankar, Kristi Sidney Annerstedt, Hemant Deepak Shewade, Petros Isaakidis, Nishith Dholakia |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Maternal mortality medicine.medical_specialty Adolescent 030231 tropical medicine Developing country India Public-Private Sector Partnerships Vulnerable Populations Health Services Accessibility Health administration Young Adult 03 medical and health sciences 0302 clinical medicine Nursing Pregnancy Surveys and Questionnaires medicine Humans Childbirth Maternal Health Services 030212 general & internal medicine Institutional delivery Cesarean Section business.industry Health Policy Public health Nursing research Public sector 1. No poverty Health Care Costs Delivery Obstetric Private sector Demand side financing 3. Good health Chiranjeevi Yojana Public–private partnership Utilization Cross-Sectional Studies Socioeconomic Factors Family medicine Multivariate Analysis Female Health Facilities business Research Article |
| Zdroj: | BMC Health Services Research |
| Popis: | Background: “Chiranjeevi Yojana (CY)”, a state-led large-scale demand-side financing scheme (DSF) under public-private partnership to increase institutional delivery, has been implemented across Gujarat state, India since 2005. The scheme aims to provide free institutional childbirth services in accredited private health facilities to women from socially disadvantaged groups (eligible women). These services are paid for by the state to the private facility with the intention of service being free to the user. This community-based study estimates CY uptake among eligible women and explores factors associated with non-utilization of the CY program.Methods: This was a community-based cross sectional survey of eligible women who gave birth between January and July 2013 in 142 selected villages of three districts in Gujarat. A structured questionnaire was administered by trained research assistant to collect information on socio-demographic details, pregnancy details, details of childbirth and out-of-pocket (OOP) expenses incurred. A multivariable inferential analysis was done to explore the factors associated with non-utilization of the CY program.Results: Out of 2,143 eligible women, 559 (26 %) gave birth under the CY program. A further 436(20 %) delivered at free public facilities, 713(33 %) at private facilities (OOP payment) and 435(20 %) at home. Eligible women who belonged to either scheduled tribe or poor [aOR = 3.1, 95 % CI:2.4 - 3.8] or having no formal education [aOR = 1.6, 95 % CI:1.1, 2.2] and who delivered by C-section [aOR = 2.1,95 % CI: 1.2, 3.8] had higher odds of not utilizing CY program. Of births at CY accredited facilities (n = 924), non-utilization was 40 % (n = 365) mostly because of lack of required official documentation that proved eligibility (72 % of eligible non-users). Women who utilized the CY program overall paid more than women who delivered in the free public facilities.Conclusion: Uptake of the CY among eligible women was low after almost a decade of implementation. Community level awareness programs are needed to increase participation among eligible women. OOP expense was incurred among who utilized CY program; this may be a factor associated with non-utilization in next pregnancy which needs to be studied. There is also a need to ensure financial protection of women who have C-section. |
| Databáze: | OpenAIRE |
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