Gujarat's Chirajeevi Yojana fails to deliver

US$ 32 million given to private healthcare sector under the scheme to improve maternal and child health, but childbirth-related complications decreased only 6.16 per cent

 
By Jyotsna Singh
Last Updated: Monday 17 August 2015

Gujarat government's Chiranjeevi Yojana for improving maternal and child health has not produced the desired results despite payment of over US $ 32 million to private healthcare providers as of 2012. The rate of institutional delivery or birth-related complications do not differ signifcantly between beneficiaries of the programme and others. The programme, launched in 2005 as a public-private partnership, has failed to deliver on the promise of reduction in household spending on private-sector deliveries, says a paper published in World Health Organization's journal, Bulletin.

Institutional delivery increased a mere 2.42 per cent in districts where the programme was running. Complications during childbirth decreased by 6.16 per cent.  Survey data suggests that 54 per cent mothers suffered complications, that included premature delivery, prolonged and obstructed labour, excessive bleeding, breech presentation, convulsions, hypertension, fever, incontinence or other birth-related problems. The probability of these complications did not significantly change with the Chiranjeevi Yojana programme. Analysis of household expenditures indicated that spending on private-sector deliveries had either not fallen or had fallen very little in spite of the programme.

The paper—Effect of Chiranjeevi Yojana on institutional deliveries and neonatal and maternal outcomes in Gujarat, India—analysed data collected from a survey of 5,597 households across Gujarat. In the study, led by Manoj Mohanan of Duke University, United States of America, the researchers collected data in 2010 about deliveries that took place from 2005 to 2010. Some districts had started the programme earlier than the others. The paper compared the results of the two. Researchers also used data from the District Level Household and Facility Survey (DLHFS) of Gujarat, conducted in 2007-08 that covered 6,484 households in all 26 districts of Gujarat to arrive at the conclusions.

The researchers collected data from the five northern districts of Banaskantha, Dahod, Kachchh, Panch Mahal and Sabarkantha, where the programme was first implemented in 2006. This was compared with data from other 21 districts where the programme was implemented later in phases.

"We use the timing of births ... together with mother’s district of residence to determine if the Chiranjeevi Yojana programme had been implemented when a delivery occurred," said the researchers about the methodology of the paper.

People still pay from their pocket

The researchers note in the paper: "even if the programme has not increased institutional delivery rates, we would expect to see lower mean household expenditures on deliveries given that the programme had paid providers over US$ 32 million as of 2012." The data revealed that the spending in private sector has decreased by 2.69 per cent.


Chiranjeevi Yojana covers the costs of delivery at designated private-sector hospitals for women from below povertyline (BPL) households. Under the programme the designated private sector hospitals are paid Rs 1,600 per delivery. In exchange, the programme expects the hospitals to offer vaginal deliveries or Caesarean sections to poor women free of charge and to reimburse at least some of the women’s travel costs. The hospitals can offer additional hospital services to beneficiaries for a separate fee.

The latest DLHFS of Gujarat showed similar trends (see box).

Primary outcomes of the Chiranjeevi Yojana recorded for 2005, before the programme was launched, and for 2008, after the programme's state-wide implementation
S. No. % of deliveries in year Present study DLHS-3
    2005 2008 2005 2008
1 In govt health facility 49.7 46.7 49.9 49
2 In private health facility 49.4 49.4 48.2 48.9
3 Assisted by physician or nurse 48.7 44.9 49.1 47.6
4 Normal delivery 23.4 25.9 29 27.8
5 Complicated delivery 49.6 49.9 49.9 49.7


A public health expert from Gujarat said that compared to the rest of the nation, the state had high proportion of institutional deliveries in private hospitals for many decades. Thus, Chiranjeevi Yojana would not make much difference. However, she said, the programme has reduced maternal mortality. According to a study, still to be published, maternal mortality was found to be one in every thousand women in Banaskantha. National average for the same is two in every thousand women.

"Such programmes need strong monitoring, which is absent most of the times. To improve health of mother and child, primary health centres have to be improved. Also, the governmnet needs to invest heavily on awareness campaigns," said Indu Capoor, founder director, Centre for Health Education, Training and Nutrition Awareness (CHETNA) in Ahmedabad.

Reasons for low institutional delivery

The paper gives two main reasons for observing no increase in institutional delivery despite the programme. "One is that the quality of services provided by private maternity hospitals is poor or, at least, is perceived to be poor by the local population. As a result, demand for institutional delivery may be low even if such delivery is provided free of charge," read the concluding remarks of the paper. Another reason given is that despite the support of the programme, institutional deliveries in Gujarat remain associated with large transportation costs, informal payments or other expenses that make programme benefits small relative to the full cost of institutional delivery.

 


Maternity Benefit Act, 1961

State of the Worlds Mothers 2011

Effect of monetary incentives on institutional deliveries: evidence from the Janani Suraksha Yojna in India

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