Utilization of the state led public private partnership program -Chiranjeevi Yojana- to promote facility births in Gujarat, India: a cross sectional community based studyReportar como inadecuado




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BMC Health Services Research

, 16:266

Utilization, expenditure, economics and financing systems

Abstract

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.

MethodsThis 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.

ResultsOut of 2,143 eligible women, 559 26 % gave birth under the CY program. A further 43620 % delivered at free public facilities, 71333 % at private facilities OOP payment and 43520 % 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.

ConclusionUptake 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.

KeywordsMaternal mortality Chiranjeevi Yojana Demand side financing Utilization Institutional delivery India  Download fulltext PDF



Autor: Sandul Yasobant - Kranti Suresh Vora - Hemant Deepak Shewade - Kristi Sidney Annerstedt - Petros Isaakidis - Dileep V. M

Fuente: https://link.springer.com/







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