maternal mortality Govt. of Gujarat launched scheme called Chiranjeevi Yojana ( CY) in Dec. Shortage of obstetricians in rural areas of India. The research. Background The Chiranjeevi Yojana (CY) is a Public-Private-Partnership between the state and private obstetricians in Gujarat, India, since. Effect of Chiranjeevi Yojana on institutional deliveries and neonatal and maternal outcomes in Gujarat, India: a difference-in-differences analysis.

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Maternal mortality is an important public-health issue in India, specifically in Gujarat. Contributing factors are the Government’s inability to operationalize the First Referral Units and to provide an adequate level of skilled birth attendants, especially to the poor. In response, the Gujarat state has developed a unique public-private partnership called the Cbiranjeevi Scheme.

This scheme focuses on institutional delivery, specifically emergency obstetric care for the poor. The objective of the study was to explore the targeting of the scheme, its coverage, and socioeconomic profile of the beneficiaries and to assess financial protection offered by the scheme, if any, in Dahod, one of the initial pilot districts of Gujarat.

The study provided insights on how to improve the scheme further. Such a financing scheme could be replicated in other states and countries to address the cost barrier, especially in areas where high numbers of private specialists are available. It is estimated that about 1. Given that the maternal mortality rate for the state is estimated at perlivebirths 1an estimated 2, of these mothers die from maternal causes.

The primary reason for these chifanjeevi deaths is that the majority of deliveries are not attended by skilled persons, women do not have access to emergency obstetric care EmOCand there is little postnatal follow-up. It is argued that most of these maternal deaths are avoidable with adequate interventions, such as skilled birth attendant SBAreferral services, and access to EmOC 2 – 5. Families below the poverty-line BPL are the most vulnerable since they face significant risk due to their poor socioeconomic status and limited access to healthcare services 6.

The Chiranjeevi Scheme, implemented by the Government of Gujarat, aims at encouraging the BPL families to access institutional delivery at a private hospital. This chirannjeevi done by providing financial protection to these families and covering their out-of-pocket costs incurred on travel to reach the healthcare facility. The scheme also provides financial support to the accompanying person for loss of wages. This card is issued to families earning less than a particular level of income and certain asset ownership criteria.

The BPL card helps identify this group of population for provision of various benefits and to target the benefits.

Chiranjeevi Yojana (CY) | The Center for Health Market Innovations

The Chiranjeevi Scheme was launched as chiranjeevk one-year pilot project in December in five backward districts: Banaskantha, Dahod, Kutch, Panchmahals, and Sabarkantha 7.

The scheme has now been extended to the entire state. When the scheme was initiated, the pilot districts were selected based on remoteness and included regions with the highest rate of infant mortality. The private medical practitioners mainly obstetricians in these districts were empanelled in the scheme to provide delivery-care services to BPL women. These care providers are reimbursed on a fixed rate for deliveries carried out by them 8.

Details of the financial package for the Chiranjeevi scheme 7. The Chiranjeevi Scheme was implemented on a pilot basis in five districts, including Dahod, starting in December The scheme involved creating a panel of private care providers who jojana accept referrals by the families covered under the scheme 9.

The medical officers and the Auxiliary Nurse Midwife ANM of the respective Subcentres undertake the responsibility of motivating the community BPL families yojaha take the benefit from the scheme. The ANM visits the communities and registers a pregnant woman for receiving antenatal care ANC ; at that time, she chiganjeevi women to avail of the Chiranjeevi Scheme. She encourages the pregnant woman to visit an empanelled chiiranjeevi.


Every yojanaa, the empanelled providers present their filled-in vouchers for deliveries conducted and claim their reimbursement. All five pilot districts were put in three groups based on their geographical proximity to each other. Group 1 was selected as it had the largest number of deliveries among the three groups.

Group 1 is also more backward, has more tribal population, and geographically in the east of the state. Group 2 districts are in the north of the state, are somewhat backwards, and has some tribal population in one of them. Group 3 has only one district of Kutch, which is geographically large, thinly populated, poor, chirankeevi deserted on north-west side of the state, bordering Pakistan.

District data on obstericians available, enrolled in the scheme and deliveries conducted in 5 pilot districts of Chiranjeevi scheme, The population of Dahod was 1, in when the study was implemented. The total number of deliveries in Dahod district was about 41, during assuming a crude birth rate of Using this as the basis, youana estimated number of BPL deliveries was about 9, per annum.

During7, deliveries were conducted under the Chiranjeevi Scheme.

This is based on the assumption that the BPL cards were issued only to the targeted population. The percentage of deliveries under Chiranjeevi Scheme yojanw about The total number of deliveries conducted in chirranjeevi district between December when the scheme started and March was 9, of which 7, were normal, by caesarean section lower segment caesarean sectionand 1, complicated.

On average, yojanx deliveries were conducted under the Chiranjeevi scheme in Dahod district per month. Within Dahod district, a multi-stage hierarchical cluster-sampling procedure was adopted to select households for data collection Fig. Data for the number of deliveries under the Chiranjeevi Scheme conducted in all seven talukas subdistrict of the district from January to December were obtained from the DHO of the district.

In the first stage of sampling, talukas of the district were classified as low, moderate, and high based on the number of deliveries under the Chiranjeevi Scheme. Three clusters of talukas were, thus, formed, and one taluka from each cluster was randomly picked.

In the second stage, yojaana falling under these three talukas were further classified into three clusters low, moderate, and high based on the number of deliveries conducted under the Chiranjeevi Scheme. Sample households were randomly selected in proportion to deliveries from the three clusters.

Two types of samples were chiranjwevi The sample size for the Chiranjeevi Scheme chirahjeevi was fixed at aroundgiven the available resources.

The final NCM sample was Initially, a pilot questionnaire was prepared which was later revised based on the field-testing. The questionnaire was divided into 10 sections, of which the first five, covering background characteristics, were the same for both CB and NCM.

Section 6 obstetric history of recent delivery in the Chiranjeevi Scheme7 details of neonatal care of the recent Chiranjeevi deliversand 8 knowledge and practice of Chiranjeevi Scheme were administered only to CB clients.

For CB clients, information was collected for both index and previous deliveries chirajeevi, in the case of NCM, only information on their index most recent delivery was collected. All the field investigators had prior experience in conducting field interviews in rural settings in the district-level household surveys.

Maternal Healthcare Financing: Gujarat’s Chiranjeevi Scheme and Its Beneficiaries

They were trained for two days, of which the first day was on the structure of the questionnaire and chirwnjeevi second day was for conducting mock interviews. In all, there were four investigators conducting about interviews per day. The whole exercise of field survey took about two months. There was one field editor and one supervisor whose jobs were to validate the questionnaire in the field and check for logical inconsistencies.

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Age at marriage and parity: The mean age at marriage for the CB and non-Chiranjeevi mothers was The average number of children born to CB was 2.

As per the Censusthis figure for the women in Gujarat state stands at This also shows a high level of targeting of the scheme to the poor. Chiranjeevi beneficiaries are not supposed to bear any expense relating to delivery, as the Government pays all the costs of chirxnjeevi directly, and they are to pay the women for transport and funds to the accompanying person. To assess this aspect of the scheme, the survey collected information on expenditure incurred by the CB and the NCM group.

These expenses were further analyzed in terms of expenditure incurred on self and child’s medicines, transportation costs, and other out-of-pocket expenditure.

The CB, an average, incurred an expenditure of Rs 3, on their previous institutional delivery; this is before the scheme started. Rs for self and Rs for the neonate. Rs 1, paid to the care provider per case basis. The Chiranjeevi beneficiaries are getting Rs for transportation from the service provider as per the yojanaa benefit.

They reported spending, on average, Rsthus incurring an additional out-of-pocket expenditure of Rs The NCM spent, on average, Rs 2, for a normal delivery. This amount includes consultancy and procedure chiranjeevu of Rs 1, paid to the doctor, transportation cost of Rsand medicine cost of Rs The weighted average for normal and complicated delivery cost for NCM came to be Rs 4, As per the design of the Chiranjeevi package, there is a provision of Rs for providing diet to clients during hospitalization.

Maternal Healthcare Financing: Gujarat’s Chiranjeevi Scheme and Its Beneficiaries

Our survey showed that only 8. The average number of ANC visits made by the clients was 2. Transportation, distance travelled, and time taken: The Chiranjeevi clients used rickshaw most commonlyjeep, and chhakdo an indigenous mechanized mode of transportation to reach the healthcare facility for delivery.

All modes of transportation are motorized, and most are private. No government ambulance was used for transportation. On average, the CB travelled Although all deliveries under the Chiranjeevi Scheme are supposed to be in the hospital of private empanelled doctors, only one delivery 0.

There was some indication that more complicated deliveries were going to the Chiranjeevi Scheme. The percentage of deliveries conducted by private doctors was 41 in the case of CB and 32 in the case of NCM deliveries.

This percentage for the NCM group was The key difference here lies in the deliveries conducted by trained and untrained attendants. The questionnaire did not seek this information from the NCMs. All beneficiaries mentioned that they possessed a BPL card. The respondents who used the Chiranjeevi Scheme were asked to provide suggestions for improving the scheme. The availability of medicines was identified as one important factor to improve services.

Around a quarter of the clients suggested providing medicines to the beneficiaries under the Chiranjeevi Scheme to improve it. Another suggestion was to improve proximity of the community to the healthcare facility. Ninety-four of the CB have an annual income below Rs 12, which comes to Rs This suggests that the scheme achieved its objective of targeting the poor.