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Has Chiranjeevi Yojana changed the geographic availability of free comprehensive emergency obstetric care services in Gujarat, India?

Vora KS, Yasobant S, Patel A, Upadhyay A, Mavalankar DV - Glob Health Action (2015)

Bottom Line: This paper examines the CY's effectiveness in improving availability of CEmOC services between 2006 and 2012 in three districts of Gujarat, India.Our analysis suggests that the availability of CEmOC services within reasonable travel distance has greatly improved in all three study districts as a result of CY.We also show that the declining participation of the private sector did not result in an increase in distance to the nearest facility, but the extent of availability of providers for several villages was reduced.

View Article: PubMed Central - PubMed

Affiliation: Indian Institute of Public Health - Gandhinagar, Ahmedabad, India; kvora@iiphg.org.

ABSTRACT

Background: The high rate of maternal mortality in India is of grave concern. Poor rural Indian women are most vulnerable to preventable maternal deaths primarily because they have limited availability of affordable emergency obstetric care (EmOC) within reasonable geographic proximity. Scarcity of obstetricians in the public sector combined with financial barriers to accessing private sector obstetrician services preclude this underserved population from availing lifesaving functions of comprehensive EmOC such as C-section. In order to overcome this limitation, Government of Gujarat initiated a unique public-private partnership program called Chiranjeevi Yojana (CY) in 2005. The program envisaged leveraging private sector providers to increase availability and thereby accessibility of EmOC care for vulnerable sections of society. Under CY, private sector providers render obstetric care services to poor women at no cost to patients. This paper examines the CY's effectiveness in improving availability of CEmOC services between 2006 and 2012 in three districts of Gujarat, India.

Methods: Primary data on facility locations, EmOC functionality, and obstetric bed availability were collected in the years 2012 and 2013 in three study districts. Secondary data from Census 2001 and 2011 were used along with required geographic information from Topo sheets and Google Earth maps. ArcGIS version 10 was used to analyze the availability of services using two-step floating catchment area (2SFCA) method.

Results: Our analysis suggests that the availability of CEmOC services within reasonable travel distance has greatly improved in all three study districts as a result of CY. We also show that the declining participation of the private sector did not result in an increase in distance to the nearest facility, but the extent of availability of providers for several villages was reduced. Spatial and temporal analyses in this paper provide a comprehensive understanding of trends in the availability of EmOC services within reasonable travel distance.

Conclusions: This paper demonstrates how GIS could be useful for evaluating programs especially those focusing on improving availability and geographic accessibility. The study also shows usefulness of GIS for programmatic planning, particularly for optimizing resource allocation.

No MeSH data available.


(a–d) Changes in availability in Surendranagar district.
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Figure 0001: (a–d) Changes in availability in Surendranagar district.

Mentions: In Surendranagar, Ai increased from less than one bed per 100,000 before implementation of CY to nine beds per 100,000 population in 2006 after CY. It remained the same in 2009 and declined to eight beds per 100,000 population in 2012–2013. The consistently high proportion of villages without any CEmOC facilities within a 15 km radius in Surendranagar (red-colored areas in Fig. 1) suggests that CY did not succeed in improving the availability of CEmOC here. Participation of CY providers did not fluctuate in Surendranagar as much as it did in the other two districts, resulting in an overall lower availability after initial gain compared with other districts.


Has Chiranjeevi Yojana changed the geographic availability of free comprehensive emergency obstetric care services in Gujarat, India?

Vora KS, Yasobant S, Patel A, Upadhyay A, Mavalankar DV - Glob Health Action (2015)

(a–d) Changes in availability in Surendranagar district.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4596889&req=5

Figure 0001: (a–d) Changes in availability in Surendranagar district.
Mentions: In Surendranagar, Ai increased from less than one bed per 100,000 before implementation of CY to nine beds per 100,000 population in 2006 after CY. It remained the same in 2009 and declined to eight beds per 100,000 population in 2012–2013. The consistently high proportion of villages without any CEmOC facilities within a 15 km radius in Surendranagar (red-colored areas in Fig. 1) suggests that CY did not succeed in improving the availability of CEmOC here. Participation of CY providers did not fluctuate in Surendranagar as much as it did in the other two districts, resulting in an overall lower availability after initial gain compared with other districts.

Bottom Line: This paper examines the CY's effectiveness in improving availability of CEmOC services between 2006 and 2012 in three districts of Gujarat, India.Our analysis suggests that the availability of CEmOC services within reasonable travel distance has greatly improved in all three study districts as a result of CY.We also show that the declining participation of the private sector did not result in an increase in distance to the nearest facility, but the extent of availability of providers for several villages was reduced.

View Article: PubMed Central - PubMed

Affiliation: Indian Institute of Public Health - Gandhinagar, Ahmedabad, India; kvora@iiphg.org.

ABSTRACT

Background: The high rate of maternal mortality in India is of grave concern. Poor rural Indian women are most vulnerable to preventable maternal deaths primarily because they have limited availability of affordable emergency obstetric care (EmOC) within reasonable geographic proximity. Scarcity of obstetricians in the public sector combined with financial barriers to accessing private sector obstetrician services preclude this underserved population from availing lifesaving functions of comprehensive EmOC such as C-section. In order to overcome this limitation, Government of Gujarat initiated a unique public-private partnership program called Chiranjeevi Yojana (CY) in 2005. The program envisaged leveraging private sector providers to increase availability and thereby accessibility of EmOC care for vulnerable sections of society. Under CY, private sector providers render obstetric care services to poor women at no cost to patients. This paper examines the CY's effectiveness in improving availability of CEmOC services between 2006 and 2012 in three districts of Gujarat, India.

Methods: Primary data on facility locations, EmOC functionality, and obstetric bed availability were collected in the years 2012 and 2013 in three study districts. Secondary data from Census 2001 and 2011 were used along with required geographic information from Topo sheets and Google Earth maps. ArcGIS version 10 was used to analyze the availability of services using two-step floating catchment area (2SFCA) method.

Results: Our analysis suggests that the availability of CEmOC services within reasonable travel distance has greatly improved in all three study districts as a result of CY. We also show that the declining participation of the private sector did not result in an increase in distance to the nearest facility, but the extent of availability of providers for several villages was reduced. Spatial and temporal analyses in this paper provide a comprehensive understanding of trends in the availability of EmOC services within reasonable travel distance.

Conclusions: This paper demonstrates how GIS could be useful for evaluating programs especially those focusing on improving availability and geographic accessibility. The study also shows usefulness of GIS for programmatic planning, particularly for optimizing resource allocation.

No MeSH data available.