Chiranjeevi Yojana (CY) is a performance-based financing (PBF) programme in the Indian state of Gujarat that aims to increase access to free delivery care for poor women. The state makes a fixed payment to accredited private hospitals per 100 deliveries performed, regardless of vaginal and caesarean section delivery proportions. CY has been operational for 6 years with over 600 000 women having benefited from the programme. In Gujarat, caesarean sections are higher among private facilities (18%) compared with public facilities (14%). Other PBF programmes report an increase in caesarean sections with improved access to delivery care. The present study compares the proportion of caesarean section deliveries among CY beneficiaries and non-beneficiaries in private facilities to study the impact of the programme on the proportion of caesarean section deliveries in the Sabarkantha district of Gujarat, especially among women who need caesarean section deliveries.


A cross-sectional survey of mothers delivering in 66 high-load (>30 deliveries per 3 months) private facilities (CY and non-CY) was done in the Sabarkantha district of Gujarat, India in 2012. Demographic and delivery care information was collected in the facilities.


224 mothers from 23 CY-accredited facilities and 372 from 43 non-CY facilities were interviewed. Caesarean section rates among CY beneficiaries were 6% (six of 97), compared with 18% (14 of 79) among non-beneficiaries in CY facilities. Non-CY programme mothers were three times more likely to have a caesarean section than were CY mothers, even after controlling for maternal age and antenatal and intranatal complications (odds ratio 3·02, 95% CI 1·06—8·57) in a logistic regression model.


Caesarean sections among CY beneficiaries were significantly lower than were those among non-beneficiaries in private facilities, contrary to reports from other PBF schemes and proportions in state-run hospitals. The non-differential financing mechanism had an embedded disincentive to prevent the overuse of caesarean section deliveries. Low caesarean section proportions could also possibly be due to the selection of clients by the accredited facilities. Given the size of the programme, it is important to explore if all women with necessary indications receive caesarean sections in the programme.


Resource Information

Author/s: Parvathy Raman, Dileep Mavalankar, Veena Iyer, Kristi Sydney, Rajesh Mehta, K Vora
Countries: India
Date of Publication: June 2013

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