Launched in 2006, Chiranjeevi Yojana (CY) is a large performance-based financing programme in Gujarat, India, which aims to provide free delivery care for poor and tribal women. The programme capitalises on the huge private health sector in the state and offers accredited private hospitals a fixed payment for providing free maternity services to vulnerable women. To date, more than 600 000 women have benefited from the programme. However, there has not been a systematic state-wide impact evaluation. The goal of this study is to explore the effect of CY on public—private maternal health service provision and on maternal mortality.
Based on data obtained from the Health Management Information System (HMIS), we assessed the effect of CY on public and private institutional deliveries across all districts from 2006 to 2010. In addition, we evaluated the programme's impact on maternal mortality by examining the association between maternal mortality ratios (MMR) and the proportion of CY-supported deliveries at the district level. A mixed effects regression model, which takes into account various socioeconomic variables, was applied.
Institutional deliveries in Gujarat increased by 23·8%, from 818 398 of 1 200 473 deliveries (68·2%) in 2006 to 1 071 653 of 1 164 841 (92·0%) in 2010. Over 99% (251 061 of 253 254) of the overall increase occurred in the private sectors. The proportion of CY-supported deliveries among all private institutional deliveries increased from 9·3% (47 706 of 510 343) in 2006 to 19·8% (150 979 of 761 408) in 2010. Results from the regression analysis suggested that the impact of CY varied considerably across districts. Significant association between MMR and CY-supported deliveries was found in a few districts.
This study is the first to systematically explore the state-wide impact of CY. Considering the dominant role played by the private health sector in India, the findings indicate that the private—public partnership schemes can potentially be an effective strategy for enhancing maternal health-care access. Nevertheless, the current study is subject to limitation in data quality, and further studies are required.