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LATEST NEWS UPDATES | Gujarat's maternal health scheme is a failure: Study -Padmaparna Ghosh

Gujarat's maternal health scheme is a failure: Study -Padmaparna Ghosh

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published Published on Dec 30, 2013   modified Modified on Dec 30, 2013
-The Times of India


Gujarat's much-touted Chiranjeevi Yojana, launched in 2006 to reduce maternal and infant mortality rates in BPL households, has not had any significant impact, says a new study by Duke University.

The programme, which subsidizes the cost of delivery at designated private sector hospitals, has not led to increased probability of institutional child-delivery. Also, analyses of household expenditure of women who used the subsidized delivery scheme in private hospitals either did not fall or fell only marginally. The findings were published online this month by the peer-reviewed international public health journal, Bulletin of the World Health Organization.

The Gujarat government had launched this programme to boost institutional delivery rates among poor women with no access to key healthcare services. Hospital deliveries are considered the best option for improving maternal health. The programme pays Rs 1,600 per delivery to the hospitals to provide free deliveries and also to reimburse at least some of the women's travel costs.

The programme, in fact, received the Asian Innovations Award in 2006 and is considered a scheme that should be replicated in other states. It was Karnataka's interest in the replication of the scheme that led the researchers to probe its effectiveness. The Duke study explains that the perceptions of the programme's success are based on the results of studies - simple cross-sectional investigations or before-and-after comparisons - that had severe limitations.

Earlier studies have indicated substantial benefits of the programme, including a 27% increase in institutional deliveries, a 90% reduction in maternal deaths and a 60% reduction in neonatal deaths. However, these earlier studies did not address women from BPL category who opted to go in for institutional delivery and not through the yojana, reporting inaccuracies by hospitals, and increases in institutional deliveries unrelated to the programme. "The programme was rolled out in a period when the economy of Gujarat was growing by over 10% per year, for example," said the study.

"Previous studies had looked at results only in the hospitals which were providing this service. We looked at the complete BPL criteria and population groups that delivered during that time. If the programme leads to more people using it, you should see that difference over time but we found a trend that looks similar to the one before the yojana. We had come to the table to find a programme so successful and impressive in ambition was not being used by half the people who were eligible for it," says Manoj Mohanan, assistant professor of Public Policy at Duke University and lead researcher on the study.

Mohanan says the huge countrywide problem of accurate BPL classification of the population is the reason the success of the campaign was misread. "Forty percent of our households above BPL have the BPL card but 45% below it do not have the card. It is a clear case of leakage and not reaching the correct population. We also found reports of providers charging extra for other services. And the Economic and Political Weekly also reported that a lot of empanelled hospitals were in the urban areas that creates a large cost of access (transport etc) to these services," he says.

In the survey - conducted in August to September 2010 - researchers collected retrospective information from a state-wide sample of women (5,597 households) who had had delivered since January 2005.

The study also looked at the quality of service and whether it affected the probability of complications during pregnancy and childbirth and concluded that 54% of the mothers in the sample suffered complications after the programme had been implemented - and that the probability of these complications did not significantly change under the Chiranjeevi Yojana programme.

What, however, puzzled the researchers most is the lack of or marginal association of the programme to costs of delivery. "At the end of the day, the private sector is the private sector. You need a monitoring system to check the extra costs that hospitals might be charging and to ensure proper implementation. The second is the costing. Is Rs 1,600 enough reimbursement to the hospital? I don't know how they came up with the number," said Mohanan.

He added that the success of the scheme needs to be scrutinized further before other states decide to adopt it.


The Times of India, 30 December, 2013, http://timesofindia.indiatimes.com/india/Gujarats-maternal-health-scheme-is-a-failure-Study/articleshow/28118995.cms


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