Considerations of private sector obstetricians on participation in the state led “Chiranjeevi Yojana” scheme to promote institutional delivery in Gujarat, India: a qualitative study

BMC Pregnancy and Childbirth

Helen Smith⁴  Dileep Mavalankar³  Ayesha de Costa¹  Kate Jehan²  Parthasarathi Ganguly³ 

[1] Division of Global Health, Karolinska Institute, NobelsVäg 9, Stockholm, Sweden;Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK;Indian Institute of Public Health Gandhinagar (IIPHG), Ahmedabad, Gujarat, India;School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK

关键词: India;    Caesarean section (C-section);    Access to health care;    Demand side financing;    Chiranjeevi Yojana;    Maternal health;    Private sector;    Performance based financing;    Public private partnership;   

Others  :  1091896
DOI  :  10.1186/1471-2393-14-352

 received in 2014-03-03, accepted in 2014-08-17,  发布年份 2014

【 摘 要 】

Background

In India a lack of access to emergency obstetric care contributes to maternal deaths. In 2005 Gujarat state launched a public-private partnership (PPP) programme, Chiranjeevi Yojana (CY), under which the state pays accredited private obstetricians a fixed fee for providing free intrapartum care to poor and tribal women. A million women have delivered under CY so far. The participation of private obstetricians in the partnership is central to the programme’s effectiveness. We explored with private obstetricians the reasons and experiences that influenced their decisions to participate in the CY programme.

Method

In this qualitative study we interviewed 24 purposefully selected private obstetricians in Gujarat. We explored their views on the scheme, the reasons and experiences leading up to decisions to participate, not participate or withdraw from the CY, as well as their opinions about the scheme’s impact. We analysed data using the Framework approach.

Results

Participants expressed a tension between doing public good and making a profit. Bureaucratic procedures and perceptions of programme misuse seemed to influence providers to withdraw from the programme or not participate at all. Providers feared that participating in CY would lower the status of their practices and some were deterred by the likelihood of more clinically difficult cases among eligible CY beneficiaries. Some providers resented taking on what they saw as a state responsibility to provide safe maternity services to poor women. Younger obstetricians in the process of establishing private practices, and those in more remote, ‘less competitive’ areas, were more willing to participate in CY. Some doctors had reservations over the quality of care that doctors could provide given the financial constraints of the scheme.

Conclusions

While some private obstetricians willingly participate in CY and are satisfied with its functioning, a larger number shared concerns about participation. Operational difficulties and a trust deficit between the public and private health sectors affect retention of private providers in the scheme. Further refinement of the scheme, in consultation with private partners, and trust building initiatives could strengthen the programme. These findings offer lessons to those developing public-private partnerships to widen access to health services for underprivileged groups.

【 授权许可】

   
2014 Ganguly et al.; licensee BioMed Central Ltd.

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