De Costa Ayesha, Vora Kranti S, Ryan Kayleigh, Sankara Raman Parvathy, Santacatterina Michele, Mavalankar Dileep
Dept of Public Health Sciences, Karolinska Insitutet, Stockholm, Sweden.
Indian Institute of Public Health, Gandhinagar, Gujarat, India.
PLoS One. 2014 May 1;9(5):e95704. doi: 10.1371/journal.pone.0095704. eCollection 2014.
Many low-middle income countries have focused on improving access to and quality of obstetric care, as part of promoting a facility based intra-partum care strategy to reduce maternal mortality. The state of Gujarat in India, implements a facility based intra-partum care program through its large for-profit private obstetric sector, under a state-led public-private-partnership, the Chiranjeevi Yojana (CY), under which the state pays accredited private obstetricians to perform deliveries for poor/tribal women. We examine CY performance, its contribution to overall trends in institutional deliveries in Gujarat over the last decade and its effect on private and public sector deliveries there.
District level institutional delivery data (public, private, CY), national surveys, poverty estimates, census data were used. Institutional delivery trends in Gujarat 2000-2010 are presented; including contributions of different sectors and CY. Piece-wise regression was used to study the influence of the CY program on public and private sector institutional delivery.
Institutional delivery rose from 40.7% (2001) to 89.3% (2010), driven by sharp increases in private sector deliveries. Public sector and CY contributed 25-29% and 13-16% respectively of all deliveries each year. In 2007, 860 of 2000 private obstetricians participated in CY. Since 2007, >600,000 CY deliveries occurred i.e. one-third of births in the target population. Caesareans under CY were 6%, higher than the 2% reported among poor women by the DLHS survey just before CY. CY did not influence the already rising proportion of private sector deliveries in Gujarat.
This paper reports a state-led, fully state-funded, large-scale public-private partnership to improve poor women's access to institutional delivery - there have been >600,000 beneficiaries. While caesarean proportions are higher under CY than before, it is uncertain if all beneficiaries who require sections receive these. Other issues to explore include quality of care, provider attrition and the relatively low coverage.
许多中低收入国家都将重点放在改善产科护理的可及性和质量上，以此作为推行基于医疗机构的产时护理策略以降低孕产妇死亡率的一部分。印度古吉拉特邦通过其庞大的营利性私立产科部门，在一项由政府主导的公私合营项目“奇兰吉维计划”（CY）下实施基于医疗机构的产时护理项目，该计划中，政府向获得认证的私立产科医生付费，让其为贫困/部落妇女接生。我们研究了CY的成效、其在过去十年里对古吉拉特邦机构分娩总体趋势的贡献以及对该邦私立和公立部门分娩的影响。
使用了地区层面的机构分娩数据（公立、私立、CY）、全国性调查、贫困估计数据、人口普查数据。呈现了古吉拉特邦2000 - 2010年的机构分娩趋势；包括不同部门和CY的贡献。采用分段回归来研究CY项目对公立和私立部门机构分娩的影响。
在私立部门分娩急剧增加的推动下，机构分娩率从2001年的40.7%升至2010年的89.3%。公立部门和CY每年分别占所有分娩的25 - 29%和13 - 16%。2007年，2000名私立产科医生中有860名参与了CY。自2007年以来，发生了超过60万例CY接生，即目标人群中三分之一的分娩。CY项目下的剖腹产率为6%，高于CY实施前DLHS调查中贫困妇女报告的2%。CY并未影响古吉拉特邦私立部门分娩比例本就不断上升的趋势。
本文报道了一项由政府主导、全额政府资助的大规模公私合营项目，以改善贫困妇女获得机构分娩服务的机会——已有超过60万受益者。虽然CY项目下的剖腹产比例高于之前，但不确定所有需要剖腹产的受益者是否都能得到。其他有待探索的问题包括护理质量、提供者流失以及覆盖率相对较低的问题。
