Ganguly Parthasarathi, Jehan Kate, de Costa Ayesha, Mavalankar Dileep, Smith Helen
Indian Institute of Public Health Gandhinagar (IIPHG), Ahmedabad, Gujarat, India.
BMC Pregnancy Childbirth. 2014 Nov 5;14:352. doi: 10.1186/1471-2393-14-352.
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.
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.
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.
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.
在印度，缺乏紧急产科护理服务是导致孕产妇死亡的原因之一。2005年，古吉拉特邦启动了一项公私合作（PPP）项目——奇兰吉维计划（CY），根据该计划，邦政府向获得认证的私人产科医生支付固定费用，以便他们为贫困和部落妇女提供免费的分娩期护理。到目前为止，已有100万妇女在CY项目下分娩。私人产科医生参与该合作项目是该计划取得成效的关键。我们与私人产科医生探讨了影响他们参与CY项目决策的原因和经历。
在这项定性研究中，我们对古吉拉特邦24名经过有目的挑选的私人产科医生进行了访谈。我们探讨了他们对该计划的看法、参与、不参与或退出CY项目决策之前的原因和经历，以及他们对该计划影响的看法。我们使用框架分析法对数据进行了分析。
参与者表示在公益与盈利之间存在矛盾。官僚程序以及对项目滥用的看法似乎影响了医疗服务提供者退出该项目或根本不参与。医疗服务提供者担心参与CY项目会降低他们诊所的地位，一些人还因CY项目合格受益者中临床情况更复杂的可能性而望而却步。一些医疗服务提供者对承担他们所认为的为贫困妇女提供安全孕产服务的国家责任表示不满。处于建立私人诊所过程中的年轻产科医生，以及那些在更偏远、“竞争较小”地区的医生，更愿意参与CY项目。一些医生对在该计划资金限制下医生所能提供的护理质量有所保留。
虽然一些私人产科医生愿意参与CY项目并对其运作感到满意，但更多人对参与该项目存在担忧。公私卫生部门之间的操作困难和信任赤字影响了私人医疗服务提供者继续参与该计划。与私人合作伙伴协商进一步完善该计划以及开展信任建设举措可以加强该项目。这些研究结果为那些发展公私合作关系以扩大弱势群体获得医疗服务机会的人提供了经验教训。
