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Gujarat's Chiranjeevi Yojana program fails to improve maternal health in India

A new study has suggested that the Chiranjeevi Yojana program in Gujarat, that claimed to reduce infant and maternal deaths in rural India by encouraging mothers to deliver in private hospitals, has been unsuccessful, despite the investment of more than 25 million dollars since 2005.

The program was launched in 2006 to help address the shortage of obstetricians at public hospitals accessible to low-income women in rural areas. It aimed to provide free childbirth care at participating private-sector hospitals to women who are below the poverty line.

The hospitals are paid 1600 rupees per delivery. The hospitals may offer additional services to patients and charge separate fees for them. By 2012, approximately 800 private-sector hospitals were participating and the program had helped pay for more than 800,000 deliveries.

Lead researcher Manoj Mohanan from Duke University along with his team surveyed 5,597 households in Gujarat to collect data on births that had occurred between 2005 and 2010.

They found no statistically significant change in the probability of delivery in health care institutions, the probability of obstetric complications or the probability that physicians or nurses were present during childbirth.

While the study did not determine why patients' delivery costs did not decline or why the program is ineffective, several explanations are possible, Mohanan said.

Media reports in India suggest that despite the promise of free care, hospitals were billing women for extra, chargeable services. Providers also complained that the reimbursement amounts were not adequate to cover costs of providing the service.

In addition, mothers may perceive the quality of care at participating private hospitals to be poor, so even when the care is provided for free, demand does not rise. Transportation costs from rural villages also could be a factor, he said.

The study is published in journal Bulletin of the World Health Organization.