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‘Chiranjeevi Yojana’ (Plan for a long life): Public-private partnership to reduce maternal deaths in Gujarat, India

UNICEF Image
© UNICEF India/2008/Gurinder Gulati
Mother and baby girl at Saraswati Hospital in Manakpur.

Context and challenge: In rural Gujarat, lack of affordable obstetric care causes poor maternal health outcomes

In the western Indian state of Gujarat, the shortage of obstetricians and gynaecologists in the rural public health sector is one of the main factors undermining the provision of affordable maternal health services. According to the Government of India, rates of maternal mortality there from 2001 to 2003 were estimated at about 170 per 100,000 live births.

Financially vulnerable families living in rural areas often face the prospect of catastrophic spending on private care because the options for government-subsidized, quality maternal health services are spare. Low salaries, distances to be covered and inadequate infrastructure are some reasons why there are few health professionals in the rural public health sector.

The state of Gujarat is, however, strong in other arenas. Industry and entrepreneurship there are vibrant, and the non-governmental and private-sector have been known to contribute to health initiatives.

UNICEF Image
© UNICEF India/2008/Gurinder Gulati
Mother and baby boy being examined by a doctor at Kuldeep Maternity and Surgical Hospital in Gujarat.

Action: Partnership with private-sector obstetricians

To bridge the gap in availability of affordable quality maternal health services in rural areas, the state Government of Gujarat has contracted the services of private practitioners in small towns and villages under an innovative public-private partnership scheme, ‘Chiranjeevi Yojana’, or ‘plan for a long life’ (for mothers and children).

Chiranjeevi Yojana was initiated in five pilot districts in 2005 after consultations among the state government, local authorities, concerned health professionals and community members. Chiranjeevi Yojana seeks to ensure that skilled attendance at delivery and emergency obstetric care is available free of cost to all women living below the poverty line in these districts. To avail of the scheme, women need only carry identification confirming that their economic means are below the poverty line. Community auxiliary nurse midwives inform eligible women about the scheme when they receive antenatal care.

The state government pays private gynaecologists at the rate of Rs 1795 (USD $40) per delivery – including Rs 200 to the patient for transportation costs in getting to the place where she will deliver and Rs 50 for the person accompanying the patient to compensate for a loss in wages.

UNICEF Image
© UNICEF India/2008/Gurinder Gulati
Mother and baby boy resting at Kuldeep Maternity and Surgical Hospital in Gujarat.

Impact and opportunities: Higher rates of institutional delivery; need for further monitoring of quality of services

Showing remarkable successes, the programme has been expanded from 5 to all 25 districts of Gujarat. From January 2006 to March 2008, 180 doctors were enlisted. Nearly 100,000 deliveries were performed, with each doctor performing an average of 540.

The Chiranjeevi Yojana experience suggests that it may save lives —and make economic sense—to harness the energies of skilled providers in the private sector at the same time as the public sector builds capacity to cater to the needs of poor rural women. By ensuring private health providers a minimum demand for services, the scheme has helped the health market grow in parts of rural Gujarat. Challenges remain for Chiranjeevi Yojana, especially in those districts with a very small number of private gynaecologists. There is also a need to monitor the quality of services provided by private practitioners, as well as more rigorously evaluate the impact of the programme. The scheme may be enhanced to cover the whole gamut of services in the continuum of care – that is, antenatal, newborn and postnatal care.


 

 

To learn more

Bhat, R. et al. ‘Public-Private Partnerships: Managing contracting arrangements to strengthen the Reproductive and Child Health Programme in India – Lessons and implications from three case studies,’ WHO 2007. | PDF English

UNICEF, The State of the World’s Children 2009: Maternal and newborn health. | PDF English | French | Spanish

UNICEF India | website

UNICEF, The State of Asia-Pacific’s Children 2008: Child Survival. | access report

WHO, Neonatal and Perinatal Mortality: Country, regional and global estimates 2004. | access report

UNICEF India Country Office, ‘Assessment of Chiranjeevi Performance’, February 2008 | access report

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