Public private partnership as a tool to increase access to maternity services: A case study of chiranjeevi scheme in gujarat, India

India began experimenting with innovative payment mechanism to deliver maternal health services around 2004-05. Government of Gujarat developed a scheme to provide free delivery services to BPL women mainly through private providers. A package of 100 deliveries was offered by the state government to the private obstetrician and gynecologists at Rs. 1,795 (USD 40) per delivery on capitation payment basis regardless of whether the delivery was normal or complicated or resulted in a cesarean section. The scheme was initiated in 2005 and by the end of 2008; approximately 235,289 deliveries were conducted in 25 districts. In 3 years, percentage of institutional deliveries increased from 63.2 to 72.5. Interestingly, the c-section rate in private facilities fell by around 14.7% and in public facilities in increased by around 10%. This model has been replicated by different states. This case study examines how payment incentives have changed the way maternal health services are delivered through public private partnership.

The goal to share the pool of complicated deliveries between government and private run providers through capitation payment system has been challenged by the risk selection which has shifted the burden of complicated deliveries on the public health infrastructure. There is limited information available on quality. In conclusion, different finance strategies adopted by the government may lead to increase in access; however, good governance and monitoring of the payment system along with focus on outcomes are critical for efficient implementation and scaling up the model at national and international level.