Accreditation of private sector health facilities for provision of Comprehensive Abortion Care Services: A new initiative of the state government of Bihar, India

Background: Recognizing the need to increase access to safe abortion services to reduce maternal mortality and morbidity, the State Government of Bihar introduced an innovative mechanism of accrediting private health care facilities. The program, YuktiYojana, was designed to accredit private health facilities and support them in providing abortion-related services free of charge to low-income rural and urban women.

Methods: This paper highlights the implementation experience of the first two years of the accreditation program in terms of creating safe access to poor women at private sector facilities. We collected both quantitative (service statistics and client exit interviews) and qualitative data (in-depth interviews).

Results: A total of 49 private facilities accredited by the state provided abortion services to 10,700 women during the first two years of the program. Overall, 53% of beneficiaries reported holding a “Below the Poverty Line” card, while 71% had low living standard. The majority of women reported satisfaction (90%) with their care, while 68% perceived good quality of services. Providers and stakeholders uniformly highlighted the process of reimbursement as the major bottleneck of the public private partnership, although overall satisfaction with the program was high.

Conclusions: The findings of this study suggest that public-private partnerships are a viable and promising strategy for increasing access to affordable safe abortion services to poor women. Outcome of this study has major policy implications in terms of influencing other states and countries to capitalize the strength of public-private partnership to eradicate the consequences of unsafe abortion.