Background
CY – a voucher program (Gujarat)
|
JSY – a conditional cash transfer (MP)
| |
---|---|---|
Area of Operation
| Gujarat (60.4 million) | Nationwide (studied here in Madhya Pradesh) (72.6 million) |
Context
| Socioeconomically relatively advanced: MMR half of that in MP (142/100 000), 16% population below the poverty line | Poor socioeconomic indicators, MMR (310/100 000), largely rural province, 38% of the population below the poverty line |
Target group
| Mothers below poverty line and tribal mothers | All mothers |
Type of Program
| Payment by state to the private provider i.e. obstetrician (voucher based)
| CCT – payment by state to the mother (conditional cash transfer)
|
Incentive for
| Institutional delivery | Institutional delivery |
Accepted place of delivery
| Empanelled private sector obstetric facilities | Public sector institutions largely |
Involvement of private sector
| Yes | Yes (extremely restricted) |
Payment mechanism
| Providers paid per block of 100 deliveries (20% in advance) | Payment to woman at the time of discharge from hospital after delivery |
Quantum of payment
| A flat amount of INR 288000($5760) is paid to the obstetrician per 100 women (regardless of delivery type) | INR1400 ($28) to rural mothers on discharge (INR1000 to urban mothers). |
Expected effect
| Provides access to EmOC care – which is available more widely | Increase institutional delivery, hence access to EmOC |
Support for Emergency transport
| Centralized 108 ambulance system | Decentralized Janani Express model |
Study level | Objectives | Proposed methods |
---|---|---|
Provincial (Policy) | To study program utilization trends | Secondary data analysis - complete times series, Document reviews, Key person interviews with policy makers, program managers and private sector representatives, Stakeholder discussions |
To ascertain the influence of changes in ANC service utilization and institutional deliveries on maternal and neonatal outcomes | ||
To study trends in private sector participation | ||
Explore the motivations for participation/non participation with the private sector in CY program | ||
To understand the exclusion of the private sector in the JSY program | ||
Explore experience of private provider in JSY | ||
Comparison of emergency care transportation systems | ||
Cost effectiveness of the programs and the emergency transportation models | ||
District (Facility) | List and classify all facilities performing deliveries according to their EmOC functionality | Facility Survey, Observations of normal deliveries, Register and case record review, Case vignettes to study provider competence, In depth exit interviews with mothers |
Survey and describe facilities conducting deliveries | ||
Assess the quality of care administered in study facilities | ||
Study outcomes (type of delivery, maternal mortality and morbidity, foetal outcomes) among program beneficiaries and non-beneficiaries in study facilities | ||
Experiences of public and private sector physicians of the programs (in terms of task load, shifting of tasks, human resources required, monetary transactions with the program) | ||
Community | Identify program beneficiaries and non-beneficiaries. | Questionnaires, In-depth interviews, Focus group discussion, Spatial methods (GIS) to study distance |
Study differences between background characteristics, geographic access to EmOC, outcomes (maternal), type of health service utilization in pregnancy (and delivery), use of emergency obstetric transportation services and expenditures during delivery | ||
Identify predictors for program uptake | ||
Compare infant health status and health service utilization between users and non-users. | ||
Among users, study perceived quality of care at facility | ||
Explore motives and barriers for participation/non-participation among eligible beneficiaries and non-beneficiaries | ||
Understand the working dynamic for the community health workers(ASHA, TBA & female health workers)and their role in the program |
Methods
Setting
Population | Administrative districts | BPL | Literacy rate | Institutional delivery | IMR | MMR | |
---|---|---|---|---|---|---|---|
Madhya Pradesh | 72.6[25] | 50 | 38%[26] | 71%[25] | 47%[27] | 62[28] | 310[29] |
Gujarat | 60.4[30] | 25 | 16%[31] | 79%[32] | 56%[33] | 44[28] | 142[28] |