EVALUATION OF CHIRANJEEVI YOJANA (CY)
Manoj Mohanan (Duke), Grant Miller (Stanford), Gerard La Forgia (Aceso Global), Kultar Singh (Sambodhi Research & Communications Pvt. Ltd.), Swapnil Shekhar (Sambodhi Research & Communications Pvt. Ltd.)
The objective of the Chiranjeevi Yojana (CY) program is to promote institutional deliveries among women in BPL households, especially in rural areas of Gujarat. In 2006, the government had introduced the CY program in response to the acute unavailability of trained obstetricians in public sector facilities in rural areas[2,3].
The policy aimed to leverage the presence of a large and vibrant private sector in healthcare available across the state by contracting with a large number of private sector providers who agreed to provide free maternity care to below-poverty-line (BPL) women in exchange for INR 1,600 reimbursement per delivery. The program was launch in early 2006 in five northern districts, and scaled out to the rest of the state by the end of 2007. By 2012, over 800 private-sector hospitals had participated and the program had helped pay for more than 800,000 deliveries .
Maternal Child Survey in progress. Photo by Manveen Kohli
The objective of the evaluation was to assess the impact of the Chiranjeevi Yojana program on institutional delivery rates as well as health, costs of delivery and other socio-economic outcomes. Previous evaluations had estimated that this program had led to a 90 per cent reduction in maternal deaths and a 60 per cent reduction in neonatal deaths among beneficiaries in Gujarat[1-3,5,6]. The program had also received the Asian Innovations Award in 2006.
Our evaluation analyzed the expansion of the Chiranjeevi Yojana program across Gujarat’s districts between 2005 and 2007. We collected data on retrospective birth histories and outcomes from ~6000 households in all districts in Gujarat. We combine this data with the rollout dates of the CY program across districts do implement a difference-in-difference (DD) analysis. Data from the DLHS-3 in Gujarat were used in parallel analyses. Figure 1 from our paper published in the Bulletin of WHO shows unadjusted means of rates of institutional delivery across early and late implementing districts in Gujarat.
The results of our DD analysis suggest there is no association between the CY program and the change in probability of institutional delivery (at either public or private institutions), obstetric complications or reductions in households’ out-of-pocket expenditures for deliveries. Previous evaluations of the Chiranjeevi Yojana program found large positive impacts of the program, but these studies faced critical limitations including self-selection of women into institutional delivery, reporting inaccuracies by hospitals, and secular improvements in outcomes related to rapid economic growth in the region.
Impact of the Chiranjeevi Yojana Program on Institutional Deliveries and Birth Outcomes in Gujarat, India: A Difference-in-Difference Analysis. Bulletin of World Health Organization (2014) Mar; 92 (3): 187-94
Manoj Mohanan, Sebastian Bauhoff, Gerard La Forgia, Kimberly Singer-Babiarz, Kultar Singh, and Grant Miller
Selected Media Coverage: New York Times, Times of India, Business Standard, ANI News, Bloomberg, DNA Newspaper
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4 Health statistics, Gujarat 2009–2010. Gandhinagar: Gujarat Government Vital Statistics Division; 2011. Retrieved from: http://www.gujhealth.gov.in/images/pdf/Health-review-09-10.pdf
5 Singh A, Mavalankar DV, Bhat R, Desai A, Patel SR, Singh PV, et al. Providing skilled birth attendants and emergency obstetric care to the poor through partnership with private sector obstetricians in Gujarat, India. Bull World Health Organ 2009; 87 : 960-4. doi: http://dx.doi.org/10.2471/BLT.08.060228 PMID:20454488
6 Mavalankar D, Singh A, Patel SR, Desai A, Singh PV. Saving mothers and newborns through an innovative partnership with private sector obstetricians: Chiranjeevi scheme of Gujarat, India. Int J Gynecol Obstet 2009; 107 : 271-6.
7 Ramesh M. Innovation award for Gujarat. The Hindu Business Line. 6 November 2006. Available from: http://www.thehindubusinessline.in/bline/2006/11/06/stories/2006110600801500.htm
8 Mohanan M, Bauhoff S, La Forgia G, Singer-Babiarz K, Singh K and Miller G. Effect of Chiranjeevi Yojana on institutional deliveries and neonatal and maternal outcomes in Gujarat, India: a difference-in-differences analysis. Bulletin of the World Health Organization 2014; 92 (3): 153-228.