A high profile maternal health program in India fails to deliver on its promises to reduce infant and maternal deaths in rural areas, according to new study. The program had intended to reduce mortality by encouraging women to deliver in private hospitals. A new study says the program provides no statistical advantage to the health of mothers and babies, despite a total cost of more than $25 million since the program began.
Since its creation in 2006, the Chiranjeevi Yojana program enjoyed worldwide attention for its mission to make maternal hospital care accessible to rural women living below the poverty line. The program, which earned the Wall Street Journal Asian Innovation Award in its first year, encouraged participating private hospitals to provide free maternal care to these patients; hospitals received 1600 Indian rupees, which is $30 to $40 USD, for each delivery. Hospitals could offer extra services for a fee. By 2012, the program helped cover the costs of more than 800,000 deliveries in about 800 different private care hospitals.
The researchers collected data on births from 5,597 households in the largely agrarian state of Gujarat, India, between 2005 and 2010. Publishing their findings in the public health journal, Bulletin of the World Health Organization, researchers from Duke University said the program did not change the likelihood of delivery in a hospital, the probability of complications, or even the presence of doctors and nurses during childbirth. Furthermore, the researchers said they were surprised to discover that free care at a hospital did not reduce the out-of-pocket expenses for the patients who received the service through the program.
The researchers did not explore why the program was ineffective and did not reduce costs but the authors of the study did say there were several possible explanations including several reports of hospitals offering free care then charging for extra services. Transportation costs from rural areas to participating hospitals were an additional factor. Some participating hospitals said reimbursements did not adequately cover the cost of care. Furthermore, women avoid hospitals with reputation for lower quality of care, even if that care is free.
The authors of the study suggest that, while the program is successful in the number of participating hospitals and patients, it suffers limitations in some of its methods.
Source: Mohanan, Manoj, Sebastian Bauhoff, Gerard La Forgia, Kimberly Singer Babiarz, Kultar Singhe, and Grant Miller. "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. World Health Organization, 9 Dec. 2013. Web. 30 Dec. 2013.