chiranjeevi scheme neeraj

8/8/2019 Chiranjeevi Scheme Neeraj

1/47

A Journey to safe

motherhood

Department of Health & FW

Government of Gujarat

CHIRANJEEVI YOJANA

GUJARAT

PRESENTED BY:-Neeraj Sharma

ICICI LOMBARD


2/47

GUJARAT:SNAPSHOT


3/47

Gujarat A Profile

Overview

Area 196,000 km 6% of India

Population 50.5 million 5% of India

Urbanization 37% India avg. 28%

SDP(2003-04)

Rs 1,425.60 billion( 26.40 bill.)

6.33% of India

Per Capita Income

(2003-04)

Rs 26,979

( 496.24)

India average -Rs.

20,989( 388.69)

Recognizing Gujarat potential the Planning Commission set a target growth rate of 10% p.a.

for Gujarat


4/47

Every Minute...

Maternal Death Watch

Global

380 women become pregnant

190 women face unplanned or

unwanted pregnancy

110 women experience a

pregnancy related complication

40 women have unsafe abortions

1 woman dies from a pregnancy-related complication


5/47

Current Status

Indicator India Gujarat

Maternal Mortality Ratio 453 389

Infant Mortality Rate 63 57

Maternal Deaths in one year 1,20,000 5000

Infant Deaths in one year 25,00,000 72000

FOR THE YEAR 2000


6/47

Infection

14.9%

Haemorrhage

24.8%

Indirect

causes19.8%

Other direct

causes

7.9%

Unsafe

abortion12.9%

Obstructed labour6.9%

Eclampsia

12.9%

Causes of Maternal Death


7/47

Timing of maternal deaths-General Conditions

Postpartum

60%

During

pregnancy

24%

During

delivery

16%


8/47


9/47

Broad Issues

Non - availability of O & G specialists

Accessibility of services-Tribal and urban slums

Poor utilization of services-

Low felt need of health & medical services

Lack of user friendly & quality public health services

Costly private health and medical services No health insurance coverage


10/47

Outsourcing Options

Private Gynecs/ GIA in their facility

Payment to Gynecs for working in government hospital


11/47

PPP in health Public-Private Partnership is an instrument for improving the health

of the population

PPP is to be seen in the context of viewing the whole medical

sector as a national asset with health promotion as goal of all health

providers, private or public

The Private and Non-profit sectors are also very much accountable

to overall health systems and services of the country

Therefore, synergies where all the stakeholders feel they are part of

the system and do everything possible to strengthen national

policies and programmes needs to be emphasized with a proactive

role from the Government.


12/47

Five basic mechanisms in the health sector

CONTRACTINGIN

CONTRACTINGOUT

SUBSIDIES LEASING/RENTALS

PRIVATIZATION


13/47

Examples

1) The Uttaranchal Mobile Hospital and Research Center (UMHRC)is three-way partnership among the Technology Information,

Forecasting and Assessment Council (TIFAC), the Government of

Uttaranchal and the Birla Institute of Scientific Research (BISR)

2) The Government of Andhra Pradesh has initiated the Arogya

Raksha Scheme in collaboration with the New India Assurance

Company and with private clinics. It is an insurance scheme fully

funded by the government

3) The Govt. of Gujarat has provided grants to SEWA-Rural in

Gujarat for managing one PHC and three CHCs4) The Government of Tamil Nadu has initiated an Emergency

Ambulance Services scheme in Theni district of Tamil Nadu in

order to reduce the maternal mortality rate in its rural area.


14/47

Chiranjeevi Scheme, Gujarat:2005

AIM

To improve the access of poor families in Gujarat toinstitutional delivery and to give them financial protection

from the health care costs


15/47

Chiranjeevi Yojna

Till 2005 government: To develop their own rural hospitals as FRUs underthe CSSM and RCH program, without much success

Most FRUs could not become functional due to lack of obgyns andpediatricians in rural areas.

Gujarat health department worked out a scheme of PPP in 2005:collaborations with key stakeholders to provide delivery care to the poorin rural areas

Stakeholders: IIM Ahmedabad

NGOs (Sewa Rural)GTZ

This scheme was called ChiranjeeviYojana (CY) a local name meaninglong life (of mothers and babies).


16/47

Implementation

Pilot basis in 5 backward districts of the state with a total

population of 9.7 million

Selection criteria for private ob gyns for enrolment in to

CY 1. Doctor must by having post-graduate qualification in Obgyn

2. Must have his/her own hospital

3. Must have Labour room and OT

4. Must be able to access blood in emergency situation 5. Must be able to arrange for anesthetists and do emergency

surgery


17/47

Health Minister wrote a letter about the scheme to presidents

of district and talukas in 5 districts.

District level Advocacy workshops of Presidents of district and

taluka panchayat

In each district IEC activities were undertaken Regular interaction with Chiranjeevi Panel doctors

The poor are to be identified either by Below Poverty Line

card or a certificate issued by designated village leader

The roles and responsibilities of different officers have clearlybeen clearly defined


18/47

Private ob gyns: To provide skilled care for deliveries of poor

women and required comprehensive Em OC free of cost in

their own hospital

In return the government would pay the doctors 4000$ for

100 deliveries (40$ per delivery)

The monetary reimbursement was worked out based on costs

in an NGO hospital in rural areas by Dr. Pankaj Shah (SEWA

Rural)

Discussed with private providers

Obgyn: To pay the poor women 5 $ for transportation out of

the 40$ he/she got from the state government per delivery

This was to reduce the delay in reaching the hospital


19/47

To allay the fears of private doctors that, governmentdoes not pay on time, in this scheme doctors were given

advance payment of about 624 $ on signing the contract

with government

Reimbursed rapidly after delivery by the district healthoffice

Based on the successful experience of one year of the

scheme it was extended to all the poor in the whole state

in November 2006(covering all the 25 districts and urbanareas covering a population of 55 million)

Financial aid


20/47

Package Rates for ChiranjiviNo. of cases Rate Per Case Cost

Normal delivery 85 800 68000

Complicated cases

Eclampsia 1000

Forceps/vacuum/breech3 1000 3000

Episiotomy 800Septicemia 2 3000 6000

Blood transfusion 3 1000 3000

Cesarean (7%) 7 5000 35000

Predelivery visit 100 100 10000

Investigation 100 50 5000

Sonography 30 150 4500

NICU support 10 1000 10000

Food 100 100 10000

Dai 100 50 5000

Transport 100 200 20000

Total 100 179500


21/47

Service Charges In Govt and GIA Institutions

Item cases Rate Cost

Normal delivery 85 200 17000

Complicated cases

Eclampsia 300

Forceps/vacuum/breech 3 300 900

Episiotomy 300

Septicemia 2 300 600

Blood transfusion 3 300 900

Cesarean (7%) 7 1000 7000

Predelivery visit 100 100 10000

Investigation

Sonography 30 150 4500

Dai 100 50 5000

Transport 100 200 20000

Total Cost 65900


22/47

Cost of the scheme

Total cost of the pilot scheme:11 Cr Rs (2.75 million $)for one year for 5 districts

When extended to the whole state:

1st year cost: 54 Crores

(3.5%) of the total health budget

This is being currently met from the state government fundsand money being provided by central government under

NRHM


23/47

Assessment

A recent evaluation undertaken by the Indian Institute ofManagement, Ahmadabad in one district : 81% of the total

deliveries among eligible poor women

On an average, a chiranjeevi client is estimated to save aroundRs. 3273 (about USD 86) per delivery

However, despite medicines being covered under the scheme

these clients incurred an average expenditure of Rs. 654 (USD17) for the purchase of medicines for the mother as well as

for the child


24/47

Results

Assessed in terms of improved availability of EmOC

Services through enrollment of private obgyn

hospitals, number of deliveries done of poor

Women and comparing reported and expected

maternal deaths and neonatal deaths

G h h i i d li i d


25/47

Graph shows increase in deliveries under

Chiranjeevi in the state from AprilNovember

2007.

Ex t d d t d t l d w b


26/47

Expected and reported maternal and new born

deaths and estimated lives saved by

Chiranjeevi Scheme up to Nov 2007


27/47

Effect on institutional deliveries


28/47

UNFPA Report

The pilot in 5 districts: significant improvement in

increase of institutional deliveries among the BPL

population with high levels of clients satisfaction

This is not only sustainable but can be stretched more

from optimal capacity-utilization point of view


29/47

IIM-A

The Chiranjeevi Scheme has put the purchasing power in the

hands of BPL families

The monitoring of the scheme lies with the district authoritiesand Block Health Officers

Attempt to extract extra payment is reduced to bare

minimum as it is now important to win the loyalty of thebeneficiaries for sustained revenue in the long run


30/47

Recognition

UNFPA Evaluation

Chiranjeevi is indeed an innovation in the area of Public-Private

Participation leading to increased access to poor for safe delivery

services. Given adequate support and guidance, this programme

can become a forerunner for many other interventions in NRHM.

States looking for models for successful PPP mechanisms will be

immensely benefited with dissemination of the experiences gained

from this scheme

Asian innovation award, by the Wall Street Journal at Singapore

Nominated for the IBM Innovations Award in Transforming


31/47

Innovation

Availability of Gynecologists in private sector met with the

shortage of gynecologists in public sector

Cashless scheme

Problem of delay in transportation is also solved

New comer Gynecologists are more attracted, as the scheme help

them to get assured income in initial period of their practice and

enlarge the clientele

Assured availability of quality services for maternity to mother and

newborn care at zero cost


32/47

Possible challenges

Private doctors who are paid on a fixed fee schedule may delaydoing needed surgery or refer complicated cases to public

facilities to avoid extra costs.

Many times private Ob gyns do not employ qualified nursing

staff, but get work done from trained women who work asnurses and midwives thus compromising quality of care.

Monitoring of maternal and neonatal deaths and morbidities

needs to improve so that we can assess the impact of the

program much more rigorously. Simultaneous efforts are needed to improve the infrastructure,

HR and management of public facilities to provide services to

the mothers and children.


33/47

Summary

Form of partnership voucher scheme to involve privateproviders in delivering maternity care

Geographical scope 1 year pilot in 5 districts & then to entire

state of Gujarat

Reasons for contracting High MMR, low institutional deliveries

Service For institutional deliveriesInformation to private parties Memoranda of understanding

Financing NRHM & state budget

Target group Women below poverty line

Implementation problems Inadequate awareness among private

providers about the scheme

Shortage of specialists

Uniform service package(for high risk

groups also)

Monitoring quality of care

Management responsibility District health officials


34/47

Private-public partnership benefits women

and newborns in India

Source: WHO website

This 21-year-old poor woman

was able to give birth to herfirst son through caesarean

section thanks to the free

service offered at a private

hospital in Mehsana district

under the Chiranjeevi scheme.


35/47

In this primary health care centre

in Kheda district, auxiliary nurse

midwives provide free antenatal

and postnatal care to women

This private obstetrician works part

time for the Chiranjeevischeme at a

public hospital in Bharuch district. She

is one of 833 private practitioners who

joined the scheme and are paid about

US$ 32 per delivery. She says she isvery happy with the programme

because it multiplied the number of

her patients and her income.

Institutional deliveries in Gujarat have

increased from 67% to 82% since the

scheme started two years ago.


36/47

Private practitioners check the

newborns in order to detect and treat

as early as possible health problems,

including asphyxia, low birth weightand infections. They also advise the

mothers on breastfeeding, hygiene and

other issues related to newborn care.

The chances of survival are very good

for this premature baby, thanks to the

services provided by a private clinic in

Mehsana district under the

Chiranjeevi scheme. Private

establishments are often betterequipped to save the lives of

premature babies. They offer special

areas for neonates, have modern

instruments like incubators and

sometimes maintain their own blood

banks


37/47

This pregnant 19-year-old girl is being

tested for HIV, malaria and anemia. In

the public hospital she is given a card

with all test results that helps the staffto monitor the health of women and

babies. Many lives are saved because

possible complications are identified

early in pregnancy and poor women

receive timely and free obstetric care

under the Chiranjeevi scheme

In this nursing school in Mehsana district,

36 students are trained for 18 months to

become skilled nurses. The training coverscare before, during and after childbirth as

well as newborn care and family planning.

After the training, the nurses will work in

rural areas where the Chiranjeevischeme

runs.


38/47

The Chiranjeevi scheme has

made better care available to

pregnant women and

encouraged them to go to

maternity hospital for delivery.More than a third of the 2000

emergency calls received by a

new ambulance service every

day are related to pregnant

women in rural areas

This young woman lost two

babies she delivered at home

with the help of a traditional

birth attendant. This time she

gave birth in hospital to a healthy

baby girl. The results ofChiranjeeviYojana have

encouraged other Indian states to

initiate similar programmes. It is

currently being replicated in the

states of West Bengal, Madhya

Pradesh and Uttar Pradesh


39/47

Key messages

CHIRANJEEVI YOJANA -

It may be more efficient to harness available private

skilled providers in private sector by paying their marginal

costs plus reasonable profit rather than waiting for

improvement in public services, which is very challengingin some developing countries like India

Develops health markets in rural areas and makes rural

and remote areas attractive for private health care

providers counteracts the pull of urban areas which normally drain

the private providers from rural areas to cities.

Our Mission:


40/47

Our Mission:

Save the lives of

thousands ofMothers and

Children dying with

no reason of theirsand prevent the

spread of infections

and promote healthy

life styles

Working together for a healthy Bharat


41/47


42/47


43/47


44/47


45/47


46/47

Good Healthcareduring pregnancy

Healthy and HappyNext Generation

Good RCH care

Healthy adulthood

Healthy ChildhoodGood care of Infants

Healthy babies

Health Care from Womb to tomb


47/47

Let Us Make Every Mother and Child Count

-Thank You

chiranjeevi scheme neeraj

Documents