Public private partnerships for emergency obstetric care: lessons from maharashtra
Chaturvedi, S.; Randive, B.
Indian Journal of Community Medicine Official Publication of Indian Association of Preventive and Social Medicine 36(1): 21-26
2011
ISSN/ISBN: 1998-3581 PMID: 21687376 DOI: 10.4103/0970-0218.80788Document Number: 573441
The National Rural Health Mission of India advocates public private partnerships (PPPs) to meet its "service guarantee" of Emergency obstetric care (EmOC) provision. The Janani Suraksha Yojana (JSY) has a provision of Rs. 1500 for contracting in obstetric specialists. The study aimed to understand the issues in the design and implementation of the PPPs for EmOC under the JSY in Maharashtra and how they affect the availability of EmOC services to women. A cross-sectional study using the rapid assessment approach was conducted in Ahmednagar district of Maharashtra spanning 1-year duration ending in June 2009. Primary data were obtained through interviews with women, providers, and administrators at various levels. Data were analyzed thematically. The PPP scheme for EmOC is restricted to deliveries by Caesarean section.The administrators prefer subsidization of costs for services in private facilities to contracting in. There are no PPPs executed in the study district. This study identifies barriers to women in accessing the benefit and the difficulties faced by administrators in implementing the scheme. The PPPs for EmOC under the JSY have minimally influenced the out-of-pocket payments for EmOC. Infrastructural inadequacies and passive support of the implementers are major barriers to the implementation of contracting-in model of PPPs. Capacities in the public health system are inadequate to design and manage PPPs.