Gujarat safe delivery vouchers

In recent years, there has been increasing interest in OBA voucher programs for reproductive health services. There have been many voucher pilots in south Asia recently. A program in Gujarat state in India called “Chiranjeevi Yojana” (“eternal life scheme”) uses vouchers to subsidize demand for maternal delivery. The program was launched in December 2005 with the objective to improve the institutional delivery rate by subsidizing access to private medical providers for pregnant women living below the official poverty line (BPL) in remote areas with the highest infant and maternal mortality. The scheme was launched as a single year pilot project in five districts: Banaskantha, Dahod, Kutch, Panchmahal, and Sabarkantha (see Bhat et al. 2009).

Voucher holders were provided a transport stipend and private contracted providers were reimbursed on a capitation payment basis. The payments were made for a batch of 100 deliveries to take care of case-mix differences (i.e., normal or complicated deliveries). The costs for normal and complicated deliveries were based on market prevailing rates and using locally relevant probabilities of complicated and normal cases, an average cost per delivery was worked out. The scheme used a voucher system to target the people living below poverty line (see Bhat et al. 2006).

An evaluation survey was conducted among 262 voucher-using mothers and 394 similar non-voucher-using mothers. A vast majority (97%) of the voucher beneficiaries delivered in private facilities, 2.7% deliveries were conducted in government facilities, and one voucher-purchaser had a home delivery. In the non-voucher group, 21% of women delivered at home, 1% in government facilities and 77% in private institutions (see Bhat et al. 2009).