Recognizing the need to increase access to safe abortion
services to reduce maternal mortality and morbidity, the state government of
Bihar, India introduced an innovative mechanism of accrediting private health
care facilities. The program, Yukti Yojana (‘a
scheme for solution’), accredits eligible health facilities and supports them
in providing abortion-related services free of charge to rural and low-income
urban women. This paper describes implementation of Yukti Yojana.
A descriptive analysis of abortion services provided under
the Yukti Yojana program was conducted using four data sources: 1) assessment
of accredited facilities over 6 months; 2) induced and incomplete abortion
service registers; 3) client exit interviews and associated direct observation
of client-provider interaction for a sample of accredited facilities; and 4)
in-depth interviews with providers and key stakeholders responsible for
providing or influencing abortion services. These analyses assessed
characteristics of women receiving abortion services, quality of care and
client satisfaction, and barriers and facilitating factors of a successful
accreditation process.
Forty-nine private facilities were accredited during the
first two years of the program, and 84 % had begun providing abortion
services, in all 27,724 women were served. Overall, 53 % of beneficiaries
reported holding a “Below Poverty Line” card, while 71 % had low living
standard. The majority of women (n = 569)
reported satisfaction (90 %)
with their care, while 68 % perceived good quality of services. Having a
government-led initiative was considered a key element of success, while
stringent requirements for site approval, long waiting time for accreditation,
complicated and delayed reimbursement process and low reimbursement fees for
abortion services were identified as barriers to implementation.
Yukti Yojana provides a model for successfully involving
private OB/GYNs and general physicians to deliver safe abortion services to
poor women on a large scale and offers additional evidence that public-private
partnerships can be used to ensure availability of high-quality maternal health
services to women in low-income countries. Private facility accreditation also
offers a promising solution to the limited availability of safe abortion
services in low resource settings such as Bihar, India.
Below: Location of 49 private sites accredited under YuktiYojana program as of May 2013 (stars indicate accredited health facilities)
Below: Three-monthly moving average of abortion caseload per month per site at Yukti Yojana accredited facilities between May 2012 and July 2014
Full article at: http://goo.gl/177iul
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