title: Providing skilled birth attendants and emergency obstetric care to the poor through partnership with private sector obstetricians in Gujarat, India.
abstract: OBJECTIVE
  India has the world's largest number of maternal deaths estimated at 117,000 per year. Past efforts to provide skilled birth attendants and emergency obstetric care in rural areas have not succeeded because obstetricians are not willing to be posted in government hospitals at subdistrict level.
  
  
  METHODS
  We have documented an innovative public-private partnership scheme between the Government of Gujarat, in India, and private obstetricians practising in rural areas to provide delivery care to poor women.
  
  
  METHODS
  In April 2007, the majority of poor women delivered their babies at home without skilled care.
  
  
  RESULTS
  More than 800 obstetricians joined the scheme and more than 176,000 poor women delivered in private facilities. We estimate that the coverage of deliveries among poor women under the scheme increased from 27% to 53% between April and October 2007. The programme is considered very successful and shows that these types of social health insurance programmes can be managed by the state health department without help from any insurance company or international donor.
  
  
  CONCLUSIONS
  At least in some areas of India, it is possible to develop large-scale partnerships with the private sector to provide skilled birth attendants and emergency obstetric care to poor women at a relatively small cost. Poor women will take up the benefit of skilled delivery care rapidly, if they do not have to pay for it.
authors.affiliation: Government of Gujarat, Gandhinagar, India.
authors.forename: Amarjit
authors.initials: A
authors.lastname: Singh
authors.forename: Dileep V
authors.initials: DV
authors.lastname: Mavalankar
authors.forename: Ramesh
authors.initials: R
authors.lastname: Bhat
authors.forename: Ajesh
authors.initials: A
authors.lastname: Desai
authors.forename: S R
authors.initials: SR
authors.lastname: Patel
authors.forename: Prabal V
authors.initials: PV
authors.lastname: Singh
authors.forename: Neelu
authors.initials: N
authors.lastname: Singh
mesh_terms: D001723:Birth Rate / Q000639:trends; D016529:Emergency Nursing; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007194:India / Q000453:epidemiology; D008880:Midwifery / Q000458:organization & administration*; D009774:Obstetrics / Q000458:organization & administration*; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D055818:Public-Private Sector Partnerships
references.citation: Lancet. 2005 Mar 5-11;365(9462):891-900
references.pmid: 15752534
references.citation: Reprod Health Matters. 2007 Nov;15(30):91-102
references.pmid: 17938074
references.citation: Lancet. 2007 Oct 13;370(9595):1311-9
references.pmid: 17933645
references.citation: Int J Gynaecol Obstet. 2009 Dec;107(3):271-6
references.pmid: 19846090
references.citation: Bull World Health Organ. 2008 Apr;86(4):243-243A
references.pmid: 18438507
references.citation: Lancet. 2006 Oct 14;368(9544):1377-86
references.pmid: 17046470
references.citation: Am J Public Health. 2005 Feb;95(2):200-3
references.pmid: 15671450