Utilization of a state run public private emergency transportation service exclusively for childbirth: the Janani (maternal) Express program in Madhya Pradesh, India.
BACKGROUND
In 2009 the state government of Madhya Pradesh, India launched an emergency obstetric transportation service, Janani Express Yojana (JEY), to support the cash transfer program that promotes institutional delivery. JEY, a large scale public private partnership, lowers geographical access barriers to facility based care. The state contracts and pays private agencies to provide emergency transportation at no cost to the user. The objective was to study (a) the utilization of JEY among women delivering in health facilities, (b) factors associated with usage, (c) the timeliness of the service.


METHODS
A cross sectional facility based study was conducted in facilities that carried out > ten deliveries a month. Researchers who spent five days in each facility administered a questionnaire to all women who gave birth there to elicit socio-demographic characteristics and transport related details.


RESULTS
35% of women utilised JEY to reach a facility, however utilization varied between study districts. Uptake was highest among women from rural areas (44%), scheduled tribes (55%), and poorly educated women (40%). Living in rural areas and belonging to scheduled tribes were significant predictors for JEY usage. Almost 1/3 of JEY users (n = 104) experienced a transport related delay.


CONCLUSIONS
The JEY service model complements the cash transfer program by providing transport to a facility to give birth. A study of the distribution of utilization in population subgroups suggests the intervention was successful in reaching the most vulnerable population, promoting equity in access. While 1/3 of women utilized the service and it saved them money; 30% experienced significant transport related delays in reaching a facility, which is comparable to women using public transportation. Further research is needed to understand why utilization is low, to explore if there is a need for service expansion at the community level and to improve the overall time efficiency of JEY.
Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Kristi
K
Sidney
Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Kayleigh
K
Ryan
Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Public Health and Environment, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India; International Center for Health Research, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India.
Vishal
V
Diwan
Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; International Center for Health Research, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India.
Ayesha
A
De Costa
D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000191:economics / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008427:Maternal Health Services / Q000191:economics / Q000706:statistics & numerical data*; D036801:Parturition; D011247:Pregnancy; D015397:Program Evaluation; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014186:Transportation / Q000191:economics / Q000706:statistics & numerical data*; D014505:Urban Population