title: A spatial analysis to study access to emergency obstetric transport services under the public private "Janani Express Yojana" program in two districts of Madhya Pradesh, India.
abstract: BACKGROUND
  The government in Madhya Pradesh (MP), India in 2006, launched "Janani Express Yojana" (JE), a decentralized, 24X7, free emergency transport service for all pregnant women under a public-private partnership. JE supports India's large conditional cash transfer program, the "Janani Suraksha Yojana" (JSY) in the province and transports on average 60,000 parturients to hospital every month. The model is a relatively low cost one that potentially could be adopted in other parts of India and South Asia. This paper describes the uptake, time taken and geographic equity in access to the service to transport women to a facility in two districts of MP.
  
  
  METHODS
  This was a facility based cross sectional study. We interviewed parturients (n = 468) who delivered during a five day study period at facilities with >10 deliveries/month (n = 61) in two study districts. The women were asked details of transportation used to arrive at the facility, time taken and their residential addresses. These details were plotted onto a Geographic Information System (GIS) to estimate travelled distances and identify statistically significant clusters of mothers (hot spots) reporting delays >2 hours.
  
  
  RESULTS
  JE vehicles were well dispersed across the districts and used by 236 (50.03%) mothers of which 111(47.03%) took >2 hours to reach a facility. Inability of JE vehicle to reach a mother in time was the main reason for delays. There was no correlation between the duration of delay and distance travelled. Maps of the travel paths and travel duration of the women are presented. The study identified hot spots of mothers with delays >2 hours and explored the possible reasons for longer delays.
  
  
  CONCLUSIONS
  The JE service was accessible in all parts of the districts. Relatively high utilization rates of JE indicate that it ably supported JSY program to draw more women for institutional deliveries. However, half of the JE users experienced long (>2 hour) delays. The delayed mothers clustered in difficult terrains of the districts. Additional support particularly for the identified hot spots, enhanced monitoring by state agencies and GIS tools can facilitate better effectiveness of the JE program.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Sabde
authors.forename: Ayesha
authors.initials: A
authors.lastname: De Costa
authors.affiliation: International Center for Health Research, R,D, Gardi Medical College, Ujjain, Madhya Pradesh, India. vishaldiwan@hotmail.com.
authors.forename: Vishal
authors.initials: V
authors.lastname: Diwan
mesh_terms: D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007194:India; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011247:Pregnancy; D015397:Program Evaluation; D012959:Socioeconomic Factors