The scheme is to benefit pregnant women who access Government health facilities for their delivery. Moreover it will motivate those who still choose to deliver at their homes to opt for institutional deliveries. All the States and UTs have initiated implementation of the scheme. High out of pocket expenses being incurred by pregnant women and their families in the case of institutional deliveries in form of drugs, User charges, diagnostic tests, diet, for C —sections.
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The stagnant performance of countries with regard to maternal and child health is linked to low investment in health and out of pocket expenditure OOP. A total of delivered mothers were included as study subjects. The study was conducted from July to September Out of , subjects delivered in government institutions and hence were eligible for benefits of JSSK scheme.
OOP expenditure was done by Most common suggestions given by subjects were the availability of ultrasound facility, cooperative staff and crowd management in hospitals. For reducing OOP expenses, up-gradation and constant supervision is required to maintain the adequacy of services. More evaluation studies need to be conducted to know the utilization pattern of JSSK so as to improve the coverage and removing the bottlenecks to further increase the utilization of JSSK scheme.
Improving the maternal and child health and their survival are central to the achievement of national health goals under the National Rural Health Mission as well as the Millennium Development Goals 4 and 5. Globally, an estimated , maternal deaths occurred in , when the global maternal mortality ratio was maternal deaths per , live births. Preterm birth has emerged as the leading cause of neonatal death, underlying the need for rapid scale-up of maternal health interventions to improve neonatal health outcomes.
The relatively stagnant performance with reference to maternal and child health indicators is linked with low levels of government investment in health. Often household health expenditure termed as out-of-pocket OOP expenditure, is catastrophic for poor households and increases the level of poverty.
The entitlements for obstetric women and infants are free and cashless delivery including cesarean , free drugs, free diagnostics, free provision of blood, free diet, and free transport to and fro to a health facility. All women residing in the study area who were registered at the subcenters and whose delivery took place from July to September were included in this study.
A total of study subjects were included for the study. From each subcenter, fifty subjects were chosen randomly, thus making a sample of study subjects from four subcenters.
All women residing in the study area, registered at the subcenters and who delivered during July to September were included in the study after their respective consent. Women or concerned family members, who were not willing to give informed consent or who could not be contacted even after two home visits. Community-based descriptive type study with cross-sectional design. A list of subcenters in the study area was obtained from the PHC, and a subcenter wise list of all registered obstetric women who had delivered was prepared from the registers maintained at the subcenters.
The list of delivered females was updated every month. The investigator visited the study subjects at their residence for interviewing the study subjects. A pretested semi-structured interview schedule was used for interviewing.
The information included socioeconomic profile, awareness, and utilization of services under JSSK. Information regarding the study subjects who were registered but died during or after delivery was obtained from the concerned family members. Informed consent was taken before interview schedule, and confidentiality of the information was assured. Data collected was analyzed using SPSS version Normally distributed data were presented as means and standard deviation.
Out of study subjects interviewed, backward class and scheduled class categories constituted Monthly family income, i.
Thus, a total of deliveries underwent in government facilities that were entitled for provisions of JSSK scheme. Figure 1 shows the utilization of different services such as free diet, drugs, diagnostics, and transport by the entitled beneficiaries.
Diagrammatic representation component bar chart of benefits received of Janani Shishu Suraksha Karyakram scheme by subjects. Fifteen Reasons for not availing free transport were being taken to a private facility, 7 used own vehicle and paid taxi 7 and nearby health facility 1.
The mean expenditure was Rs. The median OOP expenditure was Rs. Furthermore, overall subjects had OOP expenditure which had to spend on healthcare irrespective of delivery, private, or home [ Figure 2 ]. Study subjects also gave suggestions regarding difficulties faced by them to improvise the present scheme. Various suggestions were regarding need of ultrasound USG facility, cooperative staff, overcrowding management, improved diet quality, and timely response of ambulance services [ Figure 3 ].
JSSK was launched to ensure that each and every pregnant women and sick neonates up to 30 days get timely access to health-care services including transport free of cost. The present study was done to evaluate the JSSK scheme utilization. Referral transport was used by Goyal et al. This study found a higher proportion of subjects were provided free diet, and it was well received by patients as well.
Tyagi et al. Moreover, radiological investigation USG was a common deficiency in periphery and most had to shell out money to get the radiological imaging done. The present study found that entitlement of free medicines was well received by the majority of study participants.
Medicine supply in this part of the region is quite good and very few had to purchase medicines from outside. The majority of subjects suggested that ultrasonography facility should be made available at health facilities. However, it may be added here that lack of a sufficient number of radiologists to provide USG facility produces hindrance to adequate services at government facilities.
Noncooperation and lack of sensitiveness on the part of health staff were the turnoff factors for the beneficiaries. Furthermore, overcrowding at government facilities also prompted patients to go to private facilities. The present study was the only evaluation study done in the area. Therefore, changes regarding OOP expenditure cannot be commented on. In addition, as the study was conducted at the vicinity of a medical college, there was the obvious inclination of toward medical college as a place of delivery.
However, since the current study was limited to rural area, the urban area would have shown a better utilization pattern of services. The present study explores the services being provided by JSSK scheme at the grassroots level and to know whether the government schemes are adequate in rural population where more than two-third of India lives.
More evaluation studies need to be undertaken for measuring OOP expenditure which sometimes becomes catastrophic expenditure in the absence of public services and facilities. OOP expenditure has been incurred by most of the subjects as facilities are lacking in peripheral areas. Referral transport has been well received by the mothers but not by newborns. Free diet and drugs were provided to the beneficiaries. For reducing OOP expenses, up-gradation, and constant supervision is required to maintain the adequacy of services.
Figure 4 depicts the outcome of JSSK scheme from the present study. National Center for Biotechnology Information , U. J Family Med Prim Care. Sandeep Kumar 4 Medical Intern, Pt.
Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This article has been cited by other articles in PMC. Abstract Introduction: The stagnant performance of countries with regard to maternal and child health is linked to low investment in health and out of pocket expenditure OOP. Results: Out of , subjects delivered in government institutions and hence were eligible for benefits of JSSK scheme.
Conclusion: For reducing OOP expenses, up-gradation and constant supervision is required to maintain the adequacy of services. Keywords: Diagnostics, diet, out-of-pocket expenditure, referral transport. Introduction Improving the maternal and child health and their survival are central to the achievement of national health goals under the National Rural Health Mission as well as the Millennium Development Goals 4 and 5. Sample size All women residing in the study area who were registered at the subcenters and whose delivery took place from July to September were included in this study.
Study subjects All women residing in the study area, registered at the subcenters and who delivered during July to September were included in the study after their respective consent. Exclusion criteria Women or concerned family members, who were not willing to give informed consent or who could not be contacted even after two home visits.
Study design Community-based descriptive type study with cross-sectional design. Study protocol A list of subcenters in the study area was obtained from the PHC, and a subcenter wise list of all registered obstetric women who had delivered was prepared from the registers maintained at the subcenters.
Results Out of study subjects interviewed, backward class and scheduled class categories constituted Open in a separate window. Figure 1. Figure 2. Figure 3. Discussion JSSK was launched to ensure that each and every pregnant women and sick neonates up to 30 days get timely access to health-care services including transport free of cost.
Figure 4. Diagrammatic representation of Janani Shishu Suraksha Karyakram outcome. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. References 1. Ministry of Health and Family Welfare.
The World Bank. Data India. Reducing out-of-pocket expenditures to reduce poverty: A disaggregated analysis at rural-urban and state level in India. Health Policy Plan. National Rural Health Mission.
India’s MoH launches initiative to finance instutional deliveries
We did cross sectional survey in public sector facilities among consecutive mothers using structured questionnaire. We computed the proportion of mother who received the benefits and the median OOP expenditure. JSSK benefitted the mothers utilizing the public sector facilities however drugs, consumables and transport contributed to the OOP expenditure. India is one of the five countries that accounted for half of the maternal deaths worldwide.
Janani Shishu Suraksha Karyakaram
Addressing the gathering near Al-Afia Hospital, Mandi Khera, District Mewat in Haryana, Smt Gandhi noted that tremendous improvement in health care services has occurred under the initiative of National Rural health Mission started since and the new initiative of Janani —Shishu Suraksha Karyakram is but a step further in ensuring better facilities for women and child health services. She hoped that States would come forward and ensure that benefits under JSSK would reach every needy pregnant woman coming to government institutional facility. The new initiative of JSSK would provide completely free and cashless services to pregnant women including normal deliveries and caesarean operations and sick new born up to 30 days after birth in Government health institutions in both rural and urban areas. Free Entitlements for Sick newborns till 30 days after birth similarly include Free treatment, Free drugs and consumables, Free diagnostics, Free provision of blood, Exemption from user charges, Free Transport from Home to Health Institutions, Free Transport between facilities in case of referral and Free drop Back from Institutions to home. Speaking on the occasion the Union Health and Family Welfare Minister Sh Ghulam Nabi Azad stated that the number of institutional deliveries, a key determinant of maternal mortality, has increased from seven lakhs to more than a crore One of the significant activities for saving the lives of the mother and also the infant is provision of quality ante-natal and post-natal services, he noted. The Minister informed that more than Rs crores have been provided to the States for drugs, diet and ambulances under NRHM during