Janani-Shishu Suraksha Karyakrama

Janani-Shishu  Suraksha Karyakram

 

JSSK has been launched, to ensure that each and ever pregnant woman and sick neonates upto one month gets  timely access to health care services free of cost and without  any out of pocket expenses.

 

In June 2011, Ministry of Health and Family Welfare,  Government of India launched the Janani-Shishu Suraksha Karyakram (JSSK), a national initiative  which entitles all pregnant women delivering in public health institutions to absolutely free and no  expense delivery, including  caesarean section.  

The scheme emphasises utmost importance on “Free  Entitlements”. The idea is to eliminate out-of-pocket expenses for both pregnant women and sick neonates. Under this scheme, pregnant women are  entitled for free drugs and consumables, free  diagnostics, free blood wherever required, and free diet to 3 days for normal delivery and 7 days for  caesarian section. This initiative also provides for free transport from home to institution, between  facilities in case of a referral and drop back home. Similar entitlements have been put in place for all sick newborns accessing public health institutions for treatment till 30 days after birth.  

The JSSK initiative is estimated to benefit more than one crore  pregnant women and newborns who access public health institutions every year in both urban and  rural areas.  

Why JSSK ?  

India has made considerable progress in reduction of Maternal Mortality Ratio  MMR) and Infant  mortality Rate (IMR), but the pace at which these health indicators are declining  needs acceleration. The number of institutional deliveries has increased significantly, after the launch of Janani Suraksha Yojna (JSY) in the year 2005 but many of those who opted for institutional deliveries were not willing to stay for 48 hrs, hampering the provision of essential services both to the mother and neonate. Moreover, the first 48 hours after delivery are critical as complications like haemorrhage, infection, high blood pressure, etc are more likely to develop during this period and unsafe deliveries may result in maternal and infant morbidity or mortality.  

Access to mother and child health care services were also hindered by high out of pocket expenses on user charges for OPD, drugs and consumables, diagnostic tests etc. In some cases such as severe anaemia or haemorrhage requiring blood transfusion can also increase immediate expenses. The same becomes still higher in case C section is being done. So, JSSK has been launched, to ensure that each and every pregnant woman and sick neonates upto one month gets timely access to health care services free of cost and without any out of pocket expenses.

 

Entitlements  

Entitlements for Pregnant Women   

Under JSSK, free Institutional Delivery services (including Caesarean operation) are provided in government health facilities. Also, medicines including supplements such as Iron Folic Acid are to be given free of cost to pregnant women. Further, pregnant Women are entitled to both essential and desirable investigations like Blood, Urine tests and Ultra- Sonography etc. Furthermore, they are to be provided with free Diet during their stay in the health institutions (up to 3 days for normal delivery and 7days for caesarean section). Not only this, there is a provision of free blood transfusion if the need arises. A significant number of maternal and neonatal deaths can be saved by providing timely referral transport facility to the pregnant women. Pregnant Women are entitled to free transport from home to health centre, referral to higher facility in case of need and drop back from the facility to home. Besides, under JSSK there is exemption from all kinds of user charges including OPD fees and admission charges. 

Entitlements for Sick Newborn 

Free treatment is also provided to the sick Newborn upto 30 days after birth and all drugs and consumables  required are provided free of cost in public health facilities. As in the case of the mother, the new born   too is provided with free diagnostic services and there is a provision of free blood transfusion if the need arises. The facility of free transport from home to health institutions and back is also available.  

Implementation of JSSK 

All the States and Union Territories are implementing free entitlements under JSSK both to the pregnant women and sick neonate’s upto one month of age. In brief,  institutional  deliveries are a key determinant of maternal mortality and quality provision of ante-natal  and post-natal services can reduce infant as well as maternal mortality. Janani-Shishu Suraksha Karyakram supplements the cash assistance given to a pregnant woman under Janani Suraksha Yojana and is aimed at mitigating the burden of out of pocket expenses incurred by pregnant women and sick newborns. Besides it would be a major factor n enhancing access to public health institutions and help bring down the Maternal Mortality ratio and Infant mortality rates. 

However, the actual implementation of the scheme hinges on the proactive role played by state governments. The degree to which the scheme is successful would be determined by the extent to which the programme implementation is carried out by the State functionaries.  

 

Brief Status of JSSK programme in the Country 

Government of India has launched Janani Shishu Suraksha Karyakaram (JSSK) on 1st June, 2011. The initiative has been rolled out in all States and Union Territories under the overall umbrella of   National Rural Health Mission (NRHM). The scheme is estimated to benefit more than 12 million 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.  

In the year 2012-13, a sum of Rs 2082.47 crores have been allocated to the States for the implementation of free entitlements under JSSK. A quick review was undertaken by the Ministry in select health facilities in 1 to 2 districts  f 13 States between April to June, 2012 (6 EAG States and 7 others). The States included in the field visits are Andhra Pradesh, Bihar, Chhattisgarh, Gujarat, Haryana, HP, Karnataka, Maharashtra,  M.P., Odisha, Punjab, Rajasthan and UP. The information provided in this report is based on the interaction with the pregnant women and mothers in OPD and IPD, service providers in the facilities and district level health administrators. The report has highlighted certain significant progress in JSSK programme which are as under.

 

Key Positives 

User Charges in OPD and IPD for Pregnant women and  sick children exempted in 10 out of the 13 States visited except Bihar, Chhattisgarh and Odisha.  

Drugs and consumables -  Availability of drugs in the facilities have improved. Out of the 13 states, 8 states are giving free drugs from within the facility. Situation of drugs in Madhya Pradesh, Bihar, Chhattisgarh,  Odisha and Himachal is still far from adequate. 

Diagnostics- Availability of diagnostic facilities are better at the District Hospitals and even at CHCs and the routine tests for pregnancy wherever available (urine and blood) are being provided free of cost to pregnant women in the facilities.  

Diet- Provision  of  diet in IPD for pregnant women has been started in 12 states at the District Hospital and CHC levels.  

Referral transport-  Out of the 13 states, in 10 states – Andhra Pradesh, Bihar, Himachal Pradesh,  Punjab, Haryana, Rajasthan, Chhattisgarh, Madhya Pradesh, Gujarat, Karnataka national level emergency referral transport model is operational under PPP except for Haryana. Drop back has  recently been started and is slowly picking up.   

Display of entitlement and awareness of community - Health facilities in Andhra Pradesh, Maharashtra, Madhya Pradesh, Chhattisgarh and Gujarat had  displayed the entitlements prominently. In the other states, display was sporadic, generally available in DHs and SDHs and partial at the PHC and SC levels.  

Grievance redressal mechanism- Grievance  redressal Mechanism has been set up in some districts of Maharashtra, Madhya Pradesh and  Chhattisgarh, however in rest of the states it is yet to set up a system for addressing grievances from  patients with regard to JSSK entitlements. The review in 13 states also highlight some of the gaps in Referral Transport (specially drop back), grievance redressal, Display of entitlements and IEC which are being addressed.   

 

H. Bhushan The author is Deputy Commissioner, Maternal Health, Ministry of Health and Family Welfare, Government of India.