Reducing the maternal and infant mortality rate is the key goal feature of the Reproductive and Child Health Programme under the National Rural Health Mission. Several initiatives have been launched by the Ministry of Health & Family Welfare under the Mission including Janani Suraksha Yojana, a key intervention that has resulted in phenomenal growth in institutional deliveries with more than one crore women beneficiaries annually. JSY was launched to promote institutional deliveries so that skilled attendance at birth is made available and mothers and new born babies can be saved from pregnancy related complications and deaths.
However, even though institutional delivery has increased significantly, out of pocket expenses being incurred by pregnant women and their families remained high. This has acted as a major barrier for the pregnant women to opt for institutional attendance. They still prefer to deliver at home. Due to this, a large number of sick neonates die on account of poor access to health facilities.
To mitigate the problem, the Ministry of Health & Family Welfare launched Janani Shishu SurakshaKaryakram (JSSK) on 1st June, 2011 to provide better health facilities for pregnant women and sick neonates. 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 whenever required, and free diet up to 3 days for normal delivery and 7 days for C-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 & newborns both in urban & rural areas annually.
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 hours, 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 service was also hindered by the 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 caesareansection is 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 incurring any out of pocket expenses.
Under JSSK, free institutional delivery services (including caesarean operation) are provided in government health facilities. 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 three days for normal delivery & seven days 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.
Free treatment is also provided to the sick new born upto thirty days after birth and all drugs and consumables required are provided free of cost. 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.
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 Karyakramsupplements 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 in enhancing access to public health institutions and help bring down the Maternal Mortality ratio and Infant mortality rates.
The launch of the Janani Shishu Suraksha Karyakram will encourage all pregnant women to deliver at public health places and fulfil the commitment of achieving cent percent institutional delivery. It will also empower service providers working at the health facilities in providing quality ante-natal, intra-natal and post-natal services at the institutions. Providing free treatment to sick neonates will help in decreasing the neonatal mortality rate. This initiative will help in reducing both maternal and infant mortality and morbidity.
*Additional Director General(Media & Communication), PIB, New Delhi.
With inputs from the Ministry of Health & Family Welfare.