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Low coverage of Janani Suraksha Yojana (JSY) among mothers, South
24 Parganas, India, 2009
Dr. Dilip Kumar MandalWest Bengal
BackgroundGlobally, >0.5 million mothers dies annually, 99% in developing countries
>0.1 million deaths in India, MMR: 254/100000 live births
In West Bengal, MMR: 141 & Institutional delivery 49.2%
In south 24 parganas, 69.1% completed 3 ante-natal care
Institutional delivery: 33.3% rural area
Infant mortality: 46/1000 live birth
Janani Suraksha Yojana (JSY) aims to reduce maternal and infant mortality and to promote institutional delivery among underprivileged groups by:
Promoting antenatal care with financial support for nutrition
Cash incentive and Transport support for institutional delivery
Objectives of the study
Primary:
Estimate the coverage of JSY in the district.
Secondary:
Determine the factors affecting the JSY coverage
Methodology-1 1. Community survey: Eligible mothers of JSY (BPL & SC-ST), having
child below one year of age by cluster sampling using PPS (population proportionate to size) method.
• Sample size: – 256 mothers, in 32 cluster(8/cluster)
• Assumption: utilization of JSY among 70% mothers, 95% CI , 80% power, roh 0.03 (design effect as 3.1) using Right size software
In each cluster, randomly selected mothers. Trained interviewer collected the data using semi-
structured questionnaire
Methodology-22. Survey of Stake-holders: Randomly selected 97 Health Worker (Female)
(Assumption: Knowledge 50%, 95% CI, 80% Power)
• 32 Block Medical Officers of Health (BMOH) & Public Health Nurses (PHN)
12 Gram Panchayat Pradhans District Nodal Officer for JSY Interviewed using semi-structured questionnaire.
3. Analysis of performance reports of RCH and JSY:
Secondary data from the records, registers and reports at different levels
Result Survey of rural eligible women
Under JSY, pregnant mothers of poor (BPL), scheduled caste and tribes got
√ Rs 500 after completing three ante-natal Check-ups (ANC)
√ Rs.150-350 for transport to government or accredited health institution
√ Rs.500 for opting institutional delivery
Characteristics of mothers
Knowledge about JSY
Quality of Ante-Natal Checkups
Registration and recipients of JSY benefit after 3 ANC
Result- Cont’d Institutional delivery among eligible: 50% (128/256)
Institutional delivery among benefited for 3 ANC: 49% (99/188)
Got incentives after delivery for referral transport and institutional delivery: 51% (51/99)
incentives before discharge from hospital: 57% (29/51)
Husband’s education primary or more (Odds Ratio-2.48, 95%CI: 1.22-5.07) and knowledge of JSY (OR-11.17, 95%CI: 5.9-21.9) associated with getting JSY benefits.
Institutional delivery was low in Muslims (OR- 0.41, 95% CI: 0.23-0.72).
Reasons for opting home delivery: • Family tradition in 34% (43/128),
• Sudden labour pain-no time to go to hospital in 14%
• Transport problem in 11%.
Survey of Stake-holders Correct knowledge of JSY (eligibility & benefits)
ANM: 100% (97/97), BMOH & PHN: 94% (30/32) Panchayat Pradhan: 58% (7/12)
Experienced inadequate and late allotment of fund District nodal officer, 55% (53/97) Female Health Workers (ANM)47% (15/32) block officials
88% (85/97) of ANM: non-availability of necessary documents hampered payment from hospital/units
Payment in all days from 62% (23/37) institutions No beneficiary was cross-checked by district or state nodal
officer.
Analysis of secondary data
Maternal Mortality Ratio:108 /100000 live births (from reported 330985 live births and 356 maternal deaths was during Jan 2007-Oct 2009)
Infant death reported 2007-08: 2167/1350102008-09: 1604/ 120316
Trend of payment of JSY benefits to mothers, June 2007 to October 2009, South 24 Parganas
Trend of Institutional delivery region wise, 2004-09, South 24 Parganas, West Bengal
Conclusions Low ANC coverage and poor quality ANC Inadequacy / irregular of fund and delayed payments Document problems hampered payments Low coverage of JSY benefits, but in increasing trend Most of mothers knew about financial benefits but name of the
benefits was less known (i.e. JSY). Knowledge of JSY influenced getting benefits.
Institutional delivery marginally increased
Recommendation Quality ANC by early registration and arranging lab. Test Adequate/ regular fund allotment to peripheral units Payment in time from sub-centre and hospitals/units Community awareness about JSY involving ASHA, link persons,
AWW Reorientation of stakeholders with circulation of guidelines about
time of payment & documents needed