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