Janani Shishu Suraksha Karyakram (JSSK) was initiated in to reduce the out of pocket expenditure for pregnant women. We estimated the proportion of. Janani Shishu Suraksha Karyakaram (JSSK). Introduction. In view of the difficulty being faced by the pregnant women and parents of sick new-. Janani-Shishu Suraksha Karyakram In Jun , Ministry of Health and Family Welfare, Government of India launched the Janani–Shishu Suraksha Karyakram .
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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. India had MMR of perlive births in One of the key reasons for poor utilization of maternal health care services was the financial burden on the families. Government of India initiated several programs to improve the institutional deliveries with the goal of reducing maternal mortality. JSSK provides free and cashless delivery in the public sector institutions.
Institutional deliveries in the Himachal Pradesh increased from Therefore we estimated the proportion of mothers who received various components of JSSK benefits and out of pocket expenditure among beneficiaries in the secondary level health facilities of Sirmaur district. We conducted cross sectional survey among women who delivered in the public sector facilities where JSSK was implemented in district Sirmaur, Himachal Pradesh.
All consecutive deliveries in seven public sector facilities during January-March, were included till the sample size was reached. The services for the following components should be offered free to the pregnant mothers.
The components included normal delivery, ceasarean section, drugs and consumables, diagnostics, diet, blood transfusion, exemption from user charges, transport from home to health institutions, transport between facilities in case of referral and free drop back from institutions to home after 48 hrs stay. We defined full benefit if mother received all the benefits mentioned above during hospitalization except transport.
If the mother availed government ambulance both ways or they were reimbursed at the prescribed per kilometre rate for both ways or government ambulance one way and reimbursement for the other trip.
We used structured questionnaires to collect data from mothers regarding socio demographic status, antenatal history, details of the delivery, benefits received for different components, cost incurred if any and reasons for not receiving benefits. Data was collected from mothers after delivery before the discharge from health facility. Analysis was done using Epi-info 3. We estimated shish proportion for various benefits received by mothers and median cost incurred for each component.
We obtained written informed consent from the participants. Confidentiality of yoana participants was maintained. We obtained approval from the Institutional ethics committee and Himachal Pradesh Health officials. Mean age at marriage was 21 years. Fifty percent of the mothers were primigravida mothers. Mean duration of stay in the hospital for normal delivery and for caesarean sections was 34 hours and hours respectively.
Only nine mothers consulted hospital in the post partum period for minor ailments related to delivery however none were hospitalized. All nine mothers incurred expenditure in the range of Rs for the outpatient visits in nearby government or private facility. These facilities were not providing free services under JSSK. Only six newborns aged days were hospitalized and all received free services during the hospitalization and transport benefits.
Apart from hospitalization, transport expenditure was very high [ Table 1 ].
Janani-Shishu Suraksha Karyakram – Governnment of India
Our study described the level of utilization of various benefits under JSSK among mothers. Though mothers received many of the benefits, there was OOPE on many components. All mothers received user fee exemption; blood transfusion and diet however majority of the mothers did incur out of pocket expenditure on consumable, drugs, diagnostics and transport. The arrangement for cashless procurement should be made with multiple private providers in the vicinity of hospitals for beneficiaries.
Himachal Pradesh has high public sector utilization for deliveries and similar scenario was also observed in other Indian states such as Tamil Nadu.
In our study, majority of the mothers got the transport benefits as defined by JSSK guidelines however OOP incurred among those who were fully benefited was mostly due to extra cost of transport over and above the eligibility for reimbursement. Median expenditure on transport to the facility in the study population was more than double Rs of the expenditure reported in the DLHS-3 for India. Provision of accessible and reliable free transport especially in the hilly and difficult to reach villages might further help reduce the OOP.
Our study was cross-sectional in nature and there was lack of baseline data regarding out of pocket expenditure in the Sirmaur district in before JSSK program. JSSK benefitted the mothers utilizing the public sector facilities however consumables, drugs and transport continued to contribute to the OOP expenditure.
There is need for cashless transport facility and better availabiliy of drugs and consumables to further reduce the OOP expenditure on deliveries. National Institute of Epidemiology, Chennai. National Center for Biotechnology InformationU. Indian J Community Med. Author information Article notes Copyright and License information Disclaimer. Received Jan 7; Accepted Feb This article has been cited by other articles in PMC. Materials and Methods Study design and study population We conducted cross sectional survey among women who delivered in the public sector facilities where JSSK was implemented in district Sirmaur, Himachal Pradesh.
JSSK | Official website of National Rural Health Mission, Government of Meghalaya, India
Sample size and sampling procedure All consecutive deliveries in seven public sector facilities during January-March, were included till the sample size was reached. Operational definitions JSSK benefits to pregnant women The services for the following components should be offered free to the pregnant mothers. Full benefit of JSSK during hospitalization We defined full benefit if mother received all the benefits mentioned above during hospitalization except transport.
Full transport benefit If the mother availed government ambulance both ways or they were reimbursed at sufaksha prescribed per kilometre rate for both ways or government ambulance one way and reimbursement for the other trip.
Janani shishu suraksha karyakram and its repercussions on out of pocket expenditure
Data collection and analysis We used structured questionnaires to collect data from mothers regarding socio demographic status, antenatal history, details of the delivery, benefits received for different components, cost incurred if any and reasons for not receiving benefits. Human subject protection We obtained written informed consent from the participants. Open in a separate window. Discussion Our study described the level of utilization of various benefits under JSSK among mothers.
Footnotes Source of Support: National Institute of Epidemiology, Chennai Conflicts of interest: Maternal Mortality Working Group. Estimates of maternal mortality worldwide between and An assessment of available data. Maternal mortality for countries, A systematic analysis of progress towards Millennium Development Goal 5. The burden of maternal health care expenditure in India: Multilevel analysis of national data.
Matern Child Health J.
Mohanty SK, Srivastava A. Out-of-pocket expenditure on institutional delivery in India. Suraisha health, and child health and nutrition in India: State and socio-demographic group variation in out-of-pocket expenditure, borrowings and Janani Suraksha Yojana JSY programme use for birth deliveries in India. Center for Health Informatics N.
Health and Family Welfare Department; Reports from state Statistical Cell. Tamil Nadu Medical Services Corporation limited. Articles from Indian Journal of Community Medicine: Support Center Support Center.