Power Point about Janani Shishu Suraksha Karyakram

1. Janani Shishu Suraksha Karyakram
(JSSK)
Dr Gagan deep kaur
HIMS

2. Layout
• Introduction about Maternal mortality
• Evolution of Mother and Child Health Care till
JSSK
• Rationale Behind JSSK
• Objectives
• Entitlements under the Scheme
• Implementation of new initiative
• Implementation Status of Uttarakhand

3. Maternal Mortality: A Global Tragedy
Annually, 585,000 women die of pregnancy related
complications
– 99% in developing world
– 1% in developed countries

4. India
• In India, 67000 women die every year from
pregnancy or pregnancy related causes
– 25% global burden by India (with16% of world’s
population).
– Since the 1980’s successive programmes have attempted to
address the high MMR
• There have been considerable decline in India’s
MMR in the last two decades: from 398 in 1997-98
to 168 in 2015

5. Neonate mortality

6. India-Neonate mortality
• Every year 13 lakh newborns die within one year of birth.
– 2/3 of newborn deaths occur within 4 weeks
First 28 days are critical to save life of the child

7. MCH care programmes evolution
Family Welfare Programme in 1979
– integration of family planning services with those
of MCH .
– Effective IEC to improve awareness
– Easy and convenient access to FW services free of
cost

8. Child Survival and Safe Motherhood Programme;
1992
• Early registration of pregnancy
• Minimum three ANC check ups
• Universal coverage with TT immunization.
• Advise on food , nutrition and rest
• Detection of high risk pregnancies and prompt referral
• Clean deliveries
• Birth spacing
• Promotion of institutional deliveries

9. Child component of CSSM
• New born care
• High coverage levels under the UIP
• Oral Rehydration Therapy (ORT) Programme
• Diarrheal Disease Control Programme
• ARI Control Programme

10. Reproductive and Child Health
Programme
• 1997,Phase-1
• CSSM+RTI/STD &AIDS
• Major interventions are-
– Essential obstetric care
– 24 hour delivery services at PHC/CHCs
– Essential newborn care
– Emergency obstetric care
– Medical termination of pregnancy
– Prevention of RTI and STD

11. Reproductive and Child Health
Programme-II
• April,2005
• Major strategies are
• Essential obstetric care
– Institutional delivery
– Skilled attendance(SBA) at delivery
• Emergency obstetirc care
– Operationalizing FRU
– Operationalizing PHC and CHCs for round the clock
delivery services
• Strengthening referral system

12. National Rural Health Mission (NRHM)
• 2005 : provide equitable , accessible and affordable health
care
– To reduce MMR to 100/100,000
– To reduce IMR to 30/1000 LB
– The Janani Suraksha Yojana ( Safe Motherhood
Scheme) was the key strategy to achieve this
reduction

13. Janani Suraksha Yojana
• 12 April,2005
• Centrally sponsored scheme
• Benefit of cash assistance with institutional care
• Eligibility for cash assistance
– LPS- All women delivering in government health
centres
– HPS- BPL women, aged 19 years and above and the
SC and ST women.

14. Cash Assistance
Category
Mother's
package
ASHA's
package
Total Package(in
Rs.)
LPS 1400 600 2000
HPS 700 - 700
Category
Mother's
package
ASHA's
package
Total Package
(in Rs.)
LPS 1000 200 1200
HPS 600 - 600
Rural Areas
Urban Areas

15. Key findings from JSY evaluation
Positive
The JSY has unarguably resulted in an increase in institutional
deliveries, and has enabled poor women to access public health
facilities.
The no. of institutional deliveries is-41%
No of Deliveries by TBA- 49%

16. Concerns of JSY
• Whether this programme was reaching the poorest and most
marginalised.
• Persistence of home deliveries –40% in most districts
• High Out of Pocket Expenses on : OPD fee, diagnostic tests,
admissions, blood, on purchase of drugs and consumables from the
market
• Spending on transport from home to facility and back
• Spending on diet which was not provided in the facilities

17. Janani Shishu Suraksha Karyakram –
JSSK
• MoHFW: consensus to provide completely free
and cashless services
– Pregnant women (normal deliveries and caesarean
operations)
– sick new born (up to 30 days after birth)
 JSSK was launched on 1st June, 2011.

18. Objectives
– Eliminating out-of-pocket expenses for families of
pregnant women and sick newborns in government
health facilities
– Reaching the unreached pregnant women (nearly 75
lakh a year who still deliver at home)
– Timely access to care for sick newborns

19. Free Entitlements for pregnant women:
Free and cashless delivery
Free C-Section
Free drugs and consumables
Free diagnostics
Free diet during stay in the health institutions
Free provision of blood
Exemption from user charges
Free transport from home to health institutions
Free transport between facilities in case of referral
Free drop back from Institutions to home after 48hrs stay

20. Free Entitlements for Sick newborns
Free treatment
Free drugs and consumables
Free diagnostics
Free provision of blood
Exemption from user charges
Free Transport from Home to Health
Institutions
Free Transport between facilities in case of
referral
Free drop Back from Institutions to home

21. Newborn care facilities at different levels
Health facility All newborns at
birth
Sick new borns
Primary health
centre
PHC/SC
Newborn care
corners in labour
room
Prompt referral
CHC/FRU Newborn care
corners in labour
room and in
operation theatre
Newborn stabilization
unit
(NBSU)
District Hospital Newborn care
corners in labour
room and in
operation theatre
Special newborn care
units
(SNCU)

22. Ensure drugs and consumables:
• Essential drug list to be notified .
• Ensure regular procurement, Uninterrupted supply
and availability of drugs.
• Ensure quality and shelf life of drugs supplied
• The drug availability of the drugs should be displayed at the health
facility
• Empower the head of the district to procure drugs to prevent stock
outs.

23. Cont...
• Ensure a proper inventory of drugs and consumables at each
health facility.
• In charge pharmacist of the facility to ensure availability of
drugs at dispensing points.
• Ensure that first expiry drugs and consumables are used first.
• Ensure proper storage of drugs and consumables by keeping
drug stores clean and tidy with adequate ventilation and
cooling.

24. Strengthen diagnostics
• Ensure lab and diagnostic services.
• Ensure availability of routine investigations.
• Ensure postings of Lab technicians.
• Make emergency investigations available round the
clock.

25. Cont....
• Ensure uninterrupted supply of reagents, consumables
required for lab investigations
• Empower the head of District to procure reagents,
consumables and other essentials to prevent their shortage.
• Free investigations through PPP/Outsourcing.

26. Ensure provision of diet
• Ensure provision of diet at all delivery points.
• If proper Kitchen and adequate manpower is not available,
then this service can be outsourced.
• Local seasonal foods, vegetables, fruits , milk and eggs can
be given to her for a proper nutritious diet.
• MO in charge should monitor the quality of food

27. Cont....
• Diet to be provided :
– 3 days for normal delivery
– 7 days for caesarean action.
• Funds in advance for ensuring provision of free diet.

28. Ensure availability of blood in case of need
• Prepare time bound action plan for operationalising Blood
banks.
• Maintain adequate stocks for each blood group
• Availability of reagents for blood grouping and blood
transfusion
• Mandatory screening of blood before storage.
• Adequate funds to blood banks for electric backup.
• MO in charge of the blood bank to periodically visit blood
storage units for monitoring and supervision.

29. Referral Transport
• Transport from home to health facility
• Referral to the higher centre in case of need
• Drop back from facility to home.

30. Cont..
• Ensure universal reach of the referral transport.
• State is free to use any suitable model of transportation.
• Establish call centres with single toll free model.
• Vehicles with GPS, for effective tracking and management.
• Establish linkages for the inaccessible areas.

31. Dissemination of the entitlements
• Widely publicise these entitlements through print and
electronic media.
• Display them prominently on adequate size hoardings and
boards which is clearly visible from Governments health
facilities.
• IEC budget sanctioned in the PIP plan under RCH/NRHM

32. Cont..
• Widely publicise the free and assured referral
transport.
• Monitor and Supervise services at all levels

33. Exemption from all kinds of user charges
• Issue Government order for exemption from
any user charges for pregnant women and sick
newborns up to 30 days, at public health
facilities.

34. State level
• Government order on free entitlements.
• State Nodal Officer
• grievance redressal mechanism
• Availability of drugs and consumables in entire state
• Functional lab facilities and diagnostic services at PHI.
• Operationalise blood banks at district levels and Storage
centers at identified FRU’s

35. Cont...
• District wise assured referral linkage.
• Financially empower the district and facility in
charge.
• Regular monitoring and report in designated formats
at specified periodicity

36. District level
• District Nodal officer.
• Circulate the G.O on free entitlements to all facility in-charge.
• Widely Publicise free entitlements in public domain.
• Grievance redressal mechanism.
• Regularly review the stocks of drugs and consumables for
ensuring availability.
• Ensure Lab facilities and diagnostic services are functional

37. Cont...
• Time bound action plan for operationalising blood banks.
• Review referral linkages and their utilisation by beneficiaries.
• Regularly monitor and report on designated formats at
specified periodicity.
• Review the implementation status during Block Mos/Mos
meetings

38. Grievance Redressal
• Prominently display the names , addresses, e mails,
telephones, mobiles and fax numbers of grievance redressal
authorities.
• Set up help desks and suggestion/complaint boxes at
government health facilities.
• Keep fixed hours on any two working days per week.
• Take action on the grievances within a suitable timeframe, and
communicate to the complaints.
• Maintain proper records of action taken.

39. Monitoring and Follow up
• NHSRC
• MOHFW
National level
• State Nodal officer
• District Nodal officer
State
level/District level
• National
• State/District level
Check list

40. JSSK Uttarakhand: Implementation Status

41. JSSK Uttarakhand: Strengths in Implementation
• Govenment order on free entitlements is issued
• Seperate weblink for JSSK in NRHM state website.
• Programme management unit is fully staffed at state,
district and block level.
• Blood banks are available at district level
Source : PIP uttarakhand 2012-2013 M& E report

42. Cont..
• Special newborn care units (SNCU) established for care of the
sick and newborn in District Hospitals.
• Grievance redressal mechanism for beneficiaries.
• Transport and drop back for pregnant and newborn was found
very effective.
• 75% of beneficiaries were provided free drugs.
Source : PIP uttarakhand 2012-2013 M& E report

43. Weakness in implementation
• Out of 18 District Hospitals only 11 DH have C‐ section
• From a total 55 CHCs only 6 provide C‐Section and 1st
trimester abortion facility.
• Lack of coordination between the contractual staff and
permanent staff.
• Pregnancy related diagnostics such as ultra sound and other
blood tests is referred to private diagnostic centres and the
beneficiaries have to pay for it.

44. Cont...
• ASHAs and ANMs are not aware about JSSK though
they were aware about some of the JSSK
entitlements.
• Only 30% of women had institutional delivery and
32.2% had more then 3 ANC checkups

45. Beneficiaries Response on JSSK Entitlements
JSSK components Percentage
Free transport 44.8
Free Diet 37.9
Free Drugs 82.8
Free Diagnostics 24.1
Free Blood 27.6

46. IEC material provided in PIP

47. •Thank you