Low coverage of Janani Suraksha Yojana(Maternal Protection Scheme) among mothers,south 24 Parganas,West Bengal in 2009Dilip kumar mandal
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Low coverage of Janani Suraksha Yojana(Maternal Protection Scheme) among mothers,south 24 Parganas,West Bengal in 2009Dilip kumar mandal

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  • 1. Low coverage of Janani Suraksha Yojana (JSY) among mothers, South 24 Parganas, India, 2009 Dr. Dilip Kumar Mandal West Bengal
  • 2. Background
    • Globally, >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
  • 3. Objectives of the study Primary: Estimate the coverage of JSY in the district. Secondary: Determine the factors affecting the JSY coverage
  • 4. Methodology-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
  • 5. Methodology-2
    • 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.
    • Analysis of performance reports of RCH and JSY :
    • Secondary data from the records, registers and reports at different levels
  • 6. 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
  • 7. Characteristics of mothers
  • 8. Knowledge about JSY
  • 9. Quality of Ante-Natal Checkups
  • 10. Registration and recipients of JSY benefit after 3 ANC
  • 11. 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%.
  • 12. 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.
  • 13. 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: 2167/135010
      • 2008-09: 1604/ 120316
  • 14. Trend of payment of JSY benefits to mothers, June 2007 to October 2009, South 24 Parganas
  • 15. Trend of Institutional delivery region wise, 2004-09, South 24 Parganas, West Bengal
  • 16. 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