Janani Suraksha Yojana

(J )
(JSY)

State Institute of Health & Family Welfare,

Jaipur

SIHFW: an ISO9001: 2008 certified institution 1

 JJanani S j
Suraksha Yojana

• JSY scheme-2005. A safe motherhood

intervention
• Replaces "National Maternity Benefit Scheme
Scheme”.
• 100% centrally sponsored, largest cash- subsidy
scheme
• Integrates cash assistance with delivery & post
post-
delivery care.
• Pay- for performance
Source:- Paying for Performance: The Janani Suraksha Program in India
2
SIHFW: an ISO9001: 2008 certified institution
 y - for- Performance
Pay

• Pay – for –performance

performance (P4P) is a strategy that
links payment to results.

• It is an important complement to strengthen

h lth
health systems
t and
d achieve
hi Mill
Millennium
i
Development Goals(MDG) and other targets that
represent better health status for people.

Source:- Paying for Performance:The Janani Suraksha Progran in India

SIHFW: an ISO9001: 2008 certified institution 3

 Goals
• To reduce maternal and infant mortality through
increasing institutional delivery,
• Access to q
quality
y antenatal and p
postpartum
p
health care
The program provides a continuum of care
package that includes ANC, institutional delivery,
postpartum care, and family planning coordinated
by the ASHA
SIHFW: an ISO9001: 2008 certified institution 4
 JJanani Suraksha Yojna
j

Vision

• To promote Institutional Deliveries

• To reduce overall Maternal Mortality Ratio and

Infant Mortality Rate.

SIHFW: an ISO9001: 2008 certified institution 5

 Beneficiaries

• Pregnant women of all section of the society.

• No age bar.
• Irrespective of birth order
order.
• In rural & urban areas.

SIHFW: an ISO9001: 2008 certified institution 6

 JSY: Strategy
• Early registration
• Identification of complicated cases
• 3 ANC & PNC visits
• Organizing referral services and transport
• Convergence with ICDS - involving AWW
• Transparent & timely disbursement of cash
• 24 X 7 delivery services at PHC
• M ki FRU
Making FRUs ffunctional
ti l
• Building partnership

SIHFW: an ISO9001: 2008 certified institution 7

 JJSY: Implementation
p
States/UTs classified as:
¾ Low performance States (LPS)
• States covered- 10
• 8 EAG states
t t
• Assam
• J& K
¾ High Performance States (HPS)-18
¾ Cash assistance linked to ID
¾ Incentive to ASHA
Source:- Paying for Performance: The Janani Suraksha Program in India

SIHFW: an ISO9001: 2008 certified institution 8

 JS y Features
JSY: Key

• Early registration and identification of

complicated cases;

• Referral and referral transport when necessary

• Micro-birth plans

• Institutional birth

• ANC visits and postpartum visits

SIHFW: an ISO9001: 2008 certified institution 9

 JS y Features
JSY: Key

¾ Assistance for Caesarean Section – Rs.1500/-

Rs 1500/

¾ Compensation payment for Tubectomy

/Laparoscopy

¾ Disbursement of cash assistance

¾ Partnership with private sector

¾ Provision to meet administrative expenses

SIHFW: an ISO9001: 2008 certified institution 10

 Cash Assistance

• JSY program go to two types of recipient:

• Women receive demand-side payment for

accessing a continuum of maternal and newborn
health services at Gov.& accredited private
institutions

• Individual community health workers receive

supply side payment
Source:- Paying for Performance: The Janani Suraksha Program in India

SIHFW: an ISO9001: 2008 certified institution 11

 Cash Assistance

• Cash assistance also given for deliveries at

accredited
dit d pvt.
t Institutions,
I tit ti b t the
but th beneficiary
b fi i

has to pay the total cost

• No incentive for ASHA for accompanying to pvt.

pvt

Institution

SIHFW: an ISO9001: 2008 certified institution 12

 JSY: Eligibility for cash assistance for
Demand Side
Low All pregnant women delivering in
Performance Government health centers like Sub-centre,
Sub-centre
States PHC/CHC/ FRU / general wards of District and
state Hospitals or accredited private institutions

High Schedule caste, schedule tribe and BPL

Performance pregnant women,
women aged 19 years and above
States
LPS & HPS All SC and ST women delivering in a
government health centre like Sub-centre,
PHC/CHC/ FRU / general ward of District and
state
t t Hospitals
H it l or accredited
dit d private
i t institutions
i tit ti

SIHFW: an ISO9001: 2008 certified institution 13

 S
Role of ASHA
Duties of ASHA - Sahyogini:
• Registration of eligible beneficiary.
• Antenatal checkup (3 times)
• Arrange referral transport, Escort her to health
facility & facilitate cash assistance from
PHC/CHC/DH.
PHC/CHC/DH
• Post natal checkup (2 times).

Source: DM&HS
SIHFW: an ISO9001: 2008 certified institution 14
 JSY: Eligibility for Cash Assistance
for
f Supply
S l Side
Sid

• Payment is made only if the ASHA escorts the

pregnantt woman to
t the
th delivery
d li f ilit and
facility d stay
t

with her until the delivery is completed

• To receive the JSY payment the women must

present documents-JSY card, BPL certificates

SIHFW: an ISO9001: 2008 certified institution 15

 Scale of Assistance for ID
Category Rural Area Total Urban Area Total

Mother’s ASHA’s Rs. Mother’s ASHA’s Rs.

Package Package Package Package
LPS 1400 600 2000 1000 200 1200
HPS 700 700 600 600

• Rs. 300 is paid to beneficiaries for transportation who has

come directly to institution for delivery without ASHA in Rural
area.
• Beneficiary brought by 108 Ambulance the beneficiary &
RMRS are paid 150/-
150/ each (Transportation)

SIHFW: an ISO9001: 2008 certified institution 16

• ASHA-Sahayogini is paid the first installment of
Rs 100/- (for ANC reg, TT injection, 3 ANCs, IFA
tab and motivation) at the institution at the time of
discharge of the beneficiary.
• ASHA-Sahayogini is paid the second installment
of Rs 100/- after 42nd day on completion of 5 PNC
(1, 3, 7, 28, 42nd day) for mother & the new born
& immunisation of new born with BCG, DPT-I and
OPV-I
• In Rural area Rs. 400/- for transport is paid with
first installment.

SIHFW: an ISO9001: 2008 certified institution 17

• Benefits to trained Dai:
• 10-06-09 onward if trained Dai escorts the
beneficiary:-
Trained Dai is being paid Rs. 200/- for escorting the
beneficiary for institutional delivery. Except 5
di t i t Alwar,
districts Al Bh t
Bharatpur, Bhil
Bhilwara, D
Dausa &
Jhunjhunu.

• Benefits to JMC:-
11-08-09
11 08 09 onward if JMC escorts the beneficiary:-
beneficiary:
JMC is being paid Rs. 200/- for escorting the
beneficiary for institutional delivery.

SIHFW: an ISO9001: 2008 certified institution 18

• All BPL pregnant women a cash assistance of
Rs. 500/- 8-12 weeks prior to delivery.

• The remaining amount is being paid on

institutional delivery.

• An amount of Rs.500
Rs 500 for home delivery is paid
for a BPL Beneficiary, Irrespective of age &
number of Children.

SIHFW: an ISO9001: 2008 certified institution 19

 JSY: Special Approach for LPS
• Age
A restriction
i i removed d
• Restricting benefits of JSY up to 2 births removed.
th benefits
the b fit off the
th scheme
h are extended
t d d to t allll
pregnant women in LPS states irrespective of birth
orders.
orders
• No need for any marriage or BPL certification
provided woman delivers in Government or
accredited private health institution.
• GOI set the guidelines depending the specific
context of the state. For Ex. In Rajasthan 5 liters of
Desi Ghee is also provided to BPL women at the
time of her first delivery
SIHFW: an ISO9001: 2008 certified institution 20
 Number of JSY beneficiaries
(in
(i Lakhs)
L kh )
Financial
Year Rajasthan
Progress
2005-06 0.05 17.70
2006 07
2006-07 3 88
3.88 3056 00
3056.00
2007-08 7.75 13005.00
2008-09 9.17 14975.23
2009-10 9.78 16248.08
2010-11 9.86 18004.04
2011-12 10.10 15879.02
2012-13 NA
Source:(April-June)
www.rajswasthya.nic.in
2.15
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21
 Institution Delivery
y

ID in Rajasthan (%)

77.34
65 69.44
62
52.24
39.87
28

2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12

Source: www.rajswasthya.nic.in

SIHFW: an ISO9001: 2008 certified institution 22

 Accrediting of Private Facilities Under
JSY

• Under JSY a provision of facility to avail services

off private
i t hospitals
h it l through
th h accreditation
dit ti

• Up-to
Up to two private hospitals per block are to be

accredited as tehsil or block level.

level
152 private institutions accredited under JSY  
Source: MIS – NRHM 31.03.2012 
Source:-Paying for performance: The Janani Suraksh Program in India

SIHFW: an ISO9001: 2008 certified institution 23

 Main Difficulties of JSY
• Non availability of Referral Transport at block
level.
• ASHA is not assisting pregnant women at most
places.
• Delayed Payment of JSY incentive to the
beneficiaries & ASHA-Sahayogini.
• Women are discharged after delivery before
minimum recommended stay.
• Reporting of physical and financial progress of
JSY is not timely and consistent.
• Lack of required specialists at the facilities
SIHFW: an ISO9001: 2008 certified institution 24
 Deshi Ghee Scheme

• 100% State Govt. sponsored scheme

• Implemented in all the districts from 01.03.2009
• 5 liter Desi Ghee
• Applicable
¾ First delivery at govt. institution
• Includes
I l d
¾ BPL
¾ Identified families of Sahriya and Kathodi
tribes under State BPL Antyodaya Anna
Yojana
j

SIHFW: an ISO 9001:2008 certified Institution 25

25
• Benefits
¾ Promoting ID
¾ Fulfill energy requirements of lactating
mothers
¾ Fulfill
F lfill Vitamin
Vit i A requirements
i t off newborn
b
through mother
• Major provisions
¾ Coupon of ghee (indicating dairy booth
number)) g given at the time of discharge
g along
g
with JSY cheque
¾ 24 hours stay at HF must after delivery

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¾ Essential to produce
™ BPL card,
card ANC card verified by doctor
(urban)/ ANM (rural) for first delivery
¾ 5 liter Saras Desi Ghee provided within 1
month
¾ Different packing with ‘Janani Swasthya
Protsahan Yojana’ marked as a token of gift
¾ In absence of dairy booth provided through
milk collection centers
¾ Reimbursement done to related dairy by
D
Department
t t off Health
H lth
SIHFW: an ISO 9001:2008 certified Institution 27
 Rajasthan Janani-Shishu Suraksha
Yojana (RJSSY)

Object-

Assures NIL out of pocket expenses

i allll Government
in G t Health
H lth Institutions
I tit ti

F Pregnant
For P t Women
W & Newborns.
N b

Source:-DM&HS

SIHFW: an ISO9001: 2008 certified institution 28

 Entitlements for Pregnant Women
•Free
Free delivery
•Free caesarian section
•Free
F d
drugs & consumables
bl
•Free diagnostics (Blood, Urine tests & Ultra
sonography etc.)
etc )
•Free diet during stay (up to 3days for normal
delivery & 7 days)
•Free provision of blood
•Free
Free transport from home to health
institutions, between health institutions in case of
referrals and drop back home
•Exemption from all kinds of user charges 29
SIHFW: an ISO9001: 2008 certified institution
Source:-DM&HS
 Entitlements for Sick Newborn till
30 days
d after
ft birth
bi th
•Free and zero expense treatment
•Free drugs & consumables
•Free diagnostics
•Free provision of blood
•Free
F t
transport
t f
from h
home t
to h lth
health
institutions, between health institutions in case of
referrals and drop back home
•Exemption from all kinds of user charges

Source:-DM&HS
SIHFW: an ISO9001: 2008 certified institution 30
 RJSSY: Performance
S.No Services No. of
Beneficiaries*

1 Total Deliveries 622445

2 No. of pregnant women provided free medicine 1058902
3 N off pregnantt women provided
No. id d ffree lab
l b ttests
t 603797
4 No. of pregnant women availed free hot food 714253
No. of pregnant women provided free referral
No
5 370400
transport from house to health facility
No. of pregnant
g women provided free referral
6 443582
transport from health facility to house

7 No. of pregnant women provided free blood facility 31946

*: Sept 12, 2011 - July 15, 2012

Source:-DM&HS 31
SIHFW: an ISO9001: 2008 certified institution
 RJSSY: Performance
S.No Services No. of
Beneficiaries*

No. of Sick Neonates (30 days) received free

1 193164
medicine
No. of Sick Neonates ((30 days)
y ) received free lab
2 53401
tests
No. of Sick Neonates (30 days) received free referral
3 11146
transport from house to health facility
No. of Sick Neonates (30 days) received free referral
4 19062
transport from health facility to house
No. of Sick Neonates (30 days) provided free blood
5 1434
facility

*: Sept 12, 2011 - July 15, 2012

Source:-DM&HS

SIHFW: an ISO9001: 2008 certified institution 32

 Research on JSY
• A study by Center
C for
f Operational
O Research &
Training (2007), conducted Rajasthan “compared
th number
the b off deliveries
d li i i public
in bli sector
t facilities
f iliti
before and after the JSY program“.
Findings:- Number of institutional deliveries in
the public sector increased by 36%.
• Study of motivation for institutional delivery, more
than half of mothers (173 mothers interviewed)
stated that the JSY incentive payment was a
major factor in their decision to deliver
(Study conducted in Rajasthan by Center for Operational Research & Training facility.)

Source:-Paying for performance: The Janani Suraksha Program in India

SIHFW: an ISO9001: 2008 certified institution 33

 Research Cont.
Population Research Center at Mohan Lal
S kh di Uni.
Sukhadiya U i Conducted
C d t d a study
t d (2007-08)
(2007 08) in
i two
t
districts Banswara (high record of institutional
deliveries) & Barmer (low performance) in
Rajasthan. 200 beneficiaries were interviewed.
Findings:-JSY program contributed to increased
access to antenatal and postpartum care as
well as to increased institutional deliveries.
Source:-Paying for performance: The Janani Suraksh Program in India

SIHFW: an ISO9001: 2008 certified institution 34

 y
Case Study

Radha, a newlyy married young

y g woman in a small
village in rural Rajasthan, she was pregnant and
h d
her due d
date
t was jjustt one week
k away.

Against
g the wishes of her in-laws,, Radha had left
her husband’s village and returned to her parents’
home.

SIHFW: an ISO9001: 2008 certified institution 35

She was planning
g to deliver her baby
y at home, jjust
as her mother, Prema, had given birth to her at
h
home 18 years earlier.
li

According
g to Prema,, Radha’s in-laws had recentlyy
learned about a government program that is
providing a cash payment to women who opt for
institutional deliveryy over the traditional p
practice of
home delivery.

SIHFW: an ISO9001: 2008 certified institution 36

Prema said that the decision of where Radha would
deliver caused a conflict between the two families.

She said that Radha’s in-laws wanted Radha to

deliver in an institution but Prema did not agree
with that.

ASHA got information that Radha wants to deliver

at home,
home she contacted Radha and suggested for
institutional delivery.

SIHFW: an ISO9001: 2008 certified institution 37

She ggave some examples p of her neighbors
g who
delivered in hospitals.
ASHA ensured that she delivers in an institution.
Now Radha is ready for the institutional
delivery, her mother informed her in-laws. And after
t
two d
days R dh delivered
Radha d li d a girl
i l in
i institution
i tit ti and
d
received good care & incentive from JSY also.

SIHFW: an ISO9001: 2008 certified institution 38

 Thank Yo
You

For more details log on to

www.sihfwrajasthan.com
or
contact : Director-SIHFW
on

sihfwraj@yahoo.co.in

SIHFW: an ISO9001: 2008 certified institution 39