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JSSK has been launched, to ensure that each and ever pregnant woman
and sick neonates upto one month gets timely
access to health care services free of cost and without any out of pocket expenses.
In June 2011, Ministry of
Health and Family Welfare, Government of
India launched the Janani-Shishu Suraksha Karyakram (JSSK), a national
initiative which entitles all pregnant
women delivering in public health institutions to absolutely free and no expense delivery, includingcaesarean section.
The scheme emphasises
utmost importance on “Free Entitlements”.
The idea is to eliminate out-of-pocket expenses for both pregnant women and sick
neonates. Under this scheme, pregnant women are entitled for free drugs and consumables, free diagnostics, free blood wherever required, and
free diet to 3 days for normal delivery and 7 days for caesarian section. This initiative also
provides for free transport from home to institution, between facilities in case of a referral and drop back
home. Similar entitlements have been put in place for all sick newborns accessing
public health institutions for treatment till 30 days after birth.
The JSSK initiative is
estimated to benefit more than one crore pregnant women and newborns who
access public health institutions every year in both urban and rural areas.
Why JSSK ?
India has made
considerable progress in reduction of Maternal Mortality Ratio MMR) and Infantmortality Rate (IMR), but the pace at
which these health indicators are declining needs acceleration. The number of
institutional deliveries has increased
significantly, after the launch of Janani
Suraksha Yojna (JSY) in the year 2005 but many of those who opted for
institutional deliveries were not willing to stay for 48 hrs, hampering the
provision of essential services both to the mother and neonate. Moreover, the
first 48 hours after delivery are critical as complications like haemorrhage, infection,
high blood pressure, etc are more likely to develop during this period and unsafe
deliveries may result in maternal and infant morbidity or mortality.
Access to mother and
child health care services were also hindered by high out of pocket expenses on
user charges for OPD, drugs and consumables, diagnostic tests etc. In some
cases such as severe anaemia or haemorrhage requiring blood transfusion can
also increase immediate expenses. The same becomes still higher in case C
section is being done. So, JSSK has been launched, to ensure that each and
every pregnant woman and sick neonates upto one month gets timely access to health
care services free of cost and without any out of pocket expenses.
Entitlements for Pregnant
Under JSSK, free
Institutional Delivery services (including Caesarean operation) are provided in
government health facilities. Also, medicines including supplements such as Iron
Folic Acid are to be given free of cost to pregnant women. Further, pregnant
Women are entitled to both essential and desirable investigations like Blood, Urine
tests and Ultra- Sonography etc. Furthermore, they are to be provided with free
Diet during their stay in the health institutions (up to 3 days for normal delivery
and 7days for caesarean section). Not only this, there is a provision of free blood
transfusion if the need arises. A significant number of maternal and neonatal deaths
can be saved by providing timely referral transport facility to the pregnant
women. Pregnant Women are entitled to free transport from home to health
centre, referral to higher facility in case of need and drop back from the
facility to home. Besides, under JSSK there is exemption from all kinds of user
charges including OPD fees and admission charges.
Entitlements for Sick
Free treatment is also
provided to the sick Newborn upto 30 days after birth and all drugs and consumables
required are provided free of cost in
public health facilities. As in the case of the mother, the new born too is provided with free diagnostic services
and there is a provision of free blood transfusion if the need arises. The
facility of free transport from home to health institutions and back is also available.
Implementation of JSSK
All the States and Union
Territories are implementing free entitlements under JSSK both to the pregnant women
and sick neonate’s upto one month of age. In brief, institutionaldeliveries are a key determinant of maternal mortality and quality provision
of ante-natal and post-natal services
can reduce infant as well as maternal mortality. Janani-Shishu Suraksha Karyakram
supplements the cash assistance given to a pregnant woman under Janani Suraksha
Yojana and is aimed at mitigating the burden of out of pocket expenses incurred
by pregnant women and sick newborns. Besides it would be a major factor n
enhancing access to public health institutions and help bring down the Maternal
Mortality ratio and Infant mortality rates.
However, the actual implementation
of the scheme hinges on the proactive role played by state governments. The
degree to which the scheme is successful would be determined by the extent to
which the programme implementation is carried out by the State functionaries.
Brief Status of JSSK programme in the Country
Government of India has
launched Janani Shishu Suraksha Karyakaram (JSSK) on 1st June, 2011. The initiative
has been rolled out in all States and Union Territories under the overall
umbrella of National Rural Health Mission (NRHM).
The scheme is estimated to benefit more than 12 million pregnant women who access Government health
facilities for their delivery. Moreover it will motivate those who still choose
to deliver at their homes to opt for institutional deliveries.
In the year 2012-13, a
sum of Rs 2082.47 crores have been allocated to the States for the implementation
of free entitlements under JSSK. A quick review was undertaken by the Ministry
in select health facilities in 1 to 2 districts f 13 States between April to June, 2012 (6 EAG
States and 7 others). The States included in the field
visits are Andhra Pradesh, Bihar, Chhattisgarh, Gujarat,
Haryana, HP, Karnataka, Maharashtra, M.P.,
Odisha, Punjab, Rajasthan and UP. The information provided in this report is
based on the interaction with the pregnant women and mothers in OPD and IPD,
service providers in the facilities and district level health administrators.
The report has highlighted certain significant progress in JSSK programme which are as under.
User Charges in OPD and IPD for Pregnant women and sick children exempted in 10 out of the 13
States visited except Bihar, Chhattisgarh and Odisha.
Drugs and consumables -Availability of drugs in
the facilities have improved. Out of the 13 states, 8 states are giving free
drugs from within the facility. Situation of drugs in Madhya Pradesh, Bihar, Chhattisgarh,
Odisha and Himachal is still far from
Diagnostics- Availability of diagnostic facilities are better at the District
Hospitals and even at CHCs and the routine tests for pregnancy wherever
available (urine and blood) are being provided free of cost to pregnant women
in the facilities.
Diet- Provision of diet in IPD for pregnant women has been
started in 12 states at the District Hospital and CHC levels.
Referral transport- Out of the 13 states, in
10 states – Andhra Pradesh, Bihar, Himachal Pradesh, Punjab, Haryana, Rajasthan, Chhattisgarh,
Madhya Pradesh, Gujarat, Karnataka national level emergency referral transport
model is operational under PPP except for Haryana. Drop back has recently been started and is slowly picking
Display of entitlement
and awareness of community - Health facilities in
Andhra Pradesh, Maharashtra, Madhya Pradesh, Chhattisgarh and Gujarat had displayed the entitlements prominently. In the
other states, display was sporadic, generally available in DHs and SDHs and partial
at the PHC and SC levels.
mechanism- Grievance redressal Mechanism has been set up in some
districts of Maharashtra, Madhya Pradesh and Chhattisgarh, however in rest of the states it
is yet to set up a system for addressing grievances from patients with regard to JSSK entitlements. The
review in 13 states also highlight some of the gaps in Referral Transport
(specially drop back), grievance redressal, Display of entitlements and IEC which
are being addressed.
H. Bhushan The author is Deputy Commissioner, Maternal Health, Ministry of Health
and Family Welfare, Government of India.