The Janani Suraksha Yojana (JSY), launched in 2005, is an ambitious scheme launched under the National Rural Health Mission (NRHM), the Government of India’s flagship health programme. The scheme is an intervention for safe motherhood and seeks to reduce maternal and neo-natal mortality by promoting institutional delivery, by providing a cash incentive to mothers who deliver their babies in a health facility. There is also provision for cost reimbursement for transport and incentives to Accredited Social Health Activists (ASHA) for encouraging mothers to go for institutional delivery. The scheme is fully sponsored by the Central Government and is implemented in all the States and Union Territories (UTs), with special focus on low performing States. There is provision for roping in the private sector by giving accreditation to willing private hospitals/nursing homes for providing delivery services. It is a conditional-cash transfer scheme that ensures quality maternal care during pregnancy, delivery and in the immediate post-delivery period along with appropriate referral and transport assistance. It links cash assistance with delivery and post-delivery care. The scheme has made special dispensation for States having low institutional delivery rates. Further, to improve accessibility to health facilities, the scheme has made provisions for engaging the private sector through an accreditation process.
To reduce overall maternal mortality ratio and infant mortality rate and to increase institutional deliveries in below poverty line (BPL) families.
All pregnant women belonging to the below poverty line households and who are of the age of 19 years or above up to two live births.
- Early registration of the beneﬁciaries with the help of village level health workers like ASHA or an equivalent worker.
- Early identiﬁcation of complicated cases.
- Providing at least three antenatal care, and post delivery visits.
- Organising appropriate referral and provide referral transport to the pregnant mother.
- Convergence with the Integrated Child Development Services (ICDS) workers by way of involving Anganwadi workers (AWWs) intensively.
Each State prepares its budget for JSY on the basis of fund requirements of the districts and below level institutions. The State budget requirements are based on administrative cost of JSY at the State and district levels, payments to be made to the expected number of women who would deliver in institutions and to ASHA. These plans cover additional requirements of manpower, infrastructure of beds, operation theatres, drugs and other such items at each service unit level. The States convert these demands into fund requirements and subsequently submitted their demands to the Centre.
The scheme has made progress but not up to the desired levels. Inability to provide financial and human resources at the right time is one of the drawbacks of the scheme at the ground level. In many cases, it has been seen that the beneficiaries have not been provided with the financial support at the time when it is required as a result of which the scheme tends to fall short of its objectives.
- States/UTs have been classiﬁed into two categories viz., Low Performing States (LPS) and the High Performing States (HPS).
- The beneﬁts under the scheme are linked to availing of antenatal checkups by the pregnant women and getting the delivery conducted in health centres or hospitals. While the beneﬁciaries are encouraged to register themselves with the health workers at the sub centre or Anganwadi or Primary health centres for availing of at least three antenatal checkups, post-natal care and neo-natal care, the disbursement of enhanced beneﬁts under the scheme will be linked to institutional delivery.
- One of the accepted strategies for reducing maternal mortality is to promote deliveries at health institutions by skilled personnel like doctors and nurses. Accordingly, cash assistance is to be provided to women from Below Poverty Line (BPL) families, for enabling them to deliver in health institutions.
Each village of 1000 population is expected to have one ASHA or an equivalent worker registered with the
sub-centre of that concerned village, who would be
working with the Anganwadi Workers. Under JSY, her main roles are:
- To organise delivery care services for the registered expectant mother.
- To assist in immunisation of the new born and
- To act as a propagator or motivator of family planning services.
Problems and Challenges
The scheme has made progress but not up to the desired levels. Inability to provide financial and human resources at the right time is one of the drawbacks of the scheme at the ground level. In many cases, it has been seen that the beneficiaries have not been provided with the financial support at the time when it is required as a result of which the scheme tends to fall short of its objectives. Awareness levels about the scheme leave much to be desired as a result of which many beneficiaries remain in the dark about its benefits. Besides, beneficiaries sometimes have difficulty in getting the documents and forms filled at the right time because of slackness on the part of officials. In certain cases it has also been seen that the health service providers have not provided the right information to the beneficiary with regard to filling the forms within the specified time. In several cases, instead of genuine beneficiaries, other people are taking the benefits with the help of officials as a result of which the actual beneficiary is left empty handed. That’s quite a list of problems and challenges to which the Government needs to respond at the earliest.