Performance of Janani Suraksha Yojana Under Nhm in Sarupathar Block Phc, Dist

The International journal of analytical and experimental modal analysis ISSN NO:0886-9367

PERFORMANCE OF JANANI SURAKSHA YOJANA UNDER NHM IN SARUPATHAR BLOCK PHC, DIST. GOLAGHAT Submitted by: POLI BORUAH PhD Research Scholar, Economics Department, Dibrugarh University. List of abbreviation ANC - Antenatal care • ANM - Auxiliary Nurse midwife

• ASHA - Accredited Social Health Activist

• AWC - Anganwadi Centre

• AWW - Anganwadi Worker

• BPL - Below Poverty line

• CHC - Community Health centre

• IFA - Iron & Folic Acid

• IMR - Infant Mortality Rate

• JSY - Janani Suraksha Yojana

• MO - Medical Officer

• MMR - Maternal Mortality Rate

• NIHFW National Institute of Health and Family welfare

• NMBS - National Maternal Beneficiary Scheme

• NHM - National Health Mission

• NSSO - National Sample Survey Organization

• OBC - Other Backward Caste

• PHC - Primary Health Centre

• PNC - Post Natal Care

• PRI - Panchayati Raj Institution

• PPP - Public Private Partnership

• PW - Pregnant woman

• SC - Sub Centre

• VHSC - Village Health & Sanitation Committee

• ABSTRACT: Janani Suraksha Yojana(JSY) is a 100 percent centrally sponsored scheme and it integrates cash assistance with delivery and post delivery care.It identified ASHA as a link between govt. and poor pregnent women to encourage institutional deliveries among the poor women. This paper will basically be focussed on how this scheme performs by fulfilling its objectives in Sarupathar Block PHC of Golaghat district, Assam. The main objectives of this study are : (1)To assess the role of ANM / ASHA in providing services to the beneficiaries

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of the JSY .(2)To seek the opinion of ANMs / ASHAs regarding sufficiency of funds and timely disbursement of funds. (3)The extent to which the introduction of the JSY and ASHA s have helped in increasing

* ANC checkups among Pregnant woman

* Institutional delivery

(4)The quality of services offered and the scope for improvement in the programme

This study has been conducted through both primary as well as secondary sources of data. Key words: ASHA,ANM, Institutional delivery, JSY,PHC.

INTRODUCTION: JSY is an ambitious scheme launched in April 2005, under the “National Health Mission”, the Government of India’s flagship health programme. The scheme is a safe motherhood intervention and seeks to reduce maternal and neonatal mortality by promotion institutional delivery, i.e. by providing a cash incentives to mothers and let them to deliver their baby in a health facility. There is also provision for cost reimbursement for transport and incentives to ASHA s for encouraging mothers to go for institutional delivery. The scheme is fully sponsored by the Central Govt & is implemented in all 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.

Meaning of JSY:

JSY under NHM is being opposed by way of modifying the existing National Maternity Benefit Scheme(NMBS).While NMBS is linked to provision of better diet for pw from BPL families,JSY itegrates the cash assistance with antenatal care during the pregnency period ,institutional care during delivery and immediate post natum period in a health centre by establishing a system of coordinated care by field level health worker .

[ Source :Ministri of Health and Family Welfare ,Government of India]

vision : 1.To reduce overall MMR and IMR 2.To increase institutional deliveries. [Source:Ministri Of Health And Family Welfare,Government of India]

SIGNIFICANCE OF THE STUDY This paper emphasis on the performance of JSY under Sarupathar block by focusing on

• Maternal care through quality ANC

• Cash assistance to all eligible mothers for delivery care

• Cash benefits to ASHA for facilitating institutional delivery

OBJECTIVES OF THE STUDY

The present survey is entrusted to study the following objectives:

• To assess the role of ANM / ASHA in providing services to the beneficiaries of the JSY

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• To seek the opinion of ANMs / ASHAs regarding sufficiency of funds and timely disbursement of funds

• The extent to which the introduction of the JSY and ASHA s have helped in increasing

* ANC checkups among Pregnant woman

* Institutional delivery

• The quality of services offered and the scope for improvement in the programme

METHODOLOGY

This paper is conducted on the basis of primary as well as secondary data.The primary data was collected through field survey. The secondary data was collected from various articles, reports, research papers, internet sources and sarupathar block PHC.

REVIEW OF LITERATURE

• According to the report on “Government of India, Ministry of Health and Family welfare Maternal Health Division Nirman Bhavan, New- Delhi, 2006” there should be the special dispensation for pregnant women from Low Performing States (LPS) like Uttar Pradesh , Uttaranchal , Bihar , Jharkhand , Madhya Pradesh, Chhattisgarh , Assam , J & K. Age certificate is an instrument that is available easily . Many LPS states have yet to get the process of birth registration organized in rural area. In view of this , for all BPL pregnant woman belonging to LPS states any kind of age certification would not be insisted upon for availing the benefits of JSY.

• According to “NRHM common Review Mission 2007” reported that JSY has put pressures on the public health system, and to large extend of outpatient attendance in general - but it is more mixed where the patient attendance or surgeries or diagnostics etc. However, even in these though rate or improvement may not be commensurate, the trend is still upward.

• The series of assessment study report on ASHA and JSY in different states of India (2007), discusses the status of ASHA and the JSY schemes after two years of implementation of the NRHM, the studies indicate that the training period was not according to the requirements of the program, that there was some delay in payment to ASHA and that 75% of the JSY beneficiaries had received funds within a week. The studies also highlight that in spite of the JSY funds related satisfaction being relatively high, it could not be cited as the major reason for the preference for intuitional delivery.

From the above study it has been found that there is no clear cut picture about the performences of JSY ,perticularly in rural areas.So in this paper a small effort has been made to study about the performence Of JSY in Sarupathar Block PHC,of Assam.

AREA OF THE STUDY

This paper focuses on the performances of JSY under NHM in Sarupathar block PHC,Dist.Golaghat.Before we discuss about the performance of JSY here I mention a few lines about this area.

In ancient time this valley was ruled by Dimasa,Kacharies and later by the Ahom .Many archeological monuments are still present in this area.The oldest Silalipi of assam is found here in Nagajuri Khanikar village.Famous Deopani Durga Mandir,and capital of Dimasa in Telesal is in the border of this valley.Hot water Galipung ,Dubarani Sivmandir,Budhist Temple are other places of importance.

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Sarupathar Block PHC covers the entire area of Dhansiri Sub Division of Golaghat District. This beautiful fertile valley is situated in the South West part of Golaghat District. This valley is situated in between parts of Nagaland and Karbi Anglong. Its boundary are Nagalnd in the East, Karbi Anglong in the West and South, Golaghat in the North.

The total population of this Block is about 216192 with an area of 108 Sq/KM. The population pattern of this valley is also colourful. Different tribes like Ahoms, Kacharis, Miri, Misssing, Nepalis, Boroos, Nagas apart from Biharis, Muslims, Manipuris live here. [Source: Sarupathar Block Office]

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SOURCE: SARUPATHAR BLOCK OFFICE

Table:1 Background of the SarupatharBlock PHC

1. Total Population : 216192

2. Male : 109780 3. Female : 106412 4. Total Rural Population: 199062 5. Total Urban Population: 17130 6. Total Literate Person: 126012 7. Total S.C. 4751 8. Male : 2451 9. Female : 2300 10. Total S.T. 24964 11. Male : 12818 12. Female : 12146 13. Total Village 315 14. Total Tea Garden 5 15. Total House hold 16. Total BPL families 15040 Nos 17. Major Town 2 Nos (Borpothar & Sarupathar) 18.Gaon Panchayat 21 Nos.

Source: # Data as per survey through ASHA 2017-2018

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Performance of JSY under NHM in Sarupathar Block:-

Janani Suraksha Yojana (JSY) under the overall umbrella of NRHM is bring propsed by way of modifying the existing National Maternity Benefit Scheme (NMBS) . Before we discuss about the performence of JSY in the study area we have to first look into the common features of this scheme.

Features:- (1) States/ Uts have been classified into two categories based on the institutional delivery rate. The 10 states( Namely Uttar Pradesh , Uttaranchal , Bihar , Jharkhand , Madhya Pradesh, Chhattisgarh ,Rajasthan , Orissa, Assam , J & K) would constitute low performing states and the rest high performing states.

(2) Cash assistance linked to institution delivery:- The benefits under the scheme would be linked to availing of antenatal check up by the pregnant woman and getting the delivery conducted in health centres / hospitals . While the beneficiaries will be encouraged to register themselves with the health workers at the Sub centre / AWC /PHC for availing of at least 3 Antenatal Checkups, Post natal care and neonatal care , the disbursement of enhanced benefits under the scheme will be linked to institutional delivery .

(3) Cash assistance in the graded scale :- 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 woman from BPL families, for enabling them to deliver in health institutions. The assistance will be available as per the following rates. [Source :Ministri of Health and Family Welfare ,Government of India] TABLE:2CASH ASSISTANCE IN THE GRADED SCALE:

In rupees:

CC RURAL AREAS TOTAL URBAN AREAS TOTAL

Assistance Package for the Assistance Package for package to ASHA package to the ASHA Mother Mother

LPS 1400/- 600/- 2000/- 1000/- 400/- 1400/-

HPS 700/- NIL 700/-

# LPS= Low Performing states

# HPS= High performing stateCatagories of States

[Source :Ministri Of Health and Family Welfare ,Government Of India.]

• In the beginning of the study about the performance of JSY in Sarupathar block first of all we have to make a glance on the following table which indicates the health care facility in this block –

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TABLE 3: HEALTH CARE FACILITIES IN SARUPATHAR BLOCK

SL NO. No. of institution Name of institutions 1 Sarupathar CHC 2 Nowjan,Chungajan,Gelabil,Baligaon, Barpathar 3 Kachomari 4 Naloni Nagajuri

Gondhokoroi

Tengaholla Kordoiguri

2 No.Sarupathar Betoni Dhupguri Panjan Podumpukhuri Mohima Matikhula Koroighat

Azarguri Rajapukhuri Silonijan Borbali Sarulangtha Premhara Nahorbari Gorbasti Chakalimiri Avongpathar Barchapori Chabisgharia Herheri

Borholla Shyam Gaon

Source: Sarupathar Block Office Again the following table reflects the Manpower available in Sarupathar Block Manpower available in Sarupathar Block.

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Table 4: MANPOWER Status in Different Institutions Under Sarupathar BPHC

Institution LHS ANM Lab.Tech Asst.BPM/Accountant

SL No Medical Officer Staff Nurse Pharmacist

1 Sarupathar CHC MBBS-3, 9 2 14 2 2

Chungajan 2 MBBS-1 2 0 7 1 1 0 MPHC

MBBS-1 AYUR- 3 Nowjan MPHC 0 0 7 1 1 1 1

MBBS-1 AYUR- 4 Gelabil MPHC 1 0 8 1 1 1 1

Borpothar MBBS-1 AYUR- 5 2 0 7 1 1 1 MPHC 1

6 Bilgaon MPHC AYUR-1 0 0 9 1 0

7 Kachomari S/D MBBS-1 0 0 9 1 1

Source : Sarupathar Block PHC Office .

The performance of JSY depends on the human resources available in the sarupathar block which are mentioned below:

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TABLE 5 : HUMAN RESOURCE AVAILABILITY IN THE BLOCK

Sl. no Designation Nos.

1 SDM & HO 1

2 Sr. M & HO 4

3 M & HO 3

4 MO (MBBS) 3

5 MO (Ayurvedic) 4

6 Dental Surgeon 1

7 BEE 1 8 HE 1

9 Computor 0

10 LHS/LHV 0

11 GNM 14

12 Pharmacist 8

13 Lab Technician 6

14 MI ( Malaria) 1

15 SI (Malaria) 4

16 ANM 61

17 Vaccinator 1

18 BPM (NRHM) 1

19 BAM (NRHM) 1

20 Surveillance worker 8

21 MPW worker 2

22 Asst.BPM (NRHM) 6

23 ASHA 221

Source:Sarupathar Block Office.

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TABLE 6 : TREND IN INSTITUTIONAL DELIVERIES IN SARUPATHAR BLOCK BEFORE AND AFTER INTRODUCTION OF JSY

year No.of institutional delivery 2oo3-2004 121 2004-2005 150 2005-2006 168 2006-2007 210 2007-2008 253 2008-2009 282 2009-2010 762 2010-2011 1676 2011-2012 1986 2012-2013 2074 2013-2014 2104 2014-2015 1961 2015-2016 2006 2016-2017 2199

2017-2018 1946

Source:National Health Mission Office Sarupathar .

Again the trend in home deliveries after introduction of JSY in sarupathar block is as below.

TABLE 7: TREND IN HOME DELIVERIES AFTER INTRODUCTION OF JSY IN SARUPATHAR BLOCK

Sl no. Year No. of home deliveries

1 2013-2014 270

2 2014-2015 335

3 2015-2016 432

4 2016-2017 326

5 2017-2018 205

Source:National Health Office Mission Sarupathar.

The service of ANM under JSY scheme in this block is shown below.

TABLE 8: THE SERVICES OF ANM UNDER JSY SCHEME IN THE BLOCK

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Sl Objectives 2011-2012 2012- 2013- 2014-2015 2015- 2016- 2017- no. 2013 2014 2016 2017 2018

1 ANC REGISTRATION 3453 3867 3142 - - 4511 4874

2 UNIVERSAL COVERAGE OF 1928 2881 2094 - - - - ALL PW WITH PACKAGE OF QUALITY 3 ANC SERVICES

3 PW PROVIDED TT1 3170 3609 2615 - - 3944 4241

4 PW PROVIDED TT2 2955 3373 2660 - - 3651 3781

5 ANC WITHIN FIRST 2636 2443 2250 - - 3657 4175 TRIMESTER

6 NO.OF PW GIVEN IFA 1417 4198 2889 - - 3539 4505 TABLETS

Source:National Health Mission Office Sarupathar.

The main role of ANM are :-

(1) Organizing meeting with ASHA

(2) Participate and guide for organizing Health Day

(3) Updating Eligible Couple register

(4) Motivating PW for Antenatal Care etc.

Trend in MMR Similarly, the maternal mortality rate has also been reduced in this block as presented by the following table. The MMR was 11 per 100000 live births in 2013-14 which is declined to 4 per 100000 live births in 2017-18.

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TABLE 9: THE TREND IN MMR(PER100000 LIVE BIRTH) IN THE BLOCK

Sl.no. year MMR in Sarupathar Block (per 100000live birth)

1 2013-14 11

2 2014-15 9

3 2015-16 6

4 2016-17 9

5 2017-18 4

Source : National Health Miss of Fully Immunization o ion Office Sarupathar . Trend in full immunization of baby under Sarupathar Block: The Extent of fully immunization of babies has also increased as a result of the performance of JSY as presented by the following table. The Number of fully Immunized baby was 2908 in 2010-2011 and it has been increased upto 3789 in the year 2017-2018 . TABLE 10 : TREND IN IMMUNIZATION OF BABY UNDER SARUPATHAR BLOCK

YEAR NO.of immunized baby

2010-2011 2908

2011-2012 3402

2012-2013 3651

2013-2014 3196

2014-2015 3514

2015-2016 3694

2016-2017 3607

2017-2018 3789

Source :National Health Mission Office Sarupathar.

Provision of JSY incentives in Sarupathar Block:-

The extent of the performance of JSY can be judge by the number of cases where JSY incentive paid to mother for institutional deliveries (in 2014-15 and 2017-18) . The following table reflects the name of the various health institutions , where all deliveries conducted in an institution namely , government , private or accredited under JSY scheme. The table also reflects the numbers of JSY incentives paid to mothers for institutional deliveries from the year 2014-15 to 2017-18.

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TABLE 11 : PROVISION OF JSY INCENTIVES IN SARUPATHAR BLOCK:-

BPHC Health Type of health Health institution JSY incentives paid to mother for institutional deliveries Institutions institution under Govt./private/ppp 2014- 2015-2016 2016-2017 2017-2018 2015

Sarupathar Sarupathar CHC Govt. 1446 1449 1435 1397 CHC

Sarupathar Barpathar MPHC Govt. 287 265 259 198 MPHC

Sarupathar Silonijan SC SC Govt. 4 28 42 44

Sarupathar Chungajan MPHC Govt. 94 126 181 102 MPHC

Sarupathar Gelabil MPHC Govt. 130 138 162 154 MPHC

Source :National Health Mission Office Sarupathar.

The following table shows the analysis status of delivery in health institution under sarupathar BPHC:-

TABLE 12 : ANALYSIS STATUS OF DELIVERY IN HEALTH INSTITUTION UNDER SARUPATHAR BPHC

Sl Name of Health 2014-2015 2015-2016 2016-2017 2017-2018 Increase/decrease in no Institution last 2 years

1 Sarupathar CHC 1446 1449 1454 1409 45

2 Barpathar MPHC 287 265 254 198 56

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3 Silonijan SC 4 28 40 44 -4

4 Chungajan 94 126 143 102 39 MPHC

5 Gelabil MPHC 130 138 162 154 8

TOTAL 1961 2006 2053 1907 153

Source : National Health Mission Office Sarupathar.

Role of ASHA:- ASHA or an equivalent worker under supervision of ANM / AWW would have following role:-

• Indentify PW from BPL families as a beneficiary of the scheme

• Report to the ANM and bring the PW to the SC/ PHC for registration

• Assists the Woman to obtain BPL certification if BPL card is not available

• Provide and /or help the woman to received at least 3 ANC

• Counsel for institutional delivery and fixed before 7th month of pregnancy, the place of delivery, in close consultation with the ANM and The PHC and informed the beneficiary

• Assist in receiving 2 TT injection

• Arrange to immunized the new born till the age of 10 weeks

• Register the birth or death of the child or mother

• Again the following table reflects the number of ASHA paid under JSY scheme from the year2016-17 to 2017-18 under this block.

TABLE 13 : NUMBER OF ASHA PAID UNDER JSY SCHEME FROM THE YEAR2016-17 TO 2017-18 UNDER THIS BLOCK

Health Institutions JSY incentives paid to ASHA for institutional deliveries 2016-17 2017-18

Sarupathar CHC 364 1099

Kachamari SD 687 1075

Chungajan MPHC 431 471

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Naojan MPHC 117 10

Barpathar MPHC 99 0

Gelabil MPHC 206 0

Bilgaon MPHC 364 0

TOTAL PAYMENT 2268 2655

Source :National Health Mission Office Sarupathar.

TABLE 14 : •DIFFERENCE BETWEEN DELIVERY AND JSY AND DIFFERENCE BETWEEN DELIVERY AND ASHA PAYMENT FROM THE YEAR2014-15 TO 2017-18.

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Head 2014- Difference Difference 2015- Differen Differen 2016-17 Differ Differen 2017- Differ Differ s 15 between between 16 ce ce ence ce 2018 ence ence delivery Delivery between between betwe between betwe betwe total and and Asha total Delivery en Delivery en en JSY payment delivery and Asha total and Asha total Delive and JSY payment deliver payment deliver ry and y and y and Asha JSY JSY payme nt

Deliv 1957 79 -677 - - - 1982 -74 -499 2071 -35 -646 ery

JSY 1878 - 2056 2106 paym ent

ASH 2634 - 2481 2717 A

Source: National Health Mission Office Sarupathar.

Major findings of JSY :

JSY is a safe motherhood intervention under the NHM being implemented with the objectives of reducing maternal and neo natal mortality by promoting institutional delivery among the poor PW. JSY is a 100% centrally sponsored scheme and it integrates cash assistance with delivery and post delivery care. Each beneficiaries registered under the yojana should have a JSY card (ANNEXURE I). Thus an evaluation of JSY is carried out in Sarupathar block through this paper.

Major findings of this paper

 Good awareness of the scheme  Institutional deliveries have substantially increased  Shift of institutional deliveries from district hospitals to CHCs and PHCs  Increased utilisation of ANC services  Post natal care coverage is high  Poor referral system from periphery to health institution

Comments and Suggestion :

 On CHC:- In CHC there is lack of Gynaecologists , Paediatrician , Anaesthetist, Radiologists and others some important human resources which need attention. There for , though the operation theatres are available no surgeries being carried out in the OT due to this reason. The required facilities should be provided to improved the health services.  On PHC:- The PHC have no adequate infrastructure as well as medical and paramedical staff. All the selected PHC cover at population much more than the normal range. The number of PHCs in the district may be increased. In the existing PHCs , Number of Doctors, GNM, ANM and Paramedical staff should be increased. The laboratory facilities in the PHCs with full equipments should be improved.

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 On SC:- The SC are not fully equipped with required infrastructure . None of the ANM stays at night in the SC campus. None of the SCs have labour room from conducting deliveries. All the sc should be provided pipe water facilities and regular electricity supply. Conclusion:

Thus to conclude, this paper reflects that JSY scheme under NHM has made a significant impact on the Sarupathar block in Golaghat district. This yojana enables to decline the MMR through enhancing institutional deliveries and providing 3 quality ANC to PW. With the help of ASHA the rural PW can go the hospital at the time of their deliveries. This study also indicates that the optimum engagement of ASHA is yet to be achieved.

In this scheme government encourage PW to deliver in health institutions by providing cash assistance to them.

This paper also reflect that though there is in increasing trend in institutional delivery but 100% institutional deliveries yet to be achieved. For this purpose , the Government should have achieve 100% registration of PW as early as possible and to give proper counselling of every PW about the benefits of institutional delivery through ANM & ASHA .

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REFERENCES :

• Articles:-

• Dasgupta R, Quadeer 1 (2005): The National Rural Health Mission(NRHM)

• A Critical Overview . Indian J Public Health , 2005

• H. Dholakia :Improving performance of accredited social Health Activists in India. Working paper No.1 May 2011

• M.E. Khan, Avishek , Hazra : Impact of JSY on selected family health behaviours In rural UP.

• Operational guidelines for implementation of Janani Suraksha Yojana,NRHM Mission Document.

• Sutanuka Santra,Surajit Lahiri,Atanu Biswas,Prabha Shrivastava “ utilization of maternal Health care services with special emphasis on JSY in a slum of Kolkata,West Bengal, International Journal of Medicine and Public Health / Jul-Sp 2015/vol5/Issue 3.

• Shukla A (2005) : National Rural health Mission- hope or disappointment?- Indian J Public health,2005.

• Reports: Assam State Reports

• Government of India: NRHM Reports 2017-2018, Ministry of H& F welfare

• Govt. of India: Family welfare statistics in india 2018

• Govt. of India : Census reports of 2011

Website: www.nhmassam.in

[email protected]

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