Karnataka State Health System Resource Centre and Jagruti Dharwad.
This exploratory study is a joint initiative between KSHSRC and Jagruti, Dharwad. The objective of the study is to understand the implementation process and issues in JSY. The study also takes perspectives from beneficiaries and service providers in seeking and providing services under the JSY. The study sample included both high and low performing PHCs from the districts of Bagalkot and Chikmagalur and the study is qualitative.
Key study findings
Although the study sample is small, some information has emerged that could form the basis for a larger study. 11% of the women had planned to deliver at home while the majority planned to deliver in a PHC or government facility. While the reason given for opting for a home birth was cost, the reason for selecting government health facility were location, cost and to ensure safe deliveries. Only 25% women used 108, and 61% used a private vehicle. Although the women had received some form of antenatal care like abdominal examination, weight, height and blood pressure measurement, the quality of care was not assessed. Some of the problems faced by women at the PHC were lack of clean drinking water facilities and clean bedsheets. 86% women had normal deliveries. The women felt that the hospital nurse was the most friendly and supportive, the doctor was rated by 30% of the women to be supportive and friendly, whereas the ward attender was mostly seen as rude, with a poor attitude and unable to maintain cleanliness of the ward.
96% of the women were aware of the JSY scheme, and had been informed by the ASHA, ANM or Anganwadi worker. Although JSY is expected to be distributed within 48 hours, it was found to range between 15 days to 6 months, the main reasons being women not having bank accounts, banks being difficult to access and lack of fund availability. 21% women had to pay a bribe to get the JSY amount and 18% did not receive the entire amount.
Among the health service providers, 37% felt that the delivery rates had gone up since the JSY was introduced. Some of the suggestions by health providers include need for more training to ASHA and ANM about the scheme, information to the community about the scheme, timely release of funds, not withholding the money to women who have more than two children, improved hospital services, more co-ordination between the public and the hospital, money to be given in the form of cash, and more support to women from the migrant populations.
At the state level, it was felt that cheques are not disbursed on time because of incomplete entry in the thayi card which makes it difficult to identify APL and BPL.
Government health services till continue to be an important service provider for maternal health. Quality of care is important and more attention to be given to staff attitude, cleanliness of health centre and adherence to the Indian Public Health (IPHS) standards.
Health service providers need to receive some capacity development on the objectives of the JSY, criteria and also mechanisms for quick disbursal of JSY funds.
Difficulty in obtaining BPL cards sometimes leads to inability to access JSY funds. These gaps should be appropriately and efficiently filled, so that vulnerable groups like migrants do not fall out of the safety nets.
Some recommendations emerged from the stakeholders themselves. It was felt that minorities are not tracked health institution-wise and no analysis is available of access to services and quality of services.
Although the general perception about JSY is good among the post-natal women and health service providers who were interviewed, further research could focus on the quality of care and access to services like 108, JSY and delivery care.
The government services have to be strengthened to provide good quality, comprehensive maternal care. The JSY can only be a supplement and not a primary means of increasing institutional deliveries and reducing maternal mortality.