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Health : JSY

The Janani Suraksha Yojana (JSY) is a centrally sponsored scheme aimed at reducing maternal and infant mortality rates and increasing institutional deliveries in below poverty line (BPL) families. The JSY, which falls under the overall umbrella of covers all pregnant women belonging to households below the poverty line, above 19 years of age and up to two live births.

The JSY, launched in 2003, modifies the existing National Maternity Benefit Scheme or NMBS. While the NMBS was connected with providing a better diet for pregnant women from below poverty line (BPL) families, the JSY integrates help in the form of cash with antenatal care during pregnancy period, institutional care during delivery as well as post-partum care. This is provided by field level health workers through a system of coordinated care and health centres.

 

Key program components:

The Janani Suraksha Yojana (JSY) is an Indian government-sponsored conditional cash transfer scheme to reduce the numbers of maternal and neonatal deaths and increase health facility deliveries in BPL families. The JSY covers all pregnant women belonging to households below the poverty line, above 19 years of age and up to two live births. The JSY integrates help in the form of cash with antenatal care during pregnancy period, institutional care during delivery as well as post-partum. This is provided by field level health workers through a system of coordinated care and health centers. Benefits for institutional delivery are more generous in rural areas and in low-performing states, ranging from Rs.600 to Rs.1,400. A subsidy is also available to private sector providers for emergency caseareans, on referral.

 

JANANI SURAKSHA YOJANA (JSY) FREQUENTLY ASKED QUESTIONS AND ANSWER

Q.1 Has the National Maternity Benefit Scheme (NMBS) been replaced by the Janani Suraksha Yojana (JSY) from FY 2005-06?
Ans. Yes. A new 100% centrally sponsored scheme - Janani Suraksha Yojana (JSY) has been launched w.e.f 12.04.05. However, the cash benefits of the National Maternity Benefit Scheme (NMBS) have been incorporated in the Yojana.


Q.2 Why Janani Suraksha Yojana?
Ans. The NMBS was not addressing all the concerns of safe motherhood in a focused manner. Need is felt for a comprehensive package for obstetric care services to save the lives of the mother and the newborn. The main objectives of JSY are to reduce maternal and neo-natal mortality by promoting institutional delivery for making available medical care during pregnancy, delivery and post delivery period.


Q.3 Is there any change with regards to eligibility criterion for availing benefits of Janani Suraksha Yojana?
Ans. The scheme has expanded the eligibility criterion. As in October 2006, eligibility for cash assistance for institutional delivery is as follows:

LPS States
All pregnant women delivering in Government health centers like Sub-centre, PHC/CHC/ FRU / general wards of District and state Hospitals or accredited private institutions

HPS States
BPL pregnant women, aged 19 years and above

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 Hospitals or accredited private institutions



Q.4 What is basis of LPS and HPS states?
Ans. States with lower levels of institutional delivery rates have been classified as LPS states. These are - the states of Uttar Pradesh, Uttaranchal, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam and Jammu and Kashmir. The remaining states are named as HPS states.


Q.5 Why there are the special dispensations for pregnant women from LPS states?
(i) Age certificate is not an instrument that is available easily. Many LPS states have yet to get the process of birth registration organised in rural areas. In view of this, for all BPL pregnant women belonging to LPS states, any kind of age certification would not be insisted upon for availing the benefits of JSY.

(ii) Removal of restrictions on the number of child births: Restricting the benefits upto 2 births would in fact encourage women of higher fertility in the LPS states to deliver at home in an unsafe condition. Such women are exposed to higher risks of mortality and morbidity too because of neglect on their part to access health care and facilities. Therefore, the restriction on the number of childbirths for accessing benefits of JSY has been removed. In other words, the benefits of the scheme are extended to all BPL pregnant women in LPS states irrespective of birth orders.

(iii) Institutional delivery being the primary strategy for promoting safe motherhood, it is necessary that all women are encouraged to avail institutional care. With a view to encourage women from poor families to access public health institution for delivery, in LPS states, the benefits of JSY would be extended to all women (BPL and APL) availing institutional delivery care in Govt. health centres like SC, PHC, CHC, FRUs and general wards of the District and State Hospitals.

Q.6 Is it mandatory to implement JSY?
Ans. Yes.

Q.7 Is there any cash benefit for pregnant women from BPL families preferring to deliver at home?
Ans. In LPS and HPS States, BPL pregnant women, aged 19 years and above preferring to deliver at home is entitled to cash assistance of Rs. 500/- per delivery. Such cash assistance would be available only upto 2 live births and the disbursement would be done at the time of delivery. The rationale is that beneficiary would be able to use the cash assistance for her care during delivery or to meet incidental expenses of delivery.

Q.8 If the focus of the scheme is to promote institutional delivery, why should there be a provision for home delivery?
Ans. It is true that we have to discourage home delivery. However, in view of the Hon’ble Supreme Court’s direction, it is mandatory to provide for home delivery. In case of home delivery, cash benefits of JSY are as provided under NMBS. It would be the responsibility of the ANM, ASHA to counsel the pregnant woman to deliver in a health institution.


Q.9 If the Government’s policy is to control population, why would Government be relaxing two child restrictions under the Yojana?
Ans. It is true that couples in the reproductive age group, should have all the options to decide their family size and that the Government should endeavor to adhere to its stated population policy. JSY is a scheme for saving the lives of mothers from the causes related to delivery, which is also a stated policy of the Government. Women who are in the higher orders of birth, are more at risk of mortality, as they tend to neglect their delivery care and it is by bringing them to institution, and not by keeping them out of the domain of institutional delivery care that these high fertility women could be counseled for family planning.


Q.10 When would the cash benefit under JSY be disbursed?
Ans. The cash benefit should be disbursed to the beneficiary preferably at the institution. If ASHA is unable to organize transport (wherever applicable) disbursement of transport assistance should be done in the health centre as soon pregnant women arrive and registers for delivery. It should be the responsibility of ANM, MO, PHC/ASHA to take all proactive actions to ensure timely disbursement.
Q.11 What is the rationale for disbursing the cash at the time of delivery?
Ans. It is desired that the cash benefit available under this scheme is used by the beneficiary for pregnancy related care especially at the time of delivery and also for post delivery care. If cash is given earlier, it is possible that it may be expended for other purposes.


Q.12 If after having received the cash benefit, the child dies, would the benefit under JSY be extended for the next birth?
Ans. Yes. Proper record should be maintained.


Q.13 If a still child is born in a health institution, can the benefit of JSY be disbursed to the mother?
Ans. Yes. Proper record should be maintained.

Q.14 What is the scale of transport assistance out of ASHA package?
Ans. Generally, an amount of Rs. 250/- may be earmarked for this. It is, however, upto the State Government to determine the scale of transport assistance. It may be ensured that the incentive to ASHA which is part of ASHA package should not be less then 200/- per delivery facilitated by her, in addition to the transactional cost of around Rs.150/- per delivery for escorting and staying with the mother in the health centre. It may be mentioned that ASHA would get cash benefit only if she accompanies the pregnant woman to the health centre.

Q.15 Where would the transport assistance money be kept ?
Ans. Keeping in view, the need to make available the cash required to transport women in the critical condition of delivery to a health centre, transport assistance amount should be kept with the ASHA with clear knowledge of the beneficiary. The mode of transport should be pre-decided by the ANM/medical officers/family member. A proper protocol for arranging the transport should be put in place with assistance of the community, ASHA and the ANM.
Q.16 Can the parameters of the JSY be modified by the states/UTs?
Ans. No. However, if any state or UT has any cogent reason for modifying, it is welcome, in consultation with the GOI. But kindly note that unilateral change by any state or UT is not advisable as it may lead to audit objections.

Q.17 A poor woman needs treatment for C-Section or other obstetric complications. Is there any provision for such situations under JSY?
Ans. Yes. Generally FRUs / CHCs etc. would provide emergency obst. services free of cost. Where Government specialists are not available in the Govt’s health institution, assistance up to Rs. 1500/- per case could be utilized by the health institution for hiring services of experts to carry out the surgery in a Government medical facility. Remember, this assistance is to the Govt. health institution and not to the beneficiary.

Q.18 Generally, in remote areas, even a private medical expert is not available. What to do then?
Ans. In such a situation, expert doctors working in the other Government health institutions may even be empanelled provided his/her services are spare. The cash assistance for C-section or any other obstetric complications, limited to Rs.1500 per case, can be utilized to pay honorarium or for meeting transport cost to bring the expert to health centre. It may however be remembered that a panel of such doctors need to be prepared beforehand by all such health institutions where such facility would be provided and the pregnant women are informed of this facility, at time of micro-birth planning.
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