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                                                                                                                                           S. B. Sharan*
                                                                                                                                                                      Varun Bhardwaj**

A unique initiative of the Ministry of Health and Family Welfare, the Janani Shishu Suraksha Karyakram (JSSK), launched on June 1, 2011, has placed for the first time utmost emphasis on “ENTITLEMENTS”. The idea is to eliminate out-of-pocket expenses for both pregnant women and sick neonates. The initiative entitles all pregnant women delivering in public health institutions to absolutely free and No-Expense delivery, including caesarean operation. All expenses related to delivery in a public institution are borne entirely by the government and no user charges are levied. A pregnant woman is entitled to free transport from home to the government health facility, between facilities, in case she is referred on account of complications, and also drop-back home after 48 hours of delivery.


Various complications during pregnancy like haemorrhage, infection, high blood pressure, unsafe deliveries and so on may result in maternal and infant mortality. While India has made considerable progress in reduction of Maternal Mortality Ratio (MMR) and Infant Mortality 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. The first 48 hours after delivery are critical as some complications might develop during this period.

Access to mother and child health care services was also hindered by High out of pocket expenses on User charges for OPD, drugs and consumables, Diagnostic tests etc. Also in some cases such as severe Anaemia or emergencies required Blood Transfusion which increased immediate expenses. And if there was a caesarean case, the expenses would become still higher.

So, JSSK has been launched, to ensure that each and every pregnant woman and sick neonates upto 1 month gets timely access to health care services free of cost. Under the JSSK, the state governments issue an entitlement order detailing the free entitlements. The Entitlements include free drugs and consumables, Free Diagnostic Services, Free Blood Transfusion Services wherever required and Free diet for the duration of a woman’s stay in the facility. These services are provided free of cost to eliminate out of pocket expenses and ensure Zero expense deliveries.


Entitlements for Pregnant Women

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 deIivery & 7days for caesarean section).Not only this, there is a provision of free bIood 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 Newborn

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. 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

For implementation of JSSK, a government order on entitlements is issued at the state level and a State Nodal Officer is nominated. The state government takes necessary steps and ensures that all services, the beneficiaries are entitled to are provided.

Equal importance is given to dissemination of entitlements in the public domain. These are to be prominently displayed on hoardings and boards in all Government facilities so that they are visible from a distance. In fact, there is an Information, Education Communication component under NRHM which is utilized for this purpose.

Grievance Redressal

Every health facility should prominently display the names, addresses, emails, telephones, mobiles and fax numbers of grievance redressal authorities at health facility level, district level and state level. Some states have set up help desks and suggestion/complaint boxes at government health facilities. It is also required to keep fixed hours (at least 1 hour) on any two working days per week, in all the healthy facilities for meeting the complainants and redressing their grievances related to free entitlements.

At the National Level, the Maternal Health Division of the Ministry of Health and Family Welfare has brought out guidelines for JSSK. 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.

(PIB Features.)


On Completion of 1 Year of JSSK – June 1

*Director (M&C), PIB, New Delhi.

**Assistant Director, PIB, New Delhi.

PIB Aizawl

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