A Desk Review to Assess the Impact of Janani Suraksha
Yojna on Various MCH Indicators in District Gwalior,
India

Neeraj Gour; Dhiraj Srivastava; Paharam Adhikari; Anumita Shahi

A Desk Review to Assess the Impact of Janani Suraksha Yojna on Various MCH Indicators in District Gwalior, India

Neeraj Gour , Dhiraj Srivastava , Paharam Adhikari , Anumita Shahi

Neeraj Gour^1*, Dhiraj Srivastava², Paharam Adhikari³ and Anumita Shahi⁴

Assistant Professor; Peoples College of Medical Sciences & Research Centre, Bhopal (M.P.), India
Assistant Professor; Department of Community Medicine, RIMS & R, Safai (U.P.), India
P.G.Resident; Department of Community Medicine, GRMC, Gwalior (M.P.), India
Dentist; Gwalior (M.P.), India

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Abstract

Introduction: Mothers who have always been succumbed by various physical, mental and social problems since long. It’s the one group of society who always been on the edge of sward. This all above leaded to various maternal problems included high maternal mortality ratio and deprived health services, especially in developing countries like India. But over the time government has made lot of efforts to revert this pathetic condition of mothers. And in pursuance of this govt. has started number of programmes and schemes to make the mothers counted. One of such scheme is Janani Suraksha Yojna (JSY) a safe motherhood intervention started in 2005 with the objective to bring down the MMR by promoting institutional deliveries, decline in domiciliary delivery, increase in ANC registration & checkups, TT immunization etc. so they are the performance (MCH) indicators of the scheme which if anytime get analyzed can provide us at least some sort of clue about the performance of scheme over the time. Same was tried to pave out in this study with the objective of: • To desk review various secondary data which is directly or indirectly related with JSY. • To assess the impact of JSY on various MCH indicators.

Material and Methods: A desk review was done by collecting various secondary data and later on it was processed and analyzed by manually along with suitable statistical software.

Results: There has been significant rise in the No. of institutional deliveries after inception of JSY which was around 32744 (48.8%) in 2003-04 on the other hand it was counted around 36589 (50%) and 36045 (73.1%) in year 2006-07 & 2007-08 respectively.In the same way like above ANC registrations have got increased and MMR brought down.

Conclusion: JSY has worked in accordance with objectives it was started in 2005 then. It played vital role in the reduction of MMR. So Govt. should try to launch more and more schemes like JSY to make the mothers life safe and fruitful.

Keywords

JSY, desk review, MCH indicators

Introduction

Mothers who have always been succumbed by various physical, mental and social problems since long. It’s the one group of society who always been on the edge of sward. This all above leaded to various maternal problems included high maternal mortality ratio and deprived health services, especially in developing countries like India.

Worldwide, nearly 600000 women between the ages of 15 and 49 die every year as a result of complications arising from pregnancy and childbirth. The tragedy is that these women die not from disease but during the normal, life-enhancing process of procreation. Most of these deaths could be avoided if preventive measures were taken and adequate care was available.1According to current estimates, South East Asia Region accounts for 170,000 maternal deaths annually. Maternal mortality rates vary from 830 per 100,000 lives births in African countries to 24 per 100,000 births in European countries.2

India is among those countries, which have a very high maternal mortality ratio. It was 20 per 1000 live births in 1938 and declined to 10 per 1000 live births by 1959(83). According to SRS reported for the years 1997, maternal mortality for India was 407 per 100,000live births. It declined to 301 per 100,000 for the year 2003. The maternal mortality in the country has declined substantially, by nearly 24 percent during 1997 to 2001-2003. Which includes 16 percent relative decline in EAG states and Assam.3

While India has relatively high rate of Maternal Mortality Ratio (MMR) in the developing world. Madhya Pradesh has one of the highest Maternal Mortality Ratio (379 per 100,000 live births as per SRS 2006) in India.4

The health of women and children has always been an important social goal of all societies. Over the years, maternal and child health has evolved through various stages of conceptual approach, technological advances and social prioritization. The realization that, improved maternal and child health is the key to the ultimate objective of lifelong health in any society, has led to renewed interest and global focus towards this very important social health issue.5

Over the time government has made lot of efforts to revert this pathetic condition of mothers. And in pursuance of this govt. has started No. of programmes and schemes to make the mothers counted. One of such scheme in Janani Suraksha Yojna (JSY) a safe motherhood intervention started in 2005 with the objective to bring down MMR by promoting institutional deliveries. By giving incentives to the mothers and motivators it has definitely showed its role in the safeguard of mothers like in terms of rise in institutional deliveries, decline in MMR/IMR, decline in domiciliary delivery, increase in ANC registration & check ups, TT immunization etc. so they are the performance (MCH) indicators of the scheme which if anytime get analyzed can provide us at least some sort of clue about the performance of scheme over the time. Same was tried to pave out in this study with the objective of:

• To desk review various secondary data which is directly or indirectly related with JSY.

• To assess the impact of JSY on various performance (MCH) indicators.

Material & Methods

Study type: observational study with desk review of secondary data.

Data source: data of CMHO office and Health bulletin of M.P.6

Study duration: it was done from 1st of Jan 2009 to 1st of Feb 2009.

Data collection and analysis: detailed data was collected from various resources like from CMHO office with their due permission & Health bulletin of state of M.P available on the website of MP Govt.6 regarding various performance indicators of JSY like total deliveries, institutional deliveries, domiciliary deliveries, maternal & infant deaths, ANC registration etc. Later on whole data was compiled, processed, and analyzed manually and with the help of suitable statistical software.

Ethical consideration: though it was not an interventional study. But due consent was taken from authorities of data sources.

Statistical analysis: tables and figures were used for the demonstration of data. Chi square test was applied for the measurement of significance at 95% confidence level. MS Office Excel 97-2003 and Epicalc 2000 software were used for the data processing and analysis.

Results

On the basis of secondary data there have been definite mount in the No. of institutional deliveries like it was around 48.44% of total deliveries in 2003-04 increased by 73.10% in 2007-08 and the difference was found to be insignificant (p> 0.05).Domiciliary deliveries on the other hand got down from 2004-05 (51.56%) to 26.90% in 2007-08 (p>0.05). Maternal deaths & infant deaths (P < 0.001) have also reduced and there were no maternal deaths documented in 2006-07 & 08. (Table 1)

On the basis of distribution according to the block CHCs number of institutional deliveries have also got increased significantly over the time (p<0.01). Dabra was on top so far as institutional deliveries are concerned and Hastinapur (Morar) was found to be at the bottom. (Table 2)

ANC registrations have also got increased but not significantly. More or less same with ANC with 3 checkups which also got increased from 21. 48% in 2005-06 to 32.87% in 2007-08 (p>0.05). (Table 3)

Coverage of TT-PW also got increased. For TT-PW it was 89.8% in 2003-04 and increased up to 101.5% in 2007-08. Coverage of IFA though got down from 2003-04 where it was 110.6% to 81.8% in 2007-08. BCG coverage has also been increased from 111.7% in 2003-04 to 115.6% in 2007-08. (Table 4)

As far as comparison of Gwalior is concerned with other major districts of M.P in the light of various sort of performance (MCH) indicators Gwalior was set at 4th position in the state but it leaded race so far maternal mortality is concerned where no mortality was reported in the year 0f 2007-08. It lied upon second position in infant mortality out of all deliveries in the state. The number of mothers registered during first trimester was found to be least in Gwalior than other districts. But it leaded in registration of mothers in second trimester than other states. Gwalior also fall down as far as 3 ANC checkups are concerned in contrast to others districts. Achievement of TT,IFA, and BCG was found more or less same among all districts of M.P. (Table 5)

Discussion

Present study has revealed after desk review of various data available that JSY have definitely impacted upon the various performance (MCH) indicators in the Gwalior district not only in Gwalior district but indeed around all the major districts of state.

There have been definite mount in the No. of institutional deliveries like it was around 43.44% of total deliveries in 2003-04 increased by 73.10% in 2007-08 more than in NFHS- II, III (22%,30%,) 7 and very much close to the goal of NPP 2000 of India.8 But this difference was found to be insignificant (p> 0.05) between year 2003-04 & 2007-08 for institutional delivery. This shows there has been definite impact of JSY on the no. of institutional deliveries over the time since its inception in 2005 although we can’t deny other factors which might have been responsible for this like improved literacy & socio economic status etc. but by enlarge JSY have been one the most common factor responsible for the hike of this number. Monetary benefit and ASHA by large extent responsible for this reform as also found by Neeraj jain et al around 70% institutional deliveries were motivated and facilitated by ASHA.9 Shobha Malini et al found 62% institutional deliveries were motivated by ASHA and 65 % were motivated for ANC by ASHA.10 B. Mohpatra et al in their study found 78.9% beneficiaries were prompted by ASHA to avail the benefits of JSY.11 These figures reveals importance of role of ASHA and other grass root level health worker in the conduction JSY.

Domiciliary deliveries on the other hand got down from 2004-05 (51.56%) to 26.90% in 2007-08 (p>0.05). Maternal deaths & infant deaths (P < 0.001) have also reduced and there were no maternal deaths documented in 2006-07 & 08.it also shows the glory of JSY up to certain extent.

ANC with 3 checkups also got increased from 21. 48% in 2005-06 to 32.87% in 2007-08 (p>0.05). It was less than the no. of NFHS-III which was 40.2%.7 But more than the DLHS-3 (25.3% urban, 15.3% rural).12 This may be because people are not aware of the importance of ANC checkups owing to deprived information about the scheme. Ashok Mishra et al also found, no information (74%) about the scheme was the most common reason for not availing the benefits of scheme.13 This shows how awareness regarding any scheme or programme is important as far as its success is concerned. This may be the reason why still there is less proportion of JSY beneficiaries as found in DLHS- 3(34.9%).12

Coverage of TT-PW and BCG also got increased. For TT-PW it was 89.8% in 2003-04 and increased up to 101.5% in 2007-08 far more than the NFHS-I, II (53.8%, 66.8%).7 BCG coverage was 111.7% in 2003-04 and 115.6% in 2007-08 more than the DLHS- 3(82.4% urban, 77% rural).12 May be because they the essential component of JSY.

There are still sort of gaps between the districts for the performance of scheme and its indicators which need to be filled up, and there should be almost homogenous performance of the scheme throughout the state not just in one or two district.

Limited data with secondary sources were some of the limitations of study. A nationwide survey would give the more applicable results. More qualitative research is needed in this direction to assess the impact of JSY.

Conclusion

JSY have definitely impacted upon the various MCH indictors over the span of time but somehow it has ended up with limited success and still we are far away from the goals of MDG and National health policy 2002. So it demands some more needful qualitative research to explore the various performance deciding factors and to act upon these factors will definitely make this scheme more impactive & fruitful.

Acknowledgement

We acknowledge the support and help, was provided from CMHO office Gwalior.

Conflict of Interest

None declared

Source of funding

None

Abbreviation

JSY: Janani Suraksha Yojna., MMR: Maternal Mortality Rate, MCH: Maternal and Child Health., ANC: Anti natal Check up, TT: Tetanus Toxoid, IFA: Iron folic acid MDG: Millennium Developmental Goal.

References

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