As in October 2006
JANANI
SURAKSHA YOJANA (JSY)
Janani Suraksha Yojana (JSY) is a safe motherhood intervention
under the National Rural Health Mission (NRHM) being implemented with the
objective of reducing maternal and neo-natal mortality by promoting
institutional delivery among the poor pregnant women. The Yojana, launched on
12th April 2005, by the Hon’ble Prime Minister, is being implemented
in all states and UTs with special focus on low performing states.
2. JSY is a
100 % centrally sponsored scheme and it integrates cash assistance with
delivery and post-delivery care. The success of the scheme would be determined by the increase in
institutional delivery among the poor families
3. The Yojana
has identified ASHA, the accredited social health activist as an effective link
between the Government and the poor pregnant women in l0 low performing states,
namely the 8 EAG states and Assam and J&K and the remaining NE States. In
other eligible states and UTs, wherever, AWW and TBAs or ASHA like activist has
been engaged in this purpose, she can be associated with this Yojana for
providing the services.
3.1 Role of
ASHA or other link health worker associated with JSY would be to:
F
Identify
pregnant woman as a beneficiary of the scheme and report or facilitate
registration for ANC,
F
Assist
the pregnant woman to obtain necessary certifications wherever necessary,
F
Provide
and / or help the women in receiving at least three ANC checkups including TT
injections, IFA tablets,
F
Identify
a functional Government health centre or an accredited private health
institution for referral and delivery,
F
Counsel
for institutional delivery,
F
Escort
the beneficiary women to the pre-determined health center and stay with her
till the woman is discharged,
F
Arrange
to immunize the newborn till the age of 14 weeks,
F
Inform
about the birth or death of the child or mother to the ANM/MO,
F Post natal visit within 7 days of
delivery to track mother’s health after delivery and facilitate in obtaining
care, wherever necessary,
F Counsel for initiation of
breastfeeding to the newborn within one-hour of delivery and its continuance
till 3-6 months and promote family planning.
Note: Work
of the ASHA or any link worker associated with Yojana would be assessed based
on the number of pregnant women she has been able to motivate to deliver in a
health institution and the number of women she has escorted to the health
institutions.
4. Important
Features of JSY:
4.1 The scheme
focuses on the poor pregnant woman with special dispensation for states having
low institutional delivery rates namely the states of Uttar Pradesh,
Uttaranchal, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan,
Orissa and Jammu and Kashmir. While these states have been named as Low
Performing States (LPS), the remaining states have been named as High
performing States (HPS).
4.2 Tracking Each Pregnancy: Each
beneficiary registered under this Yojana should have a JSY card along with a
MCH card. ASHA/AWW/ any other identified link worker under the overall
supervision of the ANM and the MO, PHC should mandatorily prepare a micro-birth plan. Please see Annexure
– I. This
will effectively help in monitoring Antenatal Check-up, and the post delivery
care.
4.3 Eligibility for Cash Assistance:
|
LPS
States |
All pregnant women delivering in Government health centres
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 |
Note: BPL Certification – This is required in all HPS states. However,
where BPL cards have not yet
been issued or have not been updated, States/UTs would formulate a simple criterion for certification of
poor and needy status of the expectant mother’s family by empowering the gram
pradhan or ward member.
4.4 Scale
of Cash Assistance for Institutional Delivery:
|
Category |
Rural Area |
Total |
Urban Area |
Total |
||
|
|
Mother’s
Package |
ASHA’s
Package |
Rs. |
Mother’s
Package |
ASHA’s
Package |
Rs. |
|
LPS |
1400 |
600 |
2000 |
1000 |
200 |
1200 |
|
HPS |
700 |
|
700 |
600 |
|
600 |
Note 1: Importantly, such woman in both LPS and HPS states, choosing to
deliver in an accredited private health institution will have to produce
a proper BPL or a SC/ST certificate in order to access JSY benefits. In addition
she should carry a referral slip from
the ASHA/ANM/MO and the MCH - Janani Suraksha Yojana (JSY) card.
Note 2: ANM / ASHA / MO should make it
clear to the beneficiary that Government is not responsible for the cost of her
delivery. She has to bear cost, while choosing to go to an accredited private
institution for delivery. She only gets her entitled cash.
4.5 While mother
will receive her entitled cash, the scheme does
not provide for ASHA package for such pregnant women choosing to
deliver in an accredited private institution.
4.6 Limitations of Cash Assistance for
Institutional Delivery:
|
In
LPS States |
All births, delivered in a health centre –
Government or Accredited Private
health institutions. Refer to para (b). |
|
In HPS
States |
Upto 2 live births. |
4.7 Disbursement
of Cash Assistance: As the cash assistance to the mother is mainly to meet
the cost of delivery, it should be disbursed effectively at the institution
itself.
4.7.1 For
pregnant women going to a public health institution for delivery, entire cash
entitlement should be disbursed to her in
one go, at the health institution. Considering that some women would access
accrediting private institution for antenatal care, they would require some
financial support to get atleast 3 ANCs including the TT injections. In such
cases, atleast three-fourth (3/4) of the cash assistance under JSY should be
paid to the beneficiary in one go, importantly, at the time of delivery.
4.7.2 To Beneficiary:
a. The mother and the ASHA (wherever applicable) should get their
entitled money at the heath centre immediately on arrival and registration
for delivery.
b. Generally the ANM/ ASHA should carry out the entire disbursement process.
However, till ASHA joins, AWW or any identified link worker, under the guidance
of the ANM may also do the disbursement.
4.7.3 At accredited private institution: Disbursement of cash
to the mother should be done through the ANM/ASHA/ Link worker channel and the
money available under JSY should be paid to the beneficiary only and not to any other person or relative. Also refer to para (e).
ü
Should ensure that:
·
Such accredited private institution would
also be responsible for any postnatal complication arising out of the cases
handled by them.
·
They should not deny their services to any
referred targeted expectant mother.
Note: Every month, accredited
private health centers would prepare a statement of JSY - delivery / ANC/
obstetric complication cases handled by them and send it to the Medical
officer, along with the referral slips for sample verification by the
concerned ANM / ASHA.
4.7.4 In the District / Women’s Hospital / State
Hospital etc :
·
State / District should allocate
sufficient amount of money (based on the load of deliveries in these
institutions) for each of these institution. This money should be kept in a
separate account under the supervision of the Rogi Kalyan Samity.
·
The residency of the beneficiary would
determine entitlement of cash benefit in such institutions, to be verified
based on the referral slip from the ANM, carried by the beneficiary.
|
Format of Referral
Slip: State should prepare a format of the
referral slip, which should mainly indicate, identification details of the
beneficiary, JSY registration number in the register of the ANM, reason for
referral (including medical complications), name of ASHA, amount already
disbursed, amount due, including referral transport money (if applicable),
amount due to ASHA and to be paid, signature of MO/ANM. |
·
It is therefore, essential that all
targeted expectant mother should carry a referral slip from the ANM/MO where
she generally resides. This will, infact, help all such pregnant woman who go
to her mother’s place for delivery.
·
Disbursement of
money to expectant mother going to her mother’s place for delivery should be
done at the place she delivers. The entitlement of cash should be determined
by her referral slip carried by her and her usual place of residence.
·
A voucher scheme may be introduced in such a way that
along with admission slip for delivery, a voucher amounting to mother’s package
plus the transport assistance money is given to the expectant mother and that
she should be able to encash the same at the Hospital’s cash counter, at the
time of discharge.
4.8 Flow
of Fund:
i. State/ District authorities would advance Rs. 5000/- and Rs. Rs.10,000/-
to each ANM in HPS /LPS States respectively as a recoupable impressed money
from the JSY fund.
ii.
This money could be kept in the joint
account of ANM and Gram Pradhan, as in case of untied fund placed with
sub-centers so that the ANM could ‘roll’ the entire amount by advancing Rs.1500
to Rs. 2,500/- to ASHA / AWW per delivery and later she could recoup it from
the PHC or CHC, where JSY fund is parked by the authorities.
|
Expenditure
Monitoring: ASHA / AWW should provide an expenditure statement of money
advanced to her in previous month to the ANM in the monthly meeting held by
ANM. |
iii. There should be a clear authority for ANM to withdraw cash from
this account for advancing it to the ASHA or AWW / any other health link worker,
needed for ready use towards disbursement to the pregnant and also for
arranging the referral transport for escorting the pregnant women to the
institution.
|
Note:
Where an elected
body of the Panchayati Raj Institution (PRIs) exists, the State
Governments/Health society may keep the money in a joint account of the Gram
Pradhan and the ANM (like that of the untied fund). The process of recoupment
of fund should be so simple to be able to disburse the cash to the pregnant
women in time. |
4.9 ASHA Package: This package, as of now, is
available in all LPS, NE States and in the tribal districts of all states
and UTs. In rural areas it
includes the following three components:
·
Cash assistance for Referral transport to go to the nearest health centre for delivery.
The state will determine the amount of assistance (should not less than
Rs.250/- per delivery) depending on the topography and the infrastructure
available in their state. It would, however, be the duty of the ASHA and the
ANM to organize or facilitate in organizing referral the transport, in
conjunction with gram pradhan, Gram Sabha etc.
Note: This assistance is over and
above the Mother’s package.
·
Cash
incentive to ASHA: This should not be less than Rs.200/- per delivery in lieu of her work relating to
facilitating institutional delivery. Generally, ASHA should get this money after her postnatal visit
to the beneficiary and that the child has been immunized for BCG.
·
Transactional cost (Balance out of Rs.600/-) is to
be paid to ASHA in lieu of her stay with the pregnant woman in the health
centre for delivery to meet her cost of boarding and lodging etc.. Therefore, this payment should be made at the
hospital/ heath institution itself.
|
Note 1: In Urban areas, ASHA package consists of only the incentive for ASHA,
for providing the services, as at para 3.1 Note 2: In case ASHA fails to organize transport for the pregnant woman
to go to the health institution, transport assistance money available within
the ASHA’s package should be paid to the pregnant woman at the institution,
immediately on arrival and registration for delivery. Note
3:
In case ASHA is yet to join, transport assistance money may be kept with the
institution and a voucher scheme may be introduced for disbursement. |
4.10 Payment to ASHA: ASHA should
get her-
ü
First
payment for the
transactional cost at the health centre on reaching the institution
along with the expectant mother.
ü The second payment should
be paid after she has made postnatal visit and the child has been immunized
for BCG.
All payments to ASHA would be done by the ANM only. In this case too, a voucher scheme
be introduced in such a manner that for every pregnant woman she registers
under JSY, ANM would give two vouchers to ASHA, which she would be able to
encash on certification by ANM.
Important: It must be ensured
that ASHA gets her second payment within 7 days of the delivery, as that would
be essential to keep her sustained in the system.
4.11 Special Dispensation for LPS states:
ü
Age restriction removed
ü
Restricting
benefits of JSY up to 2 births removed. In other words, the
benefits of the scheme are extended to all pregnant women in LPS states
irrespective of birth orders.
ü
No need for any marriage or BPL certification provided
woman delivers in Government or accredited private health institution.
Important: The state / UTs would be responsible for instituting an appropriate
monitoring mechanism and ensure that a proper accounting procedure is put in
place for all transactions.
4.12 Subsidizing cost of Caesarean Section or management of
Obstetric complications: Generally PHCs/ FRUs / CHCs etc. would provide emergency obstetric services free
of cost. Where
Government specialists are not available in the Govt’s health institution to
manage complications or for
Caesarean Section,
assistance up to Rs. 1500/- per delivery could be utilized by the health
institution for hiring services of specialists from the private sector. If a specialist is not available or that the list of empanelled
specialist is very few, specialist doctors working in the other Government
set-ups may even be empanelled, provided his/her services are spare
and he/she is willing. In such a situation, the cash subsidy can be utilized to
pay honorarium or for meeting transport cost to bring the specialist to the
health centre. It may however be remembered that a panel of such doctors
from private or Government institutions need to be prepared beforehand in 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.
Important: State Governments would ensure
that this assistance is not misutilized and would exercise adequate control and monitor
expenditure under this component.
4.13 Assistance for Home Delivery: 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 or around 7 days
before the delivery by ANM/ASHA/ any other link worker. 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. It should be the
responsibility of ANM/ASHA, MO PHC to ensure disbursement. It is very important
that the cash is disbursed in time. Importantly, such woman choosing to deliver
at home should have a BPL certificate to access JSY benefits.
5. Compensation Money: If the mother or her husband, of their own will, undergoes sterilization, immediately after the delivery of the
child, compensation money available under the existing Family welfare scheme
should also be disbursed to the mother at the hospital itself.
6. JSY Benefits in
Accredited Private Health Institution: In order to increase choice of delivery care institutions, at least two willing private
institutions per block should be accredited to provide delivery services.
State and the district authorities should draw up a list of criterion /
protocols for such accreditation. (Please see a model criterion at Annexure-2) Such
beneficiaries delivering in these institutions would
get the cash benefits admissible under the JSY.
7. Equip Sub-centers for Normal delivery: For women living in tribal and hilly districts, it becomes
difficult to access PHC/CHCs for maternal care or delivery. A well-equipped
sub-center is a better option for normal delivery. Deliveries conducted in sub-centers, which are accredited by the state /
district authorities will be considered as institutional delivery and
therefore, women delivering in these centers would be eligible for all cash
assistance under JSY.
Important: All States and UTs to undertake a process of
accreditation of all such sub-centre located in Govt. buildings and having
proper facility of light, electricity, water, and other medical requirements of
basic obstetric services including drugs, equipments and services of trained
mid-wife for the purpose of conducting normal deliveries in these institutions.
8. Provision
of Administrative Expenses: Upto 4 % and
1% of the fund released could be utilized towards administrative expenses like
monitoring, IEC and office expenses for implementation of JSY by the district
and state authorities respectively.
9. Essential
Strategy: While the scheme would create demand for institutional delivery, it would
be necessary to have adequate number of 24X7 delivery services centre, doctors,
mid-wives, drugs etc. at appropriate places. Mainly, this will entail
·
Linking each habitation (village or a ward in an
urban area) to a functional health centre- public or accredited private
institution where 24X7 delivery service would be available,
·
Associate an ASHA or a health link worker to each of
these functional health centre,
·
It should be ensured that ASHA keeps track of all
expectant mothers and newborn. All expectant mother and newborn should avail
ANC and immunization services, if not in health centres, atleast on the monthly health and nutrition day, to be organised in the
Anganwadi or sub-centre:
o
Each pregnant
women is registered and a micro-birth plan is prepared (please see Annexure-1)
o
Each pregnant
woman is tracked for ANC,
o
For each of the
expectant mother, a place of delivery is pre-determined at the time of
registration and the expectant mother is informed,
o
A referral
centre is identified and expectant mother is informed,
o
ASHA and ANM to
ensure that adequate fund is available for disbursement to expectant mother,
o
ASHA takes
adequate steps to organize transport for taking the women to the pre-determined
health institution for delivery.
o
ASHA assures
availability of cash for disbursement at the health centre and she escorts
pregnant women to the pre-determined health centre.
10. Possible IEC strategy:
·
To associate NGO and Self Help Groups for
popularizing the scheme among women’s group and also for monitoring of the
implementation.
·
To
provide wide publicity to the scheme by:
Promoting JSY as a component of total package of services under RCH along with programmes like Pulse polio programme, Monthly Village Health Day, Health Melas etc,
ü
Printing and distributing JSY guidelines, pamphlets,
notices in local languages at SC/PHCs/CHCs/ District Hospitals/ DM’s and
Divisional Commissioner’s office and even in at the accredited Pvt. Nursing
Homes, in abundance,
ü
Supporting printing of state’s stationery, specially
for State’s Health Secretary, DMs / SDMs/ Block/ PHC/ CHC/ District Hospital,
advocating on Institutional Delivery and cash benefits of JSY,
ü
Facilitate organizing workshops and
meetings in villages / blocks - by women’s group, local leaders (PRIs), Opinion
Maker, at functional health institutions on promoting maternal health in
general, Institutional Delivery and JSY,
Undertaking wall painting in all sub-centers, PHCs and CHCs, District & State Hospitals and the accredited private institutions,
Supporting women self help Groups and NGOs for promoting the scheme,
Facilitating woman Panchayat member to take review of Janani Suraksha Yojana (JSY)
11. Establish a grievance redressal cell in each district, under the District Project Management
Unit,
mainly to facilitate meeting people’s genuine grievances on -
ü Eligibility for
the scheme,
ü Quantum of cash
assistance,
ü Delays in
disbursement of the cash assistance,
An officer,
supported by an assistant, if necessary, may be made responsible to supervise
the grievance cell. However, proper information about the grievance cell,
giving the officer’s name, postal address and his telephone number should be
displayed prominently at all health centers and institutions. If necessary,
fund available under administrative expenses could be utilized for this
purpose.
12. Display of names of JSY beneficiaries: The list of JSY
beneficiaries along with the date of disbursement of cash to her should mandatorily
be displayed on the display board at the sub-center, PHC/CHC/District
Hospitals (from where beneficiaries have got the benefit), being updated
regularly on month-to-month basis. Wherever necessary, display boards
may be procured.
13. Guidelines For urban areas: The state shall prepare detailed guidelines by stating a simple
procedure of implementing the Janani Suraksha Yojana (JSY) in the urban areas
through the Municipalities/local bodies ((where an elected body exits) and
quickly obtain approval of the state Government/SHS. The guidelines should bring out clearly, the chain of fund flow
as well as disbursement of the benefits to the ultimate beneficiaries. The quantum of grants to be placed at the
disposal of the Municipalities shall be in proportion to the BPL families in
the Municipal area. The district annual plan
will also include the plan of the municipalities in the districts wherever
applicable. The Chief medical Officer of such an
authority should be the implementing authority. It must be ensured that basic
objectives and the scale of disbursements are not altered. A copy such plan along with necessary
Government’s order should be sent to the GOI.
14. Monitoring:
14.1 Monthly Meeting at Sub-centre Level: For assessing the
effectiveness of the implementation of JSY, monthly meeting of all ASHAs /
related health link workers working under an ANM should be held by the ANM,
possibly on a fixed day (may be on the third Friday) of every month, at the
sub-center or at any of Anganwadi Centres falling under the ANM’s area of
jurisdiction. If Friday is a holiday, meeting could be held on following
working day.
14.2 Prepare
Monthly Work Schedule: In the monthly
meeting, the ANM, besides reviewing the current month’s work vis-ŕ-vis
envisaged activities, should prepare a Monthly Work Schedule for each ASHA /
village level health worker of following aspects of the coming month:
·
Feed back on
previous month’s schedule -
(a)
Number of pregnant women missing ANCs,
(b) No. of cases,
ASHA/link worker did not accompany the pregnant women for Delivery,
(c) Out of the
identified beneficiary, number of Home deliveries,
(d)
No. of post natal visits missed by ASHA,
(e) Cases referred
to Referral Unit (FRU) and review their current health status,
(f)
No. of children missing immunization.
·
Fixing Next Month’s
Work Schedule (NMWS): To include -
(i)
Names of the identified pregnant women to be registered and to be taken
to the health center/Anganwadi for ANC,
(ii)
Names of the pregnant women to be taken to the health center for
delivery (wherever applicable),
(iii)
Names of the pregnant women with possible complications to be taken
to the health center for check-up and/or delivery,
(iv)
Names of women to be visited (within 7 days ) after their delivery,
(v)
List of infants / newborn children for routine immunization,
(vi)
To ensure availability of imprest cash,
(vii)
Check whether referral transport has been organized.
Note 1: While no target needs to be fixed, but for
the purpose of monitoring, some monthly goal of institutional delivery for the
village may be kept.
Note 2: A format of monthly work schedule to be
filled by the ANM /ASHA incorporating the physical and financial aspect may be
printed.
15. Reporting: For the purpose of reviewing the progress of
implementation and also for allocating fund to the state, under the RCH-flexi
Pool, all States would provide
·
Annual District-wise report as per Annexure IV, reaching
MoHFW in the month of April of the following financial year
·
Quarterly Report as per Annexure V, reaching MoHFW in the
month following the end of the Quarter.
However, depending on the requirement of
the Ministry, special reports may also be sought.
Most Important:
16.
Any deviation from the above process will
not be accepted by the Central
Government and that such expenditure will not be treated as legitimate
utilization of the fund given under JSY. It may be noted that all payments
before or after seven days of delivery will be treated as illegitimate subject
to audit objection.
Annexure-I
MICRO-BIRTH PLAN FOR
JSY BENEFICIARIES
|
STEP |
Activity |
To be undertaken by |
Proposed Time Line |
|
1 |
Identification
and Registration of beneficiary |
ANM/ASHA/AWW or any link worker |
Atleast
20-24 weeks before the expected date of delivery. |
|
2 |
Filling
up of Maternal and Child card ( In duplicate – one each for mother and ASHA/Link worker) (This will form part of the JSY’S Registration Card). |
ANM/ASHA/AWW or an equivalent link worker |
Immediately on registration |
|
3 |
4
I-s’: Inform
dates of 3
ANC & TT Injection (s) Identify the health center for all referral Identify
the Place
of Delivery Inform
expected date of
delivery |
ANM/ASHA/AWW or an equivalent link worker Provide the 1st ANC immediately on Registration. ASHA to follow up the ANCs at the Anganwadi
Centres/Sub-center (SC) and ensure that the beneficiary attends the
SC/Anganwadi centre /PHC for ANC on the indicated dates Motivation: ANM should call the beneficiary to the
Anganwadi/SC to participate in the Monthly meeting and explain enhanced cash and Transport
assistance benefits for Institutional delivery. |
Immediately on registration |
|
4 |
Collecting
BPL or necessary proofs /certificates Wherever necessary from Panchayat / local bodies / Municipalities
|
ANM/ASHA/AWW
or an link worker |
Within 2-4 weeks from Registration |
|
5 |
Submission
of the completed JSY card in the Health center for verification by the authorized/Medical
officer. II. Take necessary steps toward arranging
transport or making available cash to the beneficiary to come to the Health
Centre III. Ensure availability of fund
to ANM/Health worker/ASHA etc. |
MO,
PHC ANM/ASHA/AWW/link
worker ANM/ MO,
PHC |
Atleast 2-4 weeks before the expected date of
delivery |
|
6. |
Payment
of cash benefit / incentive to the mother and ASHA |
ANM/ MO,
PHC |
At the institution. |
For complicated cases or those
requiring cesarean section etc:
|
Ac –1 |
Pre-determine
a Referral health center and intimate the pregnant women |
By ANM/ASHA/link worker |
|
Ac –2 |
Familiarize
the woman with the referral centre, if necessary carry a letter of referral
from MO PHC |
ANM/ASHA/link
worker |
|
Ac –3 |
Pre-organize
the transport facility in consultation with family members/community leader |
ANM/ASHA/Community |
|
Ac –4 |
Arrange
for the medical experts if the same is not available in the referred heath center |
MO,
PHC |
Annexure-II