Programme Evaluation of the Janani Suraksha Yojana
The Janani Suraksha Yojana (JSY) is one of the flagship components of the National Rural Health Mission, and the key strategy to enable women to access institutional deliveries and thereby effect reductions in maternal mortality. The scheme was evaluated in the eight high-focus states of Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttar Pradesh, and Uttarakhand, which together account for 84.3% and 66% of India’s maternal mortality and infant mortality respectively.
The objectives of the study were to:
1. Assess the availability and quality of health care provided to the pregnant mothers before, during and after delivery.
2. Assess the capability of different health institutions, their bed occupancy rates and trend in institutional delivery.
3. Quality of services provided by ASHAs and streamlining the cash incentives for effective programme performance.
4. Fund flow mechanism for administering JSY scheme and mechanism adopted for ensuring timely payment to the beneficiaries; and procedure for random verification of beneficiaries.
5. Impact of JSY services on maternal mortality rate and infant mortality rate.
The two phase study using the comparative case study approach was conducted between April 2010 and December 2010. The first phase included a review of secondary data and a rapid appraisal of health facilities in 24 districts, three in each state. In the second phase, a sub set of these districts, one per state was selected randomly and a cross sectional survey of women who had delivered in the past year and were eligible for the JSY was conducted.
In Chhattisgarh the state opted to undertake the Phase 2 survey in all three districts of Phase 1 and in Jharkhand and Orissa, two out of the three were selected. Thus in Phase 2, twelve districts were studied. The focus of Phase 1 was primarily an assessment of facilities, processes and perceptions.
In the second phase, 2759 women who had institutional deliveries and 710 women with home deliveries, eligible for JSY entitlement were randomly selected from a household listing of all women in the sampled villages who had delivered a child within the last one year and interviewed.
All women who reported complications in these villages were also studied, irrespective of whether they were eligible for JSY. Families that reported a maternal death were also interviewed. Data collection was undertaken between May to October 2010. The study was undertaken by the National Health Systems Resource Center, in response to a directive from the Ministry of Health and Family Welfare. NHSRC undertook the Phase 1 data collection and worked in partnership with arrange of partners to complete Phase 2. Data entry, analysis and report writing was done by NHSRC. A National Evaluation Team provided inputs into the design and the draft report.