The government of India launched Janani Shishu Suraksha Karyakram (henceforth JSSK) to benefit pregnant women and newborns. The JSSK provides completely free and cashless services to pregnant women including normal deliveries and caesarean operations and sick newborns (up to 30 days after birth) in government health institutions. This chapter studies the utilization of the JSSK scheme by the beneficiaries and the strategy of free entitlements implemented under JSSK through the selected policy targets. The study was carried out in Jaipur district, Rajasthan, India, and was conducted on a medium-sized sample, who have availed the benefits of JSSK in the past year to measure the correlation between three variables, policy targets, service delivery management, and utilization pattern of beneficiaries. The chapter concludes that JSSK is a good scheme but gaps in resources and lack of quality of services needs to be adequately dealt with to make it efficient.
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Family Welfare Statistics in India estimates the maternal mortality ratio at 212 per 100,000 live births. The MMRs vary across the states, with the large North Indian states contributing a disproportionately-large proportion of deaths. Uttar Pradesh and Rajasthan, for example, have high rates of fertility and maternal mortality while Kerala and Tamil Nadu have rates comparable with middle-income countries. Sequentially to fight with maternal health crises, Government of India (GOI), Ministry of Health and Family Welfare, has executed different types of programmes for the improvement of maternal and child health. With the objective to address the health needs of rural population especially women and children, Ministry of Health and Family Welfare, GOI planned and launched National Rural Health Mission (NRHM) in April 2005. All the efforts under NRHM are direct and indirect plan to provide accessible, affordable, and effective healthcare to all citizens and particularly to the poor and vulnerable sections of the society (MHFW, 2011). In the direction of achieving the objectives of the National Rural Health Mission (NRHM), Janani Suraksha Yojana hence forth, JSY ((in Hindi language, Janani= Mother, Suraksha= Protection, Yojna= Scheme) was launched in April 2005 to promote institutional deliveries among the poor population. The JSY is a conditional cash transfer scheme- a woman is paid money if she delivers her baby in a medical facility- in government health centres, like sub centres (SCs), Primary Health Centres (PHCs), Community Health Centres (CHCs) or general wards of district or state hospitals, government medical colleges or accredited private institutions. As of today, the JSY is one of the largest conditional cash transfer programs in the world.
The central government renamed and launched the JSY programme as Janani Shishu Suraksha Karyakram, henceforth JSSK (In Hindi language, Janani= Mother, Shishu= Child, Suraksha= Safety, Karyrakram= Programme) on 1st June 2011 to benefit pregnant women and newborns. The Rajasthan State Government launched JSSK on 12 September 2011 in all 33 districts. The initiative of JSSK provides completely free and cashless services to pregnant women including normal and caesarean deliveries and sick new born (up to 30 days after birth) in Government health institutions in both rural and urban areas. The scheme is fully sponsored by the Central Government and is implemented in all states and Union Territories (UTs).
The NRHM has divided states into two categories- Low Performing States (LPS) and High Performing States (HPS) depending on the institutional delivery rate i.e. states having institutional delivery 25% or less were termed as Low Performing States (LPS) and those which have institutional delivery rate more than 25% were classified as High Performing States (HPS). Accordingly, eight erstwhile Empowered Action Group (EAG) states namely Uttar Pradesh, Uttarakhand, Madhya Pradesh, Chhattisgarh, Bihar, Jharkhand, Rajasthan, Odisha and the states of Assam & Jammu & Kashmir were classified as Low Performing States, While the remaining States were grouped into High Performing States. Rajasthan ranks 19th among Indian states as per the children delivered in the hospital (Sugathan, 2001).
The cash incentive programme is estimated to benefit more than 10million pregnant women and newborns that access public health institutions every year in both urban and rural areas. The Free Entitlements under JSSK include: Free and Cashless Delivery, Free C-Section, Free treatment of sick-new-born up to 30 days, Exemption from User Charges, Free Drugs and Consumables, Free Diagnostics, Free Diet during stay in the health institutions – 3 days in case of normal delivery and 7 days in case of caesarean section, Free Provision of Blood, Free Transport from Home to Health Institutions, Free Transport between facilities in case of referral as also Drop Back from Institutions to home after 48hrs stay (Rajasthan JSSK Guidelines).