Projects

Background:

Preventing maternal deaths associated with pregnancy and childbirth is one of the greatest challenges before the nation. India has the highest number of maternal deaths in the world. The life-time risk of a woman in India dying during pregnancy, delivery and through the first six weeks after delivery is 1 in 70. The risk to women in India is 2 times greater than that faced by women in the Asia region and 60 times that of women in developed countries.

India Clinical Epidemiology Network (IndiaCLEN) and the Population Foundation of India (PFI) are jointly undertaking a study on the reach, effectiveness and impact of the Janani Suraksha Yojana (JSY) Scheme in Jharkhand. This is a centrally sponsored scheme with the objective of reducing maternal and neonatal mortality by promoting institutional delivery among poor pregnant women. The scheme was formally launched by the Honourable Prime Minister of India in April, 2005.The scheme is called Mukhay Mantri Janani Avam Shishu Suraksha Abhiyan (MMJSSA) in Jharkhand.

After several years implementation, management and functionality of the scheme require an intensive scrutiny in order to address its acceptability, reach, effectiveness, and pregnancy outcomes such as maternal and newborn health and survival. This study will provide information to program managers and policy makers in Jharkhand so that they can make necessary mprovements /modifications in strategies that will lead to improved maternal and newborn outcome through a more effective JSY scheme. The proposed study aims at identifying women who have and not have been reached by the scheme, and to identify ‘why’ women are and are not utilizing the scheme. The study will elicit the perspectives of both clients and providers to get a critical view of the current status of quality of care, and how health infrastructure, and service delivery can be improved. There will also be an attempt to measure the number of maternal deaths averted as a result of the scheme. The study will also identify barriers/ problems, and will suggest solutions based on a comprehensive analysis of responses from both the providers and beneficiaries.

Objectives:

Coverage Evaluation (Reach)

• To assess MJSSA (JSY) reach to marginalised and hard to reach segments of the population, including tribal and BPL
• To understand the determinants of utilization and non utilization of the scheme

• Evaluate processes involved in planning, management and inter-sectoral coordination in MJSSA (JSY)
• To identify the strengths and limitations, problems faced and local innovations of the program
• To assess social mobilization strategies in place to create awareness and increase MJSSA (JSY) demand in the community

• To assess the referrals, quality of care provided at the health facility and to estimate the “death averted” in selected districts

Key Areas of Investigation:

1. Program Management and inter-sectoral coordination
2. Quality of care
3. Client perspectives
4. Social mobilization
5. Influence of MJSSA (JSY) on other maternal health programs
6. Estimates of deaths averted

Methodology:

• Coverage Evaluation – Quantitative Secondary data analysis from routine monitoring system and data from DLHS survey
• Process Evaluation – Qualitative methods
• Assessment of Impact – Interviews with beneficiaries, observations of quality of care, facility-based data analysis and estimation of ‘Deaths Averted’ using Maternal Deaths Averted (MDA) models

Time Line:

12 months (Sept 29, 2008 – Sept 30, 2009)

Key Stakeholders:

• State Level
  • Health Secretary, DGHS, NRHM Mission Director
  
  
• District Level
  • Chief Medical Officer
  • Medical Superintendent (District Hospital)
  • District Officer for JSY
  • Rogi Kalyan Samiti (Patient Welfare Committee)
  
  
• Rural
  • MO (PHC/CHC)
  • Formal Obstetricians/ General practitioners/ informal practitioners (Private)
  • ANM/SBA/TBA involved in delivery
  • Sahiya/AWW
  • Clients/family members
  • Village Health & Sanitation Committee
  • Religious and Village leaders
  
  

Expected Outcome / Output:

The overall aim of the study is to expand reach of MJSSA scheme and improve effectiveness and impact for promoting and sustaining quality institutional deliveries. Thus it is expected to achieve-

• Efficiency in programme management
• Barriers in utilization of services identified
• Reach to those who are in greatest need increased
• Innovations for scaling-up documented
• Recommendations for improved quality of services and potential areas of intervention

Population Foundation of India, B – 28, Qutab Institutional Area, Tara Cresecent, New Delhi – 110 016		IndiaCLEN Office No. 16.8, Plot No. 172, 22nd Cross Street, Indira Nagar Adyar, Chennai – 600020