04-IJCBMS- Dr. Sanjeev K Gupta - Cogprints

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Sanjeev K Gupta *, Dinesh Kumar Pal , Rajesh Tiwari , Rajesh Garg , Radha Sarawagi , Ashish Kumar d e. Shrivastava , Prashant Gupta. A R T I C L E I N F O.
Int J Cur Bio Med Sci. 2011; 1(2): 06 – 11.

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Original article

Assessment of Janani Suraksha Yojana (JSY) – in Jabalpur, Madhya Pradesh: knowledge, attitude and utilization pattern of beneficiaries: a descriptive study a

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Sanjeev K Gupta *, Dinesh Kumar Pal , Rajesh Tiwari , Rajesh Garg , Radha Sarawagi , Ashish Kumar d e Shrivastava , Prashant Gupta a

*Assistant Professor, Department of Community Medicine & a Associate Professor, Department of Radiology, Mahatma Gandhi Medical College & Research Institute, Pillaiyarkuppam, Pondicherry India.

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Professor / Head & b Associate Professor, Department of Community Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India.

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Assistant Professor, Department of Community Medicine, VCSG Medical Sciences & Research Institute, Srikot- Srinagar, Dist- Pauri Garhwal, Uttarakhand, India.

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Surveillance Medical Officer in National Polio Surveillance Project, Government of India-World Health Organization (WHO) collaboration, Noida, India.

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Trainee of the course, post graduate diploma in clinical research (PGDCR) at Indian Institute of Public Health Delhi, India.

ARTICLE INFO

ABSTRACT

Keywords: Janani Suraksha Yojana (JSY) Institutional Deliveries Utilization of money Maternal mortality Transport facilities Source of JSY information.

Aims & objectives: Jananai-Suraksha-Yojana (JSY) scheme was launched in India in 2005 with the objective of reducing maternal mortality by promoting institutional deliveries. The main objectives of our study were, to assess the social profile, knowledge, attitude and utilization pattern of JSY beneficiaries. Setting & design: It was a descriptive study. Material & method: In the present was conducted in N.S.C.B. Medical College, Jabalpur (M.P. - India) during 2007 - 08 with a sample size of 300 beneficiaries. Statistical analysis: Percentages. Results & conclusion: 77.66% belonged to below poverty line (BPL) category. 67% of the respondents arranged their own / hired vehicle for transporation for delivery. Only 17.33% were motivated by ANM/DAI/ASHA/AWW for institutional delivery. Decision of expenditure depends upon husband in one third of cases. (Majority of beneficiary mothers were in favour of cash payment (94.33%). The arrangement of vehicle for transport is still a major issue of concer. In many cases the husbands decides the purpose for which money is to be used. c Copyright 2011. CurrentSciDirect Publications. IJCBMS - All rights reserved.

1. Introduction Each year, approximately eight million women suffer pregnancy-related complications and over half a million die. Some 99 per cent of all maternal deaths occur in developing countries. Two thirds of maternal deaths in 2000 occurred in 13 of the world's poorest countries. During the same year, India alone accounted for one quarter of all maternal deaths [1]. According to Statistical Report, Registrar General of India (RGI), 2004, Maternal Mortality Rate (MMR) of India in 2001-2003 was 301 per lakh live births [2]. According to SRS 2006, in the state of Madhya Pradesh, MMR was 379 per lakh of live births and in District Jabalpur MMR was 379 per lakh of live births[3]. In developing countries like India, the health care services are not equally distributed. The organizational structure requires a * Corresponding Author : Dr. Sanjeev K Gupta Assistant Professor, Department of Community Medicine, Mahatma Gandhi Medical College & Research Institute, Cuddalore Main Road Pillaiyarkuppam Pondicherry, India. Mobile: +91-7639656802, +91-7639656801 E-mail : [email protected] c Copyright 2011. CurrentSciDirect Publications. IJCBMS - All rights reserved.

villager to travel an average distance of 2.2 km to reach the first health post for getting a paracetamol; over 6 km for a blood test and nearly 20 km for hospital care [4]. It was estimated that 25% of people in Madhya Pradesh and Orissa could not access medical care due to location reasons, while it was 11% for Uttar Pradesh. Further, even when accessed, there was no guarantee of sustained care. Several other deterrents such as bad roads, the unreliability of finding the health provider, costs for transport and wages foregone, etc. make it cheaper for a villager to get some treatment from the local quack [4]. A survey of households in Jaipur (IIHMR 2000) showed delivery in a public hospital costs an average of Rs 601, private hospital about Rs 3593, while home only Rs 93. The major item of expenditure was also found to be drugs, which constituted 62 % [5]. According to a cost-benefit analysis, a woman saves nearly 85$ by choosing to deliver at the nearby Sub Centre (SC) as against nearly 105$ spent when the services are not available at the SC or are not used. For the tribal population with income of less than a dollar a day, utilization of a SC not only ensures safe deliveries, it also presents an economically feasible option [6].

Sanjeev K Gupta et al. / Int J Cur Bio Med Sci. 2011; 1(2): 06 – 11. Concerned particularly with the maternal health, the Government of India (GOI) launched various schemes to promote institutional deliveries from time to time. One such new maternity benefit scheme is Janani Suraksha Yojana – JSY (In Hindi Language, Janani = Mother, Suraksha =Protection, Yojana = Scheme). JSY was formally launched on 12th of April, 2005 under National Rural Health Mission [7]. The main objectives of JSY scheme werereducing Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) by encouraging institutional deliveries; particularly in below poverty line families. Under this scheme cash incentives are given to women who opt for institutional deliveries and also to the local health functionary i.e. ASHA (Accredited Social Health Activists) who motivates the family for institutional delivery and helps them in obtaining ante-natal and post-natal services. (In Hindi language, the word “ASHA” literally means “Hope”). Since the launch of JSY, the numbers of institutional deliveries have started increasing. Against the 27.61 Lakh beneficiaries in 200607, the number of beneficiaries jumped to 53.13 Lakh in 2007-08 [8]. But it is not only the mere establishment of a physical facility but a combination of factors such as distance, availability and quality of skills, adequacy of infrastructure and access to alternative sources of care that seem to influence health-seeking behavior. Some of the important factors like awareness, knowledge, attitude, utilization pattern and the satisfaction of the beneficiaries also influence any program's success. Due to the ever-changing world of information and technology, the people are now more aware of their rights and duties. JananiSuraksha-Yojana (JSY) scheme was launched in India in 2005 with the objective of reducing maternal mortality by promoting institutional deliveries. The main objectives of our study were, to assess the social profile, knowledge, attitude and utilization pattern JSY beneficiaries. This will certainly help in knowing the perceptions of people towards the scheme as a whole. This is important at this point of time because some important feedback is needed by health administrators, planners and policy makers to get the progress report of the scheme at the ground level for timely intervention, if needed. With this objective in mind, it was decided to take up a study on JSY in the NSCB Medical College & Hospital, Jabalpur, which is an apex tertiary care hospital of Madhya Pradesh (India) connected to 8-10 adjoining districts and is the main referral centre of the surrounding districts. 2. Materials and methods Objective: To describe the knowledge, attitude and utilization pattern of JSY beneficiaries. Study Area: The study has been carried out in the N.S.C.B. Medical College and Hospital, Jabalpur (Madhya Pradesh), India. Study Period: From 16th January 2007 to 15th January 2008. Total study period was one year. Study Design: It is a descriptive and observational hospital based study 2.1. Sample size and sampling: the study subjects comprised 300 beneficiaries. As the Knowledge, Attitude and Utilization (KAU) pattern of beneficiaries involved multiple issues, no consolidate data could be found from past literature about

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proportion of women such KAU pattern. Therefore, to determine sample size, P was taken as 0.5, considering the theory of probability 50%, which also gives the maximum sample size. Thus sample comprised 300 beneficiaries, considering 95% confidence interval and allowing 10% error. 2.2. Study tools and Technique: The collection tool used was a pre designed questionnaire, which was pre-tested. Data collected as such was compiled into a excel sheet for easy comparison, reference and analysis. Statistical Test: Percentages. 2.3. SWOT Analysis: The strength of the study is that study area, being a large and tertiary level hospital having a large catchments area; the authors were able to analyze large number of pregnant women in regard to knowledge, attitude and utilization pattern and that too from different districts. The weakness/ limitation of the study is that it is not a community based study and hence it is not possible to elicit the reasons why a large section of society still does not prefer institutional deliveries and what are the various factors which hinders in the utilization of JSY services. Also the study may not necessarily represent the country as a whole as there are wide regional variations in the maternal health services and India being a large country with varied geographical and social variation. 2.4. Ethical clearance: Ethical clearance for conducting the study was taken from the ethical committee of the institution i.e. NSCB Medical College, Jabalpur, and informed consent was taken from the women participating in prospective study group with the assurance that confidentiality will be maintained and the information obtained for this study will not be used for any other purpose except for academic purpose. 3. RESULTS: The JSY beneficiaries interviewed were young as most of the beneficiaries were in the range of 21 – 25 years age group i.e. 190 (63.3%). Most (71 %) of the respondents had no formal education and only (24 %) had schooling up to middle level. 164 (54.66%) respondents were from rural background. Out of 300 respondents, 233 (77.66 %) belonged to Below Poverty Line (BPL) category. One-fifth of the respondents 50 (16.7 %) were from upper middle and upper socio-economical class. 135 (45.0 %) of the respondents belong to Scheduled caste category, 46 (15.3 %) from Scheduled tribe and 105 (35.0 %) from other backward classes (table 1). More than half of, respondent's i.e. 180 (60%) got married at 16-20 years of age and most of them i.e. 165 (55%) had their first pregnancy below the age of 20 yrs (table 1). 121 (40.3%) of beneficiary women were primigravida and 179 (59.7%) were multigravida. Majority i.e. 285 (95%) of the respondents were registered for pregnancy before coming to the hospital for delivery. 127 (42.3 %) of the cases were referred from various hospitals from the periphery. One third of the beneficiary female i.e. 103 (34.3 %) were accompanied by the motivator i.e. ASHA/ANM for institutional delivery.

Sanjeev K Gupta et al. / Int J Cur Bio Med Sci. 2011; 1(2): 06 – 11.

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Table 1. Social Profile of JSY beneficiaries at NSCB medical college Jabalpur, India Characteristics

Total (n=300) Percentage

Age of JSY beneficiaries at the time of marriage 10-15 year 16-20 year 21-25 year 26-30 year

n=40 n=180 n=72 n=8

Table.3 Distribution of acceptors of JSY according to amount spend by the beneficiary mother for arranging private vehicle for Reaching Medical College, Jabalpur. Amount spend by beneficiary mother in Rs.

13.33 60.0 24.0 2.66

No. of beneficiary Percentage of mothers beneficiary mothers

< 100

72

37.30

101 – 200

51

26.42

201 – 300

29

15.02

301 – 400

19

9.84

401 – 500

18

9.32

> 500

4

2.07

Total

193

100

Age of JSY beneficiaries at the time of 1st pregnancy 10-15 year 16-20 year 21-25 year 26-30 year 31 years and above

n= 9 n= 165 n=108 n=15 n=3

3.0 55.0 36.0 5.0 1.0

Caste Scheduled caste Scheduled tribe Other backward classes General

n=135 n=46 n=105 n=14

45.0 15.3 35.0 4.66

n=164 n=136

54.66 45.33

Area Rural Urban

Table 4. Distribution of acceptors of JSY according to time spent from their residence to Medical College, Jabalpur for Delivery

95 (31.7%) beneficiary mother had to travel more than 40 Km for availing the JSY services. Two third of the respondents i.e. 193 (64.33 %) arranged hired vehicle for transportation for delivery (table 2). Out of the 193 respondents who spend for own /hired vehicle, 51 (26.42%) spend more than Rs 200 each (table 3). Majority i.e. 269 (89.7%) mothers reached hospital within 2 hours (table 4). Table 2. Distribution of acceptors of JSY according to availability of transport for arrival to Medical College, Jabalpur

Mode of transportation Vehicle provided by the PHC/CHC/Dist. Hospital.

No. Beneficiaries mothers n=300

Percentage of Beneficiaries mothers

31

10.33

Vehicle arranged by the AWW/ASHA/Dai/ ANM

68

22.66

Arrange private vehicle

193

64.33

Self vehicle

8

2.66

Times in hours

No. of beneficiary mothers n=300

Percentage of beneficiary mothers

1 hour

207

69

2 hours

62

20.66

3 hours

23

7.66

4 hour

4

1.33

> 4 hours

4

1.33

Table 5. Distribution of acceptors of JSY according to source of information about JSY Source of information

Number of beneficiary mother

Percentage of beneficiary mothers

Doctor

5

1.66

ANM/Dai/ ASHA/ AWW

190

63.33

Pamphlets / Holding

21

7

Neighbors / Friends / Relative

70

23.33

Any other

14

4.66

Sanjeev K Gupta et al. / Int J Cur Bio Med Sci. 2011; 1(2): 06 – 11.

In majority of respondents i.e. 190 (63.33%), the ANM/ Dai/ ASHA/ AWW were the main source of information regarding JSY and doctors were the source of information in 5 (1.66%) of cases only (table 5). Monitory benefit was the main motivating factor for institutional delivery in 101 (33.7%) respondents. Only 21 (7 %) respondents reported “hospital delivery is better than home delivery” as a reason for availing the JSY services. Only 52 (17.33 %) were motivated by ANM/Dai/ASHA/AWW for institutional delivery. Decision of expenditure depends upon husband in one third of cases 101(33.33%). One third of the respondents i.e. 95 (31.66%) intended to use the amount received for purchasing nutrients for herself. One sixth of the respondents i.e. 46 (15.3%) mothers were interested in spending the amount in purchasing medicine either for herself or for their babies (table 6). Table 6. Distribution of acceptors of JSY according to the purpose of money Spent

Amount will spend on

No. of beneficiary Percentage of mothers n=300 beneficiary mothers

Purchasing nutrients for mother

95

31.66

Purchasing nutrient & clothes for baby

53

17.66

Purchasing medicine for mother and child

46

15.33

101

33.66

5

1.66

Decision for expenditure depends upon the husband Other expenditure

Table 7. Distribution of acceptors of JSY according to their perception regarding JSY

Amount will spend on

No. of beneficiary Percentage of mothers n=300 beneficiary mothers

Very good

40

13.33

Good

185

61.66

Good but amount should be increased

65

21.66

Bad

0

0

Can't say anything

10

3.33

300

100

Total

Only 39 (13%) beneficiaries were aware about the name of JSY and its benefits. 216 (87%) beneficiaries knew that there is a scheme in which cash incentive given after institutional delivery

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but they didn't know about exact name of the scheme as JSY. Twothird 225 (75.0%) beneficiary mothers reported JSY as a good or very good scheme (table 7) and 65 (21.7%) respondents were of opinion that the amount under JSY should be increased. Majority of beneficiary mothers i.e. 283 (94.33%) were in favour of cash payment instead of payment by cheques. 4. Discussion In the present study, most of the beneficiaries i.e. 190 (63.3%) were in the range of 21 – 25 years age group). According to a study on JSY in Rajasthan and Madhya Pradesh, 76 % and 83 % of the beneficiaries were aged 20–29 years respectively [9, 10]. Approximately three fourth of the women were illiterate and one fourth were educated up to middle level only. According to a study on JSY in Rajasthan and Madhya Pradesh, majority of the JSY beneficiaries were illiterate i.e. 68% and 70 % [9,10]. This indicates percolation of the JSY scheme to the population which is illiterate. In the present study, 233 (77.7%) beneficiary women belonged to below poverty line [BPL]. The percentage of BPL families registered in National Rural Employment Guarantee Act (NAREGA) in Jabalpur is 36.9%[11], being a Govt. institute and tertiary centre, more and more BPL cases from adjoining districts came to avail the services of JSY in this hospital. In the present study, the highest number of acceptors of JSY belonged to SC category - 135 (45%).According to Census-2001, the percentage of SC and ST in the state of Madhya Pradesh is 15.40% and 19.94% respectively [10]. Being a large and tertiary level hospital having a large catchments area and that too from different districts, the number of SC beneficiaries were more than the numbers as per the census. According to a study on JSY in Rajasthan, One-third of the JSY beneficiaries belonged to SC/ST and one-half to the other backward classes [9]. similarly, in Madhya Pradesh, 22 % belonged to SC and 19 % to ST category [10]. The above fact that the scheme is addressing to the needs of socio-economically disadvantaged groups is highly appreciable. In the present study, more than half of the beneficiaries were married early in their life and had their first pregnancy below the age of twenty. According to National Family Health Survey-III (NFHS-3), 44.5% women in India and 57.3 % women in M.P were married by the age of 18 years [12, 13]. Similarly, in India and Madhya Pradesh; the women who were already mother or pregnant in age group of 15-19 years were 16 % and 13.6 % respectively [12, 13]. In the present study, one third of the beneficiary female were accompanied by the motivator i.e. ASHA/ANM for institutional delivery. In Rajasthan and Madhya Pradesh, 18 % and 21 % ASHAs accompanied the women to the health institution for delivery respectively, while women who were accompanied by Dai, ANM and Anganwadi worker were 20 % and 30 % respectively [9, 10]. According to the present study, one third of the beneficiaries had to travel more than 40 Km for availing the JSY services. In Rajasthan and Madhya Pradesh, JSY beneficiaries had to travel, on average, 11.6 kms and 10.4 Kms [9, 10].

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Sanjeev K Gupta et al. / Int J Cur Bio Med Sci. 2011; 1(2): 06 – 11.

In the present study, two third respondents arranged hired vehicle for transportation for delivery. In Rajasthan and Madhya Pradesh, the transport was arranged by family in 82 % and 90 % respectively[9, 10]. Problems of communication and transport were also reported by most of the respondents in Orissa regarding JSY [14]. ASHA is not assisting pregnant women in arranging referral transport at most places [8]. Out of the 193 respondents who spend for own /hired vehicle, 152 (50.66%) spend more than Rs 200 each. In Rajasthan, Madhya Pradesh, and Orissa, on an average, the beneficiaries spent Rs. 280.2, Rs. 297.1 and Rs 433 on transport to reach the place of delivery respectively [9, 10, 15]. In the present study, 269 (89.7%) mothers reached hospital within 2 hours. In Rajasthan, Women spent approximately one hour to arrange transport and reach the ultimate place of delivery [9]. For two-third of respondents, major source of information was ANM/ Dai/ ASHA/ AWW, and only in 1.66% cases the information sources were doctors. In Rajasthan and Madhya Pradesh, it was observed that ANMs were the main source of information ( 71 % & 60 %) followed by ASHAs (24 % & 21 %) [9,10]. Existing mechanism of village health and nutrition day not utilize for creating awareness and recruitment of women for JSY [8]. In the present study, for one third of the respondents; monitory benefit was the main motivating factor for institutional delivery. In Rajasthan and Madhya Pradesh, it was observed that monetary benefit was main motivating factor in 56 % and 89 % of the beneficiaries [9, 10]. In the present study, One third of the respondents intended to use the amount received for purchasing nutrients for herself. In Rajasthan, About two-fifths of them purchased consumables for the family and bought medicines/ tonics for self and child, while one-fourth said that they used it for self-nutrition or the husbands took it away [9]. In Madhya Pradesh, while 27 % purchased consumables for the family and one-fifth used for medical expenses during delivery[10]. According to present study, more than three-fourth of beneficiaries knew that there is a scheme in which cash incentive given after institutional delivery but they didn't know about exact name of the scheme as JSY. In Rajasthan and Madhya Pradesh, 71 % and 26 % of the beneficiaries heard that JSY provided for free institutional delivery services for poor women with monetary benefits [9]. In the present study, two-third beneficiaries reported JSY as a good or very good scheme and 21.7% respondents were of opinion that the amount under JSY should be increased Most (90 %) women were satisfied with JSY in Madhya Pradesh and Rajasthan [9, 10]. In Rajasthan and Madhya Pradesh, One-sixth and onetenth of beneficiaries said that the cash assistance was not enough to meet the expenses [9].

5. Conclusion and Recommendations Although Majority of respondents knew about the scheme regarding monitory benefit for institutional delivery, the name of the scheme is known to a very small proportion. This point towards the fact the JSY has not been able to create a “brand image” in the mind of people like other programs like Directly observed Therapy (Short term)-DOTS for tuberculosis control. This needs to be rectified by social marketing of the JSY. It is a known fact that knowing a “product” by name increases it chances of more acceptance and utilization. Extensive information, Education and Communication (IEC) strategy is needed via various channels including print, electronic, traditional, personal communication etc. The celebrities from various fields could be involved in it. In villages, for example, the “letter from an unborn child” campaign reached out to 40,000 fathers-to-be, educating them about the importance of taking care of their wives during pregnancy [16]. Social franchising i.e. a network of service providers use a shared brand name guaranteeing a certain quality of a package of health services with a fixed price line could be initiated. Experience could be gained from the 'Janani program' that was started in Bihar (India) and has now spread to other states used the 'Surya clinics' and 'Titli centres' to offer reproductive health services including contraception and safe abortion [17]. Some families are not being able to arrange vehicle at the time of delivery because of lack of money and also it is very difficult to arrange vehicles at the odd hours. The role of Panchayati raj institutions (PRIs) should be introduced for the arrangement of vehicle for institutional deliveries. Other wise 24 x 7 services by “Dial 108 ambulances” in Uttarakhand (India) could be a role model in this regard for transporting pregnant women for institutional deliveries. The sub centres which caters to a population of around 5000, are rarely equipped for delivery services and if these services were present, lot of burden on higher health centers will decrease dramatically and the families would be saved from travelling long distances, wasting crucial times and huge expenditure for these services. The concept of “maternity huts” by Haryana (India) could be further explored. ASHA/ANM should be encouraged to accompany the pregnant women for delivery as the presence of these workers supports in proper administrative and financial paper work and ease in getting the services. The decision of spending money received in the scheme by the husband is very big challenge. Most of the time, this money is spent for other purpose rather than for mother. Some in built mechanism like pre-paid vouchers could be introduced for ensuring that the basic purpose of the amount provided must be used for the purpose intended. In India, the Government of Gujarat introduced voucher schemes under Chiranjeevi Yojana-CY (meaning long life) to increase the access of poor women to antenatal, obstetric and neonatal health care [18]. It is based on a Public-Private Partnership (PPP) model in which poorer people can go to empanelled private nursing homes for delivery, and the cost will be borne by the state [8].

Sanjeev K Gupta et al. / Int J Cur Bio Med Sci. 2011; 1(2): 06 – 11.

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Acknowledgement The authors are indebted to all the participants and their family/relatives for their co-operation. We are also thankful to the staff of this health centre.

[9]

[10]

6. References [1]

[2]

[3] [4]

[5]

[6]

[7]

[8]

UNICEF. A Call for Quality. In State of the World's Children 2007; Women and Children - The Double Dividend of Gender Equality. United Nations Children's Fund (UNICEF), 2006; 5, 127. Central Bureau of Health Intelligence. National Health Profile 2006. Central Bureau of Health Intelligence. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, 2006; 25, 90- 112. Government of Madhya Pradesh. Basic Health Information. Available from: http://www.health.mp.gov.in/general.htm (As assessed on 21st Nov, 2009) Government of India. NCMH Background Papers: Financing and Delivery of Health care Services in India. National Commission on Macroeconomics and Health. Ministry of Health and Family Welfare, Government of India, New Delhi. 2005, 39-71, 187, 242. Government of India. The National Commission on Macroeconomics and Health report. Ministry of Health and Family Welfare, Government of India, New Delhi. 2005, 1-43, 71-79, 125. Joshi A. Improving the Availability of Healthcare Services through Community Participation. Change Makers. Available from: http://www.changemakers.com/en-us/node/1393 (As assessed on 21st Nov, 2009) N a t i o n a l M a te r n i t y B e n e f i t S c h e m e . Ava i l a b l e f ro m : http://www.sccommissioners.org/schemes/nmbs(As assessed on 21th Jan, 2010) National Rural Health Mission. Janani Surkshya Yojana –A Great Leap Forward. NRHM newsletter, Government of India.. Vol 4:3, July-Sep 2008. Available fromhttp://www.mohfw.nic.in/NRHM/Newsletter/July_Sep.pdf (As assessed on 13th Nov, 2009)

[11]

[13]

[14]

[15]

[16]

[17] [18]

Uttekar BP, Barge S, Khan W et al. Assessment of ASHA and Janani Surkshya Yojana in Rajasthan. Centre for Operations Research and Training. Vadodara ,India. April, 2007. Uttekar BP, Sharma J, Uttekar V,Shahane S. Assessment of ASHA and Janani Surksha Yojana in Madhya Pradesh. Centre for Operations Research and Training. Vadodara ,India. April, 2007. National Rural Employment Guarantee Act (NREGA). Government of India, Ministry of Rural Development; Department of Rural Development; Available from: http://nrega.nic.in/netnrega/writereaddata/ state_out/BPL_AC_Photo_1733.htm (As assessed on 26th Nov, 2009)[12] Government of India: Fact Sheet - India. In: National Family Health Survey (NFHS-III) 2005-06. International Institute for Population Sciences, Mumbai India and ORC MACRO Calverton, Maryland, USA. October 2007. GOVERNMENT OF INDIA : Fact Sheet – Madhya Pradesh (Provisional Data). In: National Family Health Survey (NFHS-3) 2005- 06. International Institute for Population Sciences, Mumbai India. Ministry of Health and Family Welfare, Government of India. 2007. Malini S, Tripathi R.M,Khattar P et al. A Rapid Appraisal of Functioning of Janani Suraksha Yojana in South Orissa. In: Health and Population: Perspectives and Issues, 2008, Vol 31 (2);126-131. Concurrent Assessment of Janani Suraksha Yojana (JSY) Schemes in Selected States of India, 2008- Available from http://www.mohfw.nic.in/NRHM/Documents/JSY_Study_UNFPA.pdf Vikas S. Neonatal Care in India: Raising a generation by raising awareness I n : T h e B e t te r I n d i a . Ava i l a b l e f ro m : – http://www.thebetterindia.com/tags/janani-suraksha-yojana/ Dasgupta J. Public Private Partnership in Health. Available from:http://planningcommission.nic.in/data/ngo/csw/csw_22.pdf Bhutta Z. A, Darmstadt G.L, Haws R.A,Yakoob M.Y,Lawn J.E. Delivering Interventions to Reduce the Global Burden of Stillbirths: Improving Service Supply and Community Demand. In: Biomed Central Ltd- Pregnancy and C h i l d b i r t h . M ay 2 0 0 9 , 9 ( S u p p l e m e n t 1 ) : S 7 . Ava i l a b l e fromhttp://www.biomedcentral.com/1471-2393/9/S1/S7

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