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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 13  |  Issue : 1  |  Page : 16-20

Assessment of knowledge and awareness about utilization of Janani Shishu Suraksha Karyakram: A community-based study in a rural block of Himachal Pradesh


1 Centre for Public Health and Hospital Administration, Eternal University, Sirmour, Himachal Pradesh, India
2 Department of Psychology, Eternal University, Sirmour, Himachal Pradesh, India

Date of Submission06-May-2019
Date of Acceptance22-Jul-2019
Date of Web Publication23-Jan-2020

Correspondence Address:
Dr. Priya Sharma
Centre for Public Health and Healthcare Administration, Eternal University, Baru Sahib, Sirmour, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_96_19

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  Abstract 


INTRODUCTION: In view of the difficulty being faced by the pregnant women and parents of sick newborn along with high expenditure on delivery and treatment of sick newborn, the Ministry of Health and Family Welfare has taken a major initiative to ensure better facilities for women and child health services through the Janani Shishu Suraksha Karyakram (JSSK) on June 1 2011. It is an initiative to provide completely free and cashless services to pregnant women.
OBJECTIVES: The objective of this study was (1) to find out the awareness level about JSSK among pregnant women and lactating mothers and to determine the sources of awareness and knowledge about the components of JSSK and (2) to find out the association between demographic factors and benefits and satisfaction level about JSSK among the rural women of Kangra district.
MATERIALS AND METHODS: A descriptive cross-sectional study was carried out among 106 pregnant women and lactating mothers selected by convenient sampling technique with the help of structured questionnaire from December 2016 to February 2017. The data were analyzed using SPSS version 22.
RESULTS: It was observed that among 106 women, good awareness was found only in 84.9% of them, maximum awareness (56.6%) was created through anganwadi workers, 49.1% of the women heard about it before pregnancy, 44.3% heard about it during pregnancy, and 15.1% of the women had no knowledge about the program. The study showed that educational status (P = 0.001) was significant with receiving the benefits of JSSK. However, it revealed that both educational status (P = 0.001) and occupation (P = 0.03) of the women were significantly associated with the satisfaction with JSSK.
CONCLUSION: The level of awareness regarding JSSK in pregnant women and lactating mothers was found to be good, but it was found that despite having good knowledge of the program, the women are not taking much concern about the ongoing program. The women need to be encouraged for more utilization of the services which are comprehensively built for them.

Keywords: Anganwadi workers, beneficiaries, entitlements, Janani Shishu Suraksha Karyakram


How to cite this article:
Sharma P, Gupta N L, Chauhan H S. Assessment of knowledge and awareness about utilization of Janani Shishu Suraksha Karyakram: A community-based study in a rural block of Himachal Pradesh. Indian J Health Sci Biomed Res 2020;13:16-20

How to cite this URL:
Sharma P, Gupta N L, Chauhan H S. Assessment of knowledge and awareness about utilization of Janani Shishu Suraksha Karyakram: A community-based study in a rural block of Himachal Pradesh. Indian J Health Sci Biomed Res [serial online] 2020 [cited 2020 Feb 18];13:16-20. Available from: http://www.ijournalhs.org/text.asp?2020/13/1/16/276428




  Introduction Top


Each year in India, roughly 30 million women experience pregnancy and 26 million have a live birth. Maternal mortality is defined as the death of a woman during pregnancy, childbirth or within 6 weeks after birth. With an estimated 45,000 deaths per annum, India contributes to a majority of maternal mortality burden in the region.[1] Government has taken a major initiative to evolve a consensus on the part of all states to provide completely free and cashless services to pregnant women including normal deliveries and cesarean operations and sick newborn (up to 30 days after birth) in government health institutions in both rural and urban areas.[2] The scheme is estimated to benefit more than 12 million pregnant women across India. All the states and union territories (UTs) have initiated implementation of the scheme.[3] The WHO defined maternal death as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy due to any cause directly or indirectly related to pregnancy or its management but not from accidental causes. Institutional deliveries in Himachal Pradesh increased from 63.4% in 2010–2011 to 75.5% in 2012–2013 after implementing Janani Shishu Suraksha Karyakram (JSSK). Sirmaur district had the third lowest proportion of institutional deliveries (57%) in 2011.[4] The utilization for various components of services under JSSK scheme in Himachal Pradesh was variable ranging from 40% to 70% for various components. However, there was a lack of data regarding utilization for each benefit and the out-of-pocket expenditure (OOPE) among beneficiaries.[5]

Every year, more than 13 lakh infants die within 1 year of the birth, and out of these, approximately 9 lakh, i.e., two-third of the infant deaths take place within the first 4 weeks of life. Preventable modalities such as hypothermia, asphyxia, infections, and respiratory distress continue to remain the main cause of mortality in the neonatal period.[3],[4]

India has made a concerted push to increase access to quality maternal health services. The WHO commends India for its ground-breaking progress in recent years in reducing the maternal mortality ratio (MMR) by 77%, from 556/100,000 live births in 1990 to 130/100,000 live births in 2016. India's present MMR is below the Millennium Development Goal (MDG) target and puts the country on track to achieve the Sustainable Development Goal target of an MMR below 70 by 2030.[6]

The following are the free entitlements for pregnant women: free and cashless delivery, free C-section, free drugs and consumables, free diagnostics, free diet during stay in the health institutions, free provision of blood, exemption from user charges, free transport from home to health institutions, free transport between facilities in case of referral, and free drop back from institutions to home after 48-h stay.[6]

The following are the free entitlements for sick newborns till 30 days after birth. This has now been expanded to cover sick infants: free treatment, free drugs and consumables, free diagnostics, free provision of blood, exemption from user charges, free transport from home to health institutions, free transport between facilities in case of referral, and free drop back from institutions to home [Table 1].[6],[7],[8]
Table 1: The scale of assistance under the scheme is as follows

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Universal health care is now a global goal that countries seek to achieve. Achieving universal health coverage needs a strong and efficient health-care delivery system which is affordable and accessible to all with an adequate number of skilled, trained, and well-motivated human resources. However, the reality is that significant sections of the population incur large OOPE for health services due to limited public funding, high cost of hospitalization, cost of drugs, lack of insurance, and dominance of private health service providers. Formal and informal fees act as barriers in accessing health-care services for maternal health. A reduction in OOP is essential to move toward universal coverage and financial protection and to facilitate achievement of the fifth MDG.[7]


  Materials and Methods Top


Design and setting

A descriptive cross-sectional survey was carried out on the rural community of Fatehpur block, Kangra district, Himachal Pradesh.

Sampling technique

Convenient sampling technique with a semi-structured questionnaire following interview technique was used, and the sample size was 106. Convenient sampling was done because data collection was done depending on the visits made by women to the health facilities.

Study population

Women between the age of 18 years and 35 years who were visiting the government health facilities were included in the study. Age of women included in the study was kept open ended. Once the data collection was over, the minimum age among the respondents was found to be 18 years and the maximum age was found to be 35 years.

Data collection tools, techniques, and analysis

Semi-structured questionnaire following interview technique was used to collect information on knowledge and awareness about JSSK among pregnant women and lactating mothers of rural community. The data were analyzed using SPSS statistics for windows (version 22.0 Armonk, NY: IBM Corp., USA).

Ethical consideration

Approval was obtained from the Eternal University Ethical Committee for the conduction of this research. Written consent was obtained from the respondents. Confidentiality was maintained at every step for the cause.


  Results Top


[Table 2] shows the demographic profile of the respondents which states that maximum respondents (50%) were in the age group of 18–25 years followed by 34.9% in the age group of 26–30 years and 15.1% in the age group of 31–35 years. The educational profile shows that maximum respondents (51.9%) had studied up to graduation followed by 33.0% were 12 pass, 10.4% were 10 pass, and 4.7% had cleared matric. The occupation profile shows that maximum respondents (67.9%) were housewives followed by 18.9% doing private job and 13.2% were doing government jobs. The family profile shows that maximum respondents (45.3%) were living in a joint family followed by 42.5% living nuclear and 12.3% living in extended families.
Table 2: Demographic profile of the respondents

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[Table 3] shows the knowledge profile of the respondents which states that 49.1% had heard about it before pregnancy, 44.3% heard about it during delivery, and 6.6% heard about it after their delivery. Anganwadi workers (AWW) (56.6%) were the major source of information followed by female health workers (18.9%); family members and relatives (17%); and TV, radio, and newspaper (7.5%).
Table 3: Knowledge profile of the respondents

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[Table 4] shows that maximum respondents (83%) got the benefits of JSSK and 16.9% did not get the benefits of JSSK. 31.1% had spent extra money to avail the benefits and 68.9% had not spent any extra money. It shows that maximum respondents (50%) were satisfied with the benefits of JSSK, whereas 33.01% were not satisfied with the benefits.
Table 4: Benefits and satisfaction profile of the respondents

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[Table 5] shows that educational status of the respondent is significantly associated with receiving the benefits of JSSK, while it also shows that educational status and occupation of the respondent are significantly associated with satisfaction level of the beneficiaries with the scheme.
Table 5: Association between demographic factors and the benefits and satisfaction with Janani Shishu Suraksha Karyakram

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  Discussion Top


It was a community-based study. The study reveals that the awareness level of majority of the respondents regarding JSSK was found to be good (84.9%) which was similar to the cross-sectional study carried out by Barua et al. in rural Kamrup among 387 mothers with infants revealed that 88.1% of the respondents were aware of free delivery, the flagship entitlement under JSSK. In those aware, majority, i.e., 89.4%, reported the initial source of their information as the accredited social health activist or the auxiliary nurse and midwife.[9] Furthermore, the study carried out by Kuruvilla et al. showed an awareness of 76%–79% for free transport facility for mothers. Almost 74%–80% were aware about free transport facility for the sick newborns and 77%–78% women were aware about free treatment, free drugs and consumables, free diagnostics, and free diet.[5] On the contrary to these studies, the study carried out by Chatterjee et al. showed that overall 68.75% of mothers had poor awareness regarding free entitlements of JSSK. Only 18.75% of mothers were aware about free normal vaginal delivery and free drugs and consumables each. None of the respondents were aware about free cesarean section, free provision of blood for mother, and sick infant. Parity of mother had a statistically significant influence on the awareness level regarding JSSK.[7] Another study carried out by Mitra et al. in Bankura district of West Bengal revealed similar results, with 13.3% and 3.3% lots being acceptable for awareness and 16.7% and 13.3% for utilization for mothers and infants, respectively.[10] Further study carried out by Chandrakar et al. revealed that among 352 mothers, good awareness was found in only 207 mothers (58.80%). Maximum awareness (89.20%) regarding entitlements among mothers was seen for free transport services from home to health institution followed by the drop-back transport facility from hospital to home (85.22%). None of the mothers knew about free diagnostic services for mothers and for sick infants and for free provision of blood for sick infants. Increasing parity was significantly associated with good awareness regarding JSSK.[11] Deshpande et al. carried out a study which revealed that among 1000 antenatal women, good awareness level regarding JSSK entitlements was seen in only (47.2%) study subjects. Not even a single woman answered all the 17 entitlements correctly. Regarding the source of information, the most common source of information was from health personnel, followed by friends and family which showed similarity with the results of the present study.[12] In context of timing of acquiring the information, in the present study, most of the women came to know about it before the pregnancy, i.e., 49.1% and about 44.3% during the pregnancy and 6.6% heard it after the delivery.

A study carried out by Tyagi et al. reveals that among 156 mothers surveyed, 93 (60%) received the full benefits during hospital stay and 29 (19%) received full transport benefits. Free diagnostics and drugs were given to 149 (96%) and 134 (86%), respectively.[13] Institutional deliveries in Himachal Pradesh increased from 63.4% in 2010–2011 to 75.5% in 2012–2013 after implementing Janani Shishu Suraksha Karyakram (JSSK). Sirmaur district had the third lowest proportion of institutional deliveries (57%) in 2011. The utilization for various components of services under JSSK scheme in Himachal Pradesh was variable ranging from 40% to 70% for various components. However, there was a lack of data regarding utilization for each benefit and the out of pocket expenditure (OOPE) among beneficiaries.[13] In the present study, 27.4% knew the scheme promotes institutional deliveries, 15.1% of the women had no knowledge about the program, 83% got the benefits of JSSK, and 17% did not get the benefits of JSSK due to various reasons. 67% of the women were satisfied with the benefits that they were getting through this program and about 33% participants in the study were not satisfied. 31.1% of the total sample population had to spend extra money to avail the benefits of the program. In comparison to a more recent study carried out Gupta et al. in Nahan, it was revealed that with the available infrastructure in the outpatient department, maternity and children ward, i.e., stretcher, wheelchair, bed, mattress, pillow, bedsheets, and ancillary articles such as bedpan, urine pot I/V stand, screen for privacy, and stool for attendants and benches in the waiting and resting area for attendants, almost all the pregnant mothers and attendants were satisfied. Pregnant mothers and attendants of the infants were satisfied and some of them were dissatisfied with the condition of toilets/ward and about the cleanliness, probably due to the old building of the hospital, inadequate number of manpower, i.e., housekeeping staff, and casual attitude of their supervisory staff.[14] Another study carried out by Kirti Sundar revealed that 77% benefitted from Janani Suraksha Yojana and overall 93 (60%) mothers received all JSSK benefits during hospitalization and 29 (19%) received full benefit for transport. Only 23 (15%) mothers were fully benefitted during stay and transport. Although mothers received many of the benefits, there was OOPE on many components.[15]

The study carried out by Khadse et al. reveals that though all the 78 respondents were enrolled under JSSK after admission to hospital, only 30 (38.46%) were aware about free delivery (including cesarean section) and free treatment under JSSK. 38.46% were aware about JSSK, and the hospital personnel were the main source of this information.[16]


  Conclusion Top


On the whole, there were not much studies stating the level of awareness, source of awareness, various entitlements of JSSK, and their association with sociodemographic factors in Himachal Pradesh. 38.46% were aware about JSSK and the hospital personnel were the main source of this information. For coming to the hospital, 15.38% respondents availed of ambulance facility while many travelled at their own expense. 70.51% respondents revealed that they spent money from their own funds on medicines, after admission to hospital. Overall awareness level regarding the JSSK was good, but there is a long way to go to achieve a level that accounts to the betterment of the health in the community and the nation among pregnant women and lactating mothers through successful utilization of the scheme. There were many aspects where the things are still lacking like many of the women did not know the name of the program, although they have been taking benefits of it, thus they are not able to promote it to others in their friends and family circle. Considerable efforts have been shown by the AWW and female health workers, but lack of promotion through the media is prevalent. Most of the women knew about the various components, but none were aware about all the 17 components of the program which plays a major hurdle in accomplishing the desired objectives and targets in relation to maternal and child health.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Available from: http://vikaspedia.in/health/women-health/ pregnancy-health-1/ensuring-safe-motherhood. [Last accessed on 2019 Sep 04].  Back to cited text no. 1
    
2.
Guidelines for Janani-Shishu Suraksa Karyakaram. National Rural Health Mission. Nirman Bhavan, New Delhi: Maternal Health Division, Government of India; June, 2015. Available from: http://rmncha.in/wp-content/uploads/guidelines_img/1487572074.pdf. [Last accessed on 2019 Jul 10].  Back to cited text no. 2
    
3.
National Health Mission, Ministry of Health and Family Welfare. Available from: http://nhm.gov.in/janani-shishu-suraksha-karyakram.html. [Last accessed on 2019 Jul 10].  Back to cited text no. 3
    
4.
Available from: http://nrhmhp.gov.in/sites/default/files/files/Entitlements_JSSK.pdf. [Last accessed on 2019 Jul 10].  Back to cited text no. 4
    
5.
Kuruvilla A, Parmar K, Panchal N. Assessment of Awareness of Mothers about Janani Shishu Suraksha Karyakram (JSSK) in Urban Vadodara, Gujarat, India. Int J Curr Res Acad Rev 2018;6:52-62.  Back to cited text no. 5
    
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7.
Chatterjee S, Das D, Singh R, Basu A, Chakraborty A, Ghosh P. Awareness about Janani Shishu Suraksha Karyakram (JSSK) among pregnant mothers – A community based study in a rural area of West Bengal, India. IOSR J Dent Med Sci 2015;14:1-57.  Back to cited text no. 7
    
8.
Park K, editor. Park's Textbook of Preventive and Social Medicine. 23rd ed. Published February 2011 by Banarsidas Bhanot Publishers ( first published July 1970) ISBN-8190607995 (ISBN13: 9788190607995).  Back to cited text no. 8
    
9.
Barua K, Baruah R, Ojah J, Saikia AM. Factors influencing the utilization of free delivery care under Janani Shishu Suraksha Karyakram in Kamrup district, Assam, India. Int J Community Med Public Health 2017;3:1665 71.  Back to cited text no. 9
    
10.
Mitra S, Haldar D, Sarkar AP, Biswas D, Sarkar GN. Evaluation of Janani Sishu Suraksha Karyakram in a community development block of Bankura District, West Bengal, India: A mixed methods approach. Indian J Community Health 2016;28:344-51.  Back to cited text no. 10
    
11.
Chandrakar A, Panda PS, Soni GP, Dixit S. Awareness regarding Janani Shishu Suraksha Karyakram (JSSK) among mothers: A community based cross sectional study in rural area of Raipur district, Chhattisgarh. Int J Res Med Sci 2017;5:4374-9.  Back to cited text no. 11
    
12.
Deshpande S, Gadappa S, Pagare S, Dhaduti R, Andurkar S. Awareness regarding Janani Shishu Suraksha Karyakram among pregnant women of Marathwada, Maharashtra, India. Int J Reprod Contracept Obstet Gynecol 2017;5:1985-91.  Back to cited text no. 12
    
13.
Tyagi U, Pattabi K, Kaur P. Utilization of services under Janani Shishu Suraksha Karyakram for institutional deliveries in the public sector facilities, Sirmaur district, Himachal Pradesh, India. Indian J Community Med 2016;41:65-8.  Back to cited text no. 13
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14.
Gupta MB, Gupta AK, Mazta SR. A study on level of satisfaction among beneficiaries under Janani Shishu Suraksha Karyakaram (JSSK) at regional hospital Nahan (HP). Int J Soc Sci 2016;5:55.  Back to cited text no. 14
    
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Kirti Sundar S. Out of Pocket Health Expenditure in Maternal and Neonatal Health and Coping Strategies in Urban Slums of Bhubaneswar, Odisha (Doctoral Dissertation, SCTIMST); 2014..  Back to cited text no. 15
    
16.
Khadse S, Kartikeyan S, Zade R. Awareness of Janani Shishu Suraksha Karyakram and out-of pocket expenses incurred for intra-partum and post-partum care in a tertiary care health facility – A pilot study. Int J Sci Res 2018;7. DOI: 10.15373/22778179.  Back to cited text no. 16
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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