A Study on Experiences of Mothers and Service providers under JSY/ NRHM At Saikawt & Henglep TD Blocks In Churachandpur Dist. Manipur Research Team  T. Zamngam  Dawnga Khiangte  Mis. Vahcha  Ms. Cheenny (Zougam Institute for Community Resource Development – Manipur) Authors  Peter Z. Hangmi  T.Zamngam

Background/Context (Socio-geo-politico) C C Pur Henglep Saikawt Henglep : Rural, Remote & Mountainous Saikawt : Small town close to district head quarter.

Background  Geographical boundaries Saikawt (Block A)& Henglep (Block B) in Churachandpur Dist, Manipur  Time boundaries Mothers who delivered during the last six months preceding this study (Jan–June, 08)  Stakeholders Women :Saikawt 20, Henglep – 20 ASHA : Saikawt – 10, Henglep – 3 ANM : 1 each Doctor : 1 each DFWO, DMO, VA for secondary Data

Looking at the two blocks Saikawt PHC Henglep PHC Joyous ride From Henglep to Dist. Hqtr. No labour room in both PHC

Research Objectives  Awareness level of mothers about JSY  Health Service providers view about JSY.  Factors that determine women choosing Home Delivery (H.D)  Suggestions for improving the implementation of JSY.

Methods:  Sampling From Each TD Block  Random selection of vulnerable villages 10 each  1 ID & 1 HD each from each village selected  13 ASHAs randomly from the selected villages  One ANM from Sub-centre  Doctor each from the two PHC  Methods of data collection (Tools used)  Indepth interview to Mothers (for Primary Data)  Survey from ASHA, ANM & Doctors, DMO, DFWO, Statistics Office (for Secondary Data)  FGD (Mothers & ASHA for Primary Data)

From CHSJ:  Short time period, Limited Finance resource, Little guideline on the subject From Authority concern:  Less cooperation from concerned authority. DMO.DFWO and State H&FWO. Limitations

Results/Findings SNo.Questions BLOCK A(n = 20)B(n = 20) 1Registerd by ASHA.100%0% 2Inst.identified before del.85%40% 3Pvt. transportation availed100%0% 4Receive TA0% 5Receive full ANC from Govt. inst. 100%0% From pvt. Inst. 0%95% 6ASHA visited95%0% 7ANM visited90%0 8TT and Iron Tablets. From govt. inst. 100%0% From private 0%100% Maternal Care Block A – Saikawt PHC Block B – Henglep PHC

SNQuestions BLOCK A n = 20 B n = 20 1Know about JSY and its benefits.90%45% 2Source (ASHA)100%5% 3Do you get any JSY benefit?10%0% 4Amount in Rupees (700)10%0 5Service charged (Providers)0%5% pvt. 6Service charge to Village Dai.065% 7Have JSY Card.0% 8Home delivery20%65% 9Institutional delivery80%35% Awareness & Benefits of JSY Scheme

Why did not deliver at govt. facility? Sl. Reasons BLOCK A n = 20 B n = 20 1Couldn’t afford facility*50%60% 2No JSY benefit even if in inst. 65%5% 3Distance Location (02 – 100 kms) 60%80% 4Concept of interference to staffs. 5%25% * No medicine supply in govt. institutions.

Q.No. Questions ASHA n = 13 1 What is your age? 20 – 29 years38% 30 and older62% 2 When were you appointed/elected as ASHA? % 38% 8% What was the process? (All names are proposed by village chief) Appointed by village chief, no election. 54% Elected among many nominees 46% Selection of ASHA

Q.No QuestionsASHA n = 13 1Have undergone trainings.100% 2Times of training undergone (2 full days each time) (Training medium in Manipuri, not understood by Many ASHAs.) 1 time23% 2 times16% Above 3 times 62% 3TA/DA during your training days.100% Trainings

ASHA n = 13 SN Questions 1 Participate in Pulse Polio program. 92% 2Give Health Education in village. 31% 3Organize VH Day0% 4Counsel pregnant women100% 5Accompany women38% 6Have VHSC in your village.77% 7Attend the VHSC meeting77% 8Get help from ANM.100% 9Women get TT Iron tablets.100% Roles and Responsibilities

ASHA n = 13 Q.NoQuestions 1Village received Untied Fund.85% 2Receive incentives/compensation under JSY Scheme. 0% 4The women you registered getting JSY payment. 8% How many women?3Amount Normal2Rs. 700 CS case1Rs. 700 Incentives/Compensation

Unheard Voices  Mothers : “Poorly treated in govt. hospital. No medicine supplies, expensive. No JSY Benefit as told”.  ASHAs & ANM : “Mothers don’t trust us any more. Only 3 out of all 40 women received money”.  Doctors: “Funds disbursed only at district H/Q. Women are waiting their turn, serial number published in local newspapers. So we are helpless”.

Conclusions  Implementation of JSY Block “A” avails a better facility of the scheme. Block “B” far and remote, mountanous area, inaccessible to the scheme.  However, JSY incentives/compensation has not been given neither in town nor remote areas.  Thus, No improvement in institutional delivery according to the findings.  Most serious challenge to inst. Del. in both blocks Poor treatment by staffs in govt. facility Lack of prompt payment of JSY payments.

Recomendations  Comment: To Improve fund flow system district level, state level and national level. To provide more systematic transportation referral To strength Private Public partnership system (PPP)  One big Suggestion : To introduce SOCIAL SERVICE DEPARTMENT in medical institutions nation wide.  Social workers should be Licentiate by govt. Fully recognized and supported by Human Rights Commission of the country