1. ‘A Study of the implementation of the JSY Program in Himachal Pardesh.” By “ ankur” (HP) Researchers Manisha Sharma Deepak Kumar

2. Lay out of the Presentation JSY-The Program Objectives of the Study Study population Methodology Key findings Recommendations Limitations Conclusions

3. Janani Sureksha Yojna (Safe Motherhood Program –Launched in the year 1997, as a National Maternity Benefit Scheme (NMBS) with the aim to provide cash assistance to the women of BPL family during her last semester. This assistance was to improve her nutritional status. –Under this revised scheme certain cash benefit to the beneficries as well as to the motivator have been attached to promote institutional deliveries.

4. Main objectives of the study To know how the introduction of JSY Program in the last year have brought a change in the lives of the women who have delivered & in the health practitioner (Formal and informal) who have played a role in women assessing these health requirements. If not what are the constraints..

5. Geographical area of study Geographical Areas of Study-Himachal Pradesh, District UNA,

6. Our Focus Populations for Study.. 1.Women who have delivered in institutions between 2007-2008. 2.Women who have delivered at homes (registered in JSY) between 2007- 2008 3.Govt Health Providers (AWW/ ANMs/ Doctors) 4.Private Health Providers (Traditional Midwives/ Private Doctors)

7. Other 11 Districts District UNA Gagret BlockOther 4 Blocks Himachal Pradesh Others 5 PHCs Gagret PHC Doulat Pur PHC Sub- CenterTh aplan Sub-Center Ambota Sub Center Oel Sub-Center Kaloh Sub-Center Mawakohlan

8. Methodology for Study Survey of the women who have delivered during 2007-08 291 In depth interviews FGD-women who have delivered at home and in the institution. 6 Medical Officer1 Block Medical Officer5 Registered Medical Practitioners6 FGD-with Trained birth attendant.One with each group.6 Interviews ANM5

9. Key finding-Why women choose home over Institutions for the delivery. lack of confidence in health institutions. Lack of sensitivity of the institutions, anger expressed towards the antipathy of the system. Actual cost is more, costly medicine at emergency difficulty in accessing JSY incentives. No cure is available for obstetric emergency. Difficulty in accessing JSY money. Women do not decided the place of delivery.

10. Findings why women choose to deliver at facility Women from nuclear and migrant families. Women who go far sex selective deliveries-precious male child to be delivered. Women who had adverse experiences from TBA and ANM of delivering at home. Women get motivated by ANM.

11. Findings perception of the health functionaries Administration could not decide between ASHA and AWW. Doctors have limited knowledge of the JSY and its components. They agreed that health facilities lack emergency obstetric care services. Communication gap between beneficiaries and services providers. Services providers were also of the view that the process of getting incentives is cumbersome Most of the doctors have admitted that there knowledge of the JSY is limited to monitory benefits.. They agreed that health facilities lack emergency obstetric care services. Communication gap between beneficiaries and services providers. Services providers were also of the view that the process of getting incentives is cumbersome

12. Recommendations. Appoint ASHA to bridge the communication gap between beneficiaries and health facilities. Provide good quality obstetric care to build confidence among communities to use them for the maternal emergencies. If administration failed to post specialist in the FRU, Promote Public Private Partnership by accrediting doctors/ clinic/ nursing home to provide emergency obstetric care.. Provisions for regular and good quality capacity building program for AWW and ANM to make the system sensitive to women maternal needs. Appoint more women doctors particularly gynecologist in the government health system to motivate women for institutional deliveries.

13. Limitations of the study. The scope of the finding of this study is limited to the concentration of particular cast (SC/St) in the study areas.

14. Conclusion The JSY scheme has the potential to increase the proportion of institutional deliveries. In order to increase the effectiveness of the JSY cash incentive, we need to build the confidence of women in institutional deliveries by improving health infrastructure and quality of care.

15. Thank you