How is Janani Suraksha Yojana performing in backward districts of India? - Part 2
By Ambrish Dongre, Avani Kapur, 19 Feb 2013

As mentioned previously, this blog post discusses the findings from the PAHELI survey with respect to the JSY.

1. Institutional and home deliveries

Out of 3178 deliveries, 48% deliveries took place in government facilities, 9.5% in private facilities, and 42.5% deliveries took place at home (table 1A)[1]. The proportion of deliveries in government facilities is highest in Sundargarh and Rajgarh, followed by Udaipur. Korba, Gumla and Hardoi perform the worst.

There has been a substantial decline in the proportion of home deliveries as compared to District Level Household Survey (DLHS) III, which is the latest available household-level data on maternal health[2]. Yet, the proportion remains quite high.

2. Receipt of cash benefits

As per the scheme guidelines, all women delivering in government medical facilities are entitled to the monetary incentives. However, only women from BPL families can avail of the benefits in case of deliveries in accredited private facilities or at home in the presence of skilled personnel.

The data indicates that 94.5% of women delivering in government facilities receive monetary compensation. In fact, this proportion is above 90% in all eight districts, with Udaipur (98%) and Sundargarh (97.5%) performing the best (table 1A). But only 11% of women on average delivering at home report receiving money. Rajgarh (31%) and Sundargarh (25%) have the highest proportion of women getting benefits after a home delivery.

3. Location of receipt of benefit in case of deliveries in government facilities

Payment to JSY beneficiaries should be paid at the institution itself. As per our data, 95% of the beneficiaries report that payment was indeed made at the institution (table 1B). With the exception of Sundargarh, the proportion is more than 91% in rest of the districts.

4. Mode of Payment

As per the JSY guidelines, payment is to be given through account payee cheques. 86% of the beneficiaries delivering in government facilities report receiving payment through cheques (table 1B). The proportion was highest in Hardoi (97%) and lowest in Bhilwara (76%). The proportion of beneficiaries receiving payment through cheques was lower in the case of private facilities (72%) and even lower (35%) in the case of home deliveries.

5. Payment in Installments

JSY guidelines explicitly say that the payment to the beneficiary should be made in one installment. The data indicates that in the case of deliveries in government facilities, 89% of the JSY beneficiaries received payment in one installment (table 1B). This proportion varies from 96% of beneficiaries in Sundargarh to 79% in Gumla.

6. Amount Received

Women delivering in government medical facilities receive payments as per the norm, an average of Rs. 1451, while the median amount is Rs. 1400 (table 1B). Average payment amounts are above Rs. 1500 in Gumla, Korba and Udaipur, and below Rs. 1400 in Sundargarh, Hardoi and Rajgarh.

Women delivering at home receive Rs. 859.47 on an average, while women delivering in private facilities receive Rs. 1504.39[3].  

7. Delays in receiving compensation

60% of beneficiaries who deliver in government facilities report receipt of benefits within seven days, while 71% report receiving benefits within two weeks (table 1A). Udaipur performs the best, with 93% of the beneficiaries reporting receipt of benefits within two weeks. Gumla performs the worst on this indicator, with only 24% beneficiaries receiving benefits within two weeks.

Overall, the median days to receive benefits in case of delivery in government facilities is four, while the mean number of days is ten[4]. On an average, beneficiaries in Udaipur, Sundargarh and Rajgarh can expect to receive their benefits within a week, while those in Gumla might have to wait up to a month.

In case of delivery in private facilities, beneficiaries reported receiving money, on an average, ten days after delivery. The delays seem to be even higher for payment in case of home deliveries: on average, 23 days after the delivery (table 1B)[5].

8. Payment of bribes to receive JSY benefits

Only 6% of the beneficiaries who delivered in government facilities reported that they had had to pay bribes to receive the money (table 1B). Bhilwara (1%), Gumla (2%) and Sundargarh (4%) are the best performers, while Rajgarh is the worst performer with 13% of the beneficiaries reporting that they had to pay a bribe.

9. Other problems

But having to pay a bribe is not the only problem beneficiaries might have to face. When one takes into account other problems (such as, distance to the health facility, paper work, inconvenient timings, behaviour of health workers), the proportion rises. Data indicates that 18% of the beneficiaries in case of deliveries in government facilities reported facing one or more of these problems (table 1B). The proportion was lowest in Sundargarh (8%) and Bhilwara (9%), and highest in Hardoi (31%) and Gumla (28%).

The corresponding fractions are 27% in case of delivery in private health facilities and 29% in case of home deliveries.

The above discussion suggests that JSY is working reasonably well as far as some of the important process-related indicators are concerned. But there is scope for improvement, especially when it comes to delays in transferring benefits, payment of bribes and other problems faced in receiving the benefits.

In Part III, we’ll look at indicators related to the performance of ASHAs.

TABLE 1A: JSY-related indicators

 

Location of delivering the baby

RJ

JH

UP

CH

BH

MP

OR

Overall

Udai-  pur

Bhil-wara

Gumla

Hardoi

Korba

Nal-anda

Raj-garh

Sundar-garh

Sample size (households) 

1120

1334

1190

1180

1176

1065

1178

1162

9405

% of women delivering the baby

Home

33.33

46.05

58.37

55.38

65.81

28.37

21.91

24.31

42.54

Government Facility

61.35

43.05

35.90

37.00

22.88

51.06

69.77

70.49

47.99

Private Facility

5.31

10.90

5.73

7.62

11.31

20.57

8.31

5.21

9.47

No. of Respondents

414

367

454

446

389

423

397

288

3178

Home
(DLHS III)

67.30

66.10

90.80

90.00

90.80

65.40

54.10

66.00

 

% of home deliveries in the presence of skilled personnel (dai/ doctor) 

82.26

60.78

82.19

64.56

65.22

74.75

38.89

58.33

68.78

% of Women receiving money

Home

5.69

5.07

13.30

2.83

13.81

14.00

30.77

25.00

11.34

Government Facility

98.02

92.41

90.12

93.33

92.05

93.02

95.62

97.50

94.52

Private Facility

14.29

27.78

50.00

13.79

47.73

9.46

38.46

21.43

25.94

No. of Respondents

397

332

402

406

371

389

365

274

2936

% of JSY beneficiaries receiving incentives after delivery in government facility

7 days post-delivery

89.36

78.17

19.12

35.33

37.97

43.01

67.78

78.57

60.42

 

14 days post-
delivery

 

92.77

84.51

24.26

51.33

50.63

55.38

84.94

89.01

70.87

 

Variable

Government Institutions

Govt.

Private

Home

RJ 

JH 

UP 

CH 

BH 

MP 

OR 

Overall (sample average)

Udai-pur 

Bhil-wara 

Gumla 

Hardoi 

Korba 

Nalanda 

Raj-garh 

Sundar-garh 

% of beneficiaries receiving money at the institution 

99.19 

93.06 

91.85 

96.1

93.59

96.48

98.05

85.8

94.89

90.16

55.34

% of beneficiaries receiving money through cheque

88.07

76.22

81.43

96.71

85

80.51

90.7

85.08

85.99

71.67

35.35

% of beneficiaries receiving money in one installment

93.06

93.01

78.87

93.51

82.5

92.93

82.31

95.56

89.37

90.16

55.34

Mean amount of benefits received (Rs.)

1532.22

1458.86

1571.43

1388.82

1553.12

1403.52

1399.61

1381.28

1451.25

1504.39

859.47

Mean & (Median) no. of days post-delivery to receive money

4.25 
(3)

7.13 
(3)

29.07 
(25)

14.61 
(10)

14.09
(11)

14.67 (10)

6.10 
(3)

4.79 
(2)

10.43 
(4)

10.1 
(5)

23.42

(15)

% of beneficiaries reporting payment of bribe to receive money

4.56

1.49

2.19

7.95

5.19

8.63

12.6

3.57

6.4

0.0

5.56

 

[1] Proportion of home deliveries that we find is substantially higher than 19% as reported by the MIS of NRHM.

[2] Respondents in DLHS III are woman who had given birth to a child after January 1, 2004 onward (IIPS, 2010).

[3] We don’t discuss here the possible reasons for average amount received being higher than the norm.

[4] Median numbers of days are indicated in brackets.

[5] The number of respondents in case of delivery in private facilities and home deliveries are relatively less and hence, these numbers should not be treated as representative.