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Janani Suraksha Yojana Chiranjeevi Yojana & Balshakha Yojna

Janani Suraksha Yojana Chiranjeevi Yojana & Balshakha Yojna. Dr. A.M.Kadri Associate Professor Community Medicine. Status. Timing of maternal deaths- General Conditions. Time from onset of complication to death. PPH 2 hour APH 12 hour Ruptured uterus 1 day Eclampsia 2 days

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Janani Suraksha Yojana Chiranjeevi Yojana & Balshakha Yojna

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  1. Janani Suraksha YojanaChiranjeevi Yojana &Balshakha Yojna Dr. A.M.Kadri Associate Professor Community Medicine

  2. Status

  3. Timing of maternal deaths-General Conditions

  4. Time from onset of complication to death • PPH 2 hour • APH 12 hour • Ruptured uterus 1 day • Eclampsia 2 days • Obstructed labor 1 day • Sepsis 6 days

  5. Maternal Mortality: UK 1840–1960 Improvements in nutrition, sanitation Antibiotics, banked blood, surgical improvements Antenatal care Maine 1999.

  6. Three Delays Responsible for Maternal Deaths • Delay in deciding to seek care (Individual & family) • Lack of understanding of complications • Gender issues, Low status of women • Socio-cultural barriers to seeking care • Poor economic conditions of the family • Delay in reaching care ( Community & System) • Lack or underutilization of transport funds • Non availability of referral transport in remote places • Lack of communication network • Delay in receiving care (System) • Poor facilities, personnel and Supplies • Poorly trained personnel with indifferent attitude

  7. Goals of National Population policy – • Reduce MMR to less than 100 per 100000 livebirths by the year 2010. • Increase proportion of institutional deliveries to 80% by 2010. • Interventions to increase institutional deliveries • JSY • Chiranjeevi yojana • Proportion of Home delivery (47%) in Gujarat.

  8. Goals for different policies NRHM (By 2012) – 100/100000 livebirths. RCH II Goals – 150/100000 livebirths. National Population Policy 2000 (By 2012) - 100/100000 livebirths Millennium development Goals – Reduction by 3/4th by 2015.

  9. Janani Suraksha Yojana • Centrally sponsored scheme • Safe motherhood intervention under umbrella of National Rural Health Mission (NRHM). • Launched on 12th April, 2005. • Objective : • Reducing maternal and neonatal mortality by promoting institutional delivery among the poor pregnant women.

  10. Implementation of JSY • All the states are divided in two categories. • Low Performing states ( LPS) (10) • Accredited social health activitist (ASHA) is the link between government and poor preganant women. • High Performing states (HPS) (Gujarat is one of them). • AWW and/ or TBA can act as link.

  11. Activities under JSY • Role of ASHA or other link worker • Identification of beneficiary, Provision of at least three ANC check ups including TT, IFA tablets. • Identification of Institute (Private or government). • Counselling for institutional delivery. • Escorting the beneficiary women • Etc.

  12. Activities under JSY (Continued) • Tracking of each preganancy – • Beneficary should have a JSY card. • Eligibility for Cash Assistance : • LPS – All preganant women delivering in govt. or accredited private hospital. • HPS – BPL, aged 19 years and above. • LPS & HPS- All SC and ST women delivering in govt. or accredited private hospital. • LPS- for all deliveries. • HPS – for first two births Dr. Hitesh M Shah

  13. Scale of Cash Assistance for Institutional delivery Rural area Urban area Note: Govt. is not responsible for cost for delivery in accredited private practitioner. Dr. Hitesh M Shah

  14. Subsidizing cost of LSCS or obstetric complications In Govt. set up – free of cost. If govt. specialist are not available – Rs. 1500/- per delivery for hiring specialist.

  15. Assistance for Home delivery In LPS and HPS- BPL, aged 19 years and above, preferring to deliver at home should receive a cash benefit of Rs. 500/- . This assistance is up to 2 live births.

  16. Chiranjeevi scheme • It is a state government scheme. • Objective : • To reduce maternal mortality ratio and Infant mortality rate. • To increase the institutional deliveries. • To involve the private practitioner to reduce MMR.

  17. Broad Issues • Non - availability of O & G specialists • Accessibility of services-Tribal and urban slums • Poor utilization of services- • Low felt need of health & medical services • Lack of user friendly & quality public health services • Costly private health and medical services • No health insurance coverage

  18. Chiranjeevi scheme Initiated in December 2005 as a pilot scheme in five backward districts (BK, SK, Dahod, panchmahal and Kutch) to all BPL families. Now it is implemented throughout state.

  19. Service Charges

  20. Service Charges

  21. Compensation of private practitioner – scheme II If private practitioner provides services in government set up – the package for 100 deliveries is Rs. 65900 (Rs. 659/ delivery).

  22. Bal Sakha Yojana Need & Rationale : High IMR : 50 /1000 LB to 30/1000 60% of them occurred during neonatal period. 2/3 of neonatal death during first week. Lack of pediatric doctors in Govt. Hosp Good network of Pvt Gynec & Pedia doctors. .

  23. Major features • Part – 1 : Care During first 48 hours of life • Part – 2 : Care for children up to 5 years • BPL children will be covered. • An MoU with Private Gynec & Pedia Doctors for 100 cases will be done. • Rs. 1,68,000 & Rs. 1,75,000 for part I & part II respectively • Money will be provided in advance. • Additional support of Rs. 25,000 for ventilator purchase on coverage of 500 children

  24. Major features • Part – 1 : Care During first 48 hours of life • Part – 2 : Care for children up to 1 year • BPL children will be covered. • MoU with Private Gynec & Pedia Doctors for 100 cases will be done. • Rs. 1,68,000 & Rs. 1,75,000 for part I & part II respectively • Money will be provided in advance. • Additional support of Rs. 25,000 for ventilator purchase on coverage of 500 children

  25. Major features – For Part : 1 • Cost is calculated based on the 100 cases. • For all cases Gynecologist has to keep mother for two days and provide PNC care. • Gynecologist has to ensure, BF in first half an hour of birth, Vit-K, 0 BCG & Polio & Kanagaru care • Affiliated Pediatric doctor has to visit newborn for two times in 48 hours • Based on the pattern it was presumed that out of 100 cases 20 will be required ENBC- 2 care & 5 will be required ENBC – 3 care. • ENBC- 2 care to be provided at affiliated doctor’s Hospitals & For ENBC – 3 cases to be referred to Tertiary Care hospital.

  26. Major features – For Part : 2 • Cost is calculated based on the 100 cases. • Consultation charges for all the case is considered. • Out of 100 cost for hospitalization is calculated for 25 case based on the scientific evidences. • Referral rate to tertiary care is considered 5% and for such cases additional Transport support is created.

  27. Calculation of the Cost – Part : 1 * In the case of absence of 108 services only. To be paid by doctors

  28. Calculation of the Cost – Part : 2 * In the case of absence of 108 services only. To be paid by doctors

  29. Thank you

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