Lok Sabha Question No. 1483 (UNSTARRED), answered on 2016-03-04
Subject: Janani Suraksha Yojana
Ministry: HEALTH AND FAMILY WELFARE
Asked by: SRINIVAS KESINENI, RAMCHARAN BOHARA, P. C. MOHAN

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTIO N NO. 1483 TO BE ANSWERED ON 4 TH MARCH, 2016

## JANANI SURAKSHA YOJA NA

## 1483. SHRI KESINENI NANI: SHRI RAM CHARAN BOHRA: SHRI P.C. MOHAN:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a)  the  number  of  beneficiaries  under  the  Janani  Suraksha  Yojana  (JSY)  in  the  cou State/UT - wise;
- (b)  the details  of  the  services  provided  under  the  JSY  along  with  the  cost  of  service beneficiary under the JSY;
- (c) the mechanism put in place by the Government to ensure that the quality of services un JSY is maintained;
- (d) whether there has be en an increase in the number of institutional deliveries after the lau Janani Suraksha Yojana; and
- (e) whether any study has been conducted by the Government to show the positive impact of on maternal health and child health, if so, the details thereof along with the steps taken/ being taken by the Government to strengthen the JSY?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI JAGAT PRAKASH NADDA)

- (a) : The  number  of  beneficiaries  reported  under  the  Janani  Suraksha  Yojana (JSY)  in  the country, State/UT - wise and year -wise is at Annexure .
- (b) : The Janani  Suraksha  Yojana  provides  conditional  cash  assistance  to  eligible  preg women for giving birth in government or accredited private health facility. In Low Performing States (LPS) i.e. the states of Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya P Chhattisgarh, Assam, Rajasthan, Odisha, and Jammu & Kashmir, all pregnant women regardles of any age and any number of children are entitled for JSY benefit for i nstitutional delivery. However, in the remaining High Performing States/UTs (HPS), pregnant women only from BPL, SC & ST householdsof any age and any number of children are entitled forJSY benefit for

institutional  delivery. The scheme  also  provides  performance  based  incentives  to  Accredited Social Health Activists (ASHAs) for promoting institutional delivery among pregnant women.

BPL pregnant women, who prefer to deliver at home, are also entitled to a cash assi of Rs 500 per delivery regardless of the age of pregnant and any number of children.

## Scale of Cash Assistance under JSY

Cash entitlement for different categories of mothers is as follows:

| Category of State/UT   | Rural area             | Rural area             | Urban area             | Urban area             |
|------------------------|------------------------|------------------------|------------------------|------------------------|
| Category of State/UT   | Mother's incentive     | ASHA's package*        | Mother's incentive     | ASHA's package**       |
| Institutional Delivery | Institutional Delivery | Institutional Delivery | Institutional Delivery | Institutional Delivery |
| LPS                    | Rs.1400                | Rs. 600                | Rs.1000                | Rs. 400                |
| HPS                    | Rs. 700                | Rs. 600                | Rs. 600                | Rs. 400                |
| Home Delivery          | Home Delivery          | Home Delivery          | Home Delivery          | Home Delivery          |
| LPS                    | Rs.500                 | Nil                    | Rs.500                 | Nil                    |
| HPS                    | Rs.500                 | Nil                    | Rs.500                 | Nil                    |

In Low Performing States, the cost of JSY services for institutional delivery is R per  beneficiary  in  rural  areas  and  Rs.  1400  per  beneficiary  in  urban  areas  if  the  de f acilitated by ASHA.

In High Performing States, the cost of JSY services for institutional delivery is per  beneficiary  in  rural  areas  and  Rs.  1000  per  beneficiary  in  urban  areas,  if  the  d facilitated by ASHA.

The cost of JSY services for home delivery is Rs. 500 per beneficiary in rural as well a in urban areas of both the Low Performing and High Performing States.

Contd………

- (c) : Following steps have been taken by the Government to maintain the quality of serv under the JSY:
- 1) Capacity building of MBBS doctors in Anesthesia (LSAS) and Obstetric Care includin C - section  (EmOC)  skills  to  overcome  the  shortage  of  specialists  in  these  discip particularly in rural areas.
- 2) Capacity buildings of Staff Nurses & Auxiliary & Nu rsing Midwives (ANMs) in Skilled Birth Attendant (SBA) and DAKSHATA programme to equip them for managing normal deliveries, identify complications, do basic management and then refer at the earl higher facilities.
- 3) Establishing  Maternal  and  Child  Hea lth  (MCH)  Wings  at  high  caseload  facilities  to improve the quality of care provided to mothers and children
- 4) Setting  up  of  Skill  Labs  to  strengthen  the  quality  of  training  for  different programs;
- a) Promotion  of  use  of  printed  protocols  for  skilled birth  attendance,  quality  assurance guidelines and checklists for different level of facilities.
- b) Infection  Management  and  Environment  Protection  (IMEP)  guidelines  for  biomedical waste management in public health facilities.
- c) Kayakalp awards have been instit uted to promote cleanliness and hygiene in public health facilities.
- d) Maternal Death Review (MDR) is being implemented across all the states to identify gaps and suggest  programmatic changes .
- (d): Yes, after the launch of Janani Suraksha Yojana, the number of institutional deliveries have increased from 47% (District Level Household Survey -III, 2007 - 08)  to 74.4% (Sample Registration Sys tem- 2013).
- (e): The Ministry of Health and Family Welfare had commissioned an independent evaluation of  the Janani  Suraksha  Yojana  (JSY)  by  an  expert  group led  by  National  Health  Systems Resource  Centre  (NHSRC)  in  the  eight  high - focus  states  of  Bihar,  Chhattisgarh,  Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand, which together accou nt for 84.3% and 66% of India's maternal mortality and infant mortality respectively.

The findings of the evaluation show that JSY has undoubtedly increased the number institutional  deliveries  and  enabled  poor  women  to  access  public  health  facilities. The  study further noted that with the JSY a beginning to address maternal mortality has been made.

The above findings of the NHSRC study  are also reflected in the following:

- Increase in institutional deliveries which have gone up from 47% (District Level Hou ehold Survey - III, 2007 - 08) to 78.7% (RSOC,2013 - 14);
- Maternal  Mortality  Ratio  (MMR),  declined  from  254  maternal  deaths  per  1,00,000  liv births in 2004 - 06 to 167 maternal deaths per 1,00,000 live births during 2011 - 13;
- Infant Mortality Rate (IMR), has declined from 58 per 1000 live births in 2005 to 40 per 1000 live births in 2013;

Contd…..

- The Neo-Natal Mortality Rate (NMR) has declined from 37 per 1000 live births in 2006 28 per 1000 live births in 2013.

The steps taken/being taken by the Government to strengthen the delivery care services under JSY are as under:

- 1) Exclusion criteria of age of mother as 19 years or above and upto two children on home  and  institutional  deliveries  under  the  JSY  have  been  removed  and  now  eligi mothers are entitled to JSY benefit regardless of any age and any number of children
- 2) States  are  encouraged  to  accredit  private  health  facilities  for  increasing  the delivery care institutions;
- 3) Hiring of specialists to conduct C - section and management of obstetric complications on market rates in public health facilities wherein government specialists are not in p
- 4) Difficult area/hardship allowance to hire/retain services of specialists/ officer/staff nurses etc.
- 5) User  fees  for  mothers  and  ne wborns  have  been  completely  waived  off  and  under  the Janani  Shishu  Suraksha  Karyakram,  pregnant  women  and  newborns  accessing  public health are entitled for free drugs, free diagnostics, free referral transport and fr
- 6) Operationalization of sub - centr es, Primary Health Centres, Community Health Centres and  District  Hospitals  for  providing  24x7  basic  and  comprehensive  obstetric services.
- 7) Capacity building of MBBS doctors in Anesthesia (LSAS) and Obstetric Care includin C - section  (EmOC)  skills  to  o vercome  the  shortage  of  specialists  in  these  disciplines particularly in rural areas.
- 8) Capacity buildings of Staff Nurses & Auxiliary & Nursing Midwives (ANMs) in Skille Birth Attendant (SBA) and DAKSHATA programme to equip them for managing normal delive ries, identify complications, do basic management and then refer at the earli higher facilities.
- 9) Setting  up  of  Skill  Labs  to  strengthen  the  quality  of  training  for  different programs;
10. 10)Funds  for  infrastructure  strengthening  such  as e tablishing  Maternal  and  Child  Health (MCH)  Wings  at  high  caseload  facilities  to  improve  the  quality  of  care  provide mothers and children and Human Resources as per states' requirement through NHM.

…………….

| Number of JSY Beneficiaries            | Number of JSY Beneficiaries            | Number of JSY Beneficiaries            | Number of JSY Beneficiaries            | Number of JSY Beneficiaries            | Number of JSY Beneficiaries            | Number of JSY Beneficiaries            | Number of JSY Beneficiaries            | Number of JSY Beneficiaries            | Number of JSY Beneficiaries            | Number of JSY Beneficiaries            | Number of JSY Beneficiaries            | Number of JSY Beneficiaries            | Annexure                               |
|----------------------------------------|----------------------------------------|----------------------------------------|----------------------------------------|----------------------------------------|----------------------------------------|----------------------------------------|----------------------------------------|----------------------------------------|----------------------------------------|----------------------------------------|----------------------------------------|----------------------------------------|----------------------------------------|
|                                        | States/UTs                             | 2005-06                                | 2006-07                                | 2007-08                                | 2008-09                                | 2009-10                                | 2010-11                                | 2011-2012                              | 2012-13                                | 2013-14                                | 2014-15                                | 2015-16*                               | Total                                  |
| A. Low Performing States               | A. Low Performing States               | A. Low Performing States               | A. Low Performing States               | A. Low Performing States               | A. Low Performing States               | A. Low Performing States               | A. Low Performing States               | A. Low Performing States               | A. Low Performing States               | A. Low Performing States               | A. Low Performing States               | A. Low Performing States               | A. Low Performing States               |
| 1                                      | Assam                                  | 17523                                  | 190334                                 | 304741                                 | 327894                                 | 366433                                 | 389906                                 | 412559                                 | 421359                                 | 451748                                 | 448143                                 | 310915                                 | 3641555                                |
| 2                                      | Bihar                                  | 0                                      | 89839                                  | 838481                                 | 1144000                                | 1246566                                | 1399453                                | 1432439                                | 1829916                                | 1695843                                | 153102 0                               | 1079773                                | 12287330                               |
| 3                                      | Chhattisgarh                           | 3190                                   | 76667                                  | 175978                                 | 225612                                 | 249488                                 | 303076                                 | 334098                                 | 277653                                 | 290276                                 | 321762                                 | 246545                                 | 2504345                                |
| 4                                      | Jharkhand                              | 0                                      | 123910                                 | 251867                                 | 268661                                 | 215617                                 | 386354                                 | 559507                                 | 282169                                 | 283562                                 | 249455                                 | 176253                                 | 2797355                                |
| 5                                      | Jammu & Kashmir                        | 2134                                   | 13127                                  | 10568                                  | 7771                                   | 91887                                  | 112210                                 | 132645                                 | 127041                                 | 143129                                 | 116642                                 | 77074                                  | 834228                                 |
| 6                                      | Madhya Pradesh                         | 68252                                  | 401184                                 | 1115841                                | 1152115                                | 1123729                                | 1155915                                | 1085729                                | 979822                                 | 1010824                                | 942644                                 | 686746                                 | 9722801                                |
| 7                                      | Odisha                                 | 26407                                  | 227204                                 | 490657                                 | 506879                                 | 587158                                 | 533372                                 | 634468                                 | 547648                                 | 530089                                 | 498046                                 | 328067                                 | 4909995                                |
| 8                                      | Rajasthan                              | 10085                                  | 317484                                 | 774877                                 | 941145                                 | 978615                                 | 986508                                 | 1008490                                | 1072623                                | 1106262                                | 109001 2                               | 799658                                 | 9085759                                |
| 9                                      | Uttar Pradesh                          | 12127                                  | 168613                                 | 797505                                 | 1548598                                | 2082285                                | 2341353                                | 2327830                                | 2186401                                | 2388204                                | 232501 0                               | 1680602                                | 17858528                               |
| 10                                     | Uttrakhand                             | 1360                                   | 23873                                  | 69679                                  | 71285                                  | 79460                                  | 79925                                  | 87937                                  | 89506                                  | 95344                                  | 100261                                 | 74309                                  | 772939                                 |
|                                        | Sub Total                              | 141078                                 | 1632235                                | 4830194                                | 6193960                                | 7021238                                | 7688072                                | 8015702                                | 7814138                                | 7995281                                | 762299 5                               | 5459942                                | 64414835                               |
| B. High Performing States (Big States) | B. High Performing States (Big States) | B. High Performing States (Big States) | B. High Performing States (Big States) | B. High Performing States (Big States) | B. High Performing States (Big States) | B. High Performing States (Big States) | B. High Performing States (Big States) | B. High Performing States (Big States) | B. High Performing States (Big States) | B. High Performing States (Big States) | B. High Performing States (Big States) | B. High Performing States (Big States) | B. High Performing States (Big States) |
| 11                                     | Andhra Pradesh                         | 167000                                 | 429000                                 | 563401                                 | 551206                                 | 318927                                 | 254890                                 | 261860                                 | 341041                                 | 383135                                 | 261558                                 | 201370                                 | 3733388                                |
| 12                                     | Goa                                    | 57                                     | 483                                    | 898                                    | 688                                    | 650                                    | 1352                                   | 1673                                   | 1387                                   | 1100                                   | 828                                    | 802                                    | 9918                                   |
| 13                                     | Gujarat                                | 0                                      | 121153                                 | 185956                                 | 213391                                 | 356263                                 | 343600                                 | 342211                                 | 308880                                 | 253005                                 | 277433                                 | 177444                                 | 2579336                                |
| 14                                     | Haryana                                | 1825                                   | 23123                                  | 35441                                  | 0                                      | 63326                                  | 63171                                  | 66084                                  | 61902                                  | 44076                                  | 45742                                  | 13427                                  | 418117                                 |
| 15                                     | Himachal Pradesh                       | 1585                                   | 6303                                   | 10371                                  | 8215                                   | 16851                                  | 21806                                  | 21811                                  | 13626                                  | 15766                                  | 16182                                  | 11258                                  | 143774                                 |
| 16                                     | Karnataka                              | 50542                                  | 233147                                 | 283000                                 | 400349                                 | 475193                                 | 445997                                 | 454544                                 | 407611                                 | 383251                                 | 411423                                 | 307876                                 | 3852933                                |
| 17                                     | Kerala                                 | 0                                      | 56072                                  | 162050                                 | 136393                                 | 134974                                 | 103605                                 | 105205                                 | 116816                                 | 138527                                 | 114677                                 | 104439                                 | 1172758                                |
| 18                                     | Maharashtra                            | 5650                                   | 97390                                  | 375000                                 | 224375                                 | 347799                                 | 354108                                 | 302040                                 | 364039                                 | 403405                                 | 345761                                 | 246974                                 | 3066541                                |

| 19                              | Punjab                          | 11595                           | 16079                           | 9917                            | 67911                           | 97089                           | 155242                          | 109587                          | 79511                           | 96873                           | 103423                          | 56342                           | 803569                          |
|---------------------------------|---------------------------------|---------------------------------|---------------------------------|---------------------------------|---------------------------------|---------------------------------|---------------------------------|---------------------------------|---------------------------------|---------------------------------|---------------------------------|---------------------------------|---------------------------------|
| 20                              | Tamil Nadu                      | 321567                          | 288224                          | 229609                          | 386688                          | 389320                          | 359734                          | 340454                          | 358224                          | 457770                          | 470003                          | 344332                          | 3945925                         |
| 21                              | Telangana                       |                                 |                                 |                                 |                                 |                                 |                                 |                                 |                                 |                                 | 135652                          | 106509                          | 242161                          |
| 22                              | West Bengal                     | 31363                           | 224863                          | 572651                          | 748343                          | 724804                          | 781168                          | 787604                          | 659996                          | 363655                          | 491356                          | 401695                          | 5787498                         |
|                                 | Sub Total                       | 591184                          | 1495837                         | 2428294                         | 2737559                         | 2925196                         | 2884673                         | 2793073                         | 271303 3                        | 2540563                         | 267403 8                        | 1972468                         | 25755918                        |
| C. High Performing States (UTs) | C. High Performing States (UTs) | C. High Performing States (UTs) | C. High Performing States (UTs) | C. High Performing States (UTs) | C. High Performing States (UTs) | C. High Performing States (UTs) | C. High Performing States (UTs) | C. High Performing States (UTs) | C. High Performing States (UTs) | C. High Performing States (UTs) | C. High Performing States (UTs) | C. High Performing States (UTs) | C. High Performing States (UTs) |
| 23                              | A & N Islands                   | 314                             | 600                             | 354                             | 197                             | 498                             | 132                             | 386                             | 298                             | 366                             | 398                             | 329                             | 3872                            |
| 24                              | Chandigarh                      | 0                               | 14                              | 1215                            | 467                             | 199                             | 213                             | 536                             | 449                             | 899                             | 1713                            | 876                             | 6581                            |
| 25                              | D & N Haveli                    | 146                             | 76                              | 270                             | 157                             | 594                             | 1273                            | 1104                            | 786                             | 1203                            | 1241                            | 842                             | 7692                            |
| 26                              | Daman & Diu                     |                                 |                                 |                                 |                                 |                                 |                                 |                                 |                                 | 145                             | 107                             | 66                              | 318                             |
| 27                              | Delhi                           | 0                               | 242                             | 7238                            | 23829                           | 21564                           | 19441                           | 20145                           | 21722                           | 12096                           | 13723                           | 12065                           | 152065                          |
| 28                              | Lakshadweep                     | 114                             | 42                              | 200                             | 288                             | 899                             | 866                             | 643                             | 494                             | 992                             | 1000                            | 260                             | 5798                            |
| 29                              | Pondicherry                     | 379                             | 2284                            | 4389                            | 4807                            | 4932                            | 4680                            | 5236                            | 3728                            | 3754                            | 3527                            | 2218                            | 39934                           |
|                                 | Sub Total                       | 953                             | 3258                            | 13666                           | 29745                           | 28686                           | 26605                           | 28050                           | 27477                           | 19455                           | 21709                           | 16656                           | 216260                          |
| D. High Performing States (NE)  | D. High Performing States (NE)  | D. High Performing States (NE)  | D. High Performing States (NE)  | D. High Performing States (NE)  | D. High Performing States (NE)  | D. High Performing States (NE)  | D. High Performing States (NE)  | D. High Performing States (NE)  | D. High Performing States (NE)  | D. High Performing States (NE)  | D. High Performing States (NE)  | D. High Performing States (NE)  | D. High Performing States (NE)  |
| 30                              | Arunachal Pradesh               | 794                             | 1433                            | 7689                            | 10180                           | 10257                           | 9915                            | 12135                           | 12200                           | 11827                           | 12906                           | 10187                           | 99523                           |
| 31                              | Manipur                         | 0                               | 7602                            | 8664                            | 11096                           | 17375                           | 19903                           | 17173                           | 18145                           | 17064                           | 21667                           | 17385                           | 156074                          |
| 32                              | Meghalaya                       | 471                             | 4257                            | 1003                            | 5329                            | 14738                           | 16750                           | 18905                           | 21082                           | 20151                           | 43334                           | 21476                           | 167496                          |
| 33                              | Mizoram                         | 1056                            | 7462                            | 13371                           | 15482                           | 14265                           | 13953                           | 12326                           | 12057                           | 12871                           | 5605                            | 5571                            | 114019                          |
| 34                              | Nagaland                        | 0                               | 1301                            | 8457                            | 9790                            | 22728                           | 13291                           | 15863                           | 17609                           | 13390                           | 16430                           | 11877                           | 130736                          |
| 35                              | Sikkim                          | 1128                            | 1719                            | 1616                            | 3606                            | 3292                            | 3531                            | 3285                            | 2668                            | 2383                            | 2278                            | 1580                            | 27086                           |
| 36                              | Tripura                         | 2247                            | 3203                            | 15547                           | 20166                           | 20500                           | 20202                           | 20871                           | 18682                           | 15502                           | 17943                           | 13565                           | 168428                          |
|                                 | Sub Total                       | 5696                            | 26977                           | 56347                           | 75649                           | 103155                          | 97545                           | 100558                          | 102443                          | 93188                           | 120163                          | 81641                           | 863362                          |
|                                 | Grand Total                     | 738911                          | 3158307                         | 7328501                         | 9036913                         | 10078275                        | 10696895                        | 10937383                        | 106570 91                       | 1064848 7                       | 104389 05                       | 7530707                         | 91250375                        |

*For the period April -December 2015