Determinants of utilization of services under MMJSSA scheme in Jharkhand ′Client Perspective′: A qualitative study in a low performing state of India

Abstract

Preventing maternal death associated with pregnancy and child birth is one of the greatest challenges for India. Approximately 55,000 women die in India due to pregnancy- and childbirth- related conditions each year. Increasing the coverage of maternal and newborn interventions is essential if Millennium Development Goals (MDG) 4 and 5 are to be reached. With a view to accelerate the reduction in maternal and neonatal mortality through institutional deliveries, Government of India initiated a scheme in 2005 called Janani Suraksha Yojna (JSY) under its National Rural Health Mission (NRHM). In Jharkhand the scheme is called the Mukhya Mantri Janani Shishu Swasthya Abhiyan (MMJSSA). This paper focuses on community perspectives, for indentifying key areas that require improvement for proper implementation of the MMJSSA in Jharkhand. Qualitative research method was used to collect data through in-depth interviews (IDIs) and focus group discussions (FGDs) in six districts of Jharkhand- Gumla, West Singhbhum, Koderma, Deoghar, Garhwa, and Ranchi. Total 300 IDIs (24 IDIs each from mother given birth at home and institution respectively; two IDIs each with members of Village Health and Sanitation Committees (VHSC) / Rogi Kalyan Samitis (RKS) from each district) and 24 FGDs (four FGDs were conducted from pools of husbands, mothers-in-law and fathers-in-law in each district) were conducted. Although people indicated willingness for institutional deliveries (generally perceived to be safe deliveries), several barriers emerged as critical obstacles. These included poor infrastructure, lack of quality of care, difficulties while availing incentives, corruption in disbursement of incentives, behavior of the healthcare personnel and lack of information about MMJSSA. Poor (and expensive) transport facilities and difficult terrain made geographical access difficult. The level of utilization of maternal healthcare among women in Jharkhand is low. There was an overwhelming demand for energizing sub-centers (including for deliveries) in order to increase access to maternal and child health services. Having second ANMs will go a long way in achieving this end. The MMJSSA scheme will thus have to re-invent itself within the overall framework of the NRHM.

Supply-Side Barriers to Maternity-Care in India: A Facility-Based Analysis

“…We attempted to address this by including district-level demographic factors in our final model, but many factors, such as distance to the facility and income are better studied at the individual rather than aggregate level. The supply side factors found to be significant may also interact with demand factors by altering patient perceptions of facility quality, which has been shown to drive demand for health services [32]. Finally, it is important to incorporate the quality of care, mainly the behavior of the providers such as doctors, nurses, and supporting staffs.…”

A qualitative study of factors impacting accessing of institutional delivery care in the context of India's cash incentive program

“…In the Ujjain district of Madhya Pradesh, the non-availability of transportation, and maternal perceptions that previous non-institutional deliveries were ‘easy’ were also associated with the non-use of the JSY (Sidney et al., 2012). In the state of Jharkhand, although some women were willing to opt for institutional delivery, several obstacles prevented uptake of the JSY cash incentive and institutional delivery care, such as poor infrastructure, poor quality of care, difficulties in accessing cash incentive, and corruption in disbursement of incentives (Rai et al., 2011). Varied perception of eligibility guidelines in different states, awareness of the program, the amount disbursed, documentation, delays in disbursement to beneficiaries and low or irregular financial incentives to ASHAs were reported as the operation barriers of the JSY (Zodpey and VK, 2014).…”

Factors influencing women’s preference for health facility deliveries in Jharkhand state, India: a cross sectional analysis

“…Few studies in India have explored women’s preferences for home, public or private health facility for delivery [ 20 ]. Some studies have explored determinants of utilization of facility delivery [ 19 , 31 , 32 ]. In India, traditionally medical attention is deemed unnecessary as delivery is believed to be a natural process [ 12 , 13 , 19 ] and an unassisted birth is considered a sign of courage [ 13 ].…”