Objective="Promote institutional delivery and enhance immunisation coverage"
Details for Reform Option "Voucher scheme for institutional delivery and immunisation, Jharkhand"
One of the major concerns of the state Reproductive and Child Health (RCH) Programme, phase II, is the extremely low percentage of institutional deliveries. Among women living Below Poverty Line (BPL) and in remote villages the number of institutional deliveries is almost negligible.
In order to promote institutional delivery and to enhance routine immunisation coverage a voucher scheme titled Chief Minister’s Mother and Child Health Campaign was launched in the State. It was in line with Janani Suraksha Yojana (JSY), recommended by the Union Government under National Rural Health Mission (NRHM). This scheme was started in December 2005 in all the 22 districts of Jharkhand and is implemented through the Auxiliary Nurse Midwife (ANM), Anganwadi Worker (AWW) and Sahiyya, the village level link health worker.
Vouchers are issued to BPL pregnant women at the time of registration of pregnancy. These cover services for institutional delivery; the final and last instalment is given at the time of complete immunisation of the newborn.
Responsibility for registration of the pregnant women lies mainly with the AWW and Sahiyya as they are both based in the community. At the time of registration INR 100 is given to the pregnant woman in cash as a promotional incentive, and her thumb impression or signature is taken on a receipt by the AWW or Sahiyya. The BPL status of the woman is ascertained on the basis of the red ration card, issued by the revenue department; in the absence of this card, two senior persons of the village can certify the poverty status of the woman.
The registered pregnant woman is encouraged to go to the Sub Centre to receive 100 tablets of Iron and Folic Acid (IFA) and two doses of Tetanus Toxoid (TT). On her third visit to the health facility, which is around 8 weeks before the expected date of delivery, she is issued a voucher of INR 700. With this voucher she is entitled to have the delivery at any government facility or at an accredited private health facility. In case of caesarean section she will get INR 1500.
After the delivery, the woman is encouraged to visit the health facility or Anganwadi Centre for the immunisation of the new born. After complete immunisation schedule of one year (BCG, three doses of DPT, Polio and Measles) the woman is rewarded with a cash incentive of INR 300.
There are two more vouchers, one each for INR 100. These are issued to the AWW/Sahiyya and ANM after the process has been completed, beginning from registration of a pregnancy to complete immunisation of the newborn.
5% beneficiaries are monitored by the Block Medical Officer In Charge (MOIC) and 3% beneficiaries by the district’s Civil Surgeon (CS).
A complete list of private healthcare providers at block and district levels are provided to all ANMs for referrals.
As it is a new initiative in the State, its impact will be evaluated at least after six months.
This initiative is funded by both Union and State Governments.
All over the state.
Institutional delivery: ensure skilled attendance at birth and safe motherhood.
Public-private partnership: Private healthcare sector involvement is encouraged to deliver the services where resources are limited.
Routine immunisation coverage: Women are motivated to visit the health facilities and get complete immunisation for their infants.
Coordination: Scheme devises a mechanism for better coordination between ANM and AWW/Sahiyya.
Mobilising women: Due to illiteracy and ignorance it is difficult to mobilise women to visit health facilities for check-ups and delivery.
Monitoring: To monitor the management of the vouchers is a complex job for implementers.
Fund flow: Adequate flow of funds from the state for timely payment to the beneficiary to make scheme successful.
Commitment of State Government.
Effective team of service providers.
Effective management systems and procedures.
Who needs to be consulted
Private health facilities.
NGOs and faith-based organisations
State and Union government funded scheme.
Chances of Replication
Good and is already reflected in NRHM.
Maternal deaths are a serious concern for the nation. Devising a strategy, which is accepted and adopted by the community is difficult task, but even more difficult is the implementation, which is reflected by reduction in maternal mortality.
Dr. Anuradha Davey, Research Consultant, National Institute of Medical Statistics, May, 2006.