Access and Utilisation of Janani Shishu Suraksha Karyakram Services: Identifying Solutions to Barriers Through Positive Deviance Model

Abstract

Due to pregnancy-related complications, 67,000 women die every year in India. Approximately 1,300 thousands infants die within 1 year of birth. Of these, 900,000 die within 4 weeks of birth; that is, two-thirds of the infant deaths. 75% die within the first week, most of them in the first 2 days. To reduce these death rates, the Government of India introduced a programme called Janani Shishu Suraksha Karyakram (JSSK). The main aim of this programme is to provide free transportation to pregnant women, infants and sick neonates to access public healthcare centres. With the launch of JSSK, institutional deliveries increased significantly; still, 25% of pregnant women hesitate to access these services. In this research article, the implementation of JSSK services in Chhattisgarh state has been studied. Only 40% of the people in Chhattisgarh are utilising JSSK services. This is a very low utilisation compared to the national utilisation. In this article, we describe the positive deviance (PD) model to develop access to JSSK services. In this model, focus group discussions (FGD) and in-depth interviews (IDI) were used to know about JSSK services. Additionally, we propose new methodologies and key changes that should be implemented with immediate effect in JSSK services. The primary objectives of this article are: (a) to identify best practices and evolve strategies to assure complete free services to all pregnant women and sick neonates accessing public health institute pocket expenditure; (b) to identify and disseminate the best implementation practices of service providers in terms of the decision making, planning, effective communication, effective monitoring, incentives (financial and non-financial incentives) and grievance redressal.