SECRETARIES REVIEW MEETING SEPTEMBER 11, 2012

Janani Shishu Suraksha Karyakram (JSSK)

Dr Himanshu Bhushan, DC (MH)

OBJECTIVES

– Eliminating out-of-pocket expenses for families of pregnant women and sick newborns in government health facilities

– Reaching the unreached pregnant women (nearly 75 lakh a year who still deliver at home)

– Timely access to care for sick newborns

– Free and cashless delivery– Free C-section– Free drugs and consumables– Free diagnostics– Free provision of blood– Free diet during stay in health institutions

Up to 3 days for normal delivery 7 days for Caesarean sections

– Free transport Home to health institution Between health institutions in case of referral Drop back home after delivery

– Exemption from all kinds of user charges, including for seeking hospital care up to 6 weeks post delivery (for post natal complications)

– Free treatment at the public health institutions

– Free drugs and consumables

– Free diagnostics

– Free provision of blood– Free transport

Home to health institution Between health institutions in case of referral Drop back home after delivery

– Exemption from all kinds of user charges

All the 35 States /UTs have initiated implementation of the scheme

While Rs 1437 crores was approved under NRHM for the entitlements in 2011 -12 another 2103 crores have been sanctioned in 2012-13 for provision of free entitlements

JSSK reporting Status in 1st QTR, 2012-13

REPORTED (24 states) NOT REPORTED ( 11 States)Tamil Nadu Chhattisgarh

Odisha Andhra Pradesh Mizoram Maharashtra

Uttarakhand LakshadweepSikkim Puducherry M.P DelhiJ&K Daman & Diu

Haryana Nagaland Gujarat Arunachal Pradesh

Goa A&N islands

D&N Haveli KeralaChandigarhMeghalaya

UPJharkhand Rajasthan

Assam Manipur

Karnataka HP

West Bengal PunjabBihar

Tripura

JSSK – Status of Free Entitlements

Free entitlements to PW

>70% achievement Between 40% to 70% achievement

<40% achievement

Free Drugs

TN, Orissa, Uttarakhand, Sikkim, J&K, Haryana, Goa, D&N Haveli, Rajasthan and Assam

MP, Mizoram, Gujarat, HP, Chandigarh,

UP, Jharkhand Karnataka, WB, and Manipur

Free Diet

TN, Sikkim, D&N Haveli, Rajasthan and Assam

MP, Mizoram, J&K, Chandigarh, HP and West Bengal

UP, Jharkhand, Karnataka, Meghalaya, Uttarakhand, Haryana and Gujarat

Free Diagnostics

TN, Uttarakhand, Sikkim, J&K, D&N, Rajasthan and Assam and West Bengal

MP, Gujarat, Chandigarh and Himachal Pradesh

UP, Jharkhand, Karnataka, Meghalaya, Haryana

Note : *Q1 achievement is based on the JSSK reports received by MH division from the States for the 1st QTR. Achievements are against the estimated no of PW delivering in Public Health Institutions in Q1(2012-13)

JSSK – Status of Free EntitlementsFree entitlements to PW

>70% achievement Between 40% to 70% achievement

<40% achievement

Referral Transport to PW ( Home to Facility)

None of the 21 states have achievements > 70% of the PW

Jharkhand and Rajasthan, Karnataka and Uttarakhand achievement ranging between 40-50%

UP, Tamil Nadu, Orissa Karnataka, Meghalaya, Haryana, Gujarat and Assam achievement ranging between 10% to 30%

Referral Transport to PW ( Drop Back)

All the 21 states achievements on drop back is poor ranging between 10% to 30% of the expected achievements Note : *Q1 achievement is based on the JSSK reports received by MH division from the States for the 1st QTR. Achievements is against the estimated no of PW delivering in Public Health Institutions in Q1(2012-13)

JSSK – Status of Free EntitlementsFree entitlements to Sick –new-born

>70% achievement Between 40% to 70% achievement

<40% achievement

Free Drugs for sick- new-born

TN, Orissa, Sikkim, J&K, Rajasthan and Karnataka have achievements > 70% of the estimated sick-new-born

Mizoram, Uttarakhand, Haryana, Gujarat, Jharkhand, Assam have achievements less than 40%

MP, UP, Manipur have not shared the data

Free Diagnostics for sick- new-born

TN, Orissa, Sikkim, J&K, Karnataka, Rajasthan have achievements > 70% of the estimated sick-new-born

Mizoram, Uttarakhand, Haryana, Gujarat, Jharkhand, Assam are providing free drugs to less than 40% of the estimated sick neonates

MP, UP, Manipur have not shared the data

Free Referral Transport for sick New-Borns

21 states who have reported JSSK 1st QTR data have poor Free referral transport from Home to facility and drop back for sick newborns ranging between 10% to 30% of the expected achievements

Achievements under JSSK for EAG states

State Free drugs (%)

Free Diet(%)

Free Diagnostics(%)

Free RT( Home to facility%)

Drop Back (%)

Odisha 77 No Report 44 43 36

UK 85 31 72 57 44

MP 62 59 58 49 22

J&K 74 68 74 7 16

UP 27 27 27 No report 9

Jharkhand

15 15 11 50 44

Rajasthan 100 100 69 52 56

Assam 88 88 100 29 32

HP 46 46 46 4 16

Note : *Q1 achievement is based on the JSSK reports received by MH division from the States for the 1st QTR. Achievement is against the estimated no. of PW delivering in Public Health Institutions in Q1(2012-13)

NHSRC Report –Key findings

State Districts visited

Positives & Area for improvement

UP Barabanki Azamgarh: 4 facilities

No user charges; 4 out of 10 spent on drugs & consummables; routine lab test free but expenses on USG; RT & Drop back – Not yet assured; IEC & Grievance Redressal not visible

Chhattisgarh

Dhamatari: 4 facilities

User charges exempted but OPD registration being charged; Diet provided above PHC level; medicines are purchased by P.W.; routine lab test free but USG not available even at DH; RT 66% utilising 108 , Drop back poor, informal payments being demanded;

MP Tikamgarh -5 facilities

Good IEC, No user charges; Diet available above PHC; despite free drugs prescription writing common; Rudimentary lab facility below DH; Functional USG but cases referred in private; RT not assured, drop back poor

Rajasthan Pratapgarh -6 facilities

User charges free, diagnostics & diet provided; USG not available at the DH; RT weak, 108 poorly functional; IEC & Grievance redressal not visible

NHSRC Report –Key findings –cont.State Districts

visitedPositives & Area for improvement

Odisha Nabarangpur -4 facilities

Free diet available at CHC & DH; User & IPD charges being levied at select places; RT –JE vehicle used for 50% of P.W. Diagnostics free; USG not available at DH; IEC & Grievance redressal not visible; Informal payments being asked by Doctors & ASHAs

Bihar Motihari -5 facilities

Diet provided above PHC, RT from home is good, but drop back poor; User charges being levied; Diagnostic weak –absence of reagents, consummables short in supply; Drugs as per EDL not available; Grievance redressal weak

HP Kullu and Mandi -6 facilities

No user charges;; Diagnostics available at DH; Diet available above PHC; despite free drugs not available as per the EDL, prescription writing; Drop back, IEC, Grievance redressal -poor

AP Mehbubnagar -4 facilities

Good display of IEC, No user charges; Drugs, consummables & diagnostics available; Diet available above PHC; RT at DH is good but at PHC, CHC & drop back is not assured;

Gujarat Surendranagar Banaskantha -8 facilities

No user charges; Good display of IEC; Drugs, consummables & diagnostics available; Diet not provided at PHC , CHC; RT –good but drop back is poor;

NHSRC Report –Key findings –cont.State Districts

visitedPositives & Area for improvement

Haryana Kaithal -5 facilities

No user charges; Diet provided; Consummables being bought ; Diagnostics not available at PHC; No USG at GH- Absence of Sonologist; RT –available, drop back not adequate, poor IEC

Punjab Fatehgarh Sahib -4 facilities

Blood free; User charges exempted but being charged for neonates; Drugs not available nor displayed as per EDL; Irrational high end branded antibiotics being prescribed and purchased by RKS; Diagnostics not available below district; USG from private; Diet not institutionalized; 59% P.W. availing RT but poor drop back; IEC & Grievance redressal not in place

Maharashtra

Nandurbar Nasik -10 facilities

User charges not levied; Drugs, consummables diagnostics & diet available; RT being available for 50% P.W.; Drop back is poor; Grievance redressal is good in Nasik but poor in Nandurbar

Karnataka Chamrajnagar and Kolar -8 facilities

No User charges; Diet available; Drugs & consummables available except few prescriptions from M.C. Diagnostics available except USG at CHC; Poor use of RT largely because low awareness; Drop back poor; Weak grievance redressal

– Sangeeta, FTP, reports to a CHC for her problems; No checks done; No medicines prescribed but simply written seen by Doctor & Nurse and referred to Civil Hospital

– At Civil Hospital, BP checked 180/100; No anti hypertensive given however Inj Ceftriaxone was prescribed and then referred to DWH

– At DWH, Hb done 7.5 gm%, Loading dose of Mag Sulph given and referred to the Medical College

– At MC, full protocol of treatment started, but unfortunately between the 3 referrals, the foetus could not survive (IUD) and mother was in shock

– WHY ALL THIS?

– JUST BECAUSE SHE IS POOR AND HAS NO VOICE

IEC for public & greater awareness about the free entitlements among all health providers

Orientation of clinicians and doctors for using rational antibiotics and generic drugs as per the technical guidelines not as per their habit of writing medicines.

Ensuring regular procurement and availability of drugs and consumables at health institutions

Orientation for Rational use of USG and its availability at DH, SDH, FRUs

Basic diagnostic facilities should be available at least at all delivery points

Emergency lab facilities should be at least at all DHs and FRUs.

Monitoring of ambulance network for their optimal utilization

 

– Establish district-wise assured referral linkages; GPS fitted vehicles; centralised control rooms

– Grievance redressal mechanism to be institutionalised to ensure commitments are fulfilled in letter and spirit

– Financially empower the districts and facility in-charges, particularly for emergencies / stock outs

– Periodic field visits by State & District officials for monitoring the Implementation of free entitlements

– Review by Secretary Health/ Mission Directors in Meetings at State and CMOs meetings at District levels

THANK YOU