1. SECRETARIES REVIEW MEETING SEPTEMBER 11, 2012 Janani Shishu Suraksha Karyakram (JSSK) Dr Himanshu Bhushan, DC (MH)

2. 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

3. – 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)

4. – 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

5. 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

6. JSSK reporting Status in 1 st QTR, 2012-13 REPORTED (24 states)NOT REPORTED ( 11 States) Tamil NaduChhattisgarh OdishaAndhra Pradesh MizoramMaharashtra Uttarakhand Lakshadweep SikkimPuducherry M.PDelhi J&KDaman & Diu HaryanaNagaland GujaratArunachal Pradesh GoaA&N islands D&N HaveliKerala Chandigarh Meghalaya UP Jharkhand Rajasthan Assam Manipur Karnataka HP West Bengal Punjab Bihar Tripura

7. JSSK – Status of Free Entitlements Free entitlements to PW >70% achievementBetween 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 1 st QTR. Achievements are against the estimated no of PW delivering in Public Health Institutions in Q1(2012-13)

8. JSSK – Status of Free Entitlements Free entitlements to PW >70% achievementBetween 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 1 st QTR. Achievements is against the estimated no of PW delivering in Public Health Institutions in Q1(2012-13)

9. JSSK – Status of Free Entitlements Free entitlements to Sick –new-born >70% achievementBetween 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 1 st 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

10. Achievements under JSSK for EAG states StateFree drugs (%) Free Diet(%) Free Diagnosti cs(%) Free RT( Home to facility%) Drop Back (%) Odisha77No Report444336 UK8531725744 MP6259584922 J&K746874716 UP27 No report9 Jharkhand15 115044 Rajasthan100 695256 Assam88 1002932 HP46 416 Note : *Q1 achievement is based on the JSSK reports received by MH division from the States for the 1 st QTR. Achievement is against the estimated no. of PW delivering in Public Health Institutions in Q1(2012-13)

11. NHSRC Report –Key findings StateDistricts visited Positives & Area for improvement UPBarabanki 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 Chhattisgar h Dhamatari: 4 facilitiesUser 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; MPTikamgarh -5 facilitiesGood 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 RajasthanPratapgarh -6 facilitiesUser charges free, diagnostics & diet provided; USG not available at the DH; RT weak, 108 poorly functional; IEC & Grievance redressal not visible

12. NHSRC Report –Key findings –cont. StateDistricts visitedPositives & Area for improvement OdishaNabarangpur -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 BiharMotihari -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 HPKullu 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 APMehbubnagar - 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; GujaratSurendranagar 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;

13. NHSRC Report –Key findings –cont. StateDistricts visitedPositives & Area for improvement HaryanaKaithal -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 PunjabFatehgarh 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 Maharashtr a 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 KarnatakaChamrajnagar 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

14. – 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

15. 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

16. – 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

17. THANK YOU