Moving from home delivery to Institutional Delivery

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A Study on
Experiences of Mothers and Service providers under
JSY/ NRHM
At
Saikawt & Henglep TD Blocks
In Churachandpur Dist. Manipur
(Zougam Institute for Community Resource Development – Manipur)
Background/Context
(Socio-geo-politico)
Henglep
Saikawt
C C Pur
Henglep : Rural, Remote &
Mountainous
Saikawt : Small town close to district
head quarter.
Background
 Geographical boundaries
 Saikawt (Block A)& Henglep (Block B) in
Churachandpur Dist, Manipur
 Time boundaries
 Mothers who delivered during the last six months
preceding this study (Jan–June, 08)
 Stakeholders


Women :Saikawt 20, Henglep – 20
ASHA : Saikawt – 10, Henglep – 3
 ANM : 1 each
 Doctor : 1 each
 DFWO, DMO, VA for secondary Data
Looking at the two blocks
Saikawt PHC
No labour room in both PHC
Joyous ride
From Henglep to
Dist. Hqtr.
Henglep PHC
Research Objectives
 Awareness level of mothers about JSY
 Health Service providers view about
JSY.
 Factors that determine women
choosing Home Delivery (H.D)
 Suggestions for improving the
implementation of JSY.
Methods:
 Sampling From Each TD Block
 Random selection of vulnerable villages 10 each
 1 ID & 1 HD each from each village selected
 13 ASHAs randomly from the selected villages
 One ANM from Sub-centre
 Doctor each from the two PHC
 Methods of data collection (Tools used)
 Indepth interview to Mothers (for Primary Data)
 Survey from ASHA, ANM & Doctors, DMO, DFWO,
Statistics Office (for Secondary Data)
 FGD (Mothers & ASHA for Primary Data)
Limitations
 From CHSJ:
 Short time period, Limited Finance
resource, Little guideline on the
subject
 From Authority concern:
 Less cooperation from concerned
authority. DMO.DFWO and State
H&FWO.
Maternal Care
SNo.
Questions
Results/Findings
BLOCK
A(n = 20)
B(n = 20)
1
2
3
Registerd by ASHA.
Inst.identified before del.
Pvt. transportation availed
100%
85%
100%
0%
40%
0%
4
5
Receive TA
Receive full ANC
0%
100%
0%
95%
0%
0%
95%
0%
90%
0
100%
0%
0%
100%
from Govt. inst.
From pvt. Inst.
6
7
ASHA visited
ANM visited
8
TT and Iron Tablets. From govt. inst.
Block A – Saikawt PHC
Block B – Henglep PHC
From private
Awareness & Benefits of JSY Scheme
SN
1
2
3
4
5
6
7
8
9
Questions
Know about JSY and its benefits.
Source (ASHA)
Do you get any JSY benefit?
Amount in Rupees (700)
Service charged (Providers)
Service charge to Village Dai.
Have JSY Card.
Home delivery
Institutional delivery
BLOCK
A
n = 20
90%
100%
10%
10%
0%
0
0%
20%
80%
B
n = 20
45%
5%
0%
0
5% pvt.
65%
0%
65%
35%
Why did not deliver at govt. facility?
Sl.
BLOCK
Reasons
A
n = 20
B
n = 20
1
Couldn’t afford facility*
50%
60%
2
No JSY benefit even if in 65%
inst.
Distance Location (02 – 100 60%
5%
3
80%
kms)
4
Concept of interference
to staffs.
5%
* No medicine supply in govt. institutions.
25%
Selection of ASHA
Q.No.
1
ASHA
n = 13
Questions
What is your age?
20 – 29 years
30 and older
2
When were you appointed/elected as ASHA?
What was the process?
(All names are proposed by village
chief)
38%
62%
2006 54%
2007 38%
2008 8%
Appointed by village
chief, no election.
54%
Elected among many
nominees
46%
Trainings
Q.No
Questions
1
2
Have undergone trainings.
Times of training undergone (2 full
days each time)
1 time
(Training medium in Manipuri, not
understood by Many ASHAs.)
2 times
Above 3 times
3
TA/DA during your training days.
ASHA
n = 13
100%
23%
16%
62%
100%
Roles and Responsibilities
ASHA
n = 13
Questions
SN
1 Participate in Pulse Polio program.
2 Give Health Education in village.
92%
31%
3
4
5
Organize VH Day
Counsel pregnant women
Accompany women
0%
100%
38%
6
7
8
9
Have VHSC in your village.
Attend the VHSC meeting
Get help from ANM.
Women get TT Iron tablets.
77%
77%
100%
100%
Incentives/Compensation
Q.No
Questions
1 Village received Untied Fund.
ASHA
n = 13
85%
2
Receive incentives/compensation
under JSY Scheme.
0%
4
The women you registered getting
JSY payment.
How many women?
3 Amount
Normal
2
Rs. 700
8%
CS case
1
Rs. 700
Unheard Voices
 Mothers : “Poorly treated in govt. hospital.
No medicine supplies, expensive. No JSY
Benefit as told”.
 ASHAs & ANM : “Mothers don’t trust us any
more. Only 3 out of all 40 women received
money”.
 Doctors: “Funds disbursed only at district
H/Q. Women are waiting their turn, serial
number published in local newspapers. So
we are helpless”.
Conclusions
 Implementation of JSY
 Block “A” avails a better facility of the scheme.
 Block “B” far and remote, mountanous area,
inaccessible to the scheme.
 However, JSY incentives/compensation has not
been given neither in town nor remote areas.
 Thus, No improvement in institutional delivery
according to the findings.
 Most serious challenge to inst. Del. in both blocks
 Poor treatment by staffs in govt. facility
 Lack of prompt payment of JSY payments.
Recomendations
 Comment:
 To Improve fund flow system district level, state level
and national level.
 To provide more systematic transportation referral
 To strength Private Public partnership system (PPP)
 One big Suggestion :
 To introduce SOCIAL SERVICE DEPARTMENT in
medical institutions nation wide.
 Social workers should be
 Licentiate by govt.
 Fully recognized and supported by Human Rights
Commission of the country
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