Community Observation
On Janani Suraksha Yojana (JSY)
at Kot Khalsa ( Amritsar)
a project by
Kiran- a society of creative women
kiran.scw@gmail.com
Cell: 9855181280
A n interacting exercise was conducted on random basis for 18 possible women , women ( L- 1 to L-18) , participating women in this survey had a baby child in last one year or so.
interaction was also made with other stake holders such as possible family members of woman & service providers ( Dr /nurses / pharmacist / AMN / Anganwadi)
.
The key issues was to find out
• Is community /pregnant women aware of risk involved in child birth.
• Why they don't opt for Govt hospital services for child birth / ANM care.
• Why they decided to give deliveries at home.
• On what factors , they select there service provider (Dai) for deliveries at home.
Whole exercise was conducted by keeping core, concerns of beneficiary ( the pregnant woman)
•
Description of area
(1) Total Population – 33,000
(2) No. of dispensary- 01
(3) No. of doctor(s) – 01
(4) No. of ANM – 03
(5) No of pharmacist – 01
(6) No of Anganwadi worker - 08
(7) No of trained Dai – 10
Figures for
Year | Reg. For ANC | Govt Institutional delivery | Pvt institutional delivery | Delivery at home |
2008- 2009 | 345 | 26 ( 7.53 % ) | 105 (30.43 %) | 214 ( 62%) |
2009-2010 | 515 | 56 ( 10.87 % ) | 195 ( 37.86 %) | 196 ( 38.% ) |
There is a increase of 66.99 % in registration for ANC.
Random survey of women ( L-1 to L-18) by Kiran society , survey provided following figures.
(1) No. of delivery at home : 11 ( 61 % )
(2) No. of delivery at pvt hospital : 03 ( 16.66 % )
(3) No. of delivery at Govt hospital : 02 ( 11 % )
(4) (L- 11 , L12 ) two women was pregnant at the time of survey , this is there 1st pregnancy.
(5) No. of women pregnant ( 2nd or 3rd time ) at the time of survey : 07
Out of the 18 women surveyed , 07 ( 38.88 % ) was pregnant again , a additional question was asked , where they plane for there present delivery.
– THE OUT COME WAS almost 100 % FOR OPTING DELIVERY AT HOME.
Additional interaction was made to understand , for this major trend.
The points are summarized on feed back as under
(1) No trust on services & care at government Hospital.
(2) High cost of private hospitals
(3) No clarity for JSY , if so.
To get further understanding on this key points , a in-depth series cross question was floated , that leads to a conclusion
(1) 1st impression on care from dispensary itself is not encouraging towards health sector , like absence of doctor
(2) Promotional massage of JSY , from ANM & doctors fail to generate trust.
(3) ANM not clear on guideline of JSY for assisting the pregnant women
(4) Behavior of doctors & nurses towards patients is primitive/ crude
– Personal communication of service provider (Dr & nurses ) shows “apathetic” ( Marked by a lack of interest), with patient & attendants
– Information on type on treatment, possible adverse / & side effect never taken (* this bring distrust towards the treatment , when medication show its 'natural' A/s effects ) .
– un/required clinical test are refereed to private sector,
– quarrel between service providers themselves.
The other point was understand as under
“Fear” – was a common word used in every women communication, when asked for opting delivery at Govt hospital.
The fear is associated towards - discriminated for being poor, ( no money for extra test , payment of fee ) , discriminated for being illiterate ( can't understand what is told by dr /nurses), this all brings a true evaluation towards , fear of loss of self respect for them.
As Kiran society was interacting , the women was very free to shear there experiences, on talking to L-15, it was important to understand why , she is opting to government hospital, beside she had her 1st baby at Pvt Hospital ?
– She cant affort the high cost of private hospital , that is a reason for opting towards govt hospital ( * there is no role of JSY for the change of institutional preference).
A new trend was also seen , as we name it as 'semi- JSY” , where the woman visit govt hospital & then she decide to pay 'private consultation fee ' to attending gynecologist, & finally delivering the baby under “JSY scheme”
The other woman L-16 , has yet opt for making delivery at home , beside loosing her twice child at the time of birth.
On talking with ANM , following things was understood
(1) lake of guideline/understanding on JSY
(2) No proper assurance on funding periods
(3) more emphasis on institutional deliveries
Issues with Dai :
(1) The dai (semi) financed there training programs for government
(2) the quality of training was of very poor level , so themselves they have put more resources to “skill' it.
(3) In the present practice of JSY, there non integration at the part of 'clinical delivery'
(4) They are not sure of there new / alternative role & incentives under JSY.
Summery of interaction with community woman & other stake holders
(1) Women largely know the risk of baby born dead or alive , but may not know the other complications associated with child birth.
(2) Absent of resource for transportation
(3) The awareness of JSY program is low ( what this program offer, who will provide ) !
(4) Most of promotion / registration for ANC is taken around dispensary, the distanced Gali/ streets are not covered in general.
(5) ANM not clear on guideline , transport money is available under the program
(6) Trust not built by local dispensary Drs & staff.
(7) Fear – a main factor
(8) Fail to define / integrate new role of existing grass root strength- Dai.
(9) Increase in number of registration for ANC , but not for the benefit to ANC
(10) At large women was not interested to have 'cash acceptance” - there key demand is to facilitate them with transportation at the need of hr, free treatment / hassle free environment from hospital
(11) Drs & nurses behavior is key problem.
Recommendations :
(1) Behavior of service providers to be monitored
(2)No false promises , communication should be clear on terms of services
(3)Organizing appropriate referral and provide referral transport to the
pregnant woman
(4) Pregnant woman should be accompanied with ANM at time for making hassle free paper work / or else.
(5)Making sure the presence of Dr & other staff is always at the working hrs , specially at dispensary level.
(6) assuring an accredited private Dr , (emergency referral in same area / or nearest ) associated in terms of JSY guidelines, clear terms of practices.
(7) Existing services from traditional Dia , is yet key factor at grass root, her new role should be places in JSY.
(8) At regular interval a check up camp should be conducted at the nearest possible area.
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