Janani Shishu Suraksha Karyakram

Janani Shishu Suraksha Karyakram (JSSK) is a flagship maternal and child health initiative launched by the Government of India under the National Health Mission (NHM) in 2011. The programme aims to eliminate out-of-pocket expenses for pregnant women and sick newborns while ensuring universal access to institutional healthcare. By guaranteeing free and cashless services in public health facilities, the scheme seeks to promote safe motherhood, reduce maternal and infant mortality, and encourage institutional deliveries across the country.

Background and Evolution

India has historically faced high rates of maternal mortality (MMR) and infant mortality (IMR) due to limited access to quality healthcare, inadequate transport, and financial barriers. To address these challenges, the government had earlier introduced the Janani Suraksha Yojana (JSY) in 2005, which provided conditional cash transfers to promote institutional deliveries.
Building upon JSY’s success, the Janani Shishu Suraksha Karyakram was launched in June 2011 by the Ministry of Health and Family Welfare. It extended the benefits of JSY by focusing not only on institutional delivery but also on postnatal care and treatment of sick newborns. The scheme recognises that financial constraints, such as user charges, transport costs, and expenses on medicines, often deter women from accessing healthcare services even after JSY incentives.

Objectives of JSSK

The primary objectives of the Janani Shishu Suraksha Karyakram are to:

• Ensure free and cashless delivery for all pregnant women in public health institutions.
• Provide free treatment to sick newborns (up to 30 days after birth) and later extended to sick infants (up to one year of age).
• Eliminate out-of-pocket expenditure related to childbirth and neonatal care.
• Encourage institutional deliveries and institutional care for better maternal and neonatal outcomes.
• Reduce maternal and infant mortality rates by improving access to timely and quality healthcare.

Key Features of the Programme

The JSSK guarantees a set of entitlements for both mothers and their newborns. These are provided free of cost at all public health facilities—from sub-centres and primary health centres to district hospitals and medical colleges.

Entitlements for Pregnant Women

• Free and cashless delivery, including normal and caesarean sections.
• Free drugs and consumables required during delivery and hospital stay.
• Free diagnostics, including laboratory tests and ultrasound examinations.
• Free diet during the hospital stay (up to three days for normal delivery and seven days for caesarean delivery).
• Free provision of blood transfusion if required.
• Free transport services, including:
  • From home to the health facility.
  • Between facilities in case of referral.
  • From the facility back home after discharge.
• Exemption from all user charges and hospital fees.

Entitlements for Sick Newborns and Infants

• Free treatment for sick newborns up to 30 days of age, later expanded to cover infants up to one year.
• Free drugs and consumables, including antibiotics and specialised medicines.
• Free diagnostics, including laboratory and radiological investigations.
• Free provision of blood transfusion services when required.
• Free diet during hospitalisation.
• Free transport, including:
  • Home to hospital.
  • Inter-facility transfers.
  • Drop back home after discharge.

These provisions aim to ensure that no mother or child is denied healthcare due to financial incapacity.

Implementation Mechanism

JSSK is implemented under the National Health Mission through state and district health societies. The programme functions with 100% central assistance in terms of policy, while operational flexibility is given to states for local adaptation. States are responsible for ensuring adequate infrastructure, supplies, trained manpower, and proper transport facilities.
Key elements of implementation include:

• Strengthening of referral transport systems, often through the 102 and 108 ambulance services.
• Establishment of functional First Referral Units (FRUs) equipped for emergency obstetric and neonatal care.
• Capacity building and training of healthcare workers, nurses, and ASHA (Accredited Social Health Activist) workers.
• Public awareness campaigns to inform communities about their entitlements under JSSK.
• Monitoring and evaluation through periodic review meetings, maternal death audits, and data reporting under the Health Management Information System (HMIS).

Coverage and Beneficiaries

The scheme covers all pregnant women who access public health facilities for delivery, irrespective of their financial status. It also extends to sick newborns and infants requiring treatment in government hospitals.
JSSK especially benefits women from rural, tribal, and economically weaker sections who previously faced high out-of-pocket costs for delivery and postnatal care. By ensuring comprehensive entitlements, the programme supports continuum of care from pregnancy to infancy.

Impact and Achievements

Since its inception, the Janani Shishu Suraksha Karyakram has had a significant impact on maternal and child health indicators in India:

• Institutional deliveries have risen sharply due to improved access and financial protection.
• Out-of-pocket expenditure for childbirth and neonatal care has declined substantially in public facilities.
• Maternal mortality ratio (MMR) and infant mortality rate (IMR) have shown a downward trend over the past decade.
• Enhanced availability of free transport and diagnostics has improved emergency response and continuity of care.
• Strengthened linkages between JSSK and JSY have contributed to higher utilisation of healthcare services by pregnant women.

Challenges and Limitations

Despite notable progress, the JSSK faces several operational challenges:

• Infrastructure gaps in rural and remote areas, including inadequate facilities for emergency obstetric care.
• Shortage of skilled health personnel, particularly in sub-centres and primary health centres.
• Inconsistent quality of services, especially in diagnostics and transport availability.
• Awareness issues, as many beneficiaries remain unaware of their entitlements.
• Monitoring difficulties, including variations in data reporting and inter-state performance.

Efforts continue to strengthen the implementation framework, ensure accountability, and integrate JSSK more effectively with other maternal and child health initiatives.

Linkages with Other Programmes

JSSK is closely linked with several national health programmes aimed at improving maternal and child health outcomes, including:

• Janani Suraksha Yojana (JSY) – provides cash incentives for institutional delivery.
• LaQshya Programme – focuses on improving quality of care in labour rooms and maternity operation theatres.
• Rashtriya Bal Swasthya Karyakram (RBSK) – aims at early identification and management of health conditions in children.
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) – provides free antenatal check-ups to pregnant women.