|LETTER TO THE EDITOR
|Year : 2016 | Volume
| Issue : 1 | Page : 86-87
Janani Shishu Suraksha Karyakram and out of pocket expenditure
Manas Pratim Roy1, Ratan Gupta2, Meetu Salhan3
1 Public Health Specialist, Department of Pediatrics, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
2 Assistant Professor, Department of Pediatrics, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
3 Medical Officer, Department of Pediatrics, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
|Date of Web Publication||23-Feb-2016|
Manas Pratim Roy
Department of Pediatrics, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Roy MP, Gupta R, Salhan M. Janani Shishu Suraksha Karyakram and out of pocket expenditure. Indian J Public Health 2016;60:86-7
|How to cite this URL:|
Roy MP, Gupta R, Salhan M. Janani Shishu Suraksha Karyakram and out of pocket expenditure. Indian J Public Health [serial online] 2016 [cited 2020 Feb 26];60:86-7. Available from: http://www.ijph.in/text.asp?2016/60/1/86/177352
We read with interest the article on out-of-pocket expenditure (OOPE) by Mondal et al.  The authors reiterate the need to provide financial protection for ensuring universal institutional delivery at zero expense through the Janani Shishu Suraksha Karyakram (JSSK). Different variables were indicated for higher OOPE in the study. However, consideration of economic status of the beneficiaries would have enriched the study. As pointed out previously, a higher amount during institutional delivery is incurred by economically well-off families. , While it is true that the study analyzed the amount of expenditure and it might be a proxy for wealth index, but the severity of economic burden precipitated by that expenditure would remain unclear from such analysis. In fact, the greatest effect of free care would be expected among those having the least capacity to spend. As evident from literature, a significant reduction in OOPE was experienced among the financially weaker sections, after the introduction of the JSSK. 
The authors mentioned that about 53% Janani Suraksha Yojana beneficiaries got their direct expenditure covered by cash benefit. From another research in Haryana, India, 63% of the women did not need to spend from their pockets at the public sector.  Such figures from the present study expressing the extent of cashless facilities would have scaled the success of the JSSK.
As the study was conducted at the vicinity of a medical college, it is quite obvious to get an inclination toward medical college as the first choice for the place of delivery. However, the detailed pattern of expenditure (drugs and investigations) at the level of Block Primary Health Centre (BPHC) remains unclear. As depicted earlier, the nonavailability of drugs and radiological investigation (ultrasonography) may necessitate OOPE.  It might be difficult to conclude something from a small sample size of 10; however, the mention about the availability of investigations at the BPHC level would help readers understand the situation better. This is important because not everyone in rural India gets a chance to deliver at medical colleges, where common amenities are available. Further, the study at this level would delineate whether the JSSK is able to deliver its purpose at the grassroots level.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mondal J, Mukhopadhyay DK, Mukhopadhyay S, Sinhababu A. Does Janani Shishu Suraksha Karyakram ensure cost-free institutional delivery? A cross-sectional study in rural Bankura of West Bengal, India. Indian J Public Health 2015;59:279-85.
Modugu HR, Kumar M, Kumar A, Millett C. State and sociodemographic group variation in out-of-pocket expenditure, borrowings and Janani Suraksha Y ojana (JSY) programme use for birth deliveries in India. BMC Public Health 2012;12:1048.
Mohanty SK, Srivastava A. Out-of-pocket expenditure on institutional delivery in India. Health Policy Plan 2013;28:247-62.
Tripathi N, Saini S, Prinja S. Impact of Janani Shishu Suraksha Karyakram on out-of-pocket expenditure among urban slum dwellers in northern India. Indian Pediatr 2014;51:475-7.
Prinja S, Bahuguna P, Gupta R, Sharma A, Rana SK, Kumar R. Coverage and financial risk protection for institutional delivery: How universal is provision of maternal health care in India? PLoS ONE 2015;10:e0137315.