Accredited Social Health Activist: Combatant for Reducing IMR and MMR in 21^st Century Under the Programme Janani Suraksha Yojana - A Study Under Jharadihi C.H.C of Bahalda Block, Odisha

Sangeet S. Sur¹*, Swapneswar Puthal^2,3

¹Associate Professor, MPK College of Nursing, Baripada, Odisha, India.

²Ex-Medical Officer, AYUSH, Jharadihi CHC, Bahalda, Odisha.

³Homoeopathic Medical Officer G.H.D Gadasahi, Balasore, Odisha, India.

*Corresponding Author Email: sursangeeetsarita@gmail.com

ABSTRACT:

Janani Suraksha Yojana as literary implies Maternal Protection Scheme being employed in rural community is now-a-days so much familiar in rural medically challenged area that 95% of mothers are choosing for institutional delivery at Primary Health Center (N) or Community Health Center. It employs cash assistantship nutritious food for the mother with free medical facility from primary stage to delivery including transportation where ASHA is the real combatant of frontline introducer and manager of the scheme basically in this type of undeveloped area. ASHA serves as the real guide starting from pregnancy to the period of birth age of the infant for six month covering the crucial period prior to one month of expected date of delivery to puerperal period. In this present study the role of ASHA being evaluated in 21^st century how they are managing in reducing Infant Mortality Rate and Maternal Mortality Rate by suitably managing the condition of irregular fetal development, eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum haemorrhage, postpartum haemorrhage, Pre and Post anemia. Counseling of mother by ASHA for self taking care of health, consumption of nutritious food with vitamins and minerals, routine checkup and providing IEC materials to create awareness for save delivery and infant care are the key factors for reduction of the IMR and MMR in rural undeveloped area of the nation as applicable to our population sample area.

KEYWORDS: JSY, ASHA, IMR, MMR, NHM.

INTRODUCTION:

Janani Surakhya Yojana (JSY) is a nationwide implemented programme for safe motherhood intervention under National Health Mission (NHM) erstwhile termed as National Rural Health Mission (NRHM) which was launched 12^th April 2005 by the Government of India was being implemented in all states with the objective of reducing maternal and neonatal mortality by promoting institutional delivery among the poor pregnant women^{1,
2, 3}.

It is implemented in Odisha, a densely populated state of India comprising of people 4.1974 Crore as per census-2011 where 83.13% of the population is rural based and the projected population is 4.6628 Crore as on 2019 where the district engulfing the sample study area counted its projected population as 27.85 lakhs having 92.34% as it’s rural population^{4, 5, 6}. Implementation of Welfare schemes in the rural belt of the nation basically in the low performing state due to maximum percentage of rural existence, low literacy rate, sanitisation, low growth of health sector and communication etc are the key threat for effective implementation^7,8. JSY provides cash assistance to the mother who helps her to take nutritious food as well as support with respect to medications for the health of mother and new born^{9, 10, 11}. It also provides transportation to the beneficiary mother through Accredited Social Health Activist (ASHA). JSY promotes better delivery of maternal child health (MCH) services like registration, antenatal check up, institutional delivery, immunization of infant and post natal care (PNC) with 100% effectiveness through ASHA which are the measure Reproductive Child Health (RCH) indicator of Community^{12, 13, 14}. JSY is a centrally sponsored scheme which integrates cash assistance with delivery and post delivery care with implementations in all states and union territories with special focus on low performing states. The JSY programme has identified ASHA are the effective link between the Government and pregnant women^{15, 16}.

According to WHO, India is progressing in reducing maternal mortality ratio (MMR) by 77% from 556 per 1000 live births in 1990 to 130 per 1000 live births in 2016. This progress puts India on track towards achieving sustainable development goal (SDG) with target of MMR below 70 by 2025¹⁷.

Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR) continues to rise alarmingly due to host of factors such as lack of awareness and inaccessible healthcare in tribal dominated hilly pockets of Mayurbhanj District exists in the Northern part of Odisha lying near the eastern coastline of Bay of Bengal in India. Concerned over this, the health department of the state has drawn of various plan and strategies to curb IMR and MMR by 2020 in the district. The district reported casualties of 1318 infants and 53 women in 2012-2013 while 44515 children born that year. In 2014-2015 the number of child casualties was 1280 out of total 45675 births while 45 numbers of maternal deaths were reported. The number of infants and maternal casualties in 2015-2016 was 1147 and 55 respectively while 43932 births were reported. In 2016-17 the district recorded 42456 births while 952 infant’s death and 53 maternal deaths were reported^{18, 19}

Figure1. Showing District IMR and MMR count

The Health and Family Welfare Department of the State Government of Odisha has conducted a survey on MMR on 2013 and the survey put the MMR at 222 in every one lakh while the IMR was put at 51 in every one thousand. The department has set a target to bring down MMR to 170 per one lakh and IMR to 33 per 1000. According to NHM, Dept of Health and Family Welfare, Govt. of Odisha, this state recorded 81% reduction in MMR in seven years from 303 (Sample Registration System, SRS-2006) to 222 (SRS-2013). Before NRHM from 1998 till 2006 there was only 64 point decline in eight years time period. There is a remarkable reduction in IMR by 24 point from 75 in 2005 to 51 in 2013 as per SRS, which is still highest in the country. Percentage of Institutional delivery increased from 28 % in 2005 to 95.4% (HMIS Report: 2015-16²⁰) against actual delivery and it is increased by 25% in the last one year. This is the aim here to introduce our research design for finding the role of ASHA through JSY basically in the area of our sample population which is being challenged in health sector in this 21^st century.

OBJECTIVE:

1. To assess the perception of the lactating mothers regarding JSY and the active role of ASHA at the grass root level

2. Recommendation of IEC materials to create awareness for safe delivery by the the Government and non-government organization through ASHA

MATERIALS AND METHODOLOGY:

Research methodology indicates the general pattern of organising the procedure for gathering valid and reliable data from investigation. The cross sectional statistical approach is selected for the study as it provides accurate and meaningful description of the phenomenon under study.

Study population:

The population consists of mothers having children below six months of lactation, belonging to Jharadihi of Bahalda block in the district of Mayurbhanj, Odisha, India. Choosing the area of population as the significance of its existence termed as the base level of the implementation of Janani Surakshya Yojna (JSY)

Criteria for selection:

a) Inclusion criteria:

Mothers having children below six month of lactation available and willing to participate during the period of data collection

b) Exclusion criteria:

Mothers who are not willing to take part, not available at the time of data collection and child having more than six months of lactation

Tools and techniques:

Structured questionnaires comprised of two sections.

a) Section A:

It consists of demographic data and type of family ANC received or not, sources of ANC, place of delivery and type of delivery etc

b) Section B:

It consists of eleven items based on ANC, PNC, Knowledge and meaning of JSY, amount of JSY benefit and problems regarding getting the benefits. Assessment of perception of mothers regarding JSY, by making relationship between different variables like age, education, parity, literacy status and knowledge of JSY etc.

Data interpretation has been carried out using Microsoft Office Excel and Origin Pro-6 software

RESULT AND DISCUSSION:

The study was carried out with the sample, N=62 mothers by our inclusion criteria and exclusion criteria taking into account. Out of the study sample following observation is made regarding the frequency of the sample availed JSY and non-availed JSY.

Table1. Frequency and percentage distribution of mothers related to the status of JSY availed (N=62)

Status of JSY	Frequency (F)	Percentage (%)
Availed	59	95.16
Not-Availed	03	04.84
Total	62	100

Figure 2. Schematic Representation of the Study Design

Table2. Frequency and Percentage Distribution of mothers related to their Parity and Literary Status, N=62

Parity Literary Status	P: 1		P: 2-3		> P-3		TOTAL
Parity Literary Status	F	%	F	%	F	%	F	%
Illiterate	4	6.451613	2	3.225806	3	4.838710	9	14.51613
Just Literate	2	3.225806	2	3.225806	0	0	4	6.451613
Up to Secondary	13	20.96774	6	9.677419	4	6.451613	23	37.09677
Up to Higher Secondary	7	11.29032	9	14.51613	2	3.225806	18	29.03226
> Higher Secondary	6	9.677419	2	3.225806	0	0	8	12.90323
Total, N=62	32	51.61290	21	33.87097	9	14.51613	62	100

Table3. Frequency and Percentage Distribution of mothers related to their Parity and Availability of JSY, N=62

Parity Availability of JSY	P: 1		P: 2-3		> P-3		TOTAL
Parity Availability of JSY	F	%	F	%	F	%	F	%
Availed	29	46.77419	21	33.87097	9	14.51613	59	95.16129
Not Availed	3	4.83871	0	0	0	0	3	4.838710
Total	32	51.6129	21	30.64516	9	14.51613	62	100

Figure3. Source of information about JSY (including Primipara and Multipara)

Table.4 Frequency and Percentage Distribution of mothers related to Literary Status and Availability of JSY

Literary Status Availability of JSY	Illiterate		Just Literate		Up to Secondary		Up to Higher Secondary		> Higher Secondary		Total
Literary Status Availability of JSY	F	%	F	%	F	%	F	%	F	%	F	%
Availed	7	11.29032	3	4.83871	23	37.09677	18	29.0322581	8	12.90322581	59	95.16129
Not Availed	2	3.225806	1	1.612903	0	0	0	0	0	0	3	4.83871
TOTAL	9	14.51613	4	6.451613	23	37.09677	18	29.0322581	8	12.90322581	62	100

Table.5 Testing of significance for N=62 (respective columns and rows are merged for frequency < 5 where ever applicable)

Variance	ꭓ² Calculated	ꭓ² Tabulated	D.F (υ)	Level of significance (α)	Impression
Parity @ Literary Status	8.473	7.815	3	0.05	Significant
Parity @ Availablity of JSY	2.940	5.991	2	0.05	Not Significant
Literary Status @ Availability of JSY	11.929	7.815	3	0.05	Significant

Testing of significance in table-5 indicates regarding both the correlation of parity to literary status with υ=3, literary status to availability of JSY with υ=3 are significant at α=0.05 and insignificant with respect to parity and availability of JSY with υ=2 at same level of significance. It clearly adds on the fact that the literacy is a prima factor in easy assessing the focus scheme of JSY where research outcome being obtained as significant with respect to alternate hypothesis for table-2 and table-4 where source of primary information regarding JSY is ASHA indicating their roles are highly essential in reducing the IMR and MMR in 21^st century basically in the tribal dominated area of the nation by controlling the condition of irregular fetal development, eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum haemorrhage, postpartum haemorrhage, pre and post anemia²¹ as applicable to our population sample area where no alternate private medical facility is available and majority portions of the mothers are routed to Primary Health Center (N) or Community Health Center for institutional delivery.

Awareness about ASHA among mothers:

From our sample, 95% of mothers were aware about the details about ASHA pertaining to their name, address of correspondence and cell no. The service rendered by ASHA from registration of ANC to PNC, a total of approximately 11 months is the vital sign for reduction of MMR and IMR as per goal²². Role of ASHA during the period prior to one and half month of delivery to puerperal period (six weeks after delivery) satisfied the mothers to a large extent as personal care and infant care is concerned and it is the prime focus of our study here

Essential services provided by ASHA:

a. Extending awareness about JSY and registering in the ANC and providing JSY card (the detail record maintenance data book of the mother and infant)

b. Giving support to the mother for at least three ANC check up during Antenatal period for fetus safety and in receiving designated money of Rupees 1400.00 directly by the mother.

c. Distribution of compulsory IFA tablets and creating awareness among mothers for its use

d. Assistantship given during transport of mothers from home to delivery institution either in private vehicle or JANANI EXPRESS (102-Ambulance used for pregnant women during delivery)

e. Frequent home visit between pre-delivery periods of six weeks to puerperal period of six weeks to avoid puerperal sepsis.

f. Distribution IFA and Calcium tablets for three months to the mother after delivery

g. Providing idea of Nutritious food chart as per applicability in local interior area

h. Providing awareness for compulsory vaccination for mother and infant as per immunisation schedule^23,24.

CONCLUSION:

Our study in 21^st century envisages the decreasing rate of IMR and MMR basically in the rural undeveloped area due to the adoption of JSY scheme to promote the pregnant mother for institutional delivery with availing other benefits in the scheme. To execute this scheme in the grass root level due to lack of awareness and education, ASHA is playing a significant role in extending the awareness of JSY and creating awareness to avoid DHAI (non-expert person usually involved in the rural area for delivery and increasing factor for IMR and MMR in those area). Monitoring the work plan of ASHA by senior personnel and frequent hands on training programme are being provided to acquaint ASHA with updated manuals of procedure for effective implementation of JSY^{25, 26, 27}.

RECOMMENDATION:

a. The scheme JSY has to be followed for more years as the IMR and MMR have not suitably be checked basically in rural and tribal dominated area where ASHA is the only source of hope to minimise this IMR and MMR in following years.

b. A descriptive study on malnutrition under the age of 5years can be studied

c. A study on effectiveness of National Immunisation can be studied further

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this investigation.

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Received on 17.06.2021 Modified on 19.10.2021

Asian J. Nursing Education and Research. 2022; 12(1):47-51.

DOI: 10.52711/2349-2996.2022.00009