Table 1 Themes and subthemes categorized as barriers and remedial measures for India’s Janani Suraksha Yojana program
Themes | Subthemes | Categories |
|---|---|---|
At the health facility level (Receipt of adequate healthcare) | Inability to manage birth complications Referrals to private institutions Insufficient healthcare personnel, medicine, equipment, distribution of resources Vertical program structures and standalone nature of MCH program components | Barriers |
Budgetary revisions to increase efficiency Greater oversight to ensure availability of equipment, medicine, and medical staff Employing more staff Introducing feedback and review system Building intra and inter program linkages | Remedial measures | |
Linkages between home and health-facility (Timely transfer to health-facilities once the decision to seek health-facilities was reached) | Limited availability of drivers and vehicles Delays in transport arrival High cost of alternative transport Poor quality of roads Inadequate understanding and poor attitude/ behavior of service providers Rent-seeking by service providers from beneficiaries | Barriers |
Provision of alternative transport Creation of an emergency number Regular monitoring of ambulances Budgetary revision to strengthen transport facilities Training, motivation building of service providers | Remedial measures | |
At the community and household level (Decisions to use health-facilities) | Decision-making power mostly influenced by elders in families Misconceptions about home vs. institutional birth Negative previous experiences ASHAs: inadequate support and capacities | Barriers |
Identifying pregnant women through direct observation and household visits Counselling services during prenatal, delivery, and ante-natal check-ups Awareness campaigns Counselling targeting male family members Utilizing media (e.g. radio, and TV) to provide reliable program information Strengthening ASHA support mechanisms | Remedial measures |