The Janani Suraksha Yojana (JSY) is one of the programmes of the National Rural Health Mission which is being implemented in Rajasthan through the State Government in coordination with Rajasthan Voluntary Health Association & UNICEF. The objectives of the Yojana are to (1) Decrease the rate of mother and infant mortality and (2) Promote institutional deliveries.

The Janani Suraksha Yojana Helpline was an integral part of the JSY programme. The objective of the helpline was to strengthen the JSY especially with regards to providing timely transportation facilities for pregnant women and ensuring a hassle-free experience in the hospital.

The Helpline was initiated in one block each in all the districts of Rajasthan. A NGO partner was responsible for running the helpline in the 28 districts. The project started in mid November, 2006 and Seva Mandir was implementing the helpline in Jhadol block of Udaipur District. The Jhadol JSY helpline was located in the block level hospital called the Community Health Centre (the CHC). The helpline had a toll free number (155310), which was manned 24x7 and another local BSNL number. As part of the JSY, to provide for safe motherhood and institutional deliveries a list of vehicle owners was prepared at village and panchayat level in order to meet the needs of transportation during emergency.

In practical terms, however, the toll free number was not actually toll free and for most of the project period it was not even accessible and working. This affected the number of received calls and therefore the support that could be provided to the beneficiaries at home. Between November 2006 and June 2007, a total of 99 calls were received at the helpline and 344 cases were referred for institutional delivery by the Jhadol helpline. As part of the helpline, three village functionaries were also appointed to disseminate information about the JSY helpine. More than these three, Seva Mandir’s network of village level health workers including the Traditional Birth Attendants (or Daimas) and health workers helped activate the public health facilities. For example, they helped several ASHAs receive payments for the services rendered by them in the past. In several cases the pregnant woman visiting the CHC did not know about the JSY incentive (an incentive of Rs.1400/- for every institutional delivery that a woman went through) and was told about this benefit by the helpline staff. Moreover, in some CHCs, the women were not getting the JSY incentive because the money had not been released to the PHC. That also got released because Seva Mandir field staff made enough noise about it.

One of the biggest challenges for the Seva Mandir managed helpline was being located in the premises of the CHC itself. By virtue of their presence they were witness to the rent seeking nature of the government health department, especially the block hospitals. Most of the time, the women were at the mercy of the CHC staff for any medical aid as there was little alternative. And the CHC staff charged fees for every service that was to be offered free. Everyone from the doctor to the ward boy charged a ‘fees’. After paying this ‘fees’ and cost of medicines the beneficiary often ended up with not more than Rs500-600 instead of the Rs1400. The help line staff could thwart this at times but in most cases, the woman or her family would have to pay this. But the fact that the helpline staff knew about this became a sore point with the CHC staff and there were several occasions when trouble arose between them. This also seems to be the reason for the abrupt closure of the helpline.

The helpline ran barely for 8 months when it was suddenly closed on 30th June 2007. The orders to wind up the programme were received a month prior to its closure. It seemed strange that the programme was being discontinued without any explanation and notice. All the implementing partners met the Health Secretary at Jaipur, under the aegis of RVHA, to seek reasons for the abrupt closure. However, the Health secretary himself could not throw much light on this issue. Although he agreed for a review of the programme and rethinking the decision, the results of the following rapid review remained a mystery. It did not help change the decision. The process of discontinuation does raise the question of the unilateral way in which the Government took the decision even though many partners were involved in the implementation.

Even though the helpline could not do much to curb the corruption within the hospital, it proved to be useful in times of acute crisis. For example, there was once a complicated delivery case requiring immediate surgery. The case came late at night when the surgeon had already gone home. The Seva Mandir helpline staff managed to persuade the surgeon to come to the hospital even at that late hour and attend to the woman. In another incident, a woman needed to be brought to the Udaipur hospital immediately. The CHC ambulance was not available as it had no fuel and the driver was unwilling. Once again, the helpline staff managed to get the fuel & also convince the driver to take the patient to Udaipur. In several cases, the helpline staff would help the patients financially. Given the poverty of the area, woman would often come to the hospital with no cash on them. The helpline would then help them either through personal donations or from Seva Mandir.

There are serious implications of this corruption in terms of not only the money being misappropriated from what it was supposed to be used for but also that over time it will lead to a culture where it becomes accepted. More disconcerting is the learning that everybody – the people and the government - knew about this and yet nothing was being done. For the people, there is little choice; either they go for private health care which is expensive and not always available, or they go to the public hospitals where also they have to pay. And partnerships, which have some potential of changing this culture, often, have fates such as that of the JSY helpline.

1 Village level women volunteers initiated under NRHM who are responsible for community health services.