HRLN petition seeks full implementation of JSSK scheme in Tripura

The petition noted that India accounts for the highest number of maternal deaths in the world and has a Maternal Mortality Rate (MMR) of 178 for every 1 lakh live births. Six Indian women die every hour because they became pregnant and do not have access to healthcare. At least 80 per cent of India’s maternal deaths could be prevented if women simply had access to essential maternal and basic health-care services. According to the National Family Health survey-4 (2015-16) for Tripura, just 69.1 per cent of pregnant women deliver in public health institutions and only 1.2 per cent women who deliver at home have access to skilled birth personnel. An overwhelming 98 per cent of home deliveries are conducted without assistance. Additionally, ALL (100 per cent) children born at home in Tripura miss out on the crucial visit to a health facility within 24 hours of their birth. Despite over ten years of the National Health Mission and myriad maternal and child health schemes, the state has failed to provide full antenatal care to pregnant women in Tripura. Out-of-pocket expenditures for antenatal care, delivery services, and post-natal check-ups constitute a major barrier to institutional delivery in Tripura. The NFHS-4 shows that women in Tripura regularly spend Rs 4,000 to Rs 7,000 per delivery in public facilities. The poorest women in Tripura cannot afford to deliver in government hospitals. This petition noted that under Janani-Sishu Suraksha Karyakram (JJSK), both the pregnant women and also the women who deliver child as well as others covered under the scheme need not to bear expenses for diagnostics, medication, transportation etc. The central government had come up with JJSK to reduce maternal and infant mortality which was a goal of Reproductive and Child Health Programme under the National Rural Health Mission (NHRM). The said scheme envisages free and cashless services to pregnant women including normal deliveries and caesarean operations and also treatment of sick new born (up to 30 days after birth) in all Government health institutions across the State/Union Territory. Under the said scheme following are the free entitlement for pregnant women- (i) Free delivery (ii) Free caesarean section (iii) Free drugs and consumables (iv) Free diagnostics (Blood, Urine tests and Ultrasonography etc.) (v) Free diet during stay (up to 3 days for normal delivery and 7 days for caesarean section) (vi) Free provision of blood (vii) Free transport from home to health institution, between health institutions in case of referral and drop back home. However, the scheme is regularly violated in Tripura. Even though JSSK is aimed at eliminating a out-of-pocket expenditures, which are a major barrier to institutional delivery, the Tripura government’s memorandums related to implementation of JSSK ask women to pay extra fees for care during pregnancy and delivery. “In addition to creating a financial barrier to institutional delivery, Tripura’s JSSK policy places substantial administrative burdens on families who have to produce bills, receipts, and photocopies of driver’s registrations to receive compensation for delivery-related expenses. Individual stories highlight the immense financial, bureaucratic, and emotional burdens women face in attempting to access JSSK benefits,” the petition noted. HRLN confirmed, through fact-finding missions in the state that although JSSK had been issued by the Union of India, the state of Tripura had not implemented it in letter and spirit. The team found several women who were admitted to state-run hospitals for delivery and yet were forced to spend their own money to buy medicines and other consumables which were supposed to be free under the JSSK scheme. The petition argued that the state had thus violated the women’s fundamental right to life, health, equality and freedom from discrimination and women’s protection of access to medical services regardless of status. It thus prayed to the court to direct the state to revise Tripura’s JSSK policy to ensure free services and then, to publish information on the free JSSK entitlements. It also sought the court’s direction to the state to create a ‘grievance cell’ where women who have been charged for healthcare and delivery can apply for reimbursements. In response, the court disposed of the petition after directing the ‘State-respondents to implement in letter and spirit the clauses’ of the memorandum filed by the state.