Janani Express is a low cost solution to the lack of emergency transport. The program was designed by the state's Health Department program components were adapted to the local conditions and cultural context of Orissa, including empowering local NGOs and decentralizing the system by contracting at the district and block levels. Because the project is capital intensive and involves huge operating expense, it was decided to contract local NGOs to operate the ambulance network at a lower cost. This is meant to also encourage activity in the state's NGO sector while allowing the government to focus on monitoring, policy and planning. Tenders were invited from NGOs providing the vehicle specifications and criteria; the lowest bid was accepted and shortlisted. The lowest bid in various cases was about Rs 15,000/-. The NGO operated vehicles are contracted for a period of one year; that contracting can be extended year to year. The NGOs are paid 15,000 Rs per month to manage and operate the vehicles.
Transport is made available in the Government Hospital's are of operation, effective communication is established with ANM, AWW, ASHA, Hospitals, etc. Leveraging the fact that 80% of the villages in Orissa have a mobile network, the contractual driver is equipped with a mobile phone (at a cost of about Rs 250/- per month). The contact number of the hospital, driver and doctor is displayed on the vehicle, and “Janani Express” in English and “Janani Surakhya Bahini” in Oriya is written on both sides of the vehicle.
Under the program, emergency transportation services are provided free of cost to all pregnant women, women after delivery, sick neonates, and infants (below 1 year).
Incentives & Penalties
The program provides incentives for better performance: Rs 10/- for each additional case beyond 50 patients/ month with a minimum mileage of 1500 km, and Rs 20/- for each additional case beyond 100 patients/ month with a minimum mileage of 2500 km. The distance component was added to encourage drivers to travel to remote villages. Paying fuel expense for actual distance traveled as opposed to a fix sum per trip has also been advantageous as it encourages the driver to go farther distances without the fear of losing money.
Monitoring is decentralized to the block level and monitoring is performed by the Roki Kalyan Samithi’s of the Community Health Centre, which comprises representatives of local residents, including elected members. Rogi Kalyan Samitis also play a key role in all issues including contracting, providing fuel, monitoring and paying incentives.