Strengths, Weaknesses, Opportunities, and Challenges of Conditional Cash Transfers Under the Janani Shishu Suraksha Karyakram in India: A Narrative Review.

Abstract

<h4>Background</h4>Janani Suraksha Yojana (JSY), a scheme launched by the central government of India, aimed to reduce maternal mortality by incentivizing institutional deliveries through conditional cash transfers (CCTs). An expansion to this initiative, the Janani Shishu Suraksha Karyakram (JSSK), incorporates free maternal and neonatal services. However, despite reported progress in improving access, questions remain about program efficiency and equity. This review synthesizes evidence on the strengths, weaknesses, opportunities, and challenges (SWOC) of the JSY/JSSK CCT component of the scheme.<h4>Methods</h4>A narrative review of 19 studies on the cash transfer component of the Janani Shishu Suraksha Karyakram (JSSK), published between 2009 and 2025, was conducted using PubMed, Embase, and Google Scholar. Studies were thematically analyzed to assess CCT-related implementation, equity, quality of care, and health outcomes.  Results: Strengths include increased institutional deliveries and improved access among marginalized populations. Weaknesses involve payment delays, persistent out-of-pocket expenses, and uneven quality of care. Opportunities include expanding incentives across the continuum of care, leveraging technology, and integrating with other schemes like PMMVY and Namo Shree Yojana. Challenges include regional disparities, implementation variability, and uncertainty around long-term behavioral change.<h4>Conclusion</h4>While the JSY/JSSK CCT component has improved service uptake, its full potential requires stronger implementation, inter-scheme coordination, and quality assurance. Policymakers should prioritize equity, accountability, and integration to enhance maternal and newborn health outcomes.