Original Research Article Indian Journal of Obstetrics and Gynaecology Research 2016;3(1):1-6 1 Awareness and determinants of utilization of “Nischay Yan Scheme” free assured referral transportation services in rural part of West Bengal-India Amitabha Dan 1,* , Bhatnagar Tarun 2 , Achhelal Pasi 3 , M Jalaluddin 4 1 Joint Director Public Health, 3 Asst Director Public Health, 4 Medical Officer, APHO Mumbai 2 Scientist D, National Institute of Epidemiology, Chennai *Corresponding Author: E-mail: mumbaiapho@gmail.com Abstract: Background: National Rural Health Mission introduced ‘Nischay Yan’, a free assured referral transport, since 1 st April 2011 in Nadia district, West Bengal, India to reduce neonatal mortality rate (NMR). We conducted a cross sectional study to estimate the prevalence of awareness and utilization of the scheme along with factors associated with its use in mothers and to describe the strengths and gaps in the scheme. Method: A total of 575 mothers of children born between 1 st July and 31 st December 2011 in 23 clusters were surveyed. Univariate and multivariate logistic regression was done to study the determinants of awareness and utilization of Nischay Yan services. Result: Out of 575 mothers, 77.9% were aware of Nischay Yan and knew the number 102.Majority of the mothers (96.9%) got the information from ANM and ASHA. Only 187 of 575 (32.5%) mothers had availed the services of Nischay Yan. Of the187 mothers who availed Nischay Yan, 164 (87.7%) utilized it for delivery and 23(12.2%) for the purpose of neonatal care. ASHA escorted only 42 (22.4%) of 187 mothers. Of the187 mothers who utilized Nischay Yan, 77% availed the ambulance from doorstep and (82.4%) had to wait up to one hour to get the Nischay Yan. Half of 187 mothers reached a facility in two hours. One hundred seventy one (44%) of 388 mothers did not utilize Nischay Yan because of non availability of the ambulance. On Univariate analysis mothers characteristics such as age (OR=2.9, 95% C.I=1.8 -5.1), living in nuclear family (OR=1.7, 95% C.I=1.03-2.8), Knowing the telephone number102 (OR=43.9,95% C.I=4.7-410.3), Knowing the danger sign for referral of pregnant woman(OR=6.5, 95% C.I=3.01-14.07), having three antenatal check-ups (OR=21.9, 95% C.I=2.2-219.5) and Possessing functioning mobile or landline phone (OR=12.44, 95% C.I=1.3-112.4) were significantly associated with use of Nischay Yan. Conclusion: Majority of the mothers were aware of Nischay Yan scheme while only one third utilized it. Mothers who knew the number 102 and had functioning telephones were more likely to use Nischay Yan ambulance. Major cause of non use of Nischay Yan was non-availability of ambulance. The ambulance density was adequate as per programme but less as per requirement. Keywords: Ambulance, Nischay Yan scheme, Neonatal Mortality, Awareness, Nadia and West Bengal. Access this article online Quick Response Code: Website: www.innovativepublication.com DOI: 10.5958/2394-2754.2016.00001.1 Introduction Globally an estimated 130 million babies are born each year and about 4 million of them die in the neonatal period 1-3 . India carries the highest single share of neonatal death in the world that amounts to a quarter of the global neonatal deaths 2,4 . Neonatal mortality accounts for half of all the deaths in all under-fives. India’s population policy had set a goal of achieving Neonatal Mortality Rate (NMR) below 20 per 1000 live births by 2010. Neonatal mortality rate in India was 35/1000 live births in 2009 accounting for 0.94 million deaths. The Infant Mortality Rate (IMR) in India has remained high consistently since the early nineties, mainly due to minimal reduction of neonatal mortality compared to achievements in post neonatal mortality 5,6 . The United Nation’s Millennium Development Goal (MDG) - 4 calls for the reduction of under-five mortality rate by two-thirds between 1990 and 2015. In a country like India where over three-fourths of births and most deaths take place at home, 7,8 reaching out to the mother and neonate at home and transporting a sick mother or newborn to an appropriately equipped health facility is key for their survival. Critical delays in receiving appropriate care include delay in decision making and seeking care in reaching the facility due to long distance to the facility coupled with non-availability or un-affordability of transport. 7,9-12 Studies show that shortened inter-facility transport time leads to improved outcomes for the smallest and most critically ill neonates. Medical transport of this high-risk and critically ill population requires skilled personnel and specialized equipment. 13- 15 Emergency referral transport are already in place in India e.g. GVK EMRI in 10 states, Khunti model in Jharkhand, Deepak foundation in Gujrat,Mritunjoy108 in Assam, Saving life on wheel in MP. In all 33% referral transport is for mother and neonate 12 . West Bengal has an IMR of 33 per 1000 live births 16 but the rate of decline has stagnated since 2003.