Table 1.

Themes and subthemes categorized as barriers and remedial measures for India’s Janani Suraksha Yojana program

Themes	Subthemes	Categories
At the health facility level (Receipt of adequate healthcare)	Inability to manage birth complications Referrals to private institutions Insufficient healthcare personnel, medicine, equipment, distribution of resources Vertical program structures and standalone nature of MCH program components	Barriers
	Budgetary revisions to increase efficiency Greater oversight to ensure availability of equipment, medicine, and medical staff Employing more staff Introducing feedback and review system Building intra and inter program linkages	Remedial measures
Linkages between home and health-facility (Timely transfer to health-facilities once the decision to seek health-facilities was reached)	Limited availability of drivers and vehicles Delays in transport arrival High cost of alternative transport Poor quality of roads Inadequate understanding and poor attitude/ behavior of service providers Rent-seeking by service providers from beneficiaries	Barriers
	Provision of alternative transport Creation of an emergency number Regular monitoring of ambulances Budgetary revision to strengthen transport facilities Training, motivation building of service providers	Remedial measures
At the community and household level (Decisions to use health-facilities)	Decision-making power mostly influenced by elders in families Misconceptions about home vs. institutional birth Negative previous experiences ASHAs: inadequate support and capacities	Barriers
	Identifying pregnant women through direct observation and household visits Counselling services during prenatal, delivery, and ante-natal check-ups Awareness campaigns Counselling targeting male family members Utilizing media (e.g. radio, and TV) to provide reliable program information Strengthening ASHA support mechanisms	Remedial measures