Improving the quality of care provided by auxiliary nurse-midwives in India

News article 21 Jul 2017
ANMs in Pune

Semi-skilled health workers have been providing health services effectively in high, middle and low income countries. Evidence from global research suggests that semi-skilled health workers contribute to improving the health of populations. 

Particularly, in low and middle income countries where there are shortages of human resources, the role of semi-skilled health workers in providing services is indispensable. However, increase in coverage of services may not result in better outcomes if the quality of care provided is not satisfactory. Effective strategies to improve the quality of care provided by semi-skilled health workers have the potential to improve maternal and child health outcomes.

CMNH and the Foundation for Research in Community Health are currently working together on a project to improve the quality of care provided by auxiliary nurse-midwives (ANMs) in the Pune district of Service provision by auxiliary nurse midwives in IndiaMaharashtra State, India. ANMs are a vital part of the primary health services. ANMs are desperately needed in the context of India because the existing health services cannot meet the health needs of the population. The Indian government has for long invested in ANMs to provide care during and after pregnancy and childbirth and to provide basic curative and preventive child health services. Yet, over time, the ANM’s role has expanded with less focus on maternity care.

Furthermore, although ANMs have been used for decades as frontline workers, they often stand unsupported at the fringes of the Indian health system, and thus unable to fulfil their full potential in catering to the primary healthcare needs of the population.

Our recent scoping activities in Pune aimed to identify factors that enable or hinder ANMs in their practice, to understand their scope of work and to identify what works where and how. We also tried to understand if and how this cadre can be supported in future to make an effective contribution to the delivery of healthcare for women and children at the primary level in India.

What are our findings?

ANMs have played a pivotal role in the primary health care within the district. ANMs are an indispensable asset to the primary health services. However, there are missed opportunities as the full potential of ANMs has not been utilised. For example, in the remote, poorer areas of the Pune district, women have not benefited in the same way as those in urban settings. In the remote areas, ANMs did not have the necessary skills to provide quality services - mostly due to lack of regular, refresher training to update their knowledge and skills. 

What is next?

Following our scoping activities, we are working with the government of Maharashtra State to improve the quality of work of ANMs through various activities. These include focussed training of ANMs and their supervisors depending on gaps and weaknesses identified, strengthening supportive supervision and accountability, and empowerment through learning. We anticipate that through this approach, ANMs will be enabled to fulfil their full potential to address the primary healthcare needs of the population.

Have you supported such cadres in similar contexts? What are your experiences?

About the Author 
Dr Thidar Pyone is a Clinical Research Associate at CMNH, with interest in health system governance, health system and policy research and public health evaluation.