In January 2019, researchers from the Centre for Maternal and Newborn Health (CMNH) and the Foundation for Research in Community Health (FRCH) presented the results of an operations research project at a dissemination meeting in Mumbai, India. The project aimed to strengthen the capacity of Auxiliary Nurse Midwives (ANM) to provide the continuum of care for mothers and children in Pune district of Maharashtra State, India.
This collaborative project was conducted between January 2017 and August 2018 with funding from the HT Parekh Foundation and approval of the Government of Maharashtra. The project was implemented in three phases:
Phase 1: Baseline assessment to identify factors influencing ANMS in their practices and scope of work.
- This confirmed that ANMs have an important role in the delivery of health care in India. However, the training and supervision that they receive are inadequate to address their current responsibilities and their ability to take on additional responsibilities in the future.
- The baseline assessment was followed by extensive consultations to address the expressed needs for top-up training for ANMs in maternal and newborn healthcare. With inputs from experts in India and UK, a standardised 4-day ANM training package and supporting materials for facilitators and participants were developed.
Phase 2: Implementation
- 38 health workers in Pune were trained in two Training of the Trainers courses. These selected trainers then trained 347 ANMs and their supervisors in Pune district. The quality of the training sessions was assured by quality assurance visits by the CMNH volunteers.
- Knowledge and skills testing were conducted before and immediately after the training sessions covering knowledge and selected skills in maternal and newborn care. The results showed an overall improvement in post training scores, with more than 90% increase in all the skills test, except the partograph skill test which had an increase of 77.4%.
- In addition to the training workshops, four self-directed learning strategies were built into the project to enhance the confidence and knowledge and skills of ANMs: skills malls where ANMs could practise skills, exposure visits to centres practising evidence-based maternity care, bi-annual newsletters and participation in national conferences.
Phase 3: Evaluation at the end of the project to document the perspectives and experiences of those involved.
- The evaluation found that the project was recognised by state and district officials as being relevant to the needs of ANMs to provide quality care and fill an important gap in the district’s capacity building plans for this cadre, in terms of building their practical skills and revision of their knowledge.
“We were taught about shock management, ‘anytime anywhere’, now we can do it at our level with whatever material we have.” (An ANM involved in the project)
Based on the research findings, the team made four recommendations to strengthen health workforce in the Primary Health Centres (PHCs) in the district:
- Sustain capacity building of ANMs and Lady Health Visitors (LHV) through periodic refresher training of ANMs, LHVs and their trainers to achieve 100% coverage at district level
- Build team capacity in Primary Health Centres and strengthen supportive supervision at the district level
- Ensure availability of medicines, supplies and equipment
- Strengthen leadership and governance in PHCs
These recommendations were presented to 45 stakeholders including government officials and representatives from funding agencies who attended the meeting.
The CMNH is now continuing to work with the FRCH and the Government of Maharashtra to scale up this project to other districts in the state considering the findings and recommendations from the pilot project.
Dr Helen Allott, Senior Technical Officer at CMNH:
“It has been a great privilege to be involved in this project. Auxiliary Nurse Midwives are the first port of call for many pregnant and labouring women, especially in rural areas. Many of the ANMs expressed concerns about managing unanticipated obstetric or neonatal emergencies prior to the training. It has been wonderful to see how they have grown in confidence and how the standard of care they provide to women, both in terms of improved technical and communication skills, has developed throughout this programme.”
Professor Matthews Mathai, Chair in Maternal and Newborn Health at CMNH:
“The training package addressed the expressed needs of the ANMs in Pune district. These ANMs were keen learners. Some ANMs shared their experiences in the dissemination meeting and explained how training had contributed to better care for women and children. The project also created a pool of trainers in Pune which could be utilized in future capacity building activities in Maharashtra state.”