ARTH provided support to 2 NGOs of Rajasthan – SRKPS in Jhunjhunu and Shiv Shiksha Samiti in Tonk to provide 24*7 maternal and child health services centred on nurse midwives. Each health center was providing services to a total population of approximately 20,000.
ARTH provided the following support:
- Skill based training to nurse midwives and NGO managers (12 and 8 weeks).
- Supplied checklists, clinical management formats etc
- Supplied list of medicines & equipment, formats for registers, job aids (e.g. ANC card, labor form, child health card), MIS formats, tools for drug & financial management etc.
- Refresher – review meetings with NMs & NGO managers
- Guidance on managerial and programmatic issues, including detailed standard operating procedures for running and managing the health centres
- Training materials including training manuals, pictorial booklets for VHW training
- Site visits
Between April 2008 and March 2010, these centres have seen 14411 patients in OPD and 5573 patients in field clinics. Of these client visits, 62 % were women’s care. Additionally these health centres have managed 612 deliveries.
The experience with these NGOs demonstrates that it is feasible to provide a package of services through nurse-midwife operated health centres, especially 24*7 delivery services. Models like these prove that NGOs not headed by medical persons can also manage health services, however they need adequate technical and programmatic support in initial years. In such models, economies of scale can be realised, by applying the norms of a revenue model. These models are an alternative to gynaecologist and doctor driven MNH service models. They demonstrate value-added roles for midwives (ANMs & GNMs) and contribute to the discourse on skilled attendance.