Strengthening Pre-service Nursing and Midwifery Education in Udaipur Division of Rajasthan (2011-2014)
ARTH in partnership with UNFPA and Department of Medical, Health and Family Welfare, Government of Rajasthan worked to strengthen pre-service education for nursing and midwifery cadres in 5 districts of Udaipur zone in the state of Rajasthan. The project covers 5 ANM and 2 GNM training centres at Banswara, Dungarpur, Chittorgarh, Rajsamand and Udaipur and aimed to improve the educational and clinical skills of nursing faculties of ANM/GNM training centres and strengthen attached clinical practice site by upgrading the clinical training capacity of the service providers. ARTH named the initiative as “Kushal project”, meaning a project to improve training and clinical skills. A Quality Improvement (QI) team conducted the baseline survey covering 5 broad areas viz. This was done according to allotted standards and gaps were identified within the training facilities. After identification of gaps, separate action plans were developed at the three levels viz. school, district and state level. Results: The project findings indicated marked improvement in the teaching methodology with improved infrastructure in terms of skill-labs, computer labs and library facilities. Additionally clinical practices in service sites showed considerable improvement followed by better maintenance of records both at the teaching and non-teaching levels.
School of Midwifery Practice & Training in Primary Health Care (2007 onwards)
ARTH has been working as a technical resource agency since 1997. It has periodically conducted training courses for government ANMs, doctors, and programme managers of NGOs. Since 2007, ARTH has consolidated its role of providing technical assistance and training by establishing the School of Midwifery Practice & Training in Primary Health Care. The broad objective of the school is to equip primary health service providers, managers and organizers from the non-profit and government sectors, including ARTH’s field team to improve the delivery and utilisation of primary health services in rural Rajasthan. ARTH has expanded its training infrastructure and faculty. A training centre has been constructed 20 kms from Udaipur city. In order to facilitate training of various levels of personnel, ARTH has developed a variety of training materials, such as a facilitator guide for trainers of nurse-midwives on maternal – newborn care and several pictorial materials for village level health workers/ASHAs. Training programmes have been held for various cadres of people working on reproductive and child health issues – senior NGO managers, doctors, programme supervisors, nurse midwives, village health workers and their trainers etc. Since its inception in 2007, the school has trained 217 SBA trainers from various parts of Rajasthan (these include nursing tutors from ANM and GNM training centers, staff nurses from teaching hospitals, labour room in-charge from district hospitals/ CHCs/ referral hospitals). In 2009-10 we conducted a training of nurses (on issues of contraception, RTI/STI, breast & pelvic examination, safe abortion, infection prevention, IMNCI) from 3 NGOs of Rajasthan that are running rural health centres. We conducted 2 training programmes on reproductive rights and safe abortion in which 59 field level supervisors from 31 NGOs participated. We also conducted an orientation-training course on primary health for the field supervisors of 2 NGOs, one of whom ARTH provided technical support to implement health interventions in its field area. Young men and women living in the rural-tribal interiors rarely get to enter medical and nursing schools, hence health care in these areas is delivered largely by “outsiders” that are reluctant to live and work in a marginalised area. Yet the health needs of these areas tend to be greater than average. Recognising this, in 2016, ARTH launched training of “Skilled Health Assistants” with a first batch of 9 locally resident school educated women enrolling for an intensive 3 month course to become Midwifery Assistants and counsellors. The course curriculum was meticulously designed and delivered by the experienced nurse-midwives and doctors making use of experiential learning methods, training aids and practical demonstrations through dummies and bedside training. After a rigorous examination, 8 students were declared successful and assigned to the two rural health centers by rotation. As of September 2024, we have successfully trained ___ SHAs, some of whom work in ARTH’s three health centres and others have moved on to other professions.
Strengthening government efforts to implement the MTP Act in districts of Rajasthan (2007 onwards)
ARTH is one of the eight members of the Consortium for Safe Abortion in India, which works towards increasing access to legal, safe and comprehensive abortion care services in the public health system, focusing on the rural poor. In October 2006, ARTH worked with the Medical, Health and Family Welfare Department, Rajasthan to “assist it on systemic, resource, administrative and legal issues to increase access to safe and legal abortions in the public and private sectors”. Data was collected from all the districts of the State to review the status of implementation of the MTP Act in the districts. Data on MTP certification process, MTP reporting, currently available MTP trained providers, functioning of the district level MTP committee and status of PCPNDT implementation was collected. The collected data was used to plan measures along with the State government to improve access to safe abortion services within the provisions of the MTP Act. Data from April 2007 to March 2010 was collected, compared and documented, and shared with the Department of Medical Health & Family Welfare, Government of Rajasthan. An MIS for reporting about MTPs at district level and from district to state headquarters was developed. Besides supporting and advocating with the government sector, we did a series of workshops with NGOs. Till March 2010, 3 residential trainings and 5 one-day trainings with local NGOs were conducted. We prepared a series of posters, brochures and a documentary film on the issue of safe abortion and sex selection to strengthen the advocacy campaign.
Establishing a system for reviewing maternal deaths, using verbal autopsy technique in Udaipur district of Rajasthan (2007-08)
The District RCH Society of Udaipur in collaboration with ARTH undertook a study to establish a system for identification and review of maternal deaths. The Medical, Health and Family Welfare Department, Udaipur conducted verbal autopsies of maternal deaths in two blocks of the district. At the same time ARTH conducted verbal autopsies in two other blocks of the district using a “gold standard” method that picks up all maternal deaths in the study area during a given time period. The study was carried out from December 2006 to November 2007. The MAPEDI questionnaire (UNICEF’s questionnaire for Maternal Perinatal Death Inquiry) was used to conduct the verbal autopsies. These two study approaches were adopted in roughly equal populations across the four blocks — in the blocks covered by the health department, which relied on the civil registration system, 9 deaths were picked up, while 57 deaths were picked up in the blocks covered by ARTH, which relied on a range of key informants, e.g. ASHAs, ANMs, Anganwadi workers. In the data collected by ARTH, 36% women died at home, 41% died in a health facility, while 19% died during transport. 16% women died during pregnancy, 18% due to abortion related causes and maximum 66% died in the post-partum period. Among key informants, maximum maternal deaths were reported by village level female workers – ASHA, Anganwadi worker, Anganwadi sahayika.
Supporting NGOs for providing maternal-newborn related health services (2003-2010)
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: 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.
Technical assistance on RCH initiatives to 8 NGOs of northern Rajasthan (2001-02)
ARTH provided technical assistance to enhance the capacity of a network of eight field based NGOs implementing community based reproductive and child health programmes in rural areas of northern Rajasthan. Series of field visits and orientation meetings were organised to assess the NGOs’ organisational needs and to foster consensus among them on maternal health programme approaches. ARTH helped them in implementation and maintaining MIS. Key activities undertaken: