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Empowerment of Village Health Nurses: Improving Mobility, Tamil Nadu
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Subject Area="Human Resources." Objective="Improved outreach services."
Details for Reform Option "Empowerment of Village Health Nurses: Improving Mobility, Tamil Nadu"
Summary

Background: One of the main problems of outreach services in the sub-centre area is an inability of the Village Health Nurses (VHNs - known in other states as Auxiliary Nurse Midwives or ANMs) to get around. Depending on public transport often makes it difficult for her to reach the villages. Private transportation is only available on main roads and does not reach out to the remote areas. Action: This started as a DANIDA-Tamil Nadu State Government project training 500 VHNs to ride a two-wheeler – either a moped or a bicycle - which had already been purchased with DANIDA loans but which were often being used exclusively by their men folk. It has now been extended to VHNs in three further districts in the State. The women are expected to purchase a moped using a private loan. The main features of the training are that it is given at a residential camp allowing freedom from domestic chores, with group learning in an all-woman set-up. Learners’ driving licences are provided and help given to enable them to obtain their permanent licence. Results: The resulting increased mobility has freed VHNs from relying on male family members for mobility and allows them to plan their activities on a more systematic basis. It has brought about a saving of nearly 50 to 60% of time spent on walking, waiting for buses etc. and allows VHNs to increase the quantity and to improve the quality of their service. Specifically they can now visit villages more frequently, cover a larger number of families, spend more time with each patient and be immediately available in case of emergency. Some of the VHNs feel that their mobility has also increased their status. An evaluation study was carried out by A. F. Ferguson & Co. in three districts, which had benefited by DANIDA mobility loans: in Dharmapuri and Krishnagiri districts (which received training) and in a control district Cuddalore (which did not). See report in Documents and Illustrations box.

Cost The cost of the state government loans for the two-wheelers was INR 15,000 per VHN. The state government no longer provides the loans and expects the VHN to get them privately.
Place Eight districts of Tamil Nadu between 1996 – 2003 under the DANIDA project. It has been extended to sub project districts of Madurai & Theni districts since 2001 and is now part of the regular training programme of VHNs. A modified 5-day programme is under progress in Vellore district with the funding support of UNICEF.
Time Frame Approximately seven months, which includes: Approval of the proposal by the funding agency: three months. Approval of the proposal by the state govt/allotment of budget: two months. To be done simultaneously: Discussion with the district officials for the selection of suitable training site: one month. Purchase of 12 two-wheelers and cycles: two months. Selection of resource persons for communication skills, driving trainers, mechanic for minor vehicle repairs: one month. Obtaining licences: one month. Three to 4 batches of 20 to 30 people can be trained per month.
Advantages

Time effective: Having fully mobile VHNs means that they use their time far more effectively and are able to reach remote areas more frequently. Training opportunities: The residential camp gives an opportunity for additional training. In this case, the VHNs were also taught additional computer, communication and gender awareness skills.

Challanges

Cost: The VHNs must be confident enough to take out a private loan to buy a moped. In addition one major limitation on the VHNs’ mobility still exists, and needs to be tackled, namely paying for fuel. Logistics: VHNs are still hindered by having to carry kit, negotiate difficult terrain or dangerous roads, deal with mechanical problems and ride wearing a Sari. Possible opposition: From male health colleagues who do not like to see the women empowered; older VHNs and the VHNs’ families who may view the initiative as unsuitable for a lone woman.

Prerequisites

Funding support & approval of state government. Site for training with suitable facilities including open ground for driving, class rooms and residential accommodation. Willingness of VHNs to participate in the training and purchase of two-wheelers after the training. Coordination with two-wheeler distributors and banks to facilitate the purchase of two-wheelers by VHNs. Negotiation with the transport authorities in the district to get the learners licence for the trainees and facilitating the trainees in getting the final driving licence. Resource persons, driving trainers, mechanics for the training period. Required number of two-wheelers and cycles (minimum of 12 two-wheelers and cycles) for training period.

Who needs to be consulted

Programme officers and policy makers. VHNs. VHN association office bearers. District officers. Resource persons.

Risks

Sustainability

If the training can be integrated within routine VHN/ Auxiliary Nurse Midwife (ANM) training and the funding is available, it becomes sustainable.

Chances of Replication

Good. Mobility training (on mopeds and bicycles) has now been included in the revised curriculum for “multi-purpose health workers” (ANMs) in Tamil Nadu and will benefit all the VHNs and their female supervisors in the entire state. The empowerment of VHNs programme has also been included in the second phase of the RCH programme which is scheduled to start April 2005.

Comments

The programme managers suggest that: Additional training in maintenance/ repair of vehicles and in driving on main roads should be included as a routine. A budget should be made available for fuel (between INR 280 – 420 per month) and for spare parts. The regulations relating to the wearing of a uniform Sari should be modified to allow the possibility of a Salwar Kurta. Having women trainers seemed to be a critical aspect in building confidence and the residential training was beneficial.

Contact

Submitted By

Sara Joseph, Researcher, ECTA, New Delhi. September 2004.

Status Active
Reference Files
PROD66.jpg VHNs with their mopeds
PROD66-1.jpg VHNs with their mopeds
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