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Community Midwives Programme, Uttar Pradesh
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Subject Area="Public / private partnership (including NGOs)." Objective="Improved outreach services."
Details for Reform Option "Community Midwives Programme, Uttar Pradesh"
Summary

Background: One third of all deliveries in Uttar Pradesh are by untrained providers and patients have to travel on average further than in any other state in India to reach a delivery centre. There are insufficient numbers of Auxiliary Nurse Midwives (ANMs) and the existing ones are overworked. As a result there is a high maternal mortality rate MMR (707/1,00,000 live births) and infant mortality rate IMR (82/1000 live births). Action: State Innovations in Family Planning Services Agency (SIFPSA), with funding from USAID and technical assistance from PRIME/IntraHealth, have established a new cadre of private community midwives in rural areas. To do this they recruited 239 women aged 18 to 35 and educated to a minimum 10th class pass, to train as community midwives (CMWs) at government training centres over a period of 18 months. The CMWs are then expected to go back to their communities and set up in private practice. The programme included: (i) Developing an 18-month training curriculum for CMW trainees and their trainers using the existing ANM training and adapting to meet international standards. (ii) Assessing and improving existing training centres. (iii) Training master and district trainers, mentoring these trainers and assessing their performance. (iv) Developing a business management module for CMWs. (v) Developing post-training certification by the State Nursing and Midwifery Registration Council (SNMRC). (vi) Providing logistical support for clinic set-up plus key equipment at completion of course. Results: The CMWs who passed the course were due to set up in their communities from September 2004. Four ANM Training Centres were strengthened. UP State Nursing Council has recommended that the developed curriculum be used for all its ANM training.

Cost INR 83,070 per trainee: although this figure includes the cost of strengthening the centres which is a one-off cost.
Place Uttar Pradesh: Varanasi, Sitapur, Agra and Meerut. First course ended August 2004.
Time Frame One year.
Advantages

Qualified: Uses the GOI-approved basic health worker syllabus so that CMWs are certified into an approved health care cadre. Comprehensive training: Course includes practical, on-the-job training as well as a business management plan. Improves training for all: Improves existing training centres to benefit a wider group. Extends healthcare cover: Adds a qualified provider in places where there is no ANM.

Challanges

Introduces user fee: CMWs must convince the community of the need to pay for services which they are entitled to free-of-charge from ANM. However no CMW was set up in a village with a sub-centre or ANM coverage. Limited expertise: CMWs still not trained in advanced midwifery skills so do not have the capacity for improving emergency obstetric care such as antibiotic injections, IV fluids and oxytocine. Lack of incentives for trainers: ANM tutors were not additionally compensated for training and were therefore very unmotivated. New, unfamiliar scheme: Means CMWs need the respect of doctors and ANMs (where the community respects their ANMs) to gain the trust of the community.

Prerequisites

Co-operation of state government and the SNMRC. Strengthening of ANM training centres before the course begins. Training package for trainers and curriculum (available from SIFPSA). A business plan for CMWs.

Who needs to be consulted

State government and SNMRC. ANM training centres. The community.

Risks

Sustainability

As yet unknown. Training depends on funding availability and the cooperation of the state government who part-funded the upgrading of training facilities (INR 2.5 Crore).

Chances of Replication

To date unknown. The project’s success will largely depend on the progress of the first cadre of CMWs. USAID and SIFPSA will be monitoring this.

Comments

A number of lessons were learnt/recommended from the first course: (i) the selection criteria for CMWs must be strong and give a bias to those with health service experience. Recommendation that they pay a deposit for the course ensuring they do not drop out, repayable after they serve their community for a certain time. (ii) community should be involved in selection process and the applicant’s residency there should be verified by an independent authority. (iii) CMWs should be re-certified every two to three years to ensure on-going quality of service.

Contact

Submitted By

Clare Kitchen, Research Consultant, ECTA, New Delhi. September 2004.

Status Active
Reference Files
CMW Delhi report-final.doc
Community Mid Wives Program.doc
Scope of Work of CMWs.doc
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