It was noticed that most of the deliveries of the pregnant women in the informal sector were home deliveries and were conducted by Dais. In a study conducted by SEWA under the guidance of Director of Foundation for the Public Interest in the Gandhinagar district in 1990, it was realised that rural, illiterate, poor women from disadvantaged group have least access to modern medical care at the time of delivery and largely rely on dais as services provided by them are affordable, accessible and with in socio cultural norms. In that context Dais are well suited to provide primary health care in their community. It was noticed that dais often were widow women and poorly remunerated and their skills and hygiene were severely lacking in conduction of safe delivery of the pregnant women. Therefore, with appropriate skill up gradation and support through linkages with the formal health system, especially emergency obstetric care they can make significant contribution to the health care of poor.
In cooperation with State Institute of Health and Family Welfare, SEWA started informal training of the Dais in 1990-91. Training was conducted by government doctors and was attended by the dais as well as SEWA worker who were involved in the Dais training. Training was in two part, 15 days for theoretical training and 15 days for practical hands on training in Civil hospital. Training helped to sensitise the dais and community for safe delivery practices.
With rising demand for formal training amongst dais, SEWA’s Dai school was opened in 2000. An Advisory committee for the Dai School was set up consisting of three gynaecologists who developed the curriculum for the school alongwith the admission criteria and duration of the training.
Every batch which is enrolled at the Dai School undergo a training of three months consisting of three days per week. Training is imparted in a participatory manner combining modern scientific knowledge and the indigenous knowledge of dais. Besides the theory of human anatomy and physiology being imparted on a blackboard, utilization of IEC material like posters, charts, model of human body and practical demonstration of the use of fetoscope, counting the pulse etc. are an integral part of training.
After the three month training in the classroom, dais also undergo a two days practical training at SEWA Rural Jhagadia in Narmada district of Gujarat. It gives them an opportunity to observe deliveries in a hospital setting. At the end of the entire training, a panel of Chief District Health officer or District RCH Officer and a gynaecologist from the private sector conducts a viva-voce. According to their performance in the viva-voce, dais are assigned grades. The completion of training by these Dais is formally celebrated in order to provide recognition in the community. They were given white coat, dai kit, identity card and certificate.
Course curriculum included:
A) Antenatal Care- (
i) Pre delivery care
(ii) Identification of the danger signs
(iv) Detection of the ectopic pregnancy
B) Intranatal care: Include management during normal labour and early identification of any complication for prompt referral.
C) Post natal care: Include care of the mother and baby after delivery. Breast feeding, Birth spacing.
SEWA also developed a monitoring system for the work of Dais. SEWA workers visit the women who had been delivered by the trained dais and ask the procedure used by them. If they find that a dais has not followed some of the practices taught in the training, they make it a point to review those points in the follow up training. This is done without pointing any finger at the dais that have made the errors and it works as a reminder for the entire batch present at the follow up training.
With the successful completion of six batches in series, demand of the dais training has increased in other districts also. These training were conducted on door step basis i.e. separately in each taluka so that it become convenient for the dais to attend the traing course.
488 dais from six districts have been trained on scientific lines by a gynaecologist uptil now.
At present door step mobile dai training has been conducted in Gandhinagar, Ahmedabad, Mehsana,Sabarkantha, Anand, Kheda.
Dr. Anuradha Davey, Research Consultant, National Institute of Medical Statistics, June, 2006.