Details for Reform Option "Revision of Auxiliary Nurse Midwife Curriculum, Rajasthan."
The Auxiliary Nurse Midwife (ANM) is one of the main agents for increasing the utilization of health and family welfare services in India. However despite the changing face of medicine and healthcare needs, the ANM training curriculum prepared by the Indian Nursing Council in 1977 has never been reviewed. As a result, in 1996, State Institute for Health and Family Welfare (SIHFW), Jaipur, decided to give the basic training of health workers a facelift.
In early 2003, under the European Commission-funded Health and Family Welfare Sector Investment Programme, the Government of Rajasthan asked SIHFW to review and revise the existing basic training curriculum in tune with the changes in epidemiology of disease and needs of the population.
Workshops were organized to deliberate on the existing curriculum and the changes required in the context of the changing epidemiological landscape. The workshop was attended by in-charges of the District Training Centre (DTC)/ Auxiliary Nurse Midwives Training Centres (ANMTCs), the president of the Rajasthan Nursing Council, a representative of State Government and the faculty of SIHFW and experts in community health.
Monitoring visits were also made to DTC/ANMTCs by SIHFW faculty.
SIHFW thoroughly reviewed the syllabus of the ANM course and found it to be quite comprehensive. But because of the changing circumstances, it felt there was an immediate need for micro-planning of the curriculum.
The revised curriculum has re-distributed the duration for theory, hospital-based and field-based training without changing the total duration of the 18-month course. The basic purpose of the revision of the curriculum was to update the information, knowledge and approach according to the present needs (change in epidemiological situation, disease pattern, approach to the client, programs, policies and rules etc.). The curriculum addresses these issues largely rather than changing the teaching approach. Therefore the teaching schedule /slots have not been changed.
Another workshop was then organized by SIHFW, Jaipur, to put forward its recommendations before State and National level experts including the Nursing Council of India Secretary before sending it to Government.
SIHFW has presented the revised ANM curriculum to the Government of Rajasthan (GoR) for endorsement. Unfortunately, Nursing Council of Rajasthan and Nursing Council of India did not agree to recognize the revised curriculum as they said that the revision in the curriculum is the prerogative of Nursing Council of India not the Department of Medical, Health & Family Welfare, GoR or any other institute i.e. SIHFW. Hence, it could not replace the existing one. However, GoR has accepted the revised job description of ANMs and also already endorsed the curriculum and asked the ANMTCs to use the revised ANM curriculum
Alternatively, DoMH&FW, GoR decided to teach their ANMs as per the existing curriculum. But the revised one will also be taught to them as an additional input for further development of their knowledge. However, the examination paper will not cover the revised syllabus. The GoR has now asked SIHFW to review and update the job responsibilities of all the existing technical human resource of health sector including ANMs. SIHFW organized workshops by involving various levels of officers to chalk out the responsibilities of ANMs.
Rs 8.475 lakhs given to SHIFW for the revised ANM curriculum, for the Training policy development and for the Revised job responsibilities.
Review the ANM curriculum- 10 months.
Getting it endorsed by government - 6 months.
Quality of training: Improved and up-to-date training given to students.
Service delivery: Better trained staff should result in improved health care delivery.
Transport difficulties: Lack of vehicles makes it difficult for the students to go to field and clinical sites.
Environment: Medical and nursing staff at hospitals are often uncooperative in providing practical “hands on" training to students.
Upgrading Training Centres: The training centers are also not updated and equipped with the modern teaching aides. Refresher training of faculties is not being conducted regularly and properly. There is a need to have regular staff for the Training institutes and proper infrastructure. The staff also need regular capacity building to improve their knowledge and skills
Recognition: Nursing council needs to endorse the ANM curriculum to give it status.
State Government and Nursing Council of Rajasthan must endorse the revised ANM curriculum to pave the way for a long term reform in Rajasthan.
Qualified teaching staff at the training institutions.
Sufficient teaching aids and stationery.
Transport to ensure field and hospital visits by students.
Hostels with mess facilities at each training institution.
Hospital administration and staff willing to facilitate student training.
Government orders endorsing the ANM curriculum.
Who needs to be consulted
Director SIHFW, Jaipur.
Director Public Health, Rajasthan.
Nursing council of Rajasthan and India.
Sustainable if the curriculum gets endorsement by the nursing council can be considered as teething problems.
Chances of Replication
Replicable if the programme planers and policy makers understand the necessity for introducing revised ANM curriculum which is based upon the latest changes in epidemiological situation, disease pattern, approach to the client, programs, policies and rules etc.
The job responsibilities of ANM drafted out by SIHFW does not provide any insights into what minimum facilities will be available to them to carry out their work effectively.
Dr. Nandini Roy, HS-PROD Consultant, NIMS, January 2006.