The ANMs are the pivot of peripheral health care services.
There is not much head way in reducing the maternal mortality
rate and infant mortality in past few decades. One of the
reasons is low competence of many ANMs in conducting safe
deliveries, identifying maternal and child hood complications
and defunct referral system. The root cause behind this
problem lies in the basic training of ANMs.
The
ANM training schools follow an old curriculum, which was
prepared in 1977 and part of it is not very relevant today.
Lot of time is spent on theoretical aspects of subjects
like anatomy, physiology, biochemistry, psychology etc.
The practical component of the course is weak. During their
posting in district hospitals, the trainees are most utilized
for daily chores of the wards like bed making, administering
drugs to indoor patients etc and the trainees are not given
sufficient opportunity to conduct deliveries due to vested
interest of the posted staff. During the field visits of
trainees, the supervision is inadequate. There is no training
on preparing reports and returns. The tutors in most of
the schools are old and from nursing background. They do
not have any experience of working in the field. Most of
the tutors are not interested in teaching midwifery, as
they have never conducted the deliveries. The teaching methodology
used by these tutors is very old i.e. didactic lectures,
which are not effective. Under these circumstances it is
difficult to prepare competent ANMs.
A
number of training programs are organized in health sector
to update the health care functionaries but the tutors from
ANM training centers are generally not involved in these
programs. The tutors require training on pedagogy as well
as on subject matters.
It
is proposed to redesign the ANM basic training curriculum.
This would involve carrying out a rapid social assessment
in selected areas to identify the immediate health care
needs of the community. This would be corroborated with
the available data from RCH, NFHS or other sources. Thereafter,
through a series of workshops with stakeholders i.e. ANMs,
supervisors, medical officers, community leader, and experts
the training needs of ANMs would be determined and accordingly
a more relevant curriculum would be designed. It would of
course require approval of the nursing council that could
be pursued. Besides the curriculum, the Institute of Health
Management Research, Bangalore can also develop the modules
for the basic ANM courses.
