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(CBFPT: Quality
Services Certified)
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Efficient delivery of services by the
female health worker at the village level, is the cornerstone
of a successful reproductive & child health programme.
Many studies show that practices followed by female health
workers leave much to be desired. The quality standards
are often low, particularly for intra-uterine contraceptive
device (IUCD) insertion procedures & infection prevention
practices. Often female health workers did not screen
or counsel clients before providing IUCDs. In addition,
many workers did not use proper techniques for insertion,
resulting in high expulsion rates and rising concerns
about the acceptors' health. |
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These insights led to the development
of a project that provides Clinic Based Family Planning
Training (CBFPT) to female health workers or ANMs and
their supervisors, the lady health visitors (LHVs)
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Strategic Site Selection
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The first step was to identify training
sites. The criteria for selecting a training site were
the presence of a lady medical officer, availability of
clients and facilities for classroom training. In addition
to the lady medical officer at each training site, a public
health nurse or a lady health visitor was identified to
serve as a trainer at each site. |
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All trainers identified were trained
in a two-week special training of trainers' programme
at selected medical colleges and district women's hospitals.
During this course they received updates on contraceptive
technology, IUCD insertion & removal techniques, clinical
practices and training skills. |
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Hands-on Approach |
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Each team, of one woman medical officer
and a public health nurse, trains four ANMs in a week-long
programme, which includes hands-on practice of IUCD insertion
on a pelvic model first and then on clients. Interactive
role plays on client management help the participants
improve their counseling skills and inculcate in them
the ability to discuss clients needs and offer services
according to the clients choice. |
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Training is also given on infection
prevention to enhance knowledge and practice of disinfection,
decontamination and sterilization of instruments and surfaces.
The staff of the Regional Health and Family Welfare Training
Centre (RFWTC) observes the training to facilitate on-the-job
follow up later. |
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Quality Services Ensured
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Health Sub-centres are upgraded by providing
the required equipment and infrastructure, simultaneously
while the training is going on to ensure that they are
fully equipped for the ANMs to provide services. Sub-centres
running in rented buildings are trained for adequate space
and shifted if space is inadequate. The trained ANMs are
given IUCD kits and other supplies essential for efficient
service delivery. |
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A system of follow-up of the trained
ANMs by staff of the RFWTC is also in place. The staff
of RFWTC verifies and certifies whether the ANMs are performing
to standard with respect to IUCD handling, insertion and
counseling, one month after the training and again six
months later.4678 ANMs & LHVs have been trained so far
to provide quality services in 20 districts. In addition,
a strong resource of 253 trainers has also been developed
in these districts. |
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Efforts Successful |
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Evaluation of the CBFPT projects carried
out by an independent agency has shown extremely positive
results. The number of ANMs performing to standard was
33% higher than the expected level. 93% of the sub-centres
had adequate space and met the quality standards as against
the expected level of 84% while 76% of LHVs were performing
supportive supervision as against the expected level of
50%. |
