Public Sector
(Purging Conventional Practices)
 
Newborn boys are bathed in warm water, girls in cold water. That is our tradition”, avers Shanti Devi, the popular village dai, an untrained traditional birth attendant (TBA). Such discriminatory practices are so deeply ingrained in the psyche of the rural folk that they have acquired the sanctity of tradition.
 
A further cause for concern is the fact that one-third of the total deliveries in Uttar Pradesh are conducted by TBAs, who have never been trained. These factors are partly responsible for the high rates of infant and maternal mortality in U.P.
 
Hands-on training - a dai re-learning her trade
 
Training programmes for TBAs were initiated by SIFPSA as a child survival initiative. It was realized that the trained TBA could play a major role in reducing neonatal and maternal deaths. Effective linkages for family planning services could also be developed between TBAs and grass roots health providers of the government sector. Pilot projects to train TBAs were hence implemented in Rampur, Sitapur and Agra districts.
 
Synergy for Effectiveness
 
The projects successfully involved both the public and private sectors in the districts by assigning specific roles and responsibilities to an NGO and the government health department. A carefully selected NGO in each district played the role of a facilitator to ensure that all project activities proceed smoothly. The Chief Medical Officer (CMO) ensured timely supply of all training material. The government ANMs (Auxiliary Nurse Mid-wife) conducted the actual training thereby creating the foundation for effective linkages with the trained TBAs. The main aim of the training programmes was to encourage dais to conduct deliveries in aseptic conditions, to dentify and refer high-risk pregnant women to hospitals and to promote family planning.
 
Selecting the TBA
 
This was a key activity and crucial to the success of the strategy. A complete census of dais in all villages of these districts was done through a block mapping process. The TBAs to be trained – one per village, were selected with the involvement of the community. Only those actively involved in conducting deliveries were chosen. The training was done through six master trainers from the implementing NGO and two from the government health department. Master trainers trained selected ANMs/LHVs per block as lead trainers and who, in turn, imparted training in batches of 10. The training was hands-on and intensive with a trainer for every two trainees. 2402 dais were trained in all.

Encouraging Results
 

The dai training activity

98 percent were providing family planning services to clients

53 percent were able to identify high-risk pregnancies

28 percent were able to answer questions on pill use correctly

deliveries assisted by trained dais increased three-fold after training

most dais were practising the five cleans

Encouraged by the impressive findings of the evaluation study, SIFPSA is now scaling up this activity to 15 districts and will eventually expand it to the entire state

 

Hands-on training - a dai re-learning her trade

 

A training session in progress