Public Sector

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.

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)

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.

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.

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.

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.

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.

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.

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%.