The 130th Annual Meeting of APHA

Abstract #49736

James H. McMahan, MPH, Intrah/PRIME II, University of North Carolina at Chapel Hill, Campus Box 8100, Chapel Hill, NC 27599-8100, 919-962-6797, dnelson@intrah.org, Charu Chopra, MA, Intrah, IFPS Liaison Office, 50 M Shanti Path, Gate No. 3, Niti Marg, Chanakyapuri, New Delhi, 110021, India, and Sulba Swaroop, MBBS, DPH, SIFPSA, One Kailash Tower, 19-A Vidhan Sabha Marg, Lucknow, 226001, India.

The auxiliary nurse midwife (ANM) is the Indian public health system's primary provider. In the state of Uttar Pradesh, each ANM serves approximately 1000 women of childbearing age from her subcenter. Through the State Innovations in Family Planning Services Agency (SIFPSA), funded by USAID, the role of ANMs has been expanded to include training and supportive supervision for traditional birth attendants (TBAs) and improved linkages with Indigenous System of Medicine Practitioners (ISMPs). This effort enhances referrals to ANMs for services inappropriate for traditional healers. Simultaneously, SIFPSA is improving the quality of services offered by each cadre. ISMPs are now guided to provide family planning services and TBAs are trained by ANMs in safe motherhood practices and referrals of complicated cases, while the ANMs themselves receive family planning clinical skills training. To support these augmented roles, subcenters are being upgraded with infection prevention equipment and separate areas for counseling and examination. The PRIME II Project provides technical assistance to SIFPSA by training master trainers and mentoring them as they conduct skills-based training sessions. Bringing together trainers from private institutions, public-sector ANMs, and private-sector TBAs and ISMPs, SIFPSA has created a unique public-private collaboration that builds institutional capacity and increases the accessibility, quality, and standardization of primary-level services. Initial results are encouraging. By 2001, 80% of trained ANMs were performing to quality standards in their new roles. With training and support from ANMs, three times more deliveries were attended by trained TBAs, and the number offering family planning services increased seven-fold.

Learning Objectives:

• • Articulate the supportive relationship established by a state family planning agency among three cadres of primary providers in Uttar Pradesh, India
  • Describe the expanded role of public-sector auxiliary nurse-midwives in training and supervising private-sector, community-based traditional birth attendants and accepting referrals from indigenous practitioners
  • Using this case study from the PRIME II Project, discuss the potential benefits of such public-private collaborations in improving the quality and accessibility of services

Keywords: Community-Based Public Health, Health Workers Training

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.