Role
of Auxiliary Nurse Midwives in National
Rural
Health Mission
Geeta Malik
In
India, public health nur- sing in the villages today
is still limited to services rendered by Multipurpose
Health Worker (Female) [MPHW(F)] or Auxiliary Nurse
Midwife (ANM). ANMs are regarded as the first contact
person between people and organisation, between
needs and services and between consumer and provider.
It
is through their activities that people perceive
health policies and strategies. It is through them
that planners at the upper level gain insights into
health problems and needs of the rural people. Considering
their status as grass-root level workers in the
health organisational hierarchy, a heavy responsibility
rests on them.
Their
services are considered essential to provide safe
and effective care and as a vital resource to achieve
the health-related targets. The present concern
in the country is to provide accessible, affordable,
accountable, equitable, effective and reliable health
care, especially to poor and vulnerable sections
of population in rural areas. It is, therefore,
interesting to analyse the role being played by
ANMs in providing health care services to people
in the changing context of National Rural Health
Mission (NRHM).
Background
The role of ANMs has been
The
author is Dy. Nursing Adviser, Ministry of Health
& Family Welfare, Govt. of India |
changing
with the times. In the ‘50s and ‘60s,
training courses for ANMs focused on midwifery and
Maternal and Child Health (MCH) as 9 out of 24 months,
were earmarked for these subjects. India’s
Second Five-Year Plan described the role of auxiliary
health workers as those activities that supplemented
the contributions made by doctors and other highly
trained personnel for promoting preventive and curative
health activities (GOI, 1986).
Mukher-jee
Committee (1966) recommended a system of targets
and incentives and identified ANMs and other village
level workers as agents for the popularisation of
the programme. In 1973, the Government of India
(GOI) integrated the various functions of the health
services thereby changing the role of ANMs (Kartar
Singh Committee, 1973).
In 1975, Srivastava Committee called for an expansion
of the training to prepare them for multipurpose
health work. ANMs were now required to provide child
health services and primary curative care to villagers.
In turn, the Indian Nursing Council (INC) approved
an expanded syllabus in 1977. With this came the
decision to reduce the training period from 24 months
to 18 months.
The
National Education Policy (1986) included the ANM
programme under the stream of Vocational Education.
The INC again reviewed the curriculum for the +2
level and
|
submitted
its recommendations to the Ministry of Health and
Family Welfare. However, only a few states have adopted
this course at the higher secondary level as a vocational
course.
Role
of ANMs in National Rural Health Mission
National Rural Health Mission, launched on 12 April
2005, to enhance comprehensive primary health care
services especially for the poor and vulnerable sections
of the society, continues to realise the ANMs as key
workers at the interface of health services and the
community.
The Mission seeks to provide minimum two ANMs (against
one at present) at each Sub-Centre, as one ANM at
a sub-centre has not been found adequate to attend
to the complete needs of maternal and child care in
any village. The Government of India would support
the second ANM for appointment on contract basis and
apart from fulfilling the other criteria she must
be a resident of a village falling under the jurisdiction
of the Sub-Centre. The intention is to improve accountability
at the local level.
The
second ANM would not be transferred before completion
of 10 years at the same Sub-Centre and would not be
a substitute for Male Health Worker (MHW). An untied
fund of Rs.10,000/- per Sub-Centre per annum is being
provided by opening a joint account of the ANM and
Sarpanch, to meet the emergency type expenditures
and to ensure that |
|
|
lack
of drugs and other consumables is not an issue.
Although NRHM is not even two years old, there are
significant achievements in certain areas with the
active support of State Governments. For example,
by engagement of contractual ANMs wherever required,
and by provision of Rs. 10,000 annual untied grant,
nearly all 1,46,026 Sub-Health Centres have been
made functional.
Sub-Centres
have judiciously used the united funds as per need,
from buying blood pressure equipment, weighing machine,
to repairing the examination table, cleaning the
Sub-Centre, etc. Early evidence suggests that deliveries
have started taking place in a few Sub-Centres because
of the untied grants.
Against
additional contractual ANM to be positioned in 30
percent of Sub-Centres, a second ANM has already
been in place in 7847 Sub-Centres. A review of job
descriptions prescribed nationally by the Indian
Nursing Council, Department of Family Planning,
Government of India and Health Departments of various
states reveals that an ANM is expected to participate
in Maternal Health, Child Health and Family Planning
Services; Nutrition Education; Health Education;
Collaborative Service for Improvement of Environmental
Sanitation; Immunisation for Control of Communicable
Diseases; Treatment of Minor Ailments and First
Aid in Emergencies and Disasters. Malik (2001) in
her study of Delhi observed that the job responsibilities
being performed
|
by
ANMs were in the areas of health education, medical
termination of pregnancy (MTP), nutrition, immunisation,
record keeping, minor ailments, MCH, communicable
diseases, Family Planning and also team activities,
vital events and dai training. This indicates that
the ANMs have been performing multifarious activities.
The Government of India has been funding the salary
of ANM and LHV to the States. The salary of Male
Health Worker is borne by the States but nearly
50 percent of the existing Sub-Centres do not have
an MHW. This has also some bearing on the workload
of the ANMs in position.
In
addition to these duties, the ANM would perform
the following functions in guiding and training
the female Accredited Social Health Activist (ASHA),
as envisaged in the Guidelines on ASHA, under NRHM:
 Holding
weekly / fortnightly meeting with ASHA to discuss
the activities undertaken during the week/fortnight.
Acting
as a resource person, along with Anganwadi Worker
(AWW), for the training of ASHA.
Informing
ASHA about date and time of the outreach session
and also guiding her to bring the prospective beneficiaries
to the outreach session.
Participating
and guiding in organising Health Days at Anganwadi
Centre.
Taking
help of ASHA in updating eligible couples register
of the village concerned.
Utilising
ASHA in motivating the pregnant women for coming
to Sub-Centre for initial check-ups.
|
Conclusion
NRHM provides that the ANMs will have the support
of 4-5 ASHA and the AWWs in |
|
|
|
discharging
her duties and the role envisaged in the mission.
It is therefore expected that they will be able to
devote more time to render clinical services to the
population and contribute to achieving the goals of
the mission to provide universal access to equitable,
affordable and quality health care which is accountable,
and at the same time, responsive to the needs of the
people, reduction of child and maternal deaths as
well as population stabilisation, gender and demographic
balance.
Note
An auxiliary is a “technical worker in a particular
field with less than full professional qualification
(WHO Technical Report Series, 1961).
|
References
Annual
Report (2005-2006). Ministry of Health and Family
Welfare, Government of India. New Delhi.
Geeta
Malik (2001). A Follow-up Study of Auxiliary Nurse
Midwives (10+2) Vocational Course Trained at Lady
Reading Health School, Delhi, an unpublished M.Sc.
thesis
Government
of India (1986), National Education Policy, Ministry
of Education
Indian
Nursing Council (1977). Syllabus, Regulations and
Courses of Studies for ANMs, New Delhi
Kartar
Singh Committee (1973). Report of the Committee on
Multipurpose Worker under Health and Family Planning,
New Delhi, GOI
Mukherjee
Committee (1966). Report of the Commit |
tee
Appointed to Review Staffing Pattern and Financial
Provision under Family Planning Programme, New Delhi,
GOI
National
Rural Health Mission Reference Material (Vol.1), Ministry
of Health and Family Welfare, Government of India,
New Delhi
National
Rural Health Mission (2005-2012). Mission Document,
Ministry of Health and Family Welfare, Government
of India, New Delhi
Srivastava
Committee (1975). Report of the Group on Medical Education
and Support Manpower, New Delhi, GOI
GOI (2007).
NRHM Progress So Far. Reading Material for the Meeting
of Chief Secretaries of States, 20 April 2007, Ministry
of Health and Family Welfare, New Delhi
|
::
POLICY & POSITION STATEMENT :: RESOURCES & PUBLICATION :: THE NURSING JOURNAL OF INDIA
MEMBERSHIP DETAILS :: ADVERTISE WITH US :: EVENT DIARY :: WHAT'S NEW :: SIGN OUR GUEST BOOK :: CONTACT US :: NURSE PLEDGE
Trained Nurses' Association of India (TNAI)
|
|
