Family planning training needs of auxiliary nurse midwives in Jharkhand, India: Lessons from an assessment.

Abstract

Auxiliary nurse midwives (ANMs), who play a pivotal role in the provision of maternal health services including family planning services, must be adequately trained and skilled. Systematic assessment of their training needs helps in determining this adequacy. We did a systematic assessment of the training needs of ANMs in Jharkhand. We designed a multi-stakeholder study including (i) meeting with government officials and international development partners (n=1 5); (ii) structured observation of health facilities (n=1 7); (iii) review of health management information system data; (iv) interviews with ANMs (n=19); and (v) interviews with contraceptive users (n=31). The data were thematically analysed based on gaps in technical knowledge, skills and practices; communication and counselling; infrastructural gaps; uptake of contraceptives and emerging training needs and approaches. The ANMs lacked knowledge, e.g. in natural contraceptive methods and skills, e.g. counselling and recordkeeping. Gaps in infrastructure further hampered the provision of uninterrupted service. The belief system of the community about contraception was perceived as a barrier. The lacunae in their knowledge and skills could be attributed to systemic issues such as quality of pre-service education, absence or poor implementation of in-service trainings or individual issues such as incompetence or apathy towards the provision of service. Government training to ANMs in family planning was inadequate. Our study found inadequacy in the training of ANMs in family planning. We suggest the need for systemic efforts with the life cycle approach to family planning, a mix of theory and practical training, appropriate duration of training, careful selection of trainers, a confidence-building approach and supportive environment to raise competencies of ANMs to help them manage their health facilities.