Strengthening Nursing and Midwifery Pre-Service Education in India: A national Initiative Duration: 2009-2015 Factsheet: November 2014 Partners: Indian Nursing Council (INC), Government of India (GoI)/National Health Mission; Governments of Jharkhand, Uttarakhand, Uttar Pradesh, Odisha, Madhya Pradesh, Rajasthan, Bihar, Jammu and Kashmir, Haryana, Assam, Tamil Nadu, Maharashtra and Gujarat Donors: Norway India Partnership Initiative, UKAID-Department for International Development, USAID Background Optimum midwifery services are among the most effective ways to reduce maternal, newborn and infant mortality. Some of the key causes for maternal and neonatal deaths, like infection, post-partum hemorrhage, eclampsia, birth asphyxia and pre-term birth, can be averted through competent nursing midwifery care. However, there is an acute shortage of competent auxiliary nurse midwives (ANMs) and staff nurses in the country, especially in the ten high focus states. This problem is compounded by the sub-optimal quality of available nurse midwives. Furthermore, the quality of pre-service education (PSE) at the nursing educational institutions in these high focus states has left a lot to be desired. To respond to the need for improving the quality of nursing education and develop a cadre of competent and confident nurse midwives, the Indian Nursing Council (INC) and the Ministry of Health and Family Welfare, Government of India (MOHFW, GoI) have developed a roadmap for improving the quality of PSE of ANMs and general nurse midwives (GNM) in select high focus states of India. Jhpiego, with support from Norway India Partnership Initiative (NIPI) and Department for International Development (DFID), is working closely with the INC and the national and state governments to provide catalytic and strategic support to this initiative. Jhpiego s work aims to strengthen the quality of education in nursing schools and colleges. This will result in improved provision of maternal, neonatal and child health (MNCH), including family planning services by the students graduating from these institutions. Strategic Approach The strategic approach adopted for this program includes the establishment of centers of excellence for nursing and midwifery education seven at the national level, called national nodal centers (NNCs), and ten at the state level in seven of the ten high focus states, called state nodal centers (SNCs). It is envisioned that these nodal centers, besides serving as model teaching institutions, would serve as pedagogic resource centers for the ANM/ GNM schools in their region and also provide support in the concurrent strengthening of these ANM/GNM schools. The program uses Jhpiego s Standards-Based Management and Recognition (SBM-R) approach to performance and quality improvement as an overarching mechanism for implementing the INC approved educational and clinical standards across the NNCs/SNCs and ANM/GNM schools. 1
Programmatic Approach The strengthening of the NNCs/SNCs and the ANM/GNM schools is being done through the use of simple, measurable performance standards which serve as a quality improvement guide. These Fundamental principles of the program: Strengthening infrastructure and improving quality of education in existing government nursing educational institutions Strengthening health systems Leveraging resources Being catalytic Ensuring evidence-based, proven and effective interventions Salient features of the program: Initiative led by GoI and INC Build on GoI s resources for training Build a quality assurance model for nursing and midwifery education in India Focus on the basic health worker to reach the community Focus on the clinical practices and clinical teaching in the NNCs, SNCs, ANM and GNM Schools. performance standards provide a structure for program support and a criterion-based monitoring system which allows the INC, through its nodal centers of nursing and midwifery education, to provide specific ongoing technical support. Major Accomplishments The major accomplishments under the project to strengthen the quality of PSE for nursing and midwifery cadre are as follows: At the national level A Memorandum of Understanding, specifying the roles and responsibilities of the various parties, was signed by Jhpiego with the INC and select state governments at the time of beginning the implementation of the project. A national and state level technical advisory group for strengthening of PSE was formed and a set of performance standards for use by the NNCs, SNCs, ANM and GNM schools for improvement of the educational processes and infrastructure was developed. Number of Pre Service Education Performance Standards Sec. Areas ANM Schools GNM Schools NNCs and SNCs 1 Class room and practical instruction 15 15 15 2 Clinical instruction and practice 16 16 17 3 School infrastructure and training materials 12 13 13 4 School management 16 16 16 5 Clinical site practices 20 20 20 TOTAL 79 80 81 Seven Colleges of Nursing as National Nodal Centers Kolkata Nil Ratan Sarkar Medical College & Hospital o The NNC at Kolkata has been operationalized with the setting up of a well-equipped skill lab, computer lab and training infrastructure. Two full-time training coordinators have been appointed to conduct trainings with support from the NNC faculty, and also to mentor the ANM faculty on-site during their follow-up visits. o Twelve batches of 6 weeks training for ANM/GNM faculty (153) have been completed at NNC Main components of the 6 weeks curriculum Effective teaching skills Skilled birth attendance (SBA) Integrated management of neonatal and childhood illness (IMNCI) Prevention of reproductive tract infections including prevention of parent to child transmission of HIV Family Planning Quality improvement in nursing education (SBM-R) 2
Vadodara Government College of Nursing, SSG Hospital and Vellore College of Nursing, Christian Medical College Work of strengthening these Colleges of Nursing (CoN) and establishing them as NNCs is in progress. They will be certified as NNCs by early 2015. Four more institutions are in the process of being identified At the state level Jhpiego PSE strengthening programs provide technical assistance and direct on-site support to 207 nursing educational institutions in 10 states. PN Comp Clinical Evaluation N=111 IP IP Comp Pre Test AMTSL 100% 80% 60% 40% 20% 0% Parto Post test AN Comp NB-R ENBC Clinical skills of participants trained in the nodal center have shown marked improvement as evident from OSCE # scores State ANMTC GNM School College of Nursing Total Jharkhand 10 0 1 11 Uttarakhand 5 0 1 6 Bihar 21 6 1 28 Odisha 18 4 1 23 Madhya Pradesh 32 9 2 43 Rajasthan 27 13 1 41 Uttar Pradesh 40 9 3 52 Gujarat 1 1 Tamil Nadu 1 1 West Bengal 1 1 Haryana* 78 73 1 152 Jammu and Kashmir* 11 2-13 TOTAL 242 116 14 372 * Soft Technical Assistance; Support to Haryana includes support for strengthening private nursing schools Jharkhand and Uttarakhand: With support from USAID s MCHIP program, the Colleges of Nursing, Dehradun and Ranchi have been accredited by INC as a State Nodal Center. 22 faculty members from ANM/GNM schools of Uttarakhand have undergone the 6-weeks training. (11 at the first 6-weeks training held at Dehradun and 11 had been trained at NNC Kolkata) The College of Nursing at RIMS, Ranchi is about to start its 6 weeks training later this year. 23 faculty members from Jharkhand have undergone the recommended 6-week training at NNC Bihar: College of Nursing, IGIMS, Patna has been accredited as a State Nodal Center with support from NIPI. 70 faculty members from ANM/GNM schools of Bihar have completed the 6-weeks training. (29 faculty members were trained over two batches at SNC Patna and 41 were trained at NNC ) 29 Clinical Skill Standardization (CSS) trainings have been conducted for 356 participants. 1 Training of Trainers (TOT) has been conducted for 8 participants at SNC Patna. # OSCE Objective Structured Clinical Examination is a method of examination designed to test clinical skill performance and competence in skills such as communication, clinical examination, medical procedures / prescription etc. 3
Three batches of Skills Lab Induction Training on the effective use of Mannequins and equipment for 51 faculty members from ANM/GNM schools have been conducted. Revised ANM syllabus and examination guidelines workshop was conducted over five batches for 119 participants. A pilot study is being conducted to assess the process of ANM internship at three ANM schools. Two batches of virtual training sessions have been completed in Bihar covering 12 ANM and 3 GNM schools with support from DFID. Rajasthan: 32 Clinical Skill Standardization (CSS) trainings have been conducted for 293 participants. 28 faculty members from Rajasthan have undergone the recommended 6-week training at NNC Revised ANM syllabus and examination guidelines workshops have been conducted for 57 faculty members from ANM schools at Jaipur. Mid line assessments of 26 ANM /GNM schools have been completed. Madhya Pradesh: 40 Clinical Skill Standardization (CSS) trainings have been conducted for 587 participants. 15 faculty members from Madhya Pradesh have undergone the recommended 6-week training at NNC Mid line assessments at 43 ANM/GNM schools have been completed. 4
Odisha: 22 Clinical Skill Standardization (CSS) training have been conducted for 334 participants 17 faculty members from Odisha have undergone the recommended 6-week training at NNC Midline assessment has just started. Uttar Pradesh: Jhpiego has collaborated with DFID to strengthen PSE in Uttar Pradesh This endeavor involves strengthening of PSE in all the government run ANM and GNM schools and College of Nursing in Uttar Pradesh. Orientation workshops on the performance standards given by the GoI and INC have been conducted for the faculty and service providers of nursing institutions and attached clinical practice sites and Jhpiego has made progress in fostering goodwill amongst the stakeholders involved in this project. Baseline assessments have been completed at all 52 institutions and action plans for each of the schools have been drawn detailing out gaps, interventions, and timelines and SS Visits are done regularly. 9 Clinical Skill Standardization (CSS) training have been conducted for 130 participants. 2 faculty members from Uttar Pradesh have undergone the recommended 6-week training at NNC Jammu & Kashmir: One day SBM-R workshop was conducted at Jammu and Srinagar for 215 participants. Haryana: A State Nodal Center is being established at College of Nursing, Rohtak. A workshop to orient stakeholders on PSE standards has been conducted; a baseline assessment was done and action plans have been drawn detailing out gaps, interventions, and timelines. Tamil Nadu: Jhpiego supported the government of Tamil Nadu for conducting a workshop for orienting faculty members from ANM schools of the state on the revised ANM syllabus and examination guidelines. Future Plans Establishment of functional state nodal centers with sustained quality of performance in teaching as well as clinical practice skills. Expansion of virtual classroom teaching and training to obviate the partial deficiency in the faculty positions in nursing colleges and ANM/GNM schools. Introduction of uniform competency based examination and certification for nursingmidwifery students. Continued technical assistance to strengthen State Nodal and Registration centers, ANM & GNM Training schools. Continue efforts to encourage state governments to recruit more nursing-midwifery personnel. 5