Investing in primary care human resources- the key pillar of a health system is a prerequisite for achieving comprehensive primary healthcare for all. Considering the proposed merger of FMR with its sister organization Foundation for Research in Community Health (FRCH), this area of ‘building capacities and competencies of human resource’ has been emphasized as one of the focus areas at FMR since 2019.
Growing demand for quality and sustainable health worker training in the context of Universal Health Coverage calls for strengthening of their skills through more effective and efficient strategies of education. Frontline health workers such as Auxiliary nurse midwives (ANMs), staff nurses, medical doctors and community health officers play a pivotal role in primary health care system, especially for provision of maternal new-born health (MNH) to the rural population where public health system is the preferred and probably the only available choice for seeking healthcare. Community health volunteers, more popularly known as ASHA (Accredited Social Health Activists) are a bridge between communities and formal healthcare systems. Explorations for assessing their preparedness, knowledge and skills, mentoring and support system, liaison and networking and gaps in their training is crucial for effective contribution of this cadre as envisioned by the National Health Mission.
The in-service training of all these health workers is vital for their continuous professional development, given the flux of issues in the public health system and the ever-evolving scope of their work. We believe that a health system with a resource of sustained competent trainers and a platform for continuous learning can only pave the way to build and sustain skilled health workers of quality healthcare. Our intervention research projects apply a complementary mix of directed and self-directed learning strategies and an in-built system of monitoring and evaluation for the training of health workers. The importance of demonstration-based training, adult learning principles and learner-centric approaches have been appreciated but merely incorporated. We adopted a blend of in-person and virtual learning modes for building the capacities of health workers.
Dr. Shilpa Karvande
Government of Maharashtra- approval for the study; Municipal Corporation of Greater Mumbai and Pune Municipal Corporation- a) study approval b) sharing of experiences and perspectives about urban ASHA programme and Tuberculosis as key stakeholders
Ms. Vidula Purohit, Ms. Aarti Waghmare, Ms. Laxmi Govekar, Ms. Monika Hinge, (FMR); Ms. Pradnya Ghodake (Intern)
National Academy of Sciences, through PEER programme of USAID, USA as Women in Science Mentorship Program for Career Advancement, Private donation from Mr. N.B. Godrej & Maharashtra State Tuberculosis Association
March 2022- January 2023
INR 7.58 Lakhs
This project is part of the PEER Programme- Women in Science Mentorship for career advancement (USAID) to encourage women researchers and scientists to excel in their research careers. It includes mentoring women researchers and a research project in the area of TB. The mentoring component includes focused mentoring sessions for the team of women researchers in the area of public health research and TB.
The research aims at assessing preparedness of urban ASHAs from Pune and Mumbai for delivery of primary healthcare in general and specifically in the area of TB control. The project is mixed-method exploratory research to learn the perspectives of key stakeholders- programme officials, supervisors and the community to understand the roles and responsibilities of urban ASHA, her training, knowledge and skills related to TB control and the challenges experienced by her. The research methods include a semi-structured survey of 200 plus ASHAs, focus group discussions of ASHAs (n=8) and in-depth interviews of key informants (n~15). The project is currently undergoing.
Presently urban ASHA is a potentially valuable but an unstable cadre. Her roles as an incentivized worker need to be defined, training norms to be refined and an improved eco system for her support to be revised. Furthermore, suitability of urban ASHA as a TB functionary and expected roles need more clarity. TB related knowledge gaps pointed in this study need to be addressed through comprehensive TB training of appropriate duration and supportive supervision.Media coverage of the dissemination of project findings held on 24th January 2023 in Mumbai.
Dr. Nerges Mistry
Dr. Shilpa Karvande
District Health Office of Palghar and Public Health Department, Government of Maharashtra a) Review of the training material of the project b) Active involvement in terms of providing health officials and health providers of various cadres to work as local master trainers in this project
Ms. Vidula Purohit, Mr. Prashant Kulkarni, Mr. Rajendra Kale
H.T. Parekh Foundation of HDFC Ltd.
September 2019- March 2022
INR 150 Lakhs
Maternal and newborn health (MNH) was considered as a window for the training intervention project in Palghar. The objective was to generate a local resource of trainers and through them, build the capacities of community health providers for the provision of MNH and nutrition services. It involved training various cadres of a primary health system, nutrition-sensitive intervention focusing on the first 1000 days and context-specific subjects such as anaemia, management of low birth weight babies. The Sister Foundation for Research in Community Health (FRCH) conducted a pilot project in Pune during 2016-19 to build capacities and competencies of Auxiliary Nurse Midwives (ANMs) in MNH. The trainers of this pilot project were utilized as core trainers to train local master trainers in Palghar. A team of clinical experts from the UK and Nutrition Society of India (NSI), Mumbai Chapter, provided technical inputs for the development/ adaptation of the training material and conducting the training of trainers in Palghar.
The process of developing local resource of trainers (n=32) involved assessment of potential candidates, training of trainers, continuous hand-holding and frequent sessions of quality assessments using face-to-face and virtual platforms. Their teaching and pedagogical skills were equally emphasized as their clinical knowledge and skills throughout the project training activities for training 500 plus health providers. Use of mannequin for demonstration of clinical skills, a reverse demonstration by every participant, case-based learning, the mix of various cadres in every training batch, de-centralized and convenient training venue were some of the key features of all the training activities. Subsequent use of the Extension for Community Healthcare Outcomes (ECHO) virtual platform helped the participants to refresh their knowledge and served as an opportunity to nurture the culture of sharing, appreciation and constructive feedback. Self-learning strategies- writing articles in a biannual newsletter- ‘Dialogue’ and learning through and skills mall complemented the formal directed learning.
Key recommendations are a) the need for creating avenues for refresher training in pre- and in-service education b) development and institutionalization of strategies for nurturing sustainable resource for competent trainers in the public health system and c) extension of project learning to other crucial subjects of comprehensive primary health care such as maternal mental health.