Rani Pokhri, Uttarakhand, India— “They say that home is the first learning ground for a child. An auxiliary nurse-midwife training center (ANMTC) is the first school of learning for my students in their role as a health workforce, so it is like their home. What they learn from here will stay with them forever and will shape their future in the health sector. So, we want to teach them well,” says Sister Uma Rana, tutor in-charge for the ANMTC at Rani Pokhari, located on the outskirts of Dehradun.
The ANMTC at Rani Pokhari, one of six ANMTCs in the state of Uttarakhand, has made tremendous progress in the past year, recently upgrading its infrastructure and teaching methodologies after an assessment of these centers, conducted by the Indian Nursing Council (INC) in 2007, found a series of deficiencies.
The INC assessment covered 300 training centers in five states (Uttar Pradesh, Madhya Pradesh, Orissa, Bihar and Rajasthan), highlighting major gaps in auxiliary nurse-midwife (ANM) education. These gaps included a lack of updated knowledge among ANM tutors, especially in maternal and newborn health care, and outdated teaching methods that undermined the quality of training the ANMs received.
Based on this assessment, the INC, along with the Government of India, took the initiative to strengthen the foundation of pre-service education (PSE) for the nursing and midwifery cadre, and to develop the potential of ANMs to provide high-quality reproductive health and maternal, neonatal and child health (MNCH) services at the grassroots level. The U.S. Agency for International Development, through its flagship Maternal and Child Health Integrated Program (MCHIP), is providing technical assistance to the INC for strengthening the PSE of nurses and midwives.
When the MCHIP team visited Rani Pokhari for the first time in December 2010, they realized that a lot needed to be improved, particularly in terms of infrastructure and training. As Sister Uma Rana confirmed saying, “Before MCHIP started working with us, no trainings had happened here. We thought we had all the knowledge needed to teach our students, but we now realize that our knowledge and method of teaching were outdated.”
To bring about needed improvements, MCHIP introduced Standards-Based Management and Recognition (SBM-R©)—a simple, easy to implement and locally controlled quality improvement approach. With the application of SBM-R, performance standards were set in consultation with faculty for use in monitoring and improving the quality of PSE at training centers. These standards cover all aspects of ANMTC training—including classroom instruction, clinical instruction and practice, school infrastructure, training materials and school management—and the ANMTC clinical practice site, where students undergo their clinical experience.
“There have been so many improvements in our training center and in our training methods,” says Sister Uma Rana. “This has become possible because MCHIP has taken us through a step-by-step progression of improving our teaching-learning process. Not only have our students benefited and are able to grasp concepts better and get a clearer understanding of the curriculum, but even we as faculty have benefited a lot.”
The faculty has now been trained in effective teaching skills and their knowledge on the latest developments in MNCH interventions updated. In addition, modern teaching aids—such as computers, LCD projector, printer, photocopier and fax machine—were provided and integrated with teaching. The skills lab was also upgraded with essential anatomical models, instruments, consumables and supplies, and the library received updated books and current guidelines.
Remarkable changes have occurred in the ANMTC and its clinical practice site. A clinical skills standardization workshop, conducted at the clinical site, enabled the site to use evidence-based best practices for MNCH and family planning. Significant improvements to infrastructure were also made and the ANM students moved into a new hostel building. While the ANMTC still functions out of a rented local government building, a new building for the ANMTC was sanctioned by the local government and should be ready in a couple of months.
The enthusiasm of faculty and students is evident. Pooja Verma, a first-year ANM student says, “The teaching is very good and our tutors make it very easy for us to understand the subject using a variety of methods and mediums. The library is well-stocked and helps us in our course. Our comforts are also well-looked after—we have a television, filtered water, coolers and just two girls have to share a room. Being comfortable helps us a lot in focusing well on our studies.”
Notably, the fifth Common Review Mission of the Government of India’s National Rural Health Mission, which toured Uttarakhand, recognized the strengthened quality of training at this ANMTC. “The trainers at ANMTC are updated with current knowledge of the latest guidelines and manuals in reproductive and child health, and they are completely aware of the same. This will not only help to improve the quality of PSE of the frontline health functionaries, but also bring back the outdated training institution into the mainstream of education for effective service delivery in health and family welfare,” the Mission’s report stated.
While more needs to be done to ensure sustained high-quality training, a significant change has been made at the ANMTC, and the students know their mission. Lakshmi Kumari, a student from the ANMTC, put it simply, “I am becoming a nurse-midwife because I want to serve people and save lives.”
 The Common Review Mission was set up as part of the National Rural Health Mission Steering Group’s mandate of review and concurrent evaluation.