Building capacities of Auxiliary Nurse Midwives (ANMs) through a complementary mix of directed and self-directed skill-based learning—A case study in Pune District, Western India

• Published in: Human resources for health 2020-06, Vol.18 (1), p.1-45, Article 45
• Main Authors: Karvande, Shilpa, Purohit, Vidula, Gopalakrishnan, Somasundari Somla, Subha Sri, B, Mathai, Matthews, Mistry, Nerges
• Format: Article
• Language: English
• Subjects: Analysis; Auxiliary nurse midwives; Capacity building; Case studies; Communication; Eclampsia; Educational materials; Health care industry; Health facilities; In-service training; Independent study; Knowledge; Maternal and child health; Medical education; Medical equipment; Midwifery; Midwives; Nurses; Obstetrics; Participation; Public health; Quality; Self-directed learning; Skill-based learning; Skills; Teaching; Training
• ISSN: 1478-4491; 1478-4491
• DOI: 10.1186/s12960-020-00485-9

Auxiliary nurse midwives (ANMs) play a pivotal role in provision of maternal and newborn health at primary level in India. Effective in-service training is crucial for upgrading their knowledge and skills for providing appropriate healthcare services. This paper aims at assessing the effectiveness of a complementary mix of directed and self-directed learning approaches for building essential maternal and newborn health-related skills of ANMs in rural Pune District, India. During directed learning, the master trainers trained ANMs through interactive lectures and skill demonstrations. Improvement and retention of knowledge and skills and feedback were assessed quantitatively using descriptive statistics. Significant differences at the 0.05 level using the Kruskal-Wallis test were analysed to compare improvement across age, years of experience, and previous training received. The self-directed learning approach fulfilled their learning needs through skills mall, exposure visits, newsletter, and participation in conference. Qualitative data were analysed thematically for perspectives and experiences of stakeholders. The Kirkpatrick model was used for evaluating the results. Directed and self-directed learning was availed by 348 and 125 rural ANMs, respectively. Through the directed learning, ANMs improved their clinical skills like maternal and newborn resuscitation and eclampsia management. Less work experience showed relatively higher improvement in skills, but not in knowledge. 56.6% ANMs either improved or retained their immediate post-training scores after 3 months. In India, there are some ongoing initiatives for building skills of the ANMs like skilled birth attendance and training in skills lab. However, such a complementary mix of skill-based 'directed' and 'self-directed' learning approaches could be a plausible model for building capacities of health workforce. In view of the transforming healthcare delivery system in India and the significant responsibility that rests on the shoulder of ANMs, a transponder mechanism to implement skill building exercises at regular intervals through such innovative approaches should be a priority.