‘Reclaiming our skills, redefining our scope’

ANMs/MPHWs (F)/HAs(F)/FHWs/VHNs/JPHNs voice their concerns

Advocacy for strengthening ANMs as public health professionals and midwives to consolidate primary health care

presentation by Dr. M. Prakasamma

Public Health Specialist, ANSWERS

Need for advocacy

• ANMs are front-line public health personnel – there are more than 2.00 lakhs ANMs working in the government.

• ANMs cater to the needs of the most vulnerable groups – mothers and children in rural, tribal, and remote areas.

• ANMs have worked to enhance public awareness, and take maternal and child health care to the most remote areas of India till 1980s

In search of quality and equity in health care

Need for advocacy • From 1980 onwards, ANMs were renamed multipurpose

health workers. Their course was reduced from 24 to 18 months, their training was made broader, more functions were included in their job. ANMs’ technical competence in MCH declined.

• The number of male health workers was reduced over time, leaving ANMs to take care of all national health programmes, in addition to maternal and child health and family welfare.

• Administrative, financial, coordinative and reporting functions are steadily increasing.

Need for advocacy • The career of ANMs has not moved forward over the last 50

years. Growth opportunities have become narrower. • ANMs are still treated as auxiliaries or assistants though

they carry out a wide range of functions in far flung areas. • ANMs have no opportunity to enter into the nursing

profession – unless they study the GNM course• Midwifery – the core skill and function of ANMs - has not

been introduced as a profession in the Country. Hence ANMs have no opportunity for ANMs to move forward in this area.

• Though ANMs are the only trained public health providers in the field, they have no chance to grow in public health career as there is no such cadre.

And today… Where are the ANMs in the Draft National Health Policy?

• Draft National Health Policy 2015 is a long document of 57 pages. The ‘Human Resources for Health’ section contains 15 points – 5.1 to 5.15.

• None of the points acknowledge the contribution of ANMs to primary health care nor deal with their role in future ‘assured comprehensive care’

• The Draft Policy in silent on the ANMs functions even in section 4.3.1 that talks of ‘primary care services and continuity of care’

Why do ANMs need to be advocated for? • ANMs are not organized as a professional group in

most states. There is no national forum exclusively for ANMs to represent their concerns.

• ANMs experience the effects of gender inequity both in their homes and work situation. Gender related barriers obstruct their active participation in association activities.

• ANMs have low access to information and are unable to represent themselves.

• There has not been a national convention for ANMs

Objectives of advocacy

• To acknowledge contribution made by ANMs for improving maternal and child health, achieving family welfare goals, and enhancing public awareness and health in India

• To provide ANMs with an opportunity for skill enhancement and knowledge strengthening to promote evidence-based practices in the periphery

In search of quality and equity in health care

Objectives of advocacy

• To advocate for career growth of ANMs into midwifery, health education, counseling, supervision streams with appropriate training

• To facilitate interaction and experience sharing, networking among ANMs, professional leaders and governments for improving health services at the periphery

How do we advocate for strengthening knowledge and

skill, and promoting professional growth of ANMs for public health?

Mobilizing and informing ANMs

• Meetings in states with groups of ANMs• Presentation in professional conferences• Discussion with ANM leaders, DPHNOs• State meetings:

West Bengal (13th Feb, 15th March), Odisha (16th Feb), Assam (21st Feb), AP ( 14th Feb, 16th March), Delhi ( 29th Jan, 19th Feb, 8th March), Telangana (14th Feb, 16th March), MP ( 5th Feb), Karnataka (17th March)

Creating a platform for sharing and learning

• Association strengthening• Networking with associations in other states• Collaborating with women’s organizations and

rights-based organizations • Membership in professional organizations• Conceptualizing and creating a federation of ANMs’

associations for national level advocacy

Sensitizing ANMs through review and reflection

• Review of Draft National Health Policy• Reflection on identity, role and scope of

function – ANM? Auxiliary? Nurse? Midwife?• Discussion on career pathways – potential and

possibilities in different fields• Representation to government with appeal for

review of Policy and role of ANMs

Acknowledging lives saved by ANMs: CANMs’ contribution to maternal and child health

All the lives of mothers and newborns saved due to the interventions of ANMs between 2005 to 2014 will be documented and acknowledged

Messages will be sent to all the states requesting ANMs to provide information from their records

The ‘lives saved’ will be printed in a book according to states

In search of quality and equity in health care

Documenting success stories from ANMs

• ANMs will be invited to share their success stories in the following areas• Maternal and child health• Family Welfare• Reproductive health• Public health and national programmes

• Each story will be limited to 500 words and will have photographs. The stories will be printed in a book and shared with governments and public

Representing challenges faced by ANMs

• ANMs will write about the problems they face in performing their duties in any one of the following four sub themes: – Dealing with people and leaders– Physical facilities– Work situation – Technical aspects and skills

• The content will be limited to 500 words. The papers will be printed in a book and shared with government for support.

Showcsing Model Subcentres

All interested ANMs working in Subcentres may enter into the ‘Model Subcentre Competition’ by sending 90 seconds video of their subcentre according to guidelines and win an award.

There will be many awards30 state awards of Rs. 5000 each3 national awards of Rs. 10, 000

Appreciating ANMs individually and collectively

An album of messages from across the Country for acknowledging ANMs’ contributions, encouraging

them to perform better, and wishing their professional advancement

In search of quality and equity in health care

Who will give the message?

• Individuals: Doctors, obstetricians, public health managers , officials, public figures

• Relatives, children, parents and well wishers of specific ANMs may give their message

Campaign and movement building • Signature campaign from ANMs – one lakh

signatures from ANMs to reach each state government and GOI on 5th May, 2015

• Endorsement campaign – professionals (nurses, doctors and others), interested public - NGOs, lawyers, students

• ‘ANMs are Primarily Midwives’ – 5th May media meeting and state conference in all states coordinated by SOMI to re designate ANMs as Public Health Midwives and create paths for career progression for ANMs.

Thank You

May all our struggles be fruitful!

ANMs’ National Conventionreclaiming skills, redefining scope

In search of quality and equity in health care

10-12 July 2015, Talkatora Indoor Stadium, New Delhi

Organized by ANSWERS(Academy for Nursing Studies and Women’s Empowerment Research Studies)

in collaboration with SOMI, NAMHHR, and Common Health

Participants and Facilitators • About 3000 ANMs and their facilitators from all the

states will participate• The Convention is designed to be highly interactive –

observing, discussing, learning and practicing will be facilitated through specially arranged halls.

• There will be no formal or long paper presentations because ANMs speak different languages.

• Facilitators will be assigned to groups coming from different states at 1:10 to translate when necessary.

In search of quality and equity in health care

Schematic design of Convention

In search of quality and equity in health care

Draft Programme – 10-12 July, 201512 Parallel interactive sessions (total 10 hrs) 5 Critical issue sessions for one hour each 3 formal sessions for one hour each

– Opening Session –5.00 to 6.00 PM on 10.07.2015– Keynote session –5.00 to 6.00 PM on 11.07.2015 – Closing Session - 4.00 to 5.00 PM on 12.07.2015

2 Engagements for one hour each – Commitment Evening: 10th July 6.00 - 7.00 PM– Cultural Evening: 11th July 6.00 - 7.00 PM

Many special interest activities for all

Programme Schedule

Acknowledging lives saved by ANMs

Large Panels will show details of mothers and newborns saved by the efforts of ANMs -

–Green stickers: Mothers’ lives saved – Pink stickers: Newborns’ lives saved

Technical Learning LabsKnowledge and skill enhancement activities

1. Four Technical Learning Labs with manikins, learning materials and resource persons for – Maternal care– Newborn and child care– Basic skills (BP, Inj. Hb testing, etc)– Family planning and reproductive health

Multiple stations will facilitate practice for upto 300 members during the Convention. Skill practice will be monitored through a Skill Card

In search of quality and equity in health care

ANMs’ Contribution Hall

• ANMs who have achieved high results in different areas of their work will present their experiences to their counterparts from other states. Four best performers will be given awards.

• Presentation and discussions will be held with senior ANMs from different states

Model Subcentre Hall

• Model subcentres submitted by ANms will be displayed on screen and discussions will be held

• Award winning subcentre ANMs will make presentations

• State governments and media will be invited to observe, comment and improve

Career Progression: Analysis and advocacy

1. State-level career progression charts: Comparative analysis of skills, services and scales to be presented by ANM leaders with help from facilitators

2. Career Canvas: Each state will have a Canvas for the ANMs to write their career path on a graph Discussion sessions on gender inequities in HRH

3. Nearly 200 ANMs will share their problems and their strategies to overcome problems in working situation

In search of quality and equity in health care

How you can contribute?• Register as a participant/facilitator - Rs. 1500 • Participate in all the activities • Contribute to organization expenses - Rs. 500 • Spread the message and advocate for ANMs• Identify donors for appreciation album - Rs.

10,000 per page• Find sponsors for: Conference bags, badges,

notebook, pen, halls, panels, tea, high tea, etc.

Thank YouHope to see you at the

Convention