quality improvement of the pre-service nursing and midwifery education in india
TRANSCRIPT
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Quality Improvement of the
Pre-Service Nursing and
Midwifery Education in
India
Dr Bulbul Sood
Country Director Jhpiego/India
Global Maternal Health Conference,
Arusha, Tanzania,
January 15-17, 2013
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Presentation Outline.
Programmatic approach How strengthening of
PSE for the nursing andmidwifery cadre was
initiated and scaled up
Lessons learned Current GoI strategy
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Goal of strengthening PSE Program
To strengthen the foundation of ANM/GNM education resulting in better
prepared service providers, higher
functioning educational institutions and
ultimately ANMs/GNMs who are
competent, confident and ready to work
upon graduation.
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What is planned.
Long term plan is to build extensive systemsfor supporting effective education of the
midwifery and nursing workforce
TA from MCHIP is catalytic in bringing aboutfundamental change at multiple levels of the
educational system.
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INCs strategic approach for strengthening
the Pre-Service Nursing and Midwifery
Education
Strategic guidanceDesign of intervention
Use of educationalstandardsClinical & pedagogiccourses
Improvement of own centerStructured support to ANMschools
Higher functioningeducationalinstitutions
Competent confidentANMs
TA for
1.Qualityimprovementby use ofeducationalstandards
2.Strengthenthe clinical &trainingskills of the
tutors
Jhpiego identified as the Technical Agency by the INC/GoI
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Program Components
6
Improved
Quality ofPSE
Improved
EducationalProcesses(at the institutions)
ImprovedClinical
Practices
(at the clinicalpractice sites)
StrengthenedCapacity of the
Faculty
(both teaching andclinical skills)
Strengthenedtraining
infrastructure
(Class rooms, skilllabs, IT)
Introductionof internshipfor ANMs
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Development of Performance
Standards
Performance standards foruse by the NNCs/SNCs and
ANMTC/GNM Schools
developed.
Educational Standards Clinical Standards
The standards tell Tutorsand providers not only
what to do
but alsohow to do it
Before starting the 10-days TOT at the NNC/SNC or6-weeks training of the Nursing Tutors it is critical
that the Nursing schools should achieve 60-70%
Educational and clinical standards
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How Performance Standards work??
Empowers teachers at theschools & healthcare workers at
facilities
Establishes a clear goal Shows progress and results
easilywithin and across sites
Generates healthy competition
Creates internal change vs.external monitoring
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Performance Standards Implemented at
NRSCN-Kolkata, CMC-Vellore, CMC-Ludhiana, SCON-Delhi,GCON- Vadodara
10 ANMTCs in Jharkhand, 5 ANMTCs and SNC in Uttarakhand,, 21 ANMTCs,
6 GNM schools & SNC in Bihar.
Sections Areas Number ofStandards
1. Class room and practical instruction 152. Clinical instruction and practice 173. School infrastructure and training
materials 134. School management 165. Clinical site practices 21
TOTAL 82
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Strengthening of National Nodal
Centers
Quality improvement at the NNCs using the SBM-R approach
0%
10%
20%
30%
40%
50%
60%
70%
80%90%
100%
CMC
Vellore
NRSCoN,
Kolkata
St
Stephens
CoN
CMC
Ludhiana
GCoN
Vadodara
Eduactional Standards
BL
1st IA
2nd IA
3rd IA
4th IA
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Clinical Standards
BL
1st IA
2nd IA
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Token of appreciation for the achievement
of the educational standards
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Strengthening Skills Labs
Identification of spacefor the skills lab at NNC
Procurement of modelsand equipment as perINC approved list
Setting up stations- ANC corner Labor corner Newborn corner, PNC corner Family Planning Infection Prevention Special Procedures
12
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Strengthening Skills Lab Stations
13
Labour corner
Infection Preventioncorner
Special skills corner
ANC and PNCcorners
Family PlanningCorner
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ANMTC Library
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Computer Labs, class rooms
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3 Days Clinical Skills Standardization
Training of Labor room staff
All health care providersof MCH area including
nursing tutors are trained
on
AMTSL ENBC NB resuscitation Partograph Infection prevention
practices
ManagingComplications like
Eclampsia and PPH
IPP Before and After Training
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Strengthening of selected ANMTCs
Jharkhand and Uttarakhand
Quality improvement using the performance standards
26%21% 24%
38%45%
85% 88% 88% 85% 86%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Simdega Chaibasa Giridih Ranipokhri Gadarpur
Jharkhand Uttarakhand
Baseline Current Status
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6-weeks training for Nursing Tutors
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Course Description and Evaluation methods
Knowledge: A score of at least 85% on the knowledge assessment.
Skills: Satisfactory performance of clinical skills evaluated by Objective Structured
Clinical Examination (OSCE).
Practice: Demonstrated ability to provide quality services in the clinical setting and
demonstrated good facilitation skills.
Week 1 Week 2 Week 3 & 4 Week 5 Week 6
Effectiveteachin
g &BasicComputer skills
SkilledBirth
Attendance
Clinical
training
IMNCI&
FamilyPlanning
Preventionof RTI,STI/HIV/PPTCT
&Educationalstandards
Evaluation: Knowledge and Skill
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What have we learned so far
Use of educational and clinical standardshave worked at the level of NNC, SNC, GNM
& ANM schools and in different region of the
country 6 weeks trainings of the nursing tutors is
leading to tremendous improvement in the
teaching at the ANM and GNM schools Much needed impetus to nursing education is
empowering the nursing profession
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Current GoI strategy:
To scale up strengthening of PSE for thenursing and midwifery cadre in 10 high
focus states in the country, using the
above programmatic approach with plan tocreate 10 State Nodal Centers
MCHIP to conduct orientation of allstakeholders including donors who areinvesting in PSE NIPI, DFID, UNFPA,
Unicef, WHO
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Acknowledgements
Co-authors Somesh Kumar Rashmi Asif Princy Fernando Pallavi Sinha
USAID supported MCHIP initiative MoH&FW, Government of India Indian Nursing Council
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Every Journey begins with a single
step, But you will never finish if youdont start