Auxiliary nurse midwife

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Auxiliary nurse midwife or nurse hybrids commonly known as ANM, is a village-level female health worker in India who is known as the first contact person between the community and the health services. [1] ANMs are regarded as the grass-roots workers in the health organisation pyramid. Their services are considered important to provide safe and effective care to village communities. The role may help communities achieve the targets of national health programmes. [1] [2] [3]

Contents

Background

The Mukherjee Committee in 1966 prescribed a system of targets and incentives and identified ANMs and other village-level workers as agents for the popularization of the health programmes. In the 1950s and 1960s, training of ANMs mainly focused on midwifery and mother and child health.[ citation needed ]

In 1973, the Kartar Singh Committee of the Government of India combined the functions of the health services and changed the role of ANMs. [1] The committee recommended that there should be 1 ANM available per 10,000-12,000 people. [4]

In 1975, the Srivastava Committee recommended expansion in the role of ANM. Recommended expansion included the role of an ANM as a multipurpose health worker. Along with maternity care, the committee recommended that the ANM's work include child health (immunization) and primary curative care of villagers. The Indian Nursing Council (INC) accepted the recommendations of the committee and included them in the syllabus in 1977. This decision also reduced the training period of the ANM from 24 months to 18 months. [1]

In 1986, the National Education Policy gave the ANM programme a status of Vocational Education. Following this decision, the INC again reviewed its policy and recommended that the Ministry of Health and Family Welfare make the ANM course vocational at +2 level (after 10th class/higher secondary level). However, only a few states of India have made the ANM course a vocational course at the higher secondary level of schooling. [1] According to the latest guidelines by INC, the minimum age for admission to an ANM course should be 17 years while the maximum age limit is 35 years. [5]

In 2005, the National Rural Health Mission (NRHM) was launched, which focused on improvising primary health care in villages and further increased the importance of the ANM as a link between health services and the community. [1]

Role of the ANM

ANMs works at health sub-centres. The sub-centre is a small village-level institution that provides primary health care to the community. The sub-centre works under the Primary Health Centre (PHC). Each PHC usually has around six such sub-centres. Before the launch of the NRHM in 2005, there was provision of one ANM per sub-centre. Later it was found that one ANM was not adequate to fulfill the health care requirements of a village. In 2005 NRHM made provision of two ANMs (one permanent and one contractual) for each sub-centre. The ANM is usually selected from the local village to increase accountability.[ citation needed ]

As per the Rural Health Statistics Bulletin of 2010, there were 147,069 sub-centres functioning in India, which were increased to 152,326 in March 2014. As per recent norms, there should be one sub-centre for population of 5,000 while in tribal and hilly area population allotted for each sub-centre is 3,000. [1] [6] [7] [8]

Under NRHM, each sub-centre gets an untied fund of Rs 10,000 for expenditure. The ANM has a joint bank account with the Sarpanch (head) of the village to get such funds. ANMs use untied fund for buying items needed for sub-centre, such as blood pressure equipment, weighing machine, scales and for cleaning. The rate of deliveries at the sub-centre level has been increased since the grant of untied funds via NRHM. [1]

ANMs are expected to be multi-purpose health workers. ANM-related work includes maternal and child health along with family planning services, health and nutrition education, efforts for maintaining environmental sanitation, immunisation for the control of communicable diseases, treatment of minor injuries, and first aid in emergencies and disasters. [1]

In remote areas, such as hilly and tribal areas where transport facility is likely to be poor, ANMs are required to conduct home deliveries for women. [7]

Relationship with ASHA

The Accredited Social Health Activist (ASHA) is a community health worker. Depending on the area covered by the sub-centre, each ANM is supported by four or five ASHAs. ANMs are supposed to take weekly or fortnightly meeting with ASHAs to review work done the last week or fortnight. ANMs guides ASHAs on aspects of health care.[ citation needed ]

With the Anganwadi Worker (AWW), the ANM acts as a resource person for the training of ASHAs. The ANM motivates ASHAs to bring beneficiaries to the institution. The ASHA brings pregnant women to the ANM for check-ups. She also brings married couples to the ANM for counseling on the family planning. The ASHA brings children to immunisation sessions held by the ANM. The ASHA act as bridge between the ANM and the village. [1] [6] [7]

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  2. Health sector expenditure by central government and state government, both plan and non-plan, will have to be substantially increased by the twelfth five-year plan. It was increased from 0.94 per cent of GDP in tenth plan to 1.04 per cent in eleventh plan. The provision of clean drinking water and sanitation as one of the principal factors in control of diseases is well established from the history of industrialized countries and it should have high priority in health related resource allocation. The expenditure on health should increased to 2.5 per cent of GDP by the end of Twelfth Five Year Plan.
  3. Financial and managerial system will be redesigned to ensure efficient utilization of available resources and achieve better health outcome. Coordinated delivery of services within and across sectors, delegation matched with accountability, fostering a spirit of innovation are some of the measures proposed.
  4. Increasing the cooperation between private and public sector health care providers to achieve health goals. This will include contracting in of services for gap filling, and various forms of effectively regulated and managed Public-Private Partnership, while also ensuring that there is no compromise in terms of standards of delivery and that the incentive structure does not undermine health care objectives.
  5. The present Rashtriya Swasthya Bima Yojana (RSBY) which provides cash less in-patient treatment through an insurance based system should be reformed to enable access to a continuum of comprehensive primary, secondary and tertiary care. In twelfth plan period entire Below Poverty Line (BPL) population will be covered through RSBY scheme. In planning health care structure for the future, it is desirable to move from a 'fee-for-service' mechanism, to address the issue of fragmentation of services that works to the detriment of preventive and primary care and also to reduce the scope of fraud and induced demand.
  6. In order to increase the availability of skilled human resources, a large expansion of medical schools, nursing colleges, and so on, is therefore necessary and public sector medical schools must play a major role in the process. Special effort will be made to expand medical education in states which are under-served. In addition, a massive effort will be made to recruit and train paramedical and community level health workers.
  7. The multiplicity of Central sector or Centrally Sponsored Schemes has constrained the flexibility of states to make need based plans or deploy their resources in the most efficient manner. The way forward is to focus on strengthening the pillars of the health system, so that it can prevent, detect and manage each of the unique challenges that different parts of the country face.
  8. A series of prescription drugs reforms, promotion of essential, generic medicine and making these universally available free of cost to all patients in public facilities as a part of the Essential Health Package will be a priority.
  9. Effective regulation in medical practice, public health, food and drugs is essential to safeguard people against risks and unethical practices. This is especially so given the information gaps in the health sector which make it difficult for individual to make reasoned choices.
  10. The health system in the Twelfth Plan will continue to have a mix of public and private service providers. The public sector health services need to be strengthened to deliver both public health related and clinical services. The public and private sectors also need to coordinate for the delivery of a continuum of care. A strong regulatory system would supervise the quality of services delivered. Standard treatment guidelines should form the basis of clinical care across public and private sectors, with the adequate monitoring by the regulatory bodies to improve the quality and control the cost of care,

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References

  1. 1 2 3 4 5 6 7 8 9 10 "Tnai Journal". Tnaionline.org. 2007-04-20. Archived from the original on 2016-03-04. Retrieved 2016-01-07.
  2. ↑ Mavalankar, D.; Vora, K.; Prakasamma, M. (2008). "Achieving Millennium Development Goal 5: Is India serious?". Bulletin of the World Health Organization. 86 (4): 243–243A. hdl: 10665/270164 . PMC   2647422 . PMID   18438507.
  3. ↑ "An Auxiliary Nurse-Midwife in India Sets an Example for Family Planning". Jhpiego. Archived from the original on 2016-02-15. Retrieved 2016-01-07.
  4. ↑ S.L. Goel (1 January 2008). Rural Health Education. Deep & Deep Publications. pp. 9–. ISBN   978-81-8450-115-5.
  5. ↑ "Indian Nursing Council, Official Indian nursing council website, Government India, Establish Uniforms Standards, Training Nurses, Midwives, Health Visitors". Indiannursingcouncil.org. Archived from the original on 2019-10-22. Retrieved 2016-01-07.
  6. 1 2 "Rural Health Care System in India" (PDF). National Health Mission . Retrieved 6 March 2021.
  7. 1 2 3 "Indian Public Health Standards (IPHS) Guidelines for Sub-Centres" (PDF). Government of India. Archived from the original (PDF) on 4 March 2016. Retrieved 7 January 2016.
  8. ↑ "HEALTH INFRASTRUCTURE IN RURAL INDIA" (PDF). IIT, Kanpur. Archived from the original (PDF) on 4 March 2016. Retrieved 7 January 2016.

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