Background:
Reducing maternal and child mortality are among the
most important goals of the National Rural Health Mission. At various global
platforms, India has reaffirmed its commitment to make every effort towards
achieving the Millennium Development Goals 4 and 5. The Govt. of India, in
keeping with its National Call to Action: Child Survival and Development, 2013 (an
iteration of this commitment), has been working together with its development partners
on the strategic roadmap for accelerating child survival and improving maternal
health beyond 2015.
A defined strategic approach to reproductive,
maternal, new-born, child and adolescent health (RMNCH+A) has been developed to
provide an understanding of ‘continuum of care’ to ensure equal focus on
various life stages. Reinforced efforts were undertaken to up the poor
performing districts that have already been identified as high priority districts
(HPDs).
Renewing India’s commitment for a compelling
vision of improving maternal health and child survival in the country, planned
initiatives have been rolled out to reach out to the most vulnerable and
disadvantaged segment of the population, in the country.
Context:
Govt. of Bihar, working in collaboration with its
Development Partners in this direction, has already initiated targeted health interventions
for effective execution of specified activities under the RMNCH+A 5x5 Matrix. In accordance to Cross
Cutting activities (Clause No. 2) of the matrix, the AMANAT (Mobile Nurse
Mentoring programme) is being piloted in
80 selected Public Health facilities of Bihar, as a health innovation in the state, to build the capacity of ANMs and Nurses to provide
specialized and quality care to pregnant women and children.
CALL
TO ACTION SUMMIT 2015:
The
New Delhi Summit on August 27-28, 2015, for ending preventable child and
maternal deaths, will be a confluence of health ministers from 24 priority
countries that committed to the Global Call to Action for Child Survival in
June 2012.
The
Ministerial Conclave would be co-hosted by the Ministry of Health and Family
Welfare, Government of India along with the Ministry of Health, Government of
Ethiopia, USAID, UNICEF, the Bill & Melinda Gates Foundation, and Tata
Trusts. Health ministers, international academic experts, health practitioners
and leaders from diverse sectors - corporate, civil society and media have
pledged their participation in the summit.
With
an objective to evolve a set of tangible outcomes, creating avenues for strong
partnerships among countries in maternal and child health, this conclave would
function as a platform to deliberate upon the importance of Systems,
Partnerships, Innovations, Convergence, and Evidence in ending all
preventable maternal and child deaths by 2035.
AMANAT
in context of Call to Action Summit 2015:
The Mobile Nurse Mentoring
programme, named as AMANAT, has
earned a selection as a state innovation (ongoing in the state of Bihar, India)
in the Call to Action 2015 presentations. The instant Health Innovation (first initiated
in the state of Bihar, India), has successfully demonstrated its immense potential in skill building of the on-duty
nurses in handling and management of critical maternal and neo-natal
complications.
Approach to AMANAT:
“Prevention is better than
Cure”, as the proverb goes, AMANAT programme involves iterative training and
incremental learning delivered through teams of graduate and post-graduate nurses
to the cadre of nurses functioning at different Govt. Health Centres.
A well-defined course
curriculum with a monthly mentoring roaster has been developed under the
programme. The nurse mentors and trainers go one week each month to four Block
PHCs for a period of six to eight months. Aided by lesson plans and different
tools to effectively demonstrate new techniques, such teams ensure that the
Grade A nurses and ANMs working in the Labour Rooms improve their clinical
practices in order to prevent infections, competently handle normal deliveries
and to effectively manage the most common maternal and neonatal emergencies.
Maternal and neonatal
complications are simulated repeatedly under this programme, for the
participants to practise the treatment and management of the critical cases so
that risks are avoided on actual patients. Significantly, the AMANAT mentoring process
is based on the “learning by doing” theory of adult learning techniques, and
emphasizes to learn on the job while handling women in labour and the new-borns.
Further, by practising their newly learnt skills during repeated simulations of
obstetric and neonatal emergencies, the participants are provided with
opportunities to master their hands-on skills of the subject.
Impacting the Health
Indicators:
AMANAT
Mobile Nurse Mentoring programme accentuates skill
development at a fast pace. It has been proven effective in rapid lowering of maternal
and neonatal deaths by ratcheting up the clinical skills and practice of nurses
in the Labour Rooms of PHCs to modern day expectations of Emergency Obstetric
and Neonatal Care by bringing the nursing school to their own clinical
settings.
It has successfully been piloted
in 80 Public Health facilities of Bihar. With intensive focus on the practical
knowledge and hands-on skill development of the nurses, it has been evidenced to
have sustainably changed the Labour Room behaviour and practices especially in
areas of Infection Control and the Active Management of Third Stage of Labour.
Ø
Photo 1- Accurate Weighing of Child at
Birth
Ø
Ø Photo 2- Demonstration of new-born
care
PPhoto 3 - Simulation training
Key
to Success:
AMANAT
Mobile Nurse Mentoring programme, a collaborative
initiative of the Health Department, Govt. of Bihar, and its Development
Partners, having evidenced to produce positive impacting results in selected 80
PHCs of Bihar, carries the potential of generating same results, when executed at
scale and replicated throughout the state.
The
two pronged skill development approach of the initiative of firstly providing
opportunity for the nurses to practice the care and management of common
maternal and neo-natal complications in simulated settings, and secondly the on-job
mentoring for them while handling actual cases, has been the key to success of
the Healthcare Innovation, being presently implemented by the State RMNCH+A
Unit (SRU), in Bihar.
As the Senior Communication Adviser of SRU I am proud to be a part of this innovation and I am very happy to create the brand identity of this amazing Maternal & Neonatal health programme.
Victor Ghoshe
Sr Adviser, Public Health Communication
State RMNCH+A Unit, Bihar
