Health Workers’ Perceptions about Maternal and Adolescent Health among Marginalized Populations in India: A Multi-Centric Qualitative Study

Frontline workers are instrumental in bridging the gap in the utilization of maternal health services. We performed a qualitative cross-sectional study with medical officers, accredited social health activists (ASHA), and auxiliary nurse midwifes (ANM), across 13 districts of India, in order to understand the barriers and enablers, at the system and population levels, for improving access of adolescents and mothers to services. The data were collected by means of in-depth interviews (IDI) with medical officers and focus group discussions (FGD) with ASHA and ANM in 2016. The interview guide was based on the conceptual framework of WHO health interventions to decrease maternal morbidity. Content analysis was performed. In total, 532 frontline workers participated in 52 FGD and 52 medical officers in IDI. Adolescent clinics seemed nonexistent in most places; however, services were provided, such as counselling, iron tablets, or sanitary pads. Frontline workers perceived limited awareness and access to facilities among women for antenatal care. There were challenges in receiving the cash under maternity benefit schemes. Mothers-in-law and husbands were major influencers in women’s access to health services. Adolescent clinics and antenatal or postnatal care visits should be seen as windows of opportunities for approaching adolescents and women with good quality services.

Community Health Worker Evaluation of Implementing an mHealth Application to Support Maternal Health Care in Rural India

Introduction: PIERS on the Move (POM) is a mobile health (mHealth) application developed for a smartphone to support community health workers (CHWs) for identification and management of women at risk of adverse outcomes from pre-eclampsia. POM was implemented as an addition to routine antenatal care by accredited social health activists (ASHAs) and auxiliary nurse midwives (ANMs) during the community level intervention for pre-eclampsia (CLIP) Trial in Karnataka state, India (NCT01911494). The objective of this study was to evaluate the experiences of CHWs of using POM in rural India and their perceptions of acceptability and feasibility of this mHealth intervention.Methods: A posttrial mixed-methods evaluation was designed to measure CHW knowledge and self-efficacy regarding the care of women with pre-eclampsia and perceptions of CHWs on the ease of use and usefulness of POM. A structured survey with open-ended questions was conducted between October and November 2017. The median values on a 5-point Likert scale for knowledge and self-efficacy questions were compared between trial arms by Mann–Whitney U test (p < 0.05 significant). Qualitative analysis was undertaken on NVivo 12 (QSR International, Melbourne, Australia).Results: A total of 48 ASHAs and ANMs were interviewed, including 24 who used POM (intervention arm) and 24 who did not (control arm). Self-reported knowledge and self-efficacy for the care of women with pre-eclampsia did not differ between groups. The qualitative analysis highlighted that health workers who used POM reported improved interactions with women and families in their communities. POM strengthened the role of ASHA as a CHW beyond a “link-worker” accompanying women to health services. With training, the mHealth application was easy to use even for CHWs who did not have much experience with smartphones.Conclusions: Community health workers found the POM app easy to use, useful, and well-received by women and their families. POM did not improve care through increased knowledge but built capacity by increasing the recognition of the ASHA and ANM as critical members of the continuum of antenatal healthcare within their communities. These findings support the important role that mHealth technologies can play in strengthening health systems to reach rural, remote, and marginalized populations to reduce disparities in health.

KNOWLEDGE OF HEALTH FUNCTIONARIES REGARDING NONCOMMUNICABLE DISEASES: FINDINGS OF A STUDY FROM NORTH INDIA

National Programme for prevention and control of Cancer, Diabetes, Cardiovascular diseases and stroke (NPCDCS) envisaged prevention of noncommunicable diseases (NCDs) through behavioural change. It aimed at capacity building at various level of health care for primordial prevention, early diagnosis, IEC, BCC etc. Necessary induction training was imparted to health functionaries. Regular monitoring and review of the knowledge of different health functionaries is an integral part of programme. With this background, this study was carried to assess the knowledge of health functionaries about NCDs (general and individual), their behavioral as well as intermediate risk factors and programmatic issues of NPCDCS. Knowledge of 8 Medical ofcers (Allopathic/AYUSH), 18 Auxiliary Nurse Midwives (ANMs) and 15 Accredited Social Health Activists (ASHAs) were assessed in these areas through predesigned and pretested proforma. There existed gap in the knowledge of medical ofcers, ANMs and ASHAs. In some areas their knowledge was satisfactory however, in majority of areas this was not up to the mark e.g., cut off for normal random blood sugar was known to All MOs, ANMs and 33.3% ASHAs [Z=5.55, p< 0.01]. There is need and scope for improving knowledge of health functionaries through focused capacity building initiative and overcoming barriers to promote health functionaries to take up NCD prevention in community

A brief about autism spectrum disorders for nurses and other peripheral health workers

Autism spectrum disorder encompasses a wide range of neurodevelopment disabilities which affect children and their families across all sections of the society both in rural and urban settings. The prevalence of autism is rising irrespective of the socioeconomic background of the children. Hence every health worker has to be aware of ways to suspect and diagnose this condition and decide the appropriate treatment. Earliest intervention in autism spectrum disorder gives better results due to neuroplasticity. This article is targeted to help Medical officers, auxiliary nurse midwifes, anganwadi workers and other peripheral health workers by providing information on basics of ASD, normal speech development, simple ways for diagnosis and treatment for the same.

Factors leading to neonatal mortality due to neonatal purpura fulminans through the lens of a child death review

A case of neonatal death due to neonatal purpura fulminans (NPF) was brought to community physicians’ notice by the auxiliary nurse midwife in her catchment area as part of the routine demographic health surveillance. The community physician then conducted the child death review in the community. The neonate was born out of consanguineous marriage (mother married to her first-degree maternal cousin) with spontaneous conception. This neonate was fourth in the birth order. The second-order and third-order births had also suffered from NPF and died. The baby was delivered in a tertiary care setting, and the paediatric surgeon planned debridement of the affected part on the third day of the birth, as per the mother. However, due to inadequate counselling regarding the procedure, mother left the hospital without seeking care against medical advice, and the child died at home.

Interplaying role of healthcare activist and homemaker: a mixed-methods exploration of the workload of community health workers (Accredited Social Health Activists) in India

Background Globally, community health workers (CHWs) are integral contributors to many health systems. In India, Accredited Social Health Activists (ASHAs) have been deployed since 2005. Engaged in multiple health care activities, they are a key link between the health system and population. ASHAs are expected to participate in new health programmes prompting interest in their current workload from the perspective of the health system, community and their family. Methods This mixed-methods design study was conducted in rural and tribal Primary Health Centers (PHCs), in Pune district, Western Maharashtra, India. All ASHAs affiliated with these PHCs were invited to participate in the quantitative study, those agreeing to contribute in-depth interviews (IDI) were enrolled in an additional qualitative study. Key informants’ interviews were conducted with the Auxiliary Nurse Midwife (ANM), Block Facilitators (BFF) and Medical Officers (MO) of the same PHCs. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed thematically. Results We recruited 67 ASHAs from the two PHCs. ASHAs worked up to 20 h/week in their village of residence, serving populations of approximately 800–1200, embracing an increasing range of activities, despite a workload that contributed to feelings of being rushed and tiredness. They juggled household work, other paid jobs and their ASHA activities. Practical problems with travel added to time involved, especially in tribal areas where transport is lacking. Their sense of benefiting the community coupled with respect and recognition gained in village brought happiness and job satisfaction. They were willing to take on new tasks. ASHAs perceived themselves as ‘voluntary community health workers’ rather than as ‘health activists”. Conclusions ASHAs were struggling to balance their significant ASHA work and domestic tasks. They were proud of their role as CHWs and willing to take on new activities. Strategies to recruit, train, skills enhancement, incentivise, and retain ASHAs, need to be prioritised. Evolving attitudes to the advantages/disadvantages of current voluntary status and role of ASHAs need to be understood and addressed if ASHAs are to be remain a key component in achieving universal health coverage in India.

Community Health Officer Post – Potential Concerns

Under Ayushman Bharat Health and Wellness Centre (HWC) initiative, a middle-level health provider post, named Community Health Officer (CHO), is envisioned to bridge the gap between the health system and community. This cadre has multiple roles and responsibilities that mirror what used to be done by the Auxiliary Nurse Midwife (ANM) at sub-center before conversion to HWC. Owing to educational and experience requirements of CHO, and existing other cadres at the sub-center, there may be some concerns related to role ambiguity, interpersonal issues, inter- and intra-cadre conflicts, and non-cooperation challenges.

ESTIMATION OF WORKLOAD OF ANMS AND CALCULATING THE REQUIRED NUMBER OF ANMS IN IMPLEMENTING MOTHER CHILD TRACKING SYSTEM IN NORTHERN INDIA: WISN METHODOLOGY

Mother child tracking system(MCTS) is an information system for tracking maternal and child health beneficiaries in Indias public health system, and improving service delivery planning and outcomes. Auxiliary nurse midwife(ANM) has broad spectrum of responsibilities to play in under National health mission. In the present study the workload of ANM was estimated using standard methodology WISN(Workload indicators of staffing needs) given by WHO. Quantitative research approach with time-motion research design was chosen for the study. Workload was estimated in 21 civil dispensaries of Chandigarh, India. The workload was found to be high in 9 dispensaries. It was very high in 4 dispensaries where ANMs spent their total annual working time in doing activities under MCTS and they are left with no time for doing activities under other national health programs.