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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

Presentation Outline.
Programmatic approach How strengthening of PSE for the nursing and midwifery cadre was initiated and scaled up Lessons learned Current GoI strategy

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.

What is planned.
Long term plan is to build extensive systems for supporting effective education of the midwifery and nursing workforce TA from MCHIP is catalytic in bringing about fundamental change at multiple levels of the educational system.

INCs strategic approach for strengthening the Pre-Service Nursing and Midwifery Education
TA for 1.Quality improvement by use of educational standards 2.Strengthen the clinical & training skills of the tutors

guidance Design of intervention


of educational standards Clinical & pedagogic courses Improvement of own center Structured support to ANM schools

functioning educational institutions Competent confident ANMs

Jhpiego identified as the Technical Agency by the INC/GoI

Program Components
Strengthened Capacity of the Faculty

Improved Clinical Practices

(at the clinical practice sites)

(both teaching and clinical skills)

Strengthened training infrastructure

(Class rooms, skill labs, IT)

(at the institutions)

Improved Educational Processes

Improved Quality of PSE

Introduction of internship for ANMs

Development of Performance Standards

Performance standards for use by the NNCs/SNCs and ANMTC/GNM Schools developed. Educational Standards Clinical Standards The standards tell Tutors and providers not only what to do but also how to do it

Before starting the 10-days TOT at the NNC/SNC or 6-weeks training of the Nursing Tutors it is critical that the Nursing schools should achieve 60-70% Educational and clinical standards

How Performance Standards work??

Empowers teachers at the schools & 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

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 of Standards



Class room and practical instruction Clinical instruction and practice

School infrastructure and training materials





Clinical site practices

School management



Strengthening of National Nodal Centers

Quality improvement at the NNCs using the SBM-R approach
Eduactional Standards
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% CMC Vellore NRSCoN, St CMC GCoN Kolkata Stephens Ludhiana Vadodara CoN BL 1st IA 2nd IA 3rd IA 4th IA 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Clinical Standards

BL 1st IA 2nd IA

Token of appreciation for the achievement of the educational standards

Strengthening Skills Labs

Identification of space for the skills lab at NNC Procurement of models and equipment as per INC approved list Setting up stations ANC corner Labor corner Newborn corner, PNC corner Family Planning Infection Prevention Special Procedures

Strengthening Skills Lab Stations

ANC and PNC corners Family Planning Corner Special skills corner

Labour corner Infection Prevention corner


ANMTC Library

Computer Labs, class rooms

3 Days Clinical Skills Standardization Training of Labor room staff

All health care providers of MCH area including nursing tutors are trained on AMTSL ENBC NB resuscitation Partograph Infection prevention practices Managing Complications like Eclampsia and PPH

IPP Before and After Training

Strengthening of selected ANMTCs Jharkhand and Uttarakhand

Quality improvement using the performance standards Baseline
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Current Status 88% 85% 86%



38% 26% 21% 24%



Chaibasa Jharkhand





6-weeks training for Nursing Tutors

Course Description and Evaluation methods Week 1 Week 2 Week 3 & 4 Week 5 Week 6

Effectiv e teachin g & Basic Comput er skills

Skilled Birth Attenda nce

Clinical training

IMNCI & Family Planning

Prevention of RTI,STI/ HIV/PPTCT & Educational standards

Evaluation: Knowledge and Skill

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.


What have we learned so far

Use of educational and clinical standards have 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

Current GoI strategy:

To scale up strengthening of PSE for the nursing and midwifery cadre in 10 high focus states in the country, using the above programmatic approach with plan to create 10 State Nodal Centers MCHIP to conduct orientation of all stakeholders including donors who are investing in PSE NIPI, DFID, UNFPA, Unicef, WHO

Somesh Kumar Rashmi Asif Princy Fernando Pallavi Sinha

USAID supported MCHIP initiative MoH&FW, Government of India Indian Nursing Council

Every Journey begins with a single step, But you will never finish if you dont start