USAID/INDIA FERTILITY AWARENESS-BASED METHODS PROJECT PRE-SERVICE TRAINING ASSESSMENT DECEMBER 2010 This publication was produced for review by the United States Agency for International Development. It was prepared by Carol Hooks, Priya Jha, and Jeannette Cachan through the Global Health Technical Assistance Project. USAID/INDIA FERTILITY AWARENESS-BASED METHODS PROJECT PRE-SERVICE TRAINING ASSESSMENT DISCLAIMER The authors‘ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government. This document (Report No. 10-01-435-01) is available in printed or online versions. Online documents can be located in the GH Tech website library at http://resources.ghtechproject.net. Documents are also made available through the Development Experience Clearing House (http://dec.usaid.gov). Additional information can be obtained from: The Global Health Technical Assistance Project 1250 Eye St., NW, Suite 1100 Washington, DC 20005 Tel: (202) 521-1900 Fax: (202) 521-1901 [email protected] This document was submitted by The QED Group, LLC, with CAMRIS International and Social & Scientific Systems, Inc., to the United States Agency for International Development under USAID Contract No. GHS-I-00-05-00005-00. ACKNOWLEDGMENTS The authors are grateful to many people for their support and cooperation in the completion of this assessment. Nearly 50 busy professionals gave freely of their time to participate in interviews and group discussions. To them we owe a special debt of gratitude. What they shared with us is the substance of this report. Loveleen Johri at USAID/India offered background and asked questions that helped inform the interviews. Dr. Sanjay Gupta of India‘s National Institute of Health and Family Welfare (NIHFW) arranged most of the interviews and provided insight into India‘s health system and family welfare program. Sonia Panja and Esha Kalra of the Institute for Reproductive Health, Georgetown University/India (IRH/India) provided a range of support during the India visit— everything from ensuring cell phone access to securing appointments. Nidhi Saxena of IRH/India arranged meetings in Lucknow. Puneet Singh also provided logistical support. In the United States, Erika Lutz, Michelle Ferng, and Allison Korman of the Global Health Technical Assistance Project (GH Tech) were efficient and effective in guiding the consultancy process, including travel. Miranda Beckman of IRH provided background information. Finally, USAID/Washington‘s Mihira Karra, Jewel Gausman, Megan Matthews, and Imran Mahmud saw the need for the assessment, supported it, and asked thoughtful questions during the debriefing that made the report even more targeted to the needs of those who will use it. USAID/INDIA FAM PROJECT PRE-SERVICE TRAINING ASSESSMENT i ii USAID/INDIA FAM PROJECT PRE-SERVICE TRAINING ASSESSMENT CONTENTS ACRONYMS ...................................................................................................................... v EXECUTIVE SUMMARY................................................................................................ vii Background .............................................................................................................................................. vii Methodology .......................................................................................................................................... viii Key Findings ........................................................................................................................................... viii Key Recommendations ...........................................................................................................................x Conclusion ................................................................................................................................................xi I. BACKGROUND ....................................................................................................... 1 The FAM Project ......................................................................................................................................1 FAM in India ..............................................................................................................................................1 Purpose of the Assessment ...................................................................................................................2 II. MEDICAL AND NURSING EDUCATION IN INDIA .......................................... 3 Terminology ..............................................................................................................................................3 Pre-service Education in India ...............................................................................................................3 Continuing Medical and Nursing Education in India ........................................................................4 Provision of Family Welfare Services ..................................................................................................4 III. METHODOLOGY .................................................................................................... 7 IV. OVERVIEW OF FINDINGS .................................................................................... 9 Conditions for Integration of SDM and LAM in Pre-service Education .....................................9 Syllabus Review .........................................................................................................................................9 Other Teaching Materials ................................................................................................................... 10 In-service and Pre-service Education for SDM and LAM ............................................................ 11 V. SUMMARY OF FINDINGS BY INSTITUTION .................................................. 13 New Delhi .............................................................................................................................................. 13 Lucknow .................................................................................................................................................. 16 Agra .......................................................................................................................................................... 18 Other ....................................................................................................................................................... 19 VI. RECOMMENDATIONS FOR GUIDING INTEGRATION OF SDM AND LAM INTO PRE-SERVICE AND CONTINUING EDUCATION ............ 21 Large-scale Institutionalization ........................................................................................................... 21 Pre-service Training .............................................................................................................................. 21 In-service Training and Continuing Education ............................................................................... 22 Availability of Cyclebeads .................................................................................................................... 23 Branding ................................................................................................................................................... 23 Improving Acceptability among Heads of Department, Professors, and Tutors ................... 23 Staffing ...................................................................................................................................................... 24 VII. CONCLUSION ....................................................................................................... 25 USAID/INDIA FAM PROJECT PRE-SERVICE TRAINING ASSESSMENT iii APPENDIXES APPENDIX A. SCOPE OF WORK ............................................................................... 27 APPENDIX B. PERSONS CONTACTED .................................................................... 37 APPENDIX C. REFERENCES ........................................................................................ 39 APPENDIX D. ANM EXPECTED JOB FUNCTIONS, BASED ON SYLLABUS .... 40 APPENDIX E. ORGANIZATION OF PUBLIC HEALTH SERVICES IN INDIA ...... 42 APPENDIX F. INVENTORY OF MATERIALS CONSULTED ................................... 44 APPENDIX G. INTERVIEW GUIDE ............................................................................. 46 APPENDIX H. FGD GUIDE ........................................................................................... 50 APPENDIX I. RESPONDENT CONTACT LIST ......................................................... 54 APPENDIX J. SYLLABUS OVERVIEWS ...................................................................... 60 APPENDIX K. RELEVANT EXCERPTS FROM SYLLABUS AND REGULATIONS— AUXILIARY NURSE AND MIDWIVES, INDIAN NURSING COUNCIL, 2009 .................................................................................... 66 APPENDIX L. TRANSCRIPT OF INDIA FGD AND INTERVIEW NOTES ............ 70 APPENDIX M. IRH/INDIA DRAFT ACTION PLAN .................................................. 88 APPENDIX N. SAMPLE ENTRANCE REQUIREMENTS ........................................... 94 TABLES Table 1. Number of Accredited Programs by Location ................................................ 4 Table 2. Level Trained, by Institution ............................................................................