Inservice training of health workers through distance mode

Nursing Journal of India, Sep 2003 by Koul, Pity

Introduction

Health status of any country is measured by health indicators such as Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR), Crude Death Rate (CDR), Birth Rate (BR), Life expectancy at birth and morbidity rate etc. Although, India has made a significant improvement in relation to health status by planning and implementing various health programmes since independence, yet the status in relation to certain sensitive indicators like MMR and IMR is a cause of concern. This has resulted in shift of approach in health care services from time to time such as implementation of Family Planning Programme (1951-52), Family Welfare Programme (1984-89) Universal Immunization Programme (1985-86) Oral Rehydration Therapy, Maternal and Child Health (MCH) and Child Survival and Safe Motherhood Programme (CSSM 1992-93) etc. The focus now is on Reproductive and Child Health care (RCH 1997) as women in reproductive age group and children (upto 5 years) are of crucial importance for effective tackling of population growth.

Thus, the paradigm shift in scientific advancement, emerging health scenario and commitment to achieve health for all has resulted in redesigning of health care system at all level. The custurners/clients are the focus of care and high quality and cost containment are the common themes.

Need and Relevance of Training ANM/FHW through Distance Mode

One of the goals of reproductive and child health programme is to ensure a high level performance among health workers and adequate efficiency of health system ensured by an effective system of accountability. In this context ANM/FHW who forms the huge work force in the country has to regularly participate in inservice training for upgradation of their knowledge and skills. Consequently educational offerings that address these deficits must be accessible, equitable, cost effective and meaningful.

Distance education technology can provide an effective strategy to enhance their learning and skills and extend educational opportunity mainly in the area of continuing education. Distance learning in relation to professional education refers to any educational experience in which instructor (teacher) is separated from student (learner) by geographic distance.

It is often argued that certain professional courses such as medicine and nursing cannot be taught through distance as it requires lot of skill development and deals with sensitive issue of human element, but there is enough evidence of successful teaching of these courses through distance education mainly in relation to continuing education of health professionals world over.

Issue of Access and equality

One of the major reasons for establishing distance education system is to provide more opportunities to the geographically isolated and reach the disadvantaged groups who otherwise do not have access to higher education due to various barriers. In such situation, distance learning institution can act as an agent for social change so as to realize the principle of expanded education.

The health infrastructure and trained manpower is concentrated in urban cities and metropolitan areas that leads to inequal opportunity to female health workers at grassroot level. This necessitates the development of ANM/FHW's who take responsibility for their learning and are not dependent on experts to decide what they should learn and do.

Barriers of time, money, place, income, family, shortage of resources, socio-cultural psychological, language barriers and other job responsibilities hinders them to come out of their home and work place to upgrade their knowledge and skills through continuing education. There are only 42 promotional training centers and 27 regional family welfare-training centers established for training these ANMs/ FHWs. Whatever institutions are available, the intake of candidates is very low. Most of ANM/FHW's do not get promotion throughout their career and retire as ANM/FHW only.

It is therefore, evident that there is a gross shortage of resources to train and retrain this workforce systematically to act as an agent of change in delivery of effective and efficient health care to all at grassroot level. Distance learnings system has the potential to address the issue of access and equity in relation to training of these workers and can provide them an opportunity of career promotion.

Competency Enhancement of ANM/FHW through Distance Mode

The competency enhancement programme for ANM's/ FHWs has been designed in response to the need felt by Government of India and WHO to provide uniform training in the context of Reproductive and Child Health care. As these workers play a vital role in meeting the health care needs of 70% of our population in rural India, the major focus of the programme is on enhancement of competencies in socio-cultural, RCH skills, communication skills, management skills and through technical support and ensuring community participation to address the health care needs and problems of the society as a whole.