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1. UTTAR PRADESH
TECHNICAL SUPPORT UNIT
Nursing overview in Uttar Pradesh
Feb 2021

2. •46% of maternal deaths and 40% neo-natal deaths
occur around labor and childbirth
•If adequate number of trained/mentored
nurses/midwives are available, they can provide for
about 87% of RMNCHA services
Why Staff Nurse is a critical cadre?

3. Agenda
HRH Life-Cycle framework for Nursing
Production
Recruitment
Training and mentoring
Performance Improvement
Planning, Regulation and Governance

4. Key Components
• Nursing Directorate in MH and ME
• Manav Sampada – e Human Resource Management System
Key Components
• Sanctioned vs required
• Regular vs contractual
• Nursing cadre vision
• Nursing Midwife, CHO
• Specialist Nurse
Key Components
• Performance measurement
• ACR digitization
• Unitized data
• Incentives for good performance
Key Components
• Training eco-system
• Pre-service to in-service
• Mentoring
• Skill labs
• SMTIs
Key Components
• NNMC Bill
• No: of public vs pvt institutions
• Regulating bodies in UP
• Quality of pre-service education
HRH Lifecycle Framework
Perform Produce
Recruit
Train
HRH Planning, Regulation, and Governance
Source: Adapted from Draft Human Resources for Health in Uttar Pradesh, a strategy for 2020-30

5. Production

6. NNMC Bill – Salient Features

7. • National Nursing and Midwifery Commission bill, 2020 - The Indian Nursing
Council Act, 1947
• Commission proposed to provide for:
• regulate standards nursing education and training, institutes,
• standards for nursing & midwifery faculty and clinical facility
• for uniform entry examination with common counselling
• National Exit Test- Nursing& Midwifery
• assess the nursing and midwifery requirements in health care
• ensure coordination among the Autonomous Boards
Regulations governing Nurse – National level

8. Nursing Cadre as per The Nursing and Midwifery Bill of 2020
Nursing Care (including Home-
based Personal Care) Assistants
Example: Nurse, Nurse educator and
faculty, Public Health Nursing Officer,
Clinical Nurse Specialist, Nurse Practitioner
Example: Nursing
Professional Midwife
Example: Directorate, Principals
of colleges and training centers
Example: Multi-Purpose
Health Worker (Male)
Example: ANM and
Lady Health Visitor
Assistance with
activities of daily living

9. • 4 Autonomous boards proposed:
• the Nursing and Midwifery UG Education Board;
• the Nursing and Midwifery PG Education Board;
• the Nursing and Midwifery Assessment and Rating Board; and
• the Nursing and Midwifery Ethics and Registration Board
• Role of state governments - Every State Government shall, by notification, within one
year of the commencement of this Act, constitute a State Nursing and Midwifery
Commission, provided if no such State Commission exists in that State by a State Law
(primarily a supportive role to central commission)
• The Central Government shall constitute an advisory body to be known as the Nursing
and Midwifery Advisory Council
Regulations governing Nurse – National level

10. Growth in Nursing Institutions
29 29 26
180
461 (30%)
8
35
114
228
415 (14%)
0 2
28
58
203 (10%)
0 0 4 9
37 (5%)
0
50
100
150
200
250
300
350
400
450
500
2000 2005 2010 2015 2020
Uttar Pradesh
ANM GNM BSc MSc
298 360
676
1921 1904
285
983
2083
2958
3212
30
377
1326
1690
1968
10 59
315
577
653
0
500
1000
1500
2000
2500
3000
3500
2000 2005 2010 2015 2019
India
ANM GNM BSc MSc
*INC Annual Report 2019

11. GNM to BSc ratio across India
Number of Nursing Institutes
State ANM GNM BSc MSc
Uttar Pradesh 238 280 96 (0.3) 34
Madhya Pradesh 95 400 186 (0.5) 59
Gujarat 28 175 172 (1) 27
Tamil Nadu 42 211 182 (0.9) 82
Andhra 34 159 148 (1) 32
India 1903 3212 1968 (0.6) 778
Number of Nursing seats*
State ANM GNM BSc MSc
Uttar Pradesh 8250 12650 5340 (0.4) 409
Madhya Pradesh 3080 15530 10225 (0.7) 978
Gujarat 3600 6165 4829 (0.8) 334
Tamil Nadu 1380 7320 12980 (1.7) 1809
Andhra 1010 6930 7735 (1.1) 935
India 55208 130676 98864 (0.75) 24520 * -as on 2017 in INC Annual report 2019

12. 2310
12
5…
Uttar Pradesh Nursing Pre-service – Public vs Pvt
UP State Medical Faculty website 2021
39
42
2
13
40
2
10
193
1
36 Government
Institutions
613
14043
520
73
10
50
75
Seats
• ANM – 10+2 any subject
• GNM – 10+2 any subject
• BSc – 10+2 in science
• MSc – BSc/Post-basic BSc
• NPM – GNM/BSc with 2 yrs in MH
Eligibility
• ANM – 14851
• GNM – 14656
• BSc – 7830
• MSc – 809
Annual Production Capacity
• ANM – 60258
• Nurse and Midwife - 74777
Total registered with INC (2017)
Private

13. Comparison of Nursing Councils of various States
State
Inspection of
Institutions
Provide NOC
for INC
Maintain
registered
institution list
Grant registration
certificate to
individuals
Maintain list of
registered
individuals
Conduct
qualifying
examination
Uttar Pradesh UP State Medical Faculty Council UP Nursing and Midwives Council
UPNMC for
ANM/GNM,
University for
BSc/MSc
Rajasthan Rajasthan Nursing Council
Gujarat Gujarat Nursing Council
West Bengal West Bengal Nursing Council
Tamil Nadu Tamil Nadu Nursing Council

15. • UP State Medical Faculty Council
• Government of Uttar Pradesh (United Provinces Government) had established “United Provinces
Board of Medical Examination” in 1917, and was granted powers under “Indian Medical Degrees Act
1916”
• Only those paramedical courses, for which there is no council situated at the centre or state level, all
the work regarding their regulations and control
• GoUP has transferred U.P. State Medical Faculty and allied councils from the Department of Medical,
Health and Family welfare to the “Department of Medical Education” in 2005
• UP Nurse and Midwives Council
• U.P. Nurses & Midwives Council is established by U.P. Act No. XV of 1934. U.P. Nurses & Midwives
Council is registered & recognized by Indian Nursing Council
• The council is authorized to do the Registration of Nurses, General Nurse & Midwives, Health Worker
(Female), B.Sc. Nursing & Auxiliary Nurse Midwives as per the schedule of Indian Nursing Council
• Maintains digital registry of all Nurse and Midwives, and provides NUID
Registration of institution delinked from registration of Students

16. Quality of pre-service

17. Why Pre-service training is important?
*Jhpiego Baseline

18. Why Pre-service training is important?
*Jhpiego Baseline

19. Key pre-service strengthening efforts undertaken so far
• National Nodal Centre (CoN Kanpur) and State Nodal Centres (CoN BHU Varanasi & CoN
Meerut) established
• Quality of pre-service education in public and private sector nursing institutions by
implementing Pre-Service Education standards (INC)
• 16 out of 17 (6 CoNs, 10 GNMTCs, and 1 ANMTC) identified public nursing institutes
strengthened and fulfilled over 70% standards
• All 13 private sector nursing institutes chosen achieved 70% or above on the
performance standards
• Concept on pvt. Nursing institute assessment for grading in UP has been developed in
collaboration with Nursing council;
• Tool developed and formal communication to all pvt. sector colleges
• Assessment done for 300+ private nursing institutes in the state and submitted
• Recommendations for next steps have also been provided in the report

20. Key pre-service strengthening efforts undertaken so far
S.No: Part 1 - Basic Requirement (60%) S.No: Part 2 – Performance Standard (40%)
1 Statutory Compliances 1 Facility-Student ratio
2 Biometric attendance system 2 Academic policy of institution
3 Virtual Classroom set up 3 Academic Calendar
4 Training infrastructure (Teaching block) 4 Computer lab
5 Training infrastructure (Hostel block) 5 Lesson plans
6 Teaching Human Resources 6 Effective facilitation skills
7 Clinical Practice site 7 Utilization of learning labs
8 Clinical rotation plans
9 Clinical supervision
10 Evaluation systems
11 Monthly staff meetings
12 Continuing Nursing education
Basic components of Grading/Ranking tool

21. • Issues:
• Boom in Nursing schools in the pvt. sector with limited regulation on quality
• Two different bodies for registration of institutes and individuals
• Ratio of GNM to BSc
• GNM entry with non-science background
• Leading to graduates unsuitable for public health
• Recommendations:
• Unified council for institute and individuals registration as envisioned by NMC Bill (and other councils
for quality?)
• All govt. medical colleges to also have Nursing colleges
• Grading system for pvt. nursing colleges
• Formalize and disseminate grading, and provide recognition for good colleges
• Frequency and owners for conducting grading/ranking of all nursing colleges to be decided and
budgeted for
• Potential linkage to recruitment, fee structure and short term trainings of faculty
• One-time incentive for conversion of good ranking GNM schools to BSc with regulation
Issues and Recommendation

22. Recruitment

23. < 0.5 0.5 to 1 1 to 1.71 > 1.70
J&K,
Jharkhand,
Uttar
Pradesh
Manipur,
Haryana, Bihar
Odisha, Chandigarh,
Maharashtra, Arunachal
Pradesh, Assam, Tamil
Nadu, Andhra Pradesh,
Tripura, Sikkim,
Himachal Pradesh,
Chhattisgarh, Punjab
Madhya Pradesh,
Meghalaya, Goa,
Gujarat, Kerala,
Karnataka, Nagaland,
Puducherry, Rajasthan,
Mizoram, West Bengal,
Telangana, Delhi
National
Average
Staff Nurse to Doctor ratio (Regular)
1.71
Source: NHSRC presentation

24. Sanctioned Posts v/s norms
Facility Type
No. of facilities
existing
SN sanctioned per
facility (IPHS Norm)
Total SN required (as
per IPHS) for existing
facilities
Total SN required as per
IPHS norms (Total)
DH- 100 bed
147 (100
bedded)
38 (45) 6615
20,612
DH- 200 bed 20 (200 bedded) 55 (90) 1800
DH- 300 bed 9 (300 bedded) 74 (135) 1215
DH- 400 bed 1 (400 bedded) 74 (180) 180
DH- 500+ bed 2 (500 bedded+) 74 (225) 450
CHC 853 3 (10) 8530 20820
PHC 3615 0 (3) 10845 20820
Special Units Details in next slide 8264 8264
Total
9335 (R) + 16409 (C) =
25744
37899 SN 70516 SN

25. Delivery – PHC Nurse
Sanctioned in Uttar Pradesh Required sanctioned as per IPHS
Contractual
SN are
posted
mostly at
special units
• PHCs have only 1 MO sanctioned
for all clinical services
• Contractual SN for PHC-HWC
and CHO for SC-HWC
SC
PHC
CHC
DH
Levels
of
care
33 45

26. Regular vs Contractual
Regular
36%
Contractual
64%
Staff Nurse Distribution
Available
58%
Vacancy
42%
Type Sanctioned Available Vacant
Regular 9335 5434 3901
Contractual 16409 15894 515

27. • Fill all existing regular vacancies
• Additional weightage for contractual Nurse in regular recruitment has been included
since 2018
• 3 States allow for contractual to regular movement – Odisha, TN, Rajasthan
• Create a pathway for phased creation of regular Nursing positions in all
health facilities
• Option 1: GoUP sanctions certain number each year
• Option 2: TN model for fund sharing for creation of new posts (1 regular: 2
contractual) (Ref GO: 400)
Increase sanctioned positions of Staff Nurse
Option Regular pay Contractual pay
Per 1000 SN posts
sanctioned (in lacs)
Option 1: GoUP creates additional Staff Nurse posts 42030 0 5043.6
Option 2: TN model for fund sharing 42030 21500 3971.5

28. Existing Cadre Structure (1996 Rules)
Staff Nurse
Ward Sister
Tutor
Principal Tutor
Asst. Superintendent
Asst. Matron
Matron
Sr. Matron
Deputy Superintendent
Joint Director
7 years
5 years
7 years
5 years
3 years 3 years
PB2-4200
PB2-4800
PB3-5400
PB3-6600
7770
1469
310
1
18
1 ANMTCs, LHV Training
Center and GNM
Nursing Schools
Sanctioned
4833
848
7
0
10
0
Available

29. Defunct pre-service institutes under Medical Health
Tutor
Principal Tutor
Asst. Superintendent
5 years
3 years
Training
Centre
Number of
centres
Number of
positions
sanctioned
Total
positions
required
Positions
filled
% vacancy
ANMTC 41 5 205 35 83%
LHVTC 4 2 8 2 75%
Achal TC 30 1-3 60 1 98%
GNM TC 6 9 54 NA NA
ANMTC ceased to be pre-service requirement for ANM in 2018
Convert all training centers into In-service training centers and post tutors

30. • A key addition to the primary health team at the SC-HWC, PHC-HWC, would be the Mid-
level Health Provider (MLHP) who would be a Community Health Officer (CHO)
• Qualification: BSc. in Community Health or a Nurse (GNM or B.SC), with additional skills
• CHO posts expected to be sanctioned under NHM are as given below:
Community Health Officer (CHO)
11329 15329 19239 23239
6819 ---- ---- ----
Sanctioned Posts
Available
2021 2022 2023 2024

31. Nurse Practitioner Midwife – GoI estimated requirement for UP
S.No:
Delivery Load (no. of
deliveries per year)
No. of Labor tables/birthing
beds recommended by MNH
Toolkit
No. of
Midwives
required
Remarks
1 601 to 1200 2 8 - @4 Midwives per labor table (1 per shift
per labor table x 3 shifts plus reliever for
rotation / labor table)
- Additional Midwives could be posted for
facilities conducting more than 20000
deliveries per year (very high delivery load)
2 1200 to 6000
4 to 6 16
3 > 6000
8 32
State
600- 1200
deliveries/
year
1200 - 6000
deliveries/ year
> 6000
deliveries/
year
Requirement of Midwives for each
level
Total
Midwives
Required
Less than 1200
deliveries/
year @ 6
midwives
1200 - 6000
deliveries/ year
> 6000
deliveries/ year
Uttar Pradesh 882 689 29 7056 11024 928 19008
All India 5174 2595 100 41392 41520 3200 86112

32. Number of SMTIs required to train reqd. NPMs

33. Nurse Practitioner Midwifery Pathway
• 6 Midwifery educators
• Training Duration : 18 Month
• Batch size : 30
• Attached maternity clinical
• B.Sc. Nursing institute
Skills lab, Library, &Computer
lab
• Adequate classrooms for
theory sessions
State Midwifery Training Institute
• GNM)/BSc Nursing with 2 years
experience in Maternal Health
• Registered with State Nursing
Council
• Age under 45
• WT, OSCE and PI
• Monthly Salary + 10k stipend during
training
• Commit 6 years post –training to
work in the MLCUs
NPM
• MSc/BSc + of 5 years of
clinical experience
• Training : 6 month –
NMTI
• Selection based on WT,
OSCE and PI
Midwifery Educator

34. Specialist Nurse in Uttar Pradesh
Source: MOHFW guidelines, NHM SAMS Job descriptions, data collected through telephonic communication
Type of degree Potential posting (special units) Production capacity in
Uttar Pradesh
MSc Nursing General
MSc in Child Health Nursing SNCU, PICU, NBSU, NRC, FRU, MCH Wing 54
MSc in Community Health Nursing NRC, RBSK, NCD 59
MSc in Medical Surgical Nursing Trauma, FRU, MCH Wing, HDU 54
MSc in Maternity Nursing FRU, MCH Wing 25
MSc in Pediatric Nursing SNCU, PICU, NBSU, NRC, FRU, MCH Wing 38
MSc in Obstetrics and Gynecological
Nursing
FRU, MCH Wing 57
MSc in Psychiatric Nursing Mental Hospital 39
MD Midwifery FRU, MCH Wing 4

35. Pay variation – similar qualification
Type of Post
Staff Nurse-
Regular
Staff Nurse-
Contractual
CHO
Salary
PB2-4200
~40000 pm
20000 pm 35000 pm
Qualification
Required
GNM, BSc
Nursing, MSc
GNM, BSc
Nursing, MSc
GNM or B.SC,
with additional
skills
Projected
sanctioned
9335 16409 23329
Availability 5434 15894 6819

36. Nursing numbers min. required
Type of Post Qualification Projected Sanctioned
Staff Nurse – Regular GNM, BSc Nursing, MSc 9335
Staff Nurse – Contractual GNM, BSc Nursing, MSc 16409
CHO
GNM, BSc with
additional skills
23329
Midwife
GNM, BSc with
additional skills
19008
Total 67991
Required as per norms = 70516

37. Existing Cadre Structure (1996 Rules)
Staff Nurse
Ward Sister
Tutor
Principal Tutor
Asst. Superintendent
Asst. Matron
Matron
Sr. Matron
Deputy Superintendent
Joint Director
7 years
5 years
7 years
5 years
3 years 3 years

38. 7 years
Vision for unified cadre (Aligned with NMC Bill and Midwifery)
Staff Nurse/CHO
Principal (ANMTCs)
Deputy Nursing Superintendent (AD)
Nursing Superintendent/ Deputy Director
Joint Director (Clinical, Admin, Training)
3 Years
Clinical Nurse Specialist
Asst. Nursing Superintendent
(PHN) (CMO)
Nursing Tutor
Ward Sister/
Nurse Mentor
Midwifery Professional
Direct Entry: Dip. In GNM or BSC Nursing
Direct Entry: MSC Nursing
3 Years
2 yrs at DP + 18 months
Training
3.5 years 4 years as Specialist
Nursing and
Midwifery
Managers
Nursing
Professional
Ward Sister (LR)
Matron (DWH)
5 years 5 years
5 years 5 years
Matron (DCH/DMH)
Additional Director

39. Integrated Cadre Structure
Staff Nurse/Community Health Officer/Clinical Nurse Specialist
Sister/Ward Master/Nurse Mentor/Nurse Practitioner Midwife
Tutor/Asst. Matron/Public Health Nurse
Principal Tutor/Matron
Asst. Sup/Sr. Matron
JD Nursing
7 years
7 years
5 years
3 years
Dep. Nursing Spdt

40. Recommendation
Convert 16409 existing contractual staff nurse posts to regular over next 3 years with continued
funding from NHM
Additional financial implication is 180 Cr pa for 5000 new posts
OR
Convert ~23000 existing and future CHO posts to regular posts over next 5 years with continued
funding from NHM
Additional financial implication is 126 Cr pa for 5000 new posts
OR
Create ~20000 new posts for Nurse Practitioner Midwifery over the next 5 years from State funds
Additional financial implication is 240 Cr pa for 5000 new posts

41. Training and Mentoring

42. In-service Training

43. Trainings for Staff Nurse and ANM prescribed by GoI
Programme Division Training Name Staff Nurse ANM
Child Health 4 day Training for Facility based Newborn Care(FBNC) 4
Child Health 4 days Trainings on IYCF 4 4
Child Health Child Death Review Trainings 1
Child Health FBNC 12 Days Observeship 12
Child Health F-IMNCI Training for Staff Nurses 5
Child Health HBYC District Training 5
Child Health IMNCI TOT
5 5
Child Health IMNCI training districts 5 5
Child Health NSSK Training for ANMs 2 2
Child Health One day IDCF Trg. 1 1
Child Health SNCU on Line MIS training 1
Child Health All Child Health Trainings 39 23

44. Trainings for Staff Nurse and ANM prescribed by GoI
Programme Division Training Name Staff Nurse ANM
Maternal Health DAKSHTA training 3 3
Maternal Health GDM 2 2
Maternal Health GDM 2 2
Maternal Health Midwifery
Maternal Health
Onsite mentoring at Delivery Points/ Nursing
Institutions/ Nursing Schools
2 2
Maternal Health TOT for SBA 2 2
Maternal Health Training of Staff Nurses/ANMs/LHVs in SBA
21 21
Maternal Health Trainings at Skill Lab 6 6
Maternal Health All Competencies 38 29
Family Planning Counseling training for services providers 1 1
Family Planning
Training of Nurses (Staff Nurse/LHV/ANM)(IUCD
insertion training) 5 5

45. Trainings for Staff Nurse and ANM prescribed by GoI
Programme Division Training Name Staff Nurse ANM
Community Process ToT on VHND 3
Community Process VHND Training 3
Community Process ASHA Cluster meeting as training platform 5
National Program
Any other (please specify)
Integrated Health Information Platform (IHIP) Training 1
NCD State NCDCell 5
NCD Training @ Rs. 10 Lakh per district for 7 level training 3
MIS
Training cum review meeting for HMIS & MCTS at
Block level 1
NUHM Malti Skilling of FHW 3
NUHM Training of M0& Staff Nurse for H&WC 3
QA SERVICE PROVIDERS TRAINING 3
RI Bridge Trainingin Non IMI Districts 1
RKSK AFHS training of ANM/LHV/MPW 5
RKSK Training of Peer Educator (District level) 5
All Programs All relevant trainings 102 80

46. Convert GNM Nursing Schools, LHVTC, ANMTC for in-service – Activate
1632000
1920000
76760
1758205
0 500000 1000000 1500000 2000000 2500000
Staff Nurse
ANM
Training capacity used in 2019-20
Total Training Capacity
In training man-days

47. Nurse Mentoring

48. Nurse mentoring in Uttar Pradesh
Need for mentoring
75 - Districts
820 - Blocks
Nurse Mentoring Landscape in UP
Pre-service
quality
In-service
capacity
constraint
Peer-based
continuous
mentoring
To accelerate
Quality
improvement
initiative
TSU NMs will be placed in DWHs across 75 districts

49. Initial
assessment
1
Labour
monitoring
2
Active
management of
third stage of
labour
3
Management of
4th stage of
labour and Post
natal care
5
Essential new
born care
4
Infection
Control and
BMW
1
Availability &
Use of drugs
and supplies
2
Referral
strengthening
3
Documentation
4
Service
integration
with
community
5
Core Areas
Goals and objectives
Objective-
• Sustain and optimize quality MNH services in district and sub district
block facilities
• Improve clinical competencies of service providers and system
strengthening in 10 core areas

50. Trends, RFS (Optimization block, 25 HPDs)
0
10
20
30
40
50
60
70
80
90
100
2015 2016 2017 2019
Trends in AMTSL(%)
Initiated uterine massage
Oxytocin administered
Performed controlled cord traction
Examined placenta
Disposed the placenta in a yellow coloured bin
0
10
20
30
40
50
60
70
80
90
100
2015 2016 2017 2019
Trends in Essential newborn care (ENC) (%)
Clamped the cord as per protocol
Cut the cord using new blade/ sterile
scissor
Provided skin to skin care
Supported initiation of breastfeeding
Weighed the newborn
Recorded the weight correctly

51. Knowledge/skill and clinical practices: Shift from RFS-3 to RFS-4 , 25 HPDs
RFS-3 RFS-4
Composite index is calculated based on 8 knowledge/skill and 9 practice indicators

52. Skill labs

53. Skill Labs - Landscape
6 State of the
Art Skill Labs
75
District/Divisional
Skill Labs
820 Mini Skill Labs
• Discussion room and classrooms available for trainings
• Fixed cabins for permanent skill stations at individual
dedicated buildings
• Equipped for high quality trainings
• Additional mannequins and equipment from MSL
• ~2 lakh budget for procurement
• Larger dedicated space for skill stations at DH
• Basic set of mannequins and equipment
• ~1 lakh budget for procurement
• Designated spaces for skill stations at CHCs

54. 2 established skills lab- HR, Training and maintenance cost proposed in PIP
Covid hospital, Noida
SIHFW, Lucknow
Reception Infection Prevention Labour room PNC, complication management
Reception Skill Stations Labour room PNC, complication management

55. • 6 Skills labs to be established in UP (2 already established in Lucknow and Noida, 4 more
need to establish in Gorakhpur, Jhansi, Bareilly and Prayagraj) through BMGF funding
• In PIP of FY 21-22, budget for operational cost, overhead expenditure, human resources
and training has been proposed through NHM
• Trainings to be conducted for successful functioning of skill labs
• TNAI
• Dakshata
• Adult learning techniques
• UPTSU to start operationalizing the LKO skill lab by kick starting the training program
• Who will manage?
Establishment and operation of 6 State of the Art Skill Labs

56. Mini Skill Lab – Training cycles
SI. #
RAPID IMPROVEMENT
CYCLES
Skill
Station
1 CYCLE 1 PARTOGRAPH
2
CYCLE 2
APPROACH TO CLIENT IN LABOR
ROOM
3 PREGNANCY DETECTION TEST
4
EDD, WEIGHT AND BP
MEASUREMENT
4A DIGITAL BP MEASUREMENT
5 ABDOMINAL EXAMINATION
6 PER VAGINUM EXAMINATION
7 HAEMOGLOBIN ESTIMATION
7A DIGITAL HAEMOGLOBIN ESTIMATION
8
URINE TEST FOR ALBUMIN AND
SUGAR
9
CYCLE 3
INSERTION OF IV LINE
10 CAB APPROACH
11 MANAGEMENT OF PPH
12 MANAGEMENT OF ECLAMPSIA
13
USE OF ANTENATAL
CORTICOSTEROID (ANCS) IN
PRETERM LABOUR (24-34 WEEKS)
14
CYCLE 4
CONDUCTING NORMAL DELIVERY
(SECOND STAGE OF LABOR)
15
ACTIVE MANAGEMENT OF THIRD
STAGE OF LABOUR (AMTSL)
16 ESSENTIAL NEWBORN CARE (ENBC)
17
MONITORING OF MATERNAL &
NEWBORN
IN 4TH STAGE OF LABOR & POST
NATAL WARD
18 ORIENTATION ON BREASTFEEDING
19 COUNSELLING ON FAMILY PLANNING
20
CYCLE 5
USE OF RADIANT WARMER
21 NEWBORN RESUSCITATION (NBR)
22 KANGAROO MOTHER CARE (KMC)
23
CYCLE 6
PERSONAL PROTECTIVE EQUIPMENT
(PPE)
24 HAND WASHING
25 PREPARATION OF 0.5% CHLORINE
SOLUTION
26 PROCESSING OF INSTRUMENTS
27 WASTE SEGREGATION AND DISPOSAL
Max. 120 mins per skill station per nurse
Min. 2 rounds of mentoring suggested
Time required for 1 Nurse/ANM to cover all Skill
Stations twice = 6480 mins = 108 hours = ~18 days

57. Utilization of Mini Skill Lab
Number of Skill Labs/Mini Skill labs Training days
per Annum
No: of years to train
all Staff Nurse
No: of years to
train all ANM
Existing 225 67,500 4.8 yrs 6.4 yrs
After establishing all for which
budget is approved – 895
2,68,500 1.2 yrs 1.6
Total training man days required for; All Staff Nurse = 3,24,000 ; All ANM = 4,32,000

58. Performance Management

59. Performance monitoring:
• Digitization of ACR process and past ACRs of all regular Staff Nurse to be
undertaken through Manav Sampada
• Relevant program indicators to be defined for Staff Nurse recruited through
NHM for performance measurement
• Pathway for availability of unitized data of service delivery for individual
nurse to be planned for through the NDHM framework
Performance Management of regular and contractual Staff Nurse

60. Motivation for Staff Nurse:
• NO promotions in the regular cadre in the past few years
• Home District for Staff Nurse
• Opportunity for in-service MSc Nursing ?
• Prompt payment of sanctioned honorarium for Nurse Mentors
• Currently, Nurse gets no incentives for any service delivery other than C-
section at FRUs
• May be explored to propose more monetary, non-monetary incentives for objective
good performance in critical service delivery through NHM funds
• NHM already provides for 10% of the salary cost to be given as Performance Based
Incentive (PBI). Currently given without checking any performance.
Performance Management of regular and contractual Staff Nurse

61. Planning, Regulation and Governance

62. State nursing directorates – National and Others states
• GoI issued directives to all states in 2012 and 2017 to establish Nursing cell/Directorates
• GoI also committed to fund the creation of a Nursing cell through NHM funds
• Till now Odisha is the only state in the country to have a fully functional Directorate of
Nursing (since 2013).
• A unified structure for councils, boards, education etc
• Does cadre management as well
• Responsible for Competency based exams, performance standards
• Comprises Nursing Council, Nursing Board, Nursing management unit, establishment
work related to nursing cadres
• Other states like Bihar, Madhya Pradesh, Rajasthan and Jharkhand are also in the process

63. GoI Proposed Structure for a Nursing Directorate
• the smaller states and UTs may customize and adopt a leaner structure based on the local
context and need.
• the State Nursing Directorate may be strengthened by hiring of additional human resources such
as consultants, program assistant and data assistant.

64. West Bengal Nursing Directorate

65. Odisha Nursing Directorate

66. State Nursing Directorate – Uttar Pradesh
• Nursing directorate was proposed in 2017 which led to only sanction of a
Director, Nursing (converted from Director, Mahila) from PMHS cadre
• JD nursing is a nursing cadre position but for past many years filled by PMHS
cadre doctors holding additional charge
• Proposed objectives Nursing Directorate
• Planning of nursing manpower by suggesting the number, recruitment policy, job
responsibility, promotion and transfer etc.
• Planning, organizing nursing in-service training, mentoring programs
• Communication with various units of health services
• Receiving, processing and disseminating the information related to nursing services
• Evaluating nursing services, training and administration
• Conducting nursing research work

67. Uttar Pradesh Technical Support Unit
India Health Action Trust
404, 4th Floor Ratan Square
No 20A, Vidhan Sabha Marg,
Lucknow, 226001
Uttar Pradesh, India
 +91-522-4922350 / 4931777
 www.ihat.in
Thank You