This presentation was conceptualised and made by me as a part of my Summer training project work. The project was a real time activity carried out by the Public Health division of ASTRON Hospital & healthcare Consultants Pvt. Ltd.

1. Training of ANMs on HIV/AIDS Dr. PoojaPassi

2. Training project carried out by ASTRON Hospital & Healthcare Consultants Pvt. Ltd. New Delhi

3. Layout Evolution & Role of ANMs Concept of capacity building of ANMs Methodology Coverage of the North East district Analysis of Pre & Post test Questionnaires Comparative responses of ANMs- Pre-test and Post- test evaluation. Responses related to specific issues related to HIV/AIDS Recommendations

4. Evolution Midwifery existent ever since medical services have been available to the masses. In India Bhore Committee placed foremost emphasis on preventive healthcare services right from the grass root and defined a cadre of healthcare workers called the midwives . These are selected from among the community Act as the point of FIRST contact towards access of health services . Eventually came to be known as Auxiliary Nurse & Midwives.

5. Contd. In the ‘50s and ‘60s, training courses for ANMs focused on Midwifery and Maternal and Child Health (MCH). 1973, Kartar Singh Committee integrated the various functions of the health services thereby changing the role of ANMs (, 1973). 1975, Srivastava Committee required the ANMs to provide child health services and Primary Curative care to villagers. Second Five-Year Plan described the role of auxiliary health workers as those activities that supplemented the contributions made by doctors for promoting preventive and curative health activities (GOI, 1986).

6. Job Responsibilities The Primary Health Center (PHC) through its Auxiliary Nurse Midwives (ANMs) and Multipurpose Workers (MPWs) at the sub center level carry out the RCH program. They deliver these preventive and promotive health services and health education. Maternal & Child Health Care in the village / community. Conducts deliveries in S/C and Home on call.

7. Contd. Identify the beneficiaries and complete necessary formalities for benefits under JananiSurakshaYojana (JSY) scheme and timely disbursement JSY benefits to eligible BPL mothers and submit utilization certificate every month for further release of funds. Family Planning motivation and activities. Identify the women, requiring help for Medical Termination of Pregnancy (MTP). Nutritional Care such as weekly IFA supplementation & Bi-annual vitamin A supplementation.

8. Contd. Organization of Health & Nutrition day in Anganwadi centre. Full coverage of routine immunization to children in time. Treatment of minor ailments and timely referral. Record of Vital events in the village. Implementation of all National Health Programmes in the community. Training for ASHA / Anganwadi Worker / Dais of respective areas.

9. Contd. Work in cooperation with PRIs/ NGOs in the village. Proper maintenance of record of Untied fund for SC development and their submission to MO I/cPHC/CHC.

10. Concept of capacity building of ANMs

11. INTEGRATION SIMILAR GOAL: RCH and PPTCT both working on improving the IMR and MMR. The same workforce can be utilized to provide PPTCT services because of similar objectives, activities, areas, target population and deliverables in both programs. DSACS has launched an initiative in collaboration with the Delhi State Health Mission (DSHM) to create and implement HIV/AIDS training programs for Auxiliary Nurse Midwives (ANMs)

12. Methodology Training sessions undertaken for the ANMs covering all the 8 districts of Delhi. Sessions guided by a core team comprising of experts from the fields of HIV/AIDS and Public Health. The approach to training was highly participatory in nature, employing innovative means

13. Training Material Handouts, leaflets, flip chart, flip book and material which was easy to understand and assimilate.

16. Training Sessions Session 1: Introduction, Expectations, Pre test. Session 2: Basics of HIV/ AIDS, Myths and Misconceptions Session 3: STIs and there management Session 4: HIV and Women, Pediatrics HIV and Care of New Born Session 5: High Risk Groups and Targeted Interventions Session 6: Overview about Service availability

18. Training Sessions Session 7: Facilitation and Communication skills Session 8: Session with a PLHA to discuss about issue of Stigma and Discrimination with PLHAs and their Rights. Sharing perspective of PLHAs Session 9: Role of ANMs in Integration of HIV with RCH services Session 10: Practice Session Session 11: Post Test Evaluation and Training Feed back

21. Integration of “JananiSurakshaYojana” with PPTCT services

22. Developing communication & Counseling skills among the ANMs

23. Pediatric HIV/AIDS and service availability including care of new born & HIV positive mother

24. Follow up, referral and linkages with the existing healthcare services under the Public Healthcare Delivery system

26. Coverage at a Glance (NORTH-EAST DISTRICT)

29. Rehabilitation of people living with HIV/AIDS

32. Comparative status of awareness about Care & Support services Important issues like awareness about PPTCT centers, consent for HIV testing, role of ART in HIV/AIDS and ARV prophylaxis in PPTCT appear to have achieved clarity among the ANMs as compared to the pre-training awareness levels

33. Comparative status of awareness about Preventive aspects of HIV/AIDS

34. Comparative status of awareness about Stigma & Discrimination towards PLHAs

35. Comparative status of awareness about Myths & Misconceptions related to HIV/AIDS

36. Specific issues related to HIV/AIDS

37. Knowledge about referral and linkage with PPTCT center This infers that now the ANMs possess adequate knowledge about the referral and linkages and in practice will be able to refer their ANCs to the center for availing the required PPTCT services

38. Significance of ARV prophylaxis This infers that this existing workforce can now be effectively utilized in improving the uptake of PPTCT services.

39. Role of ART in care & support of PLHAs ANMs now will be an effective resource to refer HIV +ve mothers, children and their families to ART centers, counsel and follow up those on treatment and hence compliment the existing efforts in reducing drop outs

40. Feedback from the ANMs “Hume HIV/AIDS kebaaremeinbahutacchitarah se batayagaya… ab hum apni ANC koaurbhi ache prakar se dekhsakenge” “Training baut hi acchithi…. Aisi training hotirehnichahiye” “HIV se judehumaresabhisavalon ka jawabaajhume mil gaya… bahutdhanyavaad”

41. Recommendations Refresher trainings on the similar topics covered during the training should be taken up. These could be done to cement the knowledge imparted during these trainings and also clarify existing doubts which still remain in the minds of some of the ANMs. Training should be conducted for 2 days, so that all the sessions are delegated adequate timings and the ANMs get adequate time to deliberate and satisfy their queries.

42. Hands on training of the ANMs should be done by making them visit the service delivery points (ICTC/ART/DIC/CCC) to acquaint them about the field level services. This being provided will also give an opportunity to interact with the counselors. This activity can be fruitful in strengthening linkages between beneficiaries and service delivery points The ANMs who are not posted in the maternity homes should be made to visit the same to have an practical insight into administration of Neverpine, so that they can take care of an HIV +ve women who delivers at home.

43. Regular training on HIV/AIDS need to be done at frequent intervals in lieu of the turnover of this field level workforce so that sustained community dissemination of correct messages is done. ANMs being an experienced field worker can now be utilized as counselors in improving the uptake of HIV testing of the pregnant women and their families.

44. ANMs along with their ASHA workers can be effective in improving utilization of PPTCT services both through home based and clinic services. Important pointers (E.g. HIV/AIDS Toll free number, List of ICTC/PPTCT/ART Centers etc) could be displayed in the form of attractive and captivating posters/banners in the Training Units so that there is constant revision and recall of information.

45. THANK YOU