From RECOUP

THREE VERSIONS OF ACCOUNTS from the Recorded Interview Excerpt

Brief glossary to help understand these accounts:

ANM is the shorthand for an Auxiliary Nurse-Midwife (a particular category of health staff in India)

TBA: Traditional Birth Attendant

WHO: World Health Organisation

UP: Uttar Pradesh, a large north Indian State

RJ: Interviewer

SS: Interviewee

1 Summary of interview from notes

RJ said that in White Ribbon Alliance it was discussed that ANM is the minimum level to be used for safe delivery. Do you agree with that?

SS: said that there are two aspects to it. WHO says that skilled birth attendant is the doctor, staff nurse and ANM - with additional training, refresher training etc. TBA is not a skilled birth attendant for WHO. SS: said that in UP they will be there for few more years. 42% ANMs are doing up-and-down [i.e. living in a nearby town and commuting every day]. In a block, on an average there are 25 sub centres and hardly 2-3 will have residential ANMs. Rest will be available only during working hours or during PPI (Pulse polio campaigns) when they are supposed to stay because it starts early in the morning, they can't come in every day.

RJ asked whether she thinks that PP is making things more difficult. SS: said that it is the need of time. It is essentially required. In 1973 there were smallpox programs. But for eradication programs additional time is required out of 8 hours. You have to give. But then with this expansion of activities, programs and new inputs it is difficult to cope with the other programs, very difficult. She said that she did a rapid analysis. One more pilot program was implemented by me on community women and midwives. NPP [National Population Policy]- women empowerment component. It was observed that ANM caters to 5000 and the periphery is always left out. So freelance ANMs were suggested. We developed a community link and in four districts of UP, community midwives were trained using the public health resources. Some of them have also started their clinics. They are doing very well, on their own.

2 Rough transcription

RJ:in White Ribbon Alliance discussions it seemed to be that most people thought that ANM was the minimum level that could be used for safe attendance. Do you agree with that?

SS:no, see there are two aspects to it. WHO says that skilled birth attendant is doctor, staff nurse or auxiliary nurse (yes with additional training) it cannot be.. with additional trainings. (not the simple ANM) no. additional training in form of a refresher training. So TBA is not a skilled birth attendant (for WHO) as per WHO. But you see the scene in UP cannot, see 89% of domiciliary delivery you cannot change the scenario overnight. They didn't went there for years and until unless service from auxiliary nurse and midwives are available on assured basis at the community level. 42% women's are doing up and down either from block level or from district level or from adjoining districts. In a block on an average there are 25 sub-centres which is the lowest functional medical unit. Out of 25 say hardly 2 or 3 sub-centres have the residential ANM otherwise rest of the ANMs are ... they are available on the working hour or may be when this PPI round is there. Then they are suppose to stay because the round starts early in the morning. They cannot come from ... .

RJ:a lot of people think this Pulse Polio is making it more difficult to meet other kinds of targets.

SS:absolutely right. This is need of the time if you like those days when I joined service in 1973 small small ??? (20.11) programmes were there, we were involved in that. We just could not avoid if any eradication program is going on you have to give more time. Additional time or you know out of your 8 hours. You have to do. But then with this expansion or activities and programs and your inputs, its very difficult to cope with other things. I did that rapid analysis, one more pilot project was implemented by me, particularly model was developed, community need based. It was demand intervention in the national population policy in women empowerment component that the community should have besides ANM because she is supposed to cater to the population of 5000. the periphery area is always left. Suppose she resides to she is available for sub-centre ... ??? (21.22) so freelance ANM. You give another community midwives. We pilot tested that model in 4 districts of UP. In the public health facility I have been using public health facility and public health resource. We trained those community midwives and they are doing very well on their own. We studied their clinic also.

3 Closer transcription

RJ:In the White Ribbon Alliance discussions it seemed to be that most people thought that the ANM was the minimum level that could be used for safe attendance. Do you agree with that?

SS:No, there are two aspects to it. [RJ: mm] See WHO says that skilled birth attendant is doctor, staff nurse or auxiliary nurse-midwife [RJ: yes with additional training] It cannot be, it cannot be … with additional trainings. [RJ: not the simple ANM] No. Additional training in form of a refresher training. So TBA is not a skilled birth attendant [RJ: for WHO] As per WHO. But you see the scene in UP cannot, see 89% of domiciliary delivery you cannot change the scenario overnight. They didn't went there for years and until and unless you, until and unless services from auxiliary nurse midwives are available on assured basis at the community level. 42% women's are doing up and down, either from block level or from district level or from adjoining districts. [RJ: Very few actually there on a regular basis ...] In a block on an average there are 25 sub-centres which is the lowest functional medical unit. Out of 25 say hardly 2 or 3 sub-centres have the residential ... [RJ: ANM] ANM otherwise rest of the ANMs are ... they are available on the working hour or may be when this PPI round is there. Then they are supposed to stay because the round starts early in the morning (laughs) [RJ: (laughs) Yes]. They cannot come from ... .

RJ:A lot of people think this Pulse Polio is making it more difficult to meet other kinds of targets.

SS:Absolutely right, but then see, this is need of the time if you like those days when I joined service in '73 small small vertical programmes were there, we were fully involved in that. We just could not avoid if any eradication program is going on you have to give more time. Additional time or you know out of your 8 hours. You have to give, you have to. But then with this expansion of activities and programmes and your inputs, it's very difficult to cope with ... mmm ... other things, it's very difficult [RJ: other programmes, hmm]. I did that rapid analysis, one more pilot project was implemented by me, particularly model was developed, community need based. It was demand intervention in the population policy, national population policy, policy in women empowerment component that the community should have, besides ANM, because she is supposed to cater to the population of 5000. The periphery, the twilight area is always left out. Suppose she resides to she is available for sub-centre work, but periphery is always left out (21.22) So freelance ANM. You give another community midwife. We pilot tested that model in 4 districts of UP. In the public health facility I have been using the public health facility and public health resources. We trained those community midwives and they are doing very well [RJ: So who is paying?] on their own. [RJ: who is paying?] We studied their clinic also.