LSTM Home > LSTM Research > LSTM Online Archive

Building capacities of Auxiliary Nurse Midwives (ANMs) through a complementary mix of directed and selfdirected skill-based learning—A case study in Pune District, Western India

Karvande, Shilpa, Purohit, Vidula, Gopalakrishnan, Somla ORCID:, Subha, Sri, Mathai, Matthews ORCID: and Mistry, Nergas (2020) 'Building capacities of Auxiliary Nurse Midwives (ANMs) through a complementary mix of directed and selfdirected skill-based learning—A case study in Pune District, Western India'. Human Resources for Health, Vol 18, e454.

Karvande_et_al-2020-Human_Resources_for_Health.pdf - Published Version
Available under License Creative Commons Attribution.

Download (590kB) | Preview
[img] Text
ANM SKILL BUILDING- SUBMITTED VERSION- HRHE-D-19-00178_R1.pdf - Submitted Version
Restricted to Repository staff only

Download (1MB)


Auxiliary nurse midwives (ANMs) play a pivotal role in provision of maternal and newborn health at primary level in India. Effective in-service training is crucial for upgrading their knowledge and skills for providing appropriate healthcare services. This paper aims at assessing the effectiveness of a complementary mix of directed and self-directed learning approaches for building essential maternal and newborn health-related skills of ANMs in rural Pune District, India. Methods: During directed learning, the master trainers trained ANMs through interactive lectures and skill demonstrations. Improvement and retention of knowledge and skills and feedback were assessed quantitatively using descriptive statistics. Significant differences at the 0.05 level using the Kruskal-Wallis test were analysed to compare improvement across age, years of experience, and previous training received. The self-directed learning approach fulfilled their learning needs through skills mall, exposure visits, newsletter, and participation in conference. Qualitative data were analysed thematically for perspectives and experiences of stakeholders. The Kirkpatrick model was used for evaluating the results. Results: Directed and self-directed learning was availed by 348 and 125 rural ANMs, respectively. Through the directed learning, ANMs improved their clinical skills like maternal and newborn resuscitation and eclampsia management. Less work experience showed relatively higher improvement in skills, but not in knowledge. 56.6% ANMs either improved or retained their immediate post-training scores after 3 months. Self-directed learning helped them for experience sharing, problem-solving, active engagement through skill demonstrations, and formal presentations. The conducive learning environment helped in reinforcement of knowledge and skills and in building confidence. This intervention could evaluate application of skills into practice to a limited extent.
Conclusions: In India, there are some ongoing initiatives for building skills of the ANMs like skilled birth attendance and training in skills lab. However, such a complementary mix of skill-based ‘directed’ and ‘self-directed’ learning approaches could be a plausible model for building capacities of health workforce. In view of the transforming healthcare delivery system in India and the significant responsibility that rests on the shoulder of ANMs, a transponder mechanism to implement skill building exercises at regular intervals through such innovative approaches should be a priority.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WQ Obstetrics > Childbirth. Prenatal Care > WQ 160 Midwifery
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
Depositing User: Tina Bowers
Date Deposited: 22 Jun 2020 11:35
Last Modified: 08 Jul 2020 10:44


View details

Actions (login required)

Edit Item Edit Item