Improving Performance of ANMs for Safe Delivery in

Jharkhand

February 2012

Dr. Manju Shukla, State Director, Jharkhand

Factors Responsible for Optimal Performance• Clear Job Expectations

• Knowledge & Skills

• Supplies

• Supportive Supervision – Review

– Timely feedback

– Problem-solving

• Motivation– Rewards

– Recognition

CONS IDERINS TITUTIONAL

CONTEXT

MIS S IO N

G O ALS

S TR ATE G IE S

C U LTU R E

C LIE NT AND

C O MMU N ITY

PE R S PE C TIVE S

OBTAIN AND MAINTAIN S TAKEHOLDER AGREEMENT

MONITOR AND EVALUATE PERFORMANCE

DEFINE DES IREDPERFORMANCE

FIND ROOTCAUS ES

WH Y D O E S TH E

PE RFO R MAN C E

G AP E X IS T?

S ELECTINTERVENTIONS

WH AT C AN BE D O N E

TO C LO S E TH E

PE R FO R MAN C E G AP?

DES CRIBE ACTUALPERFORMANCE

PERFORMANCEGAP

EXTERNAL FACTORS

Performance Improvement Framework

SBA Technical Assistance Framework

Improvement in quality of delivery and other services

by SBAs

Reduced maternal and infant mortality

Increase in number of deliveries by SBAs

Improving quality of training

Ensuring regular supplies

Supportive supervision &

feedback

Motivating with

rewards & recognition

Key Inputs• Skill and competency-based training

• Focus on weak trainees

• Job aids – partograph, drug list

• Post-training follow-up for skill retention

• Supportive supervision to

– Review performance

– Solve problems

– Encourage, recognize good performance and motivate

– Job aid for supervisors

• Use of data for decision-making

Supportive Supervision: A Framework for Capacity-Building

Recognition of High-Performing SBAs

Key Results• Almost all SBAs listed midwifery as one of their top three

primary job functions

• Increase in SBAs who reported receiving support from supervisor

• Availability of supplies increased for SBA-related activities at sub-centres

Increased Job Priority

Improved Supplies

Improved Supervision

Increased Skilled Attendance at Birth

Improved Quality of Care by SBAs

Lessons Learned

• Gaps in all factors influencing SBA performance need to be addressed

• Competency-based training and quality can be ensured by trainer selection and capacity-building, site readiness, focus on clinical practicum and participatory training

• Regular feedback and review of performance are critical for training to result in improved performance

• Building a culture of performance and quality requires a shift in attitude and supervisory processes

• Agreement on eligibility criteria and process for validation of data for reward and recognition is important to ensure transparency and consistency

For more information: Email - infovistaar@intrahealth.org Website - www.intrahealth.org