1

A STUDY ON TRAINING EFFICTIVENESS AND

MAPPING TRAINING NEED OF EMPLOYEES UNDER DOTMA BPHC (BLOCK PRIMARY HEALTH CENTER) OF KOKRAJHAR (B.T.A.D) DISTRICT OF ASSAM

A project submitted to the central I.T college ( Center Code- 01729) authorized under Sikkim Manipal University Of Health, Medical & Technological Sciences Gangtok737102

In partial fulfillment for the award of the degree of Master of Business Administration (MBA)

By

MISS DEBARCHANA KASHYAP BARUAH REGISTRATION NUMBER-521041177

PREFACE
Projects are an indispensable part of any kind of formal education. They help us to have a practical exposure as well as better outlook of the subject, which we are studying. In a professional course like M.B.A, students are equipped with strong theoretical knowledge about the business operations and the time tasted methods of running successful business. To make this theoretical knowledge stronger, the students assigned certain projects in various organizations to get an idea of the practical working styles. I was assigned to do my project inDotma BPHC (Block Primary Health Center) of Kokrajhar (B.T.A.D) District of Assam. The topic of the study was A Study on training effectiveness and mapping training need of employee. The project commenced from 2nd April to 2ndJune. In order to make the data and findings easily understandable, efforts have been made to present the information in a simplified, lucid and organized manner. Whenever possible, tables and figures have been incorporated. Recommendations have been made on the basis of the findings herein. Its gives me immense practical exposure to the practical working patterns and the environment. I shall be honoured if the organization gets benefits from the study and the findings.

MISS DEBARCHANA KASHYAP BARUAH. MBA 4th SEM (HR) REG NO: 521041177

TABLE OF CONTENTS
Chapter A. B. iii iv v vi I II Section Title DIRECTORS CERTIFICATE ORGANISATION CERTIFICATE EXAMINERS CERTIFICATE UNIVERSITY STUDY CENTRE CERTIFICATE STUDENT DECLERATION INTRODUCTION OF THE PROJECT INTRODUCTION OF THE HOSPITALS AIMS AND OBJECTIVES LETERATURE REVIEW MATHODOLOGY REVIEW DATA ANALYSIS AND INTERPRETATION RESEARCHE FINDING RESULT AND DISCUSSION RECOMANDATION CONCLUSION LIMITATION OF THE STUDY SCOPE OF FURTHER RESEARCH BIBLIOGRAPHY REFRENCE APPENDIX Page No.s

III IV V

GOVT.OF ASSAM OFFICE OF THE SUB DIVISIONAL MEDICAL AND HEALTH OFFICER NATIONAL RURAL HEALTH MISSION DOTMA BPHC, KOKRAJHAR
NO.BPMU/NRHM/DOT/CRT /12-13

Dated: June2012.

CERTIFICATE This is to certify that project entitled ,A Study on training effectiveness and mapping training need of employee under Dotma BPHC (Block Primary Health Center) of Kokrajhar (B.T.A.D) District of Assam submitted to the Central IT college authorized under Sikkim Manipal University in partial fulfillment for the award of the degree of Master of Business Administration (MBA) is a record of project work carried out by Miss Debarchana Kashyap Baruah for a period of 2 months w.e.f 02-04-2012 to 02-06-2012 under our personal supervision and guidance . All help received by her have been duly acknowledged. No part of this project has been reproduced elsewhere for any degree.

Dated: Dotma . The .. June 2012. Dr. Anil Mahilary Sub-Divisional Medical and Health Officer, In Charge (Dotma BPHC)

Mrs. Porna Sarmah Chakravarty, Block Programme Manager cum Block Nodal evaluation and Monitoring Officer,NRHM, Dotma BPHC

Examiners certification

The project report of

Miss DebarchanaKashyapBaruah

Is approved and is acceptable in quality and form

AKNOLEDGEMENT
If words can be considered as a symbol of approval and token of acknowledgement then let the words play the heralding role of expressing my gratitude acknowledgement. At the very outset, I take the privilege to convey my gratitude to those people whose cooperation, suggestion, and heartfelt support helped me to accomplish the project report works successfully. My sincere thanks to my faculty guide to ShriPakshitPachani, Deptt. of Business Administration for his careful supervision, valuable guidance and constant encouragement right from the inception to the successful completion of my project. I would like to express my sincere thanks to all the faculty members of the Deptt. of Business Administration for their support. My profound gratitude toDr. Anil Mahilary (Sub-Divisional Medical & Health Officer) and Mrs. PornaSarmahChakravarty,( Organizational Guide)Block programme Manager cumBlock Nodal evaluation and monitoring Officer),NRHM, Dotma BPHC for giving me the opportunity to do my project work in their esteemed organization. My veracious gratitude to my Organizational GuideMrs. PornaSarmahChakravarty, (Block programme Manager cumBlock Nodal evaluation and monitoring Officer),NRHM, Dotma BPHC for supporting me by his valuable guidance through out the study. My sincere thank to ShriNipenHaloi, Non- Medical Assistant (Dotma BPHC) for helping me in all official works and formalities essential for carrying out my project. My heartfelt thanks to Mr.NabajitChakravarty, (Block programme Manager cum Block Nodal Evaluation and monitoring Officer),NRHM, Kachugaon BPHC for his valuable guidance . Last but not the least, I express my heartfelt thanks to all other staff members of Dotma Block Primary Health Center, my parents,ArindamMahanta (Brother), and friends for the timely help and support they have rendered in bringing my study so its relevance in a fruitful manner.

DEBARCHANA KASHYAP BARUAH

UNIVERSITY STUDY CENTRE CERTIFICATE

This to certify that the project report entitled A Study on training effectiveness

and mapping training need of employee under Dotma BPHC (Block Primary Health Center) of Kokrajhar (B.T.A.D) District of Assam.Submitted in partial fulfillment of the requirements of the degree of Master
of Business Administration, of Sikkim Manipal University of Health, Medical and technological sciences.

BY
MISS DEBARCHANA KASHYAP BARUAH She worked under my supervision and guidance and that no part of this report has been for the award of any other degree, Diploma, Fellowship or other similar titles or prizes and that the work has not been published in any journal or Magazine.

REG. No: 521041177Certified

SRI PARIKSHIT PACHANI MBA (HR)

Declaration

I, Miss DebarchanaKashyapBaruah, hereby declare that this project entitled A Study on training effectiveness and mapping training need of employee under Dotma BPHC (Block Primary Health Center) of Kokrajhar (B.T.A.D) District of Assamis a bonafide work done in partial fulfillment of the requirement of Master of Business Administration of Sikkim Manipal University under the guidance ofSri ParikshitPachani, Faculty,Deptt. Of Business Administration and this report has not been previously submitted for the award of any degree, diploma or any other equivalent title of any other university, institution and society.

DEBARCHANA KASHYAP BARUAH DATE : PLACE: MBA 4th SEM (HR) REG NO: 521041177

Chapter-I

Introduction

Introduction

Kokrajhar district (Assamese: ) is an administrative district in the state of Assam in north-eastern India.Kokrajhar district is located on the north bank of the river

10 Brahmaputra that slices the state of Assam into two, identified as north and south banks. The district lies roughly between 89.46' E to 90.38' E longitudes and 26.19" N to 26.54" N latitudes. The district occupies an area of 3,169.22 km and is bounded on the north by the Himalayan kingdom of Bhutan, by Dhubri district on the south, Bongaigaon district on the east and the Indian state of West Bengal on the west. (Figure:1 Location of Kokrajhar District and its surrounding Boundary )

Bhutan Jalpaiguri district, West Bengal Cooch Behar district, West Bengal

Kokrajhar district

Chirang district

Dhubri district

Bongaigaon district

Dotma block is an important place of kokrajhar district which is located at the Middle- East of the district. The boundary of the block is Bhutan on the North, Dhubri district on the South, Kokrajhar Block on the East and Gossaigaon and Kachugaon Block on the West. Further,there are four health block under kokrajhar district where Dotma BPHC is among one.In Dotma BPHC there are 1 PHC, 1 CHC, 3 MPHC, 2 SHC, 8 SD, 31 SC covering a 153537 population.The Dotma Block primary Health Center was established in 1939.Since then several health programmes were initiated and implemented to provide health service to unserve and underserved rural people of the block. Moreover,Several health programmes were initiated where National Rural Health Mission,(NRHM)Assam is one of them. 1st phase of NRHM in Dotma BPHC was started in 2005 and ended till 2012.2nd phase of NRHM is in process which emphasizes on quality health service to the tribal population especially women and children. The National Rural Health Mission (NRHM) has been launched with the view to bringing about dramatic improvement in the health system and the health status of the people, especially those who live in the rural areas of the country. The Mission seeks to provide universal access to equitable, affordable and quality health care

11 which is accountable at the same time responsive to the need of the people, reduction of child and maternal deaths as well as population stabilization, gender and demographic balance. In this process, the Mission would help to achieve goals set under National Health Policy and the Millennium Development Goals. The goals of NRHM are as follows: Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) Universal access to public health services such as Womens health,Childs health, water, sanitation & hygiene, immunization and Nutrition. Prevention and control of communicable and noncommunicable diseases, including locally endemic diseases. Access to integrated comprehensive primary healthcare Population stabilization, gender and demographic balance. Revitalize local health traditions and mainstream AYUSH. Promotion of healthy life styles.

To achieve different goals under NRHM it has implemented various health schemes in Assam where Dotma Block primary health center is not an exceptional. Thecomponents under the mission are Reproductive and Child Health-II, Universal Immunization Programme, National Vector Borne Diseases Control Programme, National Leprosy Eradication Programme, Revised National Tuberculosis Control Programme, National Blindness Control Programme and Convergence.The different schemes under the mission are as follows: Mamoni ( Incentive given to pregnant women @ Rs. 1000/- for Nutritional supplement during pregnancy) JananiSurakshaYojana ( Incentive given to pregnant women after delivery in Govt. Hospital @ Rs.1400/- to rural women and Rs.1000/- to urban women for safe delivery) Mamta ( A Mamta kit is a gift given to new born baby after 48 hrs. stay in hospital after her delivery) Majoni(Fixed deposit of Rs. 5000/- is given to 1st and 2nd girl child born in Govt. hospital for 18 years) .

12 JananisishusurakshaKaryakram.( Everything /every service will be available free of cost to pregnant women and to her new born Child) RastriyaSwathaBimaYojana.(A Sum of Rs. 30,000/- is given to all BPL families for avail health service in any Govt. hospital).

To achieve the goal of NRHM different training programmes were conducted time to time at different levels( District level/Block level) to impart and re-orient there skill and knowledge for smooth implementation of ongoing programmes and thus to serve poor people by providing quality health service especially to women and children and thus to achieve desired goal set under NRHM. Therefore, the study was conducted to assess the training effectiveness and mapping training needs of employees so as to achieve the goal of NRHM in true sense which will be reflected if IMR( Infant Mortality Rate, MMR( Maternal Mortality Ratio),TFR ( Total Fertility rate)will be reduced up to state average as because the IMR,MMR,TFR in Kokrajhar District is very high in comparison with state average.In order to have a comprehensive idea of the different training programmes held under Dotma BPHC and proper documentation of the same, a systematic and scientific approach is essential.Several projects have been conducted on various training programmes under health in different parts of India but to the knowledge of the researcher no such attempt has been made so far in regards to training effectiveness and training need under Dotma BPHC of kokrajhar District.

Hence, the present investigation was undertaken with a view to have training effectiveness and mapping training need of Dotma BPHC with the following objectives: To find out types underDotma BPHC. of training conducted/attended

To Measure Human Resource at different level with requisite knowledge and skill. To compare the Performance of Employee before and after the training attended in various fields/ area of activities.

13 To assess and mapping the need of human resource in terms of training to improve the performance at different level.

Figure: 1 Map showing Dotma BPHC location in Kokrajhar District.

The district now has two revenue sub-divisions--- Kokrajhar and Gossaigaon Sub-divisions. The river Gongia which is known as Tipkai in the southern part is the natural boundary of two civil sub-divisions. Gossaigaon town is the headquarter of Gossaigaon Sub-division.

Dotma BPHC At a Glance.

Block Population: 153537.

14 Area of the health Block : 892 Sq.km. Inhabitant Villages: 320. ST Population of the block : 61621 ( 40.15 % ) ( 2001 Population Cencus ) SC population of the BlocK: 4,374 ( 2.85 % ) No. of Village Council Development Committee: 25. Total Number of Samabay Committee: 5 No.s. Total Number Of Health Institutes under the Block : Block PHC -1 Community Health Center : 1 Primary Health Center : 1 Subsidiary Health Center : 2 Mini Primary Health Center : 3 State Dispensery: 8 Sub-Centers : 30. Total Number of ASHA under the Block : 307. Total Number of Village Health and Sanitation Committee: 307. Total Number of Anganwadi Center: 292.

Figure No: 2 Geographical Map of Dotma BPHC, DistrictKokrajhar ( GPRS Mapping)

15

. BLOCK PROFILE OF DOTMA

Dotma Block is completely rural area even some important places like Fakiragram, Dotma&Serfanguri are yet to be considered as urban area. Dotma block is an important place of kokrajhar district

16 it is located at the Middle- East of the district. The boundary of the block is Bhutan on the North, Dhubri district on the South, Kokrajhar Block on the East and Gossaigaon and Kachugaon Block on the West.

AREA
The block cover area of as per 2001 Census is 892 Sq. Km Table:-1 Dotma Block Profile. Development Block Community Dev. Block Number Number 1 1

Police Station Revenue Circle Inhabited Village

Number Number Number

3 1 320

Village Council (VCDC). Sam bay Samittee

Development

Committee Number

25

Number

Table:4 Performance of Institutional Deliveries Under Dotma BPHC, District- Kokrajhar

Name of the Health Institute under the Block Dotma CHC Fakiragram SHC Sakti Ashram SD Bonorgoan SD Pertapkata SD 200708 1045 334 126 188 18 200809 621 312 97 176 43 200910 749 372 55 169 47 201011 883 315 181 160 32 Requirement 2011-12 602 184 83 102 24 Proposed for 1 additional doctor 123 and 2 GNM. Proposed for 1 additional doctor 70 and 2 GNM. 32 Proposed for 1 additional doctor 133 and 2 GNM. Proposed Institution upgraded for 24*7 0 PHC Proposed for 1 additional doctor 22 and 2 GNM. Health Institute is in rented Building. Proposed for New PHC building with 24*7 facility as Doctor and ANM already Appointed 0 there. Proposed Institution upgraded for 24*7 0 PHC Health Institute was renovated from a detoriated condition. Hence proposed for 24*7 PHC, with 1 Doctor, 2 GNM, and 1Paramedical Staff. Only 1 ANM,

17

Chithila SD

150

131

255

181

Lakhnabari MPHC Jharbari SD

532 95

400 94

458 72

336 53

Serfanguri SD

693

370

339

247

Dumariguri SD

Dauliguri MPHC

47

Angthihara SD

Gossainchina SD

18

HEALTH CARE INFRASTRUCTURE:

There is 01 Community Health Centre, 01 Block Primary Health Centre, 1 Primary Health Centre, 2 Subsidiary Health Centre, 3MPHC, 8 State Dispensary and 30 Sub-Centre in the block.
Table:5 Health Care Infrastructure Under Dotma BPHC, Kokrajhar District.

Institution
Block PHC Leprosy Control Unit Primary Centre CHC SHC S.D. Dispensary) Sub-Centre (SC) MPHC

Numb er
1 1 Dotma Dotma Dotma Dotma Chithila&Fakiragram

Detail

Health 1 1 2 (State 8

Angthihara, Bonargaon, Gossainichina, Jharbari, Saktiahram&Serfanguri Sanctioned=30/Functioning--30 Lakshnabari, Dhauliguri&Bhalukmari

Dumariguri, Pratapkhata,

31 3

BUILDING:
The Community Health Centre needs major repairing and facility up gradation in which OT needs to be renovated and need to be well equip with all equipment and instrument, including OT surgeon, Anesthetist and other related staff so as to carry out major and minor operations, including Laparoscopic sterilization etc;Sectorial Hospital under the block as Angthihara SD is still residing in rented building with 1 doctor and 1 ANM already appointed. Hence, it is proposed that along with hospital building, Provision may be made for 24*7 PHC. Further, Gossainchina SD, Dumariguri SD needs to be upgraded to 24*7 PHC, by providing facility for Institutional Delivery and other necessary equipment and instruments including adequate staff. The 3 MPHC and 8 State Dispensaries are needs major repairing along with new construction of Doctor and Nurse quater and facility up gradation. There are 30 Sub-Centre (SC) in the block and all are sanctioned / completed as

19 Government Building except Jodumoni SC .Moreover, In one Subcenter name Aflagoan SC needs to be Converted to MCH center as BTC Kokrajhar have already Constructed Hospital Building and quarters for Doctor, Nurse and Para medical staff .Hence, if Doctors and Staff if appointed there then the health institution will be functional to provide services to rural population.

STAFF PROFILE:
The Existing situation with staff sanctioned and in position reveals significant number of vacant position at every level of health care services delivery. TABLE NO 6: STAFF PROFILE
Sl.N o. Category Total Sanctione d In Position Vacanci es Addl. Position required

Sr. Medical 1 Health Officer

1 OT surgeon and 1 Anesthethist required to make OT functional in Dotma CHC 1 MO required in Bhalukmari MPHC, Gossainchina SD, Dumariguri SD, Jharbari SD, Lakhnabari MPHC, Serfanguri SD, Chithila SD for smooth implementation of 24*7 PHC.

Medical Officer(Com munity Health)

30

3 4

Male Medical Officer Female -

15 2

1 Female doctor

20 Medical Officer 5 6 Dentist Medical Officer (AYUSH) BEE LHV Male Supervisors Female Supervisors Male Workers Female Workers ANM 62 14 GNM 26 17 9 1 1 1 1 1 12 is required in Fakiragram SHC

7 8 9 10 11 12 13

1 1 13 1 15 35

1 in Saktiashram SD 2 GNM Required in saktiashram SD, 2 in Pratapkata SD, 2 in Chithila SD, 1 in Lakhnabari MPHC,1 in Jharbari SD, 1 in Dauliguri MPHC, 3 ( Saktiashram SD, DumariguriSD,Pra tapkata SD)

15

Laboratory Tech.

16 17 18

Pharmacists Total Dais Health Educator 12 3

13 3 3

21 19 20 21 22 23 24 25 26 27 NMS SI(PH) RH-I SW MPW MI SI (Malaria) Computer RHP 1 1 11 1 0 1 11 6 1 3 1 3 0 2 ( Kharidamadati SC, Aflagoan SC) for MCH Center 0 1

DETAILS OF THE STAFF POSITION UNDER NRHM

Table:7 Block Programme Management Unit,Dotma BPHC.

TRAINING AND DEVELOPMENT OBJECTIVES

Units Sanctioned Posts In Position Vacant Requir ed

Block Programme 1 Manager Block Manager Accounts 1

1 1 8 1 2No.s (Angthi hara, ,Saktias hram SD)

PHC Accountanat 9 CUM Asstt. Block Programme Manager

Block Pharmacist Block data manager ASHA Facilitator

1 1 31

1 1 29 2 2

The principal objective of training and development division is to

22
make sure the availability of a skilled and willing workforce to an organization. In addition to that, there are four other objectives: Individual, Organizational, Functional, and Societal. Individual Objectives help employees in achieving their personal goals, which in turn, enhances the individual contribution to an organization. Organizational Objectives assist the organization with its primary objective by bringing individual effectiveness. Functional Objectives maintain the departments contribution at a level suitable to the organizations needs. Societal Objectives ensure that an organization is ethically and socially responsible to the needs and challenges of the society. ( WWW.Training and development.Naukrihub.com).

Identification of training needs is important from both the organisational point of view as well as from an individual's point of view. From an organisation's point of view it is important because an organisation has objectives that it wants to achieve for the benefit of all stakeholders or members, including owners, employees, customers, suppliers, and neighbours. These objectives can be achieved only through harnessing the abilities of its people, releasing potential and maximising opportunities for development. Therefore people must know what they need to learn in order to achieve organisational goals. Similarly if seen from an individual's point of view, people have aspirations, they want to develop and in order to learn and use new abilities, people need appropriate opportunities, resources, and conditions. Therefore, to meet people's aspirations, the organization must provide effective and attractive learning resources and conditions. And it is also important to see that there is a suitable match between achieving organizational goals and providing attractive learning opportunities.

The main focus and objectives of DLHS-3 is to provide RCH indicators covering the following aspects:
Coverage of antenatal check-up and immunization services Institutional/safe deliveries JSY Beneficiaries Contraceptive prevalence rates

23 ASHAs involvement Unmet need for family planning Awareness about RTIs/STIs and HIV/AIDS Family life education among unmarried adolescent girls Health facility and infrastructure.

REVIEW OF LITRATURE

24

REVIEW OF LITRATURE
The literatures pertaining to the present study have been reviewed extensively keeping in view the objectives of the study. To the knowledge of the investigator no studies have so far been undertaken on training effectiveness and mapping training need of Dotma BPHC under Kokrajhar district of Assam. However, there are literature found available on Training programmes in health sectors on other part of state and its related aspects. The relevant literatures reviewed for the purpose of the study are presented in this chapter under the following heads: Types of Training under Health. Training effectiveness. Training need of employees.

2.1 TYPES OF TRAINING UNDER HEALTH.

(Kothari 1997) Training is concerned with imparting developing specific skills for a particular purpose.Training is the act of increasing the skills of employees for doing a particular job. Training is the process of learning a sequence of programmed behaviour.In earlier practice, training programme focused more on preparation for improved performance in particular job. Most of the trainees used to be from operative levels like mechanics, machines operators and other kinds of skilled workers. When the problems of supervision increased, the steps were taken to train supervisors for better supervision.
Training is widely understood as communication directed at a defined population for the purpose of developing skills, modifying behaviour, and increasing competence. Generally, training focuses exclusively on what needs to be known. Education is a longer-term process that incorporates the goals of training and explains why certain information must be known. Education emphasizes the scientific foundation of the

25
material presented. Both training and education induce learning, a process that modifies knowledge and behaviour through teaching and experience. Training means to teach them to do something (DK dictionary). According to Planty, Cord and Efferson, Training is the continuous, systematic development among all levels of employees of that knowledge and their skills and attitude which contribute to their welfare and that of the company. According to Flippo:- Training is the process or the act of increasing the knowledge and skills of an employee for performing a particular job. According to S.Beach:- Training is the organized procedure in which people learn knowledge and / or skill for definite purpose. According to Business Dictionary:- Organizedactivity aimed at imparting information and/or instructions to improve the recipient'sperformance or to help him or her attain a required level of knowledge or skill.

Training of employees takes place after orientation takes place. Training is the process of enhancing the skills, capabilities and knowledge of employees for doing a particular job. Training process moulds the thinking of employees and leads to quality performance of employees. It is continuous and never ending in nature. (http://www.managementstudyguide.com/trainig_of_employees.htm.)

Training evaluation is a critical component of analyzing, designing, developing, and implementing an effective training programme. This section addresses the key elements of determining training effectiveness through evaluation activities. The National Academy For Nuclear Training document ACAD 88-002 states: Training evaluation determines a training programme's effectiveness in meeting its intended purpose,which mainly is producing competent employees. Programme evaluation focuses on the results of the training programme and not on the process of training. The key to conducting an effective training evaluation is to first identify the questions to be answered by the evaluation.Should the programme be modified? What performance gains are being realized? Is the need for training being addressed in the best way possible? Determining a training programmes effectiveness is critical to the success of a nuclear facility. Training based on a sound analysis

26 of job specific criteria has a strong foundation that should yield effective results. This report addresses how an organization can determine if its training can be effective before it has been developed and whether it has been effective after it has been delivered. Several key elements of training programme effectiveness that should be addressed are: (1) Training design and development; (2) Training delivery; and (3) Training implementation. The first element requires correctly designed and developed training. However, even though properly designed and developed to a defined set of job relevant criteria, if the recipients are already qualified to do the job, this training will not be effective, resulting in a waste of time and resources. The second element is addressed using a defined set of activities and methods to evaluate training delivery effectiveness. The third element is critical to help management allocate resources most effectively. This element addresses activities and methods that will ensure that training to be developed is needed and that it has resulted in improved performance. This section will address these three elements and methods and activities to determine whether training is the appropriate solution to a plant or personnel deficiency. Activities and methods will then be introduced to evaluate the effectiveness of training after it has been delivered. This section also addresses evaluation activities and the analysis of indicators. A training effectiveness matrix is included to address the necessary elements associated with measuring training effectiveness. This matrix provides a structure for an organization assess its own training evaluation procedures and activities.

TRAINING EFFECTIVENESS.
CONCEPT - TRAINING EFFECTIVENESS Training effectiveness is an impact of the training given to work group staff on work conducted in the plant. Training effectiveness is achieved if people being trained are able to perform their duties errorless. Training effectiveness is an extent of achievement of defined training objectives within the planned training schedule and available budget. The training objectives are related to

27 knowledge, skills and attitudes and are therefore connected to a better plant and human performance. (This definition came from an organization providing training services) Training effectiveness shows whether the personnel knowledge and skills are increasing over several years. (This explanation from an organization providing training services) Effective training the training that is done in the best and most economical way. The same result could not be obtained at a lower cost, or a better result could not be obtained at the same cost. The training effectiveness matrix is based on the work of Donald L. Kirkpatrick, who introduced a four-level approach to training evaluation in 1959. These four levels have become commonly known as: customer satisfaction (internal and external) level one, learner performance level two, training process performance level three, and returned value level four evaluation. The Training Effectiveness Matrix introduced in this section is a tool developed though the combined efforts of the International Atomic Energy Agency (IAEA), the United States Department of Energy, industry best practices, input received from an IAEA specialist meeting and from a survey distributed to member states. 3.2. TRAINING EFFECTIVENESS The determination of training effectiveness should address three categories: (1) Training activities; (2) Evaluation activities; and (3) Training effectiveness indicators. The best way to determine that training has been effective is to fully understand the reason why the training has been developed. The reason to develop and implement training is a key factor in determining that a training course or programme will be effective in addressing performance deficiencies. If the reason for training was not clearly identified prior to training development, it could lead to training that is not appropriate to correct the performance deficiency. Establishing a valid need for training is the foundation upon which an organization can determine training effectiveness. If there is a valid need for training, and training addressed that need, when training has been effectively implemented indicators will validate that the

28 training addressed the need for training and whether the desired results were achieved.

TRAINING NEED OF EMPLOYEES.

Training need identification is a tool utilized to identify what educational courses or activities should be provided to employees to improve their work productivity. Here the focus should be placed on needs as opposed to desires of the employees for a constructive outcome. In order to emphasize the importance of training need identification we can focus on the following areas: To pinpoint whether training will make a difference in productivity and in bottom line. To decide what specific training each employee needs and what will improve his or her job performance. To differentiate between the need for training and organizational issues and bring about a match between individual aspirations and organizational goals. Identification of training needs (ITN), if done properly, provides the basis on which all other training activities can be considered. Also requiring careful thought and analysis, it is a process that needs to be carried out with sensitivity as people's learning is important to them, and the reputation of the organizationis also at stake.

REASON FOR TRAINING (TRAINING NEEDS)

If a clear need for training has been identified, an organization should be able to determine that the training is effective. The need for training should be documented along with the reasons behind it. Without a clearly defined need, an organization may not be able to determine its training effectiveness. There are several ways to identify and document training needs. From best practices and input received by the International Atomic Energy Agency a method that has been effective is provided in the following sections. The method is known as table top training needs assessment/analysis. The United States Department of Energy and other Member States have used this or similar methods that have been effective in determining whether training is appropriate to address the performance need before devoting the resources to develop training materials. With this information, sufficient baseline information is available to develop the training and to document the set of performance deficiencies that exist. This method clarifies job specific performance deficiencies that are then used to design the training programme. This method should be employed before a

29 training programme is developed. It is also useful after training has been developed to verify the validity of training needs.

TRAINING PROGRAMME DEVELOPMENT

For training to be effective, it must address or preclude a deficiency such as human performance, policy, procedure, facility, or equipment. If training can be traced to a deficiency and training was instrumental in eliminating that deficiency, then that training was effective.However, it is important to understand that a performance deficiency may not exist because training has been effective. For example, a nuclear power plant developed and implemented a comprehensive training programme on lock-out/tag-out of equipment. After developing and implementing the training, an evaluation concluded that there was no need to continue the training because there were no deficiencies. What the evaluators had not recognized was that training had prevented deficiencies from occurring. The following example illustrates what can happen when training is developed without determining if a performance deficiency exists: An audit finding at a nuclear facility determined the mechanics were not trained on the firewater protection system. After examining the mechanics training records, the audit team could not uncover any evidence of this training. Findings were sent to the training department manager who directed the lead training developer to develop training for the mechanics on the firewater protection system. The training developer asked the training manager if he would help him organize training needs assessment with the mechanics. The training manager did not believe enough time existed to do an analysis before the finding needed to be corrected and declined the request. Because of the time constraints, the training developer decided to seek subject matter expertise. The subject matter expert told the trainer that the reason mechanics were not trained on the fire water protection system is that they did not work on the system because it was maintained under contract by another organization. When the training manager was provided this information, he contacted the regulatory agency that performed the audit and the audit finding was removed. Had the training been developed, time and resources would have been wasted. The training developer contacted the right people in time to avoid performing unnecessary work. Individuals at any level of an organization can search their training history to identify training that was unnecessary. Individuals responsible for developing training should periodically

30 conduct needs assessments with the goal to achieve more effective training.

THE TABLE TOP NEEDS ASSESSMENT/ANALYSIS PROCESS

The table top needs analysis works best when a skilled facilitator organizes a focus group of select individuals who possess job specific skill and knowledge who get together around a table to determine training needs. They review existing performance deficiencies and emergent training requirements. The three documented outputs from a table top needs assessment/analysis are: A validated list of job requirements (task statements or competencies), which represent what job incumbents are required to do in order for that job or task to be performed correctly. A validated list of performance deficiencies, complete with a list of causes and or barriers related with each of these deficiencies. A validated list of training and or non-training related recommendations to address the performance deficiencies or needs.

EVALUATION ACTIVITIES: Transfer of knowledge and or skill to the job after training provides an excellent indicator of training effectiveness and takes the evaluation process as described in the Training Effectiveness Model to the 3rd level of Kirkpatricks evaluation model. This type of evaluation provides higher level performance indication for training effectiveness. This level involves line management in the evaluation process. Managers observe work in the field that is performed by students who have recently completed the associated training. This feedback provides excellent training effectiveness indicators. Line manager observations of field performance before the training takes place improves the validity of subsequent observations and yield more accurate indication of effective training.
Development:

31
According to Business dictionary:1.The systematic use of scientific and technicalknowledge to meet specific objectives or requirements. 2. An extension of the theoretical or practical aspects of a concept, design, discovery, or invention. 3. The process of economic and social transformation that is based on complex cultural and environmental factors and their interactions. 4. The process of adding improvements to a parcel of land, such as grading, subdivisions, drainage, access, roads, utilities.

TRAINING AND DEVELOPMENT

Training and development is a subsystem of an organization. It ensures that randomness is reduced and learning or behavioral change takes place in structured format.

TRADITIONAL AND MODERN APPROACH OF TRAINING AND DEVLOPMENT

Traditional Approach Most of the organizations before never used to believe intraining. They were holding the traditional view that managers are born and not made. There were also some views that training is a very costly affair and not worth. Organizations used to believe more in executive pinching. But now the scenario seems to be changing. The modern approach of training and development is that Indian Organizations have realized the importance of corporate training. Training is now considered as more of retention tool than a cost. The training system in Indian Industry has been changed to create a smarter workforce and yield the best results.

32

MATERIALS AND METHODS

33

MATERIALS AND METHODS

The present Investigation on A Study on training effectiveness and mapping training need of employee under Dotma BPHC (Block Primary Health Center) of Kokrajhar (B.T.A.D) District of Assam was under taken with the well planned approaches as presented under the following subheading: 3.1 3.2 3.3 Conceptual background. Locale of research study. Sample and sampling procedure. 3.3.1Selection of respondent. 3.4 3.5 3.6 3.7 3.8 3.9 Data collection method. Development of data collection tools. Pilot study. Procedure of data collection. Reference period. Limitation

3.10 Analysis of data.

3.1: CONCEPTUAL BACKGROUND:

The present study aims to investigate training effectiveness and mapping training need of employee under Dotma BPHC of kokrajharDistrict.The terms of concepts, frequently used in the text are explained below with the sense in which these are used for the purpose of study.

34
Training: The term training is a short-term process utilizing a systematic and organized procedure by which non-managerial personnel acquire technical knowledge and skills for a definite purpose.It refers to instructions in technical and mechanical operations, like operation of some machine. It is designed primarily for non- managers, it is for a job- related purpose.

Once a valid training need has been identified, programme content is then developed.During the development process ongoing evaluation activities that monitor training needs should be used to update training development. Human Resource Management :Human Resource Management is defined as the people who staff and manage organization. It comprises of the functions and principles that are applied to retaining, training, developing, and compensating the employees in organization. It is also applicable to non-business organizations, such as education, healthcare etc.Human Resource Management is defined as the set of activities, programs, and functions that are designed to maximize both organizational as well as employee effectiveness. The National Rural Health Mission (2005-2012) was launched by the Government of India(GoI) in 2005-06 to provide effective health care to rural population in the country with special focus on states which have poor health outcomes and inadequate public health infrastructure and manpower. The primary focus of the mission is to improve access of rural people, especially women and children, to equitable and affordable primary health care. The main goal of NRHM is to reduce infant mortality rate (IMR) and maternal mortality ratio (MMR) by promoting newborn care, immunization, antenatal care, institutional delivery and post-partum care.

ASHA: Every village/large habitat will have a female Accredited Social HealthActivist (ASHA) - chosen by and accountable to the panchayatto act as the interface between the community and the public health system. ASHA would act as a bridge between the ANM and the village and be accountable to the Panchayat. She will be an honorary volunteer, receiving performancebased compensation for promoting universal immunization, referral

35 and escort services for RCH, construction of household toilets, and other healthcare delivery programmes. She will be trained on pedagogy of public health developed and mentored through a Standing Mentoring Group at National level incorporating best practices and implemented through active involvement of community health resource organizations. She will facilitate preparation and implementation of the Village Health Plan along with Anganwadi worker, ANM, functionaries of other Departments, and Self Help Group members, under the leadership of the Village Health Committee of the Panchayat. She will be promoted all over the country, with special emphasis on the 18 high focus States. The Government of India will bear the cost of training, incentives and medical kits. The remaining components will be funded under Financial Envelope given to the States under the programme. She will be given a Drug Kit containing generic AYUSH and allopathic formulations for common ailments. The drug kit would be replenished from time to time. Induction training of ASHA to be of 23 days in all, spread over 12 months. On the job training would continue throughout the year. Prototype training material to be developed at National level subject to State level modifications. Cascade model of training proposed through Training of Trainers including contract plus distance learning model Training would require partnership with NGOs/ICDS Training Centres and State Health Institutes.

36

DATA COLLECTION METHOD:

3.4.1 CONCEPT OF TYPES OF DATA: Analyze data directly related to the objectives of the training programme. Most companies collect the data needed to evaluate training but often fail to recognize the value to assess training effectiveness. The outcome of some programmes that produce hard skills such as technical training is observable and can be measured. The speed and quality of an assembly line operator before, during, and after a training programme can be measured. However, soft skills such as behavioral outcomes associated with effective management are less obvious and measurable. Demonstrating that a manager delegates effectively or is a strong motivator is often difficult to determine. Therefore, the following sections are provided in two categories: hard data, andsoft data. 3.4.1.2. Hard and soft data comparison Hard data are the primary measurements of improvement, presented in rational, undisputed facts that are easily accumulated. They are the most desired type of data to collect. Criteria for measuring the effectiveness of management primarily rest on hard data, such as productivity, profitability, cost and quality control. Because changes in these data may lag behind changes in the condition of the organization by many months, it is useful for management to supplement these measures with assessments of skill, motivation, satisfaction, and attitude. A supervisory programme designed to build delegation and motivation skills should have an impact on hard data but it may be best measured by soft data. Soft data are difficult to collect and analyze but are useful when hard data are not available. The contrasting characteristics of the two types of data emphasize this point. Hard Data 1. Easy to measure and quantify. 2. Relatively easy to assign cost values. 3. Objectively based.

37 4. A common measure of organizational performance. 5. Very credible in the eyes of management. Soft Data 1. Difficult to measure or quantify directly. 2. Difficult to assign cost values. 3. Subjectively based in many cases. 4. Less credible as a performance measurement. 5. Usually behaviourally oriented. Hard data Hard data can usually be grouped into four categories (subdivisions): output, quality, cost and time. These data are measured in almost every organization. Examples of hard data are included in Appendix D. When they are not available, a common approach is to convert soft data to one of these four basic measurements. 1. Output: Most organizations have basic measurements of work output. Before-training and after-training work output changes are easily monitored. 2. Quality: Methods to measure quality are usually in place and training programmes designed to improve quality can be measured documented. 3. Cost: Training programmes that produce a direct-cost-savings can show a financial contribution. There can be as many cost items as there are accounts in an accounting system. Also, cost categories can be combined to develop combinations that maysupport more in-depth evaluation. 4. Time: A time savings may mean a project is completed sooner than planned, a new product was introduced earlier, or the time to repair equipment was reduced. Time savings translate into additional output or lower operating costs. The distinction between these four groups of hard data is sometimes unclear becausetheir effects may overlap. For example, accident or occurrence costs may be listed under the cost category, number of accidents listed under quality, and lost-time days due to an accident listed under the time category. This occurs because

38 accidents represent a cost, are usually caused by someone making a mistake and are a reflection of the quality of work, and days lost from the job represent time costs to the organization. The distinction between the subdivisions is not as important as the awareness of measurements in these areas. Soft data When hard data do not exist, soft data may useful in evaluating training. Soft data areusually behaviour based and difficult to measure accurately. Soft data are categorized into six areas: work habits, new skills, work climate, development and advancement, feelings and attitudes, and initiative. Appendix E provides examples of soft data. The following describesthe six areas: Work habits. Employee work habits are critical to the success of a work group. Poorwork habits can lead to an unproductive and ineffective work group, while good workhabits can boost the output and morale of the group. The most common and easilydocumented poor work habits include absenteeism and tardiness, and these can be tiedto cost savings much easier than the other types of soft data. Training can be used totrain supervisors on improving employee work habits. Systems to record employee workhabits such as absenteeism, tardiness, and visits to the first-aid station can beimplemented. Poor work habits may be documented by the employee's supervisor. New skills. Skill building is an important area for training. The successful application ofnew skills might result in hard-data measurements such as a new employee learning a production procedure. They may also involve soft data measurements such as decision making, problem solving, conflict resolution, grievance resolution, and listening skills. The success of skill-oriented training relies on the frequency of use after training is completed. The frequency and extent of the use of new skills can be monitored and documented to provide additional data for evaluation. Work climate. Work climate is important. Grievances, discrimination charges, complaints, and job dissatisfaction often result in reduced efficiency, less output, unionization drives, and employee resignations. 4. Development/advancement. There are two perspectives: (1) the development of participants who attend programmes; and (2) the extent managers and supervisors provide developmental opportunities for their

39 employees. Promotions, transfers, payincreases, and performance ratings are typical data that can be used to measure development and advancement. 5. Feelings/attitudes. Almost every training programme is designed to get a favourable reaction toward the subject being taught. These reactions provide additional evidence of training effectiveness. Some programmes are conducted to change attitudes toward employees, the job, or the organization. Some programmes are designed to change the participant's perception of the job or other aspects of the work setting. In these situations the feelings and attitudes can be documented with questionnaires and surveys. 6.Initiative. In some training programmes participants are encouraged to try new ideas and techniques. The extent to which employees accomplish what they plan provides evidence of the success of the programme. Also, the employee's initiative to generate ideas and submit suggestions is indication training effectiveness.

3.4.2 METHOD OF DATA COLLECT FOR THE PROJECT:

Interview method was considered as an appropriate method to elicit the necessary data for the present study because of the following reason: To get complete and reliable information To explain certain terms to the respondents which facilities the data collection process. To establish rapport with the respondent so that authentic data could be obtained. To observe and record certain queries which could not have been possible by other method.

Report and DotmaBPHC . Inter-Personal Beneficiaries.

Returns

submitted

monthly

by

the

staff

of

Communication

with

trainer,

trainee

and

Personal Observation.

3.5 DEVELOPMENT TOOLS:

OF

DATA

COLLECTION

40
After reviewing related literature in the relevant areas, three separate research schedules were developed keeping in view the objectives of the study for collection of data on different aspects of the investigation.

3.6 PILOT STUDY:

Pilot study was very essential to pre-test the self-structured interview schedule to judge the clarity and reliability of the same. The interview schedule I administered to 10 beneficiaries and schedule II was pre tested on 10SC and 3 PHC. This helps the researcher to make some minor changes to finalize the interview schedule.

3.7. PROCEDURE OF DATA COLLECTION:

Interview and observation method were followed with the help of an interview schedule designed for the purpose of the study. Interview schedule was considered as an appropriate tool for present study to get complete and reliable information. In addition to the selected respondents, some experienced and knowledgeable person, Sub-divisional Medical and health officers, sectorial in-charges of peripheral hospitals were also interviewed in order to collect relevant data.Information was also collected from the available literature including books, newsletter, books, magazines, internet etc. Photographs of training programmes etc. were taken during field visit/ investigation to supplement the field data.

3.8 REFERENCE PERIOD:

The period of actual field visit was started from April 2011- March 2012.

3.9 LIMITATION:
The project was limited to NRHM 1st phase which effect from 20052012.

3.10 ANALYSIS OF DATA:

The collected data were supplemented with secondary data available from literature and analyzed in accordance with the objectives of the present study following the appropriate analytical tools/ devices like frequency and %age.

41

LOCALE OF RESEARCH STUDY:

The study was conducted in Dotma BPHC of Kokrajhar district (BTAD) under the state of Assam. A multistage stratified purposive cum random sampling design was followed for collecting the necessary information and data.At first, 10 sub-centers (SC) and 3 Primary Health Center (PHC) under Dotma Block Primary Health Center(BPHC) viz. Puthimari SC, Ghoramari SC, Kharidamadati SC, Dangarkhuti SC, Loadanga SC, Baghmara SC, Tetliguri SC, Mahendrapur SC, Jharbari SC, Baldiabathan SC and 3 PHC as Dhauloiguri MPHC, Dumariguri SD and Dotma CHC were selected. Purposively in view to patient load in health institutes under the block, underserved areas or outreach area, quality of service availability in accordance to training to the needy poor people, areas that seeks to upgraded service in terms of maternal and child health were accessed. After listing of all health institution were purposively selected for conducting the study.

3.3 SAMPLE AND SAMPLING PROCEDURE:

The systematic and purposive sampling design adopted for the purpose of the study is discussed below:

3.3.1 SELECTION OF RESPONDENTS:

In order to collect primary information for the purpose of the study respondents are categorized as under: Trainer providing training to the staff. Trainee receiving training on various skills for providing quality health service.

Finally the beneficiaries / patient/ villagers come under the Block primary health center.

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43

DATA ANALYSIS & INTERPRETATIONS

DATA ANALYSIS & INTERPRETATIONS This chapter Deals with result of the study and the relevant discussion thereon are represented under the following heads: 4.1 Types of Training given in NRHM. Achievement/performance of employee before and after

4.2 training.

44 4.3 Mapping training need of human resource so as to improve the performance at different level.

4 .1 TYPES OF TRAINING GIVEN IN NRHM

The National Rural Health Mission (2005-2012) was launched by the Government of India(GoI) in 2005-06 to provide effective health care to rural population in the country with special focus on states which have poor health outcomes and inadequate public health infrastructure and manpower. The primary focus of the mission is to improve access of rural people, especially women and children, to equitable and affordable primary health care. The main goal of NRHM is to reduce infant mortality rate (IMR) and maternal mortality ratio (MMR) by promoting newborn care, immunization, antenatal care, institutional delivery and post-partum care. MAIN GOALS OF NRHM: Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) Universal access to public health services such as Womens health,child health, water, sanitation & hygiene, immunization, and Nutrition. Prevention and control of communicable and non-communicable diseases, including locally endemic diseases Access to integrated comprehensive primary healthcare Population stabilization, gender and demographic balance. Revitalize local health traditions and mainstream AYUSH Promotion of healthy life styles. The National Rural Health Mission (NRHM) foundation is built on community involvementin drawing a village health plan under the auspices of village Health & Sanitation Committee (VHSC), making rural primary health care services accountable to the community and giving authority to the District Health Mission for implementation of inter-sectorial District Health Plan including drinking water, sanitation, hygiene and nutrition. The interface between the community and the public health system at the village level is entrusted to a female Accredited Social Health Activist (ASHA), a health volunteer receiving performance based compensation for promotion of universal immunization, referral and escort services for reproductive & child health (RCH), construction of household toilets, and other health care delivery programmes. To promote institutional delivery, cash incentive programme under JananiSurakshaYojana (JSY) is made an integral component of NRHM.The third round of the District Level

45 Household and Facility Survey (DLHS-3) on Reproductive & Child Health (RCH) carried out during 2007-08 was designed to collect data at district level on various aspects of health care utilization for RCH, accessibility of health facilities, assess the effectiveness of ASHA and JSY in promoting RCH care, to assess health facility capacity and preparedness in terms of infrastructure. The integration of facility survey with the household survey was done with a view to link the RCH care outcomes to health facility accessibility, availability of medical & paramedical manpower and other village infrastructure. The broad objective of DLHS-3 is to provide RCH outcome indicators at the district level in order to monitor and provide corrective measures to the NRHM. The other important objective being, to assess the contribution of decentralization of primary health care at the district level and below by way of involving village health committees under the Panchayat in the implementation of health care programmes.

To achieve the long term goal of NRHM different trainings were imparted to different designated staffs under the health block which includes Doctors, Staff Nurse, Pharmacists, Laboratory technicians, Programme Managers, Accounts Managers, Data manager, PHC Accountant Cum ABPM,ANMs, ASHAs, AWW( Anganwadi Workers), PRI members, Teachers, Health Educators, Grade IV, sweeper and other pera-medical, technical and non-technical staff. The surveyed project give me the types of training provided under health, purpose of providing training to different designated staff, its short term and long term effect and gives us a clear concept that how NRHM Assam takes one step ahead in the rally to reduce MMR, IMR and thus to provide quality health service to the community through training. The details of training available under Dotma BPHC are as follows in Table - :

SL.N O.

DESIGNATI ON

NAME OF TRAINING

APPLICATION OF TRAINING

LONG TERM EFFECT

4.2 ACHIEVEMENT/PERFORMANCE OF Doctors/ NSSK Required Reduce Medical (NavajatakSi during birth of Infant EMPLOYEE BEFORE AND AFTER TRAINING. officers,GN shusurakhsa a new born mortality M. karyakram) baby/sick new Rate and born baby. neonatal mortality Rate ANM Routine Effective and Save 78 Immunization timely children training. Vaccination of from six Infant/children killer . disease Doctor,GN Bio medical Appropriate Hygienic, 30 M,ANM,Gra waste segregation of clean and Doctors deManagement hospital healthy +17GNM IV,Sweeper waste. environmen +78 . t. ANM+ 23 Grade IV sweeper ANM,GNM, IMNCI Save mother Reduce IMR 78 ANM, AWW and Child & MMR. 17 during illness GNM,257 AWW

TOTAL NUMBERS OF STAFF 46 AVAILABL E 47

TOTAL TRAIN ED STAFF 12

78

All Staff

77 ANM, 17 GNM, 31 AWW. Doctor, IUCD Copper-T Family 30 30 GNM, ANM, insertion to Planning Doctor,17 Docto LHV( Lady women after Service-TFR GNM,78 r,17G Health one ,Two or ( Total ANM, 2 NM,78 Visitor) More Child Fertility LHV ANM, Rate) 1 LHV Doctor, E-MOC, B- Management Reduce 30 1 GNM MOC, C-MOC of Obstetrics MMR, IMR Doctors, Docto and 17 GNM r, 2 Gynaecology GNM. before, during or after delivery PRI VHSC( Village Smooth Developme All Staff All Members, Health and Functioning of nt and Staff Goan Sanitation VHSC in awareness Buddha,AS Committee)Village of Villagers HA Rule & in terms of Regulation health. for utilizing the Rs.10,000/fund given to

47 Training effectiveness can only be accessed and measured after comparing the activities wise performance before and after training. If the performance of a particular indicator is increased/Decreased according to its criteria than we may directly or indirectly conclude a positive effectiveness of training after Comparison of performance with last year achievement. But the performance before and after training is stagnant or not up to the expected level than it may conclude a negative or zero effectiveness of training. To measure the training effectiveness of Dotma BPHC, a Comparative study on various heads were done which are categorised under following sub- heads under RCH II and NRHM:

MATERNAL HEALTH
Pregnant women registration. Early registration of Pregnant women ( Within 1st trimester) Complete ANC. TT vaccination and IFA Consumption. Institutional Deliveries Home deliveries through SBA and Non- SBA( Skilled Birth Attendent)

CHILD HEALTH.
Routine Immunization Performance

FAMILY PLANNING
Performance of Copper-T (IUCD)(Intra Uterine Cervix Device).

REPRODUCTIVE AND CHILD HEALTH CARE Reproductive and Child Health approachhas been defined as people have the ability to reproduce and regulate their fertility, women are able to go through pregnancy and child birth safely, the outcome of pregnancies is successful in terms of maternal and infant survival and wellbeing, and couples are able to have sexual relation free of fear of pregnancy and of contracting disease.(MoHFW,1997) Promotion of maternal and child health has been one of the most important objectivesof Family Welfare programmes in India. The Government of India took steps to strengthen maternal and child health services as early as the 1st and 2nd Five Year Plans (1951-56 and 1956-61). As part of the Minimum Needs Programme initiated during the 5th Five Year Plan (1974-79), maternal health, child health and nutrition services were integrated with family planning services.

48 The Reproductive and Child HealthProgramme, Phase I was launched in October 1997 incorporating a new approach to population and development issues. The programme integrated and strengthened the services/interventions under the Child Survival and Safe Motherhood (CSSM) Programme and Family Planning Services and added to thebasket of services, new areas on Reproductive Tract/Sexually Transmitted infections (RTI/STI). Some of the new interventions that were added to this programme, in addition to the CSSM programme were essential obstetric care, 24-hour delivery services at PHCs/CHCs, emergency obstetric care, essential newborn care, Medical Termination of Pregnancy, prevention of reproductive tract infection (RTI) and sexually transmitted diseases (STD). The introduction of this programme was asignificant paradigm shift from a target oriented approach; to one which focussed more on responding to broader reproductive health needs identified by the local communities. However, it did not go without some limitations such as central focus, weak decentralised planning process, multiple funding organisation, improper monitoring system, limited role of the private sector etc. which undermined its efficacy and led to less than expected results. The second phase of the RCH programme,launched in 2005, has been introduced keeping in mind the weaknesses of the first phase. The primary focus is on reducing the regional imbalances in Reproductive and Child Health services. RCH will be integrated, focussed, participatory programme aiming to meet the unmet demands of the target population. ASHA ( Accredited Social Health Activist) an honorary volunteer, receiving performance-based compensation for promoting universal immunization, referral and escort services for RCH, construction of household toilets, and other healthcare delivery programmes and act as a bridge between the ANM and the village and be accountable to the Panchayat. Every village/large habitat will have a female ASHA - chosen by and accountable to the panchayatto act as the interface between the community and the public health system. Induction training of ASHA to be of 23 days in all, spread over 12 months. On the job training would continue throughout the year.

49 ASHA plays an important role in motivating pregnant women for ANC Check-up, Mamoni Schemes Hospital Delivery in Government Hospital, JananiSuraksha Schemes, Timely Vaccination of Children before their 1st birthday etc. and for quality Motivation and service through ASHA to poor women and children various training were given to ASHA. Table No.:-9 Training status Of ASHA
Sl.No Module 1 Module 2 Module 3 Module 4 Module 5 Module 6 Module 7 NumberofASHATrained 212 95 new selected + 212= 307 307 307 307 307 307 Targetfor2012-13 95 + 23=118 23 23 23 23 330 330

23 days training was imparted to ASHA which consist of 5 modules.1st module training to ASHA for7 days, 2nd module for 4 days, 3rd Module for 4 days, 4th Module for 4days and 5th Module is also for 4 days. 6th and 7th Module ASHA training for 5 days is in Process and will be completed in last week of July 2012 refer Plates No.-1 ASHA were health activist and thus work volunteer and get minimum incentives in accordance to assist beneficiaries from village to hospitals or to the service centres.The ASHA incentives were given in table no:-10 Table No. - :- 10 ASHA INCENTIVES UNDER VARIOUS SCHEMES OF NRHM Sl . N o 1 Incentive Incentive AmountperASHA TotalAmount Proposed

Incentive underJSY

Rs.600/-for 1st and 2ndpara delivery, Rs.400/- for 3rd delivery,Rs. 200/- for 4th Delivery and no incentive for 5thdelivery 444

50

2 3

Quality and full ANC Incentive underimmunization programme 4 Incentive underFamilyPlanning 4 5 Village Health And Nutrition Day 6 ASHA kiron

Rs.100/Rs. 250/-

Rs.500/-

Rs 100/- per month per VHND Maximum of Rs 25,000/medical assistance was given to ASHA

Location Institutional Delivery Home Delivery ASHA (only for ID) ASHA Full Immunization incentive Mamoni Majoni

Rural Amount (in Rs.) 1400 500 600 250 500 5000( Fixed Deposit)

Urban Amount (in Rs.) 1000 500 -

500 5000( Fixed Deposit)

MATERNAL HEALTH CARE:

Maternal health care package of antenatal care (ANC) is the main programme of NRHM to strengthen RCH care. ANC provided by a doctor, an ANM or other health professional comprises of physical

51 checks, checking position and growth of foetus and giving Tetanus Toxoid injection (TT) at periodic intervals during the time of pregnancy. At least three check-ups are expected to complete the course of ANC to safeguard women from pregnancy related complications. Institutional delivery and post-natal care in a health facility is promoted in NRHM through the JananiSurakshaYojana(JSY) to prevent maternal deaths. The MMR of Assam is 480 (SRS, 2006) / 333 (RRC-NE, 2009). The state started with MAPDA in 2008-09 in 2 districts Barpeta and Dibrugarh. It is used as a tool to increase awareness in the community and mobilize them to take local action and also to stimulate the policy makers to improve health services. Along with this it also empowers the community to take effective local actions and advocate for improved services.(State PIP,2010-11)

ANC
Antenatal care (ANC) refers to pregnancy related health care provided by a doctor or a health worker in a medical facility or at home. It is the care of the women during pregnancy so as to achieve at the end of the pregnancy a healthy mother and a healthy baby. This care usually begins soon after conception and continues throughout pregnancy including services such as monitoring pregnancy for signs of complications; promoting, protecting and maintaining the health of the mother during pregnancy, detecting high risk cases and giving them special attention, delivery care and postnatal care. Thus, the primary focus of antenatal care interventions is on improving maternal health, this being both an end in itself and necessary for improving the health and survival of infants. ( IndraneeDutta, ShaillyBawari, may 2007).

REGISTRATION OF PREGNANT WOMEN:

Pregnant women registration is increased in a very appreciating way in Dotma Block primary Health centres as clearly reflected in Graph No.-1 which clearly indicated the aware ness of pregnant women for quality Antenatal service and importance of registration in Hospitals. The Graph shown below also reflects the impact or effect of training programme on Quality ANC as shown in plate No. -8. Sudden rise in registration of pregnant women directly indicates positive effect of training.

52

GRAPH NO.-1 REGISTRATION OF PREGNANT WOMEN

Pregnant woman registration is increased by 2042 numbers in comparison with 2009-10 thus shows a significant growth in registration of pregnant women by 57%. Further, there is a significant increase of 14% growth in pregnant women registration from last year performance i.e. 2010-11.Moreover, the performance of ANC registration is also increased due to a new scheme in NRHM Assam known as Mamoni and proper IEC of the scheme through NRHM, Dotma BPHC as stated by Dr. Anil Mahillary , In-Charge, SubDivisional Medical & Health Officer, Dotma CHC. The MAMONI under Assam VikashYojona A scheme under Govt. of Assam implemented to improve early registration and to improve quality ANCs for 3 or more. A booklet MAMONI, a pictorial easily understandable on DOs and DONTs during pregnancy in vernacular is handed over to the PWs on registration (1st ANC) and Rs. 1000.00 is provided in two instalments @ Rs. 500.00 in the 2nd and 3rd ANC for nutritional support during pregnancy. The nutritional

53 scheme under IGMSY has just been launched in 2 districts of the state and not in all the 27 districts. The State will ensure that there is no duplication of the scheme. AkashWankhede and PuspitaDatta 2010 stated in her survey study also emphasise that in Assam, ANC coverage is reasonably good with more than 83 % of women receiving any ANC irrespective of socio-economic background. A distinctive feature is that any ANC increases sharply with education and wealth index. Any ANC is 57.6 % among non-literate as against 100 % among women educated for 10 or more years and 91.6 % among lowest wealth index as against 95.8 % among women in highest wealth index. There is rural-urban gap of 16.4 %age points in availing any ANC, with 89.2 % among urban residents and 72.8 % among rural residents.

EARLY REGISTRATION OF PREGNANT WOMEN:

Early registration of pregnant women means registration of pregnant women within 1sttrimester {within 3(three) month from the date of last menstrual period} after confirmation of pregnancy through urine test. Access to CAC Comprehensive Abortion Care Services by detecting pregnancy through Nichay Kit (GoI) available for ASHA and ANMs and subsequent advice for Safe Abortion Services at Govt. approved centres. Early registration of pregnant women in Assam is very low and thus to increase the registration of pregnant women within 1st trimester is an important objective of NRHM.ANMs appointed under each sub-centres (SC), PHC( Primary Health Centres) and CHC(Community Health Centres) were well trained, oriented and their performance was reviewed by the Block PHC so as to motivate them to increase their home Visit and thereby register all pregnant women as early as possible in Government hospitals for quality ANC service. IndraneeDutta, ShaillyBawari in 2007 clearly stated in her study that the RCH programme has stressed the need for getting atleast three ANC check-up during the entire period of pregnancy and that the first check-up should be in the first trimester. In Assam, about 51 % of the urban women go for more than four ANC check-up while only 16 % of the rural women go for 3 ANC. The majority of the rural women (41 %) do not go for any checkup. The median number of check-up that a rural women gets done is two. Amongst the women who get their ANC check-up done, only 29 % of the rural women and 63 % of the urban women get it done in the

54 first trimester of the pregnancy. Inter-state comparison for the year 1998-99 shows that, only 31 % of the total women of Assam had received three or more ANC check-up and that in the first trimester, which is much below the national average of 44 and 33 % respectively. Also, Assam stands at a much lower position, compared to the larger states of India, with only Bihar, M.P., and Rajasthan and UP lagging behind Assam. The proportion of women who received at least 3 ANC is 45% and 31.1% women had received first ANC in the First Trimester of Pregnancy. (AkashWankhede and PuspitaDatta 2010) GRAPH NO.-2. EARLY REGISTRATION OF PREGNANT WOMEN - A Comparision.

Early registration of pregnant women shows a significant increase in Dotma BPHC in every year. Increasedregistration within 3 month or within 1sttrimester gives a clear picture and result of before and after training. Time to time orientation of ANM, on job training to ANMs on early registration (plate No.-6) and Community/Village Meeting as shown in plate No.- 4 & 5 also contribute in increased number of early registration of pregnant women. Moreover, the above data also indicates awareness of Village women in terms of early registration benefit.Proper training to staff, Inter-personal Communication with pregnant women,Focal Group Discussion with Villagers, Motivating Family members especially mother-in-law and husband by ASHA (Accredit social Health Activist) ,AWW( Anganwadi

55 workers), ANM( Auxiliary Nurse Midwife) ,Doctors and other para medical staff contributing to increase the performance of Early registration. 1047 no.s of pregnant women is increased early registration no.s in comparison with 2009-10. Pregnant women registration is also increased by 652 with last year performance. (Graph No.-2)

COMPLETE ANC
Complete ANC means 3 or more Ante natal check-up of pregnant women. Full ANC comprises of 3+ ANC visits, 2+ TT injections and received 100+ IFA tablets as these are the minimum requirement for a pregnant. The %age of women receiving full ANC is very low with only 16 % while the national average is 20 %. However the DLHS-RCH study of 2002-04 shows that 16 % of women in India and only 10 % in Assam get a full ANC check-up and that Sibsagar has the highest amongst all the districts with 24 %. It suggests that the RCH programme of 1998-99 has not been able to achieve its objective to its full potential and the government must take adequate steps to ensure that the programme is carried out to its entirety. ( Dutta.I, Bawari.s, 2007) IndraneeDutta, ShaillyBawari in their found that the %age of rural women is higher than the national average with 41 % not receiving any ANC check-up.Further, their finding also reflects a positive relationship exists between women seeking/not seeking ANC check-up and mothers level of education. Ninety % of the women who had completed their high school and above had received an ANC check-up from a doctor in the year 1998- 99, though it has decreased by eight % since 1992-93, and about four % did not receive any ANC check-up.Moreover,it was also mentioned that religion does play an important role in women receiving antenatal care, as about 50 % of the Muslim women in the year 1998-99 did not receive any antenatal check-up as against 32 % of the Hindu women,while only 37 % of the Muslim women received ANC check-up from a doctor as against 61 % of the Hindu women. AkashWankhede and PuspitaDatta (2010) in her study stated that 68% of women had received at least one TT injection whereas 85% of women received full ANC in Assam.

GRAPH NO- 3. PERFORMANCE OF COMPLETE ANC- A year wise study.

56

Performance of Complete ANC is increased by 652 numbers as reflected in Graph No:- 3 and thus it not only indicates the effect of qualitative training but also clearly indicates well motivation and urge of pregnant women to have complete and qualitative ANC in Government Hospitals. Quality ANC training of ANM directly relates with gradual increase in complete ANC.

TT VACCINATIONS AND IFA TABLETS TT VACCINATIONS

Tetanus toxoid (TT) injections are given to pregnant women to immunise the mother and the child from the risk of sometimes getting infected by the use of unsterilized instruments or unhygienic environment during delivery. If a mother has not been immunised earlier, two doses of adsorbed TT should be given- the first dose at 16-20 weeks and the 2nd dose at 20-24 weeks of pregnancy, with a minimum interval of one month between the 2 doses. For a woman who has been immunised three years earlier, one booster dose is sufficient as it provides necessary cover for subsequent pregnancies, during the next five years.

57 The TT immunisation programme, a part of the Universal Immunisation Programme (UIP) of 1985-86, has been incorporated in the RCH programme. Thus, the RCH programme recommends two doses of TT vaccine to a pregnant woman with the 1stdose at 16 weeks and the 2nd at 20 weeks (CBHI, 1991). IFA TABLETS

Anaemia, a result of the adverse effects ofiron deficiency, is one of the main causes of maternal deaths in developing countries(WHO, 1989, and Mathai, 1987). Iron deficiency may be due to inadequate diet or poor absorption of iron due to morbidity. While prevalence rates in developed countries for iron deficiency anaemia range from 10 to 20 % (Scrimshaw,1984), two-thirds of women in developingcountries are estimated to be anaemic(WHO, 1989). In rural India, prevalence of anaemia among women of ages between 15- 44 ranges in between 34 % to 99 % according to a study conducted in Hyderabad, Calcutta, and New Delhi (GOI, 1981). The majority of women in India suffer fromiron and folic acid deficiency. The prevalence rates of anaemia are even higher among pregnant women. At the onset of pregnancy, about 20 %s of women are anaemic and it increases to over 60 % by the last trimester. At the same time, up to 20 % of pregnant women are deficient in folic acid too. It poses a major threat to the mother and to the infant because anaemia per se is associated with high incidence of premature births, postpartum haemorrhage, and low birth weight, lowered resistance to infection, impaired cognitive development and decreased work capacity. To prevent the mother and the child from developing complications and impairment, the RCH programme provides and recommends the consumption of 100 IFA tablets during pregnancy. IFA tablet contains 60 mg of elemental iron and 0.5 mg of acid. While pregnant women are having three antenatal check-ups, health workers distribute IFA tablets to all pregnant women (1 tablet a day for 100 days and to those clinical anaemia two tablets a day for 100 days). The paleness seen in the nails, tongue, inside of lower eyelids and complaints of weakness or dizziness are visible signs of anaemia. Anaemia can also be confirmed by checking haemoglobin level. Those found having below 11 grams are considered clinical anaemic and are recommended to take two tablets daily for at least three months and continued till delivery (GOI, 1994). When the haemoglobin level is below seven grams or less, the woman is considered to be suffering from severe anaemia.

58

GRAPH NO.-4 PERFORMANCE OF ANC-

Tetanus Toxoid Commonly known as TT vaccine is given to pregnant women to get rid her from unhygienic / infection danger during deliveries. The performance of TT1 and TT2 or Booster Dose gives a clear picture of increased number of Vaccinated women. The graph No:-4not only reflect a clear picture of awareness among women but also reflect work efficiency of skilled staff of the health block.In case of TT1 vaccine 3486 number of pregnant women were vaccinated during 2010-11 but in 2011-12 it increase to 3834 numbers.Further, if we see TT2 or TT Booster Dose there is an increased performance from 2010-11 to 2011-12 as 3353 and 3437 respectively. IFA tablet consumption is also increased from 4081 to 4733 and thus a good sign to fight with Anaemia and indirectly give a clear picture of Qualitative Training and Training Implementation up to Field Level or grass root Level. The percentage of anaemic women in Assam is considerably higher (70 %) than the all India average of 52 % and is highest amongst all the major states indicating that women in Assam, across all age group are anaemic and require enough supplements or iron rich food and that their dietary pattern needs to be checked. (Dutta.Iand Bawari.S may 2007).

59 As per NFHS-3reports of 2006-06, 72% women were reported to be anaemic in the age group 15-49 years. The analysis of 173 maternal deaths has revealed that 39.3% are associated with anaemia. A study has been undertaken on a pilot in a Block PHC (Mukalmua, Nalbari- a High Focus Dist). ASHA have been involved for direct supervision of IFA tablets consumption by PW from 2nd trimester for 100 tablets and base line Hb estimation by using Hbcolor scale every month for a period of 3 months. Dutta.Iand Bawari.S in2007 in her study has also stated that the % of women taking two or more TT injections has increased significantly from 35 % in 1992-93 to 52 % in 1998-99. Further, it was also said that during the year 2003-04, the government of Assam as part of its UIP had been able to achieve around 40-50% of the target set and in the subsequent year 2004-05 it achieved almost 70-80 % of its target. Moreover, Inadequate health centres, shortage of supply of vaccines/tablets in Sub-Centres, PHCs and CHCs, lack of trained health workers to motivate and inform the rural women about its benefits are the other potent factors contributing to the availability of IFA tablets and vaccines to the rural women of Assam. The proportion of women who consumed 100 IFA tablet/ Syrup and received at least one TT injection are 38.5% and 68.3% respectively (AkashWankhede and PuspitaDatta in 2010). Evidence based studies have proved that parenteral iron with iron sucrose has advantage over IFA tablet in moderate anaemic PW. Routine Hb (Haemoglobin) estimation by using Hbcolor scale at sub-centre by ANMs has been in use in Dibrugarh District in 6 BPHCs for 1- year for management of anaemia during pregnancy. The analysis of first 6 months data reveals that the prevalence rate of anaemia of pregnant women is 67% out of which moderate anaemia is 24.9% & severe anaemia is 7.24%. It is expected to raise the percentage of Hb by 4g/dl over a span of 2 weeks. A pilot project on iron sucrose injection 100 mg per 5ml, 2 ampoules for each beneficiary has been worked out to be implemented in 2 districts Kamrup and Dibrugarh. The Faculties of the O&G department of the 2 Medical Colleges of Guwahti and Dibrugarh will be a part of the project. Kamrup district have been selected as the population is more and wide spread over char areas, Dibrugarh district has been selected because of the tea garden population where the anaemia is more. Case selection criteria: Moderate and severe anaemia with Hb<9gm/dl detected in 2nd trimester and early 3rd trimester, not responding to IFA oral tablet. This group of women will be selected for

60 parenteral iron sucrose injection as per fixed protocol. Expected pregnant women with moderate to severe anaemia in the state are expected to be 6943. One day orientation on use of parenteral iron sucrose injection at Guwahati with the resource person from Medical College where at least 1 Gynaecologist from all the 11 selected Hospitals and 2 Medical Colleges will participate from each institute to develop Guideline, protocol and reporting formats for implementation of the program. INSTITUTIONAL DELIVERIES The place of delivery and the assistance received during delivery are important factors in ensuring safe childbirth. The need for effective intra-natal care is therefore, indispensable as it helps to maintain hygienic environment and tackle complicated cases. One of the important objectives of the NRHM programme is to encourage deliveries under proper hygienic condition under the supervision of trained health personnel. Assam is one of the 18 states of the country where the National Rural Health Mission (NRHM) was launched on April 12, 2005, to provide effective healthcare to rural population. With the objective of reduction of Infant and Maternal Mortality rates, the Mission intends to create a health care system which is holistic in nature including promotion of healthy lifestyle. In order to promote safe delivery the JananiSurakshaYojana (JSY), has been launched under the broad NRHM umbrella. This scheme replaces the National Maternity Benefit Scheme. While NMBS is linked toprovision of better diet for pregnant womenfrom BPL families, JSY integrates the cashassistance with antenatal care during thepregnancy period, institutional careduring delivery and immediate postpartumperiod in a Health Centre byestablishing a system of coordinated careby field level health worker. However,concerns about deprivation of women wereexpressed by different quarters in view ofthe inadequacy of existing healthinfrastructure and preference of women fordelivery at home. As such parameters of thescheme were modified and the followingscheme is in operative at present.

TABLE NO.-11 EXPECTED INSTITUTIONAL DELIVERIES PER MONTH UNDER THE DOTMA B.P.H.C.

61 Sl. No Name of Health institutions Expected Institutional delivery Per Month CHC/ BPHC SD/SHC/MPHC SCs 75 100 12 187 Annual Total 900 1200 141 2241

1 2 3 Total

GRAPH NO.-5 PERCENTAGE OF INSTITUTIONAL DELIVERY AND HOME DELIVERY

From the above graph No.-5 reflect decreasing trend of Institutional deliveries by 1% and increasing trend of Home deliveries by 1%.Total functional delivery point under the health block is shown in Table no.- .Further, Table no.- shows institution wise performance

62 of institutional deliveryand thus indicates the institution where staff are to be re-oriented. Moreover, as hospitals have to work 24 hours and hence known as 24 X 7 with limited staff ( Table No.) to conduct delivery and are contributory in decreasing delivery. Therefore,it clearly depict negative or no impact of training to institutional staff as the performance is decreased or almost stagnant. It simply indicates that a reorientation of hospital staff on quality service before and after institutional delivery is needed. In the same context, it can also be stated that increase in performance of home delivery though by only 1% gives positive effect of training as only 9 number of ANM were undergone 21 days SBA training out of 78 total numbers of ANM. When we compare the performance of SBA and Non-SBA delivery as shown in Graph No.- 6 it reveals increase number of SBA delivery of 42 number with last year performance In Assam, according to NFHS-II, only 18 % of institutional delivery- either public or private takes place, lagging behind the allIndia average of 34 % and is at the lowest rung of the ladder amongst all the major states of India. Kerala is at the top with 93 % of institutional delivery.
TABLE NO.:- 12TOTALFUNCTIONALDELIVERYPOINTS INPUBLIC HEALTHFACILITIES OF THE BLOCK. S.NoIndicator 1 a 2 a 3 a 4 a 5 a TotalNo. ofSCs No. of SCsconducting>3 deliveries/month TotalNo. of 24X7PHCs No. of 24X7 PHCsconducting> 10 deliveries/month TotalNo. of any otherPHCs No. of anyotherPHCsconducting> 10 deliveries/month TotalNo. of CHCs (Non-FRU) No. of CHCs ( Non-FRU)conducting> 10 deliveries /month TotalNo. of CHCs (FRU) No. of CHCs (FRU)conducting> 20 deliveries/month Numb er 30 2 10 06 0 0 0 0 01 01

63
b 6 a No. of CHCs (FRU)conductingC-sections TotalNo. of any otherFRUs (excluding CHC-FRUs) No. of anyotherFRUs(excludingCHC-FRUs)conducting> 20 deliveries /month b No. of anyotherFRUs(excludingCHC-FRUs)conductingCsections (Courtesy-Dotma BPHC, Kokrajhar,Date -4th Jan 2012) Around 78 % of the women get unskilled delivery done i.e. from a TBA or dais, which are not trained proficiently in the skills to manage normal deliveries or diagnose complications, posing a great threat to the mother and the child. 00 00 00 00

In Assam, the institutional delivery improved progressively from 23.8 % in DLHS-1 and 26.8 % in DLHS-2 to 35.1 % in DLHS-3 (200708).Further, 40 % of deliveries, either institutional or home deliveries were safe delivery, assisted by skilled person in Assam. At present in the State 63.6% is the home delivery and 40.2% is safe delivery as per DLHS-3 (2007-08). Hence it shows even after implementation of JSY there are pregnant women who cannot reach health facilities for institutional delivery; these are the women from far flung area such as Char / Riverine Island with bad connectivity with the mainland. Even after awareness through ASHA & various IEC activities the State is unable to bring these women especially from char area where a SC cannot be constructed nor transports could be made available. Hence, it is proposed that in these difficult areas women such as Dai who anyhow is conducting delivery will be trained and provided with Disposable Delivery Kit. So, that at least clean delivery practices could be ensured in these areas. There are 2251 villages in these char areas and estimated pregnant women is 67,576.The state in the year 2010-11, proposes to train at least 1 TBA in these char villages so that they conduct clean delivery and also they will be provided DDK. The training will be conducted in phases where in first phase a total of 1000 TBA will be trained as mentioned in State Programme Implementation Plan 2010-11 ,National Rural Health Mission, Assam 66

64

TABLE NO.: 13 - PERFORMANCE OF INSTITUTIONAL DELIVERIES INSTITUTE WISE AND YEAR WISE.

GRAPH NO:-6 PERFORMANCE OF SBA & NON SBA DELIVERIES

65

TABLE NO.:- 14KEYPERFORMANCE INDICATORS(KPI) OF DELIVERY POINT UNDER DOTMA BPHC.

Sl.No (Deliv er yPoint )

Name andType ofthe Facility (MC,DH, DWH, SDH, CHC- FRU, CHCNon-FRU, 24x7 PHC, Other PHC, SC, Any other. Type ofFacility

Total deliveries inthe reporting monthin the facility

Tot al No. of PW det ect edw ith Hb leve l7 gma nd belo w

MOs Avail abilit y of Esse n. Drug s (Y/N) &Speciali st(Mentio nNo of esth. OBG, Pedia. LSAS/ EmO C Train edMO and other MO

Bio Medical Waste (Y/N)

NO.of SNs/ ANMs posted atthe facility

96

yes

Dotma CHC 2 Fakiragram SHC 25 1 yes

Yes, But not Not as per norms, available Required Sharp pit and Deep burial -do-

SN=7, ANM=5

SN= 4 ANM=3

66
3 4 5 6 7 8 9 10 11 12 13 14 Sakti Ashram SD Bonorgoan SD Pertapkata SD Chithila SD Lakhnabari MPHC Jharbari SD Serfanguri SD Dumariguri SD Dauliguri MPHC Angthihara SD Gossainchina SD Bhalukmari MPHC 15 16 03 20 12 0 26 0 06 00 00 00 1 yes yes yes yes yes yes yes yes yes yes Yes yes -do-do-do-do-do-do-do-do-do-do-do-do-

SN=0 ANM=1 SN=2 ANM=3 SN=0 ANM=1 SN= 0 ANM=1 SN= 1 ANM=1 SN=0 ANM=1 SN=2 ANM=1 SN=0 ANM=1 SN= 1 ANM=2 SN=0 ANM=1 SN=0 ANM=1 SN= 0 ANM=1 SN=17, ANM=22

Total

219

14

The SBA training load of the State is very high and more than 10,000 ANM will take couple of years to complete the training. Moreover during the last 4 years around 800 (8%) ANMs could be trained. The indicators for maternal & child health components are far from satisfactory. A study was conducted by RRC-NE for skill assessment of ANM/GNM/LHV of Assam during 2009-10 and recommended for training need. Some of the skills like MCH care, plotting of partograph, biomedical waste management, record keeping & reporting need strengthening through training. (RCH) AkashWankhede and PuspitaDatta stated that 63.8 % of women who had home deliveries, the main reasons cited for not delivering their child in a health facility were not necessary (35.0 %), no time to go to health facility (29.2 %), and cost too much (18.0 %) There are 78 numbers of ANMs and 17 GNM in Dotma BPHC. Out of which only 9 ANM and 8 GNM were SBA trained till 2012-13 as shown in Table No.- 15 .Target to be trained in future are shown in Table no.-16

67 As per MDR review of 173 maternal deaths of the state, revealed that anaemia is associated with 39% of maternal deaths and hypertensive disorders with 23% of maternal death. The use of Tab. Misoprostol and Inj. Magnesium Sulphate will be expedited through 4 day orientation training. TABLE No.- 15 TRAINING STATUS OF STAFF NURSE & ANM IN NSSK AND SBA. Health Institute
Dotma CHC Serfanguri SD Fakiragram SHC Lakhnabari MPHC

TRAINING SN
3 2 3 1

NSSK ANM
0 0 1 0

Others

SN
4 0 4 0

SBA ANM
5 1 3 0

Others

TABLE NO.:-16 TRAINING STATUS AND TARGET UNDER THE DOTMA BPHC.
Achievementin IMNCI ChildHealth Training20112012 F-IMNCI NSSK Total Num b er of ASH A sinthe Block Prop Achi Prop Ach osed eve d Number of Districts covered AWW ASHA osed iev ed Pro pos ed Ach iev ed Achieve d ASHA Modu le6 &7 ASHA Modu le6 &7 ASHA Modu l e6 & ASHA Modu l e6 & 7

Round Round 7 One Two

Round Round Three Three

330

330

330

330

68
ANM MPW(M) LHV

78

Supervisor (M) 11 SN 30 MO 1 Others 42 Total 41 119 330 330 330 30 30 11 11

COMPLICATIONS DURING DELIVERY PERIOD:

PREGNANCY,

DELIVERY

AND

POST-

Women who either did not receive ANC or have received an incomplete course of ANC are exposed to the risk of maternal death. In Assam, as much as 60.2 % of women who had still/live births in the three years preceding the survey had some complications during pregnancy. About two-third of the women (67.8 %) in Assam had faced at least one delivery complication. The main cause of delivery complications experienced by women who had still or live births in the three year period preceding the survey are obstructed labour (55.8), premature labour (54.9 %), prolonged labour (28.9 %) and excessive bleeding (15.6 %). Reporting of delivery complication is slightly higher among the women who live in rural areas (67.9 %) as compared to their urban counterparts (66.4 %) Moreover; Two-fifth of women (42.8) in Assam had post-delivery complications. The major types of post-delivery complication are lower abdominal pain (60.6 %), high fever (44.9 %) and excessive bleeding (23.5 %). Among women who had post -delivery complications, near half of them (46.3 %) had sought treatment. (AkashWankhede and PuspitaDatta). Graph no.-2 & 3 shows that still the Early registration, Complete ANC Performance is not 100% which means certain number of pregnant women have incomplete course of ANC, and some were drop-out or left out and the untraced pregnant women are in risk to maternal complication and are contributory to maternal and infant mortality.

POST NATAL CARE

69
The care of the mother and the newborn after delivery is known as postnatal care and is important for the mother to prevent complications that may develop after delivery and to provide care for the rapid restoration of the mother to optimum health. Postpartum check-up within two months after delivery is particularly important for births that take place in noninstitutional settings. The NRHM programme recommends three postpartum visits for the mother.

In the year 1999, outof the 82 % of non-institutionaldeliveries, 26 % of the births were followed by a postpartum check-up withintwo months of birth and that it is muchhigher than the national average of 17%. Interstate comparison by NFHS-IIreveals that Assam is in a better position compared to other major states.The DLHS-RCH study of 2002-04 indicates that 32 % ofthe women in Assam had postdelivery complications. The state in the year 2009-10, have stressed upon hospital stay after delivery to reduce mortality and morbidity and is providing baby kit (having blanket, clothes, mosquito net and toiletries for baby) under Mamta scheme to mothers staying for 48 hrs. The cost of the kit with commodities is Rs.300/-. This will be continued in 2011- 12 and in process in 2012-13. HMIS (Health institute monthly information system), MCH (Mother and child health Register, UIP (Universal Immunization Programme) andMCTS (Mother and child tracking system) of Dotma BPHC reveals that PNC performance after delivery that is within 48 hours (PNC 1st visit) is upto the expected level but follow up of PNC needs to be improved as the performance is very low. Training or reorienting staff on importance of PNC may increase the performance up to the expected level.

CHILD HEALTH CARE AND IMMUNIZATION:

To promote child survival and prevent infant mortality, NRHM envisages new born care, breastfeeding and food supplementation at the right time and a complete package of immunization for children. Child health care comes under the purviewof the Reproductive and Child Health (RCH) Programme that incorporates thecomponent of Child Survival and SafeMotherhood Programme. The Integrated Child Development Services Scheme of1975 had the following interventions withrespect to childcare: a) Supplementary Nutrition b) Immunisation c) Health check-ups d) Treatment of common diseases likediarrhoea, dysentery, respiratoryinfection, skin and eye diseases.

70 e) Deworming f) Referral services g) Nutrition and health education h) Growth monitoring and promotion i) Vitamin A and IFA supplementation j) Pre-school non-formal education. Most of these services pertain to health and nutrition and the target populationconsists of children less than six years,adolescent girls of 11-15 years in selectareas and women in the age group of 1545 years.

BREAST FEEDING

Postnatal care offers an excellent opportunity to find out how the mother is getting along with her baby. For many children breast milk provides the main source of nourishment in the first year of life. A great asset in India is that an average mother, although poor in nutritional status, has a remarkable ability to breast feed her baby for prolonged periods, sometimes nearly extending to two years. Longitudinal and cross-sectional studies indicate that poor Indian women secrete as much as 400 to 600 ml of milk per dayduring the first year. No other food is required to be given until four to five months after birth. At this age of 4 to 5 months, breast milk should be supplemented by additional foods rich in protein and other nutrients, called supplementary food, which should be introduced very gradually in small amounts. Breast-feeding should be initiated within an hour of birth instead of waiting several hours.The first milk, called colostrum, is the most suitable food for the baby during this early period because it contains a high concentration of protein and other nutrient the body needs; it is also rich in anti-infective factors, which protect the baby against respiratory infections and diarrhoeal diseases. The percentage of mothers breast-feeding within one hour of birth in Assam has increased substantially from 20 % in 1992-93 to 45 % in 1998-99. It is extremely high as compared to the national average and is also the highest amongst all the bigger states of India, indicating that the women in Assam are aware of the benefits of this. However, it is interesting to note that a high proportion of women in the rural areas and illiterate women breast-feed within one hour. During the year 1992-93, the urban rural gap was wide being 14 and 21 %respectively, though in the year 1998-99 it became negligible. Mothers educational status has found a negative relationship with 38 % of the educated women giving their first milk

71 while 48 % of the illiterate women breastfeeding within one hour of birth. The place of delivery and the religion also has a significant impact with mothers who have home delivery and Hindu women being more likely to start breast-feeding within one hour of birth. Although the women in Assam initiate breast-feeding within one hour of birth, they are not aware of the benefits of the first milk as 64 % of the women squeeze their first milk from breast as against 63 % at allIndia level. Contrary to the belief, urban and educated women are more likely to squeeze out than rural and illiterate women. (Dutta.Iand
Bawari.S, 2007)

The WHO recommends that the child should be exclusively breast-fed for six months and then it should be supplemented with other supplementary food, while the RCH programme by the Government of India, recommends exclusive breast-feeding for four months. In the year 1998-99 only 16 % of the childrenwere exclusively breast fed for four to six months as against the national average of 27 % while 34 % of the children who were less than four months were given supplementary food.

IMMUNISATION
The Universal Immunisation Programme(UIP) started in India in 1985 and immunisation of children is one of the two vital components. It seeks to immunise children in their first year of life against the six targeted diseases with three doses each of DPT, OPV, one dose of BCG and one dose of Measles vaccine. Universal immunisation implies the ideal that no child should be denied immunisation againstTuberculosis, Diphtheria, Whooping cough, tetanus, polio, and measles. A recent survey conducted by OKDISCD, sponsored by UNICEF (2006) on immunization status of children in Assam, found that the prime factors responsible for poor coverage of the immunization programme were unawareness of family members on the need for immunizations, wrong ideas and fear of side effects, and non-availability of time to get their child immunized. The %age of children who do not receive any vaccination at all is still higher than the national average, though the national survey data shows a declining trend since the year 1992-93. The percentage of children receiving immunisation for all the diseases i.e. full immunisation has been fluctuating from 19.4 in 1992-93 to 17.0 in 1998-99 and then shooting to 32 % in 05-06.But still it is at a quite lower position as compared to the all India

72 average. The DLHS-RHS survey on 11 districts out of 23 found that only 19 % of the children are immunised while the all India average was 48 %. Since full vaccination includes all the three of DPT and Polio and one dose of BCG and Measles each.

GRAPH NO.-7 DOTMA BPHC.

ROUTINE

IMMUNIZATION

PERFORMANCE

Graph No.-7 states that from BCG To measles dropout is 5.48% and is acceptable as supply of BCG Vaccine in Kokrajhar District was not available for last 9 month. DPT 1 to DPT3 drop-out is low that is 2.84% and DPT1 to measles drop-out is high as 9.24% and thus need to be tackle through motivating and re-orienting ASHA, ASHA Facilitator, AWW, ANM in Routine Immunization programme. DIARRHOEA AND ACUTE RESPIRATORY INFECTION (ARI) MANAGEMENT: According to UNICEF, diarrhoea can be managed at home by providing children with an increased amount of fluid or ORT, and a combination of usual feeding.

73 Training was already provided to all ASHA, ASHA Facilitator, AWW, ANM under Dotma BPHC and are worked up to the expected level in treating Diarrhoea and ARI Management.

FAMILY PLANNING AND CONTRACEPTIVE USE:

To achieve population stabilization and promote healthy married life, NRHM promotes contraceptive use on voluntary basis through a comprehensive package of improved accessibility and incentive programme. The knowledge of any modern contraceptive method among currently married women is universal in Assam. There is near universal awareness of Female sterilization for limiting and it is the most widely known contraceptive method in Assam. Pill is widely known contraceptive method for spacing, with 92 per cent of women knowing about it. Other popular modern contraceptive methods for spacing are Condom and IUD. Female condom is least known contraceptive method among women (11.1 per cent). Similar pattern of knowledge and awareness of different contraceptives are also found in all the districts of Assam.

An expert committee (1971) of the WHOdefined family planning as a way of thinking and living that is adoptedvoluntarily, upon the basis of knowledge,attitudes and responsible decisions by individuals and couples, in order topromote the health and welfare of the familygroup and thus contribute effectively to thesocial development of the country. Familyplanning helps individuals or couples to avoid unwanted births, to determine thenumber of children in the family, toregulate the intervals between pregnancies and to control the time atwhich births occur in relation to the agesof the parent. The National Population Policy of 2000reaffirms the commitment of thegovernment towards target free approachin administering family planning services.In Assam, the prevalence of knowledgeabout family planning is quite low ascompared to other states. With around 24% of girls getting married below the legal age of 18 years and 41 % of themhaving more than three children, Assamcalls for an urgent need of educating thePopulation about family planning.

Family Planning
NFHS-II survey carried out in Assam in1999, found that 98 % of the total female population, had knowledge aboutany method of contraceptives. Among themodern method, knowledge about femalesterilisation was more prevalent (96.3%)followed by about the pill (87.3) and then male sterilisation (85%). Knowledge aboutthe

74 modern methods of contraceptives wasthe same across the urbanrural areas, withknowledge about IUD and condom beingmore prevalent in urban than in rural areas. Traditional methods such aswithdrawal and safe period are less knownin rural areas compared to the urban areas. The DLHS (2002-04) survey also found that95 % of women in Assam have knowledge about any modern methodwhile only 24 % of them knowingabout all the methods.Analysing by the backgroundcharacteristics, both modern andtraditional methods are more used in urban areas than in the rural areas, though theurban areas have shown a decline by three% in the use of modern methods in 1998-99 since the year 1992-93. Low levelof literacy rate among the women of Assam i.e. fifty-five % has a major influenceon the use of contraceptives. IndraneeDutta, ShaillyBawari mentioned in her 61 % of illiterate women didnot use any method. Religion has also beenfound to have a considerable impact on the use of contraceptives with 94 % ofwomen having no children not using anymethod. As the number of children increases, use of contraceptive methodsincreases. Family planning and contraceptive use relates with use of Family planning method which are mainly categorised as follows: Permanent Method. Temporary Method Permanent method includes Tubactomy (Female sterilization) and vasectomy (Male sterilization). Temporary method includes IUCD insertion that is insertion of Copper-T (365), use of OCP (Oral contraceptive pills),CC ( Condoms), i-pill ( Emergency Contraceptive pills) etc. There is a significant increase in Copper-T insertion and is due to IUCD trained ANM ( Graph No.- 8). Training, re-orientation , Camp approach and performance review of all IUCD trained staff in terms of IUCD insertion are contributory to increased performance. GRAPH NO.- 8. PERFORMANCE OF IUCD A YEAR WISE COMPARISION

75

Contraceptive use
Total numbers of reported CC user in Dotma BPHC is 64323 and OCP user in 2011-12 is 13884
FEMALE STERILIZATION Female sterilization, regardless of family size, is more among currently married women who have one or more living sons compared to those with no living son.

4.3 Mapping training need of human resource so as to improve the performance at different level.
The training needs of employee under NRHM can easily be assessed from their activities performed in last year 2011-12. Performance in terms of maternal health includes registration of pregnant women, Early Registration of pregnant women; Complete ANC, TT Vaccination and IFA consumption are all in increasing trends of achievement and thus seek reorientation of all program and performance review of staff every month. Institutional deliveries though in decreasing trends also have a positive impact on SBA trained staff in terms of Delivery. Health institution where there is decreasing trends in institutional deliveries needs to be trained again to develop self-confidence of hospital staff and at the same time their skill and knowledge will

76 also be increased. Moreover, Non-SBA trained staff is more than trained staff and thus needs to train all ANM as soon as possible to reduce MMR and IMR. Progress in terms of Child health reveals that breast feeding within 1 hour, exclusive breast feeding up to 6 month, diarrhea and ARI management are up to the expected level but Immunization needs to be view again to have an expected level of achievement. Hence, re-orientation of staff on Routine immunization may help to decrease the DPT1 to Measles Drop-out % up to expected level. Family planning performances are also in satisfactory trends. IUCD insertion is increased with encouraging trends and hence monthly review of performance of IUCD trained ANM will be adequate.

RECOMMENDATIONS
1. The selection test should include business games stress interviews also. 2. Organization should conduct meetings with the consultants, which will help both consultant agencies on recruitment and the organization to understand each other better. 3. The three rounds of interview, which is standard for all the jobs, are appropriate but time, which is taken, is lengthy. So officers concerned should make themselves free on the day of interview to take the final interview so that the candidate doesnt wait for long.

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SUMMARY & CONCLUSION

Since the inception of NRHMpeople of Dotma block were found more conscious about their health and seeks to avail quality health services where the services provided from the overall staff under health institutions is or will rewarding in future. Different training programmes were conducted as and when required to different designated staff so as achieve the long term goal of NHRM .Training provided under NRHM gives substantial better health service and which obviously seen in all hospitals by judging increase in numbers ANC, increase of patient both in the indoor and outdoor, increase of family planning service, increase in performance of health & nutrition day, increase in utilization of fund which cant be reflected unless and until the IEC or other activities were performed. Training need of employee were also mapped through evaluation of data and by surveyed population and thus advice to Dotma BPHC to conduct and reorient staff on different programme under the health block to provide more accessible, affordable, and quality health

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service to the rural, poor and needy tribal population of the Block.

Limitations:
v In view of the limited time available for the study, only the Training and training need of employee under NRHM could be studied. v The sample size is too small to reflect the opinion of the whole organization. v The answers given by the respondents have to be believed and have to be taken for granted as truly reflecting their perception.

SCOPE OF FUTURE RESEARCH

1) Most of the qualification of employees in DOTMA BLOCK PRIMARY HEALTH CENTRE (BPHC) Control Society is Technical Education in the field of Medicine and others are social science.

79 2) Majority of rounds of interview conducting in selecting employees is 3 rounds 3) Majority of employees felt that recruitment is done on regular basis. 4) Most of the employees viewed that recruitment is done on external sources. 5) Majority of the employees strongly disagree that they have any freedom to do what is right to the society. 6) Most of the employees are willing to refer their friends to join in their organization. 7) Most of the employees felt that organization is adopting job description in selecting a candidate. 8) Most of the respondents felt that it is necessary for the company to conduct various test in selecting a candidate. 9) Most of the respondents felt that there should be closed ended questions in selection test. 10) HR Department, i.e. Establishment Branch should be more involved in welfare activities of its employees.

BIBLIOGRAPHY
WEBSITES:

http://india.gov.in/in/citizen/health/health.php?id=56 Source: National Portal Content Management Team, Reviewed on 10-022011 India.gov.in/citizen/health/health.php?id=48(NRHM)
http://india.gov.in/citizen/health/health.php?id=61 Source:- National Portal Content Management Team, Reviewed on 10-02-2011 http://cs de.washington.edu/-Securron/files/regerds/May26/Cassels. %20Health%20 Section%20Reform.pdf. http://www.healthsystems2020.org/files/571-file-01-chapter-1.pdf

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http://www.businessdictionary.com/defination/training.html http://nhsrcindia.org/pdf-files/reasources-thematic/health-sectoroverview/NHSRC-contributi www.cdc.gov/niosh/docr/99-142/ A Model for Research on Training Effectiveness www.biomedcentral.com/147/-2458/9/469 BMC Public Health/Full text/Effectiveness of a training programme www.nrhmassam.in/state-pip/c4-rch pip-2011-12.pdf Reproductive child health www.rrcnes.gov.in/pdf-ppt-ZIP/SPIP-assam-10-11-chapter-6-part-awww.rchiips.org/pdf/rch3/report/As.pdf A Assam m www.esocialsciences.org/Download/repec Download/repecDownload.aspx?frame=Do HEALTH AND HEALTHCARE IN ASSAM

REFERENCES
1) Alayaran- The raising sun, News letter of NRHM, District Health Society, Kokrajhar (2011-12 issue) 2) Alayaran- The raising sun, News letter of NRHM, District Health Society, Kokrajhar Vol.-3, No.-III, December,2009 3) Anup Sharma (2006) Health care in a Torniquet, Times Of India, March 31, 2006 4) Centre for Monitoring Indian Economy (CMIE) (2006). Public Finance- November 2006. Economic Intelligence Service, Mumbai 5) Centre for Monitoring Indian Economy (CMIE) (2001). Public Finance- March 2001. Economic Intelligence Service, Mumbai 6) Central Bureau of Health Intelligence (CBHI) (2006). Health information of India 2005. Directorate General of Health Services, Government of India, New Delhi

81 7) Census Of India (1991). Assam state District Profile 1991. Registrar General and Census Commissioner, India 8) International Institute for Population Sciences (2006). District Level Household and Facility Survey (2002-04), Reproductive and Child Health- Assam, Round 2. RCH- II 9) ELECTRICITE DE FRANCE, Quality of Training Programmes (1995). 10) Gangolli L.V, Ravi D, and Abhay S. (2005) Review of Health care in India. Centre for Enquiry into Health and Allied Themes (CEHAT) 11) INSTITUTE OF NUCLEAR POWER OPERATIONS, Principles of Training System Development Manual, ACAD 85-006 (1993). 12) International Institute for Population Sciences (IIPS) and ORC Macro (2000). National family Health Survey (NFHS-II), 19981999. India. Mumbai:IIPS 13) International Institute for Population Sciences (IIPS) and ORC Macro (2002). National family Health Survey (NFHS-II),India, 1998-1999:Assam. Mumbai:IIPS 14) International Institute for Population Sciences (IIPS) (1995). National Family Health Survey (MCH and Family Planning), India 1992-93. Bombay : IIPS 15) Indian Pediatrics(2002). Deaths in Assam during Vitamin A pulse Distribution: The needle of suspicion is on the new measuring cup 39:114-115 16) Ministry of Health and Family Welfare (MoHFW) (1997). Reproductive and Child Health Programme: Schemes for Implementation. New Delhi: Department of Family Welfare, MoHFW 17) NRHM Newsletter : Vol.4 No.4 Oct.- Feb. 2009 18) NRHM Newsletter : Vol.3 No.3 Sept-Oct 2007 19) Omeo Kumar Das Institute of Social Change and Development (OKDISCD) (2006), Coverage evaluation survey for Immunisation status of Children in Assam.Sponsored by UNICEF 20) Population Research Centre, Gauhati University, Guwahati (PRC, Guwahati) and International Institute for Population Sciences (IIPS) (1995). National Family Health Survey (MCH and Family Planning), Assam 1992-93. Bombay : PRC, Guwahati and IIPS 21) P. Jyothi, P., Venkatesh, D.N., Human Resource Management 22) Research Methodology Methods and Techniques: Kothari C. R.: Willey Easter: New Delhi. 23) Training &Development : A Better way: Robert Hayden: Volume 52.

82 24) NRHM Newsletter : Vol.4 No.4 Oct.- Feb. 2009

APPENDIX

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APPENDIX-I Questionnaire.
PART-I PROFILE OF EMPLOYEE.
What is your Full name? What is your designation? Your year of service in Health? Have you ever attended any training in health? ( Please Tick)
a) Yes b) No

PART-II TRAINING DETAILS

Undergone Quality ANC training? a) Yes b) No

Are you satisfied with quality ANC training? a) Yes b) No

If yes, have your knowledge and skill is improved after training? a) Yes b) No

The training programme of Quality ANC has enriched your knowledge / skill in particular field which training was imparted. a) Yes b) No

Are training programmes boost up your confidence level? a) Yes b) No

6. Undergone IUCD training?.

a) Yes

b) No

If yes, how many cases have been inserted with IUCD after training? 0 1-5 5-10 10-15 15-20 21-25 25-50 above 50

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The training programme of IUCD has enriched your knowledge / skill in particular field which training was imparted. a) Yes b) No

If no, are you interested to have IUCD Training? a) Yes b) No

Other Family planning training is imparted? a) NSV b) Laparoscopic sterilization for female ( Tubectomy)

The way of delivery of Trainer is satisfactory.

a)

Yes

b) No

Your superior provides you adequate feedback on the progress made due to training taken.

a)

Yes

b) No

Are the training programmes providing training as per need.

a)

Yes

b) No

The schedule of training programmes hurdles your regular work.

a)

Yes

b) No

Dotma BPHC is providing training as per need.

a)

Yes

b) No

Do you think the training and development programmes motivate you and help to increase your performance? a) Yes b) No

Which type of delivery did you conduct? a) Institiutional b) Home

If Home then, a) SBA b) Non-SBA

Do you satisfy with Health training and development programmme? a) Yes b) No

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Do you think that you need to another training? a) Yes b) No

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