Introduction
Methods
Study design and study area
Indicator | Srikakulam | Chittoor | Khammam | India |
---|---|---|---|---|
Family planning | ||||
Current use of any family planning method | 67.7 | 61.3 | 69.1 | 53.5 |
Unmet need of family planning | 6.7 | 3.3 | 4.5 | 12.9 |
Fertility | ||||
Births to women 15–19 years out of total births | 14.0 | 14.0 | 16.9 | 7.9 |
Antenatal care | ||||
Pregnant women who had antenatal check-up in first trimester | 82.2 | 72.0 | 83.9 | 58.6 |
Pregnant women who had at least four antenatal check-up visits | 72.7 | 70.4 | 79.2 | 51.2 |
Delivery care | ||||
Institutional | 91.2 | 94.0 | 94.2 | 78.9 |
Government | 42.3 | 53.0 | 32.4 | 52.1 |
Private | 48.9 | 39.0 | 61.8 | 26.8 |
Child received full vaccination | 59.2 | 67.6 | 62.4 | 62.0 |
Study population
Sample size and sampling
Data collection and study tools
Quantitative
Qualitative
Data analysis
Results
Social profile of ANMs
Time spent home to home
Particulars | Total | Non-tribal PHC | Tribal PHC | 1st ANM | 2nd ANM |
---|---|---|---|---|---|
Travel from home to home | 8:04 (7:18–8:49) | 8:09 (7:30–8:48) | 7:58 (6:53–9:00) | 8:04 (7:02–8:37) | 8:01 (7:25–9:00) |
Travel from home to work place and work place to home | 1:04 (0:36–1:36) | 1:00 (0:32–1:26) | 1.37 (0:58–2:06) | 1:12 (0:37–1:41) | 1:02 (0:37–1:29) |
Time on job (including within field travel) | 7:00 (6:08–7:31) | 7:10 (6:27–7:42) | 6:20 (5:16–7:09) | 6:54 (6:00–7:20) | 7:09 (6:12–7:57) |
Within field travel | 1:02 (0:36–1:36) | 1:02 (0:38–1:37) | 1:02 (0:25–1:42) | 0:57 (0:30–1:25) | 1:07 (0:39–1:52) |
Work time | 5:52 (4:45–6:44) | 6:06 (5:11–6:48) | 5:01 (3:49–6:25) | 5:54 (4:54–6:40) | 5:49 (4:35–6:49) |
Time spent on activities
Particulars | Total minutes/week | ||||
---|---|---|---|---|---|
Count N = 43 (%) | Range | Median (IQR) | Avg./week/ANM | ||
Min | Max | ||||
1. Programme | 43 (100.0) | 742 | 2 368 | 1 358 (1248–1 621) | 1 441 |
1.1 Direct service to beneficiary | 43 (100.0) | 234 | 1 405 | 586 (439–872) | 664 |
Adolescent health | 4 (9.3) | 0 | 8 | 0 (0–0) | 4 |
Blindness/cataract | 2 (4.7) | 0 | 32 | 0 (0–0) | 21 |
Camp work | 11 (25.6) | 0 | 221 | 0 (0–14) | 99 |
Child health | 15 (34.9) | 0 | 13 | 0 (0–6) | 8 |
Communicable diseases | 18 (41.9) | 0 | 162 | 0 (0–4) | 20 |
Curative care | 7 (16.3) | 0 | 29 | 0 (0–0) | 17 |
Family planning | 6 (14.0) | 0 | 43 | 0 (0–0) | 17 |
IEC activities amongst group(s) | 13 (30.2) | 0 | 35 | 0 (0–8) | 15 |
Maternal health | 24 (55.8) | 0 | 197 | 8 (0–22) | 43 |
National health day | 3 (7.0) | 0 | 71 | 0 (0–0) | 35 |
Non-communicable diseases | 12 (27.9) | 0 | 73 | 0 (0–3) | 17 |
Nutrition | 2 (4.7) | 0 | 4 | 0 (0–0) | 4 |
School health | 27 (62.8) | 0 | 259 | 25 (0–56) | 70 |
Seasonal diseases/epidemic outbreaks | 34 (79.1) | 0 | 121 | 10 (3–38 | 34 |
Universal immunisation day | 30 (69.8) | 0 | 777 | 257 (0–470) | 387 |
Home visits | 42 (97.7) | 0 | 727 | 200 (105–360) | 250 |
Others | 31 (72.1) | 0 | 534 | 51 (0–89) | 95 |
1.2 Records and reports | 43 (100.0) | 12 | 886 | 422 (236–537) | 386 |
Beneficiary records | 12 (27.9) | 0 | 39 | 0 (0–4) | 16 |
Computer data entry | 15 (34.9) | 0 | 268 | 0 (0–43) | 104 |
Health pro formats | 1 (2.3) | 0 | 6 | 0 (0–0) | 6 |
Registers | 41 (95.3) | 0 | 581 | 232 (101–413) | 264 |
Reports | 33 (76.7) | 0 | 623 | 21 (5–100) | 102 |
Others | 21 (48.8) | 0 | 135 | 0 (0–18) | 31 |
1.3 Travel to and within field | 43 (100.0) | 101 | 893 | 352 (289–450) | 391 |
2. Programme support | 43 (100.0) | 97 | 981 | 518 (341–670) | 523 |
Trainings | 07 (16.3) | 0 | 331 | 0 | 307 |
Meetings/discussions with co-workers or village community | 43 (100.0) | 53 | 428 | 214 (150–316) | 225 |
Meetings/discussions with seniors | 43 (100.0) | 4 | 547 | 146 (90–211) | 157 |
Non-health but work-related activities | 17 (39.5) | 0 | 121 | 0 (0–14) | 39 |
Administrative work | 43 (100.0) | 17 | 270 | 66 (39–91) | 75 |
3. Other work | 43 (100.0) | 220 | 787 | 426 (335–484) | 420 |
Waiting | 36 (83.7) | 0 | 210 | 59 (11–114) | 87 |
Miscellaneous: personal work | 43 (100.0) | 79 | 520 | 307 (249–365) | 309 |
Others/uncategorised | 22 (51.2) | 0 | 333 | 2 (0–52) | 76 |
Total on-job | 43 (100.0) | 1 083 | 3 948 | 2 439 (2129–2 598) | 2 384 |
Programme activities
Programme support activities
Other work
Qualitative results
Work plans
Job responsibilities
Facilitating factors or barriers to utilisation of time
Domain | Facilitating factors* | Barriers* |
---|---|---|
Interpersonal factors and community related |
Co-worker’s support
|
Lack of community support
|
Community support
| Lack of co-workers’ support | |
Family support
| Local community beliefs | |
School support | Fear of violence and alcoholism in remote tribal areas | |
Community awareness | ||
Beneficiaries support | Movements of village people for seasonal jobs disrupts continuity of care | |
Self-motivation | ||
Knowing local language | ||
Health system-related factors |
Clear work plan
|
Difficult transportation
|
Ease in transportation
|
Training needs
| |
Proper infrastructure, stocks and supplies |
Poor infrastructure, inadequate stocks and supplies
| |
Supervision and support from district health system |
Accompanying beneficiaries to higher facilities
| |
Work atmosphere |
Vacant positions
| |
Low salaries of contractual ANMs | ||
Carrying heavy vaccine kits | ||
Multiple health programmes | ||
Records maintenance | ||
Online MCTS | ||
Work pressure | ||
Sudden meetings | ||
No ambulance service | ||
Health facilities in interior locations | ||
Others | Political support |
Extreme climatic conditions
|
Political interference | ||
Physical ill health | ||
Emergencies/ outbreaks | ||
Concerns of family |
Discussion
Core categories of work | Time observed, hours/week | Time suggested, hours/week* |
---|---|---|
a) Outpatient services at the sub-centre | 2 | 30 |
b) Services delivered in the outreach mode: immunisation/nutrition and health day/school health/camps, etc | 10 | |
c) Services delivered during home visits and visits to the community | 4 | |
d) In-patient midwifery services of the sub-centre | 0 | |
e) Maintaining records and reports, planning her work, building her capacity, meetings, inter-habitation movement | 22 | 10 to 14 |
f) Referral of high-risk pregnancies, sick neonates and other emergencies | 0 | |
Others (no such category suggested by the government) | 7 | – |