Lately, Gujarat has pursued aggressive efforts to bring about improvements in the health sector by introducing new schemes and policies. But because of various reasons district public health nurses (DPHNs) remain underutilised affecting the quality of maternal and child health services in districts of Gujarat.
A working paper of the Indian Institute of Management, Ahmedabad (IIM-A) suggests the state needs to resolve problems faced by district public health nurses (DPHN)and DPHN officers to maximise use of their potential.
The paper, 'The Role of the District Public Health Nurses: A Study from Gujarat', by Bharati Sharma, Sweta Roy, Dileep Mavalankar, Pallavi Ranjan and Poonam Trivedi says the DPHNs lack public health knowledge and experience.
Their role is to supervise nursing staff doing public health work while the eligibility criteria to become a PHN is diploma in general nursing and midwifery. This qualification is for posting as clinical staff nurses in hospitals.
Providing outreach services in a public health set-up is a different kind of challenge. Another issue is gap in the completion of training for nurses and their posting - a survey in the paper suggests seven years gap that diminishes their knowledge and skills.
"Their 10-month training to qualify for PHN is inadequate to develop knowledge and skills in public health. There is a gap between their training and posting due to delays in government procedures of promotion. The DPHN/DPHNOs spend majority of their time in the office (49%) where they have a limited role. Their supervisory role for nurses and midwives has lost its importance," states the paper.
They spend about one-third of their time in field supervision mostly visiting centres accessible by public transport as they do not have an allotted government vehicle.
As they do not submit any field report, there is no follow-up action from their visit. Nevertheless they seem to have an important role in solving problems of field workers as they are mediators between the district and peripheral facilities, says the paper.
According to the paper, training programmes for developing skills and a professional development courses should be made mandatory for them. "Except for computer training there is no other training organised for their professional growth.
The DPHNs seem to have some skill gaps which affect their functioning, such as supervisory skills, management skills, leadership and team building. They also require training in public health and health statistics, NRHM and health sector reform, and computer and MIS training," states the paper.
To do a sample survey in Gujarat, around 25 districts were grouped into six regions - Ahmedabad, Gandhinagar, Rajkot, Bhavnagar, Vadodara and Surat.