Questions and Answers
AID-JHU Questions - First Set:
Q1.What is the total number of TBAs that are going to be trained under the
programme over one year (in the four workshops that is)? Are all the four
workshops going to have the same curriculum or are they designed to impart
increasingly higher levels of training to the same set of TBAs?
Total 30 TBAs are going to be trained under the programme over one year.
The trainees will be mostly illiterate. Some of them are educated up to primary
school in vernacular language. As the villagers understand local Marathi all
four workshops will be in Marathi only. The training model is based on practical
demonstration model drawing, painting & audio visuals. Hence the same
curriculum will be applied for the four workshops. But along with the curriculum
we will try to develop counseling skill in TBAs on F.P. & Reproductive
health.
A TBA will provide ANC/ PNC care. She will also guide about reproductive
problems. This will sustain her own employment in the setup.
Q2. Some of the volunteers expressed concerns about the efficacy of a 5-day
workshop as they felt that it was not enough and that a minimum of thirty
days of workshop teaching along with hands on practical training was necessary
to achieve success in reducing maternal mortality. They also pointed out towards
the need for post-workshop support to the TBAs in terms of transportation
etc. Does FPAI have any plans to this effect?
All the subjects related to Antenatal, Intranatal & Postnatal care will
be covered in the 5-days training module. The difficulties, problems faced
during the quarter in attending the deliveries will be discussed & clarified
in the next workshops. We feel that five days workshop within three months
time is not enough for the TBAs. But the TBAs selected for the workshop cannot
spare one-month time away from the house for training. We (FPAI) will see
that every Dai trained in the workshop will complete a minimum five day practical
hand on training at Bhandara district hospital.
We plan to form village level committee in each village including key persons
= Gram panchayat member & Mahila mandal representative. They will arrange
funds to use in emergencies for transfer of high risk-mother to the referral
hospital.
Q3. Are the TBAs to be trained under the programme people from the local
community who have been traditionally doing the job of delivering babies?
Total 15 villages are covered under the TBA training programme. At present
there are 7 traditional birth attendants in 6 villages but out of them 4 are
very old. The remaining 3 TBAs are conducting the deliveries but they are
not well trained. Therefore we plan to train 2 TBAs from each village. TBAs
selected for the workshop will form a mixed group (two experienced & others
totally new).
Q4. What role does the government play in the FPAI? Does it share any administrative
responsibilities?
Govt. does not share any type of administrative or financial responsibility.
However, Govt. district hospital & primary health center co-operate with
us for the 5-days practical training.
Q5. Is the government providing any kind of support for the T.B.A training
project in Bhandara?
No.
Q6. Where is the proposed workshop planned to be held? Is it going to be
near one of the villages or in some other place?
These workshops will be held at Lakhani where FPAI’s project office is situated.
There we can do all the arrangements for the training, as the villages selected
for the programme are situated within the 30 KM radius. The TBAs can easily
reach the place of the workshop.
Q7. Is there a plan to follow up on the workshops by monitoring their success
in reducing the maternal and child mortality during birth and by providing
technical and material support to the TBAs attending the workshops afterwards?
FPAI workers will monitor the work of the TBAs & also provide technical
support. Delivery kit will be provided by the project, which is also mentioned
in the proposed budget. After training, TBAs name will be registered in the
PHC record so that they will get material & technical support in future
by PHC (primary health care centre).
Q8. Could you kindly elaborate on what kind of incentives are to be offered
to the TBAs and the need for the same? Also what is covered under "boarding"
expenses?
Under the budget head incentive each TBA will be given allowance of Rs.
40/- per day to compensate their loss of daily wages, which they earn while
working in rice fields. Boarding expenses cover 2 meals per day for 30 TBAs
(Minimum Rs. 20/-).
Q9. Has FPAI done similar kind of workshops in Bhandara district or in other
parts of the country? If yes what has been the experience with them?
Yes, FPAI Bhandara project has conducted 26 TBA training programmes in the
past, where in 242 TBAs were given training. These TBAs are conducting deliveries
safely in other area.
Q10. What kind of work has FPAI done in Bhandara district up till now? You
say that FPAI started work there in 1992 but the project later phased out
December 2000, were there any specific reasons for that?
FPAI has worked in three talukas of Bhandara district (Bhandara, Pauni &
Sakoli) from Oct. 1992 to Dec. 2000 on family planning (mainly to increase
contraceptive acceptance) reproductive health , women empowerment, youth sexuality,
mother & child care, male motivation, gender sensitization. FPAI Bhandara
project was a time bound project. After achieving the goal in the stipulated
time it was phased out in Dec. 2000. Separate note is enclosed herewith on
FPAI Bhandara project.
Q11. Can you elaborate on the U.N.F.P.A. project that FPAI is currently
running in the district? Is the TBA training a part of it?
FPAI currently running UNFPA project titled "Improving the status of reproductive
health including Family planning". Main strategies are 1) IEC activities 2)
Referral service 3) Direct service delivery.
The components were: 1) Maternal health 2) Child care 3) Family planning.
4) RTI STD 5) Safe abortion 6) Infertility 7) Gender sensitivity.
TBA training was not the major part of this project. But it was included
in the component ‘Maternal health’. Hence budget was less on TBA training.
So proper emphasis could not be given on TBA training. We have arranged orientation
training for existing TBAs only.
Q12. Can you give us some statistics about the existing maternal and child
mortality rates in Bhandara and any other indicators of health care
situation there?
Infant mortality rate in Bhandara is 32.25% (per thousand). Maternal mortality
rate is 221.65%( per lakh). In the proposed project area, infant mortality
rate in 79.29% Maternal mortality rate is 440% 9 per lakh); birth rate 25.66%
overall death rate 6.25% immunization rate of ANC87.15% children 95%.
Q13. How do you select the resource persons to train TBAs? Are they government
doctors?
We select the resource person from private medical practitioners from Bhandara
& Lakhani. PHC’s medical officers & sister tutors also help us by
rendering services as resource person.
Q14. What is the percentage of deliveries conducted at home in the district?
80.57% deliveries are conducted at home.
Q15. Could you provide us with some details of the health infrastructure
in the district in terms of hospitals, primary health centers and health posts,
etc.?
Health infrastructure in Bhandara district:
1) One district hospital; 2) Five cottage or rural hospitals at Pauni, Tumsar,
Mohadi, Sakoli, Lakhandur (Five talukas); 3) Thirty-one primary health care
centres covering 20 to 30 thousand Population. Each PHC has one or two medical
officer, 1 ANM, 2 Supervisors (male), 2 Supervisors (Female), MPW (Male paramedical
workers), 1 chemist; 4) 202 Subcentres each covering 3 to 5 thousand population
under guidance of one AHM.
District health officer (DHO) is the superior authority of district health
department who controls PHC & subcenters. Civil surgeon is in charge of
one district hospital & 5 rural hospitals located at taluka places.
Q16. What is the proportion of people seeking maternal and neonatal health
services in private sector?
Only 5.5% people seeking maternal & neonatal health services in private
sector. Majority of the population is poor; hence they cannot offer the fees
of private doctors. Therefore they go to Govt. health services or vaidu's
(swindler) or use herbal medicine, which they know from their ancestors.
Q17.What are the linkages between the TBAs and health care system, if any?
There is some linkage between health care system & TBA. After attending
the deliveries, TBA reports the ANM of the subcenter & registers the name
of mother & sex of child.
Q18. Are there any special reasons of concern on maternal and neonatal mortality
and morbidity in the area over and above what we know for the country?
We feel that out of total infant mortality 75% can be avoided through proper
delivery conduction. The area is specially selected for the conduction of
project because after our primary survey we come to know that the infant mortality
rate is much high in the villages in forest belt of our project. There are
many social & economic reasons for this. We feel that proper training
of local women as trained birth attendants will definitely help in decreasing
infant mortality rate.
Justification of budget
1] Lodging includes 5 overnight stay of 30 TBAs & expenses needed for
them
(1) Bed charges (for one workshop): Rs.1500/-
(30 x 10 x 5)
(2) Bed sheet charges: Rs.750/-
(30 x 5 x 5)
(3) Pillow charges: Rs.450/-
(30 x 3 x 5)
(4) Mats: Rs.300/-
_________________________________________________________________
(30 x 20 x 5) Total Rs.3000/-
_________________________________________________________________
2] Boarding includes only 2 meals per day per TBA
(1) Meal: Rs.6000/-
(30 x 2 x 20 x 5)
(Rs.20/- per meal, per day 2 meals for each TBA . Total 60 meals a day for
5days 300 meal x Rs. 20 = 6000/-)
_________________________________________________________________
3] Hospitality includes only tea, breakfast of resource persons & TBAs
(A) Snacks (30 TBA + 5 resource person): Rs.875/-
35 x 5 x 5 ( Rs. 5/- per day per person )
(B) Tea: Rs. 350/-
35 x 2 x 5 (Rs. 2/- per day per person)
__________________________________________________________________
Total 1225/-
__________________________________________________________________
4] Travel expenses
(1) Rs. 44/- travel for 7 villages to & fro (44 x 14) 616/-
(2) Rs. 38/- for 3 villages (38 x 6) 228/-
(3) Rs. 32/- for 3 villages (32 x 4) 128/-
(4) Rs. 30/- for 3 villages (30 x 6) 180/-
_____________
Rs.1152/-
________________________________________________________________________
5] Incentive: Only Rs.40/- daily allowance will be given per TBA to compensate
for their loss of daily wages which they earn while working in paddy fields.
30 x 40 x 5 = 6000/-
________________________________________________________________________
6] Educational Material
Three types of material will be required under budget head - Educational
material. Some material will be hired, some will be purchased, and some will
be printed.
1 w/s 4 w/s
(1) VDO Rent (Rs.300 x 2days.) 600-00/-
2400-00/-
(2) Slide Projector Rent (150 x 4days) 600-00/-
2400-00/-
(3) Model Rent (100 x 2)
200-00/- 800-00/-
(4) Flip charts purchasing (75 x 32) 2400-00/-
2400-00/-
(for distribution to all TBAs)
(5) Printing of booklet (50 x 32) 1600-00/-
1600-00/-
on FP / RH / MCH
(for distribution to all TBAs)
(6) Stationery
(Pen, Paper, Notebook, Cello tape, 600-00/-
2400-00/-
Sketchpen, Drawing sheets, colorbox, etc.
and Xerox copies of some printed material
____________________________
Total: 6000-00/- 12000-00/-
____________________________
* Total cost of educational material for 4 workshops will be Rs. 12000/-.
Hence Rs. 3000/- is mentioned in each workshop.
* Flip chart & printed books will be given in first workshop to all
TBAs. 2 copies will remain with the project.
________________________________________________________________________
7] Resource Person
(1) 3 Specialists for 2nd, 3rd, & 4th day (2 hrs a day) 1500-00/-
(per day Rs. 500 x 3 )
(2) 4 Doctors (private practitioners) (for 2 to 4th day) 1200-00/-
(per day Rs. 300 x 4)
(3) 1 Doctor from govt. 150-00/-
(4) 2 ANM from govt. 150-00/-
____________
3000-00/-
____________
8] Delivery Kits
Delivery kit will be given all TBA in 1st. workshop. It will be filled up
again
(1) Small kit bag: Rs. 30-00/-
(2) Scissors: 10-00/-
(3) Thread bundle: 5-00/-
(4) Blade packet: 15-00/-
(5) Cotton bundle: 10-00/-
(6) Gauze '' 10-00/-
(7) Soap: 5-00/-
(8) Plastic paper: 5-00/-
(9) Antiseptic lotion: 10-00/-
__________
Rs.100-00/-
__________
Rs. 100 x 30 = 3,000 for first workshop
Rs. 1,000/- for filling up of kit in next workshops
AID-JHU Questions - Second Set:
1. Training: Our understanding is that over a period of one year, 30 TBAs
will be trained over 4 rounds. We had the following issues and concerns regarding
the training:
(i) Will the same material be covered repeatedly over the 4 workshops or
will there be any variation across the 4 workshops? We did understand that
there will be some problem solving across the 4 workshops but we were wondering
about the gains from a workshop that is repetitive.
No. The same material will not be repeatedly used for the 4 workshops. There
will be variation regarding material given to the TBAs. But as the TBAs are
mostly illiterate, repeated revision of previous lessons is needed.
(ii) Also, is it possible to prioritize components of training curriculum
and deal with a small unit each time?
It is possible to prioritize components of training curriculum at each w/s.
(iii) Is there provision for hands on training in labor room of district
hospital or any models before the TBAs are certified?
Yes, we will make provision for hand on training at Bhandara district hospital.
(iv) Are there satisfactory visual aids for training considering that TBAs
are illiterate? Will the TBAs carry any training material back with them for
reference, e.g., a visual chart on danger signs during pregnancy?
Yes, we have enough audiovisual aids for the training. The TBAs will carry
training material, flip chart, danger signs in pregnancy, due date cards etc.
to their home.
(v) Is there an evaluation plan for the training workshops?
Yes, feedback of the training will be taken from each TBA. at the end of
every workshop. Evaluation of their work will be done after one year.
(vi) Is it possible for TBAs to maintain basic records (births and deaths)?
They can maintain visual records, even if they are illiterate.
Yes, The TBA will be trained to keep the basic records.
(vii) Is there any mechanism to monitor their work in the field?
One village level worker will monitor the work of the TBAs.
2. Recruitment of new TBAs and retaining them. Some of the questions that
we had around it are:
(i) How are the TBAs supposed to support themselves financially? Is conducting
deliveries the primary profession of both old and new TBAs?
Conducting delivery is not a primary profession of new or old TBAs. The
TBAs are mostly agricultural farm workers but they also work as TBAs in the
villages. This will provide them very little extra income (Rs. 150 or 20
kg of rice from each delivery).
(ii) Are the TBAs (they seem to be agricultural workers also) supposed to
sustain themselves through conducting deliveries on payments made by clients?
TBAs cannot sustain themselves by conducting deliveries as village people
are very poor & can pay little amount. The number of deliveries conducted
by TBA per month is on an average two.
(iii) The proposal mentions new and old TBAs. Who are the new TBAs and how
will they be recruited and retained?
It is observed that old TBAs usually take the new recruits for performing
deliveries. Similarly new TBAs are selected by village panchayat.
(iv) What is the average number of deliveries that each of these TBAs conducts
annually? We had concerns on this one because if the number of deliveries
is not large, it will be difficult for the new TBAs to get enough cases to
practice and importantly support themselves.
As mentioned about the average number of deliveries conducted every year
by one TBA is 20 to 24 TBAs will be given hand on training at Government district
hospital.
3. Facilitating clean deliveries:
(i) Will the TBAs be provided delivery kits and what is the plan for their
replacement?
Yes. TBA will be provided with delivery kit by the project. Throughout the
year the needed material will be replaced. After the training period is over
(one year) we will request PHC people to provide the same.
(ii) Is it feasible idea to have single use delivery kits and a plastic
sheet? These delivery kits contain: cotton balls (to clean the baby’s eyes),
gauze (to wipe the baby dry), new blade (to cut the cord), soap (to wash
hands) and thread to tie the cord. Many safe motherhood initiatives have
used these delivery kits.
Some of the material in the delivery kit (thread bundle, cotton bundle,
gauze bundle, soap) can be used for more than one delivery.
Other issues:
4. In the hierarchy of health service delivery infrastructure, what is the
lowest level (realistically) at which deliveries can occur? Is it the Primary
Health Center or only the District Hospital? Do any of these needs to be revamped
for conducting safe deliveries?
PHC is the lowest level where delivery can be conducted.
5. Is district hospital the place for conducting surgeries and the level
of care where blood bank is available?
Yes, the district hospital is the place for conducting surgeries & blood
bank is available there.
6. Is it possible for the TBAs to distribute oral contraceptives and condoms
after a basic orientation?
Yes, this is the basic idea of holding this TBA programme. The TBAs will
distribute oral contraceptives as well as condoms. They will also promote
the cases for IUCD & terminal method of contraception (Tubectomy &
Vasectomy).
AID-VT Questions - First Set:
Q1. How many members are there in FPAI Bhandara? What are their qualifications
and roles? You told us that some are volunteers and some are not. So, who
pays for the non-voluntary members? Is the project money being used towards
their salaries?
At present there are 2 FPAI Volunteers & 3 staff members working at
Bhandara.
Volunteers:
1. Dr. (Mrs.) Leena Joshi, MBBS. MD. (Ob. Gy.)
2. Mr. Rajkamal Job, BA. BEd.- LLB., Coordinator Maharastra bird lovers
organization, Honorary wild life wardan for Bhandara District, District Representative
of news paper "Lokmat Times'' (English)
Workers:
1. Mr. Vasant Yelane, Project Manager
2. Ku. Shalini Agalawe, Field worker
3. Mr. Gidmare, Field worker & Driver
Staff members are paid by FPAI main office Mumbai.
The FPAI has already wound up the Bhandara project last year on March 31st
2002. The volunteers & workers worked on a RCH (Reproductive & Child
health) project funded by UNFPA through SOSVA. However, funds for the salaries
of three workers were provided by FPAI for one year. Both SOSVA project &
FPAI support will cease to function from 31st March 2003.
Q2. Do the people in the project area really see a need for trained TBAs?
How many tribal families do the delivery by themselves? Are the Government-trained
TBAs, who are old now, still performing deliveries? Are the TBAs to be trained
already performing some kind of delivery work? If so, is it under supervision
of a regular TBA?
Yes, there is a need.
Q3. What is the follow up for the project? And how will you evaluate the
effectiveness and achievements of this project?
Infant mortality rate is the best indicator to evaluate the achievement
of the project. Similarly, contraceptive acceptance rate will evaluate the
work on family panning.
Q4. What procedure is being currently followed during delivery? Will the
TBAs be trained to deliver babies by the Western method (lying on back during
delivery) or by the traditional method (squatting)? We were told that the
tribal in India use the traditional method of delivery. Is that the case in
the project area? If so, how do you justify and convince the tribal to go
for the western method (if you do so)?
Now-a-days in Indian villages routinely deliveries are conducted by western
method.
Q5. Is the current training module based on FPAI’s previous project experience
or on Government recommendations for TBA training?
Current training module is based on FPAI's previous project experience.
Government training module is also included.
Q6. At the end of a workshop, will the TBAs be given any kind of certificate?
Will the TBAs be evaluated while performing deliveries after the training?
Yes, a certificate will be given after completion of the workshops. The
suggestion is ideal, but in practice it will be difficult to evaluate the
TBA while performing deliveries.
Q7. You had mentioned that the proposed workshops would be held in the FPAI
Lakhani center. If so, why is there a Hall Rent in the budget?
Hall rent is in the budget because we do not have place for the training
at Lakhani office. The project office consists of only two small rooms &
training programme cannot be held there.
Q8. Isn’t Rs.40/day for 2 meals a bit costly?
Rs. 20/- per meal is not at all costly. One cannot find anywhere less than
this cost for one meal.
Q9. Will 3 specialists be required in addition to 4 doctors on each day
as resource persons? Isn’t Rs.500/day for a specialist and Rs.300/day for
a doctor a bit too much?
Not 4 but minimum 2 doctors on each day will be required. Three specialists
for three days (2hrs.) will be required within five days workshop. Rs.500/-
is not too much because this is the rate that they are charging.
Q10. TBAs will be provided information regarding maternal and child care
(health, nutrition, etc.). Will the TBAs be given supplements (like vitamin
tablets, etc.) for distribution, or are they just informed about the importance
of supplements?
TBAs will be providing information regarding maternal & child care etc.
She will also supply oral pills, condoms. She will distribute Vitamins &
Iron tablets & will also inform about the importance of above-mentioned
supplements.
Q11. Is female infanticide prevalent in the project area?
There is no female infanticide prevalent in the project area.
Q12. Have you approached (or would you be approaching) other agencies (UNFPA,
etc.) for funding for the TBAs training project? If so, what would you do
if you get funding for this project from two or more agencies?
No, we have not approached any other agency.
Q13. Could you please send us (by post) the annual reports and audited accounts
of FPAI Bhandara for the past 2 or 3 years?
Sent!
-----------------------------------------------
QUESTIONS BEFORE & AFTER SITE VISIT
==================================
Pre-Visit Questions sent to Prasad (psubrama@iucaa.ernet.in) and Nishant
(haskarnis@lycos.co.uk), who’ll be visiting the project site.
AID-JHU Questions:
Hi Prasad!
Here are the minutes of our last CSH in which we discussed TBA project with
Mr. Job (volunteer from FPAI Bhandara). Just wanted to list a few questions
that we would like to be answered during the site visit apart from those you
think are relevant.
q1) Since FPAI Bhandara has done similar projects earlier we would like
to get an idea of their experience with those and the associated problems
etc.
q2) I am still not clear about the role of local liaison committee and the
village level committee, one is supposed to look after the overall implementation
of the project and the other is supposed to raise resources locally for referral
support services etc. I would like to have a clearer idea of their respective
roles and how they interact with each other.
q3) They have already identified 26 out of the 30 TBAs, we would like to
have an idea about the educational background of these TBAs, how many of them
have actually been doing this work before and for how long. If you could talk
to some of these and get an idea of their level of motivation and skills it
would be helpful.
q4) Who is going to do the monitoring and evaluation of the project,
members of FPAI Bhandara only or some outside agency. It is important to have
a thorough evaluation of the project by some independent body to be able
to learn from the project's experience.
q5) Mr. Job said that the main aim of their project is to promote family
planning, since the proposal we got was for training TBAs we would like to
have a clear idea as to how the family planning aspect enters in to it and
their experience in this regard with earlier projects also what is the average
family size in this region, the birth rate and average age of marriage amongst
girls.
Finally if possible we would like to have a sample of visual aids and delivery
kits that are to be distributed amongst the TBAs and if you could also get
some pictures of the project area, TBAs etc. that would be great.
Thanks and hope you have a great time visiting the project.
Anubha
AID-VT Questions:
Hi Prasad,
We have some more questions. I hope I'm not late!
1. Audit Report of 2001:
(a) The Dearness Allowance (Rs.1,20,831) is almost double that of Basic
Pay
(Rs.62,611). Is that usually the case in NGOs?
(b) What is the Goodwill Cost (Rs.30,600) under section Personal Cost for?
2. In the five-day workshop, a govt. doctor is present for a day and is
paid
Rs.150. What is her/his role? Is it legal to pay the govt. doctor for what
she/he is supposed to do anyways?
3. Who are the follow-up workers? What is their role? How many workers?
4. In the revised budget, they've included Rs.1,000 per month for
administrative expenses including stationary, xerox, phone, fax, etc. Please
ask for a split up if possible.
(Note: In the old audit reports, the administrative costs mentioned are
much
lower - around Rs.5000 totally per year!)
Looks like they don't have other funding sources - even from FPAI headquarters
(right?). Hence, they might be trying to take care of their other
administrative expenses through this project. So, please tell them that
AID
will not fund administrative expenses not related to the project.
5. What is the retention rate? How many TBAs do they expect to remain till
the
end of the year long training program? Will they find replacement TBAs?
6. Are there any special incentives for the good TBAs - ones showing a lot
of
interest and improvement? This might be good in the long run.
7. What is FPAI's plan after this project is over? Will they be continuing
the
TBA training project?
Have an enjoyable visit!!
Thanks,
Pramod and Alok
AID-VT
---------------------------------------------------------------------------------------
Post-Visit Questions
AID-JHU Questions:
Q: Is transportation available in the areas to shift the patient to the
PHC?
A: Village level committee is supposed to raise funds for TBA and patient
transport. The liaison committee is monitoring the progress of the village
committees to help in transportation.
Work is funded by many agencies but many of them ignore the finer issues
like transportation which can improve the efficacy of the project. There is
more than enough money required but finer details like this should also be
taken care of.
Q: We should also take care that issue of caste is not resulting in a dichotomy.
Q: Is it a national curriculum or they developed the curriculum themselves?
“It is extremely important to involve the govt also. TBA and govt staff
also should be working together. The training includes some hands on component
in the PHCs.
AID-VT Suggestions:
a) Dr.Raman Kumar suggested a need to discuss whether to fund family planning
projects or not as AID has never funded these kinds of projects previously.
b) Jaideep suggested that trained TBAs could train new TBAs in the next
workshop.
c) Dr.Raman Kumar suggested that instead of having 4 workshops for same
set of
TBAs they can have 2 workshops for reinforcement and 2 workshops can be
used
to train new TBAs.
----------------------------------------------------------
TBA TRAINING FEEDBACK
======================
1. Training:
Our understanding is that over a period of one year, 30 TBAs will be trained
over 4 rounds. We had the following issues and concerns regarding the training.
• Will the same material be covered repeatedly over the 4 workshops or will
there be any variation across the 4 workshops?
• We did understand that there will be some problem solving across the 4
workshops but we were wondering about the gains from a workshop that is repetitive.
• Also, is it possible to prioritize components of training curriculum and
deal with a small unit each time?
• Is there provision for hands on training in labor room of district hospital
or any models before the TBAs are certified?
• Are there satisfactory visual aids for training considering that TBAs
are illiterate? Will the TBAs carry any training material back with them
for reference, e.g., a visual chart on danger signs during pregnancy?
• Is there an evaluation plan for the training workshops?
• Is it possible for TBAs to maintain basic records (births and deaths)?
They can maintain visual records, even if they are illiterate.
• Is there any mechanism to monitor their work in the field?
2. Recruitment of new TBAs and retaining them. Some of the questions that
we had around it are:
• How are the TBAs supposed to support themselves financially? Is conducting
deliveries the primary profession of both old and new TBAs?
• Are the TBAs (they seem to be agricultural workers also) supposed to sustain
themselves through conducting deliveries on payments made by clients?
• The proposal mentions new and old TBAs. Who are the new TBAs and how will
they be recruited and retained?
• What is the average number of deliveries that each of these TBAs conducts
annually? We had concerns on this one because if the number of deliveries
is not large, it will be difficult for the new TBAs to get enough cases to
practice and importantly support themselves.
3. Facilitating clean deliveries:
• Will the TBAs be provided delivery kits and what is the plan for their
replacement?
• It is feasible idea to have single use delivery kits and a plastic sheet.
These delivery kits contain: cotton balls (to clean the baby’s eyes), gauze
(to wipe the baby dry), new blade (to cut the cord), soap (to wash hands)
and thread to tie the cord. Many safe motherhood initiatives have used these
delivery kits.
Other issues
4. In the hierarchy of health service delivery infrastructure, what is the
lowest level
(Realistically) at which deliveries can occur? Is it the Primary Health
Center or only the District Hospital? Do any of these needs to be revamped
for conducting safe deliveries?
5. Is district hospital the place for conducting surgeries and the level
of care where blood bank is available?
6. Is it possible for the TBAs to distribute oral contraceptives and condoms
after a basic orientation?
Some suggestions:
(a) Considering that referral linkages with government counterparts and
partnership with private sector are crucial to the success of TBA training,
it might be useful to organize sensitization and orientation sessions with
them with clear expectations on the nature of cooperation that is expected
from them. For example, appropriate treatment of clients referred in an emergency.
(b) More emphasis on working out the referral linkages and transport in
an emergency.
(c) Linkages with other groups or individuals working on similar themes.
For example, Abhay Bang and Rani Bang in Gadchiroli district of Maharashtra
who have worked on similar issues with amazing success.
(d) More comprehensive information on what are the major causes of infant
mortality and maternal mortality in the area and a thorough check on how each
one of them can be impacted. It will provide a reality check on how much
the TBA training can be expected to achieve. For example, for post partum
hemorrhage (excessive bleeding after delivery), TBA cannot do much until blood
can be arranged. But TBA can reduce post partum sepsis by conducting deliveries
in a hygienic manner or recognize pre-eclampsia (high blood pressure) and
prevent some adverse consequences by timely referrals. This is crucial to
the success of the program.