Strengthening Training Infrastructure in India: Assessment and Recommendations

1. Assessment & strengthening of training infrastructure available in IndiaNIHFW

2. BACKGROUND NIHFW acted as the “Apex Technical Institute” for capacity building programmes Vision was for each state to have its own apex training institutions linked, on one hand, to NIHFW, and, on the other, to the other training institutions in the state, to which they would provide expert support. Subsequently State Institutes of Health and Family Welfare [SIHFW] were established in different states with world bank support. Due to various reasons some HFWTCs were upgraded to SIHFWs & in some states HFWTCs were converted to Regional Health and Family Planning/Welfare Training Centres Below the chain were ANMTCs and male MPW training centres.

3. DTCs [District training Centres/Teams] were also envisaged at district level, but these are not functional due to various reasons. Once the Project was over, the various states have not owned SIHFWs in terms of financial, human resource and ongoing trainings, resulting in mismatch between the Directorate and these training institutions. GOI funding was given to various SIHFWs/HFWTCs under various sub-heads, There was no linkage between the NIHFW, SIHFWs and HFWTCs & other training institutions.

4. Present Situation • The term CTI has now been given a newer connotation as Collaborating Training Institutes. These include the SIHFWs. • In view of the advent of NRHM, as also the addition of new institutions in the training set up, it has been felt necessary to study and streamline the training in health sector, with special focus on strengthening the relations between the state level and national level institutions. • A review of CTIs & other training institutions was undertaken for this purpose.

5. States Institutes of Health and Family Welfare

7. CTIs

8. * RCH training funded

9. Review of ANMTCs, GNMTCs, HFWTCs and SIHFWs was done through checklists sent to each institution. • Information was also collected through on the spot assessment by faculty and consultant during monitoring visits. • Objectives of the assessment focused on identifying lacunae in the infrastructure, training imparted and possible networking mechanism between the institutes and also with NIHFW.

10. Profile of Training institutions Data received from 95 training institutions : 59 ANMTCs, 11 HFWTCs and 25 GNMs Nursing Schools/other institutions from 85 districts of 9 states. Data has been analyzed for all training institutions with respect to : Infrastructural facilities including hostel and mess Manpower Position Training activities Distance from hospital/ clinical training site

11. INFORMATION RELATED TO SIHFWs(15 institutions)

12. Administrative / governance details • Only two SIHFWs were reported to be autonomous institutions registered under Societies Registration Act, 1860. • Most of SIHFWs were following the respective state govt. rules. • As regards the institutional objectives and vision statement, most reported that they exist, except in few. • UP did not have it because, reportedly, the institution is “an integral part of the Deptt. of Health and FW, UP”.

13. ORGANIZATIONAL DETAILS • Only two SIHFWs had professorial designations. • The majority of posts [more than 50% of those sanctioned] were lying vacant in 2 SIHFWs. • Vacancy/adhocism at the top i.e. Director post. • Manpower varies enormously both in terms of numbers and in terms of area of specialization. Moreover, there is no uniform faculty structure. • Eight contractual posts - four consultants and four support staff - some of the institutions have not been able to recruit. (may be because of the anomaly in the pay structure) (Rs.15,000 – Rs.26,000 in NIHFW) & (Rs.13,000 – Rs.16,000 in CTIs). • The overall picture of teaching faculty, whether professorial or directorial, was that of a large number of vacancies, often at the top. It is felt that the two issues [non-autonomous nature and non-professorial staff] are interlinked and, together, tend to be non-conducive to development of a strong training system.

14. INFRASTRUCTURAL FACILITIES All reported • good infrastructure facilities • good building with classrooms with adequate audio-visual facilities, • library and computer facilities • hostel with boarding and lodging facilities • vehicles or mechanism for outsourcing of transport if required. But all need modernization/upgradation of physical infrastructure, AV aids, reprography etc.

15. INFORMATION RELATED TO ANMTCs(59 ANMTCs from 57 districts)

16. Infrastructural facilities at ANMTCs 57 (97%) ANMTCs had minimum infrastructural facilities with classroom and teaching aids. Only 18 (31%) ANMTCs had LCDs. Few ANMTCs in Orissa & Assam either do not have hostel rooms or the rooms need renovation. Mess facilities exists in 39 (66%) ANMTCs throughout the year. Rest of the ANMTCs provide food only during training.

17. Manpower Position in ANMTCs None of the ANMTCs (except six) has the requisite faculty & staff in position. No uniform staffing pattern exists

18. Training Activities in ANMTCs Some training activities have been conducted in majority of the ANMTCs. Training is episodic and does not follow uniform pattern.

19. Distance of ANMTCs from hospital/ clinical training site Majority of the ANMTCs are located within the hospital premises in Assam, Bihar & Orissa. In other EAG states, the ANMTCs are located far away from the hospital/ clinical training site There is no transport facility available in ANMTCs to take the participants to hospitals/clinical training sites. The participants have to make their own arrangements to travel to the hospital/clinical training site.

20. Trainings conducted at NIHFW (2005-2008)

21. NO TRAINED AT NIHFW (NRHM / RCH TAU) (focus on training of master trainers)

22. * Around 60 training course (mostly training of trainers) are held at NIHFW every year. * Partnership with World Bank Institute Flagship training courses: Flagship Course on Health System Policy and Management January 28th 2008 – February 2nd 2008 Training Course on Public Private Partnership, 28 March – 3 April, 2008 Workshop on Strengthening of Human Resources for Health, May 26-31, 2008 Workshop on Planning and Designing Courses on Improving Quality of Care, June 4-8, 2008 * Partnership with Harvard School of Public Health, Boston, USA

23. PUBLIC HEALTH EDUCATION AND RESEARCH CONSORTIUM Network and Partnership • Community Medicine/ PSM /Social Medicine Departments of Medical Colleges • SIHFWs/HFWTCs/CTIs and other Research Institutions • Nursing Colleges and Schools • Mother NGOs

24. PUBLIC HEALTH EDUCATION AND RESEARCH CONSORTIUM • Joint collaborative effort • Two way process • Pool all the available human resources from all the interested Institutions

25. PUBLIC HEALTH EDUCATION AND RESEARCH CONSORTIUM Activities Initiated • Sharing of information on Programmes/ Guidelines and recent updates through print and electronic media • Research Methodology Workshops • Rapid Appraisal Methods for Partnership Research

26. PUBLIC HEALTH EDUCATION AND RESEARCH CONSORTIUM • GIS Mapping of Health Manpower • Capacity building for improving District Health System through Workshops/Joint Meetings etc. • To initiate discussion on priority issues on Public Health

27. PUBLIC HEALTH EDUCATION AND RESEARCH CONSORTIUM Already members of Consortium • 175 Medical Colleges • 55 SIHFWs/HFWTCs/CTIs • 139 Nursing Colleges/Schools • 79 NGOs

29. Sharing of Information • 21–12–2007 : Women Centered Comprehensive Abortion Care-Resource material • 21–1–2008 : National Family Health Survey 3 (NFHS 3) 2005-2006  • 28–01–2008 : Information on Government Of India Guidelines for Maternal Health Interventions • 10–03–2008 : Standard Treatment Guidelines - Medical Management & Costing of Select Conditions • 02–04–2008 : Information on Child Anaemia • 31–07–2008 : Networking to Reduce Maternal and Neonatal Mortality and Morbidity in South Asia: The Human Resource Dimension

30. WHAT NEEDS TO BE DONE

31. The SIHFWs need to be strengthened alongwith HFWTCs, ANMTCs, etc. • Stronger networking between SIHFWs and other training institutions • Commitment of the state is essential.

32. National Training strategy

34. MODUS OPERANDI

35. Situation analysis of all the training institutions (funded by central government or state government) needs to be done. This exercise has already started and the profile of a number of SIHFWs, HFWTCs and ANMTCs is available with NIHFW. Onsite visits/other modes for getting information will now be undertaken for completing this exercise. • After the situation analysis , a detailed plan for each institution needs to be worked out and a corresponding rejuvenation package for each institution can be taken from NRHM funds as a one time investment.

36. For ensuring all this, it is proposed to identify & have a dedicated training coordinator stationed in each state to assist Director/Principal of these training institutions. He will ensure linkages between state training plan/District training plan/performance and feed back so that in state/district PIPs training plan & activities including budge can be incorporated. To be funded by NRHM and with the administrative control of NIHFW. Each state to develop state training plan

37. NIHFW core team will be of six faculty/ consultants (three existing and three newly hired). • Each will be responsible for 5-7 states and work closely with the states.

38. Capacity Building of SIHFWs through sharing the training courses at the SIHFW level. • Capacity building for research - Rapid Appraisal of Health Interventions • NIHFW through the SIHFWs will take up the responsibility of knowledge, skill and pedagogical development of the faculty of the training institutions. • Identified private institutions/NGOs will also be roped in for working with the training institutions and there can be a good model of PPP for ANMTCs (as shown by West Bengal)

39. REQUIREMENTS

40. Commitment from NRHM • Rejuvenation package for each institution from NRHM • NIHFW’s role in decision making to be specified to the states

41. Advocacy for having regular Director/ Principal posts at the training institutions. • Flexibility of salary structure (especially for contractual faculty) • All CTPs routed through the SIHFWs and ultimately through NIHFW • Budget for training under RCH-II/NRHM/ Immunisation/ HIV to be routed through NIHFW. If this is not possible because of the financial envelope. SOEs for the trainings conducted at CTIs may be routed through NIHFW.

42. NIHFW is hopeful of getting Deemed University status soon. The state level and other training institutes can then be linked for regular courses also through Study Centre/ Video Conferencing/ Distance Learning Centre. • E-learning initiative is also to be launched soon by NIHFW. It is proposed to link the SIHFWs in the first phase and then the HFWTCs and ANMTCs in the next phase. • Training software has also been developed at NIHFW for monitoring the training • Long term vision of NIHFW is to achieve the status of a National Public Health university which will oversee the work of all universities of health sciences.

43. Thank you!