“I’ve taken my family planning work into my own life. I had two children, both girls, and they each have only two children as well. This is the way nurse-midwives can make the greatest impact when counseling their clients and supervising village dais.”

An Auxiliary Nurse-Midwife (ANM), Bina has spent many years as the public health system’s primary provider of reproductive health services for nearly 1,000 women through her two room health subcenter in Varanasi District of Uttar Pradesh, India. In December 2001 she attended a training session at the Pindra Primary Health Center with 27 other midwives from her district who were updating their skills as part of the State Innovations in Family Planning Services Agency (SIFPSA) initiative for providing facilitative supervision to traditional birth attendants, the village dais.

The PRIME II Project, under the direction of USAID/New Delhi, provides technical assistance to SIFPSA by training master trainers from carefully selected nodal agencies in each district, and then following up with them as they conduct skillsbased training sessions for the ANMs. The ANMs, in turn, supervise and train the dais in their district. PRIME facilitates this unique private-public sector collaboration, builds institutional capacity, and supports the cooperative efforts of the local agencies, district health administration, ANMs and dais.

Striving to improve prenatal care, delivery skills and postpartum family planning in ten districts of Uttar Pradesh, PRIME brings assistance in developing curricula, strategies and proposals; offers technical input for training and mentoring; and strengthens the process through all stages of program implementation.

Initial results have been encouraging. When MACRO International assessed the impact of training 1,200 dais in eight blocks of the Sitapur and Agra districts, more than half the trained dais were able to identify high-risk pregnancy conditions (up from 11% the previous year). Nearly 21,000 deliveries had been attended by trained dais (up from 6,500), and 28% of the dais were offering family planning services (up from 4%). In the two years since the MACRO study, the impact has multiplied: over 5,000 more dais have been trained and 1,470 more ANMs have become trainers and/or supervisors in the program.

During a break in the Varanasi training session, participants entertained each other with songs and stories. Bina sang one of her own compositions, a poignant demonstration of her understanding of the complex cultural factors that often face families. She held the whole room entranced as she described the burdens of dowry, a mother’s aspirations for her daughter, and a father’s worry as he tries to collect everything that’s needed to give her bliss, so that she can become “a queen in her own palace.” As she sang, the trainers and ANMs gathered in the room understood that their work helps to empower every woman.

The PRIME II Project works around the world to strengthen the performance of primary-care providers as they strive to improve family planning and reproductive health services in their communities.

PRIME Voices #9, India: Supervising and Training the Village Dais, 2/14/02.