A Research Plan

on
How might we improve the performance monitoring and
assessment system of Auxiliary Nurse Midwife and Supervisory
Staff in primary health care and design an evidence-based capacity
building and performance incentive system for effective health care
delivery in Assam?

Submitted by:
Vivek Singh Rana
Arna Bairagi
Vagisha Alok
Prince Priya Ekka
Yalavarti Suma Krishna

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An exhaustive and imaginative list of stakeholders (beneficiaries, members of Piramal
Foundation, local government bodies, subject matter experts et al) that you can research
with, to find insights about the challenge.

 Foundation for Research in Community Health

 Rural Health Care Foundation
 Dr. Ranjan Pal
 Pwc Health Research Institute
 USAID Bureau for Global Health - Maternal and Child Health Integrated Program
(MCHIP)
 Public Health Foundation of India (PHFI)
 Indian Institute of Public Health
 All India Institute of Hygiene and Public Health
 Institute for Health Metrics and Evaluation
 Indian Institute of Health Management Research
 National Centre for Disease Control
 Urban Health Resource Centre
 The George Institute for Global Health
 St. John's Research Institute: SJRI
 National Institute of Health & Family Welfare
 National Institute of Public Health Training and Research
 HSRII | Health Systems Research India Initiative
 Indian Council of Medical Research
 Global Institute of Public Health (GIPH)
 TPG Healthcare
 Medical Associates for Research and Communication
 Institute for Indian Mother and Child
 Indian Medical Service
 Indian Nursing Council
 Indian Association for Medical Informatics

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Enlist all areas from the case study you plan to focus on (perhaps because you find them
interesting/confusing/rich in opportunity), and what facts/figures or past knowledge have
prompted you to choose these.

Area of study: To measure auxiliary nurse midwife and nurse motivation in rural areas

A worldwide lack of health workers in rural zones rises the importance of motivating and
helping existing health workers. Understandings of motivation may differ in diverse settings,
and it is vital to use measurement methods that are contextually fitting.

Table 1 Nursing entry level qualifications and training

Length of
Course Entry level
training

Maternal and Child Health Worker Grade 8 3 months

Auxiliary Nurse Midwife Grade 10 18 months

Proficiency Certificate Level (PCL) in Nursing Grade 10 (including Science, Maths

3 years
(Staff Nurse) and English)

Bachelors in Nursing (Generic BSc) Grade 10 plus 2 in Science 4 years

PCL Nursing and 2 years work

Bachelors Nursing 2 years
experience

Master of Nursing BSc 2 years

Table 2 Demographic characteristics and motivation scores of nursing

personnel

Variable N % Mean motivation score SD

District        

 Dailekh 40 29.2 4.74 0.31

 Kailali 59 43.07 4.56 0.38

 Banke 38 27.74 4.65 0.36

Age group        

 18–19 years 6 4.38 4.56 0.37

 20–29 years 60 43.8 4.53 0.39

 30–39 years 43 31.39 4.68 0.32

 40–49 years 25 18.25 4.83 0.23

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 Variable N % Mean motivation score SD

 ≥50 years 3 2.19 4.70 0.38

Ethnicity        

 Dalit Hill 4 2.92 4.80 0.30

 Dalit Teraia 1 0.73 3.18 —

 Disadvantaged Janajati Hill 14 10.22 4.69 0.28

 Disadvantaged Janajati Terai 16 11.68 4.52 0.42

 Relatively advantaged Janajati 9 6.57 4.71 0.33

 Upper caste 93 67.88 4.65 0.33

Job title        

 Upgraded MCHW 8 5.84 4.97 0.07

 ANM 89 64.96 4.61 0.36

 Senior ANM 23 16.79 4.73 0.21

 Staff nurse 13 9.49 4.39 0.47

 Senior staff nurse 3 2.19 4.91 0.09

 Sister in-chargea 1 0.73 4.27 —

Type of current health facility        

 Zonal hospital 13 9.49 4.64 0.37

 District hospital 13 9.49 4.52 0.30

 Primary health centre 24 17.52 4.59 0.41

 Health post 64 46.72 4.63 0.36

 Sub-health post 23 16.79 4.76 0.31

Time spent in current post        

 Less than 1 month 12 8.76 4.51 0.50

 1–6 months 23 16.79 4.55 0.30

 7–12 months 6 4.38 4.65 0.21

 1–2 years 22 16.06 4.69 0.31

 ≥2 years 74 54.01 4.66 0.37

Salary after tax        

 Less than 5,000 5 3.65 4.15 0.69

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 Variable N % Mean motivation score SD

 5,000–9,999 39 28.47 4.56 0.38

 10,000–14,999 71 51.82 4.69 0.28

 15,000–19,999 21 15.33 4.69 0.35

 More than 20,000a 1 0.73 — —

a
1. Indicates only one observation for this characteristic. As a result, the standard deviation is
not calculated.

Area of study: Role stress among auxiliary nurses’ midwives in rural areas
Understanding Role Stress is vital as health service benefactors, especially nurses experience high
points of Role Stress which is linked to exhaustion, poor class of care and high turnover.

Table 1 Details of ANMs included in the study

Blocks ANMs (%)

Block 1 14 (17%)

Block 2 32 (38%)

Block 3 18 (21%)

Block 4 9 (11%)

Block 5 11 (13%)

Total 84

Health Facilities

 SC 60 (71%)

 PHC 24 (29%)

 C.H.C. 0

 D.H. 0

Total 84

Mean Age (in years) 43.1

Average Work Exp (in Years) 16.9

Table 2 Test to assess normality of data

Respondent Kolmogorov-Smirnov Shapiro-Wilk

  Statistic df Sig. Statistic df Sig.

ANM .072 84 .200 .978 84 .170

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Respondent Kolmogorov-Smirnov Shapiro-Wilk

  Statistic df Sig. Statistic df Sig.

Table 3 Mean, Median and SD Scores for different dimensions of RS

for ANMs
No. Dimensions ANMs (N = 84)

    Mean Median SD

1 Inter role distance 10.86 11 3.68

2 Role stagnation 11.65 12 3.91

3 Role expectation conflict 7.26 8 3.46

4 Role erosion 9.98 10 3.56

5 Role overload 12.05 13 3.74

6 Role isolation 8.25 9 3.31

7 Personal inadequacy 9.7 9 3.89

8 Self-role distance 7.44 7 3.42

9 Role ambiguity 9.07 9 5.48

10 Resource inadequacy 12.26 13 3.93

  Overall Role Stress 9.86 9 2.44

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