The Auxiliary Murse Midwife (ANM) cadre was created by the Mukherjee Committee in 1966 to focus on maternal and child health. ANMs are respected members of their communities and providers of maternal and child health care at the sub-centre level. They are the grass-roots workers in the health organisation pyramid in India. Under the National Rural Health Mission (NRHM), ANMs were established as a link between health services and the community.
The roles of ANMs further expanded under the National Urban Health Mission (NUHM), which focuses on providing healthcare to the vulnerable and disadvantaged groups in the urban area. In urban areas, the ANMs and the Accredited Social Health Activists (ASHAs) play a crucial part in helping people living in slums and slum-like habitations. ANMs and ASHAs help with the health needs of this population and also in tackling various social and environmental factors affecting their health. Each ANM is supported by 4-5 ASHAs and are collectively in charge of a population of about 2500 in plains and 1500 in hilly or tribal areas.
What does an ANM’s training include?
It is important to ensure that ANMs are well trained as they play an essential role in providing maternal and newborn health at a primary healthcare level in India. Effective in-service training is crucial for upgrading their knowledge and skills for providing appropriate services. ANMs receive 24 months of training (should have a minimum qualification passing 12th grade) and additional training from time to time.
The Ministry of Health and Family Welfare (MoHFW) published a guidebook in 2017 for enhancing the performance of ANMs in urban areas. This training module aims to help ANMs understand their role within the Urban Health Mission and to help them develop empathy towards the plethora of social and economic challenges faced by the population. This will help to shape their health-seeking behavior and improve health outcomes.
What services do they provide under NRHM?
ANMs work at health sub-centres. The sub-centre is a village-level institution that provides primary health care to the community and is in charge of a population of 5000 people in plain areas and 3000 people in hilly or tribal areas. In 2005, NRHM made provision of two ANMs (one permanent and one contractual) for each sub-centre. The ANM is usually selected from the local village to increase accountability.
ANMs are expected to be multi-purpose health workers. Along with maternal and child health, their work includes family planning services, health and nutrition education, efforts in maintaining environmental sanitation, immunisation for communicable diseases, treatment of minor injuries, and first aid. In remote areas where transport facility is likely to be poor, ANMs are even required to conduct home deliveries for women.
What services do they provide under NUHM?
The myriad responsibilities of an ANM under the NUHM with respect to maternal care are:
1. Outreach sessions and camps: The activities conducted by the ANM during various outreach sessions include –
- Antenatal care and Postnatal care (all components such as ANC registration, PNC Checkup, etc)
- Counselling and raising awareness for family planning and delivery of contraception
- Growth monitoring and counseling on nutrition and breastfeeding
2. Services delivered during home and community visits
- Ensuring that RCH services like ANC, PNC, immunization, family planning, and safe abortions are delivered to all eligible beneficiaries, with particular emphasis on the marginalized communities.
- ANMs should prioritise and motivate women with high-risk pregnancies, those in the final month of pregnancy and those who missed their ANC during outreach sessions, for institutional delivery.
- Support ASHAs to ensure home-based newborn care for all home deliveries.
- Midwifery services for pregnant women delivering at home.
- Home based care for post-partum mothers as indicated by ASHA or due to failure to attend UHND.
- Review, and refer when appropriate, sick new born/low-birth weight babies and malnourished children.
- Motivate families and ensure that unprotected children receive vaccination during subsequent immunization sessions.
3. Responsibilities at the UPHC
- Provide facility-based immunisation on the weekly fixed day/s for this activity.
- Facility-based family planning counselling and offering contraceptive services (IUCD, condoms, OCPs, emergency contraception).
- Assist in ‘Special Day Clinics’ e.g. Adolescent Health, Family Planning, Chronic Illnesses, Elderly care etc.
- Provide midwifery services if the UPHC is a delivery point. At Delivery Points when a pregnant woman is in labour, it is mandatory for the ANM to be with her, until at least 4 hours after the 3rd stage of labour is completed.
4. Administrative responsibilities
- Listing of beneficiaries in the catchment area.
- Creating family folders including ANC and PNC register, Immunization register, Outreach Registers, and Family Planning.
- Registering and maintaining these records and reports.