The Dai training under RCH programme has been implemented on priority basis in 142 districts covering 17 states in the country. These districts have poor safe delivery rate of less than 30 percent. The purpose of Dai training is to provide Dais with necessary training to ensure skills for antenatal check-up, conducting of safe and normal delivery, to identify high risk pregnancies, and danger signals during delivery for appropriate referral and also provide counselling on nutrition and safe delivery.
In Madhya Pradesh there are 42087 trained Dais in 52317 villages covering 45 districts. In 42087 villages have at least one trained Dai by November, 2002. Target is set by the state government to have at least one trained Dai (1 month basic Dai training) in every village by end of December, 2002. The Dai training under RCH programme has been initiated in the fourteen districts in Madhya Pradesh. These districts are Tikamgarh, Balaghat, Raisen, Damoh, Narsimhapur, Vidisha, Chattarpur, Jhabua, Rewa, Bhind, Mandla, Satna, Panna and Sidhi.
Objectives: The World Bank in its aide-memoir has desired that the Dai training programme under RCH needs to be evaluated in the state. Specific objectives of the study are –
· To observe procedures adopted for the selection of the Dais and site of training
· To ascertain quality of training in the area of skill enhancement
· To assess impact of training on their skills and practices during deliveries
· To study the involvement of district level officials and their supervisory role
· To understand the operational constraints faced in implementing the programme
Methodology: Three types of questionnaire were imparted, (i) For district and state level officials, (ii) trainers involved in training, and (iii) Dais who trained. Secondary data were collected from directorate of public health and family welfare, Bhopal CMHO office, and from the CHCs of the two districts selected for evaluation namely Tikamgrh and Jhabua.
Major Findings and Suggestions:
· All 14 districts, identified for Dai training has received a total amount of Rs. 46,78,800 for imparting Dai Training.
· Each district has received an amount of Rs.3, 34,200 for training. Till the September 2002 Rs.7, 70,139 has been spent under the programme and the balance amount is Rs 39, 08,661.
· It is noticed that out of 14 districts, Satna, Panna, Sidhi, Rewa and Chattarpur districts have not utilized grants sanctioned by state government. These districts have opted for Dai Training under the sponsorship of DANIDA and are being conducted by the trainers from the Integrated Population Development Project (IPDP).
· The Chief Medical and Health Officer of the district is over all in charge of implementation of the programme. The District Public Health Nursing Officer (DPHNO) coordinates the scheme, by identifying and finalizing the training of trainers, and selection of Dais.
· Altogether 23 trainers from Tikamgarh and 60 from Jhabua have been imparted the training of trainers (TOT). The BMOs, LHVs and ANMs received 2 days’ TOT training at the district head quarter. In Tikamgarh district, BMOs, LHVs and ANMs received 3 days orientation training at RHFWTC Gwalior.
· It is observed that Dais who are already trained under the basic training programme, have been selected for training under the RCH programme. In Tikamgarh, out of 6 CHCs where Dai training took place, only in 4 CHCs, Niwari, Prithivipur, Jatara, and Palera, on an average 40 deliveries take place in one month. In Jhabua, Out of 10 CHCs, in 8 CHCs (Meghnagar, Thandla, Petlavad, Ranapur, Udaigarh, Jobat, Sondawa, and Bhabra) the minimum required number of 40 deliveries takes place in a month.
· Main operational constraint observed in Tikamgarh is that Dais work in some areas is caste based. Mainly women of Basore caste are involved in the Dais’ work. It is difficult to find local Dais from Basore community in some of the remote villages. So, preference of selection of Dais from remote villages gets affected. Although, a few women from other community got training, but do not practice because of the caste-bias.
· The main operational constraint in Jhabua as noticed is that in some of the blocks of Jhabua, male Dais are functioning. Male Dai is preferred because people in tribal area believe that males are strong compared to females and will be more helpful during strenuous procedures of delivery. Also, in non-accessible tribal areas males can move in night more conveniently as compared to females. The CMHO reported that it is very difficult to get a female Dai in some villages for Dais’ training because of preference for male Dais.
· All Dais enrolled for training has completed the two phases of 10 days training. The training was conducted in CHC, where more than 40 deliveries in a month take place.
· The curriculum of the training included is being completed. During the ten days training Dais have never visited any referral unit during the training programme.
· Dais have observed deliveries at respective CHCs where they were trained.
· Dais have not conducted deliveries independently as part of their training.
· No pre or post training evaluation has been done to assess skill enhancement in terms of knowledge acquired.
· Routine monitoring or review of Dais work has not been done since there are no records maintained.
· The concerned MO has also not done quarterly monitoring or supervision.
· No identity card or certificate has been issued to the Dais by the district authority so that they are recognized as a trained Dai.
· There are Dai training programmes funded by various international agencies running on same lines simultaneously. It is necessary to have a proper planning and co ordination among programme managers to reduce programme overlapping.
· It is suggested that IEC activities must be intensified to mitigate caste bias or discourage male Dais particularly in areas where traditionally males are conducting deliveries.
· Dais’ job is carried out generally from generation to generation. Over a period of time they have developed a particular mind set to carry out their job. A few days’ training has its limitations to bring about a change in their attitudes and behaviour. Only a constant monitoring and supervision of their work during post-training period may yield desired result. It is suggested that neglected monitoring and supervision of Dais’ work during post training period need to be strengthened.
· It is noticed that all he Dais have not received necessary practical experience of conducting one or two deliveries independently under the supervision of LHV/ANM. It is suggested that during training period practical experience of conducting one or two deliveries should be done independently by the Dais under the supervision of LHV/ANM as stipulated in the guideline.
· Dais have not visited any referral unit during training. It is necessary that all Dais should visit a referral unit during training period, so that when they need to refer a complicated case they can do more conveniently.
· It is expected that Dais would be involved not only during delivery but also during ANC and PNC stages of pregnancy of women. They also assist ANM and Anganwadi Worker in their work. Dais are generally very poor and also get a very meager amount in cash or kind from a household in the rural area. The state government should think of some incentive for Dais for their services. Also, necessary steps should be taken to ensure that the sanctioned amount reaches to the Dais timely.
· As stipulated in guideline Dais should be issued identity card for due recognition of her role in the community.