Johnson & Johnson capacity building initiative for Auxiliary Nurses and Midwives

By auther pic. Faiza Ruksar Arif

January 2, 2020

Johnson & Johnson capacity building initiative for Auxiliary Nurses and Midwives

ANM nurses conducting community health programs

The Indian healthcare scenario is a spectrum of contrasting landscapes. One end of the spectrum holds glitzy steel and glass structures delivering high tech Medicare to urban Indians. The other end consists of ramshackle outposts in remote areas, trying desperately to live up to their identity as health subcenters, waiting to be transformed into shrines of health and wellness. With the rapid pace of change currently being witnessed, this spectrum is likely to widen further, presenting even more complexity in the future.


Despite the health sector employing five million workers in India it continues to have a low density of health professionals. This workforce statistic has put the country into the "critical shortage of healthcare providers" category. "Southeast Asia needs a 50% increase in healthcare manpower to achieve universal health coverage by 2030. India faces the problem of acute shortages and inequitable distributions of skilled health workers as have many other low- and middle-income countries".  said K. Srinath Reddy, president of, Public Health Foundation of India. He reiterates that the need of the hour is to design courses for different categories of non-physician care providers. "Competencies (and not qualification alone) should be valued and reform must be brought in regulatory structures to provide flexibility for innovations", he added.


Johnson & Johnson a global conglomerate that blends heart, science, and ingenuity to profoundly change the trajectory of health for humanity has found a promising solution to this crisis in healthcare. Johnson & Johnson Private Limited, India (J&J India) is a subsidiary of Johnson & Johnson and is one of India's most comprehensive and broad-based manufacturer of health care products, as well as a provider of related services for the consumer, pharmaceutical and medical devices markets.J&J India derives its corporate social responsibility vision from the conglomerate's core values of quality, reliability, and trust guided by international standards and best practices.


J &J’s impactful capacity building program aims at strengthening healthcare systems in rural India by training auxiliary nurses and midwives (ANM). Multiple research studies have highlighted the abysmal conditions of healthcare in rural India, which is characterized by minimal facilities, untrained hospital staff, and a repeated inability to access health care due to infrastructural and financial restraints. Given this skewed demand and access to healthcare, hospitals are forced to hire unskilled persons which directly impacts patient care, wages and working conditions of health service providers. The most severely affected population consisted of women, children and the elderly. Interestingly, women emerged as victims of inadequate health care and unemployment but were also constructed as a group with immense potential for capacity building and employment within healthcare.


Recognizing that the role of women is critical in developing sustainable, healthy successful communities, J & J India launched its initiative that focuses on capacity building and employment of Auxiliary Nurses and Midwives. ANMs (Auxiliary Nurse Midwives) is tasked with assisting nursing practitioners in administering care to patients – residing in old age homes, help centers for the disabled, in house hospice, and hospital patient care. Started in 2010, Johnson & Johnson supports the training of girls from rural Maharashtra to study at the School of Nursing for Auxiliary Nurse Midwife (ANM) at the Bel Air College of Nursing, Panchgani and at the St. Joseph's Multipurpose Health Workers Training School, Nellore for ANMs and midwives.


The first project was piloted at the Bel Air Hospital, Panchgani, run by the Indian Red Cross Society.  Bel-Air established a College of Nursing and operates in collaboration with an American University, the University of Illinois at Chicago. It is a first of its kind, owing to its focus on HIV/AIDS.  The objective of Bel-Air College of Nursing is to enhance the content and quality of nursing education in India to international levels. Bel-Air College of Nursing proved to be a success, leading to J & J India expanding and establishing an ANM training program at St. Joseph's Multipurpose Health Worker Training School, Nellore, Andhra Pradesh in 2015.


The program was rolled out in the villages of Satara District around Panchgani and villages in Andhra Pradesh given the harsh socio-economic conditions of the region. These areas are occupied by small laborers and farmers with small landholdings who earn the bare minimum to keep their families afloat. A vast majority of the girls from these socio-economically strained areas are unable to pursue secondary education and are either married off at a young age or forced to labor in the fields. Each year, 80 girls are selected for the ANM capacity building initiative not exclusively based on merit but their economic background is also taken into consideration. The beneficiaries undergo a 2-year residential course where their course fees, accommodation, food, study material, uniforms, and stationery costs are borne by the organization. They undertake a robust and rigorous course where they are taught about community health nursing, health promotion, primary healthcare, child health nursing, antenatal and Intra natal labor room management, postnatal care and health center management.  After completing the course approved by the Indian Nursing Council, the girls are placed in village health programs under the National Rural Health Mission


The program seeks to transform the quality of health care in rural India in the long run while also positively impacting the lives of women and children specifically. It also seeks to educate and empower adolescent girls and young women through employment opportunities.  At Bel-Air Hospital, 228 girls completed the course (direct beneficiaries) going on to positively impact over 200,000 people (indirect beneficiaries) through health care management and procedures. Similarly, at St. Joseph's Multipurpose Health Worker Training School, 172 girls completed their training and were able to provide health interventions for over 70, 000 indirect beneficiaries. The training program has reduced infant and maternal mortality rates significantly, while also boasting of a 60% to 30% decrease in the number of anemic and malnourished cases in the villages specifically in the areas where the ANM trained girls are placed.  The results show an increase in best hygiene practices from 30% to 70% amongst the population that the ANM girls cater to.


Many of the trained ANMs have been placed in community health programs, thereby improving the quality of healthcare in rural villages in Maharashtra and Andhra Pradesh, and there has also been a noteworthy improvement in the economic, educational and social status of beneficiaries. Their interventions have increased the levels of health awareness hygiene, sanitation, and nutritional intake among the villagers. The difference is noticeable in the villages with households following proper hygiene and sanitation practices.  During the last year, 398 families in the Satara district had started kitchen gardens to supplement their vegetable intake, which resulted in improvement in their BMI and hemoglobin levels.


Given the plethora of long term and short-term effects documented across the districts of Maharashtra and Andhra Pradesh, there is a need to expand and scale the program for a larger outreach. This can be done by increasing the number of seats in the courses at the two locations. Hence, both implementation partners are currently working tirelessly towards garnering the necessary permissions to greenlight the project on a larger scale. They are also simultaneously facilitating the placement of a maximum number of trained ANMs in Primary Healthcare Centers and Sub-centers.


Swati Chavan, qualified as a nurse through the Auxiliary Nurse and Midwives Training Program


Swati Chavan, a 25-year-old woman from Kamathi Village, in the district of Satara, shared her experience in training.  "When I was younger, I dreamt of becoming a nurse to care for the sick and suffering people of my village, but as I grew older, these dreams only felt farther away. You see, I come from a poor family of farmers. We are heavily dependent on the farm but with over half the land barren, the farm's income barely suffices our daily sustenance needs. After completing my secondary education, my father had decided to marry me off to reduce the burden of care. In what can only be deemed as godly intervention, I received timely information about a free Auxiliary Nursing and Midwifery (ANM) course being offered in the Bel Air College of Nursing, Panchgani from a relative. I visited the institute where Father Tomy, Director of the College, urged me to apply for the course and has since continued to remain my mentor and supporter for the duration of the course. I was given two years of free training, and my living needs were all taken care of. The course was a life-changing experience and has significantly shaped my confidence, personality, and mindset. I have come to realize the crucial role educations plays in emancipating women like me. It gives us financial independence, a purpose in life and builds status in society. Thanks to Johnson & Johnson I am now a qualified nurse with my income and a bright future. After I started working I was able to help my father build a house and support my younger brother in his studies. I have also enrolled in a distance course for a Bachelor of Arts degree. My future is now filled with endless possibilities."


Swati's story is just one droplet within a vast ocean of voices from the grassroots. These voices are a resounding testament to the power behind collective action, paving way for a future where healthcare is not a privilege but a prerequisite to a healthy happy life.


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Faiza Ruksar Arif is a content specialist and researcher based in Bangalore who has worked extensively on curating curriculum and educational programs for adolescents in Telangana. With a Master’s degree in Gender Studies from Tata Institute of Social Sciences, Faiza is on a mission to improve social realities by equipping women and other marginalized sections, with improved access to health, education and livelihood opportunities. She also dabbles in artwork and is passionate about issues pertaining to mental health and minority politics.


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