Nurses are one of the key building blocks of the health system; and comprise roughly 30% of the health workforce.[1] Tackling any health challenge and achieving the Millennium Development Goals is impossible without nurses, and yet, like most health cadres in India they are in short supply. Despite their centrality to the health system, nurses suffer from low status, are given little recognition for their work, and have little decision-making authority. Additionally, poor management contributes to low morale.
Nursing education in India has suffered policy neglect. Many studies have found knowledge and skills of practicing nurses to be inadequate to face the health challenges of the poor.[2] Furthermore, nurses are generally poorly equipped and unmotivated to work in rural settings where the need is greatest. Recently, to meet health worker shortages, standards were relaxed and private schools and colleges have mushroomed, further diluting the quality of training.
Awareness of these significant challenges is increasing. In the current policy context in India, with the roll out of the National Rural Health Mission and the dialogue around Universal Health Coverage and the 12th 5-year plan, human resources have become a central policy concern. There is recognition that the nursing cadre is an important part of the solution.
To equip the cadre to tackle the challenges ahead, the Indian Nursing Council has now mandated continuing education for nurse re-registration. Ideally this will update nurses’ knowledge and practice, bringing into line with current practice, filling the skill gaps, and increasing access to care. The huge scale of the nursing workforce in India means a massive roll-out of ongoing nurse training. There are many implicit challenges. Due to nurse shortages, releasing nurses from the facility for training is problematic. Also, the cost of travel and accommodation for offsite training is high.
While infrastructure is in its early stages, computer based learning (or ‘m-learning’) delivered in the facility or home has a huge potential to increase efficiency, effectiveness and convenience of nurse education and training. While mlearning may not be a solution for all contexts in India at this stage, it will likely work in some states, and other states are enroute towards “e-readiness”. Ultimately, once systems are strengthened, computer-based training will be efficient and highly cost effective – allowing equity in access to training.
I did some work for a private foundation in Maharashtra to examine “what works in building the capacity of nurses in India?”. I examined the literature and spoke to leaders in Nurse education. I compiled what is currently known to see how we could apply it to computer based continuing education modules. What is clear is that while computer-based learning holds much promise for reducing the cost of rolling out standardised quality training, it needs to be complemented by practical face-to-face training to build skills and build confidence in these skills.
I also found that the knowledge base for nurse education in India is huge, but the evidence base is minimal. There is a need for more operations research to figure out the best ways of cost-effectively introducing continuing education to the cadre, without disrupting service provision.
Download the full brief What Works in Building Capacity of Nurses in India 200513. [1] Rao, M; Rao, K. Shiva Kumar, A.K.; Chatterjee, M. (2011) Human Resources for Health in India, The Lancet, January 12 [2] See, for example; IntraHealth International, The Vistaar Project 2010. Technical Report: Skilled Birth Attendance by Auxilliary Nurse Midwives in Select Districts of Jharkhand. New Delhi.