Creating the conditions for scale-up of the Men in Maternity intervention in India

Abstract

The Frontiers in Reproductive Health Program (FRONTIERS) conducted an operations research study, called the Men in Maternity (MiM) study, in collaboration with the Employees" State Insurance Corporation of India (ESIC), the objective of which was to involve men in the antenatal and postpartum care of their partners to raise knowledge and use of postpartum contraception and preventive practices against sexually transmitted infections, as well as improving pregnancy outcomes. The original operations research study is described elsewhere. As soon as it was clear that the intervention was effective, ESIC decided to scale it up within the Delhi Directorate. The scale-up was initiated in January 2003; during the first phase ESIC expanded the intervention from three to 10 dispensaries. Of these ten dispensaries, six participated in the original MiM study and a further four dispensaries were added. Through two more phases ESIC would introduce the MiM model into the remaining 20 dispensaries by adding 10 dispensaries in each phase. The scale-up process began with the training of Master Trainersnine doctors from two ESIC hospitals and the three original MiM intervention dispensaries.All Auxiliary Nurse Midwives (ANMs) and Doctors working at the dispensaries were to receive training. However, there were many delays in training due to the inability to release staff for training, key staff transfers, long gaps in appointing a new person on key managerial positions, other priorities (e.g. RCH and DOTS), and inability to foresee the materials and supply demands and allocate resources to print and provide materials to dispensaries in time. These delays forced a change in the strategy and the MiM services were introduced as soon as the core staff providing antenatal and postnatal services was trained.Training of supervisors and whole site orientation of all clinical and non-clinical staff at each dispensary were conducted as soon as it was estimated that the core staff of program introducing dispensaries had been trained. During the first phase of scale-up it was planned that the Additional Director of Inspections (ADI) from the four zones would take over supervisory responsibilities, under the supervision of Additional Director (PS&CA). This process had to be abandoned due to ESIC restructuring as the whole cadre of ADIs was removed and personnel were transferred to other responsibilities within ESIC. Realizing that supervision of MiM activities needed to be decentralized, ESIC managers organized a one-day orientation workshop on MiM supervision in which all 30 Medical Officers in-charge of ESIC dispensaries in Delhi participated.FRONTIERS provided all additional BCC materialsposters, brochures, maternity cards and penis modelsfor the first year of implementation. ESIC committed to print and provide these materials during the second phase of scale-up. All requests for MiM materials were channeled through the AD (PS&CA) so that future demands from dispensaries were made through their routine indenting system. Although ESIC made s...