BMC ( Bhavnagat Muncipal Corporation) MPHW- Multi Purpose Health Worker Exam Written Exam Result Declared.

Our study observed that ANMs spent a median of 7 h on the job per day, of which only 60% of the time was spent on direct program activities. With respect to time utilisation by ANMs, we compared our findings with the suggested time in the NHM guidelines (Table 5) . We observed that ANMs spent a median 45 h per week against suggested 42 h per week. There is less scope of increasing ANMs’ working hours but the ANMs who were spending less time should be closely supervised and supported to at least provide 42 h on the job per week. Adequate community health worker management comprising of effective and supportive supervision is known to have had demonstrated tangible impact onto their performance .

We observed that despite two ANMs at SC and geographic distribution of work, the distances and population to cover are large with respect to the time required to provide promotive and basic curative care through outreach activity. This is even more difficult in sparse habitations, an absence of transportation, low skills and multiple tasks in hand.We observed that most of the service delivery was only for a few components of two health programs (maternal and child health and communicable disease outbreaks). They provide services for other health programs during home visits and camps or special days. ANMs spent negligible time on programs for non-communicable diseases, specific communicable diseases, adolescent health, nutrition, etc. Apart from direct service delivery, ANMs were required to do several programmatic (records and reports), programmatic support (meetings, trainings, etc) and non-health related activities (election duties, surveys, etc). The latter two are usually not considered while recommending/monitoring ANMs work schedule/plan. ANMs do a lot of multi-tasking to be able to carry these tasks. Studies suggest that multi-tasking by health workers coupled with other systemic factors like lack of staff, skills and supervision compromises on their capacities 

District administration may call for any training or meeting or ancillary work (reports, surveys, election duties, etc.) without considering its impact on ANMs’ regular work schedule. Although these tasks are in a broad domain of work, frequent untimely disruptions in routine work reduce performance. In low- and middle-income countries amidst a human resources crunch and dual burden of diseases, task shifting and prioritisation with a rational distribution of tasks can be instrumental . In India, this would require adding more numbers to existing frontline health cadres, adding more male-MPHWs, and providing close supervision. Mostly, the administration will need to respect the schedules of the frontline health workers and align their agendas accordingly.Strength and limitationOur study is unique in that it observed the functioning of ANMs and assessed views about it from supervisors at different levels. Although we could only observe 43 ANMs, it was the biggest sample of such studies from India. We used a mixed-methods approach and imbedded inductive philosophy into a deductive approach of data collection. We could have gathered more information and variation if we had observed each ANM for two subsequent weeks. Nonetheless, we observed 249 ANM days that provided us with enough sample data to arrive at important results and conclusions.

BMC ( Bhavnagat Muncipal Corporation) MPHW- Multi Purpose Health Worker Exam Written Exam Result Declared.

LABORATORY TECHNICIAN RESULT