| dc.description.abstract | Background: The policy processes of the policy on ‘Nurse practitioners in midwifery’
(NPM) are described. The policy aims to educate and create a new cadre of
competent midwives in the government hospitals as an alternate human resource for
maternal and newborn care for remote rural facilities.
Methods: Participant observation in every day setting, in depth interviews with actors
involved in policy processes and a self administered questionnaire to one batch of 37
NPMs were used. The conceptual framework of policy processes developed by
Andrew et al (2011) was used for analysis.
Findings: The NPM policy was delayed because of frequent change of secretaries and
commissioners of health who led the policy process but did not share the vision of
policy initiators, and there was less push and shared vision unlike the national
programmes, being a state driven policy. The nature of the issue influenced the policy
process; many were unconvinced about developing an autonomous cadre of
midwives who can fill in for doctors. It was seen as competition by obstetricians. The
policy processes were closed though many departments within the government and
some actors outside the government were involved. There was less space for open
dialogue amongst the various actors, all the discussion was through notes on the file.
The main actor s to push the policy forward were less powerful within the
government machinery.
Overall the NPM course has been successful in developing competence for normal
childbirth; some more practice is needed for complications during labour. Since
majority of the candidates for the course come from cities, the objective of human
resource for remote rural facilities may only be partially fulfilled.
Conclusions: There is a need to develop a protocol for robust policy processes which
are unaffected by changes in leadership, where there are opportunities for dialogue,
to bring in and examine evidence, to improve policy processes. | en_US |
