Effect of Comprehensive Training Package of National Health Programs on Knowledge and Skills of Auxiliary Nurse Midwives in Haryana, India

Abstract Introduction: Auxiliary nurse midwives (ANMs), a key cadre within India’s National Health Programs (NHPs). However, gaps in training, particularly in practical application, limit their effectiveness. This study evaluates the impact of a comprehensive training package on the knowledge and skills of ANMs in Haryana, India. Methodology: A quasi-experimental pre–post design with no control group was conducted among 250 ANMs across 149 subcenters in Ambala and Panchkula districts, Haryana. A universal sampling method was used. Data collection included a self-administered questionnaire (SAQ) and an objective structured clinical examination (OSCE) checklist to assess knowledge and skills. A training intervention consisting of a modular training package and video demonstrations was implemented. Data analysis involved paired t -tests and multivariate regression to evaluate changes in knowledge and skill scores. Results: Baseline data revealed significant knowledge gaps, particularly in mental health and tobacco control. Following the training, knowledge scores improved by 46% and skill scores by 37% ( P < 0.0001). Notable skill improvements were observed in areas, such as pregnancy detection, blood pressure measurement, newborn resuscitation, and ORS preparation at home, with most ANMs shifting from the poor/average categories to the good category (>70% score). The greatest overall gains were seen in the National Tuberculosis Elimination Program (NTEP) and Reproductive Maternal and Child Health (RMNCH + A). Factors positively influencing knowledge scores included working alongside a second ANM and receiving the training intervention ( P < 0.05). However, a decline was noted in certain skills, such as tetanus toxoid (TT) administration, highlighting the need for targeted refresher training. Conclusion: A structured, job-oriented training package significantly enhances ANMs’ competencies. Integrating practical, hands-on training with existing theoretical models is essential for improving public health outcomes. Policymakers should prioritize periodic refresher training and comprehensive capacity-building strategies to optimize the impact of trainings on ANMs.