Country report. Evaluation of traditional birth attendants (DAIS) training scheme in India. A collaborative study.

In 1978 UNFPA provided funds to India to evaluate its training program of traditional birth attendants (dais) which existed since 1956. The National Institute of Health and Family Welfare and 8 other institutions did the evaluation and compared trained and untrained dais in 15 major states. None of the states had had a systematic implementation and monitoring plan with continual feedback of dais training. Moreover the states did not coordinate with each other to organize a consistent training program. 35% of trainers had no guidelines for training dais. In addition little supervised field training occurred. Moreover class room training tools basically consisted of dai kits. Trainers did not have audiovisual aids models dummy and fetal dolls. Besides most dais did not receive maternity kits after training. In fact Jammu and Kashmir (J&K) had not provided any kits since 1979. Therefore the states were basically unable to achieve their targets for training of dais during 1978-1981. For example no training of dais occurred at all in Kerala since 1979. Most dais were from the lower socioeconomic class. Untrained dais made more money than trained dais in all states except Maharashtra and West Bengal. Trained dais delivered more infants than untrained dais in all states except J&K and Tamil Nadu. Dais in all states except West Bengal thought they could avoid evil spirits if the room where delivery occurred was dark dismal and closed. Dais in 7 states still believed the cord should be dressed with ghee oil and ash to ward off sepsis. 679.1% of trained dais used scissors to cut the cord compared to 24.2% of untrained dais. Further 70.7% of trained dais boiled instruments before use whereas only 40.5% of untrained dais did so. Trained dais were more likely to comfort the mother than untrained dais. In conclusion the dais training program needed much improvement.