title: Task-shifting challenges for provision of skilled birth attendance: a qualitative exploration.
abstract: BACKGROUND
  Shortage of skilled birth attendants (SBA) is one of the determinants of maternal mortality in India. To combat this shortage, innovative task-shifting strategies to engage providers of the Indian system of medicine (Ayurveda and Homeopathy), called AYUSH practitioners (AP), to provide SBA services is being implemented.
  
  
  METHODS
  Engagement of APs for SBA service provision was assessed in 3 states of India (Maharashtra, Rajasthan and Odisha) through 73 in-depth interviews (37 with APs and 36 with programme managers). The interviews explored the providers' SBA training experience, barriers for SBA service provision, workplace and community acceptance, and the perspective of programme managers on the competence and quality of SBA services provided.
  
  
  RESULTS
  SBA training led to skill enhancement with adoption of appropriate maternal and newborn care practices. A dedicated trainer, more hands-on practice, and strengthening training on newborn care practices and management of complications emerged as the training needs. Conditional involvement in SBA-related work, a discriminatory attitude at the workplace and lack of legal/regulatory authorisation were identified as barriers to the inclusion of APs in SBA service provision.
  
  
  CONCLUSIONS
  Quality skill enhancement measures, an enabling work environment, a systematic task-shifting process, role definition, supportive supervision and credentialing could be key for the integration of APs and their acceptance in the health system.
authors.affiliation: Division of Reproductive and Child Health, Indian Council of Medical Research, P.O. Box No. 4911, Ansari Nagar, New Delhi 110029, India n_chandhiok@hotmail.com.
authors.forename: Nomita
authors.initials: N
authors.lastname: Chandhiok
authors.affiliation: Consultant, Qualitative Data Analyst, Pune 411030, Maharashtra, India.
authors.forename: Neelam
authors.initials: N
authors.lastname: Joglekar
authors.affiliation: Consultant, Obstetrics and Gynecology, Pune 411004, Maharashtra, India.
authors.forename: Aparna
authors.initials: A
authors.lastname: Shrotri
authors.affiliation: Consultant, Pediatrics, New Delhi 110023, India.
authors.forename: Panna
authors.initials: P
authors.lastname: Choudhury
authors.affiliation: Asian Institute of Public Health, Bhubaneswar 751002, Orissa, India.
authors.forename: Nayanjeet
authors.initials: N
authors.lastname: Chaudhury
authors.affiliation: Division of Reproductive and Child Health, Indian Council of Medical Research, P.O. Box No. 4911, Ansari Nagar, New Delhi 110029, India.
authors.forename: Shalini
authors.initials: S
authors.lastname: Singh
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D006282:Health Personnel; D006705:Homeopathy; D006801:Humans; D007194:India; D008427:Maternal Health Services; D008428:Maternal Mortality; D008515:Medicine, Ayurvedic; D008875:Middle Aged; D008880:Midwifery; D011247:Pregnancy; D024382:Professional Role; D036301:Qualitative Research; D014937:Work; D000078329:Workforce
keywords: Credentialing; Integration; Skilled birth attendant; Supportive supervision; Task shifting