Volunteer community health workers (CHWs) are a major strategy for increasing access to and coverage of basic health interventions. Our village health worker training course reviews the process of training and continuing education of CHWs as an important component of involving communities in their own health service delivery. Participants will be guided through the steps of planning training and continuing education activities for village volunteers. The course draws on real-life examples from community-directed onchocerciasis control, village health worker programs, community case management efforts, peer educators programs and patent medicine vendor training programs, to name a few.
Lecture 6D: A Simple Training Guide
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From the course by Johns Hopkins University
Training and Learning Programs for Volunteer Community Health Workers
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From the lesson
Selecting Training Methods, Materials, and Resources
In this module, we will focus on a variety of methods, training logistics, and educational materials. There will be a quiz that covers lecture 5-6 to after completing these lectures in this module.
Meet the Instructors
William Brieger, DrPHProfessor, Health Systems Program of the Department of International Health
Bloomberg School of Public Health
Welcome to our final section of this lecture.
As we promised, we're going to introduce you to the idea of
writing down your plans and your activities in a simple training guide.
The point of all this, again, is to pull things together, where you
can clearly see what you're planning to do, how you're going to do it.
The guide will help you remember the steps that you plan to take in carrying
out the training.
Help you remember the materials and resources you
need to pull together to make it happen.
And one good thing about having it written up
is that you can share it with other people.
Maybe your colleagues in another district want to replicate your training.
And they can use your guide, if it's well written, and very
simple, and straight forward, to carry out the same training in another location.
This is not absolutely the way things have to be, but here's a suggestion
of some of the content that we hope would be covered in a training guide.
As a document, you'd want a simple title page to let people know what it's about.
you know, you would want a section on
describing who are the people this is aimed at.
Who are the trainees?
Where are they working? how do we recruit them?
Then we
would also want to explain a bit about training needs diagnosis.
we can report on the findings that we had for our own program.
But if other people are going to use it, we'd want to clearly
describe the kinds of diagnostic methods we use to put our materials together.
There needs to be a preparation section, telling people what to do in advance.
The materials
to get together, the arrangements to be made, the people to be involved.
No matter how long your training is, whether
it's one day or one week or longer.
There does need to be an introductory session at the very
first of the program, and so you need to describe that.
Subsequently, there may be var, numerous sessions,
depending on how many objectives you have.
And like
I said, it may be that you have a couple two hour
sessions based on two or three objectives that, that have been formulated.
And you would describe how to carry out those different sessions.
As I said, it could be sessions during one
day, it could be two or three day workshop, depending.
with our village health workers what we often do is, if we're
trying to be based in the community, we may do it weekly.
And they would come together you know one afternoon a week for several weeks.
But each session with them would be described clearing what your going to do.
at the very end, there has to be some sort
of a wrap-up and pulling together what people have learned.
Finally, there should be a section on evaluation.
And we will talk a bit about evaluation in an upcoming lecture,
but we definitely need to look at what's happening during the training.
Are things going as planned?
After the training, did people actually gain something before they go home?
In terms of knowledge and skills.
And then also, follow up.
Will we visit the village health workers in their community.
Or when they come
back to the health center for their monthly meetings to see
what they have retained in terms of their knowledge and skills.
We've talked about training matrices as part of your assignments.
And so when you develop these, you can put them as appendices to your training guide.
They're nice to pull out for the trainers as a, as a nice, as a, quick summary of
all of the things that need to be done for a particular training session.
The title page here taking an example of a program we did.
Training existing village health workers, sort of as an
in-service or continuing education activity for guinea worm surveillance.
And we discovered as the Guinea worm was being eliminated and eradicated
around Africa, we needed to keep an eye out for any cases.
and contain those before
they spread.
So surveillance is a very important activity in malaria control now.
People are trying to develop ways of promptly
identifying cases of malaria, and treating and reporting those.
So this issue of surveillance, especially at the village level, where people have a
keen eye on what's happening to their neighbors is, is a very important thing.
So you could substitute malaria, or
onchocerciasis, or any other condition for, for guinea worm in this case.
on your title page, where are you working. Also, who is organizing this?
Is there a sponsoring agency? Is there a local health department?
Is there an NGO? the dates.
And any other important information that you think would be necessary.
And especially if you're doing this with support from,
from financial support from a agency you may want
to put some sort of acknowledgment that type of thing.
The next section would be who are the trainees.
And in this case with the guinea worm we
were working With existing health workers in about 80 hamlets.
These were surrounding four big farm markets in one local government.
In fact, we held the training at the market because
people would come on market day.
And this made it easy for bringing people together
from the villages since they would have to come in.
So these were existing volunteers in these villages surrounding these markets.
And this was a continuing education.
So we were adding guinea worm case
detection on their existing duties, community case management.
Promotion of water and sanitation, first aid, and other duties.
So again,
he's describing who these people are.
Some things, if you're starting a new package of health interventions
you may need to describe the recruitment process from, from scratch.
How you're reaching out to the surrounding villages and getting
them, to select their volunteers, the criteria they come up with.
So the level of detail depends on the nature of the program you're doing.
We, again, want to describe what should be done,
and what we actually do for diagnosing the training needs.
We would want to talk about, in this case, interviewing the
existing village health workers on what they know about guinea worm.
How do they recognize it?
focus groups with villagers to find out more about local
perceptions and beliefs, and responses, when people have the disease.
Do they hide it?
Do they share it with their
neighbor to ask for help? What do they do?
again in-depth interviews with the health staff to
ask them their experience with working in the village.
And whether people bring guinea worm cases to them or not, and how they respond.
Looking at the clinic records to see if you find anybody coming to the clinic.
And then observing in the village what people are doing.
You know, if they have guinea worm. Are they sitting around like this guy in
the picture where everybody can see, oh yeah, he has guinea worm?
Are they lying on the mat inside their house and nobody knows?
So we need to find out normally by observing, how people respond to this
illness in order to figure out the best way to train people to identify cases.
The preparation section, as I said, this deals a lot with logistics.
One key component
though is stating clearly the objectives of the training.
We have four objectives here for the surveillance.
You want to talk about your logistics, the time, the venue.
in our case, we talked about the nearest market and finding a school nearby.
Your arrangements and discussions with market leaders and village leaders to
make sure that this was acceptable in getting people to come.
when we did identify a school that was near these markets,
wanted to make sure that there were enough benches or seats.
Some schools didn't have chalk boards, some did.
If they did, we had to bring our own chalk.
And if there were no chalk boards, we had to bring flip chart paper and markers.
So these are the kind of things you need to spell
out, because as we said, if you give the training guide
to somebody maybe in the next district or another NGO to
carry it out, you don't want to leave things to chance.
You want to make
sure that you explain the steps that you need to
do, the resources that you needed to pull this off.
You'll certainly want to visit the villages in this particular case.
to find out if they have village health workers, to
ask them to select somebody who will come to this training.
Maybe they have more than one, maybe all of them want to
come or maybe just one person wants to handle Guinea Worm surveillance.
We prepared a handout or a little pamphlet in the local language for
them with some pictures.
And so we needed to make sure that we printed enough copies of those.
Clearly you have to draw up a time table so that you're clear
what you're doing when and what order, and estimating the amount of time.
do we need refreshments, any other kind of logistical arrangements
need to be spelled out clearly in our training guide.
Once we actually get into the running of the training.
The first thing we will do
is an introduction.
And you need to spell out, and again I've, Ive bulleted these, but you would
want to give a narrative of telling the
trainer, even if it's yourself, as a reminder.
Okay, what do you do first?
Welcoming participants, introducing everyone.
explaining the purpose, sharing the objectives.
In some training programs, if people can read or write, you
may want to put up the objectives on a flip chart
in the local language.
But if you have, that's what you want to
do, write it out in your introductory section.
So that it's very clear what somebody, as
the trainer, is supposed to do to get ready.
explaining in this case, the purpose of being there, the
scope of work for this new task of, of surveillance.
And the rationale for that.
In the introduction, before we really get
into details, ask participants to share their experiences.
Making sure that they're involved in what's going on, that
they get excited about it, that they learn from each other.
We at this point can give out our handouts,
making sure that there's enough for everyone.
some of you, depending on the kind of program it is and
resources, you may want to even do a pretest during this introductory period.
maybe a short ten answer true false or multiple choice in the local language.
Sometimes, if people are not literate, we've found that you
have to do the pre-test and the post test through interview.
and so, you know the trainers, you know,
would divide up the trainees and, and actually
administer a brief oral test to them and see how they, how they did.
But again, all these needs to be spelled
out of what you do during this first session.
So it's clear to you and to anyone else
who may want to use your training guide later.
There will be sessions as we said, depending on the number of objectives.
in this case we had four objectives.
So we would have four
approximately one hour, 1 1/2 hour sessions.
Here, what we are writing out is an example of just one session.
And on the first objective, which is recognizing guinea worm.
And we would then spell out all of these things in much more detail.
That's why it's called a narrative.
First thing, of course, is to conduct a
brainstorming, you can go into as much detail
as you want, in terms of saying how you do it.
Assuring everyone contributes their ideas, writing it up on the chalkboard.
You can be as specific on what should be done as possible, so that
anybody else who picks up your training guide is clear on how to use it.
the next step would be reviewing the
pictures in the pamphlet, talking about those.
Having a discussion on how you can distinguish guinea worm from other
common diseases.
Some people in the villages where we were said oh, guinea worm causes rashes.
Well, there are many disease that cause rashes.
How do you know it's guinea worm and not one of these other diseases?
Reviewing the key points of this identification
of guinea worm, recognition for guinea worm.
That ultimately results in the village health worker notifying a program staff.
And what we did based on the diagnosis where we found
out that people had many beliefs about guinea worm.
It wasn't just when they see a worm come out somebody's leg.
But also stomach troubles, back ache, muscle pains
rashes, swelling here and there on the body.
And from the epidemiological point of view, unless the worm comes out of
your skin and the, deposits the larvae in the In the pond it's
not going to be transmitted.
So what we tried to do is go through
all of these issues through the brainstorming and say.
When you actually come regularly to report cases, tell us
especially the ones that you saw coming out of somebody's skin.
And then, with each session of course, there would
be questions and answers at the end of the session.
But, spelling out these details is very important for you, to make sure that
you cover everything.
And one of the things you'll notice, of course too, is that some of this,
this narrative corresponds with the kind of methods
that you've chosen for doing the training session.
So if you've mention that brainstorming is important than here
it is describing how you're going to go about the brainstorming.
If you talk about discussion here we are describing how and what we are discussing.
So,this narrative is what lets
you explain in detail what it is you want to do or you want another trainer to do.
So let's assume that we've done the three, four, five sessions.
Now we want to wrap up.
We definitely need a clear wrap-up time spelled out.
we want to give participants a chance to recall and
repeat some of the key things they've learned during the training.
we want to
use this as a reminder for people of what's coming next.
In this particular case we were setting up a weekly reporting system at the market.
So reminding people that the very next market on, let's say,
the following Thursday, we expect to see everybody will be around.
And you can tell us what you've seen with guinea worm for that week.
obviously thank people for attending if it's a workshop that's being held for
the very first time, you may want to give out certificates of attendance.
But you definitely want to make sure that you keep a record of everybody who came.
finally, you know, you may want to
schedule your post-test during this, this period.
Which leads us into the question of your evaluation plan.
So we mention there are three things you need to keep track of to evaluate gains in
knowledge and skills that can be done through testing.
The observation of trainees interest level, the adequacy
of resources can be done during the training session.
Some, one of the trainers needs to keep an eye out on what's happening.
Are people satisfied, are they bored, are
there enough handouts, are there enough demonstration materials?
What is the attendance going on?
That's part of the monitoring of what's happening in terms of process.
So you've done your testing for knowledge and skills,
you've observed the functioning in the process of the training.
And then finally your evaluation plan would want to look at follow-up.
visiting villages, checking on the trainee performance, are they
identifying cases if you know, nobody reported from this village.
And then you go an you see, oh yes but
there was a person In this house, nobody went in
to check her, and she has guinea worm but she can't get up.
So these are the kinds of things that we want to be
sure that you address as a clear evaluation plan in your guide.
So that you are accountable.
And again, if you're getting funding from someone to do this, they'll
want to report back and have some clear indicators of what was achieved.
So finally in, in summary, we've looked in this lecture at
our key materials and resources that we need.
we've drawn on our previous lectures about
our training objectives and content, our training methods.
And pulled that all together to develop a simple training guide
that we can use ourselves to have a more successful training.
Remember what we're supposed to do.
And also share that with other. People who want to repeat that.
So thank you for joining us.
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