Mapping of training resource packages on sexual …...Health Service, 2009 Linking Communities with...

Mapping of training resource packages on sexual and reproductive health and maternal, newborn, child, and adolescent health for community health workersThis mapping was undertaken between October and December 2012 with the objective of organizing and classifying training resource materials for Community Health Workers (CHWs) in sexual and reproductive health and maternal, newborn, child, and adolescent health (SR/MNCAH) that had been developed by UN agencies and other partners. The training resource packages were gathered from key informants and online search of targeted websites and through general search engines. Training resource packages targeting CHWs and including both job aids and a training guide on topics related to SR/MNCAH were included in the mapping. The following were excluded from the analysis: job aid alone, policy guidance alone, programme manager guide alone, materials on community-based activities not related to CHW training. Relevant materials in English, French, and Spanish produced in or after 2000 were included. The materials were classified according to the SR/MNCAH continuum of care as defined by WHO. Information was extracted from the selected training packages as per the following areas: purpose, description, scope and training methodology of the tool; integration of the tool in countries and health systems; strengths and limitations. To assess the strengths and limitations of the tools, the following questions were applied: 1. Did the interventions of the training package match the home/community interventions recommenced by WHO? ; and 2. Did the training package use: role- and

context-specific contents, competency- and practice-based training, supportive supervision, continuing and refresher training, sound training and pedagogy including pre-training, training and post-training steps, inclusion of job aids, and integration of acquired skills into the overall CHW role? Two reviewers carried out the quality review, data abstraction and synthesis of materials and cross-checked their findings. When feasible, the results were verified with the authors or relevant authoring agencies. A technical consultation organized by the World Health Organization (WHO) and the United Nations Population Fund (UNFPA) on behalf of the United Nation health agencies (H4+) was subsequently held to review the mapping and discuss the training of CHWs in SR/MNCAH. (The report is available from WHO/Department of Maternal, Newborn, Child and Adolescent Health website or at [email protected]).

This mapping exercise was led by Nguyen-Toan Tran, an independent consultant. Kirsten Beek provided support. Annie Portela of WHO/MCA and Luc de Bernis of UNFPA provided technical oversight and guidance. The authors are grateful for the contributions from agencies and individuals for the identification of training resource packages,and for the thoughtful recommendations from participants during the expert meeting. This mapping was possible thanks to the funding from the H4+ grant from the government of Canada.

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Integrated packages (package addresses more than 1 health area)01 02 03 04 05 06 07 08 09 10 11

1. Identification of the tool

Tool name, year, author

Community Health Worker Trainer’s Manual. Millennium Villages Project. 2011/2013 Update

Training manual for volunteers on maternal and newborn health care. Society for Family Health (in collaboration with PSI and Gates Foundation). Revised edition, 2012

Timed and Targeted Counselling. World Vision, 2010 (in partnership with WHO, UNICEF, ACNM)

Guide for Training Community Health Workers/Volunteers to Provide Maternal and Newborn Health Messages (USAID, POPPHI, BASICS, 2009)

Training manual for cluster representatives and health volunteers, Module 1 and Module 3. WHO, 2009 (2 VOLUMES OUT OF 3).

Community-Based Health Planning and Services (CHPS), Community Health Volunteers Training Manual, The Population Council, Ministry of Health/ Ghana Health Service, 2009

Linking Communities with the Health System: the Kenya Essential Package for Health at Level 1. MOH Kenya, 2007

CHW Certificate Program - Facilitator’s Guide (selected modules). National Department of Health, Papua New Guinea, 2006

Reproductive Health Manual for Trainers of CHWs. CEDPA (Centre for Development and Population Activities), India, 2003

Health Surveillance Assistants Training Curriculum, MoH Malawi, 2006

Health Extension Worker Program of Training Packages Ethiopia, Ministry of Health Federal Democratic Republic of Ethiopia, The Earth Institute at Columbia University Centre for National Health Development in Ethiopia, 2003/2004.


Link /Source Early revision draft shared by Anne Liu, Columbia University, NY. Contact authoring agency

Contact authoring agency Draft version can be obtained from [email protected] or [email protected] (Shared by WPRO, Contact authoring agency.)

http://www.basics.org/documents/CHW-training-guide-Final-1.pdf

http://applications.emro.who.int/dsaf/dsa1139.pdf;

http://applications.emro.who.int/dsaf/dsa1137.pdf

Contact authoring agency http://www.hennet.or.ke/downloads/20070706-225am-CHW%20Training%20Manual%20Mar07%20-%20MC%20-%20CLEAN.pdf

Contact authoring agency http://www.k4health.org/sites/default/files/Reproductive%20health%20manual_for%20comm%20health%20workers.pdf

Contact authoring agency http://cnhde.ei.columbia.edu/training/index.html

2. Purpose, description and scope of the tool

Purpose To train CHWs in conducting household visits once per quarter, each CHW covering 150-200 households, and equipped with key competencies* in maternal, newborn and child health, in addition to reporting

To equip health volunteers from target states in Nigeria with core knowledge and skills in:

- reproductive health and rights

- pregnancy care - care of the mother and baby

after delivery - referral and record keeping

By the end of the training, CHWs, or any other appropriate community-based volunteer cadre, will be equipped with:

• Competency in communication skills and building good relationships with the family when making home visits, following a standardized, story-based household counselling approach.

• Knowledge and understanding of all of the technical content and recommended behaviours to be introduced to households.

• Competency in carrying out the data collection and monitoring functions associated with their home based counselling.

To build the capacity of CHW/CH volunteers to use counselling cards with effective communication and negotiation skills for promoting and negotiating desired health behaviours to improve maternal and newborn health in their communities.

The goal of this workshop is to not only expose participants to new ideas, skills, and problem-solving approaches, but to change their knowledge, attitudes and behaviours, where required (p2).

Specifically, CHWs will be able to:

• Develop effective communication skills to establish open conversations with women, families, and other community members on MNH.

• Develop information skills to identify, select, and convey the technical elements accurately to pregnant women, families, and community members.

• Use the counselling cards with effective communication skills to promote key healthy behaviours among women and their families.

• Advocate for improved community behaviours through building the capacity of community leaders, religious leaders, and relevant community-based organizations.

• Commence facilitation of community mobilization activities.

• Take necessary steps to seek and collect the necessary predetermined newborn and maternal health information/data, review them, and transmit them appropriately to the Ministry of Health and implementing organizations (p11).

To train health volunteers and cluster representatives on their specific roles and responsibilities, and on simple and timely actions to prevent and manage common diseases and health-related issues.

It is expected that more extensively trained community representatives and health volunteers will be able to assist the health system in improving the access of the target population to primary health care services and in helping to ensure the provision of timely health services to the entire population (p5), starting with communities by involving them in a sustainable way at grass-roots level.

The purpose of this training manual is three-fold:

1) To serve as a set of resource materials that health managers can use to train community volunteers

2) To make the training of health volunteers more systematic and standardised

3) To provide skills to volunteers to improve teamwork, develop their personality and improve attitudes for health promotion and community development (piv).

As a result of attending this training community health volunteers should be able to achieve key objectives*

To build the capacity of CHWs to be able to lead their communities in health improvement initiatives in terms of disease prevention, health promotion, and simple curative care. In this way the CHW is able to motivate and advocate for the key household health practices in his area of coverage. The CHWs are expected to engage with the communities in the processes of assessing their health situation, dialogue with them on causes, and current actions in order to identify gaps that may require additional knowledge and skills and thus influence improvement of health practices and therefore health status.

Specifically, by the end of the training course the CHWs are expected to be equipped with key skills*

As part of the general two year Community Health Worker Certificate Program in Papua New Guinea, participants are trained to:

• Deliver family planning services

• Provide care for pregnant women

• Provide care for women in labour and childbirth

• Manage Obstetric emergencies.

As a result of completing these aspects of the two year training program, participant CHWs are expected to acquire key knowledge and skills.*

The goal of this manual is to develop the capacity of community-based workers to mobilize the community and increase access to quality reproductive health information and services in rural and urban communities.

By the end of the workshop, the participants will be able to:

• describe the basic concepts of reproductive health and family planning

• discuss the reproductive rights of every client

• counsel and refer clients for safe motherhood and care of the newborn

• counsel and provide clients with family planning services and referrals

• counsel and refer clients for reproductive tract infections.

This training emphasises the acquisition of skills basic to the promotion of health workers and the prevention and recognition of hazards contributing to personal and community health problems. The HSA graduate will be proficient in motivating and informing persons at the community level on positive health practices and health issues peculiar to Malawi, and referring personal and community problems to the appropriate resource and performing selected tasks relative to: community assessment, growth monitoring, child spacing, village hygiene, safe water supply, immunizations along with disease surveillance and follow up (p6).

This training course was introduced with the aim of producing Health Surveillance Assistants with essential skills*

As part of the Health Extension Program of Ethiopia, Health Extension Workers undertake a one year basic health care training course. This course is based on 16 major training packages.

Objectives of this one year course relevant to this exercise include the following: For Health Extension Workers:

• To provide antenatal, delivery, postnatal and child health services as a package to prevent mothers and children that constitute a majority of our population, from illness, death and disability

• To create a conducive environment in communities for the prevention and control of HIV/AIDS. To reduce the spread of the virus and death from AIDS.

• To work to produce a healthy adolescent population that is physically, mentally and socially well-developed.

• To work to reduce morbidity and mortality of mothers and children by spacing child-bearing; preventing unplanned and unwanted pregnancy.

• To make children healthy and competent citizens and the provide adequate health care to women of child-bearing age; provide full information and education about vaccination; reduce and control the illness, death and disability among children and women, caused by vaccine preventable diseases.

• By preventing diseases that are caused by malnutrition, create a healthy society that has a balanced physical structure.


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General overview Curriculum developed in the context of the Millennium Village Project to address the human resources crisis. It consists of:

• Trainer’s Manual but NO trainee manual

• Job aids for trainees• CHW Supervision Trainer’s

Manual & checklists

The Trainer’s Manual is divided into 4 units:

• Unit 1: General overview and preparation: CHW role in a health system, CHW rights and support system, using information to improve health, prep work and household visit structure, identifying danger signs

• Unit 2: care of the healthy child, preventing illness (bednets, vaccination, watsan hygiene food safety, proper nutrition)

• Unit 3: care of the sick child, treating illness (cough, diarrhea, fever)

• Unit 4: caring for the pregnant woman (danger signs, ANC promotion, pregnancy counselling, birth prep) and newborn (danger signs, counselling the mother to keep the baby warm and breastfeeding)

The provision of home care to women during pregnancy, delivery, post partum as well as care for the newborn is a key objective of SFH’s MNH care project project in target states of Nigeria. The curriculum is based on and adapted from ‘Community-based reproductive health promoters and traditional birth attendants manual’. In most rural communities, Traditional Birth Attendants still remain the most acceptable traditional care givers to women during pregnancy, childbirth and care of the newborn, especially during the first month of the baby’s life. SFH and its partners require that the Volunteers be trained before they go into the communities to provide the counseling services in MNH care. This training manual is therefore developed to respond to this need by tailoring the training content to meet the specific knowledge and skills for home-based care during pregnancy, delivery as well as care for the newborn.

Curriculum consists of: Trainers’ manual & Job aids

Covers 3 Modules:

MODULE I: OVERVIEW

1) Overview of maternal and neonatal deaths,

2) Concept of Health Education,3) Reproductive Health and

Reproductive Rights4) Roles and responsibilities

of Volunteers,5) Anatomy and Physiology of

Female reproductive organs,6) Counselling

MODULE II:PREGNANCY AND ANTE-NATAL CARE:

1) Role of men in Reproductive Health,2) Women at Risk of Pregnancy,

3) Signs of Pregnancy,4) Common Discomforts/

complaints in pregnancy,5) Ante-natal Care (ANC),6) Personal hygiene and

maintenance of good health in pregnancy,

7) Nutrition in pregnancy,8) Danger signs in pregnancy,9) Signs of miscarriage,10) Getting ready for Baby.

…

Timed (neither too early or too late) and Targeted (to those practicing taught behaviours, or those influencing behaviour adoption) Counselling (ttC) refers to a CHW/Volunteer approach to extending primary health care and nutrition counselling on preventive and care-seeking behaviours to the household level. Build around evidence-based, cost-effective interventions for pregnant women (7 interventions) and children <2y.o. (11 interventions)* over 12 scheduled visits: pregnancy (3, 4, 6, 8, 9m), postpartum (1, 4 wk), children (6, 9, 12, 18, 24m). Training package includes:

• Trainers’ Guide + CD• Facilitator’s Manual (3

modules: M1: country context, id pregnant women in community, BCC, comms & counselling skills + visit 1-3; M2: visit 4-6; M3: visit 7-11)

• CHW Manual (one-stop reference for literate CHWs)

• CHW Job Aids: illustrated story flip book

• Household reminder tool: illustrated handbook In addition: introductory materials (country readiness guidelines, CHW program functionality assessment) & data collection/monitoring system

This document presents a guide to a three-day training course designed to train CHWs to improve maternal and newborn health in their communities. This publication is one in a series of that make up the USAID/BASICS Newborn Health tool kit. This tool kit comprises:

• Facility level tools: Reference Manual, Technical Presentations, Facilitator’s Guide, Participant’s Notebook, Clinical Logbook with Learning and Evaluation Checklists

• Community level tools (this document): Guide for Training Community Health Workers/Volunteers to Provide Maternal and Newborn Health Messages

• Set of Counselling cards

Training sessions in this manual address key competencies*

The training approach focuses on specific messages and the practical use of counselling cards related to maternal and newborn health, with role plays and immediate feedback to improve counselling skills (p2).

The community-based initiatives programme of the WHO Regional Office for the Eastern Mediterranean produced this training manual for cluster representatives and health volunteers in coordination with the 17 relevant technical units in the Regional Office.

The Training Manual provides guidelines for community involvement in health actions, addresses comprehensive primary health care and is comprised of four modules:

1) Family Health: Birth and emergency planning; Birth spacing; Child health, Nutrition and Dental hygiene

2) Emergencies, environmental health and food safety: Emergency planning, First aid, Health environment, Food and chemical safety,

3) Communicable diseases: Tuberculosis; AIDS and sexually transmitted infections; Malaria; Childhood diseases and immunisation,

4) Noncommunicable diseases: Noncommunicable diseases, Prevention and control of blindness; Active and healthy ageing and old age care; Mental health and substance abuse; Tobacco and health.

Module 1 and Module 3 will be the focus of this summary.

The Community-based Health Planning and Services (CHPS) initiative is the Government of Ghana’s strategy to bring quality health care to the door step of the people. In collaboration with the Ghana Health Service, the CHPS-Technical Assistance project has developed this training material for Community Health Volunteers (CHVs) and Village Health Committees (VHCs) (both called health volunteers in this manual).

There are four training modules in this manual:

1) The CHPS Concept:• communication skills• interpersonal relationships• teamwork• conflict prevention,

management and resolution

2) Community mobilisation and tools

• Developing a community profile

• Community based surveillance

• Community mobilisation and participation

• Community participatory tools

3) The work of the health committee

• selection and training of volunteers

• Advocacy for health• Managing

community resources• Supervision of volunteers

4) The work of community health volunteers

• Home visiting• Disease prevention and

environmental sanitation• Nutrition education• Reproductive and child health• Home management of

minor ailments• Assisting the CHO to provide

services (ppix-x).

This manual for training CHWs aims at building their capacity to accompany the households and communities in their efforts to improve their health. Recognising that households and communities are fully engaged in addressing their own health issues, the training intends to enable CHWs to assist communities in assessing their situations, identifying gaps and reflecting on the causes of gaps in order to take action.

The manual describes the information, knowledge and skills that a CHW should have in order to be effective in influencing key household and community action to improve their own health situation. This document provides facilitators with technical content, presentations, and handout materials for use as deemed necessary (pp9-10).

The content of the course is organised into the following 9 modules:

1) Concepts of health and development

2) Community strategies for Kenya Essential Package for Health

3) Health promotion4) Mother and child5) Community nutrition6) STI, HIV/AIDS

and Tuberculosis7) Water safety and

sanitation and hygiene related conditions

8) Disability9) Monitoring and evaluation

Community Health Workers in Papua New Guinea undergo a 2 year training program which includes aspects of SR/MNCAH, together with other basic health services.

Training sessions relevant to this mapping exercise include key areas*

This Reproductive Health Manual for Trainers of Community Health Workers has been developed by The Centre for Development and Population Activities (CEDPA) to help organisations who provide reproductive health services through the Community-Based Distribution approach, train their CHWs in reproductive health.

Training units in this manual address the following areas:

• Basic concepts of reproductive health and family planning

• Safe motherhood and care of the newborn

• Contraceptive technology update

• Reproductive Tract Infections, Sexually Transmitted Infections and HIV/AIDS

The Health Assistants Training Program focuses its activities on the Ministry of Health’s Human Resources Development Plan which highlights the number of Health Surveillance Assistants (HSAs) needed to fulfil the goal of the National Health Policy.

The training of HSAs will help in the successful implementation of the Human Resources Development Plan by ensuring the availability of appropriate and adequately trained human resources to provide curative, preventive and promotive health services in line with the Essential Health Package.

The HSA Training Program includes the following 19 modules:

1) HSA job description,2) Introduction to Essential

Health Care Package,3)Reproductive Health,4) Nutrition,5) Growth Monitoring,6) EPI,7) Common Diseases,8) Community Water Supply,9) Vector Control,10) Village Sanitation,11) Food Hygiene,12) Village Inspection,13) Community Assessment/

Health and Vital Statistics,14) Formation and Training of

Village Health Committees,15) Social Mobilisation and

Health Education,16) Planning Health Activities,17) Use and Maintenance of

a Bicycle,18) Formation of Village

Support Group,19) Patient Follow

Up (pp9-12).

The Health Extension Program is designed to achieve significant basic health care coverage in Ethiopia over five years through the provision of a staffed health post to serve every 5000 people, with a total of over 72 million people served. This new community-based health care delivery system will improve access and equity in health care through a focus on sustained preventive health actions and increased health awareness.

Every health post (current or to be built) will be staffed by two Health Extension Workers (HEW), who will have undergone a one year training course.

The training program for Health Extension Workers includes 16 training packages under the following 4 components:

1) Hygiene and Environmental Sanitation

2) Family Health Services3) Disease Prevention

and Control4) Health Education

and Communication. Training packages most relevant to this mapping exercise fall under components 2 and 3.

These Training Packages are:

• Maternal and Child Health• Adolescent

Reproductive Health• Family Planning• Vaccination services• Nutrition• HIV/AIDS and Tuberculosis

Prevention and ControlThe HEW training packages provide guidance rather than curricula.

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General overview …

MODULE III: CARE OF MOTHER AND BABY AFTER DELIVERY

1) Common complications in mother after delivery,

2) Common complaints in the newborn (complications after baby is delivered),

3) Low birth weight,4) Exclusive breast feeding5) Immunisation

MODULE IV: REFERRAL AND RECORD KEEPING

1) Two-way referral system

2) Record keeping

Target audience: trainees

Must be literate, have completed primary school, with some secondary school; must be from the local community.

Volunteers who should be:

• Female• Able to speak the local

language (some level of English and writing skill will be an advantage)

• Accepted and respected in the community.

• Able to interact with others.• Ready to volunteer time

and services.• Honest and willing

to participate without monetary incentive.

• Interested in RH programme/women development activities.

• Not younger than 18 years of age.

• Available to perform after training.

• Resident in the community• Obtained consent from

spouse to participate as a volunteer

Literate CHWs. But this is not an exclusion criteria, as it gives the option to train non-literate CHWs (focusing on job aid exercises and verification of memory)

Community health workers and/or community health volunteers.

The target audience for this training is:

• Cluster representatives [note: Each village is divided into clusters of 25 to 40 households. Each cluster elects one representative (http://www.jointcenter.org/hpi/sites/all/files/13-Tackling%20Social%20Determinants.pdf)]

• Health volunteers (no further criteria stated).

Community Health Volunteers and Village Health Committees (who serve as a link between the community and the health care system) (piv).

Community Health Workers, who must have the following characteristics:

• Must be a respected literate member of the community

• Must be creative, hardworking and responsible

• Should be a good example in matters of health and development

• Should be approachable and able to motivate others

• Should be willing to volunteer for a period of five years (p10)

Community Health Worker trainees.

Community Health Workers- The community-based reproductive health approach entails the identification, recruitment, training, and fielding of community residents to provide FP information and services to their neighbours (pix).

CHWs must be functionally literate, from the same community, married and an FP acceptor.

Admission requirements for trainees are as follows:

• The course is designed to train NEW HSAs for employment in Malawi.

• Females and males are encouraged to apply.

• JCE education minimum.• Physical and mental

capability to perform job tasks of HSA.

Health Extension Workers.

Target audience: trainers

Bachelor’s degree, often masters and occasionally medical. From the country, but might not be local.

Nurse/midwives who have had previous experience in training volunteers

Facilitators from WV, MOH, or partner agencies, involved in field implementation. Information about level required not found

Ideally, trainers will already have interpersonal communication and counselling skills. However, those needing more information may consult guides offered in the additional reading listed at the end of this guide (p2).

Not stated. Cluster representatives and health volunteers are generally trained by «specially selected trained nurses and technicians working in the nearest health facility to the CBI site supervised by members of the CBI intersectoral team and related technical programmes at the district level» (p5). No indication given in this manual that these nurses and technicians will facilitate this training. Instead, it is stated that «In using this manual health volunteers and cluster representatives will be trained on their specific roles and responsibilities…» (p5) implying self-directed learning but this is unclear.

Community Health Officers, District Health Management Team/ Community-based Health Planning Services. No other criteria listed.

Not stated. Not stated. Community Health Worker Certificate Program developed by the National Department of Health Human Resource Management Branch Curriculum Development and Training Unit- trainers may be provided by this organisation?

Not stated. Not stated. Not stated.

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Training methodology, including clinical practice and assessment of competen-cies acquired

• Very detailed step by step instructions for facilitator, with tips and caveats

• Interactive presentations, small group work, group discussions, case studies, role plays

• Within each unit, regular quizzes to ensure that participants grasp concepts

• At the end of each sub-unit, trainees go through a written test to assess knowledge.

• Demonstration and practice: using job aids, filling reporting forms, entering data into mobile phone, asking and looking for danger signs, giving pre-referral treatment for danger signs (D: 1st dose ORS & Zinc, Pneumonia: antibiotics, malaria: Coartem), and HOW to do so (arranging for transport, advising caregiver…)

• Does not appear to have a systematic assessment of competencies against gold standard for each trainee

Participatory and embrace adult learning principles. Includes:

• Lecture/discussion• Brainstorming• Discussion• Repetition• Case studies• Demonstrations and

return demonstration.• Role play• Field trip to facilities• Observation• Group work• Singsongs

Typical session format:

• Learning objectives• Training and

learning methods• Resource materials• Pre-session preparation• Content• Summary• Evaluation.

No clinical practice to recognize danger signs

The suggested methods of evaluation include pre- and post-tests, rapid feedback, and continuous questions and answers at the end of each topic.

Evaluation is at the end of each session. No competency-based assessment.

• Overall approach: session introduction, brainstorm to determine what CHWs already know, give relevant info, reinforce information through story telling, role plays (problem/positive behaviours), small group discussions and practice.

• Core: simulation of the 4 HH visit steps (review of previous meeting and actions, problem story, positive story, dialogue and ‘negotiation’), story-based dialogue counselling

• Centered on utilization of job aids

• Training on data collection for each visit

• Trainees demonstrate skills by role-playing with debriefing in small group.

This training manual suggests trainers use interactive methods to stimulate active participation and ensure that learning objectives are met. These methods include: group discussions, small group work, role play, brainstorming sessions, demonstrations, practical sessions, recording of key points, issues, suggestions, new practices and solutions identified during the workshop (p4). Assessment of competence to be undertaken during training (before and after the course) and/or post-training during supportive supervision. Checklist for Evaluating Community Health Workers in Using Counselling Cards contained in Guide (pp112-113).

Possibly self-directed learning and/or workshop format and/or a combination of the two. Role-play dialogues included for some units, but no accompanying instructions for use. Group work included for some units. Assessment is based on pre-and post-testing of each unit.

The manual states that, due to the educational level of volunteers, training sessions should be very practical and interactive. A variety of participatory methodologies should be employed in the sessions, e.g. use of pictures, drama, film, case studies, role plays, songs, storytelling, jokes, discussions, group work, site walkthroughs, field activities, translation of key words into local languages (pv).

It is suggested that CHO and DHMT/CHPS training coordinators should collect real life stories from communities and training sessions and adapt them for volunteers training. They should also learn the most appropriate ways of communicating and imparting knowledge and skills in various communities and employ them in their training sessions. This will enhance the training programmes and make them realistic to the needs of the volunteers. The use of the local language and picture teaching was found to enhance comprehension in all pretested districts pv).

Training methodology listed for use throughout the modules include:

• Story telling• Group work• Plenary• Games and other activities• Brainstorming• Demonstration• Group discussion• Lectures and mini-lectures• Individual work• Group presentations• Practical exercises• Field exercises• Role play• Story analysis• Experience sharing• Skills practice

Methods of assessment not stated.

«The Facilitator’s Guides for selected modules state that learners must demonstrate competence in the assessment criteria for all learning outcomes. Assessment criteria for each learning outcome are tabulated in respective Facilitator’s Guides.

It is further stated that the learner must provide a range of evidence that demonstrates competence in a number of assessment situations, and through a number of assessment tools for each module. Suitable assessment tools are listed to include (but not be limited to):

• observation by tutor or assessor of clinical skills

• reports from supervisor or tutor• case studies• assignments• role-plays.

In addition to general assessments for each module, module specific conditions of assessment include the following:

1) Family planning:• End of module test

2) Care for Pregnant Women• End of module test• The learner must have access

to a range of health facilities where they can demonstrate their abilities to provide care for pregnant women

• The learner must witness 5 pregnant women being interviewed and examined, and then interview and examine 10 pregnant women under supervision

3) Manage Obstetric Emergencies:• End of module test

4) care for Women in Labour and Childbirth

• End of module test• The learner will require access

to a model pelvis to demonstrate abdominal palpation, vaginal examination, and partograph off-the-job

• The learner will require access to foetus (baby doll) with cord, placenta and membranes to demonstrate foetal assessment and management of birth, cutting cord, and assessing placenta off-the-job

• The learner will require access to scales and measuring jug to weigh newborn and assess blood loss

…

The manual has been designed as a self-contained curriculum for training CHWs on community mobilization and reproductive health. It is important that the CHW be trained in all the topics before s/he begins her/his work in the community. The method of training is participatory, i.e., brainstorming, group work, demonstration, role play, illustrated trainer presentation and case studies. The training consists of four major units or modules.

Each module includes:

• an introduction page which summarises the tasks to be performed by the CHW,

• learner objectives,• contents and

materials required.• methods of training which

detail training steps and include trainer’s notes, and

• time allotments for the module (pxi).

Evaluation is based on pre- and post-tests for each module.

This curriculum has an emphasis on skill training supported by lecture sufficient to understand the specific skill, and hands on training provided by structured laboratory and practical training activities at selected sites in Primary Health Care Training Centres (p6).

Teaching methods:

(a) Lectures and demonstration.

(b) Practical teaching: so that an HSA student can acquire skills by performance of similar skills.

(c) Discussing methods: the trainer using spontaneous conversation in which all students may take part, e.g. brainstorming, role-play, syndicates, etc. (p5). Requirements for the completion of this course are as follows: Satisfactory completion of EACH module in the course: Includes skill performance, written examination at a 70% and personal and professional behaviour appropriate to that of an HSA:

• Weekly written and practical examinations.

• The student must complete each module of instruction satisfactorily.

• Student will demonstrate knowledge (70%); appropriate behaviour; and satisfactory performance of practical skills.

• Student will be provided the opportunity to take supplemental examinations in the event of not being able to achieve 70%.

• The final grade will be a composite of all assessments.

The training package documents provided for the one year HEW training program are presented as guidance rather than curricula.

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Training methodology, including clinical practice and assessment of competen-cies acquired

…

• The learner must assist with and witness at least 5 normal births, and manage at least another 5 normal births under supervision to achieve competency in this module

• The learner must have the ability to suture episiotomies and second degree tears in an emergency. This may be demonstrated in a simulated environment or in the workplace if the opportunity presents.»

Aspect of the continuum of SRMNCAH care covered

Care of the healthy child

Care of the sick child

Pregnancy and newborn care

Pregnancy care

Newborn and post partum care

Pregnancy care

Infant and child care <24m

Pregnancy care

Childbirth care

Postpartum care

Newborn care

Module 1- Family Health: Childbirth Care; Postpartum care; Newborn care; Infancy and childhood care.

Module 3- Communicable Diseases: HIV/AIDS and STIs; Pregnancy care; Newborn care; Infancy and childhood care.

Briefly covers: Family Planning; Safe Abortion care; Pregnancy care; Childbirth Care; Postpartum care; Infancy and childhood care.

Pregnancy care; Childbirth Care; Newborn care; Infancy and Childhood care.

Family Planning; Pregnancy care; Childbirth Care; Postpartum care; Newborn care.

Family Planning; Pregnancy care; Postpartum care; Newborn care; HIV; RTIs/STIs.

Family Planning; Pregnancy care; Childbirth Care; Postpartum care; Infancy and childhood care.

Family Planning; Pregnancy care; Childbirth Care; Postpartum care; Newborn care; Infancy and Childhood care.

Other health subjects covered

Births and deaths (incl. stillbirths and miscarriages) reporting, using mHealth/sms platform: Childcount+ with real time information and feedback (see www.childcount.org)

Reproductive rights See module outlines above. See list of skills See objectives above. Adolescent reproductive health.

Duration of training course

5 days for the whole package of 4 units (the first unit takes 3d, unit 2: 1d, units 3 and 4: 1d)

4-5 days • CHW training: Total of 20 days, in 3 blocks over 9-12 months. M1: 10d - 4-6m practice interval, M2: 5d - 3m practice interval - M3: 5d)

• TOT: 6 days

5-Day Training. This guide recommends at least three days of training in a classroom setting followed by at least two days of practical application.

Not stated. The suggested training schedules are two (2) training sessions per year per CHPS zone with four (4) to eight (8) topics per session. In addition to being organised as standalone trainings, volunteer training can also be tagged unto other integrated training programmes in the District Health Management System such as HIV & AIDS, Guinea worm eradication and TBA training. The other topics in Modules 1 and 2 can be incorporated into other DHMT and CHO volunteer meetings and fora.

For training newly recruited volunteers, a five-day training programme has been found to be adequate, and a suggested training schedule has been attached to the modules (pv).

The basic course is designed to take six weeks, organised into three phases of two weeks each (p12)

Selected training modules form part of the 2 year Community Health Worker Certificate Program.

The manual provides a thirty-hour curriculum. It can be covered in full five days or if necessary, trainers and participants can adapt it as per the need of their program (pxii).

The training of HSAs to this curriculum takes 10 weeks.

One year to complete 16 Training Packages.

Follow-up training and supervision (if planned)

Strong supervision and management system of CHWs, who report to a Senior CHW at the village level, who in turn reports to a CHW Manager, who reports to an overall Health Coordinator

Mentions about the importance of:

- monitoring and supervision - collection of Data

from Volunteer - Quarterly review meetings

and updates

BUT does not go into detail

• Include data collection, monitoring, supervision review and regular CHW debriefings

• Recommends to hold yearly refresher training to keep CHWs updated to new interventions and local health initiatives.

Adequate competence (in meeting training objectives) will require additional follow-up supportive supervision (p11).

Not stated. Not stated. This document states that CHW training should be lifelong. It is suggested in the manual that continuing education could be three days a trimester, based on their own priorities (p12)

See training methodology above.

Community Health Worker roles to be undertaken with supervisor support for tasks listed.

Not stated. Not stated.

6
















Training course evaluated, and key results

Challenges identified by evaluation include: quality standards, user-friendliness of job aids, how to make the training modular enough

To follow up ? • Final reports available for BASICS technical areas of:

• Newborn survival and health• Health timing and spacing

of pregnancy. Contain mention of this training but provide no details on key results or evaluation specific to this training guide. Available at: http://www.basics.org/reports/FinalReport/Newborn-Final-Report_BASICS.pdf http://www.basics.org/reports/FinalReport/HTSP-Final-Report_BASICS.pdf

Evaluation of a training workshop conducted to this curriculum in Amman (September 2012) showed an overall increase in content knowledge from 50% to 97% (through pre- and post- testing). Participants reported that sessions on planning for safe delivery and family planning required more than the allotted time, while the session on child health was too long. Generally, participants’ training expectations were met and it is reported that the training workshop successfully covered its intended topics.

Unknown. Training was provided for community health extension workers and community health workers. In total, 274 CHEWS and 3,100 CHWs were trained and deployed using the new guidelines. Pilot community units have been established in Nyanza since 2006. In 2006/07 FY, a total of 129 community units were established and became functional, of which 78 are per the new guidelines. The functionality and effectiveness of these units have not been reviewed.

Unknown. Unknown. Unknown. While some improvement has been observed in health indicators since 2000, it is important to be cautious in interpreting and attributing improvements to HEWs, of which the first graduates were only deployed in the beginning of 2005. According to 2005 statistics, infant mortality was 77 per 1000 (down from 97 in 2000); under five mortality was 123 per 1000 (down from 160 in 2000); and DPT 3 coverage rose from 38% in 2000 to 80%. Early results from areas where HEWs are deployed are encouraging: immunization, contraceptive use, and personal and environmental hygiene all appear to be improving (Report available at www.who.int/workforcealliance/knowledge/case…/Ethiopia.pdf).

3. Sustainability

Integration of curriculum into national health system for implementation at scale

Will cover half a million people over 10 countries. Integration into the following national CHW curricula: Tanzania, Uganda, Rwanda, Malawi

To follow up Under field testing Unknown. Unknown. Yes- Ghana. Yes- Kenya. Yes- PNG Unknown. Yes- Malawi. Yes- Ethiopia.

Countries where curriculum has been implemented and number

4 countries: Malawi, Uganda, Rwanda, and Tanzania. 6 future countries: Ethiopia, Ghana, Kenya, Mali, Nigeria, Senegal

target communities in Gombe state, Nigeria

Field testing in numerous countries in Africa, Latina America and Asia

Unknown. • All community health workers in Southern Jordan trained on the manual last September.

• 2 countries of the region: Iran and Morocco are doing routine training of volunteers using an adapted version of the manual into their local language.

• Sudan, Pakistan, Somalia and Yemen have used the manual on a small scale.

• Other countries are in different stages of implementation based on their needs and priorities.

Ghana. Kenya (see above for #). PNG India. Malawi. Ethiopia- It is reported that as of June 2007, more than 17,000 HEWs have been deployed (Report available at www.who.int/workforcealliance/knowledge/case…/Ethiopia.pdf).

Estimated cost of training course (USD)

USD 2,619 for about 50 CHWs for 5 days including printing costs [granted, this was combined also with the mHealth training]

To follow up Unknown. Unknown. Unknown. Unknown. Unknown. Unknown. Unknown. Unknown. Unknown.

7















4. Strengths and limitations

Strengths • Integrated package focusing on 20 key tasks related to MNCH

• Thorough approach, e.g. handwashing: how to wash hands, how to set up washing station, where to buy soap, how to assess household at each visit

• Multi-country implementation & monitoring

• Not only technical information, but also covers the role, including a code of conduct, and rights of CHWs within a wider system with strong supportive supervision and reporting mechanisms.

• Detailed prep work and how to structure the flow of each household visit, including tips for good communication and active listening

• Emphasis on mHealth and reporting (1.5 days)

• Includes a CHW Supervision Training Manual and Checklists

• Training packages are context specific and integrated into the Gombe state, Nigeria.

• Volunteer training appears congruent with local policy and priorities.

• Job aids contextualized• Encourage

men’s participation

• Integrated package of focused interventions, covering clinical, M&E, and effective communication issues

• Modular approach possible• ToT manual with

detailed preparation instructions for training, including pre-training homework assignment

• Session on developing communication skills (e.g. respect, body language, asking questions, listening, praising, responding, check understanding)

• Emphasis on filling and using CHW register which has pictorials that are easy for CHWs to manage, including illiterate groups

• Also addresses non-literate CHWs

• Training alternates with several months long practice intervals allowing reinforcement of competencies

• ‘Country Readiness Process’ to help planning staff through the various steps required to adapt the curriculum to local contexts.

• Competence based with instructions for assessing competence

• Provision of tools/resources: counselling cards

• Curriculum specific to the CHW role and includes components on the roles and responsibilities of Community Health Workers/Volunteers, basic communication skills and negotiation in addition to technical knowledge and skills.

• Integrated package of materials covering essential primary health care topics

• Provides job aids (e.g., questionnaires, birth and emergency preparedness card).

• Context specific (regionally based) with brief guidance on further adaptation within member states.

• Curriculum is congruent with government policies.

• Provides training on generic health worker skills (e.g., communication, community mobilisation, community-based surveillance, advocacy for health etc.) together with technical components.

• Guidance given on adapting training to participant needs and local context.

• Training can be incorporated into other existing courses and fora.

• Provides job aids.

• Congruent with government policy.

• Includes details on the roles and tasks of CHWs.

• Addresses generic skills required by CHWs.

• Addresses adolescent sexual and reproductive health.

• Competence based and assessed.

• Selected modules form part of an accredited training course for CHWs.

• Congruent with government policy.

• Context specific curriculum (including addressing local cultural issues and barriers).

• Supervisor involvement detailed.

• Provides clear guidance for follow-up, including assessment.

• Curriculum specific to the CHW role

• Certification and resourcing of CHWs recommended (not accreditation)

• Includes practical learning guides to aid skill practice

• Component addressing adolescent reproductive health

• Curriculum is congruent with government policy and planning.

• Competence-based and assessed (required competencies of HSAs converted into learning objectives).

• Comprehensive assessment including demonstration of knowledge, behaviour and practical skills.

• Integrated package that goes beyond SRMNCH and addresses determinants of health at community level (e.g. building location, protection of water source, others)

• The 16 training packages provide an integrated approach which goes beyond, but includes, SRMNCH.

• Training packages are context specific and integrated into the national health system and processes.

• HEW training is congruent with government policy and priorities.

• Each package contains guidance on information management, monitoring and evaluation.

• Contains a package specific to adolescent reproductive health.

Limitations/ Weaknesses

• Does not address: benefits of family planning, counselling and distribution of basic FP methods; awareness of signs of GBV; education about consequences of unsafe abortion; support for WLHIV; newborn stimulation and play; birth registration

• Clinical modules (units 2, 3, 4) may be too short (few hours each) to ensure competency

• Lack systematic assessment of trainees competencies against standards

• Job aids lack pictorials for the client/caregiver side

• Training methodology: may be too didactic and not practical enough.

• Not competency-based assessed

• Does not address: - Awareness of signs of

domestic and sexual violence and referral

- Support for women living with HIV (pre & postpartum

- Recognition of blues/depression (postpartum

- Prevention of indoor air pollution (newborn)

- Newborn stimulation and play (newborn)

• No details given on assessment or follow-up.

• Does not address the SRH needs throughout the lifecycle such for adolescents or non-pregnant women, Needs of children >2yo not addressed.

• Promotes basic principles of health timing and spacing of pregnancy for all women but does not address it in depth

• Does not address: awareness of signs of GBV; education about consequences of unsafe abortion

• Lack systematic assessment of trainees competencies against standards

• Still undergoing field testing throughout 2013

• Large amount of materials to be printed and laminated, which can be costly.

• Does not address: - Support for women living

with HIV - Assessment of signs

of domestic violence and referral



- Birth registration (newborn)• Limited guidance on

follow-up through supervisor support and/or refresher training/continuing education.

• Does not address: - Support for WLHIV - Assessment of signs

of domestic violence and referral

- Newborn stimulation and play

• No clear definition provided of ‘Cluster Representatives’ or ‘Health Volunteers’ (i.e., the trainee target audience).

• Training strategy and methodology- whether workshop format and/or self-directed learning unclear.

• Instructions for training/trainers lacking.

• Trainer target audience unclear.

• Not competence based or assessed.

• Assessment by pre- and post-testing only.

• Follow up to training and supportive supervision not mentioned.

• Does not address: - Adolescent sexual and

reproductive health (family planning

- Emergency contraception - Awareness of signs of


- (Post abortion care mentioned only as an available service)

- Support for women living with HIV

- (Childbirth care, postpartum care, infancy and childhood care discussed in no detail)

• Covers key technical areas briefly.

• Target trainee audience is Community Health Volunteers, not CHWs (overlap?).

• Criteria for trainers lacking.• No supervisor

involvement stated.• No guidance on follow-

up given.• Not competence based

or assessed.

• Does not address: - Support for transport

(childbirth care - Companion of choice

to support the woman to attend a facility (childbirth care)

• Generic skills for CHWs covered but superficial on SRMNCH.

• Not competence based or assessed. No details on assessment provided.

• Target trainer audience not stated.

• Details on follow-up lacking.• Details on supervisor

involvement lacking.

• Selected modules do not address: - adolescent sexual and

reproductive health specifically (mentions young unmarried women only in Family Planning component).

- Awareness of signs of domestic and sexual violence and referral (family planning/postpartum).



• The PNG concept of CHWs goes beyond what is usually expected from CHWs to perform during household visits (e.g. skilled delivery). The extent of training (2 years) is more in line with the curriculum of auxiliary nurses.

• Does not address: - Awareness of signs of


- Support for women living with HIV-Reporting birth and death (postpartum)

- Use of insecticide treated bed nets (postpartum



- Birth registration (newborn)• Not competence based/

assessed. Evaluation is by pre/post-testing only

• Limited guidance on follow-up through supervisor support and/or refresher training/continuing education.

• Target trainee audience is Health Surveillance Assistants (equate with CHWs?). - Does not address: - Awareness of signs of

domestic and sexual violence and referral (family planning)

- Recognition of blues/depression (postpartum)


- Newborn stimulation and play

• No details given for target trainer audience.

• Guidance on supervisors involvement lacking.

• Guidance on follow-up lacking.

• Documents provide guidance rather than curricula - Does not address: - Awareness of signs of


- Support for women living with HIV (pre & postpartum)

- Support for care for the rest of the family (childbirth)

- Support for transport (childbirth)

- (Support for exclusive breastfeeding until 4 months of age only)

- Recognition of blues/depression (postpartum)



• Target trainees are facility based (Health Post)- not specific to CHWs.

• No details given on trainers.• No details given on

assessment or follow-up.

8

Family planning01 02 03 04 05 06



Training Resource Package for Family Planning. WHO, UNFPA, USAID, 2012

Population, Health and Environment (PHE) Community-based Distribution and Peer Education System: A Guide for Training PHE Community-based Distributors. Balanced Project (Coastal Resources Center, PATH Foundation Philippines, Conservation International), 2012.

Training for community-based delivery of injectable contraceptives. FHI360, Child Fund Zambia. 2009 (2011 update)

Postpartum Family Planning for Community Health Workers. Jhpiego, ACCESS-FP / USAID, 2010.

Community Health Worker Postpartum Family Planning - Training Package for CHW Trainers, USAID (2008)

Offering CycleBeads: a Toolkit for Training Community Health Workers. Institute for Reproductive Health, Georgetown University, 2008.


Link /Source www.fptraining.org http://www.k4health.org/sites/default/files/CBD_Manual_508_FINAL.pdf

http://www.k4health.org/toolkits/cba2i/sample-community-health-worker-training-curriculum

http://reprolineplus.org/resources/postpartum-family-planning-community-health-workers-learning-resource-package

http://www.k4health.org/toolkits/miycn-fp/community-heal-0

http://www.irh.org/?q=SDM_training_tools


Purpose The training Resource Package for Family Planning is designed as a generic tool to be used and adapted by trainers of health care providers. It is not a curriculum per se, but instead a toolkit from which curricula can be built to match local contextual and trainee needs. The package covers combined oral contraceptives (COCs), male and female condoms, implants, IUDs, and FP counselling. To take COCs, as an example, trainees will be able to:

1) List the key messages about COCs2) Describe the characteristics of COCs in a manner

that clients can understand, including: how it works, effectiveness, side effects, non-contraceptive health benefits, dual protection, ease of use, return to fertility, possible health risks

3) Demonstrate the ability to: screen clients for medical eligibility, explain to clients how to use COCs and what to do when pills are missed, explain when to return to the clinic, address common concerns, misconceptions, and myths, conduct follow-up for COC clients in a way that enhances continuing safety, satisfaction, and acceptance

4) Describe when to initiate COCs (postpartum, switching from another method)

5) Explain how to manage side effects6) Identify new conditions that may require a client

to switch to another method or to temporarily stop COC use

7) Identify clients in need of referral for COC-related complications

The objectives of this training are to increase understanding and general knowledge of the training participants on PHE linkages, reproductive health (RH)/ family planning (FP), and on the mechanics and operation of the PHE CBD system that will support community-based, integrated PHE education and FP services.

By the end of this training, participants will be able to:

• Explain the effects of rapid population growth on human health and natural resources;

• Describe the benefits of PHE linkages/integration and explain what PHE is in their context;

• Describe the human reproductive anatomy and the fertility process;

• Describe the roles, functions and responsibilities of an effective PHE CBD;

• Discuss how to social market contraceptive information, products and services, and manage PHE CBD outlets, including the effective management of the supply and re-supply of commodities;

• Provide and discuss options regarding the use of contraceptives with sexually-active men and women in communities using correct information;

• Address rumours and gossip about contraceptive methods, and

• Report and monitor PHE CBD activities (p7).

To equip CHWs with skills in delivering injectables as part of community-based access to modern contraceptives, including:

• Providing family planning counselling, including informed choice counselling

• Correctly screening clients for medical eligibility using the checklist

• Correctly using Reinjection Job Aid to determine client reinjection window, if applicable

• Administering the Depo intramuscular injection safely and competently

To equip CHWs with skills on how to counsel (not provide FP methods) accurately and effectively mothers and families on:

• PPFP, including• healthy spacing of pregnancy,• return to fertility,• appropriate birth spacing or limiting methods.

To train CHWs on PPFP (LAM and other methods), and interpersonal communication skills. (Lack of clarity on learning objectives)

To equip CHWs with the following competencies:

• Offer CycleBeads within the context of informed choice• Check to see if CB will work for a woman and her partner• Teach women and their partners how to use CB• Talk with a woman or couple about ways to manage the

days she can get pregnant• Refer a woman or couple to a more experienced health

provider or clinic when needed

General overview The Training Resource Package for Family Planning is a global resource package for trainers, supervisors and program managers. It contains materials and resources for designing, conducting and evaluating training for family planning providers. The resource package is specifically designed for mid-level providers but also contains more advanced materials for physicians and can be adapted for use with lower-level community health workers.

The Training Resource Package for Family Planning includes the following resources:

• Illustrative Module Session Plan• Facilitator’s Guide• PowerPoint Slides• Handouts• Evaluation Tools• References

Modules within this curriculum include:

• Combined Oral Contraceptives• Condoms- Female• Condoms- Male• Contraceptive Implants• Family Planning Counselling• Intrauterine Devices

This training guide was developed for use in courses to train population, health and environment (PHE) Community-based Distributors (CBDs) who work on integrated PHE activities. A PHE CBD is a Ministry of Health (MOH) community volunteer, local storeowner, storekeeper, accredited drug dispensary, community village worker, or a member of a people’s organization (PO) or a cooperative, etc. that/who is trained to provide information on PHE, family planning (FP) methods, and the stocking and sales of FP commodities (p1).

This manual was developed by the BALANCED Project, which promotes wider adoption and use of effective PHE approaches worldwide.

This training contains the following modules:

• PHE Integration• Ecosystems- overview and the link between ecosystem

health and human well-being• Human reproductive anatomy• Human fertility• Overview of the PHE CBD system• Social marketing of contraceptives for PHE CBDS• Gossip and rumours• Sexually Transmitted Infections, including HIV• Communicating PHE and FP information to PHE

CBD clients• Management information system for PHE CBD• Evaluation

• Developed as part of a pilot study in Zambia, the curriculum focuses on topics related to the safe provision of DMPA, and includes a refresher on basic reproductive health, the full range of FP methods, counselling, referral, and recordkeeping.

Materials include:

• Trainer’s binder• CBD’s binder• Counselling flipbook: main tool used by CBD agents to

counsel their clients, based on WHO’s DMT• Brochure for new DMPA clients

Generic package developed to be used alone or with other MNH training materials. Covers counselling skills and counselling on suitable PPFP choices, primarily for breastfeeding mothers, with strong emphasis on LAM, and why and when to transition from LAM to another modern method.

Materials include:

• Trainer’s manual• Participant’s manual• LAM card• Counselling guides: Nigeria, Guinea, Afghanistan.

Covers: MNH situation in Afghanistan, interpersonal communication and counselling, current CHW tasks in pregnancy care, breastfeeding, basic LAM concepts and providing LAM services, healthy timing and spacing of pregnancy, FP methods, advocacy to community leaders and community at large, Islam perspectives on FP.

Materials include:

• Trainer’s manual• Counselling cards

A package of modular training resources to train CHWs on Standard Day Methods (SDM) using CB. It includes adaptable lesson plans and supporting materials for developing training courses. It covers:

• FP and informed choice• How to use CB• Who can use CB• When to start using CB• Asking about breastfeeding and FP• Helping the couple use CB successfully• Practice counselling with CB

Materials include:

• Trainer’s toolkit• Job aids («insert panels») & set of CB.• Storyboard for a 2-hour training only• Knowledge improvement tool (checklist for supervisors)


9












Depending on module:

• Mid-level providers• Physicians, nurses and midwives• Other health care providers• Lower-level CHWs (with adaptation)

PHE CBD is a Ministry of Health (MOH) community volunteer, local storeowner, storekeeper, accredited drug dispensary, community village worker, or a member of a people’s organization (PO) or a cooperative, etc. This training may:

• Target new PHE CBDs,• Provide refresher training to existing PHE CBDs, or• Be used to add new tasks to jobs of existing PHE

CBDs (p5).

Meant for CHWs who have already been trained in the provision of oral contraceptive pills and condoms. In Zambia: trainees with at least 9th grade.

At least sixth-grade reading level. Resident in local area, age 20-50, volunteer, motivated, respected in the area.

Basic literacy: an advantage but not essential.

«Some» primary education. The training does «not require a high reading level»


Clinical trainers and pre-service educators with a thorough understanding of adult learning principles and the ability to provide clinical training on Family Planning topics in pre-service or in-service settings.

Facilitators who use this guide should have participated in the PHE Community-based Distribution and Peer Education System Training-of-Trainers (TOT) (training guide for ToT available at: http://www.crc.uri.edu/download/TOT_Manual_for_PHE_CBD_and_Adult.pdf).

No mention Trainers must be nurses, midwives or other health care providers with at least 10th-grade reading level.

No mention Trainers must be nurses, midwives or other health care providers with at least 10th-grade reading level.

Training methodology, including clinical practice and assessment of competencies acquired

All of the parts needed to develop a curriculum for each module are included in the TRP.

The Facilitator’s Guide for each component provides a diagram which shows how the different elements of the module fit together. Each piece of the modules may be adapted to fit the circumstances in the country where they will be used, the trainers who will be conducting training, and the level of expertise and skills of the trainees. The modules can be adapted to fit any kind of training e.g., face-to-face or self-study combined with clinical practicum, on-the-job training, etc. The modules can be used as a stand-alone module or as part of a comprehensive course in FP.

The modules can be used as a resource for refresher training or for training new providers. Whenever possible, the modules should be translated into the local language.

Each module is competency-based and assessed.

Each of the 12 modules contains participatory learning exercises for teaching the topic covered in that module. The exercises are based on adult learning principles and designed to help participants retain the information learned. Each module has a ‘Facts to Know’ section that gives the training team key information to emphasize while conducting an exercise.

The trainer can provide the information contained in the ‘Facts to Know’ through a short lecture either before or after the ‘Exercise’ to reinforce and strengthen the learning.

The guide provides guidance on when to use lectures, but it is the prerogative of the trainer/training team to decide how to provide this information (p3).

Evaluation is through pre- and post-testing.

• Adult learning methods: interactive presentations, games, role plays, demonstration, practice (in classroom and clinic). Injectable skills practiced first on fruits such as mangoes.

• Cascade training approach for scale up in Zambia• Assessment: includes a pre- and post-training

questionnaire, but also a very detailed competency checklist for clinical practicum.

• Competency-based training: interactive, small-group work, demonstration and practice, case studies, games and role plays.

• Focuses on the use of the counselling guides• Assessment: simulated and actual practice of the PPFP

counselling using the CHW PPFP counselling checklist.

• Competency-based training: participatory discussion, short presentations to conceptualize the basic principles, group work, exercises and role‐play of key skills in decision making, counselling and negotiation, classroom and clinic-based practice.

• Unclear how assessment of skills is made

• Competency-based training: interactive, small-group work, demonstration and practice, case studies, games and role plays.

• Heavily focused on job aids and CB practice• Assessment: competency checklist


Family Planning Family Planning. FP Postpartum FP, postpartum care Postpartum FP, to some extent: pregnancy care, postpartum care

FP


Population Health and Environment (PHE). n/a n/a n/a


Dependent on adaptation. Illustrative Training Schedules provided for each module.

2 Days (see pp9-14 for program). 3 weeks total. Theoretical training: 1 week of classroom training. Practical training: supervised clinic-based practicum over a period of about 2 weeks

3 days. 4 days to add skill-building practice. 4-5 days 2-3 hours


The manual recommends that the training be followed up with periodic refresher training and exercises and/or on-the-job mentoring during supervisory visits (p2).

Refresher trainings are being held during the scale up phase. Supervision is integrated into the curriculum

not addressed CHW trainers need to provide 3 supportive supervision visits to each group of trainees every 4 months for a year.

Addressed and highly recommended. The institute also developed a ‘knowledge improvement tool’ with a comprehensive checklist to help supervisors oversee CHW’s competencies.

10












n/a Unknown. Mid-term evaluation of the Balanced Project released August 2011 (available at http://www.ghtechproject.com/files/1%20523%20BALANCED%20Evaluation%20FINAL10.28.11_508.pdf) but this pre-dates the included curriculum.

The curriculum has not been rigorously evaluated, but it has evolved overtime based on the feedback from end users (trainers and trainees). It is also updated with the latest normative guidance.

Afghanistan:

• Under the five-year Health Services Support Project (HSSP), which focuses on improving the delivery of high-quality health care services in health facilities across 21 provinces in Afghanistan, there were 14,389 CHWs trained on PPFP across all 34 provinces of the country and integrated within the Basic Package of Health Services. The BPHS forms the core service delivery package in primary health care facilities, including health posts.

• The National Reproductive Health Strategy (2012-2016) includes the expansion of community-based PPFP using CHWs and community-based distribution of FP methods.

• An uptake of FP services at the health post level in 13 USAID provinces was observed. CPR also increased nationally from 10 to 20%.

Bangladesh: Findings at 12 and 18 months post-delivery showed significantly higher contraceptive prevalence among study participants compared with the control group in 4 unions of Sylhet District (42% versus 27% at 12 months, and 47% versus 34% at 18 months post-delivery, respectively).

Nigeria: ACCESS endline evaluation revealed that the proportion of women receiving FP counselling during both antenatal and postnatal services increased from 80% to 90% and 58% to 65%, respectively. Even with an ongoing commodity shortage, contraceptive method mix was improved, especially for long-acting methods, and postpartum women were more likely to be using a modern method, increasing from 1% to 11%. This is much higher than 1-2% contraceptive prevalence rate from DHS. Furthermore, the proportion of women delivering with a skilled birth attendant increased from 20% to 25%.

Unknown Unknown

3. Sustainability


n/a Unknown. No MOH countries to date. But some of the job aids were included into Uganda’s MOH’s National Community-Based FP Curriculum.

Yes: Afghanistan, Bangladesh (Sylhet District), Nigeria (Northern Part), Tanzania

Integrated into the national community-based health care program, under the leadership of the MOPH.

Unknown


n/a The Balanced Project has field initiatives in the Philippines, Tanzania, Zambia and Ethiopia.

Zambia and Liberia. Some of the job aids were included in the Uganda MOH’s National Community-Based FP Curriculum, and in the ChildFund Senegal’s CBA2I curriculum.

Curriculum adapted and implemented in 4 countries: Afghanistan, Bangladesh, Nigeria, Tanzania.

13 provinces of Afghanistan Unknown


n/a Unknown. On average, USD 20,000 for 20 CHWs (5 days classroom, 10 days practicum)

Varies by location and timing and depends on: Stakeholder meetings with government officials for collaboration, Performing formative research or needs assessment, Developing/Adapting IEC materials and messages, Adapting training materials, Training costs for CHWs and supervisors, as well as any other field staff responsible for implementation, Printing costs for IEC materials, monitoring and supervision tools, and training materials, Travel costs for supervision and field visits by stakeholders, Staffing costs for any new employees

Unknown Unknown


Strengths • Clear guidance on adaptation to local context (including to national standards and guidelines) provided.

• Clear guidance on adaptation to different types of health workers and their varying learning experience and needs.

• Competency-based and assessed.• Each module of the TRP provides a complete set of

learning resources needed to meet learning objectives.• Job aids and tools provided.

• Provides sample tools for use on-the job (e.g., reporting and monitoring forms, referral slip).

• Includes generic health worker skills together with technical components.

• Competency-based approach to injectables. Role plays with different and realistic scenarios (adolescents, breastfeeding, new clients, etc.). Intensive clinic practices.

• Based on decision-making tool/DMT for clients and providers - promote women’s choice and gives IEC on all methods

• Addresses issues of counselling couples and men• Provides examples of counselling guides from

3 different countries• Comprehensive PowerPoint presentations available to

back up lectures.• Extensive evaluation in various countries

• Developed locally and integrating local knowledge, attitudes (e.g. Islam and FP) and practices (e.g. wet warm cloths with some honey applied to small tears of external genitalia).

• Training put in the context of overall pregnancy and postpartum care, including refresher information

• Dynamic, highly interactive, and hands-on training• Richly illustrated job aids, allowing training of low-

literacy CHWs• Provides a supervision tool

Limitations/ Weaknesses • Not specifically targeted to CHWs (though adaptation possible).

• Not a curriculum per se. Building blocks for creating curricula provided.

• Does not address: - Adolescent sexual and reproductive health - Awareness and signs of domestic violence and referral

• Guide recommends follow-up through refresher training, exercises and/or on the job mentoring during supervisory visits but details and tools lacking.

• Evaluation is by pre- and post-testing only.• Not competence based or assessed.• Target trainee audience is broad- CBDs,

not exclusively CHWs.

• Job aid for CHWs/CBDs relatively wordy and is not adequate for low-literacy CHWs

• Limited information regarding health system integration, but this training needs to be fitted within the overall FP training for CHWs.

• Does not provide examples on how to integrate the package into other FP/MCH packages for CHWs.

• Does not address the issue of supportive supervision and health system integration.

• Limited information for counselling WLHIV• Limited training on record keeping

• Document format is dense, wordy and difficult to navigate. At times, too theoretical.

• Competencies to be acquired not well defined, lack of final assessment.

• Unclear structure for home visits (when and what to counsel/check)

• Some issues may be too complex to be addressed in a short time period (e.g. breast pathologies in 60 min)

• Some contents may be too theoretical or difficult for low-literacy trainees (e.g. LAM vs. BF, LAM vs. amenorrhea)

• Does not provide examples of how to integrate the package into other FP/MCH packages for CHWs - however, encourages trainers and managers to think about these aspects before organizing the training

• No training on record keeping

11

Safe abortion care01


Tool name, year, author Only briefly mentioned in: Community-Based Health Planning and Services (CHPS), Community Health Volunteers Training Manual, The Population Council, Ministry of Health/ Ghana Health Service, 2009 (see Integrated Packages tab)

Link /Source


Purpose

General overview









3. Sustainability





Strengths


Pregnancy care01


Tool name, year, author See integrated packages tab

Link /Source


Purpose

General overview









3. Sustainability





Strengths


Postpartum care01


Tool name, year, author See integrated packages and FP tabs

Link /Source


Purpose

General overview









3. Sustainability





Strengths


12

Childbirth care01 02 03


Tool name, year, author Prevention of Postpartum Hemorrhage at Home Birth - A Program Implementation Guide. Access Program / Jhpiego. 2009 Prevention of postpartum hemorrhage at home birth - Facilitator’s guide & Reference manual. MOH&Population Nepal, 2005 Also see integrated packages tab

Link /Source http://reprolineplus.org/resources/prevention-postpartum-hemorrhage-home-birth-program-implementation-guide http://www.k4health.org/sites/default/files/2b%20NP%20Trainers%20Notebook-PPH_0.pdf


Purpose To prepare CHWs to give information to women, families and community on the causes and prevention of PPH. Will provide CHWs with knowledge and skills to provide misoprostol to pregnant women in case of home birth - message about skilled birth attendance is reinforced as the best way to prevent PPH.

To equip Female Community Health Volunteers (FCHVs - self-motivated local community women, selected by local mothers’ group for health) with the knowledge and skills to talk to women, support persons, families and community to:

• recognize PPH• act to prevent PPH using Misoprostol• act if bleeding persists

General overview Guide developed to provide the managers of reproductive health programs with a step-by-step approach to setting up a community-based misoprostol program. It is intended to provide organizations and agencies with the information they need to introduce, implement and sustain a program of community-based distribution of misoprostol as an approach to the prevention of PPH.

The guide includes 2 sections:

I: Program implementation guide on how to bring innovation to scale, ensure enabling policy, establish a technical advisory group, site selection, adaptation of materials, miso procurement etc, with examples and lessons learnt from the field (Afghanistan, Indonesia, Nepal)

II: Resources for training community volunteers, including training curriculum, competency checklist, postcourse questionnaire, and training tips. Curriculum appears to be largely drawn from the Nepali one.

Curriculum developed to train FCHV on PPH prevention at home births using misoprostol, although messages about attendance of ANC with midwife and skilled birth delivery are also reinforced. Focus on the use of misoprostol to prevent excessive bleeding after childbirth at home birth and will provide FCHVs with the attitudes, knowledge, and skills needed to provide miso to pregnant women in their communities.

Training package include:

• Facilitator’s guide (outline of training agenda)• Reference manual (technical information for facilitators)• Job aids and forms [not available online]: Prevention of Excessive Bleeding at Home Births: Nepali Flipchart, FCHV

Distributor Register, excessive bleeding after childbirth Referral form, birth and death registration form.

Target audience: trainees Trainees can be literate or illiterate Non-distributor (of Misoprostol) FCHV must have completed basic FCHV training. Distributor FCHV (of Misoprostol) need to be in addition: literate, able to travel frequently to her coverage area and working in maternal health.

Target audience: trainers No ToT manual but: trainers should be at least midwives, experienced in training, with understanding of group dynamics, train people with low levels of basic education, can model strong interpersonal skills that students can replicate, ensure local words for bleeding, vomiting, pain, etc are used in the training so that the training context is culturally appropriate, include students’ experiences in role plays and discussions, valuing their contribution

No ToT manual identified but: trainers need to have been trained in district ToT on community-based maternal and neonatal care. One of the trainers must be an assistant nurse midwife


• Much of the curriculum and approach appears to be drawn from the Nepali training package for FCHV• Illustrated lectures and group discussions, role plays, exercise, demonstration, brainstorming, games• Competency-based: participants must score 85% on knowledge assessment and 100% on steps and tasks (checklist)

• Illustrated lectures and group discussions, role plays, exercise, demonstration, brainstorming, games• Intensive use of repetitive demonstration and role plays for key intervention steps: interpersonal and communication skills;

identification and registration of pregnant women (& calculate estimated date of delivery); IEC provision to women, family, community; provision of misoprostol to women at 8 months; follow up visit and data recording; retrieval of used/non-used Misoprostol.

• Mid-course and end of course assessment by trainer, 80% score in knowledge assessment, 100% in steps/tasks.


Childbirth care Childbirth care

Other health subjects covered none none

Duration of training course 3 days 3 days


Not mentioned in available materials Not mentioned in available materials

Training course evaluated, and key results Info not found. But is based on training materials from Nepal, Afghanistan and Indonesia • Evaluation of training course per se: info not found• Positive results from different ops research (e.g. Rajbhandari IJGO 2010)

3. Sustainability


Nepal, Afghanistan, Bangladesh, Mozambique Developed by Nepal MOH&Pop


11: Bangladesh, Ghana, Mozambique, Nigeria, Pakistan, Tanzania, Zambia, Rwanda, Madagascar, Liberia, South Sudan Nepal

Estimated cost of training course (USD) Unknown Unknown


Strengths • Curriculum is part of comprehensive implementation guide that summarizes field experiences and pearls from different settings, including samples of IEC, M&E, checklists and other supportive materials.

• Train CHWs on common implementation pitfalls and solutions (e.g. sharing medication)• Outline of job descriptions for CHW, CHW supervisor, and pharmacists

• Short evidence-based hands-on training for a very specific life-saving intervention, taking into consideration the context of Nepal

• Simple and contextualized language (miso is called matri suraksha chakki - mother’s protection tablet)• Critical steps are rehearsed intensively, with competency-based assessment at the end• Emphasis on data monitoring/register

Limitations/ Weaknesses • Beside job description for CHW supervisors, little on supportive supervision• Missed opportunity to train/refresh on other pregnancy danger signs• Suggests curriculum to be integrated into wider MCH training for CHWs, but does not provide practical ways on how.• Relies on women remembering counselling messages (vs. leaving them with IEC materials)

• Supportive supervision not mentioned• Missed opportunity to train/refresh on other pregnancy danger signs [but this may be covered in the more general MCH

training for FCHV]• Relies on women remembering counselling messages (vs. leaving them with IEC materials)

13

Newborn, infant and childhood care (note that some packages, such as 1 and 5, also briefly address pregnancy and postpartum care)01 02 03 04 05 06 07 08



Caring for the newborn at home, a training course for community health workers. WHO, UNICEF, 2012

Care for child development: improving the care of young children. WHO, UNICEF, 2012.

The Community Infant and Young Child Feeding Counselling Package: Facilitator Guide, September 2012, UNICEF & URC/CHS

Caring for the sick child in the community. WHO, UNICEF, 2011

Manual de agente comunitario de salud: Atencion integrada a las enfermedades prevalentes de la infancia (AIEPI) [IMCI]. PAHO, 2010.

Community IMCI. MOH Cambodia, 2008 Infant young child feeding counselling: An integrated course. WHO, UNICEF, 2006.

How to Train Community Health Workers in Home-Based Newborn Care. The SEARCH Team, 2006.


Link /Source http://www.who.int/maternal_child_adolescent/documents/caring_for_newborn/en/index.html

http://www.who.int/maternal_child_adolescent/documents/care_child_development/en/index.html

http://www.unicef.org/nutrition/files/Facilitator_Guide_Oct_2012.pdf

http://www.who.int/maternal_child_adolescent/documents/imci_community_care/en/index.html

http://www2.paho.org/hq/dmdocuments/2011/Manual%20Agente%20Comunitario%20de%20Salud_LR.pdf, http://www2.paho.org/hq/dmdocuments/2011/Agente-Comun-Salud-Guia-Facilitador-LR.pdf

Contact authoring agency and CD-ROM http://whqlibdoc.who.int/publications/2006/9789241594769_eng.pdf;

http://whqlibdoc.who.int/publications/2006/9789241594752_eng.pdf;

http://www.who.int/nutrition/publications/infantfeeding/9789241594745/en/index.html;

http://whqlibdoc.who.int/publications/2006/9789241594776_eng.pdf;

http://archive.k4health.org/toolkits/pc-mnh/how-train-community-health-workers-home-based-newborn-care


Purpose To equip CHWs with the following competencies during home visits:

• promotion of ANC and skilled care at birth

• counselling on care for the newborn in the 1st week of life (immediate postpartum care, breastfeeding, weight, optimal care)

• recognition of NB danger signs and referral

• special care for LBW babies

Detailed competencies are listed below*

Health workers and other counsellors to become competent in counselling families and communities on, and promoting and supporting child development (through communication and play)

This is a generic resource designed to equip community workers (including CHWs and volunteer health workers, referred to as CWs), and primary health care staff to support mothers, fathers and caregivers to optimally feed their infants and young children.

The training component of the package is intended to prepare CWs with technical knowledge on the recommended breastfeeding and complementary feeding practices for children from 0 up to 24 months, enhance their counselling, problem-solving and reaching-an-agreement (negotiation) skills, and prepare them to effectively use the related counselling tools and job aids (Facilitator Guide p1).

The Facilitator Guide contains information on conducting Training of Master Facilitators/Trainers (ToMT), Training of Facilitators/Trainers (ToT), and Training of Counsellors (ToC) workshops.

By the end of each training component, participants will have developed specific skills*.

The ultimate goal of training in the Community IYCF Counselling Package is to change the behavior of both the CWs (the learning participants) and the mothers, fathers and caregivers that they counsel (Facilitator Guide p5).

To equip CHWs with the following competencies in assessing and treating sick children 2 to 59 months of age during home visits:

• identification and referral of children with danger signs

• treatment (or referral) of pneumonia, diarrhea and fever

• identification and referral of children with severe malnutrition

• referral of other problems needing medical attention

• advise on home care and prevention of illness

• To equip CHWs with the following general competencies:

• To help families protect the health of pregnant women and children through the practice of key preventive measures

• To recognize the danger signs in pregnant women and children, and refer For details on competencies, see * below.

This curriculum was developed to train Village Health Support Group members, who are community-level educators, to deliver effective health education and promotion at the village level for caretakers of children up to five years old (preface). Objectives of this course include improving participants’ ability to:

• Communicate effectively with and give advice to caretakers so that caretakers adopt new behaviours that improve their children’s health

• Educate caretakers of children under 5 in their communities on basic disease prevention and health promotion

• Educate caretakers about proper home care for sick children

• Educate caretakers about why, how, and when to use the health centres

• Refer children who show danger signs of severe sickness to health centres for treatment

• Mobilise and organise people in their communities to work towards improved health for children

• Assist with village health information gathering

• Provide reports on their activities (Facilitator’s Manual p9).

This document states that there is an urgent need to train all those involved in infant feeding counselling, in all countries, in the skills needed to support and protect breastfeeding and good complementary feeding practices (Director’s Guide p2).

This course is designed, therefore, to give health workers the competencies required to carry out effective counselling for breastfeeding, HIV and infant feeding and complementary feeding.

After completing this course, participants will be able to:

• counsel and support mothers to carry out WHO/UNICEF recommended feeding practices for their infants and young children from birth up to 24 months of age

• counsel and support HIV-infected mothers to chose and carry out an appropriate feeding method for the first two years of life (Director’s Guide p4). See below for detailed competencies*.

This manual presents a set of materials for training village health workers to deliver basic yet comprehensive home-based neonatal care at the community level. Upon successful completion of this training, the CHW will be able to perform key skills*


14












General overview Package of training materials promoting access to essential interventions for pregnant and lactating women and their newborn infants. Provides guidance for CHWs to conduct home visits in the ANC and PNC periods. Drawn on experiences from several research studies.

Materials include:

• Facilitator guides• CHW manual• CHW register• Counselling cards• Mother and baby card• Referral note• CD-ROM: training resources

Package to prepare persons who work with families to promote the healthy growth and psychosocial development of children. NOT TARGETING CHWs per se.

Materials include:

• Facilitator notes• Participant manual• Counseling cards• Guide for clinical practice• Framework for M&E• Poster: recommendations for care for

child development• CD-ROM: training, advocacy,

technical resources

The primary objective of training community workers (CWs) or primary health care staff as IYCF Counsellors is to equip them with the knowledge, skills and tools to support mothers, fathers and other caregivers to optimally feed their infants and young children (Facilitator Guide p3).

Training Materials include:

• Facilitator Guide• Participant Materials• Counseling cards• Key Messages Booklet• Framework for M&E• Take-home brochures• Training Aids• Planning Guide• Adaptation Guide• Supportive supervision/Mentoring and

Monitoring 1-day training• Orientation Presentation

Sessions of this training include:Why IYCF matters,

• Common situations that can affect breastfeeding,

• How to counsel, • How to breastfeed, • Complementary feeding and foods, • Common breastfeeding difficulties:

symptoms, prevention and ‘what to do’, • Action-oriented groups, IYCF support

groups, and home visits,• Women’s nutrition,• Feeding the sick child,• IYCF in the context of HIV,• Integrating IYCF support into community

services, • Field practice and feedback.

Package of training materials to assess and treat sick children 2 to 59 months at home, using selected interventions and requiring the use of four simple medicines: antibiotic, antimalarial, ORS and zinc tablets.

Materials include:

• Facilitator’s notes• CHW manual• Chart booklet (simple decision-

making tool)• Photo book• DVDs: demonstrations and exercises

for identifying signs of illness; rapid diagnostic test for malaria

Modular training package to be tailored to the needs of each country. The facilitator’s guide has 2 sections. Section 1 deals with adult learning principles and preparatory information and actions facilitators need to be aware of before, during and after the training, including supportive supervision. Section 2 deals with building the CHW competencies.

The course has 35 sessions, covering IMCI topics including:

• Pregnancy care & nutrition• Postpartum care• Newborn care until 2 months• Care of the child from 2 months to

5 years• Care of the sick child (cough/cold,

diarrhea, fever, malnutrition, anemia)• Child development• Accident prevention, and other

preventive measures, including against influenza pandemic

• Care of the sick child (cough/cold, diarrhea, fever)

• Clinical practice• Register

Materials include:

• Facilitator’s guide• CHW’s manual, where job aids

are attached• Video for classroom demonstration

This course was first developed in 2004 to train Village Health Support Groups to deliver health education and promotion for caretakers of children up to five years old at the community level.

The curriculum was developed according to the twelve Key Family Practices that make up the Community Integrated Management of Childhood Illness strategy:

1) Breastfeeding,2) Complementary feeding,3) Micronutrients,4) Hygiene,5) Immunisation,6) Malaria,7) Psychosocial development,8) Continued feeding when children

are sick,9) Appropriate treatment for sick children,10) Recognising child illnesses and refer to

the health centre,11) Appropriate treatment and follow-up,12) Antenatal care

This training manual is to be used in conjunction with the 12 Key Family Practices flip chart and a smaller job aid developed in complement (available from National Centre for Health Promotion) (Facilitator’s Manual p6).

This curriculum was developed to serve as one of many tools required to implement a successful community health program. It is organised into the following Modules:

0) Introduction1) Adult learning and basic

communication skills2) Antenatal, delivery and postnatal care3) Breastfeeding and complementary4) Micronutrients5) Immunisation6) Hygiene7) Home care of sick children8) Psychosocial development of the child9) Malaria prevention and treatment

(area specific)

Supplementary module: Community case management of pneumonia, diarrhoea and fever.

The Training course is comprised of the following sessions:

1) An introduction to infant and young child feeding,

2) Why breastfeeding is important, 3 How breastfeeding works,

4) Assessing a breastfeed,5) Listening and learning,6) Listening and learning exercises,7) Practical Session 1, Listening and

learning. Assessing a breastfeed,8) Positioning a baby at the breast, Practical

session: Positioning a baby using dolls,9) Growth charts,10) Building confidence and giving support,11) Building confidence and giving

support exercises -Part 1, 12 Practical Session 2: Building confidence and giving support. Positioning a baby at the breast,

…

The WHO and UNICEF developed The Global Strategy for Infant and Young Child Feeding in 2002 to revitalize world attention to the impact that feeding practices have on the nutritional status, growth, development, health, and survival of infants and young children. This strategy is based on the conclusions and recommendations of expert consultations, which resulted in the global public health recommendation to protect, promote and support exclusive breastfeeding for six months, and to provide safe and appropriate complementary foods with continued breastfeeding for up to two years of age or beyond.

However, many children are not fed in the recommended way.

To address this, the Infant and Young Child Feeding Counselling: An Integrated Course combines three existing courses available from WHO/UNICEF:

1) Breastfeeding Counselling: A Training Course,

2) HIV and Infant Feeding Counselling: A Training Course,

3) Complementary Feeding Counselling: A Training Course

The integrated course is not designed to replace these three standalone courses, but rather was designed in acknowledgement that in many situations there is not enough time for health workers to attend all of the above courses (Director’s Guide pp2-3).

Materials available to support this training include:

• Director’s Guide,• The Trainer’s Guide,• Slides, •Participant’s Manual,• Guidelines to Follow-Up After Training,• Answer sheets,• Forms and checklists (including job aids)• Story cards,• Updates (available at CAH and

NHD websites),• Training aids.

This manual is based on the programme developed by SEARCH to train CHWs in home-based newborn care (HBNC) in Gadchiroli District, Maharashtra, India. This manual is part of the home-based newborn care training package developed to assist organisations or governments in implementing this approach in communities.

The package consists of:

1) A manual for training CHWs in Home-Based Newborn Care: including

• CHW progress book• Photograph album of newborn conditions

and congenital anomalies• Health education flipchart• Health education film in Hindi (Nanhisi

Jaan) and Marathi (Tanhula)• Survey forms and newborn health records

2) Training of Trainers (ToT) manual for home-based newborn care (under preparation)

3) Traditional birth attendant (TBA) manual for home-based newborn care In addition to the clinical objectives mentioned above, the manual also covers a range of topics including:

• Selection and training of a community health worker in each village

• Community cooperation •Making and regularly updating a list of pregnant women in the community •Health education to mothers and groups

15












General overview …13) Taking a feeding history,14) Common breastfeeding difficulties,15) Expressing breast milk,16) Cup-feeding,17) Overview of HIV and infant feeding,18) Counselling for infant feeding decisions,19) Breastfeeding and breast-milk options

for HIV-infected mothers,20) Breast conditions,21) Replacement feeding in the first

six months,22) Hygienic preparation of feeds,23) Preparation of milk feeds –

measuring amounts,24) Practical Session 3: Preparation of

milk feeds,25) Health care practices,26) International Code of Marketing of

Breast-milk Substitutes,27) Counselling cards and tools:

Counselling scenarios,28) Importance of complementary feeding,29) Foods to fill the energy gap,30) Foods to fill the iron and vitamin

A gaps,31) Quantity, variety and frequency

of feeding,32) Building confidence and giving support

exercises -Part 2,33) Gathering information on

complementary feeding practices: Practice scenarios,

34) Feeding techniques,35) Practical Session 4: Gathering

information on complementary feeding practices,

36) Checking understanding and arranging follow-up,

37) Feeding during illness and low-birth-weight babies,

38) Food demonstration,39) Follow-up after training (Trainer’s

Guide ppi-ii).


• At least 8 years of formal school education & literacy

• Preferably women• Clear plan for CHWs to start work soon

upon successful completion of training

Not targeting CHWs per se Training of Counsellors:

Training participants may be community workers and/or traditional birth. They may also be primary health care workers or project staff with more advanced IYCF training who act as ‘points of referral’ for the less experienced CWs and together form a community network of IYCF support.

It is assumed that training participants will have basic literacy.

Supervisors are encouraged to attend the training so that they are familiar with the training content and skills, and thus better able to support and mentor the training Participants on an ongoing basis.

Literacy CHWs must live in the community, be elected by the community, work must be volunteer based, teach by example, preferably be able to read and write, maintain and promote good interpersonal relations, and have a vocation to help.

Target trainees are Village Health Support Group (VHSG) members. Each village has one VHSG. The VHSG includes one VHSG Leader and other supporting VHSG members. VHSG membership is determined by the needs of the community and can include other specialised VHSG members in the village such as:

• Red Cross volunteers• Community Based Distributors• Village Malaria Workers• Community Home Based Care Teams• Community Direct Observation of

Therapy Watchers• Traditional Birth Attendants• Community-Based Peer Educators for

Chronic Disease• Mother Support Groups• Other health volunteers (i.e.. VHVs).

Most organisations that currently work with VHSGs require VHSGs to be literate to a level where they can fill out forms, read BCC materials, etc. Given this, this curriculum assumes that participants possess a certain level of functional reading ability (Facilitator’s Manual pp7-8).

This course is aimed at the following groups of people:

• Lay counsellors• Community health workers• PMTCT counsellors (first level

counsellors at district level)• Primary Health Care nurses and doctors-

especially if supervising and/or a referral level for lay counsellors, community health workers or PMTCT counsellors; clinicians at first referral level.

Course participants are not expected to have any prior knowledge of infant feeding (Director’s Guide p4).

The CHWs in both the SEARCH and Ankur programmes are women with limited education, some having as little as four years of schooling (although a few have up to 12 years). The vast majority of these women are married and have children (p1). Selection of CHWs:

The method of selecting CHWs in Gadchiroli (and followed in the Ankur project) involved:

• setting eligibility criteria• wide publicity and community

involvement to get the maximum number of eligible candidates

• personality testing of the candidates in a 3 day workshop

• objective evaluation and finally, testing in the field (p13).

NOTE- this is what has been done. No further details on trainee selection or the tools mentioned above given.

16













• Technical knowledge and skills in MNH (e.g. trained in IMCI)

• Experience with training CHWs• Must have attended the course previously

as trainees.

no further analysis done Training of Master Facilitators/Trainers (ToMT) and Training of Facilitators/Trainers (ToT):

The agency sponsoring a training event should select 2 individuals who will be trained as focal persons during both Training of Master Facilitators/Trainers (ToMT) and Training of Facilitators/Trainers (ToT).

The training responsibilities for Master Facilitators/Trainers and Facilitators/Trainers (ToT) of IYCF Counsellors need to be reflected in job descriptions and TORs (Facilitators Guide pp2-3).

Training of Facilitators/Trainer (ToT) participants [and Master Facilitators/ Trainer (ToMT participants? unclear] should:

• Be currently involved in the promotion of infant and young child feeding (IYCF) for the Government (e.g. Ministry of Health, Nutrition agency), a training institution, an NGO, a UN agency or other type of institution specializing in nutrition and child health.

• Have previous training experience and skills, including strong communication skills.

• Have basic knowledge of IYCF.• Have IYCF Program Experience.• Be proficient in English (mandatory).• Be interested in becoming a Community

IYCF Counselling Facilitator/Trainer (is motivated and enthusiastic) and to conduct in country training courses.

• Be committed to mentoring community workers learn about how to support IYCF.

• Be willing and able to attend the entire course (mandatory).

• Have scope for the following duties to become part of the candidate’s job description (or for them to undertake the following duties through contractual agreements): - Conduct in country Community IYCF

Counselling Trainings in at least some of the MYCNSIA sites

- Provide follow-up assessment and mentoring of new counsellors

- Submit a simple 1 page preformatted report on their accomplishments related to this training programme every 6 months. (Facilitator Guide pp190-191).

• Technical knowledge and skills in IMCI)• Experience with training CHWs• Must have attended the course previously

as trainees.

no mention The Facilitator’s Manual advises that community educators will be trained by provincial, operational district, and health centre staff, who will themselves need to be trained on this curriculum before being able to train others (Facilitator’s Manual p6).

The following training cascade is proposed:

1) National Centre for Health Promotion/ Communicable Disease Control Department (IMCI) National Master Trainers ®

2) Provincial Health Department/ Operational District Provincial Master Trainers ®

3) Health Centre Staff Trainers (and Provincial Master Trainers when Health Centre staff are not adequate) ®

4) Village Health Support Group ®5) Community Members (Facilitator’s

Guide p7).

There should be one trainer for each group of four participants. Trainers should be interested in and available and given the support to conduct other training courses in the future. Trainers are ideally people who are already involved in the promotion and support of infant and young child feeding and who have some previous training experience. They should:

• be convinced that infant and young child feeding is important

• be interested in becoming a trainer in the Infant and Young Child Feeding Counselling: An Integrated Course

• be a trainer on the WHO Breastfeeding Counselling: A training course

• ideally also be a trainer on the other two WHO feeding courses: Complementary Feeding Counselling: A training course or HIV and Infant Feeding Counselling: A training course

• be willing and able to attend the entire course, including the preparation for trainers

• be willing and able to conduct other courses in future

• be available to conduct the follow-up assessment of participants.

The preparation of trainers takes place before the participants’ training and takes approximately five days (Director’s Guide pp24-25).

In the Ankur project, the trainers who used this manual were mostly graduates. Since many trainers did not have significant teaching experience, the manual is very detailed, giving step-by-step instructions to trainers and providing them with ready-made training aids and tools such as model role play scripts and skill checklists. Eligible Trainers:

The personal qualities and attitudes (openness, ability to communicate, respect and empathy for trainees), and the willingness to train village women (CHWs) are very important eligibility criteria.

Professional background of the trainers should be diverse.

In the experience of SEARCH, a team of three persons makes the ideal combination of trainers.

1) a doctor (MBBS or non-MBBS),2) a nurse and3) a social worker (p2).

NOTE- it is noted that a Training of Trainers manual is under preparation (p1). Unable to locate.

17













• Competency-based approach• Based on adult learning principles• Recommends ratio of 1 facilitator /

4 trainees max• Includes classroom learning, group

discussions, games, demonstration (video, role plays) and most importantly, hands-on supervised field practice in a health facility and in the community.

• Teaching steps in classroom sessions: introduction, determine what CHWs already know, give relevant info, discuss and explain, reinforce learning through exercise, skills demonstration and practice, summary

• Revolves around practice with job aid (counselling card) following key steps: greet the family, ask/listen/understand the situation, tell the story, check understanding & discuss, praise, solve any problems the family has in adopting positive behavior.

• Competency-based assessment against checklist

no further analysis done Hands on practice is the focus of the training, with emphasis on counselling skills. The competency-based participatory training approach reflects key principles of behaviour change communication (BCC) with a focus on the promotion of small doable actions, and recognition of the widely acknowledged fact that adults learn best by reflecting on their own personal experiences.

The approach uses the experiential learning cycle method and prepares Participants for hands-on performance of skills.

The course employs a variety of training methods, including the use of counselling materials, visual aids, demonstrations, group discussion, case studies, role plays and practice.

Participants also act as resource persons for each other, and benefit from clinical and/or community practice, working directly with breastfeeding mothers, pregnant women and mothers/fathers/caregivers who have young children (Facilitator Guide pp5-6).

Certification Requirements:

UNICEF/MOH should discuss and agree on the criteria for certification of Master Facilitators/Trainers and Facilitator/Trainers of IYCF Counsellors (Facilitator Guide p3). Requirements for the award of certificates:

• The Master Facilitator/Trainer needs to conduct 2 cascade trainings for Facilitators/Trainers and/or Counsellors; and the Facilitator/Trainer needs to conduct 2 cascade trainings for Counsellors before they can be certified,

• Facilitators/Trainers need to conduct 2 cascade trainings for Counsellors before they can be certified,

• Newly trained Counsellors must counsel five mothers, as well as conduct two Action oriented Groups or IYCF Support Groups (Facilitator Guide p193).

• Competency-based approach• Based on adult learning principles• Includes classroom learning, group

discussions, games, demonstration (video, role plays) and most importantly, hands-on supervised practice with many sample cases, but also in outpatient clinic

• Centered around the use of job aids, and sick child recording form that outlines a systematic clinical approach with detailed decision-making algorithm:

1) identify problem (ASK & LOOK - any danger signs?)

2) DECIDE: refer (if danger sign) or treat at home (if no danger sign)

3) Refer&TREAT (with first dose of treatment given) or TREAT at home and ADVISE,

4) Check vaccines received & advise,5) Other problem that needs referral6) When to follow up7) Findings on follow up visit.

• Assessment of performance through role plays

• Competency-based training: interactive, small-group work, demonstration and practice including at clinic and household levels, case studies, games and role plays.

• Includes daily evaluation of the workshop (achievements, challenges, solutions)

• Assessment by competency checklist

This curriculum was developed with the 12 Key Family Practices (KFP) as its starting point, and therefore use of the 12 KFP flipchart figures prominently in each module. A smaller job aid has been developed to complement the 12 KFP flipchart.

Training methods used in this course include:

• games• group discussion• demonstration• role play• question and answer• lecture• Health Centre tour

It is advised in the Facilitator’s Guide that the necessarily limited scope of this curriculum did not allow for inclusion of other facilitation techniques like puppet shows, drama, song, etc., due to the difficulty of training trainers and VHSGs to use these techniques, and high level of resources (time, equipment, creative ideas, etc.) required to use these ideas successfully. Programs that are interested and able to employ these other types of facilitation are encouraged to do so instead of, or in combination with, the activities in this curriculum (Facilitator’s Manual p6).

Facilitators are encouraged to adapt and/or make training activities more appropriate for their situations. This curriculum is a guide that facilitators can adapt according to their needs and their participants’ needs. While the activities in this curriculum can be implemented as they are written, they do not necessarily have to be followed to the letter. Having said that, technical content of activities should be kept consistent with messages in this curriculum, as the technical content contained here is reflective of current national health policies (Facilitator’s Manual p9).

Assessment is through pre- and post-testing.

The training course comprises 39 sessions which use a variety of teaching methods, including:

• lectures• demonstrations• work in smaller groups of four

participants with one trainer• role-play• practical work• exercises.

The sessions are structured around four 2-hour practical sessions, during which participants practise counselling and technical skills with mothers, caregivers and young children (Director’s Guide p34).

This course is based on a set of competencies which participants are expected to learn during training and follow-up*.

Training activities in this manual focus on adult learning methods that require participation, including large and small group discussions, role plays, demonstrations, games, case presentations, case studies and practice in both classroom and in communities (p1).

Final Evaluation and Certification of CHWs conducted in a final workshop of 3 days:

1) Revision of all (17) the earlier modules.2) Final evaluation3) Certification of those CHWs who score

minimum 70 % (p605).

Evaluation plan:

Two tier evaluation:

1) Evaluation of CHWs by trainer/supervisors:

I: A written testII: For assessing the attitudes and strengths

of individual CHWs, the trainers/supervisors use their accumulated knowledge of the trainee, and complete the questionnaire using a scale.

III: Skills of CHWs are assessed and recorded by the trainer/supervisors by observing skills in the field using the CHW progress book (p605). The gaps in the skills should be corrected by the trainer/supervisor in the field itself and followed-up and rechecked in the next visit.

2) Field evaluation by external evaluators: An independent evaluation of the CHWs conducted by an external evaluator. Training Evaluation Field Guide provides guidelines for evaluation of CHWs by a member other than the regular trainers/supervisors (p606).


• Pregnancy care• Postpartum care• Newborn care to 1 week of age

no further analysis done Nutrition: (young child and infant feeding). •Infancy and childhood care Pregnancy care

Postpartum care

Newborn, infant and child care up to 5 years

Newborn care; Infancy and childhood care. Childbirth care; Newborn care; Infancy and childhood care- re: Breastfeeding, complementary feeding and replacement feeding only.

Newborn care.


Infancy and childhood care Preventive measures to keep the family healthy, including pandemic influenza (this was developed following the 2009 influenza threats)

Treating minor ailments in the community: basic care of wound and skin problems, using paracetamol and aspirin, handwashing.

Stock keeping and treatment records.

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• 6 days for ToT• Option 1: 2 blocks of 3 and 4 days

separated by a few weeks, or Option 2: 6 continuous days

• 3 days • 6-Day Training of Trainers/Facilitators• 5-Day Basic Course (common content

for Training of Trainers/Facilitators and Training of Counsellors

• 3- Day Training – Abbreviated Community IYCF Counselling Package

• 3-Day Training – Integrating IYCF Support into Emergency Activities.

• Version 1: 3.5 days (id illness, referral, treat diarrhea at home)

• Version 2: 6 days (same as above + treat fever and fast breathing at home)

Modular depending on local needs. Minimum is 10 days.

• Modules 0- 9 total 12.5 days.• Supplementary module is an additional

3 days. Each training day is a total is 7 hrs. duration which includes:

• 6 hr. training (3 hrs. in the morning & 3 hrs. in the afternoon)

• 1 hr. optional break times for snacks and other activities.

• Facilitators are encouraged to be flexible in how they arrange module trainings throughout the year. It may be that specific topics are conducted slightly before or during months in which that topic is important for communities. For example, diarrhea prevention and treatment is taught in the wet months, micronutrients is taught before or during national campaign months, malaria is taught in common malaria months, etc.

• Although facilitators are welcome and encouraged to use modules in any order they find convenient, please keep in mind that topics should be taught according to local priorities (Facilitator’s Manual p8).

• Training of Trainers preparation course- 5 days.

• Participants’ course- full time for 5 days: The course is divided into 39 sessions, which take approximately 35 hours without meals or the opening and closing ceremonies. The course can be conducted consecutively in a working week, or can be spread in other ways (Trainer’s Guide p10).

The manual is divided into seven training workshops containing a total of 17 modules. Training during the Ankur project was divided into seven training workshops spread out over a period of one year. The sequence of the modules and the grouping of topics have been carefully planned for maximum learning and while trainers are encouraged to follow the sequence, the manual is flexible and changes can be made when needed.

Most of the modules are taught in one training workshop, with the exception of Module 3, Treating Minor Problems, which is spread out over the first two workshops. The planners felt that the CHW would be accepted more readily by the community if she could attend to minor problems—headache, body ache, and minor wounds—from the very beginning of her training.

With further experience, SEARCH felt the need for more flexible training schedule for the diverse situations. Hence, three different training schedules covering the contents of this manual are suggested [see pp5-6] (p4).


Mentions about importance of regular supervision but does not provide detail on possible ways of doing so.

no further analysis done Training of Counsellors (ToC) Participants & Training of Trainers (ToT) Participants (UNCLEAR- ASSUMED):

Management Follow-up:

mentor learner, reinforce behaviours, plan practice activities, expect improvement, encourage networking among learners, be realistic, utilize resources, provide supportive on-going supervision and mentoring, motivate, continuously monitor and improve quality.

Facilitator follow-up:

provide follow up refresher or problem-solving sessions; Learner- know what to expect and how to maintain improved skills, be realistic, practise to convert new skills into habits, be accountable for using skills.

Management & Facilitator: follow-up provide feedback, monitor performance; Management & Learner- provide feedback, monitor performance; Management & Facilitator & Learner- provide feedback, monitor performance, commit to system of on-going supervision or mentoring; Facilitator & Learner- provide feedback, evaluate.

Facilitator (Master Facilitator/Trainer & Facilitator/Trainer (ToT) follow-up: During the ToT, each participant will be asked to make an implementation “Plan of Action”, which will be monitored every 6 months thereafter by UNICEF colleagues until December 2014. (Facilitator Guide p186-188).

ToT participants will receive a certification for completion of the course. It will be necessary for newly-trained Facilitators/Trainers to conduct cascade training before they can be certified. UNICEF will also require the participant’s first 6-month “Plan of Action Monitoring Report” before the certificate will be granted (Facilitator Guide p 189).

no mentioned in documents Outlines the importance and guiding principles for supportive supervision without going into the details of how.

Not stated. Guidelines for Follow-up After Training manual provided (http://www.who.int/nutrition/publications/IYCF_Guidelines_for_followup_after_training.pdf).

The objectives of this follow-up after training are to:

1) Reinforce the theoretical knowledge learnt in the course;

2) Reinforce the counselling and practical skills learnt in the course;

3) Identify problems faced by course participants in their work situation which affect implementation of infant feeding counselling;

4) Assess the theoretical, counselling and practical skills of participants after the course.

Follow-up should include a visit by a trainer to the workplace of trainees and the completion of an assessment of competencies at 1-3 months post-training course (Guidelines for Follow-up After Training pp2-12).

Field supervision (two visits in each month to each CHW) is a crucial component of the HBNC.

It should be viewed as an extension of training and support to CHWs rather than inspecting.

It should result in improved skills, motivation and performance of CHWs, problem solving and community support. The time requirement for the work of supervision is 8 hours per day per 20,000 population (p13).

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• All the Community Health Workers found the course easy to learn.

• There was need to develop a comprehensive and appropriate training video for the course

no further analysis done Evaluation not yet complete- will be pursued in 2013.

• Overall the CHWs found the course very interesting and useful and rated the materials as easy to read and understand.

• The CHW appreciated the outpatient and inpatient clinical practice sessions in health centers and hospitals as they were able to have hands on practice in applying the knowledge and skills.

• Most of them were very confident in asking the caregiver about child’s problem, performing the RDT test on sick children, interpreting it correctly, and following the steps of managing a sick child.

• In general all CHWs were able to interpret the RDT results without any difficulty and this gave them a lot of confidence.

No training evaluations due to insufficient human and financial resources

No evaluation yet conducted. To follow. This manual is based on the programme developed by SEARCH to train community health workers (CHWs) in home-based newborn care (HBNC) in Gadchiroli District, Maharashtra, India. The success of the programme—a significant reduction in neonatal mortality—led to replication of the SEARCH HBNC model programme by other nongovernmental organizations (NGOs) through the Ankur Project, supported by Save the Children US. During the implementation of the Ankur Project, this manual was field-tested by seven NGOs in Maharashtra state, where 100 new CHWs were trained. Using CHWs’ actual experiences during the training, the manual was revised to make it more effective and user friendly. The manual was then sent to a number of national and international experts in newborn health for review. The revised version was translated into Hindi, Marathi and Oriya languages and used in the field trial in 5 states by the Indian Council of Medical Research. The experience gained was used to further improve this version of the manual (Training Manual p1).

From the experience in the Ankur field test, the training was assessed as «extremely effective» in an extensive evaluation (Training Manual foreword).

Results of evaluation were presented at a convention in New Delhi in 2006 (report available at: http://nipccd.nic.in/mch/fr/nbc/erl27.pdf)

3. Sustainability


Ethiopia, Malawi, Rwanda, no further analysis done In most countries listed below, local adaptation of the package has been adopted as the national material for IYCF for community based cadres. In some, such as Bangladesh, it is used in selected areas only.

Ethiopia, Malawi, Rwanda, Madagascar, Mozambique, Uganda, Zambia.

Adapted and implemented in Nicaragua, Mexico, Panama, Ecuador, Colombia, Peru

Cambodia- course developed by the National Centre for Health Promotion (Cambodia) and the Communicable Disease Control Department of the Ministry of Health (Cambodia).

To follow. Unknown.


Ethiopia, Malawi, Rwanda, no further analysis done There are 21 countries using the training package in some way with UNICEF involvement: Sierra Leone, Nigeria, Ghana, DRC, Kenya, Somalia, Tanzania, Rwanda, Malawi, Zambia, Zimbabwe, Namibia, Mozambique, Nepal, Bangladesh, Afghanistan, Indonesia, Philippines, Laos, Timor Leste and Uzbekistan. This does not include countries where there may be use of the package at sub-national level by partners (such as in India or Haiti).

Countries are at various stages of implementation- from adaptation and translation of the materials to large scale use (such as in Zimbabwe, Rwanda, Zambia and Sierra Leone).

7: Ethiopia, Malawi, Rwanda, Madagascar, Mozambique, Uganda, Zambia.

6: Nicaragua, Mexico, Panama, Ecuador, Colombia, Peru

Cambodia. To follow. India. The SEARCH approach has also been implemented in Bangladesh, Bolivia, Ethiopia, Malawi, Nepal, Pakistan, Uganda and Zambia ( http://businesstoday.intoday.in/story/innovation-in-health-dr-bang-search/1/186625.html)


Unknown no further analysis done Costs reported for different countries are $5,000, $13,000 (for CHWs), $7,300, $17,000, $24,000 & $30,000 (to train trainers).

Unknown Not obtainable No cost estimation available. To follow. Training a CHW costs SEARCH approximately RS 15000 (approximately $280 USD), including RS 1500 (approximately $28 USD) for equipment (http://businesstoday.intoday.in/story/innovation-in-health-dr-bang-search/1/186625.html).

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Strengths • Integrated maternal and newborn package, in spite of the title that highlights newborn care

• Outlines key steps in preparing for the course (incl. involving policymakers, supervisors, selection of CHWs, equipment checklist, etc...)

• Strong emphasis on communication skills and processes of behavior change with detailed role-play scripts

• Realistic job aids using pictures vs. drawings

• Recommends extra visits for: small babies, babies referred to health facility

• Emphasis on practice e.g. handwashing, weighing babies, etc.

• Holistic considerations: CHWs must be considered part of the health work force whether they are employed by the government or supported by NGOs. Must be linked to higher levels of health services that support their training, and help maintain performance through regular follow-up, periodic skills reinforcement, and continuous flow of medicines and supplies.

no further analysis done • Includes training on generic skills for CWs (e.g., problem solving, negotiation) together with technical components.

• Includes a comprehensive set of training resources (Facilitator Guide, Participant Materials, Counselling cards, Key Messages Booklet, Framework for M&E, Take-home brochures, Training Aids, Planning Guide, Adaptation Guide, Supportive supervision/Mentoring and Monitoring 1-day training, Orientation Presentation).

• Provides participants with job aids (e.g., counselling cards, take home brochures etc.).

• Provides a cascade structure for training: Training of Master Trainers Training of Trainers Training of Counsellors.

• Generic tool which includes a guide for adaptation.

• Provides clear guidance on supportive supervision, mentoring and monitoring, and follow-up mechanisms.

• Includes clear instructions on work to be undertake pre-, during- and post-training.

• Includes field practice.• Details trainer profile and criteria.• Competency based and assessed. Criteria

for certification given.

• Systematic clinic-based approach with iterative learning through games, role plays, and hands on practice

• Very thorough job aids where key steps are covered in a logical clinical algorithm

• Curriculum evaluated and implemented in several countries

• Modular, standard curriculum on IMCI in Spanish

• Implemented in several countries• Package has a section on workshop

preparation, adult learning principles, facilitation skills and follow up considerations

• Richly illustrated job aids attached to the CHW manual (with one side for client, one for CHW)

• Provides useful generic checklists and forms for: competency assessment, workshop evaluation, client clinical form that is logical and directive, indicators for household visits

• Includes practice at clinic and household levels

• Curriculum is congruent with government policy.

• Local context specific (based on locally developed and evaluated curricula).

• Further adaptation recommended to meet participant needs and local priorities.

• Provides a clear cascade training strategy integrated into existing health system structures.

• Flip charts and job aid provided for participant use on the job.

• Designed to complement existing tools.

• Comprehensive set of training materials, including: Director’s Guide, Trainer’s Guide, Slides, Participant’s Manual, Guidelines to Follow-Up After Training, Answer sheets, Forms and checklists (including job aids), Story cards, Updates (available at CAH and NHD websites) and Training aids.

• Competence-based and assessed.• Counselling skills taught in combination

with technical components.• Provides tools for use on the job (job

aids, forms and checklists).• Training guides cover pre-, during and

post-training strategies.• Curriculum includes 4 timetables

practical sessions.• Provides clear instructions for

comprehensive follow-up including continued assessment of competencies.

• Guidance on integration of this training with existing courses given.

• Guidance on local adaptation give.

• Comprehensive coverage of newborn care.• Curriculum includes field practice.• Curriculum specific to the CHW role

and includes components on working in the community in addition to technical content.

• Curriculum planners have addressed the acceptance of CHWs by the community through strategic planning of modules.

• Detailed training guide suitable for varying levels of facilitator experience.

• Competence based and assessed.• Clear guidance for follow up,

supervisor involvement, evaluation and assessment given.


• Technical contents: limited coverage on HIV, support for WLHIV; does not address safer sex, harmful effects of alcohol and smoking, domestic violence. Addresses FP only in postpartum care. Does not address blues/depression.

• Mentions importance of health system support, regular supervision, supply chain, but does not go into detail about examples to implement it.

Note: the Package of Interventions for FP, SAC, MCH recommends under ‘infancy and childhood care’: promotion and support for child stimulation and play. This training material targets a wide audience and is not specifically tailored for CHWs Recommendations: further simplify job aids, define roles and functions of CHWs in counselling and supporting child development at household level. When, how often, integrated with what other interventions, etc.?

• Follow up instructions provided but target of follow-up actions unclear.

• Requires good level of literacy, not adapted for non-literate CHWs

• Does not address issues of health system support, supportive supervision, supply chain.

• Does not provide examples of training agenda

• Requires good level of literacy to use the CHW manual

• Does not train CHWs to administer treatment for home management or before referral

• Does not address: blues/depression, domestic violence, birth registration

• Does not address: - Prevention of indoor air

pollution (newborn).• Not specifically targeted at CHWs.• Not competence based or assessed.• Assessment is by pre-/post-testing only.

• Does not address: - Prevention of indoor air pollution - Newborn stimulation and play

• Limited guidance on selecting training participants and eligibility criteria.

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Guide for Training Community Health Workers in WASH-HIV Integration. C-CHANGE (FHI360, Kenya MoPH and Sanitation), 2011

Accompagnateur Training Guide, Partners in Health, 2008. HIV Prevention Treatment Care and Support- A Training Package for Community Volunteers WHO, IFRC, Safaids, 2006

Community Home-Based Care for People and Communities Affected by HIV: Training Course and Handbook for Community Health Workers, Pathfinder International, 2006


Link /Source Trainers guide: http://www.c-hubonline.org/sites/default/files/resources/main/Kenya%20WASH-HIV%20Integration%20Trainers%20Guide.pdf

Counselling cards: http://www.c-hubonline.org/sites/default/files/resources/main/WASH-HIV%20Integration%20Counselling%20Cards%20for%20Community%20Health%20Workers_0.pdf

http://model.pih.org/accompagnateurs_curriculum https://www.plhivpreventionresources.org/index.cfm?action=main.abstract&id=1318 http://www.pathfinder.org/publications-tools/publication-series/Community-Home-Based-Care-for-People-and-Communities-Affected-by-HIV-AIDS-Training-Course-and-Handbook-for-Community-Health-Workers.html


Purpose This training guide is intended for use by any organization that works at a community level to help people adopt healthier behaviours related to water, sanitation, and hygiene in the context of HIV.

New or improved practices will result in significantly fewer cases of diarrhoea (and therefore less illness and fewer deaths), especially among people living with HIV and their families.

After participating in the workshop, CHWs should be able to use the knowledge and skills acquired to carry out the following activities:

1) Describe the local WASH and HIV situation2) Define their role and responsibilities as an outreach worker3) Describe the four key WASH practices and the small doable actions that households can

take to move toward the ideal practice4) Negotiate with households to choose a WASH small doable action to adopt using

effective communication and negotiation skills5) Use appropriate monitoring tools to record their progress (p7).

This training curriculum has two over-arching goals:

1) To help accompagnateurs- community health workers trained and employed to provide medical and psychosocial support for their neighbours- develop confidence in active casefinding for diseases and social needs

2) To instil a sense of solidarity and social justice in supporting patients, households and the community.

By the end of this training, participants are expected to be able to carry out key tasks*.

The goals and objectives of this training are to:

1) Increase knowledge of participants surrounding HIV prevention, treatment, care, and support

2) Address attitudes of participants surrounding HIV prevention, treatment, care, and support interventions

3) Equip participants with problem solving skills for addressing community specific issues related to community-based HIV management

4) Promote the transfer of skills from participants to clients and their family members regarding important information, skills and practical knowledge required for community-based HIV management.

The goal of this course is to add skilled Community Health Workers to the forces that are fighting the HIV epidemic. These CHWs will complement facility-based HIV services by providing and training caregivers to provide care and support to People Living with HIV, reducing stigma, and mobilising the community to prevent future HIV infections. By the end of training on Core Units, participants should be able to carry out the key activities*

General overview This document is a compilation of several training documents that were produced by the USAID/Hygiene Improvement Project that were then adapted into a Kenya-specific Trainer’s Guide (pii). It should be used to train local community health, home-based care or other outreach workers to carry out activities at the community level to reduce diarrhoea in the context of HIV (p7).

The Trainer’s Guide is accompanied by counselling cards and guidance is given on the use of suggested or existing tools to monitor the progress of CHWs and track changes in WASH practices in the community (p4).

The training course is divided into the following 8 Modules:

1) Introduction: why WASH matters and key practices for preventing diarrhoea2) Communication and negotiation: interpersonal communication for improved practices

and the role of the CHW3) Making water safe to drink4) Hand washing with soap5) Handling faeces6) Faeces management at household level7) Caring for HIV+ women with menses8) Action planning with multiple WASH needs (ppvi-vii).

Accompagnateurs have played a central role in the community-based health care programs of Partners in Health (PIH) since PIH began working in Haiti 20 years ago. Serving as a link between the clinic and the community, they provide medicine, education, and psychosocial support to people living with tuberculosis, HIV/AIDS, and other illnesses. They are often selected by patients themselves and are people who are respectful and empathetic, can maintain confidentiality, and can understand what it means to stand in solidarity with those who are suffering.

Accompagnateurs receive an orientation from PIH clinical staff before they begin supporting patients and they also attend the seven day, 15-unit intensive training program described in this Facilitator’s Manual (Facilitator’s Manual pxv). The following units are covered in this training curriculum:

Unit 1) Introduction to Accompagnateur Training,Unit 2) Introduction to Partners In Health,Unit 3) What is HIV/AIDS?,Unit 4) HIV/AIDS: Prevention and Transmission,Unit 5) Treatment of HIV/AIDSUnit 6) Side Effects of Antiretroviral Medicine,Unit 7) Women and HIV/AIDS,Unit 8) STIs,Unit 9) Stigma and DiscriminationUnit 10) Psychosocial Support and Effective CommunicationUnit 11) Tuberculosis, Unit 12) Tuberculosis Treatment and Side Effects,Unit 13) Roles and Responsibilities of AccompagnateursUnit 14) Challenges Faced by AccompagnateursUnit 15) Summary and Evaluation

The training is supported by the following resources:

• Facilitator’s Manual• Participant’s Handbook to be used throughout the training and as a reference for

accompagnateurs when working with patients and community members• Visual Aids (PowerPoint)• Visual Aid Notes

The goal of this training package will be to provide participants with the relevant knowledge, attitude, problem solving and skills transfer capabilities required to assist and support community-based HIV prevention, treatment, care and support. This document represents a collaborative effort between the International Federation of Red Cross and Red Crescent Societies, WHO and Southern Africa HIV/AIDS Information Dissemination Service.

The training package consists of eight generic training modules which have been designed for global use to train and empower community-based volunteers with the skills and knowledge to support the roll out of comprehensive programmes on HIV/AIDS (Facilitator’s Guide p4).

These eight generic modules are as follows:

1) Basic facts on HIV and AIDS2) Treatment literacy3) Treatment preparedness4) Adherence5) Community-based counselling6) Nutrition7) Palliative care: symptom management and end-of-life care8) Caring for carers

The package provides the following tools:

• Facilitator’s Guide• Introduction to the training manual• Participant’s Handbook• Evaluation Tools Manual• Flipchart• Information pamphlets for each module.

This curriculum aims to provide CHWs with the knowledge and skills necessary to provide Community Home-Based-Care for people living with HIV in their communities.

It includes a Trainer’s Guide for the trainers and a Handbook for the participants. The Trainer’s Guide is divided into 13 core units, a practicum, and 5 advanced units that contain additional information that CHWs might find useful after they have covered the core areas (Trainer’s Guide pxiv).

The units are as follows:

Unit 1) Introduction to the trainingUnit 2) Facts about HIV and People Living with HIVUnit 3) Community Home-Based-Care: The BasicsUnit 4) Our Bodies and Safer SexUnit 5) Talking with Others: Communication SkillsUnit 6) The Community Health Workers’ Role in Community Mobilisation and

HIV PreventionUnit 7) Promoting Positive Living and Emotional WellbeingUnit 8) NutritionUnit 9) Basic Nursing CareUnit 10) Managing and Treating AIDS-Related ConditionsUnit 11) Teaching Others and Transferring SkillsUnit 12) Taking Care of YourselfUnit 13) Record KeepingUnit 14) CHBC PracticumAdvanced Unit 15) Expanded Role of the Community Health WorkerAdvanced Unit 16) Introduction to Family PlanningAdvanced Unit 17) PMTCT of HIVAdvanced Unit 18) Antiretroviral TherapyAdvanced Unit 19) CHBC for Groups Needing Special Attention (Trainer’s Guide ppvi-ix).

The Handbook contains the content areas covered in each unit. Participants will use their Handbooks throughout the training and as reference after the training when they are working in the communities. The Handbook can also be used as a visual aid in some instances when transferring skills to the client or caregiver (Trainer’s Guide pxv).


Existing CHWs. Accompagnateurs. Community Based Volunteers (CBVs) are the target trainee audience of this training. CBVs are described as community members who provide home-based care and support to People Living with HIV and AIDS.

CBVs do not require any previous experience in community-based HIV management. This training content has been designed to suit the lowest level of education within training audiences. Facilitators are expected to adapt content to match the particular skills and knowledge levels of the training audience, and meet the requirements of the working environment of participants (Facilitator’s Guide p5).

The target trainee audience for this training is Community Health Workers. It is advised that CHWs be selected:

• By the community, with the help of Community-Based Organisations (CBOs) and/or Faith-Based Organisations (FBOs).

• That both women and men be chosen, as well as PLWHIV.• That favouritism and patronage be avoided.• That while selection criteria should be community driven but should include basic level

literacy (enough so they can fill out basic record keeping forms), interest in serving their community, and ability to devote time to CHBC activities (Trainer’s Guide pxiii).


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The Trainer’s Guide has been written purposefully in a «recipe» style, so that someone whose primary duties are not related to training will be able to implement the workshop.

Experienced trainers may find the training directions too detailed and should treat them accordingly.

Also, experienced trainers can «upgrade» the training methodologies based on their level of comfort with training and the content (p6).

Not stated. The training package has been designed for facilitators who may not have extensive experience in training specific to comprehensive HIV management. However, facilitators are expected to have the following minimum of skills:

• Prior experience in conducting training programs• A working knowledge of training methodologies• The ability to read and write English to a secondary education level• A health background which provides the capacity to understand the concepts within

If facilitators do not have a health background, they should be supported through contacts and resources in the community that can assist with specific, technical aspects of training (Facilitator’s Guide p6)

The Trainer’s Guide recommends that where possible, trainers (or at least one of the trainers) should be facility-based providers. In cases where there are multiple trainers, it is suggested that the inclusion of a CBO/NGO trainer with skills in community-based services or community mobilisation can significantly enrich the training (Trainer’s Guide ppxiii-xiv).


The workshop methodology is based on adult learning principles. Each session is structured to follow an experiential learning cycle.

The techniques used to facilitate this training:

1) Uses structured learning activities: presentations, group discussions, demonstration, role plays, practical exercises, etc.;

2) Engages participants through active involvement in exercises and small groups;3) Enables participants to experience the same activities they will carry out in their

communities (pp7-8).

The training is modular in design and as such can be used in full, modified as necessary to fit context and circumstances, or particular sessions integrated into alternate trainings or presentations (p4).

Guidance on deciding training session relevance and whether to incorporate WASH activities into existing programming is given (p3). Assessment is based on pre- and post-testing self-assessment at the beginning and end of the training workshop.

This curriculum uses training methods that are participatory, active and engaging. Short lectures and presentations are incorporated into this manual but are not the primary technique for sharing information with participants. Rather, various techniques are used that build upon the existing experiences, knowledge and skills of the participants. These methods include:

• Small group activities• Large group activities• Large and small group discussions• Pair share• Role-play• Demonstration• Case study• Facilitator presentation• Brainstorm• Reflection journey• Panel discussion• Picture story• Peer teach• Review

Assessment is conducted through participatory evaluation through daily evaluation sheets

The training methodology of this training package has been designed to support adult learning. These include:

• Mini-lectures• Group discussions• Activities• Games• Demonstrations• Role-plays (Facilitator’s Guide p14).

Following the completion of each module, participants will have the opportunity to be evaluated on that topic area. The criteria for evaluation for each module involves a combination of two types of assessment:

1) Post-Test Knowledge2) Demonstration of Core Skills

In order to pass evaluation for any individual module, participants must achieve a minimum of 50% pass on the post-test and a minimum level of performance to enter practice in core skill assessment (a list of required core skills is provided in each module of the training).

The nature of this training program is intended to be participatory and based on adult learning principles. The methodologies used throughout this training include:

• Lectures• Discussions: Large and small group• Group work• Demonstrations and return demonstrations• Role plays (coached, spontaneous, rotating trio)• Case studies• Brainstorming• Question and answer• Games• Constructive feedback (Trainer’s Guide ppxx-xxiv).

Evaluation and assessment methods include:

• Pre- and post-tests• Observation and assessment during classroom, home-based, and community practicums• Use of skills checklists• Practicums• Participant feedback• Participant course evaluation (Trainer’s Guide pxxiv).

Guidance is given to adapt the curriculum to the varying experience and literacy levels of CHW participants (Trainer’s Guide p xvi).


HIV HIV and TB focus STIs

HIV HIV


WASH, diarrhoea in the context of HIV. Community Home-Based Care; Basic nursing care; CHW self-care; Teaching others and transferring skills; Record keeping; Nutrition; Community mobilisation; Communication skills; Positive living.


A full training is three days, but any module can be used by itself or integrated into another training or presentation. Raising awareness can be done in a 1-2 hour session (p4).

7 day intensive training course with on-going monthly education sessions for a year. The training course is modular and as such, it is not necessary to undertake the training as a single block. A phased approach may be used. The approximate length of time required for each module is stated as the following:

Introductory session: 3 hours

• Module 1: 10.5 hours• Module 2: 10.5 hours• Module 3: 11 hours• Module 4: 12.5 hours• Module 5: 12.5 hours• Module 6: 12.5 hours• Module 7: 18 hours• Module 8: 8.5 hours

• Core Units 1-13 and the Classroom Practicum: 14 Days.• Home-Based Practicum 2 Days.• Community-Based Practicum 2 Days.• Advanced Units 15-19: 6 Days.

This curriculum is also designed to be flexible and in a way that units can be put together for a shorter course, a training series, depending on the time and funding available, and on the key issues being addressed in a particular setting (Trainer’s Guide pxvi).


Should an organisation decide to sponsor WASH training for CHWs, program managers are directed to be responsible for several tasks before, during, and after the training (p2).

1) Deciding whether to incorporate WASH activities into your program (at the strategic level) (p3)

2) Preparing for the training (become familiar with training guide and WASH/HIV conditions in CHW target communities, prepare logistics, decide which sessions trainers should cover, modify the training) (p4)

3) Supporting CHW training (welcome participants and tell them that they have the organisation’s approval and support. Explain how their new tasks will help meet organisational goals and objectives. Monitor progress of the workshop (p5)

4) Supporting CHWs in the field (help CHWs put new skills/knowledge into practice as soon as possible. Provide supportive supervisions. Assist CHWs with monitoring forms. Conduct debriefing sessions (p5)

5) Brief trainers (p6).

After the 15-unit intensive training, accompagnateurs participate in on-going monthly education sessions for a year, receiving additional training in nutrition, malaria, paediatric HIV/AIDS, clean water and diarrheal disease, family planning, active case finding, parasites, chronic disease, vaccinations, reproductive health, and oral hygiene.

Between completion of the 15-unit intensive training and their first monthly education session, newly trained accompagnateurs participate in peer coaching, during which they join another accompagnateur in conducting patient visits. This provides a practical, hands-on learning experience a, helps accompagnateurs within a particular region to develop a support network of fellow accompagnateurs, and enables new accompagnateurs to internalise the concepts and issues discussed during their training and gain confidence in conducting their own patient visits (Facilitator’s Guide pxvi).

Suggestion is given for facilitators to schedule on-site visits with individual training participants (or provide supervisors with information on assessing core skills) periodically following training to ensure retention of skills and knowledge over time (Facilitator’s Guide p24).

It is suggested in the Trainer’s Guide that trainers double as supervisors of CHWs as they are in the best position to reinforce transferred skills and strengthen ties between CHBC and facility-based services.

It is advised that ongoing supervision and support is needed to help the CHW overcome challenges, to ensure that PLWHIV are getting good quality services, and to facilitate learning between trainings (Trainer’s Guide pxiv).


This trainer’s Guide was drawn from two guides developed for Ethiopia and Uganda. The compilation was developed based on feedback from the community of practice. The document was revised and rewritten based on pilot testing with 30 District Public Health Officers (pii).

This curriculum is currently being pilot tested with partners in Haiti, Lesotho, Malawi and Rwanda.

The final drafts of these modules were tested at the community level by training 22 community based volunteers actively involved in implementing programmes on HIV/AIDS at community level (p4).

The curriculum was pre-tested in Tanzania and Mozambique, and underwent an internal and external peer review.

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HIV01 02 03 04






3. Sustainability


Unknown. Unknown. Unknown. Much of the content of this tool has been incorporated into different versions of Tanzania’s national CHBC training tool.


Kenya. Haiti, Lesotho, Malawi and Rwanda. Workshops have been organised in Tanzania, Malawi, Cameroon and Burkina Faso. Tanzania, Uganda, Ethiopia and India.


Unknown. Unknown. Unknown. Unknown.


Strengths • Clearly defines roles and responsibilities of target trainees.• Contains strategies for working with communities together with technical components.• Includes strategies to transfer new knowledge and skills to the workplace through action

planning and learner-focused objectives.• Provides trainees with counselling cards for use on the job (available at http://www.c-

hubonline.org/sites/default/files/resources/main/WASH-HIV%20Integration%20Counselling%20Cards%20for%20Community%20Health%20Workers_0.pdf).

• Provides clear guidance to supervisors on ensuring this training is congruent with their organisational context and other activities.

• Provides guidance on integrating new skills and activities into existing roles and tools.

• Comprehensive package of training resources provided (Facilitator’s Manual, Participant’s Handbook, Visual Aids (PowerPoint), Visual Aid Notes).

• Tools and resources for use on the job provided.• Provides clear guidance on follow-up training.• Clear guidance for supervision by peer-coaching given.

• Provides a comprehensive package of training resources (Facilitator’s Guide, Introduction to the training manual, Participant’s Handbook, Evaluation Tools Manual, Flipchart for Client Education, and information pamphlets for each module).

• Provides tools/resources for use on the job.• Generic training package with guidance on adaptation to participant needs and the

working environment of participants.• Assessment includes demonstration of core skills.• Clear guidance on follow-up by trainers and/or supervisors given, including on-going

evaluation of participants n the field to ensure retention of skills and knowledge over time.

• Includes instructions for arranging on-site training within real-life community settings where possible.

• Training Guide provides instructions on CHW selection and motivation.• Provides resources and tools (see Participant’s Handbook) for participants to use in their

daily work.• Includes general CHW skill-building together with technical components.• Well illustrated- appropriate for low literacy• Guidance given on integrating this training course and participants into existing health

system structures.• Curriculum includes home-based and community practicums.• Evaluation and assessment includes observation and assessment during practicums.

Limitations/ Weaknesses • Assessment is through pre- and post-testing and self-assessment only.• Not competence based or assessed.

• Target trainee audience is accompagnateur not CHWs (overlap with CHW?)• Target trainer audience not stated.• Not competence based or assessed.• Evaluation through daily evaluation sheets only (participatory evaluation).

• Target trainee audience is Community Based Volunteers not specifically CHWs (though there may be overlap). This generic training resource provides the possibility of adaptation for CHW training.

• Tool requires updating.

• Slightly out of date with regard to ART and breastfeeding while using ARVs, but these dated items only affect a few modules.

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Gender-based violence01


Tool name, year, author Rethinking Domestic Violence: A Training Process for Community Activists (Raising Voices, 2004)

Link /Source http://www.raisingvoices.org/women/domestic_violence.php


Purpose This training process is a tool for strengthening the capacity of a wide range of community members to prevent domestic violence- not specifically targeted at CHWs.

It will help participants think about, discuss and take action to prevent domestic violence. It is a practical tool for trainers and activists who want to begin a process of change in their community (p5).

General overview This training tool includes programming materials, films, and articles for trainers and activists who want to begin a process of change in their community by helping community members learn about and prevent domestic violence (p5).

The training process contained in this document was developed by Raising Voices in collaboration with the Centre for Domestic Violence Prevention in Kampala, Uganda.

It is organised into the following six parts:

1) Introduction: overview and description of ideas behind this work, and tips on facilitating the process2) Becoming aware of gender and rights3) Deepening understanding of domestic violence4) Developing skills to prevent domestic violence5) Taking action to prevent domestic violence6) Appendices: including monitoring and evaluation tools, additional information for facilitating the process, handouts and learning tools (p6).

Target audience: trainees This tool is designed for use with a range of stakeholders. Reference is made to ‘health care workers’ amongst these, but not specifically to CHWs.

Potential participants include anyone «interested in helping community members learn about and prevent domestic violence» (p5).

These may include:

• a trainer working with an NGO• an activist who wants to help people talk about and take action against domestic violence• a police officer, community leader, health care worker, teacher, religious leader or a professional who wants to help their colleagues, clients or fellow

community members to better understand domestic violence• a member of a group of women, men or youth interested in promoting women’s rights• anyone who is interested in women’s right to safety who wants to work with others to prevent domestic violence (p5).

Target audience: trainers Trainers and activists (p5)- no further details stated.


The sessions described in this Training process are based on a participatory method of learning (p12).

Assessment and competence not stated.

Aspect of the continuum of SRMNCAH care covered Cross-cutting: Domestic violence.


Duration of training course The sessions in the tool can be used as:

• independent activities during any training process• part of regular capacity building of a selected group of people, for example, weekly or monthly sessions with staff or community groups.• four separate workshops held over 9 to 18 months with follow up support to participants in between the workshops• a resource for adaptation to fit your needs and objectives (p5).

Follow-up training and supervision (if planned) Tools for follow-up provided in appendices (Action Plan & Guidelines- which include tracking outcomes/indicators, conducting monitoring and completing Phase Reports (Appendix p10).

Training course evaluated, and key results Evaluation Report released October 2005 (available at http://www.raisingvoices.org/files/RVProgramToolsEvaluation.pdf) as combined evaluation of this training curriculum and document Mobilising Communities to Prevent Domestic Violence: A Resource Guide for Organisations in East and Southern Africa.

Combined key findings for both documents are as follows:

• Organisations have very high confidence in Raising Voices and the Program Tools. They frequently recommend Raising Voices and share the Tools with partners.

• The publications are used to develop and implement violence prevention programs in communities and regions around the world.• The majority of respondents also regularly use the Tools for reference and capacity building. In addition, organisations reported that the Tools have positively

impacted the quality of their violence prevention programs.• Respondents commented on the high quality of the publications, their clarity, usefulness and the ability to easily adapt the resources.• Respondents found the Resource Guide comprehensive and the Training Process valuable for implementing training.

3. Sustainability


Unknown.


321 trainings have been held utilising this training curriculum, resulting in 9462 participants trained.

Although originally intended for use in East and Southern Africa, approximately 2,500 Program Tools (combined result for this curriculum and Mobilising Communities to Prevent Domestic Violence: A Resource Guide for Organisations in East and Southern Africa) have been disseminated by request in 65 countries.

Estimated cost of training course (USD) Unknown.


Strengths • Comprehensive set of training resources provided.• Action plan and guidance including tracking outcomes/indicators, conducting monitoring and completing Phase Reports provided for follow-up.

Limitations/ Weaknesses • Not specifically designed for CHWs. Broad target trainee audience.• No eligibility criteria for trainees listed.• No eligibility criteria for trainers listed.• Not competence based or assessed.• No guidance on assessment included.

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