Thanks for being with us. We're going to continue our discussion preparing the health workers, training of trainers. As we said before, the training of trainers is extremely important. The health workers need to understand the process of working with volunteers, how they can become facilitators. They're not going out and telling people, you select three, four people. Or you select one person, and, so that the community is supportive. Get them to make the community take responsibility for the health program. And for the volunteers. we need to, again, get the health workers to understand how volunteer work helps them. Clearly, if less people are coming in for Malaria treatment, because they've gotten it as soon as they need it. It will reduce the workload. At the same time, it will increase the coverage. And they can report those statistics. Because more people are helping them provide the treatment that people need. The increased contact with the community is very important. it builds trust. If the community has concerns, they will bring it to the health worker, and they can resolve problems more easily. And again, if the health worker is showing interest in the community, people will be more responsive to new ideas from the health worker. Again, as we're talking about the, the issue of adult learning that we've talked about, the idea is transferring of skills from nurses health inspectors, front-line staff, to volunteers. And we need to adjust our training methods to the best way that the volunteers learn. We can't guarantee in many remote communities that we can always find people who can read and write. So the health workers themselves need to draw on training methods that are more visual. More participatory. Things like role plays. demonstrations. Return demonstrations. using illustration. Talking about motivation. For example, personal testimony about successful treatment of malaria. Getting the community members involved. Telling stories, story telling is a very important thing. We'll talk more about that. Traditional proverb, not that the health worker knows all the proverbs [LAUGH] in the area. But this is a way of drawing ideas from the trainees, from the community members. To help them, as adults, learn more themselves. Now, health workers, as we said, not only do the training, not only stock the supplies, but as much as possible, they need to reach out and supervise the community. We know, in most places transportation is a challenge, and sometimes what's happened is that by organizing monthly meetings in a central place. Say, people do need to come to market. People come to a town for, for other kinds of reasons on Fridays, Sundays, or what have you. If we know people are coming to a central location at a certain time, can plan opportunities for the health workers to meet the volunteers, and so supervision ideally should occur in the community. Because part of it may be problem solving with the community leaders. If there's some dissatisfaction. But if not, at least getting together where everybody would naturally come on, on certain occasions. Supervision with checklists is very important. It should be based on the skills that were taught during the the basic training, and then going back out to see if the, the volunteers are treating malaria, for example, by steps that they were taught to do in terms of identifying if the person has potential signs and symptoms of malaria, like fever. we've trained volunteers in the village to use the rapid diagnostic test, watching them, the checklist, to see that they followed the procedures correctly. That they picked the right medicine for the age of the person. That they explain this. So all of the supervisory checklists are very, very important. Again, all of this information coming from the field should help the health workers sit down and think about how effective they are in transferring these skills, and getting these ideas, and getting the services out to people. And one thing that helps very much is what we call feedback to the volunteers. This is a basic supervisory principle anyway. But one thing that sometimes happens is that we've done in Nigeria, is when we've used the checklist in the community, then at the upcoming monthly meeting of the volunteers. the health worker share some of their general observations, well we noticed, out of the 20 volunteers, that ten of them did not wash their hands before they started doing the malaria test. And well, what can we do about that, and then the volunteers can discuss, well we had a problem of getting soap or there's water at this and that. Okay, let's do problem solving. And so involving the trainees well, who are no longer trainees but involving the volunteers in solving the performance problems that they have. Some of it may be solving problems related to community support. nobody appreciates me, or they don't understand this, or we ask them to use their bed nets and they don't. What can we do? So this kind of two-way communication about what's happening in the field and engaging the volunteers in problem solving and learning from each other. One volunteer may have been very successful in getting everyone in his or her village to sleep under a net. What did you do? How can we learn from you? So the supervisor, the health worker, can facilitate this kind of interaction among the, the the volunteers. So that they become more effective. Again, the front line health workers are planning, monitoring, evaluating the activities of the program that they've gotten started. They have had objectives in terms of what services they want to deliver, in terms of what coverage targets they wanted to achieve when they wanted to get feedback, when they wanted to introduce some new programs. So they need to think carefully about their own work as supervisors, and ultimately, like I said, this work is the, an extension of the work they would normally be doing within the four walls of the clinic. So what we want to, them to be thinking about is planning beyond those walls. So that they can increase the coverage and, and achievements that they have. And then, not only do they collect up reporting forms from the volunteers from the villages. They put all that together. They need to pass that on, in a timely manner, to the district headquarters. so that they can then combine that with requests for additional supplies the next month. they can identify problems that they may have in terms of transportation, whatever. So, again, documenting and then reporting is very important. And then, as we mentioned. Not just reporting up to the district, but also when the volunteers gather, you know, reporting, does the supervisor back to them how well we're doing. Uh-huh, this, this time we had a major increase in the number of you reporting people using their bed nets. We had a major increase in the number who reported that they got people to do hand washing, whatever it happens to be. So this reporting should be both ways. The health department or the front-line clinic role with volunteer program doesn't stop after training. As we talked about, the supervisory visits with your checklist. another key thing is refresher training. We said with the checklist you may learn that many of the volunteers may have forgotten certain steps in the treatment of people with malaria and the diagnosis. And so, refresher training is important. One thing that we've found, it's helpful to get volunteers themselves to help conduct those refresher sessions. You may have a monthly meetings with your volunteers and say okay, I've noticed that some people are having trouble with this. Would one of you want to demonstrate or explain how's the best way to go about doing this malaria testing? And additional training may be needed because some people naturally will drop out. If the volunteer program is the responsibility of the community, the community usually doesn't drop out. The community is still there. So, but if somebody leaves, let's say one of the volunteers is an older woman, and her first daughter is having her own baby, and she may go stay, six months, whatever, with that daughter in another village to help take care of the baby, and they would need to replace that woman. Maybe [COUGH] somebody got a job somewhere else, and they've moved out, and the community will replace. So the health workers need to be prepared to train any of these replacements. But not just the health workers, the other volunteers should help train any new people who are recruited to replace any of their members who have left. The monthly meetings is an important way of bringing together the, forms the summary forms that the volunteers have had. It might just be a checklist or, you know, where they have columns for different kinds of services, and they just tick off what they've done, something simple. But an opportunity to bring those things together, everybody analyze it together, this is what we, in this catchment area, have all done together. To improve, you know, the healthcare of, of this area. And as we said before, this information needs to be forwarded so that not only does the Health Center get credit for all of this, but they also get replacement supplies for anything they've used.
