Volunteer community health workers (CHWs) are a major strategy for increasing access to and coverage of basic health interventions. Our village health worker training course reviews the process of training and continuing education of CHWs as an important component of involving communities in their own health service delivery. Participants will be guided through the steps of planning training and continuing education activities for village volunteers. The course draws on real-life examples from community-directed onchocerciasis control, village health worker programs, community case management efforts, peer educators programs and patent medicine vendor training programs, to name a few.
Lecture 2C: Approaching the Community
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En provenance du cours de Johns Hopkins University
Training and Learning Programs for Volunteer Community Health Workers
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Getting Started
In this module, we will focus on the principles of learning, as well as approaching the health service and the community. There will almost be a quiz covering the first two lectures.
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William Brieger, DrPHProfessor, Health Systems Program of the Department of International Health
Bloomberg School of Public Health
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.
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