Facilitator's Guide Draft 081811

7/30/2019 Facilitator's Guide Draft 081811

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DOH and A2Z Manual; For pre-tesng only.





Training of Service Providers on

the Implementaon of theMicronutrient Supplementaon Program

TRAINING MANUAL/FACILITATOR’S GUIDE

DOH and A2Z Manual; For pre-tesng only.



Foreword

ii



Acknowledgment

iii



TABLE OF CONTENTS

Page

About the Course and the Course Materials vi

Training Design and Schedule

Training of Service Providers xi

Course Content and Session Plans on Training of Service Providers

Module 1 – Introductory Sessions 1

Session1:“GengtoKnow”andFormingTeams 2

Session2:SharingExpectaonsandSengGroupNorms 4

Session3:OrientaontotheCourseandCourseMaterials 7

Module 2 – Understanding the Micronutrient Situaon

Session1:BasicInformaon,FunconsandFoodSourcesofMicronutrients 13 Session2:Causes,ConsequencesandPrevenonofMicronutrientDeciencies 16

Session3:MagnitudeofMicronutrientDeciencyProblems 19

Module 3 – The Micronutrient Supplementaon Program 29

Session1:MSPGoals,PolicyandImplemenngGuidelines 30

Session2:ProvidingEssenalMSPackageforInfantsandChildren,

Women,MothersandOtherAdults 34

Session3:StrengtheningHealthPromoonandCommunicaonforMS37

Module 4 – Enhancing Integraon of MS Intervenons in Service Delivery Sengs 50

Session1:DeliveryofMSIntervenoninDierentSengs 51

Session2:IntegrangMSIntervenoninRegularHealthServices 54

PraccumSession–HealthCenter 59

Module 5 – Managing Service Delivery of MS Intervenon 87

Session1:DeliveringQualityMicronutrientSupplementaonServices 88

Session2:DeliveringMSServicesbyCompetentandResponsive ServiceProviders 92

Session3:ManagingResourcesandHealthInformaonSystem 95

Session4:SupervisingDeliveryofMSServices 99

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Page

Module 6 – Acon Planning 118

Session1:PlanningforImprovingMSPImplementaonfor

MSPImplementaon 119

Session2:HarmonizingAconPlansofServiceProvidersandSupervisors 122

Course Content and Session Plans on Training of Trainers / Facilitators

Training Design and Schedule 129

Module 7 –Training of Facilitators/ Trainers 133

Session1:OverviewoftheConceptsonTeaching-learningandTraining 134

Session2:ApplyingFacilitaonandPresentaonSkillsandTechniques 137

Session3:PracceSessionforFacilitator-Trainee 141 Session4:AconPlanningonTrainingofServiceProviders(“Roll-out”) 144

Reference Guide on Training for Trainers/Facilitators 156

Session1:OverviewontheConceptsofTeaching-LearningandTraining 157

Session2:ApplyingFacilitaonandPresentaonSkillsandTechniques 163

Evaluaon Tools Pre-and Post Test- Course Evaluaon 172

SampleLeers 180

References 188

v



Annexes

Annex1.1. HumanBingoCard 10

Annex1.2. MatrixonSharingExpectaonsandSengGroupNorms 11

Annex2.1. MatrixonFunconsandFoodSourcesOfMicronutrients 24

Annex2.2. MatrixonVulnerable/mostaected(atrisk) Causes,ConsequencesandPrevenonof MicronutrientDeciencies/Diarrhea 25

Annex2.3. CaseScenarioonMagnitudeofMNDeciencyProblem 26

Annex2.4. MatrixonIdencaonofFactors/BarriersandPossibleSoluon 27

Annex2.5. MaternalandChildHealthIndicators 28

Annex3.1a. QuesonsonMSPGeneralGuidelines 40

Annex3.1b. AnswerKeystoQuesononGeneralGuidelinesonMSP 41

Annex3.2. OralDrillandKeyAnswersonMSPackageforInfants,Children, Women,MothersandOtherAdults43

Annex3.3a. CaseScenariosonHealthPromoonandCommunicaonforMS 48

Annex3.3b. PossibleAnswersand/orKeyPointstoEmphasizeforeachCaseScenario 49

Annex4.1a. WorkshopMatrix/GuideonAlternaveServiceDeliverySengs 63

Annex4.2. CaseScenarioforDemonstraoninthePlenary(Facilitator’sCopy) 72

Annex4.3a. CaseScenariosforSmallGroupExercises(Facilitator ’sCopy) 73

Annex4.3b. Key/PossibleAnswerstoCaseScenarios(Facilitator’sCopy) 76

Annex4.4. ObservaonChecklist(ForClassroomExercises) 79

Annex4.5. ObservaonChecklist(ForPraccum) 82

Annex4.6. StaInterviewChecklist(Praccum) 84

Annex4.7. RecordsReviewChecklist(Praccum) 86

Annex5.1a. CaseScenarioforSmallGroupDiscussionsforSession1andSession2 103

Annex5.1b. PossibleAnswers/notesontheSmallGroupDiscussionsforSession1 104

Annex5.2a.GuideQuesonsfortheSmallGroupDiscussioninSession2 105

vi



Annexes

Annex5.2b. PossibleAnswers/Notes-QuesonsfortheSmallGroup DiscussioninSession2 106

Annex5.3a. ExercisesonManagingMSResourcesandHealthInformaonSystem 107

Annex5.3b. AnswerstoSampleexercisesoncomputaonsofMSneeds (Facilitatorscopy) 108

Annex5.4a. CaseScenarioforSession4-Supervision 111

Annex6.1. PlanningforImprovementsinMSPImplementaonfor ServiceProviders 125

Annex6.2. SupervisoryPlanonImprovingPerformanceofServiceProvidersonMSP126

Annex6.3. HarmonizingAconPlansofServiceProvidersandSupervisors 127

Annex7.1. PossibleAnswersandNotesforSmallGroupDiscussiononTraining148

Annex7.2. MonitoringForm1:ClassroomSession 149

Annex7.3. MonitoringForm2:PraccumSession 150

Annex7.4. MonitoringForm3forFacilitangandPresentaonTechniques 151 Annex7.5. Facilitators’PracceSession 152

Annex7.6. AconPlanningforTraining“Roll-out”ofMSTraining 155

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ABOUT THE COURSE AND THE COURSE MATERIALS

I. Structure of the Course

TheTrainingofServiceProvidersonImprovingImplementaonofMicronutrient SupplementaonProgramisa3.5-daycourseconsisngof6modules,17sessionsand1

praccumsession.Itusesavarietyofteaching-learningmethodsincludinglectures,actual facility-basedpraccesession,workinginsmallgroupsusingdiscussions,role-playsandpracce exercises.Parcipantsprogressivelydeveloptheircompetenciesinclassroomwithpracce sessionsandinactualhealthcenterseng.

ToecientlyimplementtheTrainingofServiceProvidersinvariousareasofthecountry,itis necessarytoconducttheTrainingofTrainers(TOT)forthecourse.Thisisa5-daycoursedivided into2parts:therstpartisontheTrainingofServiceProviders(modules1to6);andthe secondpartistheTrainingofTrainers(module7).Thecompletecoursehasatotalof7 modules,21sessionsand1praccumsession.Itusesavarietyofteaching-learningmethods speciedinthetrainingdesignfortheTrainingofServiceProviders.Inaddion,eachparcipant willundertakeapraccesessionasafacilitator/trainer.

II. The Trainer’s Manual/Facilitator’s Guide and Parcipant’s Support Materials

The(1)Trainer’sManual/Facilitator’sGuidecontainswhatafacilitatorneedinordertoleadand guideparcipantsthroughthecourse.Italsocontainsthetechnicalinformaon,detailed instruconsonhowtoteacheachsession,exercisesthatparcipantswilldo,casescenariosfor discussionsandroleplays,forms/worksheetsneededforpracceexercisesandpraccum sessions.

Thefacilitatorshouldhavehis/heracopyof:(2)DOHMicronutrientSupplementaonProgram ManualofOperaons(MSP-MOP)whichisthemainreferenceintheimplementaonofthe MSP,and(3)Parcipant’sSupportMaterials.Beingfamiliarwiththeparcipant’ssupport materials,thefacilitatorcanleadparcipantsatwhatpointsthesessionsarethreadingand assistinlocanginformaonthatparcipantsmustbefamiliarwithasaneecveimplementer oftheMSprogram.

Eachparcipantshouldhaveacopyofthe(1)DOHMicronutrientSupplementaonManualof Operaons(MSP-MOP)whichisthemainreferenceintheimplementaonoftheMSPat varioussectorsandlevelsofmanagementandservicedelivery.Inaddion,parcipants shouldbeprovidedwith(2)Parcipant’sReferenceGuideandothertrainingsupportreferences andmaterialsthatwillbeusedduringthedierenttrainingsessionsandpracceexercises, includingthoseofpraccumacvies

III. Preparaon of a facilitator for the TOT-MSP

1.TheparcipanttotheTOTneedstoaendtheCourseonTrainingofHealthWorkerson ImprovingImplementaonoftheMSProgram,inordertolearnthescopeofthetechnical

contentandcompetenciesindeliveringmicronutrientsupplementaonservices.Aendanceto

anyMScoursewillbeanaddedpreference.

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2.Oncompleonofthecourse,theparcipantneedtoaendtheTOTandFacilitator’s Orientaonsessionsinordertolearnhoweachtrainingsessionwillbeconductedtomeetthe learningobjecves,applyingthesuggestedmethodologiesandguidelines.

IV. General Funcons of a Facilitator

Afacilitatorneedstobeveryfamiliarwiththecourseandhe/sheisexpectedto:

1.Answerquesonsandtalktoindividualparcipantsabouttheirworkonthetrainingsessions,

inperforminglearningandassessmentacvies;and,

2.Giveparcipantsanyhelpneededtomeettheirrequirementsforthecourse.

Asafacilitator,oneisexpectednotonlytoteachthecontentofthecoursethroughformal

lectures,butalsotoassistparcipantsdevelopthecompetencieswithahighdegreeof

sasfaconbytakingwhateveracviesthatwillbehelpfulorneededbytheparcipant.

Tofacilitate,onewillneedtoperformacviesaccordingtothethree(3)funcons:

1. Instruct

1.1. Makesurethateachparcipantunderstandshowtoworkthroughthecourseandwhathe

orsheisexpectedtodoineachmoduleandtrainingexperience.

1.2. Encourageparcipantstocometoyouatanymewithquesonsorcomments.

1.3. Takemewitheachparcipanttoanswerthequesonsfully.

1.4. Clarifyanyinformaonthataparcipantndsconfusing.

1.5. Guideacviestomakesurethatthelearningobjecvesareaccomplished.

1.6. Idenfyweaknessesintheparcipant’sunderstandingoftheknowledgeandthelearning

performanceandprovideappropriatetrainingreinforcements.

2. Movate

2.1. Encourageparcipanttorelatehowthetopicsapplytotheirworkandhowtheycanhelp

servetheirclientswithMSdecienciesandpromotegoodnutrion.

2.2. Provideappropriateandperiodicfeedbackonlearningprogressmadeandoer

suggesonstopursuefurtherdevelopmentofcompetencies.

3. Manage

1.1. Provideparcipantsaccesstotheneededsupplies,materialsandequipmentneededat

thespeciedmeandplace.

1.2. Makesurethesessionsareconductedaccordingtoschedulebyensuringthat:

1.2.1. Resourcepersonsarepresentasscheduled

1.2.2. Parcipants,resourcepersons,facilitatorsobservememanagement

1.2.3. Trainingvenueispreparedforthesessions

1.3. Checkthattherearenomajorobstaclestolearning(toomuchnoise,notenoughlight,not

enoughworkspace,andsuppliesfortheacvies).

1.4. Monitortheprogressofeachparcipant

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How does a Facilitator do these things?

* Showenthusiasmforthetopicscoveredinthecourseandfortheworkthatthe parcipantsaredoing.

* Beaenvetoeachparcipant’squesonsandneeds.Encourageparcipantstocometo youwithquesonsorcomments,beingavailableatscheduledmes.

* Watchparcipantsastheywork,andoerindividualhelpifyouseeaparcipantlooking troubled,staringintospace,notwringanswers,ornotturningpages.

* Promoteafriendly,cooperaverelaonship.Respondposivelytoquesons.Tryto addressparcipants’concerns,ratherthanrapidlygivingthe“correct”answer.

* Alwaystakeenoughmewitheachparcipanttoanswerhis/herquesonscompletely (thatis,sothatbothyouandtheparcipantaresased).

What NOT to do.....

* Duringmesscheduledforcourseacvies,donotworkonotherprojectsordiscuss maersnotrelatedtothecourse.

* Indiscussionswithparcipants,avoidfacialexpressionsormakingcommentsthatcould causeparcipantstofeelembarrassed.

* Avoidbeingtoomuchofashowman.Enthusiasmisgreat,butlearningismostimportant. Ensurethatparcipantsunderstandthematerials.Dicultpointsmayrequireyoutoslow downandworkcarefullywithindividuals.

* Donottalktoomuch.Encouragetheparcipantstotalk.

To prepare yourself for each module, a facilitator/trainer should:

* Readthemoduleandtoworkontheexercises,

* ReadfromtheTrainer’sManual/FacilitatorGuidetheinformaonprovidedaboutthe module/session,

* Planexactlyhowtoworkonthemoduleandwhatmajorpointstomake,

* Collectsuppliesfortheexercisesandprepareforanydemonstraonsorroleplays,

* Thinkaboutseconsthatparcipantsmightnddicultandquesonstheymayask,and planwaystohelpwithdicultseconsandanswerpossiblequesons,

* Thinkaboutthecompetenciesand/orskillstaughtinthemoduleandhowtheycanbe appliedinparcipants’ownhealthfacilies,

* Askparcipantsquesonsthatwillencouragethemtothinkaboutusingtheirlearningin theirworkplace.

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Funcons of Facilitators During Pracce and Praccum Sessions

Thereshouldbe(1)facilitatorforeverygroupof4to5parcipants.Detailedacviesand instruconsarecontainedintheSessionPlansforPracceandPraccumSessions

TheroleofthefacilitatorduringPracceandPraccumsessionsisto:

1.Doallnecessarypreparaonsforcarryingoutthepracce/praccumsessions.

2.Explainthesessionobjecvesandmakesuretheparcipantsunderstandwhattododuring eachpraccumsession.

3.Demonstrateskillsexactlyasparcipantsshoulddothemwhentheyreturntotheirown areastoconductTOTandwhentheyapplythemintheirownclinics.

4.Observetheparcipants’progressthroughoutthepraccumsessionsandprovidefeedback andguidanceasneeded.

5.Beavailabletoanswerquesonsduringthepraccumsessions.

6.Leaddiscussionstosummarizeandmonitortheparcipants’performance.

7.CompletetheChecklistforMonitoringPracce/PraccumSessionstorecordthe parcipants’performanceandtheacviesperformed.

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for: TRAINING OF SERVICE PROVIDERS


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Training of Service Providers on the Implementaonof the Micronutrient Supplementaon Program

Background and Raonale

NutrionaldeciencyremainsaconnuingchallengeinthePhilippinesasitaectsclientsin

variousagegroupsandincertainphysiologicalstates.UsingtheWHOandnaonalstandards, only68%ofchildrenundervehavenormalweight-for-age.In2005,therewas24.6%prevalence ofunderweightpre-schoolchildren(0-5years),26.3%werestunted,4.8%wastedand2.0% overweight.Exclusivebreast-feedingislowat34%ofchildrenexclusivelybreast-feduptoagesix months.Inaddion,childrenfacetheproblemsof1)anemia–withprevalenceratesof66%in children6-12months;2)vitaminAdeciency–with40%inchildrenagedsixmonthstoveyears; and3)iodinedeciency–withesmated1.5millionschoolchildrenaged6-12yearsatriskof mentalretardaonduetoiodinedeciency.

MicronutrientdecienciesinVitaminA,ironandiodinehavereachedthelevelsofpublichealth signicance.Facedwitheconomic,agriculturalandchallengeslikeemergencies/disastersinmany areas,theproblemincreasesfurtherinmagnitudedueoflackoffoodandhighincidenceof

infeconsduetocongesonandpoorsanitaryenvironmentandhygiene.

TheissuanceofAdministraveOrder(AO)No.2010-0010bytheDepartmentofHealththisyear whichprovidedtheoverallpolicydireconontheMicronutrientSupplementaonProgram(MSP) willsignicantlycontributetoaccelerangeecveimplementaonoftheMSPinreaching moreclients.Thispavedthewayfortheneedtoupdateserviceworkersontheircompetencies inimplemenngtheMSP.Todate,thelasttrainingconductedonMicronutrientSupplementaon wasin1992,whiletechnicalupdateswereperiodicallyconductedwithintheinterimperiodto supportthehealthworkers.Hence,thecapacity-buildingtomeetthetrainingandinformaon needsofserviceproviderstoenablethemtoimproveimplementaonoftheMSP.

General Objecve

Toassisthealthserviceprovidersenhancetheircompetenciesonimprovingimplementaonof theMicronutrientSupplementaonProgram(MSP).

Specic Objecves

Duringthecourse,eachparcipantwillbeabletoachievethefollowinglearningobjecves:

1.Explainthefollowing:

1.1. Healthgoals,objecvesandtargetsonmicronutrientsupplementaon–naonalandlocal basedonthesetMDGforthecountry 1.2. TheMicronutrientSupplementaonProgram(MSP) 1.3. KeyprovisionsoftheMicronutrientSupplementaonGuidelines(AO2010-0010) 2.Discussthefollowing:

2.1. StatusofMicronutrientSupplementaon 2.2. Eectsofcommondecienciesonvulnerablepopulaon 2.3. Basicinformaon,funconsandfoodsourcesofMicronutrients

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2.4. WaysofimprovingimplementaonofMSProgram 2.5. ConceptsandprinciplesofSupervision 3.Demonstrateskillsinmanagingmicronutrientdeciencies:

3.1. Assessingsignsofmicronutrientdeciencies/riskfactors 3.2. Diagnosing/classifyingdeciencies 3.3. Idenfyingappropriateintervenons 3.4. DeterminingappropriateMSpackageforthedierentagegroupsandthoseinlifestages/ condionsrequiringMS. 3.5. IdenfyingkeymessagesonMSappropriatetoclients’need

4.DemonstrateskillsinimplemenngtheMicronutrientSupplementaonprogram:

4.1. ProvidingMSservicesinvariousdeliverychannels 4.2. IntegrangMSservicesinrounehealthservicesandprograms 4.3. FormulanganaconplanforeecveimplementaonofMNSprogram

Course Content:

Module1–IntroductorySessions

Session1:“GengtoKnow”andFormingTeams Session2:SharingExpectaonsandSengGroupNorms Session3:OrientaontotheCourseandCourseMaterials

Module2–UnderstandingtheMicronutrientSituaon Session1:BasicInformaon,FunconandFoodSourcesofMicronutrients Session2:Causes,ConsequencesandPrevenonofMicronutrientDeciencies Session3:MagnitudeofMicronutrientDeciencyProblems

Module3–TheMicronutrientSupplementaonProgram

Session1:MSPGoals,PolicyandImplemenngGuidelines Session2:ProvidingEssenalMSPackageforInfantsandChildren,Mothers andOtherAdults Session3:StrengtheningHealthPromoonandCommunicaonforMS

Module4–EnhancingIntegraonofMSIntervenonsinServiceDeliverySengs

Session1:DeliveryofMSinDierentSengs Session2:MSIntervenoninRouneClinicServices

PraccumSession–HealthCenter

Module5–ManagingServiceDeliveryofMSIntervenons

Session1:DeliveringQualityMSServices Session2:DeliveringMSServicesbyCompetentandResponsiveServiceProviders Session3:ManagingResourcesandHealthInformaonSystem Session4:SupervisingDeliveryofMSServices

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Module6–AconPlanning

Session1:PlanningforImprovingMSPImplementaon Session2:HarmonizingAconPlansofServiceProvidersandSupervisors

TrainingMethodology

Parcipatoryteaching-learningmethodssuchaslecture-discussion,smallgroupdiscussion, roleplays,drills/games,praccesexercises.Onepraccumsessioninthemorningwillbe conductedinselectedhealthcenters

EvaluaonMethods

Pre-testandPosttest Completedwork/outputsduringsessions Observaonofdemonstratedskills Post-trainingquesonnaire

MainReference:TheDepartmentofHealthMicronutrientSupplementaonProgram-Manualof Operaons2011

OperangDetails Parcipants: FrontlineHealthWorkers–RMS,PHNsandMHOs/RHPs Duraon: 3.5days(Live-in). Venue/site: Provisionsforadequatespaceforinteracvelearningmethodslikeroleplays, demonstraonsandsmallgroupacvies.Inaddion,arrangementswithnearbyhealthcenters shouldbemadefortheonepraccumday(Day3AM).

SourceofFunds:_______________________

TrainingSchedule: Refertothenextpage.

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T r a i n i n g o f S e r v i c e P r o v i d e r s o n I m p r o v i n g I m p l e m e n t a o n o f t h e M S P

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Module 1:

Introductory Sessions

FACILITATOR GUIDE (SESSION PLANS)





Module 1- Introductory Sessions

Session 1: “Geng to Know” and Forming Teams

OVERVIEW •Introducingparcipantsandfacilitatorsisessenalinachievingaheadstartin

anytrainingacvity.

•Gengacquaintedwiththepeoplethatonewillworkwithduringthecoursewillhelpparcipantsfeelcomfortable,helpdevelopcondencewiththegroup

andapproachthetrainingacviesposively.

•Teamworkhaslongbeenrecognizedasaneecvemethodofimproving

organizaonalperformance.Inthesamemeasure,grouplearningmethods

havealsobeenacceptedaseecvemeanstoachievinglearningobjecves.

OBJECTIVES Attheendofthelearningsession,theparcipantswillbeableto:

1.Getacquaintedwitheachother

2.Discloseinformaonaboutone’sselftoothers

3.Organizeashostteams

4.Agreeontherolesandresponsibiliesofhostteams

METHODOLOGY Game:“HumanBingo”andgroupdiscussion

ESTIMATED TIME 60minutes

ADVANCE

PREPARATION

•HumanBingocards(RefertoFacilitator’sGuideAnnex1.1)

•Instruconsheet(inpowerpointslidesorprintedinmanilapaper)

•PowerPointslidesonSessionObjecves



TEACHING-LEARNING PROCESS

TOPIC/TIME METHODS / ACTIVITIES

Introducon

(05 min)

•Greettheparcipants.

•Explaintheobjecvesofthesession.

•Explainthemechanicsofthegame“HumanBingo”withtheaidofahuman

bingocardandaninstruconsheet/projectedslides(PowerPoint).

Game

(10 min)

HumanBingo

Distributeacopyofthehumanbingocard(Facilitator’sGuideAnnex1.1.)to

eachparcipant.Givethefollowinginstrucons:

•Readrstallthedescriponsfoundinyourbingocard’sboxes/cubes

•Eachparcipantwillapproachapersonwhomyouthinkbesttthe

descriponsorcharacteriscswrienineachoftheboxesinyourbingocard.

•Thepersonmeengthedescriponshallprinthis/hernameandsigninthe

spaceprovidedforasacknowledgement.

•AnindividualmayonlysignontheparcipantsBINGOcardonce.Inorderto

win,anindividualmusthave5signaturesinarow,diagonally,horizontallyor

vercally.TheindividualshouldshoutBINGOonceshecompletestheneeded

lines.

•WhentheyhearthewordGO,theparcipantswillstartroamingaround.

•Oncesomeoneshouts:BINGO”,everyonereturnstotheirseatsandtheperson

mustintroducethepeoplewhosignedhis/herBINGOcard.

Processing

(10 min)

Requesttheparcipantstogobackintheirseats.Thenthefacilitatorwill

iniatethegroupdiscussion,usingthefollowingguidequesons:

•Howdidyoundtheacvity?

•Whatdidyoudiscoverfromyourco-parcipants?

•Whatdidyoudiscoversomethingnewaboutsomeoneyoualreadyknow?

•Whatarethelearninginsightsthatcanbedrawnfromtheexercise?

Aerthegroupdiscussion,gatherallparcipantsinaplenarysession.

4




Formaon of Teams

(10 min)

Orient on the roles/

responsibilies of

Host Teams(05 min)

Lecturee

Acknowledgetheparcipaonofparcipantstotheacviesdoneand

reinforcetheimportanceoftheexperienceandtheinsightsdrawn.

Explainthatparcipantshelpmakelearningfunandeecve.Inorderforeach

daytorunsmoothlyandmakeacviesexcing,facilitatorsneedthehelpandacveparcipaonofparcipantstoworkashostteamsforeachday.

Informtheparcipantsthattheyweredividedintogroupsfollowingaraoof1

facilitatorfor7parcipants.Presentthegroupingsinplenary.

Note:Thefacilitatorshouldhavegroupedtheparcipantspriortohis/her

session.Ingroupingtheparcipants,ensurethateachgroupisheterogeneous,

composedofparcipantscomingfromthedierentmunicipalies,professions

andhavevariedpersonalies.

Designateahostteamforeachday.Dependingontheneedsofthetraining,

hostteamscanbetaskedtohelp:

•Lead“icebreakers”or“unfreezingexercises

•Ensurethatparcipantsarepresentinthesessions.

•Setupphysicalarrangementoftrainingroom

•Recapitulatetheacvies/learningfromthepreviousday’strainingsession

•Monitortheaendanceandobservanceofparcipantstogroupnorms

Synthesis

(05 min)

Informtheparcipantsthatthesessionisastarngpointtogettoknoweach

otherandtoworkwithoneanotherbeer.

Thesucceedingacvies,exercisesandworkingforoutputsinthesucceeding

dayswillprovidemoreopportuniesforparcipantsto:

1.Shareandlearnmorefromeachother,and

2.Worktogetherasateam



Module 1- Introductory Sessions

Session 2: Sharing Expectaons and Seng Group Norms

OVERVIEW Inanyhumanresourcedevelopmentacvity,itisimportantforparcipantsand

facilitatorstohaveunityofpurposeandcommonunderstandingofthetraining

objecves.

OBJECTIVES Attheendoftheacvity,theparcipantswillbeableto:

1.Sharetheirexpectaonsaboutthetraining

2.Clarifytheirexpectaonsinrelaontothecourseobjecvesintermsof:

a.Knowledgeandskills

b.Scopeand/orlimitaonsofthecourse

3.Agreeoneachparcipant’slearningroleandtheresponsibilies

4.Establishgroupnormstoobserveduringthetrainingweek

METHODOLOGY Individualwork,Groupdiscussion


ADVANCE

PREPARATION

Cartolina(5colors)cutintometa-cardsizes,markers(pentelpens),Manilapapers

(“tear”sheets),maskingtapes,whiteboardmarkers,andwhiteboardforeach

group.

Preparenumbers1to5inabowlenoughtomake5groups.

6





Introducon

(05 min)


•Provideappropriatelinkwithsession1.

•Explaintotheparcipantstheobjecvesofthesession.

Individual work

(10 minutes).

•Introducetheinialacvityofthesessionbyinformingtheparcipantsto

groupbasedonthegroupingspresentedinsession1.

•Giveeachparcipantatleast5Metacards,1cardpercolor.Tellparcipants

theycanaskformorecardsiftheyhavemoreideastowrite.

GivethefollowingInstrucons:

1.Askeachparcipanttothinkof1-2ideasasexpectaonfromthistrainingand

writeitintheidea/metacards.Eachonewillsharetheseideaswithinthesmall

group.

2.Theseexpectaon/swillincludethe5aspectsasfollows:

2.1.what(new)knowledgewillyoupersonallywanttogain

2.2.what(new)skillswillyoubeabletodoaerthecourse

2.3.whatareyourexpectaonsfromthefacilitators

2.4.whatcontribuonswillyouexpectfromco-parcipantstocommit

2.5.whatcontribuonscanyoupersonallycommittothistraining

3.Thefacilitatorwillassignacolorofideacardsforeachaspectsofthe

expectaondependingontheavailablecolorsduringthetraining.

4.Remindtheparcipantsonthegeneralrulesofwringonidea/metacards:

4.1.useonly5-7words,

4.2.writeinBIG,capitalleers,

4.3.writeoneideapercard,and

4.4.bespecic

5.Eachparcipantinagroupwillposthis/herexpectaonstotheManilapaper

providedforeachgroup.

6.Aereveryoneinthegrouphaspresentedhis/herexpectaons,thegroupwill

reviewthelistanddecidewhatwillbethegroup’sexpectaonstobeshared

tothebiggroup.

7.Tellthegroupstoposttheirgroup’soutputstothedesignated“posterareas”

foreachofthe5Idea/ExpectaonBoards.

7




Processing

(10 min)

Clarifytheparcipants’expectaonsaboutthetrainingby:

1.Reviewingthelistofexpectaonspresented

2.Idenfyingwhatcanbeandcannotbeachievedbythecourse

3.Presenngtheobjecvesandscopeofthecourse

•Recognizetheimportantideas/expectaonspresented

•Explainthelimitaonsandconstraintsofthecourse,andtheneedtofocus

onlythepriorityworkareasinMSprogram.

Seng Group Norms/

Learning agreement(10 min)

Lecturee

Explainthefollowingpoints–

1.Learningacvieswillinvolvegroupwork

2.Successofthetrainingdependsonhoweachparcipantperformsanacvity

3.Howgroupmembersinteractandworkwithco-parcipantsandwith

facilitatorsaectsmoothowoftrainingprocess.

Fromtheresultsofthediscussionsonthetrainingexpectaonspresented

1.Askparcipantstoreviewthelistofexpectaonspresented.

2.Askfromeachgrouptomenonwaysthatparcipantscancommittohelpto

ensuresmoothowofacvies.

3.Aco-facilitatorwillwriteormarkontheboardtheanswersgivenbythe

parcipants.

4.Aseachparcipantmenonsanitemalreadypresented,marktheitemsto

tallyideas.

5.Iftherearehouserules,thesemaybeaddedtothelist.

6.Aerasucientlisthadbeencompleted,goovereachitemone-by-oneand

askparcipantsifeachstatementishelpfuland/oracceptableornot.

7.Clarifyfromthegroupiftheagreedlistiscompleteorsucient.

8




8.Withtheapprovalofthegroup,declarethelistasthenormsforthegroup

toobservefortheduraonofthetrainingsothatthegroupcanworktogether

eecvely.

Examplesofgroupnorms:

•Beonmeinaendanceandinperformingwork

•Speakoneatame

•Beopen

•Beaenveandparcipateacvely

•Beresponsibleforyourlearning

•Besupporvetothelearninganddevelopmentofothers

•Becooperave

•Havefunandenjoy

•Keepcellphonesonsilentmode

Postthenallistofnormsagreedbythewholegroup.

Synthesis

(05 min)

•Conrmwithparcipantstheimportanceofsharingandunifyingtraining

expectaons.

•Informparcipantsthatthedetailsonthecoursewillbepresentedinthe

nextsession



Module 1: Introductory Sessions

Session 3: Orientaon to the Course and the Course Materials

OVERVIEW TheTrainingofTrainers(TOT)ontheTrainingofServiceProvidersonImproving

ImplementaonofMicronutrientSupplementaonProgramisa5-daycourse

dividedinto7modules,22sessionsand1praccumsessions.Itusesavariety

ofteaching-learningmethodsincludinglectures,workinginsmallgroupsusingdiscussions,role-plays,games,pracceexercisesandfacility-basedpracce

sessions.Parcipantswillprogressivelydeveloptheircompetenciesinclassroom

sengsandpraccetheminhealthcenters.

Thiscapacity-buildingacvityintendstorespondtotheneedsoftrainers/

facilitatorstofacilitateinthetrainingofserviceproviderstoeecvely

implementtheMicronutrientSupplementaonProgram.

OBJECTIVES Attheendoftheacvity,theparcipantswillbeableto:

1.Explainthekeyelementsinthecoursedesign

1.1.Objecvesandcontent

1.2.Methodologyandacvies

1.3.Expectedoutputs/outcomes

1.4.Overallstructureofthecourse

2.FamiliarizeonthecontentoftheMicronutrientSupplementaonProgram-

ManualofOperaons

3.Locatefromthemanualthetechnicalsecon/contentsonMSP

METHODOLOGY Lecture-discussionandgame


ADVANCE

PREPARATION

•CopiesoftheTrainingdesign(RefertoFacilitator’sGuidepp.xi-xiv)

•MicronutrientSupplementaonProgram-ManualofOperaons,jobaidsand

othersupportmaterials

•Powepointpresentaonofthesessionobjecves

10





Introducon

(05 min)

Greettheparcipants.

•Recallrelatedinformaondiscussedfromtheprevioussessionsuchasthe

parcipants’expectaons,courseobjecvesandscopeofthecourse.

•Explaintotheparcipantstheobjecvesofthesession.

Course Design

(10 minutes)

Lecture-Discussion

•Presenttheobjecvesofthesession

•MakeaPowerPointpresentaonabouttheCourse

1.Objecvesandcontent

2.Methodologyandacvies

3.Expectedoutputs/outcomes

4.Overallstructureofthecourse

•Engageparcipantsintoadiscussionaboutthecourse,relangtheneedfor

thepresenttrainingtotheircompetenceinimplemenngtheMSP.

•Presenttheoverallscheduleandexplainthedailyschedule-content,

acvies,preparaonsneeded,etc.

•Aligntheexpectaonswiththecourseobjecvesanddesiredoutcomes.

•IntroducetheMSP-MOPasthemainreferenceandpresentthejobaidsandothersupportmaterials.

MSP-MOP

(10 min)

Lecture-discussion

•MakeapresentaonontheoverviewontheMicronutrientSupplementaon

Program-ManualofOperaons

•DistributeacopyoftheMS-MOPtoeachparcipant.

•Emphasizethefollowingpoints

1)TheMOPisaguideinimplemenngthemicronutrientsupplementaon

programincompliancewithDOH-AO2010-0010

2)Itisaimedatintegrangthemicronutrientsupplementaoninthedelivery

ofservicesforwomen,mothersandchildrenasoutlinedintheMNCHN

connuumofservicesbasedonlifestagesapproach.

3)Itwillserveasguidetovariousstakeholdersinvarioussectors.

11




MSP-MOP

(10 min)

•InformparcipantsthattheMOPhasthefollowingsecons:

Secon1:TheMSProgramGuidingPrinciples,PolicyandGeneralGuidelines

Secon2:TheEssenalMicronutrientandCommonDecienciesSecon3:MagnitudeoftheMicronutrientDeciencyProblems

Secon4:MicronutrientSupplementaonIntervenons

Secon5:DeliveryofMicronutrientSupplementaonServices

Secon6:HealthPromoonandCommunicaonforMicronutrient

SupplementaonProgram

Secon9:ImplementaonArrangements

•Themanualaimedtotrainserviceprovidersandlocalimplementersonthe

managementofmicronutrientprogrambasedonthecontentsontheMOP

•Informparcipantsthatthroughoutthecourse,theywillbeusingmoretheMOPandgetmorefamiliarwithitscontent.

Synthesis

(05 min)

•Askiftheparcipantshavequesonorclaricaonsaboutthesession.

•Tosummarize,informparcipantsthatbeingclearaboutthemechanicsofthe

courseandfamiliarwithcoursematerialswillhelpthegroupbefocusedand

beguidedinthesucceedingsessions.

12



Annexes for

Module 1





Annex 1.1. Human Bingo Card

Human Bingo Card

TrainedonVAD-

IDA-IDD

Walkstowork Receivedanaward

inthepastyear

Achievedatleast

95%VACcoverage

for6-59months

lastGPround

Celebratedher/

hisbirthdaylast

month

Single Knowshowto

ballroomdance

Currentlytaking

ironsupplements

NewGrandma

(recentlyhadrst

grandchild)

Fearofridinga

boat

Withoneunder

vechild

Workingin

micronutrient

supplementaon

forlessthanayear

FREE

Currently

breaseeding

Abouttorerein

thenext5years

Notlivingin

her/hisplaceof

assignment/work

Hasahomegarden Doesnotdrinkso

drinks

Rodeazipline Marriedbut

childless

Knowsabout

AO2010-0010

(Newpolicyon

Micronutrient

supplementaon)

Neverrodeaplane Involved in

micronutrient

supplementaon

workinthepast10

years

SeentheAO2007-

0045(ZINCAO)

TrainedonCBP-

MNP

15



Annex 1. 2. Matrix on Sharing Expectaons and Seng Group Norms

What (new)

knowledge will

you personally

want to gain

What (new) skills

will you be able to

do aer the course

What are your

expectaons from

the facilitators

What

contribuons will

you expect from

co-parcipants to

commit

What

contribuons can

you personally

commit

16



MODULE 2:

Understanding the Micronutrient Situaon







Session 1: Basic Informaon, Funcons and Food Sources of Micronutrients

OVERVIEW •Micronutrients(vitaminsandminerals)aresubstancesthatenablethebodyto

produceenzymes,hormonesandothersubstancesessenalforpropergrowth

anddevelopment.

•VitaminA,iron,folicacidandiodine,areimportantpublichealthconcerns

becausetheirlackrepresentsmajorthreatstothehealthanddevelopment

ofpopulaons,parcularlyinchildrenandpregnantwomeninlow-income

communies.Theroleofzincasanadd-oninthemanagementofdiarrhea

hasalsobeenestablished.

•Micronutrientsaretakenfromfoodsincethebodycouldnotproducethem.

OBJECTIVES Attheendofthesession,parcipantscan:

1.Explainthebasicinformaononmicronutrients

2.Discussthefunconsofmicronutrientsinthebody

2.1.VitaminA

2.2.Iron

2.3.FolicAcid

2.4.Iodine

2.5.Zinc

3.Idenfythesourcesofmicronutrients

METHODOLOGY Lecture–discussion,quesonandanswer


ADVANCE

PREPARATION

•ReadMSP-MOPpp.5to17andotherreferences

•Quesonsandguidelinesforthesessionexercises

•Worksheets,markers,manilapaperandothersuppliesfortheexercises

•PowerPointonthesessionobjecvesandtechnicalinputs.

19




Session 1: Basic Informaon, Funcons and Food Sources of Micronutrients



Introducon

(05 min)


•Ask2-3parcipantsabouttheirknowledgeonMicronutrientsinthescaleof

1-3,3beingthehighest.

•Makeabriefoverviewonthescopeofthesessionbysayingthatthesession

willdiscussmicronutrientsasvitaminsandmineralsthatenablethebodyto

produceenzymes,hormonesandothersubstancesessenalforpropergrowth

anddevelopment.VitaminA,iron,folicacidandiodinearethefourmost

importantmicronutrientsastheirdeciencybringsmajorthreattopublic

healthparcularlytochildrenandpregnantwomen.

•Introducethesessionbypresenngthesessionobjecves.

•Askparcipants“Whenyouhearmicronutrients,whatcomestoyourmind?

Micronutrients

(10 min)

•Thepossibleanswersmaybe:

oExamplesofmicronutrientsarevitaminA,iron,iodine,folate,zinc

oMicronutrientscanbevitaminsandminerals

oMicronutrientsareneededbythebodyinsmallamounts

oLackofmicronutrientsinthebodymayleadtoillnessesthatcanbe

detrimentaltothehealthofaperson.

oMicronutrientsaresuppliedbyfoodbecausetheyarenotproducedby

thebody

Basic Informaon on

MN

(10 min)

•Tell:Useparcipants’responsestoconrmandemphasizetheimportanceto

haveaccurateinformaonaboutmicronutrientssothattheHWcan:

1.Explainbeertoclientstheimportanceofmicronutrients.

2.Helpclientsplanwaysinpromonggoodhealthandnutrionparcularly

thosewithriskfactorsandwhenincertainpredisposedlifestages.

Lecture-discussion

•MakeapresentaononthebasicinformaononMicronutrients.

Useslides7-9.

•Askparcipantstoshareinputsaboutthetopicfocusingon:

1.Signicantroleandfunconsofmicronutrientsinone’shealth

2.Immediateproblemswhenabsentordecient

•Informparcipantsthatdiscussionsonthetopicwillconnuewiththesmall

groupexercise.




Exercises on Funcons

and Sources of MN

(15 min)

Introducontotheexercise/groupwork

Thegroupexercisewillfocusedonroles/funconsinthebodyandfoodsources

ofmicronutrients.

Groupwork/exercise

Dividetheparcipantsinto5.Eachgroupwillbeassignedaparcularmicronutrienttoworkon.

•Tellparcipantsthefollowinginstrucons:

1.Thegroupisgiven10minutestocompletethetask

2.Everymembermustparcipatetoaccomplishthegrouptaskbyanswering

thesequesons:

2.1.nameatleast2funconsofeachMNinthebody

2.2.nameatleast2richfoodsourcesofeachMN

3.Writedownallyouranswersintheideacardandpostitintheworksheet

(manilapaper)provided

4.Thegroupfacilitatorfromothergroupswillbeassignedtovalidatethe

correctnessoftheothergroup’soutput.

GroupExercise1:FunconsandFoodSourcesofMicronutrients

Micronutrient:____________

Funcons FoodSources

•Afacilitatorwillbeassignedtoassisteachgroupinaccomplishingthe

task.Aer10minutes,theassignedfacilitatorforthegroupwillvalidatethe

correctnessoftheothergroup’soutput.

Inplenary,requesteachgrouptopresenttheirnaloutputandsharediculty

induringthegroupworktobediscussedinplenary.Aerthepresentaon

permicronutrient,themainfacilitatorcanpointouttheotherfunconsand

foodsourcesofthemicronutrientnotidenedbythegroupandcorrectany

misinformaononthefunconsandfoodsourcesofthemicronutrientsthat

mayariseinthepresentaons.




•Declaretheoutputsofeachgroupassasfactoryorneedingimprovements

accordingtothecriteriaof“speed”and“accuracy”ofanswers.

•Acknowledgeandcomplimenttheacveparcipaonofallthegroupsand

theparcipantsineachgroup.

•Emphasizetheimportanceofthefollowingknowledgetoeecvelyassist

clientsinmeengtheirneedsandprevenngMNproblems:

1.FunconsoftheMNsandthe

2.FoodsourcesofeachoftheMNs.

Synthesis

(05 min)

•Inclosingthesession,presentthesummaryoffunconsandfoodsources

ofmicronutrients

•Askamemberofeachgrouptoshareabouttheirexperienceandthe

importantlearninggainedfromSession1focusingonnewthingsdiscovered.

•Askparcipantsiftherearequesonsand/orclaricaonstheywanttoraise.

•Informparcipantsthatthissession’slearningwillbefurtheraddressedinthe

succeeding2sessionsaswefocusonproblemsonMS.

22



Module 1: Introductory Sessions

Session 2: Causes, Consequences and Prevenon of Micronutrient Deciencies

OVERVIEW •Micronutrientdecienciesarecausedbyinadequatefoodintake,declineof

breaseeding,frequentillness,highneedformicronutrientsandmadeworse

duringdisasters/emergencies.

•LackofvitaminA,iron,folate,iodinepresentsmajorthreatstothehealthand

developmentofpopulaons,parcularlyinchildrenandpregnantwomenin

low-incomecommunies.

•Whileonlynyamountsareneeded,theconsequencesoftheirabsenceor

deciencyaresevere.

•Micronutrientdecienciescanbepreventedthroughadequatedietary

measuresandotherhealth,nutrionandenvironmentalintervenons.


1.Enumeratethedierentmicronutrientdeciencies

2.Idenfythedirectcausesofmicronutrientdecienciesanddiarrhea

3.Idenfypopulaongroupsthataremostvulnerable/highriskforspecic

MNdecienciesanddiarrhea

4.DiscussconsequencesofspecicMNdeciencyanddiarrheaforeach

populaongroup

5.IdenfywaystopreventMNdecienciesanddiarrhea

METHODOLOGY Lecture–discussion,groupdiscussion/work


ADVANCE

PREPARATION

•ReadMSP-MOPpp.5to17andotherreferences

•SamplePicturesofclientswithsignsandsymptomsofMNdeciencies

•Quesonsandguidelinesfortheexercises

•Worksheets,markers,manilapapers,maskingtapefortheexercises,yellow

ideacardswherethepopulaongroupsarewrien,onegrouppercard

•PowerPointonthesessionobjecvesandtechnicalinputs





Introducon

(15 min)


•Reviewrelevantfacts/informaonfromSession1.

•Introducethesessionbypresenngthesessionobjecvesandashort

overview.

•Askparcipantsfromtheirpastknowledge,tonameproblemsresulngfrom

Micronutrientdeciencies.Possibleanswersmaybeanemia,blindness,

frequentillnesssuchasdiarrhea,etc.

•Acknowledgeparcipantsforsharingtheiranswers.

MN deciencies and

Diarrhea, vulnerable

populaon, direct

causes, consequences,

prevenon of

deciency and illness

(35 min)

•Useparcipants’responsestolinkwithsessions’objecvesandtopics.

•Tellparcipantsthatgroupexerciseswillbedonetofurtherappreciateeects

ofMicronutrientdeciency.

Groupdiscussion/exercises

1.Dividetheparcipantsintosmallgroupsandassigntoeachgroupaspecic

problemtobeaddressedthroughgroupdiscussion.Groupassignmentmaybe:

a.Group1-VitaminAdeciency

b.Group2-IronDeciencyAnemiac.Group3-IodineDeciencyDisorder

d.Group4-FolateDeciency

e.Group5-Diarrhea

•Eachgroupwillselectaleadertoleadinthediscussionandensurethatthe

assignedtasksareaccomplishedwithinthemealloed.

2.Usingtheformat/matrixshownbelow,eachgroupwillaccomplishthetasks

foreachofthecolumnfortheassignedMNdeciency/diarrhea:

a.Vulnerablepopulaongroupsincolumn1:

b.Directcause/sofMNdeciency/diarrheaincolumn2;

c.ConsequencesofMNdeciency/diarrheaincolumn3;and

d.WaystopreventMNdeciency/diarrheaincolumn4

24




MN deciencies and

Diarrhea, vulnerable

populaon, direct

causes, consequences,

prevenon of

deciency and illness(35 min)

GroupExercise:Idenfyvulnerable/mostaectedgroups,causesand

consequencesandwaystopreventDecienciesandDiarrhea

MNDeciency:______________

Vulnerable/

mostaected

(atrisk)

(1)

Causes

(2)

Consequencesof

MNdeciency/

diarrhea

(3)

Waystoprevent

MNdeciencies

and Diarrhea

(4)

3.Eachgroupmembershouldhelpcheckandcounter-checkeachentryto

makesurethatalltheentriesarecorrect.Thisstepmayrequiremore

discussionamongthememberstoarriveatcorrectentries.

4.Whenagrouphascompleted,thegroupmemberswillclaptheirhandsthree

mestoletthefacilitatorknowthattheyaredone.

Processing

5.Whenallthegroupshadnishedtheiroutputs,thereviewoftheoutputsof

eachgroupwillproceedinplenary.

6.Thisacvityisgiven15minutestocomplete.Eachgroupisgiven2minutesto

presentthegroupoutputbyreporngwhatiswrieninthemanilapaper

onlytosaveme.

7.Aereachgrouppresentaon,theMainfacilitatormayreinforceinputs

onthetopicsbyprovidingandclarifyingtechnicalinformaon.Thegroup

facilitatorsmayalsoberequestedtoprovideaddionalinformaon.

Facilitate a short discussion

1.Askparcipantsfromthedierentgroupstosharelearninginsightsaboutthe

exercises

2.Encouragetoaskquesonsand/orclaricaonsaboutthetopicsdiscussed.

25




Synthesis

(10 min)

Highlightthesekeypoints:

•Allpeopleneedmicronutrients,butcertainlifestagesandcondions

predisposesomepopulaongroupstoMNdeciency.Thevulnerablegroups

areinfants,children,pregnantandlactangwomen.

•Ingeneral,micronutrientdecienciesarecausedbyinadequatedietary

intake,poorabsorponduetinfeconsandincreasedneedsduetoinfecons

orphysiologicalstate

•MNdeciencyispreventable

•Simpleandeecveintervenonscanbeprovidedand/oraccessed

likemicronutrientsupplementaon,foodforcaon,Breaseeding,

complementaryfeeding,dietarydiversicaon.Thesecanbesupportedbythe

deliveryofotherhealthserviceslikeimmunizaon,deworming,water,

sanitaonandhygiene(WASH),familyplanningandhealthandnutrion

promoon.

•Importantimplicaonstotheirfunconsintheirworkplaces.

Informparcipantsthatthissession’slearningwillbefurtheraddressedinthe

succeedingsessions.




Session 3: Magnitude of Micronutrient Deciency Problems

OVERVIEW •VitaminAdeciency,irondeciencyanemiaandiodinedeciencydisorders

areproblemsinthePhilippinesthatgreatlyaectinfants,preschoolers,

pregnantandlactangmothers.

•Micronutrientdeciencieshaveserioushealthconsequencesforindividuals

andnegaveimpactsontheirdevelopmentandeconomicproducvity.

•MicronutrientdecienciesinVitaminA,ironandiodinehavereachedthe

levelsofpublichealthsignicance.Facedwitheconomic,agriculturaland

challengeslikeemergencies/disastersinmanyareas,theproblemincreases

furtherinmagnitudeduetolackoffoodandhighincidenceofinfeconsdue

tocongesonandpoorsanitaryenvironmentandhygiene.


1.DiscussthestatusofMicronutrientSupplementaoninrelaonto:

1.1.PrevalenceratesofMNdeciencies

1.2.PerformancecoverageofMicronutrientSupplementaonservices

1.3.Levelofpublichealthsignicance

2.Enumeratetherelevantfactors/challengescommonintheirareas(municipal/

barangay)thatpresentasbarrierstoMicronutrientSupplementaonservice

goalsandobjecves.

3.Classifyfactorsandchallengespresented.

4.Idenfypossiblesoluonstothebarriers/gapsonMSprogram

METHODOLOGY Lecture–discussion,groupdiscussion,workshop


ADVANCE

PREPARATION

•ReadMSP-MOPpp.18to27,annex16andotherreferences

•Workshopguidelinesandworksheets

•Markers,manilapaper/ipchart,maskingtapes

•PowerPointonthesessionobjecvesandtechnicalinputs

•SelectedquesonsrelevanttoRHMlevel.





Introducon

(10 min)


•ReviewwithparcipantstheproblemsonMNdecienciesidened/discussedinSession2.

•FromamongtheproblemsonMNdeciencies,askparcipants:

1.Whatis/arethemagnitudeofeachdeciencyproblem?

2.Whatwere/arethepossiblereasonsthatcontributedsignicantlytothe

magnitudeofsuchproblems?

•Complimentresponsesappropriately

•Presentthesessionobjecves

Current Status of MN

deciencies

(20 min)

Lecture-Discussion

Tell:Itisimportantforhealthworkerstobeupdatedonthecurrentstatusof

theproblemonMNdeciencynotonlyintheirareasandalsototheprovincial/

regionalareaswheretheyaresituated/belong.

Thepresentstatusisoenusedasthestarng/take-opointsinplanningfor

improvementsinprovisionofservices.

Present:PowerPointslidesonthecurrentstatusofMNdecienciesandtheir

contributoryfactorsattheNaonal/regionallevel.

Emphasizetotheparcipantsthatthemicronutrientdeciencystatuspresented

arelimitedtothenaonalandsomemesregionallevelonly.Thisisbecause

nutrionsurveysareveryexpensivetoconductandalargenumberofpeople

areneededtobesurveyedtogetaprovincialormunicipalprevalence.

Intheabsenceofaprevalencesurveyonmicronutrientdecienciesmost

especiallyinthebarangay,municipal,cityorprovinciallevels,proxyindicators

canbeusedtodeterminetheriskformicronutrientdecienciesofacommunityorarea.Theseproxyindicatorsincludenutrionalstatus,lowbirthweight,

immunizaoncoverage,supplementaoncoverage,illnesseslikediarrhea,

measles,accesstohealthservicesandsocioeconomicindicators.

Presentselectedserviceperformancecoverageindicatorsforasample

municipalityN.Informtheparcipantsthataddionalproleofthe

municipalitywillbegivenashandoutforthenextacvity(situaonalanalysis)




Contributory Factors/

barriers to MSP

implementaon

(30 min)

Brainstorming /workshop/group discussion

Tell:LetusnowlookdeeperintothefactorsthatcontributetotheMN

decienciesandthebarriersinMicronutrientSupplementaonProgram

implementaon.

oYouwillbeworkinginsmallgroupswithafacilitator.Thegroupcomposions

willbemaintainedforthesucceedingacvies,includingthepraccum

sessions.

oIdenfyfactorsandbarriersthatcontributedtothemicronutrient

supplementaoncoverageoftheMunicipalN.Focusbarriersthatyoucando

somethingaboutinsteadoftradionalbarrierslikeTEVandhighpopulaon,

etc.

oSomeguidequesonsinAnnex6ofMOPwhichcanbeusedtolookintothesituaonofthemunicipalitypresented.

oDistributecopiesofthecasescenario(Facilitator’sGuideAnnex2.3)andthe

form(FacilitatorsGuideAnnex2.4)shownbelowtoparcipants.Provideeach

smallgroupwithipchart/manilapaperandmarkers.

Workshop:IdencaonofFactors/BarriersandPossibleSoluons

NameofSampleMun/Brgy___Region:

Factors/Barriers PossibleSoluons

Guidequesons/Instrucons:

1.Thegroupisgiven15minutestoaccomplishtheworkshopoutputs.

2.BaseonthegivencasescenarioinMunicipalN/barangayP(province/

municipality/barangay),whatarethefactors/barriersthatcontributetohigh

riskforMicronutrientdeciencies?

3.Applythemethodofbrainstormingforparcipantstocomeupwithalistofthesefactors/barriers.

4.Remindparcipantssomeimportantrulesinbrainstorming:

4.1Thebestoutputhasa“sucient”listofideasfromawiderangeof

perspecve.

4.2Allideasareaccepted–thereisno“right”and“wrong”answers

4.3Donotlimit/”fence-in”theresponses/ideasshared

4.4Generangasmanyideaspossibleistheideaof“brainstorming”.




5.Fromyourgrouplist,idenfythosefactorsandbarriersthatyouthinkhave

strongeectstoriskofMNdecienciesinyourarea.

6.Whenidenfyingthem,donotlimittothoseexpressedbytheclients.Include

otherfactorsthatmostserviceprovidersareencountering.

7.Clarifywhethertheexpectedoutputsandtheinstruconsareclear.

8.Remindthegroupsthatclaricaonsandotherconcernsmaybereferredto

theirgroupfacilitator.

•Whileparcipantsareworking,facilitatorsprovideguidancetofocuson

barriersandchallengesrelatedtoclientsandserviceproviders,without

ignoringothercontributoryfactorsthatcontributetoMNdeciencies.Ensure

thatguidequesonsinAnnex6areulizedforthebrainstorming.

•Aernongasubstanalresponsesintheirpapers,markthelistaccordingto

thefollowingcategory:

A.Client-related(C)

B.Serviceprovider-related(SP)

C.Healthsystem-related(HS)

D.Others,specify(O)

•Fill-upthesecondcolumnwithpossiblesoluonsaccordingtotheidened

factors/barrierstoMicronutrientSupplementaonProgram

Note: Iflowcoverage,whatarethebarriers,ifhigh-howtosustain

•Selectamemberofthegrouptopresenttheoutputsintheplenarysession.

WS outputs

(20 min)

Plenary Discussion

AernongthatallgroupshavecompletedWS1,inviteeveryonetoaplenary

sessionforpresentaonofeachgroup’soutputs.

PresentaonofWSOutputs:

•Askforavolunteerreporterfromanygrouptomaketherstpresentaon

•Encourageallparcipantstolistenandfocustheiraenontotheoutputs

presented.

•Informthegroupthattheopenforumshallbeconductedaerallthegroups

hadpresented.

•Encourageparcipantstotakenote/writedowntheirquesons

30




•FacilitatetheWSpresentaonforallgrouppresentaons

•Encourageparcipantstoaskquesonstothepresenters.Thefacilitatorneed

topreparequesonstoiniateand/orstrengthentheoutputs.

•Basedonthepresentaons,statethattheresultswillshowthatmostof

thebarriersandchallengesrelatemoreto:e.g.clientsandserviceproviders

(dependingontheresultsoftheWS).

•Highlightcommonaliesand/ordierencesofresultsbetweenthedierent

groups.

•Recognize/acknowledgetheworkofallthegroupsandthankthemfor

everyone’sparcipaon.

Synthesis

(10 min)

Synthesizebytellingthat:

•Ingeneral,factors/barrierstosuccessinMSimplementaoncanhave

workableintervenons.

•Majorityofthecauses/barriersidenedcanbemodiedbyproviding:

1.ClientsandtheirfamilieswithadequateinformaononMS.

2.Healthworkerswithadequateresources,technicalupdatesandsupporve

supervisionfocusedonMSP.

•Ask2-3parcipantstoshareimportantlearninginsightsaboutthetopics

discussedand/orraisequesonsand/orclaricaons.

•Informparcipantsthatthissession’slearningwillbefurtheraddressedinthe

succeeding/futuresessions.

31





Annexes for

Module 2



Annex 2. 1. Matrix on Funcons and Food Sources of Micronutrients

Funcons and Sources of Micronutrients

Micronutrient:___________________

Funcons Food Sources



Annex 2.2. Matrix on Vulnerable/ most aected (at risk) Causes, Consequences and

Prevenon of Micronutrient Deciencies /Diarrhea

MNDeciencies:________________________

Vulnerable/ most

aected(at risk)

(1)

Causes(2)

Consequences of MNdeciency/diarrhea (3)

Ways to preventMN deciencies and

Diarrhea (4)



Annex 2.3. Case Scenario on Magnitude of Micronutrient Deciency Problem

Case prole: Municipal N

•Comprisedoftwentyeight(28)barangaysand40sios.

•Totalpopulaon-67,365in2007

•Ofthe28barangays,BarangayPwhichisthetownproperhasthehighestpopulaondensity

with2,338personspersquarekilometer.

•68.5percentofthetotallandareaispredominantlyoccupiedbyagriculturallandsulizedin

variouscropslikecoconut,banana,rice,corn,fruitcrops,etc.

Health Manpower and Facilies

•With2PHNand18RHMs,butnodoctorsta

•With22BHSwithOPBandTB-DOTSceredfaciliesinthemunicipalies

•NoBEmONCfacilityintheprovince

•NoRHUisMCPaccredited

•NoBHSwithsafebirthingfacility

Health status1. Maternal Deaths

•Hadone(1)maternaldeathin2006andfour(4)in2008

•Causesofmaternaldeaths-postpartumhemorrhage,hypertensivedisorderand

puerperalsepsis.

•In2009,97%ofthepostpartumwomenintheprovincereceivedVACand99%in

BarangayP.

•InMunicipalN,88%ofpregnantwomenweregivencompleteironand93%inBarangayN.

2. Under ve Mortality

•Therewere4undervedeathsinthemunicipalityin2009,butnodeathfromBarangayP.

•Leadingcausesremaintheinfecousdiseasessuchaspneumoniaanddiarrhea.

3. Immunizaon and Nutrion

•FIC92.4%in2009,anincreasefrom77.5%in2007to88percentin2008.

•MunicipalNisagreenbannerawardeewith1.95%prevalenceofunderweight.

•Provincial/municipalcoverageforvitaminAsupplementaonishighbutbelownaonaltarget.

•Dewormingcoverageforthemunicipalityhasachievedthenaonaltargetof85%with93%and

91%coverageforAprilandOctober.Twobarangayswithcoverageof73%and74%.

4. General Health Seeking Behavior

•Only25%ofthepopulaonconsultedinhealthfacilies •50%ofthepopulaonfromthepoblacionareaconsultedinhealthfacilies

5. External Factors

•Provinceisamongthepoorerprovincesinthecountry

•Withsomeinaccessibleareasforhealthservicesatthehealthcenters.

•Manyareashaveaccesstohealthservices(exceptin5areaswhichcanbereachedbyfoot).The

provinceisacalamitypronearea,with4incidentsoflandslidesandashoodsin2008.



Annex 2.4. Matrix on Idencaon of Factors/Barriers and Possible Soluons

NameofSampleMunicipality/Barangay:

Region:

Factors/Barriers Possible Soluons



Annex 2.5. Maternal and Child Health Indicators

Child Health Indicators (2009)

Indicators

Perfor-

mance

Standard

Region

D

Province C Municipa

lity N

Brgy. P

% % % %

6-11 months given VAS

(April)

95% 100 90 100 99


(October)

95% 96 89 101 95


(April)

95% 94 88 94 87


(October)

95% 95 88 90 90

2-59 months given iron

supplements

83 93 No Data No Data

Diarrhea cases given ORS

(0-59 months)

100% 62 50 No Data No Data

Diarrhea cases given ORS

and Zinc (0-59 months


Child Health Indicators

Indicators

Perfor-

mance

Standard

Region

D

Province C Municipa

lity N

Brgy. P

% % % %

High risk cases given VAS 77 68 No Data No Data

LBW given iron

supplements


LBW infants 6 8 No Data No Data

FIC (0-11 months fully

immunized)

95% 87 83 No Data No Data

Infants exclusively

breastfed

69 59 74 No Data

Given Deworming meds

(April)

85% 86 84 93 73

Given Deworming meds

(October)

85% 88 85 91 74

Maternal Health Indicators

Indicators

Perfor-

mance

Standard

Region

D

Province C Municip

ality N

Brgy. P

% % % %

PP women given VAS 80% 63 61 97 99

Pregnant women given

iron

80% 21 24 88 93

Pregnant women 4 ANC

visits

80% 17 24 74 No Data



Module 3:

The Micronutrient Supplementaon Program






Module 3 – The Micronutrient Supplementaon Program (MSP)

Session 1: MSP Goals, Policy and Implemenng Guidelines

OVERVIEW •Signicantstepshadbeentakeninreducingtheprevalenceofmicronutrient

decienciesthatwillcontributetotheachievementofthe2015Millennium

DevelopmentGoals(MDGs)ofreducingunder-veandmaternaldeaths.

•TheDepartmentofHealthissuedtheAdministraveOrderNo.2010-0010in

April19,2010withtheaimtostrengthenandacceleratetheimplementaon

oftheMSP.TherevisedAO119incorporatesrelevantprovisionsofAO

Nos.2007-0045(Zinc)and2008-0029(MNCHN).ThenewAOprovidespolicy

direconandguidelinesonMSP.

•WiththepolicydeclaraonofDOH-AO2010-0010,aManualofOperaons

wasdevelopedtoprovideimplemenngguidelinesforvariousstakeholders.

OBJECTIVES Attheendofthissession,theparcipantswillbeableto:

1.EnumeratethenaonalgoalsandtargetsfortheMSprogram

2.DiscussthemainprovisionsofDOH-AO2010-0010

2.1.Raonale,strategiesandobjecves

2.2.Guidingprinciples

2.3.Generalguidelines

3.IdenfytheseconsintheManualofOperaons(MOP)thatareusefulfor

specicsituaons.

4.ExplainthechangesinthenewMSpackagesbasedonthetechnicalevidence

5.Explaintheusesand/orimportanceoftheMOPguidelinesinimprovingthe

performanceofhealthpersonnelatvariouslevels.

METHODOLOGY Lecture–discussion,game


ADVANCEPREPARATION

•ReadDOH-AONo2010-0010inMSP-MOPAnnex1pp.105to112

•ReadMSP-MOPpp.1to4

•Latestdata/guresontheMSnaonalgoalsandtargets

•Instrucons,quesonsandkeyanswersforthegame/exercise(Referto

Facilitator’sGuideAnnex3.1aand3.1b)

•Workshopmatrix,marker,newsprint,maskingtape,whiteboard





Introducon

(05 min)


•AsktheparcipantswhattheyknowaboutthepreviousMSguideline.

•LinkthefactorsonMNdecienciesidenedinModule2,specicallyonthe

HealthServiceProviderlevel,withthegovernment’sresponse-theMS

program(AO2010-0010)andit’simplemenngguidelines(MOP).

•Introducethesessionandpresentthesessionobjecves.

Naonal goals,

objecves and targets

on MSP

(10 min)

Lecture-discussion

•Engageparcipantsinadiscussiononthefollowing:

1.stangthenaonalhealthgoalsandobjecvessetbytheDOH

2.relangMSPgoalsandobjecvestotherelevantMDGs

•Acknowledgecorrectresponsesandclarifyincorrectresponses

PowerpointPresentaononMSP:Naonalgoals,objecvesandtargets

•Referringtotheoutputsinprevioussession,askparcipantsfromdierent

provinces/cityand/ormunicipalitytheiropinionsonhowclose/fararetheir

performancefromthesetgoalsandtargets.

•Provideaddionalinputstohighlightthesignicantroleof:1.LGUscontribuonstoserviceperformance/successofMSP

2.MSPinachievingnaonalhealthanddevelopmentgoals.

DOH-AO No. 2010-

0010

(30 min)

Lecture-discussion

•ProvideappropriatelinkfromthediscussionontheMSPgoalsandtargetsto

thecreaonofDOH-AO2010-0010.

•AskwhoamongtheparcipantshaveseenorreadtheAOon2010-0010.

•Ask2-3parcipantstoenumerateandexplainone(1)oftheseven(7)guiding

principlesinmicronutrientsupplementaon.Thefacilitatorshouldwritethe

responsesontheboard.

42




•Thefacilitatorwillensuretosupplementtheexplanaonoftheparcipants

andprovideanexampleforeachguidingprincipleforbeerunderstanding.

Thefacilitatormayusethetablebelowasguide.

Guiding Principles Descripon Example

Rights-Based

SystemsApproach

Life-CycleBased

Intervenons

Complementaonof

Intervenons

EvidenceBased

intervenonsandApproaches

Thegovernmentis

obligedtoassistthe

poorandmarginalized

todevelopcapacityor

facilitateaccesstoMS

Performsinhealth

servicedelivery,

governance,nancing

andregulaonsshallbeinstalledforclients

tobenetfromthe

deliveryofqualityand

adequatemicronutrient

supplements

Micronutrient

decienciesearlyin

lifehasimpactonthe

health,nutrionalstatus,

economicproducvityinadultlifeandthenext

generaon

Addionofother

intervenonstoMS

provisionwillensure

maximumresults

Studieshaveshown

thatmicronutrientsupplementaonisone

ofthemosteecve

intervenon

ReachingouttoIPs

thrueducaonandMS;

Propercoordinaonwith

triballeaders

-Procurement

ofmicronutrient

supplementsincluded

intheprocurementplanoftheMunicipality/

Barangay

-MNCHN

-PMCseminar

-RPMclasses

-IronSupp.(10yo-49yo)

Deworming+Food+MS

-NNSResult

-RapidCoverageassessment/highorlow

performance

43




Guiding Principles Descripon Example

IntegratedService

Delivery

Equity

Includingmicronutrient

supplementaonduring

premaritalcounselingisanexample

Givetoppriorityto

populaongroups

withleastcapacityto

accessMSandthose

mostvulnerabletothe

deciency

MS+growthmonitoring

MS+EPI

-Vulnerablegroups

regardless of

geographicallocaon,

economicstatus,sex,

age,disastervicms

-Pregnantlactang

womenPS/SCinupland

areasandpoorerfamilies

-GeographicalIsolated

depressedareas

(GIDA)aregivenbeing

priorized

•Thefacilitatormayopttoasktheparcipantsforaddionalexampleto

illustratetheguidingprinciple.

BeforeproceedingtotheotherpartoftheAO,informtheparcipantsthatthey

willhaveanacvity.

Game:

•Divideparcipantsinto5groupsthefacilitatorwillgivetheinstruconforthe

game.

Instrucons:

1.Divideparcipantsinto5groupsusingthepreviousgroupings.

2.Eachgroupwillformacircleorhuddle.

3.Eachgroupisgivenmetacardsandpentelpensforthemtowritetheir

answers.

4.The“gamemaster”willreadoutaquesonpertainingtothegeneral

guidelinesonMicronutrientsupplementaon.Thegroupshouldcomeupwith

aconsensusonthebestanswerandwritethemetacardsprovided.(Referto

Facilitator’sGuideAnnex3.1a-1bforthequesonsandanswerkeys).




5.Whenthefacilitatorsays“cardsup”,oneofthegroupmembersshouldraise

thegroup’sanswer.

6.Allthosewhoshowedthecorrectanswerwillgetonepoint.Thosewith

correctexplanaonwillgetanotherpoint.

7.Aerallquesonswereasked,thegroupwiththehighestpointwillbe

declaredthewinner.

•Asareviewoftheanswers,thefacilitatorwillprovideasshortpowerpoint

presentaononthegeneralguidelinesonmicronutrientsupplementaon.

•Thefacilitatorinformstheparcipantsthatinaddiontotheguidingprinciples

andgeneralguidelinesonmicronutrientsupplementaon,theAONo.2010-

0010alsocontainstherolesandresponsibiliesofvariousstakeholders

involvedinimplemenngmicronutrientintervenonsinthecountry.Refertoannex1ofthemanualofoperaonswhichwillbedistributedtothem.

The MSP-MOP

(10 min)

Lecture-Discussion

•Linkthepolicydiscussedearlier(AO2010-0010)tothetopic.

•ExplainthataMOPisatooltoguidehealthserviceprovidersinthe

implementaonofthepolicy.

•TellparcipantstoopentheircopyoftheMOP,asyougothroughtheoutlineintheTableofContents,orienngthemtoeachofthesecons.

•Askparcipantsiftheyhavequesonsand/orclaricaonsonthetopic.

•InformparcipantsthattheywillhaveamplemetoreadtheMOPontheir

ownmeandpace.

Synthesis

(05 min)

•Emphasizethevalue/importanceoftheAOandMOPforMSprogram.Being

awareandfamiliarwiththesedocumentswillhelpHWsto:

1.Helpclientstakeposivestepstoseek/availofMSservices,and

2.HelpadvocateforsupporttotheMSprogramfromvariouspartners.

Note: 1&2needtobeemphasizedintheprocessingandsynthesis

•Informparcipantsthattheywillhavemoreopportuniestousethecontents

oftheMOPinthesucceedingsessionsandapplyduringpracceand

praccumsessions.



Module 3 – The Micronutrient Supplementaon Program

Session 2: Providing Essenal MS Package for Infants and Children, Women, Mothers

and Other Adults

OVERVIEW •Micronutrientsupplementaonhasbeenproveneecveasanintervenonin

addressingmicronutrientdeciencyamongvulnerablepopulaongroups.

•Allpeopleneedmicronutrients,butcertainlifestagesandcondions

predisposesomepopulaongroupsmoretoMNdeciency.Thus,MS

intervenonpackagevaryaccordingtothespecicneeds,requirementsand

condionsofthedierentpopulaongroups.

•HealthServiceProvidersshouldunderstandtheeecvenessofMSasan

intervenonthatmustbeprovidedtotheidenedprioritygroupsorthosew

ithphysiologicalorclinicalcondionsandthepossiblesideeectsofMS.

•Session3willfocusontheEssenalMSPackagesforinfantsandchildren,

women,mothersandotheradultclients.


1.Reviewthetechnicalbasisofmicronutrientsupplementaon

2.Thegeneralguidelinesinselecngage-appropriateMSpackagefor:

2.1.Infants0-11months

2.2.Children12-59monthsold(1-<5yearsold)

2.3.Children5-9yearsold

2.4.Femaleadolescents10-14yearsold

3.DeterminethecorrectMSintervenonasprevenveortherapeucdosesby

specicclientproleduringlifeevents:

3.1.Normalcondions

3.2.Emergencysituaons

4.ExplaincontraindicaonsandsideeectsofMS

METHODOLOGY Lecture–discussion,quesonandanswer,oraldrill


ADVANCE

PREPARATION

ReadMSP-MOPpp.28to43andDOH-AONo2010-0010Annex1pp.105to112

25quesonswithanswerkeysforOraldrill(RefertoFacilitator’sGuideAnnex

3.2)





Introducon

(05 min)


•Askparcipantsquesonsorremarksinrelaontotheprevioussessions.

•Introducethesessionandpresentthesessionobjecves.

MS Package in Infants,

children

Tell:Giventheeecvesofmicronutrientsdiscussedinmodule2theDOHhas

comeupwithMSpackagesthatshouldbegiventoinfants,children,andadult

and adults

(45 min)

populaongroupstopreventandcontrolmicronutrientdeciencyand

increasingchancesofsurvival.

Lecture-discussion

•Conductalecture-discussionfocusingonthefollowingessenalinformaon:

1.Allpeopleneedmicronutrientstomeettherequirementstosustain

physiologicfunconsandprocessesinthebody.

2.CertainlifestagesandcondionspredisposesomepopulaongroupstoMN

deciency

3.Forinfantsandchildren,thereisgenerallyahigherMNrequirements

comparedtoadults,tomeettheirgrowthanddevelopmentalneeds.

4.OtherfactorspredisposeinfantsandchildrenmoretoMNdeciency

(illnesses,poorinfantandyoungchildfeedingpracces,family,domesc

andenvironmentalcondions,etc.)5.Inlikemanner,somelifestages,condionsandfactorspredisposesome

adultsvulnerabletoMNdeciency(age,illnesses,eangpracces,family,

domescandenvironmentalcondions,etc.)

6.MSintervenonpackageneedtovarybasedontheneeds,requirements

andcondionsofthedierentpopulaongroups

7.ContraindicaonsandsideeectsofMSininfants,childrenandadult

populaongroups.

Apowerpointpresentaononthegeneralguidelinesinimplemenngage

appropriateMSpackage

•TellparcipantsthatforeachtobebeerfamiliarwiththecurrentEssenal

MSpackagesforinfantsandchildren,womenandotheradultclientsanoral

drillwillbeconductedinsmallgroupsessions.

•Informtheparcipantstogototheirgroupfortheacvity.Adrillworksbest

whenchairsarearrangedinacircle.




Oral Drill in Small groups

(Ifmebecomeslimited,conducttheOralDrillaspartoftherecap.The

followingareguidesforthegroupfacilitatorfortheconductofOralDrill.

•Priortothestartofthesession,thegroupfacilitatorshouldhaveacopyofthe

25quesonswithkeyanswersfortheOralDrill(Facilitator’sGuideAnnex3.2).

•Eachgroupfacilitatorwillconducta15-minuteoraldrillonthefollowing:

1.IdenfyingthecorrectMSpackage

2.Stangcorrectdosages,preparaonandduraonofMSintervenon

•Providetheparcipantswiththefollowinginstruconsfortheoraldrill:

1.Tellthemthatadrillisnotatest.Itisanopportunitytopracceataskor

proceduretodevelopspeedandcondence.2.EachonemayusetheirMOPtosearchfortheanswerstothedrillquesons.

3.Parcipantswillbegiven10minutestofamiliarizewiththeMOPbefore

starngthedrill.

4.Aparcipantisgiven2secondstogivetheanswertothequeson.

•Thefacilitatorwillaskthequesondirectlytoeachparcipantinthegroup

toanswerinaround-robinfashion.

•Iftheparcipantcannotanswerthequesonoranswersincorrectly,askthe

samequesontothenextparcipant.

•Connueaskingquesonstoparcipantsinorder,goingaroundthecircle.

•Keepthepacelivelyandthemoodcheerful.

•Congratulatetheparcipantsastheyimproveintheirabilitytoanswer

correctlyand/ormorequickly.

Synthesis

(10 min)

Summarizetheacvitybyaskingparcipantsthefollowingquesons:

1.Whichquesonswereeasy?Whichweredicultorvague?

2.Whatchange/esdidyounoceinthenewMSprotocol?

3.“Whenyougobacktoyourworkstaon,aretherechangesthatyouwilldoin

implemenngtheMSprogrampackages?”

Informparcipantsthat:

1.Theyshouldprovidemoremetoreadagainandpraccehowtouse/apply

guidelinesinprovidingMSpackagestovariouspopulaongroups.

2.Therewillbemorediscussionsaboutthetopicsduringthepracceand

praccumsessions.

3.Thenextsessionwillfocusonprovidinghealthmessagestoclientswhen

deliveringMSservicesandwhenadvocangforMSPtostakeholders.



Module 3 – The Micronutrient Supplementaon Program

Session 3: Strengthening Health Promoon and Communicaon for MS

OVERVIEW Healthpromoonistheprocessofenablingpeopletoincreasecontrolover

thedeterminantsofhealthandtherebyimprovetheirhealth.Parcipaonis

essenaltosustainhealthpromoonacon.

Healthcommunicaonisakeystrategytoinformthepublicabouthealth

concernsandtomaintainimportanthealthissuesonthepublicagenda.

[Reference:adaptedfromCommunicaon,EducaonandParcipaon:A

FrameworkandGuidetoAcon.WHO(AMRO/PAHO),Washington,1996]

HPusesvariouscommunicaonstrategiestoinformandinuencetheway

clientsthink,feel,behaveandmakeinformeddecisionsabouttheirhealth.

Goodcommunicaonisessenaltohealthcare.Eecvelycommunicangwith

clientsresultinsignicantbenetsforboththehealthcareprovidersandthe

clients.Conversely,poorcommunicaoncanyielddisastrousresultstoboth.

ForMSintervenonstosucceed,itisimportantthatcommuniesbecome

involvedaspartnersinpromongtheprogramforimprovedfamilypracceson

nutrionandmustbesupportedbysupporvecommunityenvironment.


1.Denehealthpromoonandcommunicaon

2.Discussthefollowing:

2.1.Goalsofhealthpromoonandcommunicaon

2.2.5AconAreasofHealthPromoon2.3.StrategiesofHealthPromoon

3.DiscussCommunicaonacvies,toolsandkeymessages

4.ApplystrategiesandkeyMSmessagestotargetaudience

4.1BarangayCaptain

4.2Partners/stakeholders

4.3Beneciaries

METHODOLOGY Lecture-discussion,roleplayandsmallgroupdiscussion


ADVANCE

PREPARATION

Readings/reviewonMSP-MOPpp.53to73,andannexes6-9pp.152to171

Powerpointpresentaonson:SessionObjecvesandtechnicalinputs

Scenarioswithkeyanswersforthegroupwork(Facilitator’sGuideAnnex3.3a)





Introducon

(05 min)


•Askparcipantsquesonsabouttheirexperiencesand/oracviesinHPCbeingimplementedintheirhealthfaciliesandcommunies.

•Introducethesessionandpresenttheobjecves.

Goals & principles of

HPC

(10 min)

Lecture-Discussion

•Usetherelevantresponsesofparcipantstolinktothenewlesson.

1.PresenttheHPCgoalsandprinciples

2.LinkthegoalstotheMSsituaondescribedinModule2.

3.DiscusseachprinciplebrieyandgiveexamplesofitsapplicaoninMSP

Strategies and key

messages per target

audience

(30 min)

Socialized discussion

•Discussthe5AconAreasofHealthPromoon

•DiscusstheHPCStrategiesnamely,advocacy,socialmobilizaonand

communicaon.

•Focusonthecommunicaontofurtherdiscusscommunicaonacvies

andtools

•DiscussthemessagesfromtheMOPforvarioustargetaudiences.

•Stresstotheparcipantsthatthemessagesareallimportanttothe

performanceofthedesiredbehaviourofaparculartargetaudience.

Unnecessarymessagesornicetoknowmessagesneednotbecommunicated

tominimizeconfusiononthepartofthetargetaudience.

•Explainthatnotallthemessagesneedtobecommunicatedtothetarget

audienceatonesingoroneIPCsession.Itwilldependonthecurrent

concernsandneedsoftheclient,hence,itisverycricalforthehealth

providertolistencarefullytotheclientanddiscusstheproblemtobeableto

providetheappropriatemessages.

50




Strategies of HPC

(30 min) and Key MS

messages for clients

Lecture-Discussion

Smallgroupdiscussionandcreavepresentaon

•Dividetheparcipantsinto5groups.Eachgroupwillbeassignedastrategyfor

aspecictargetaudiencetopromoteMS.•Givethefollowinginstrucons:

1.Acasewillbeprovidedfordiscussion(Facilitator’sGuideAnnex3.3a)

2.Basedonthecasescenario,thegroupwillidenfyanddiscussthestrategy

andkeymessagesonMSthatareappropriatefortheclient’sgeneralprole

andspeciccondion

3.Inplenary,eachgroupreportthrougharoleplay.

4.Othergroupswillbeaskedtoprovideconstrucvecommentsand

suggesonsonwhatwasportrayed.

Synthesis

(05 min)

•Summarizethemainpointsdiscussedbypresenngthepowerpoint

presentaon.Linkthesessiontothenextsessionandfuturesessions.

51





Annexes for

Module 3



Annex 3.1a. Quesons on MSP General Guidelines

1.Whatsituaonsorcondionsshouldmicronutrientsupplementaonbegiven?

2.Whataretheve(5)populaongroupstobepriorizedforMicronutrientSupplementaon?

3.WhenmicronutrientsupplementaonisrecommendedfortheChildren5-9yearsold,adult

males<50yearsold,andAdults,>50yearsold?

4.Whatshouldbefollowed/observedingivingmicronutrientsupplementstoclients?

5.Whatways/placescanwedeliverMSasidefromhealthfaciliestowidenreachandcoverage?

6.WhatareasinimplemenngmicronutrientsupplementaonattheLGUlevelshould

beimproved?

7.Inwhatwayshallnancingformicronutrientsupplementaonbesecuredandsustainedatthe

locallevel?

8.Howwillyouimprovedatarecordingandrepornginyourhealthfacility?

9.WhatshouldbethefocusofpromongMicronutrientSupplementaon?

10.WhatarethewaystoimprovethemonitoringandsupervisionoftheMSprogram?



Annex 3.1b. Answer Keys to Queson on General Guidelines

1.Whatsituaonsorcondionsshouldmicronutrientsupplementaonbegiven?

Answers:Micronutrientmicronutrientsupplementaonshallbeadoptedasanintervenonto

addressmicronutrientmalnutrioninanyofthefollowingcondions:

a.prevalenceofmicronutrientmalnutrionforaparculargrouporoftheenrecountryisata

levelofpublichealthsignicance

b.micronutrientneedsofpopulaongroupscannotbemetthroughcurrentdietsand

inadequateuseofforedfoods

c.useofmicronutrientsupplementshasbeenproventobesafeandeecveinimproving

healthateachstageinthelife-cycleandonthenextgeneraon

d.inmesofdisastersoremergencies

e.inareasthatareendemictomalariaandschistosomiasis

f.whenapersonisdiagnosedtobedecientinamicronutrient

2.Whataretheve(5)populaongroupstobepriorizedforMicronutrientSupplementaon?

Answers:lowbirthweightinfants,6-59monthsoldchildren,pregnantandlactangwomen,

femaleadolescents(10-14y.o.old),andnon-pregnant/non-lactangwomenofreproducve

age(15-49yearsold)

3.WhenismicronutrientsupplementaonrecommendedfortheChildren,5-9yearsold,Adult

males<50yearsold,andAdults,>50yearsold?

Answer: Whendeciencyexistintheindividual.

4.Whatshouldbefollowed/observedingivingmicronutrientsupplementstoclients?

Answer: rightdosage,ming,andfrequencyandduraon

5.Whatways/placescanwedeliverMSasidefromhealthfaciliestowidenreachandcoverage?

Answer: IntegrateintoexisngMaternal,NewbornandChildHealthandNutrion(MNCHN)

servicedeliverychannelsaswellasinschoolsandworkplaces

6.WhatareasinimplemenngmicronutrientsupplementaonattheLGUlevelshouldbei

mproved?

Answer: diagnosis,administraonofmicronutrientsupplements,counseling,promoon,

systemsdesign,clientreferral,recordingandreporng,follow-upandtracking.

7.Inwhatwayshallnancingformicronutrientsupplementaonbesecuredandsustainedatthe

locallevel?

Answer: havingaspeciclineiteminthelocalbudget.



8.Howwillyouimprovedatarecordingandrepornginyourhealthfacility?

Answer:completeandaccuratellingoutofTCL,monthly,quarterlyandannualFHSISreports,

melysubmissionofFHSISreport,regularupdangofmasterlists.

9.WhatshouldbethefocusofpromongMicronutrientSupplementaon?

Answer:Behaviorofaccessingmicronutrientsupplementsavailableintheregularmarketorthe

publichealthsystemandonimprovingtheclients’awarenessandappreciaonofMSbenets

anditsnegaveconsequences.

10.WhatarethewaystoimprovethemonitoringandsupervisionoftheMSprogram?

Answer:includetrackingofindicatorsonthestatusofgovernance,nancingandresulaonsin

addiontoservicedeliveryindicators,integrangMSintheMNCHNmonitoringandinthePIR



Annex 3.2. Oral Drill and Key Answers on MS Package for Infants, Children, Women,

Mothers and Other Adults

Queson Answer

A. Low birth weight infants

1.Whatmicronutrienttogive?

2.Whatdosage?3.Howmanyml?

4.Starngwhatmonth?

5.Uptowhatmonth

6.Howfrequent?

IronDrops

15mgelementaliron/0.6mlGive0.3ml

starngat2months

upto6months

Onceaday

B. infants 6 months old

1.Whatmicronutrienttogive?

2.WhatdosageofvitaminA?

3.Howoen?

4.Howmanyml?

5.Foriron,whatdosagetogive?6.Howfrequent?

7.Howlong?

VACapsuleandiron,

100,000IU,

Onceduringtheperiodof6-11months

15mgelementaliron

Give0.6mlonceaday

3months

C. 7 month old Infant sick with

measles

1.Whattogive?

2.Whatdosage?

3.Howmanycapsulestogive?

4.Howtogive?

VACapsule,

100,000IU,

2capsules

Give1capsuleupondiagnosisregardlesswhenthelastdoseof

VACwasgiven.Giveanothercapsuleaer24hours.

D. 4 month old Infant with diarrhea

1.Whattogive

2.Whatdosage?

3.Howmanyml?

4.Ifnodrops,whatotherforms

togive?

5.Dosage?

6.Howmanytogive?

7.Howlong?

Zincdrops

Drops27.5mg/ml(equivalentto10mgelementalzinc)

1ml

Tablet,

10mgelementalzinc.

½tablet

Give10mg/dayelementalzinc

fornotlessthan10days

E. Four year old have diculty seeing

in the dark upon diagnosis,

1.Whattogive

2.Howmanytogive3.Howtogive

VA

3VA

Give1capsuleof200,000IUupondiagnosis,1capsulethenextdayandanothercapsule2weeksaer.

F. Two year old with measles

1.Whattogive

2.HowmanyVAcapsulestogive?

3.Howtogive

VAcapsuleof200,000IU

2VAcapsules

Give1VAupondiagnosisregardlesswhenthelastdoseofvit.A

wasgiven.GiveanotherVAaer24hours



Queson Answer

G. 3 years old, was brought to the

health center due to diarrhea.

1.Whattogive

2.Whatdosage

3.Whatotherformtogive?

4.Howmanytogive?5.Forhowlong

Givenzincsyrup

5mlcontaining55mgzinc

zinctablet.

give1tabletof20mg/dayelementalzincnotlessthan10days

H. Leo is 12 months old and has severe

pneumonia

Whenweighed,hewasfoundtobe

severelyunderweight.

Given1capsuleof200,000IUupondiagnosisexceptwhenshe

wasgivenVAClessthan4weeksbeforediagnosis.

PreviousMNgivenissucient

I. Adolescent girl

1.Whattogive2.Dosage

3.Howmanytogive

4.Howfrequent

5.Whentostart

6.Forhowlong

IronTablet,60mgelementalironwith2.8mgfolicacid

1tablet

Onceaweek

Startofmenarche

Unlonegetspregnant

J. 11 years old girl with malaria

1.Whattogive

2.Howmanytogive

3.Howfrequent

4.Howlong5.Howtoadminister

IronTablet

Give1tablet

Daily

2monthsGivemalariadrugsrstandaeratleast24hoursadministered

ironsupplements.

K. 14 year old girl with schistosomiasis

1.WhatMNtogive

2.WhatDosage

3.Howmanytogive

4.Howfrequent

5.Howlong

6.Howtoadminister

IronTablet

100mgelementaliron

Give1tablet

daily

for30days,

GiveironsupplementrstbeforeadministeringPraziquantelfor

severelyanemicwomenL. 12 year old clinically diagnosed

with IDA

1.Whatdosagetogive

2.Howmanytogive

3.Howfrequent

4.Howlong

60mgelementalironwith400ugfolicacid

2tablets

daily

3monthsorunlhemoglobinreachesnormallevel



Queson Answer

M. 10 years old boy clinically

diagnosed with bito’t spot

1.Whattogive

2.Howmanytogive

3.Whentogive

GiveVAC200,000IU

3capsules

immediatelyupondiagnosis,anothercapsulethenextdayand

anothercapsule2weeksaerN. 15 year old Virgie

1.Whattogive

2.Dosage

3.Howmanytogive

4.Howfrequent

5.Whentostart

6.Forhowlong

IronTablet,

60mgelementalironwith2.8mgfolicacid

1tablet

Onceaweek

Startofmenarche

Unlonegetspregnant

O. 34 year old woman with malaria

1.Whattogive

2.Dosage3.Howmanytogive

4.Howfrequent

5.Forhowlong

6.Howtogive

IronTablet,

60mgelementalironwith400ugfolicacidGive1tabletfor

onceaday

2months.

Givemalariadrugsrstandaeratleast24hoursadministered

ironsupplements

P. 25 years old clinically diagnosed

with IDA

1.Whatdosagetogive

2.Howmanytogive

3.Howfrequent

4.Howlong

Tablet,60mgelementalironwith400ugfolicacid

Give1tablet

onceaday

unlhemoglobinreachesnormallevel.

Q. 27 year old clinically diagnosed

with night blindness

1.Whatdosagetogive

2.Howmanytogive

3.Howfrequent

4.Howlong

200,000IU

Giveimmediately1capsuleupondiagnosis,1capsulethenext

dayandanothercapsule2weeksaer

R. 4 months Pregnant woman

What to give1.AnyotherMNtogive

2.Whatdosage

3.Howmany

4.Howfrequent

Tablet,60mgelementalironwith400ugfolicacid

Give1tabletonceaday.Giveatotalof180tabletsadministeredonceadaytobetakenforthewholeduraonofpregnancy.

Iodizedoilcapsule

200mgelementaliodine

Give2capsulessingleoraldose

onceayear

*Iodizesuppshouldfollowthecriteria



Queson Answer

S. A woman who just gave birth a

week ago

1.WhatMNtogive

2.Whatdosageofiron

3.Howmanytogive

4.Howoen5.Howlong

6.HowmanyVAtogive

7.Whatdosage

8.shewasgivenIodizedoilcapsule

whenshewaspregnant

Iron,VA,iodine

60mgelementalironwithfolicacid2.8mg

Give1tablet

onceaweekunlonegetspregnantagain.

1Capsule

200,000IU

Noneedtogiveiodine

T. A nursing mother clinically

diagnosed with iron-deciency anemia

1.Whatdosageofiron

2.Howmanytogive

3Howoen

4.Howlong

60mgelementalironwith400ugfolicacid

Give2tablets

onceaday

for3months

U. 1 month pregnant clinically

diagnosed with xerophthalmia

1.WhatMNtogive

2.WhatdosageofVA

3.WhatfrequencytogiveVA

4.HowlongtogiveVA

5.currentlytakingmulvitamins

withVA

VA,ironandiodine

10,000IU

onceaday

fourweeksupondiagnosisregardlessofageofgestaon

donotgivethe10,000IUVAC.

V. Woman who delivered a baby

3 weeks ago diagnosed with nightblindness

1.WhatMNtogive

2.dosage

3.HowoentogiveVA

VA,ironandiodine

Capsule,200,000IU

Give1capsuleupondiagnosis,1capsulethenextdayandanother

capsule2weeksaer.

W. 61 years old is postmenopausal

1.Whattogive

2.Dosageofcalciumtogive

3.DosageofvitDtogive

CalciumandVitD

~1000g/d

400to900IU/d

X. 56 year old living in malaria

endemic area

1.Whattogive

2.Dosage

3.Howoen

4.Howlong

5.Whentogive1stdoseofiron

ironsupplement

60mg.elementalironwith400mcgfolicacid

Itabletonceaday

2months

Aertherstdoseofthean-malarialdrugsisgiven.



Annex 3.3a. Case Scenarios on Health Promoon and Communicaon for MS

Case Scenario I - Integrang MS messages in the roune health services in the health center

Ateenagemotherwhogavebirthathome,broughtherchildtoHealthCentertoavailservicesfor

immunizaon.Herbabyis3weeksold,LowBirthWeightandPremature.AsaHealthService

Provider,what(message)willyousay?

Case Scenario 2 (Evacuaon Center) Integrang informaon service in special situaons

AHealthTeamvisitedanEvacuaonCenteraerTyphoonBagyo.Duringthevisit,theyfound

Lilibeth,a7montholdinfant,sueringfromdiarrhea(sowaterystools).Inthecourseofthe

interviewthemotherproudlysharedthatsheisfeedingherchildotherfoodsinaddionto

breastmilk.Asamemberofthehealthteam,what(messages)willyoutellthemother?

Case Scenario 3 (Alternave Delivery Seng) Introducing/ Integrang MS messages

CiudadCity,withaprojectedpopulaonof97,380,hasanesmated3,408pregnantwomenfor 2009.Accordingtoreports,only5%ofthemhavecompletedtheirironwithfolicacid

supplementaon.Themidwifehasexhaustedalltheirstrategiestoidenfythepregnantwomen

inthedierentbarangaysthrutheirBHW’s.Advocacymeengshavebeenconductedtothe

Mayorstoprocureironwithfolicacidfortheirpregnantwomen.Recordingandreporngofdata

havebeenvalidatedtoensureaccuracyofdatareported.InoneoftheBarangaymeengsshe

aended,shemetanNGOworkingwiththepublic.Ifyouarethesupervisorofthemidwife,how

wouldyouhelpthemidwifehandlethissituaonintermsofestablishingpublicprivate

partnership,consideringthatshelearnedthatthisNGOhasbeenworkingwithprivatecompanies

whichemploywomenofreproducveage.HowwillyouinvolvetheNGOintheMSprogram?

Case Scenario 4 Introducing MSP to an Local Chief Execuve (LCE) for Support

Manggahanisathirdclassbarangaywithaprojectedpopulaonof5,814.Theprevalenceof

underweightchildrenis15.5%orabout114childrenoutofthe739esmatedunder-ve

children.ThehealthcentercanonlyprovideVitaminAandirontoasmallpercentageofthe

targetpopulaon.Theothertargetgroupslikepregnantandlactangwomenandhighrisk

childrenarenotprovidedwithMSespeciallyironandzinc.Asamidwifehowwillyougo

aboutdoingadvocacytoyourBarangayCaptainforhimtopurchaseMSsupplementsforyour

targetpopulaons.

Case Scenario 5 Giving Advice to an Older Person

AlingCarmenisanolderpersonaged65yearsofage.Sheconsultedyourhealthcenterbecause

shefeelssheisnotgengenoughnutrionandisfeelingweakbecauseshelacksappeteand

hasdicultyeangbecauseoflossofteeth.HowwouldyouadviceAlingCarmenonher

nutrionalneedsandconcerns.



Annex 3.3b. Possible Answers and/or Key Points to Emphasize for each Case Scenario

Case Scenario I - Integrang MS messages in the roune health services in the health center

--------------------------------------------------------------------------------------------------------------

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Case Scenario 2 (Evacuaon Center) Integrang informaon service in special situaons

--------------------------------------------------------------------------------------------------------------

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Case Scenario 3 (Alternave Delivery Seng) Introducing/ Integrang MS messages

--------------------------------------------------------------------------------------------------------------

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Case Scenario 4 Introducing MSP to an Local Chief Execuve (LCE) for Support

--------------------------------------------------------------------------------------------------------------

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Case Scenario 5 Giving Advice to an Older Person

--------------------------------------------------------------------------------------------------------------

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Module 4:

Enhancing Integraon of MS Intervenons

in Service Delivery Sengs






Module 4 – Enhancing Integraon of MS Intervenons in Service Delivery Sengs

Session 1: Delivery of MS Intervenon in Dierent Sengs

OVERVIEW MSdeciencyincreasechildhoodmortalityfromdierentdiseasesandisalso

associatedwithpoorhealthamongnon-pregnant,pregnantandlactang

womenandotheradultswithpredisposedhealthrisksandcondions.This

makesitaveryimportantpublichealthprobleminthecountry.

TheDOHpolicydeclaraonrecommendsforMSintervenonstobeaccessible

andavailableinamelyandappropriatemannertotheprioritypopulaon

groupsinbothrouneandalternaveservicedeliverysengs.Itsupportsthe

integraonofMSintohealthprogramsaspartofrounecomponentofhealth

careandinallpotenalservicevenues.

Cricaltoreducingmalnutrionandillnessesisthechangeofbehaviorsof

caretakersandfamilies.Thisrequireschangesinbehaviorsandpracces

ofhealthprovidersandserviceprovisionpraccesinourhealthfacilies,

parcularlyonMSintervenons.


1.IdenfythecurrentpraccesinprovidingMSservices.

2.ExplaintheMSP-MOPguidingprinciplesandgeneralguidelineson:

2.1.IntegraonofMSservices

2.2.ProvisionofMSservicesindierentsengs

3.Discussthefollowing:3.1.AlternaveservicedeliverysengsforMSservices

3.2.WaysofintegrangMSintervenonsinalternaveservicesengs.

METHODOLOGY Lecture-discussion,smallgroupexercises


ADVANCE

PREPARATION

ReadMSP-MOPSecon5(pp.44-52)

(AttheendofDay1,instructparcipantstoreadtheseseconsasassignment.)

Metacards,maskingtapeandpermanentmarkerpensPowerpointpresentaonson:

1.SessionObjecves

2.GeneralguidelinesandexamplesofwaysonhowtointegrateMSPin

alternaveservicesengs

Assignandorientco-facilitatorsfortheSmallGroupDiscussiononintegraonto

alternavesengs





Introducon

(05 min)


•Introducethesessionobjecvesandpresentshortoverview.

•Tellparcipantsthatthefocusofthesessionwillbeon:

1.Thedierentservicedeliverysengs,and

2.HowprovisionofMSintervenonscanbeimprovedbyintegrangthese

intorounehealthservicesandexpandingthescopeofservicedelivery

sengs.

Alternave Service

Sengs

(45 min)

Smallgroupexercise

1.Dividetheclassinto5smallgroups.

2.Assigneachgroup2servicesengstoworkonhowtointegrateMS

provision

3.Askparcipantstoidenfywhatother/alternaveservicesengswhere

MSpackagescanbeprovidedtoclients.

4.Or,usethelistofalternaveservicesengsbelowforparcipantstobe

assignedtoworkon:

•Shoppingmall•Factory(agriculturalorindustrial)

•School(Elementaryandhighschool)

•Birthinghomes

•Teencenters

•Prison(womencorreconalfacility)

•DayCarecenter

•Evacuaoncenter

•Orphanage

•Temporaryshelters

5.Give15minutesforthediscussion.•Idenfyacviesthattheycandointheseservicesengs

•Give/enumeratethestepsonhowtointegrateMSintheacviesthat

theycando

6.Writethestepsinmetacardstobepresentedinthesmallgroup.

7.Eachgroupisgiven5minutespresentaonforeachseng.

8.Inplenary,eachgroupwillsharelearninginsightsfor2-3minutes

66




Alternave Service

Sengs

(45 min)

Provideinputsusingapowerpointpresentaononthefollowing:

1.RecommendedwaysandstepsinintegrangMSprograminthedierent

alternavesengs.

2.Ifthealternavesengsusedduringthegroupexercisewereselectedby

theparcipants,provideaddionalslidestoshowotherservicesengsthat

werenotselectedbyparcipants.

Synthesis

(10 min)

Emphasizethekeypointsasnotedinlearninginsightsmenonedbythe

parcipantsforthesession.

Informparcipantsthattheywillhaveopportuniestodiscussaboutthetopics

andpracceitsapplicaoninsucceedingsessionsandatthepraccumsites.

67



Module 4 – Enhancing Integraon of MS Intervenons in

Service Delivery Sengs

Session 2: Integrang MS Intervenon in Regular Health Services

OVERVIEW TheDOHpolicysupportstheintegraonofMSintotheexisnghealthprograms’

servicedeliverysystem.CricaltointegrangMSintotheregularhealthservices

andachievingthegoalsoftheMSprogramisachangeinthepraccesofcaretakersinservicedeliveryandfamiliesinaccessingtheservices.

Micronutrientsupplementaonisnotastand-aloneprogramanditcan

beprovidedinexisnghealthfacilies(hospitalsandhealthcenters)and

communiesthroughoutreach.Inhospitals,interaconsofhealthservice

providerswithbothin-andout-paentsareamongtheopportuniesfor

providingmicronutrientsupplementaon.

IntegrangMSinregularhealthservicesstartswithagoodassessmentofeach

client,regardlessoftheirreasonforcontacngahealthserviceprovider.During

assessment,theserviceproviderneedstoidenfyrisks,signsandsymptomsofmicronutrientdeciencyandthereaerprovidetheappropriateservice

package,includinginformaononmicronutrientsaspartofqualityservice

provision.


1.ExplaintheimportanceofintegrangMNintervenonsinregularclient

services.

2.IdenfyclientswhoneedMNsupplementaonand/ortreatment.

3.IdenfysignsofMNdecienciesthroughadirectedphysicalexaminaon

onclients.

4.ExplainwaysofintegrangthefollowingMSintervenonsbasedonagoodclientassessment:

4.1.MStreatment/supplementaonpackages

4.2.KeymessagesonMS

4.3.MSFollow-up

METHODOLOGY Lecture-discussion

DemonstraonandReturnDemonstraon

Smallgroupdiscussion/work


ADVANCE

PREPARATION

InstructparcipantsonedaybeforetoreadMSP-MOP(pp.44-52)

PowerpointslidesonModule4Session2

RefertoParcipantReferenceGuide(pp.___)

ClientRecordForm/IndividualTreatmentRecords

Manilapaper,markers,tape,BPapparatus,stethoscope,alcohol,handtowel

CasescenariosforDemonstraon(Facilitator’sGuideAnnex4.2)Return

DemonstraonofAssessment(Facilitator’sGuideAnnex4.3aand4.3b)

ObservaonchecklistonAssessment(Facilitator’sGuideAnnex4.4)





Introducon

(05 min)


•AskparcipantsforquesonsorconcernsregardingSession1ofModule4.MenonthatinSession1,variousservicedeliverysengwhereMScanbe

integratedandprovidedwerediscussed

•Providesessionoverviewandpresentthesessionobjecves.

•Telltheclientsthatintheprevioussession,theylearnedthattherststepin

integrangMSintotheregularhealthservicesisdoneduringassessmentof

theclient.

•Thissessionwillfocusonhowtoproperlyconductanassessment.

Assessing a Client for

MS Using a Flowchart

(10 min)

Lecture-demonstraon

Telltheparcipantsthatagoodassessmentofclientsisneededbecause:

1.AllclientscanbeorbecomeMNdecient

2.Micronutrientdeciencyanditsconsequencescaneasilybepreventedif

recognizedearly

3.Partofqualityserviceprovision

4.AgoodassessmentandhistoryisacosteecveintervenontopreventMN

deciency

ExplainthatassessingclientsforMScanbeguidedbyusingaFlowchart.

•DistributecopiesoftheAssessmentowcharttoeachparcipant.

•Orientparcipantsontheowchart,showinghowassessmentforMSneeds

canbedoneateachpointintheserviceow.

•Discussthecomponentsofeachmajorareainthetotalassessmentofaclient.

•Askforanyquesonsorclaricaons.

•Respondtoeachconcernandquery.

Client Assessment –

integraon point for

MS services

(20 min)

Interacve Lecture-Discussion

Telltheparcipantsthatassessingclientsessenallyishistorytakingand

physicalexaminaon.Historytakinginvolvesaskingquesonsandthiscanbe

aidedbyusingexisngformsusedbytheserviceprovidersuchastheIndividual

TreatmentRecords(ITR).




a. History

b. Physical

Examinaon

Flashpowerpointslidesonquesonstoaskinthehistorytoassessclientsfor

MSandgooverthese,brieyexplainingtheuse/sorpurposeoftheinformaon

obtainedbyaskingthequesons.

GothroughsampleITRs–antenatalcare,post-partumcare,childandnewborncare–andpointoutwhatinformaonwillbeusefulforMSthatcanbeare

gatheredfromthegeneraldata,historyandreviewofsystemssecon.

PointoutaswellthatitisduringhistorytakingthatquesonsrelatedtoMS

shouldbeasked.

Flashpowerpointslidesthatshowthephysicalexaminaonndingsforsome

MNdeciencies:

a.VitaminAdeciency–Bitotspots,keratomalacia,cornealdryness,hair

discoloraon,roughskin

b.Anemia(asinIDA)–palmarpallor,paleconjuncva,paleoralmucosa

c.IDD–thyroidenlargement

Telltheparcipantsthatdoingaphysicalexaminaonprovidesaddional

informaonthattheserviceprovidercanusetomakeamorespecic

assessmentoftheneedofaclientforMS.

Thephysicalexaminaontobedonemaybedirectedatlookingforthephysical

manifestaonsofMNDs.

1.Formeconsideraon,thesessionwillmerelyfocusonspecicpartsofthebodythatarecloselyconnectedtoMNdeciency.

2.Emphasizethatathoroughandcompleteexaminaonisencouragedasme

permits.

3.Askparcipantstopairo.Asyoudiscusseachkeyareaofthebodyusingthe

powerpointslides,askeachpairtolookateachotherandtrytopracce.

4.Askco-facilitatorstomovearoundtheroomtoassistthepairs.

5.Atthispoint,thefacilitatorsneednotensurethattheparcipantshavegraspedtheskill.Theacvityisintendedtoprovidethemwiththeinial

experienceinpreparaonforthereturndemonstraon.

6.Aercoveringeachspecicareaofthebody,askparcipantsforany

claricaonorquesonbeforeproceedingwiththenextareaofexaminaon

followingthesameprocess.




Directed Physical

Examinaon for MS

assessment

(20 min)

Lecture-Demonstraon

Essenaltotheconductofthissessionisthepreparaonofthelogiscsthatwill

beneededfortheactualdemonstraonandbriengofthegroupfacilitatorson

theoverallprocess.Thisshouldbedoneadaybefore(Day1)andwillincludethedetailsbelow:

Preparaon:

•Adaybeforethedemonstraonwillbeconducted,itistheresponsibilityof

thefacilitator/trainertoplanforthesessioninadvance.

•Thisprovidesmetosecureanythingthatmayhavebeenmissedand/orto

makethenecessaryadjustments.

•Thepreparaonmayincludethefollowingbutisnotlimitedtothese:

1.Overallclassroomarrangement–plenaryandsmallgroupsessions

2.Adequatelighngandsoundsystem3.Seleconofcasestudyforthedemonstraon.

4.Praccewithco-facilitatoronhowtodeliverthedemonstraon.

5.Allthethings(equipment,materials,supplies,forms)thatwillbeneeded

duringtheactualandreturndemonstraon

Actual Demonstraon

1.Distributecopiesoftheobservaonchecklist.

2.Providemeforparcipantstobefamiliarwiththecontentsofthechecklist.

3.Tellparcipantsthatasyoudemonstratehowtoassessandmanageaclient,

theyaresupposedtoobserveifallthoselistedinthechecklistwere

undertaken.

4.Askforanyquesonand/orclaricaon.

5.DemonstratetheprocedureinaRolePlay(serviceprovisionforaclientusing

preparedscenario:PregnantwomancomingforANCtaggingalongher3year

oldchild).

6.Aerthedemonstraon,askparcipantswhoactedasobserverstoshare

theirobservaonsintermsofwhatwasdonewell,whatwasmissed,whatcan

beimproved.

7.Informparcipantsthattheywillhaveopportuniesto:

7.1.praccethedemonstraonprocedure7.2.begivenfeedbackforconrmaonand/orimprovementofskillsinclient

assessmentenhancedwithMSfocusedelements/steps,and

7.3.discussconcernstoproperlyintegrateMSfocusedassessmentsteps.

8.Informparcipantsthatthereturndemonstraonwillbeconductedinsmall

groupsandtheywillbeguidedbytheirgroupfacilitator.

9.Thereturndemonstraonsessionwillbealloed40-45minutes.

Note: Thetrainermayhavetheopontouseavideopresentaoncustomized

forthedemonstraonofMSfocusedassessment.




(30 min) Return Demonstraon

ThisacvitywillbeconductedasPracceExercisesintheSmallGroups.

1.Divideparcipantsintothevegroupsaspreviouslyorganized.

2.Remindassignedfacilitatorineachsmallgrouptoprovidethefollowing

instrucons:

2.1.Selectoneparcipanttoactastheserviceproviderwhowilldotherst

returndemonstraon.

2.2.Providepre-selectedcasescenariostobeusedforreturndemonstraon

ofparcipantswithinthesmallgroups.

2.3.TherestofthegroupmemberswillactasobserversusingtheSkills

ObservaonChecklist.Asobservers,lookcloselyatwhatisbeingdone

andhearwhatthehealthworkerissaying.

2.4.Theparcipantdemonstrangtheprocedurewillbegivenseven-to-ten

minutestocompletethereturndemonstraon.

2.5.Fiveminuteswillbespenttoprovidefeedbacktotheparcipantaerhis/

herreturn-demonstraon.

2.6.Aerprocessingtherstreturndemonstraon,selectanother

parcipanttodothedemonstraonfollowedbytheothers,usingnew

casescenarioeachmeforanotherdemonstraon.

2.7.Concludethegroupwork,askingparcipantsontheirlearninginsights.

Synthesis

(05 min)

3.Thesessionsynthesismaybedoneeitherinplenaryorinthesmallgroup

session.

4.Askparcipantstomenonsomeoftheirlearninginsightsfromthesession

and/orimplicaonstotheirworkstaons.

5.Emphasizethefollowingpoints(frombothModules4Sessions1and2):

1.MSservicescanbeprovidedaspartofrounehealthservicesinhealth

facilies;inthecommunitythroughoutreach;andinalternaveservice

sites.

2.Everyclientisaserviceopportunityfortheserviceprovidertoassessfor

MNdeciencyand/ortheneedforMS.Withagoodassessment,MScanbeintegratedintotheregularservicedeliveryofmosthealthprograms.

3.Theimportantthingistodoagoodassessment-completehistoryand

goodPE.



PRACTICUM SESSION (DAY 3 AM)

Health Center

OVERVIEW Thecourseisaresponsetoupdateserviceprovidersintheircompetencies

inimplemenngthenewly-revisedMOPonMSP.Learningandimproving

thecompetenciesinprovidingMSservicestoclientsisachievedbeerwith

experiencesinpraccalsessions.

Inthissession,parcipantswillhavethechancetopraccetheseskillsusing

theknowledgelearnedonMSPinprovidingMSservicestoclientsseekingcare

inhealthfacilitysengs.Inaddion,parcipantswillavailoftheopportunies

tolearnsomeinsightsonimprovinghealthfacilitypraccesforbeerMSP

implementaon.

OBJECTIVES Attheendofthepraccumsession,parcipantsshouldbeableto:

1.UsetheknowledgeandskillsininvolvedinprovidingMSservicestoclients.

2.ProvideappropriateMSservices,includingthekeyMSmessagesneededby

theclients.

3.Explainwaysofimprovinghealthfacilitypracces:

3.1.IntegrangMSinrouneservices&otherprograms

3.2.ManagingMSresources

3.3.Recording&reporngMSservices&resources

4.Idenfylearninginsightsfromthepraccumexperienceusefulinimproving

MSPimplementaon.

METHODOLOGY Groupdiscussion,parcipaoninselectedclinicacviesonMS–a)assessing

andprovidingMSservicestoclients,b)stainterview,c)reviewofrecordson

MSservices;Healthfacilityobservaon/checking–a)recordkeeping,andb)

storageofMSresources

ESTIMATED TIME 2.5to3Hours(Day3-AM)includingtravelme.

ADVANCE

PREPARATION

1.Idencaonandocularinspeconofthehealthcenter/s

2.Coordinaonwithhealthstaassignedinthehealthcenterforthespecicacvies/clientsneededforthepraccum.

3.Idenfyanareainthehealthcenterwherethesessionshallbeconducted.

4.Arrangementsof:

4.1.Vehicletoferryparcipantsandfacilitatorsto-andfrom-healthcenter.

4.2.Take-outAMsnacksfortheschedulepraccumsession.

4.3.Provisionofcommunicaonmaterialsandjobaidsbygroup:

(MOP,andformsona)StaInterviewGuide,b)RecordsreviewChecklist,c)

Clientcare/ObservaonChecklist.





Orientaon-brieng

on the Praccum

(10 min)

Greetparcipants.

Introducethesessionbygivinganoverviewandbypresenngtheobjecvesof

thesessiontotheparcipants.ConductanOrientaon-briengforthePraccumsession

I.Informparcipantsthatthetheywillundertakeacviesinthehealthcenter

asassignedbytheFacilitators:

1.Clientservice:

1.1.asessclientsforMSneeds

1.2.ProvideneededMSservices(packageandkeymessages)

2.StaInterviewandreviewofrecords

2.1.ManagementofMSresources

2.2.RecordingandreporngofMS

3.Healthfacilityobservaon

3.1.Client/serviceow

3.2.StorageofMSresources

3.3.Recordskeeping

3.4.“BestPracces”onMSdelivery

II.Remindparcipantsonthefollowingpoints:

1.WeartheirtrainingID.

2.Greet/introduceselftostaandclients.

3.Seekclient’spermission/consentfortheassessment/interview.

4.Thankclientsandstaattheendofeachacvity.

5.Submittheirfullyaccomplishedforms/checkliststothefacilitatorattheend

ofthesession.

III.Entertainquesons/claricaonsfromparcipants.

Praccum Acvies

(60 min)

Uponarrivalatthehealthcenter,thefacilitatorwill:

1.Greetandintroduceselfandparcipantstotheheadofthehealthcenterand

otherclinicsta.




2.Explaintheobjecvesofthepraccumandthespecicacviesthat

parcipantswillbedoing,suchas:

2.1.AssessclientsforMSneeds,giveMSpackage(ifneededandifavailable)

andprovidekeyMSmessages

2.2.Endorseclientsbacktoclinicstaforotherservicesneeded2.3.Interviewclinicsta(2-3)andreviewMSrecords

2.4.CheckstorageofMSresourcesandrecord-keepingsystem

3.Explaintoclinicstathattheacvityisapartofthetrainingsessiononthe

newMSP-MOPguidelinesandthattrainingofserviceproviderswillsoonbe

conductedbytheconcernedCHDs.

4.AskHCstaifmewouldallowattheendofthepraccumsession,willthey

welcomeashortfeedbackfromtheparcipants’learninginsightsfromthe

experience.

Assignacviestoeachparcipant,makingsurethateachwillhaveassigned

taskandvarietyofexperience:

1.SelectclientsforMSassessmentandservice.Thismaybedoneinpairs:

1.1.Oneparcipantassessandprovideservice,whiletheotherparcipant

observes,llsouttheobservaonchecklistandgivesperformance

feedbacktothepartner.

1.2.Then,twoparcipantswillexchangeroles

1.3.Endorseclientstoclinicstaforotherservicesneeded.

2.Assignparcipant/sforstainterviewandreviewofMSrecording

3.AssignparcipantforfacilitycheckingonMSstorageandrecordingkeeping.

4.Observeparcipantswhileworkingandprovideneededguidanceand/or

assistance.

5.Thankclientsandstaaereachacvity.

Facilitateafeedback/postconferencewithclinicsta,guidingparcipantsto:

1.Idenfystrengthsand/or“goodpracces”observed

2.Idenfyareasneedingimprovements

3.Makesuggesons/recommendaonsinaccordancewiththenewMSP-MOP

guidelines.

4.Thankand/orcongratulate(asappropriate)thehealthcentersta.




Post conference/ de-

brieng

And Synthesis

(20 min)

Askparcipants:

1.Theirlearninginsightsdrawnfromthepraccumexperience.

2.Encourageeachparcipanttosharetheirthoughtsandfeelingsabouttheir

specicexperiences.

3.HCpracces/acviesrelatedtoprovisionofMSservices

Reviewwiththeparcipantsthelearningobjecvesforthepraccumandask

whethereachobjecveswereachieved:

1.Whichobjecve/sweremet?Fullyorpartly?

2.Whichobjecve/sweremet?Why?

3.Whatacvies/changeswilleachconsiderdoingintheirhealthcenterto

improveprovisionofMSservice?

Clarifywithparcipantsimportantlearningastheserelatewiththenewrevised

MSP–MOPguidelines.

76



Annexes for

Module 4 and Praccum





Annex 4.1a. Workshop Matrix/Guide on Alternave Service Delivery Sengs

Name of Alternave Service Seng for MS Delivery: _______________________________________

Acvies that can be Done/

Conducted

Steps on how to Integrate MS

services in the Acvies

Implementaon Notes/Remarks

79



Name of Alternave Service Seng for MS Delivery: SHOPPING MALL /

FACTORY (Agricultural or Industrial)


Conducted




Wellness clinic

CoordinaonmeengwithMall/

factoryocials

Orientaononthemicronutrient

supplementaonprogram

Assessmentonthemicronutrient

statusoftheemployees

Presentaonofndingswith

Mallocials

Agreeonaconstotaketo

addresstheproblemsandhow

toassisttheDOHtoaddress

MNproblems,e.g.costschemes

schemes,recordingand

recording

RecordingandreporngofMS

acvies

PutupboothsforGP

Giveoutyerstomallers/factory

workers

Healthpromoandawareness

campaign

Counselling

Referral



Name of Alternave Service Seng for MS Delivery: SCHOOL (Elementary & High School)


Conducted




Healtheducaontoincludeuse

ofironfolictabletonceaweek

unlpregnancysetsin

Coordinaonmeengwithschool

ocials


supplementaonprogram

Agreeonaconstotaketoaddressthe MN problem among their

students e.g. health educaon,

trainingofschoolhealthstaon

theMSguidelines,etc.

Recording and reporng of MS

acvies

Ferlityawarenesslecture/

campaign

AssessmentofchildrenwithMN

deciencytobeintegratedthe

annualcheckofchildren



Name of Alternave Service Seng for MS Delivery: BIRTHING HOMES


Conducted




ConsultaonvisitCoordinaonmeengwithbirthinghomesowners


supplementaonprogramand

thenewguidelines,

Agreeonaconstotakeatthe

birthingfacilitytoaddressthe

MNproblemamongpartumwomene.g.givingofironffolic

acidsupplementsbeforethey

leavethehealthfacilityaspartof

Philhealthbenet.Counselling

ofmotherontheimportance

oftakingtheMSsupplements,

referraltoHCforvitaminA

supplementaonorproviding

vitaminAcapsulestobirthing

home,recordingandreporng.

RecordingandreporngofMS

acvies

Counsellingsession

Givingofironfolicandvitamin

supplementaon



Name of Alternave Service Seng for MS Delivery: PRISON (women correconal facilies)


Conducted




1.Conductofconsultaonvisits

Clinical/physicalAssessment

Referral

Coordinatewiththeocialsfor

theconductofconsultaonvisit

oroutreachacvity

Conductofconsultaon/

outreachacvityincluding

provisionofMSandhealth

informaoneducaon.

2.MicronutrientServices(Iron,

Folate)

3.Counseling

4.Follow-upVisit

5.DistribuonofIECMaterials



Name of Alternave Service Seng for MS Delivery: TEEN CENTERS


Conducted




1.Conductofconsultaonvisits

Clinical/physicalAssessment

Referral

Coordinaonmeengwiththe

TeenCenterocials

Identyacvies/programsof

thecenterwhereMScanbe

integrated

Orientaonofteencentersta

ontheMSPguidelines

2.MicronutrientServices(Iron,

Folate)

3.Counseling

4.Follow-upVisit

5.DistribuonofIECMaterials



Name of Alternave Service Seng for MS Delivery: DAY-CARE CENTERS


Conducted




GPACTIVITIES Coordinatewithday-careteacher

andthebarangaycaptain

regardingconductofGP

Requestforthemasterlistof

pupilstoincludeageandweight

EstablishaGPcenterinthedaycarecenter

Recordinginthegrowthchart,

submitreporttoHCsta

DisseminateIEC

DistributeMSandotherGP

package

Recordandreporttoschool,

RHU



Name of Alternave Service Seng for MS Delivery: EVACUATION CENTERS /TEMPORARY SHELTER


Conducted




Medicalmission Coordinatewithevacuaoncenterleadersorocialsforthe

conductofoutreach/medical

mission

Requestforthemasterlist

ofchildrenandpregnant

andlactangwomeninthe

evacuaonsite.

ProvideMSdothosehighrisk,

providemessagesonMSand

recordinappropriateindividual

recordlikegrowthchart,mother

andbabybook

Referclientsneededspecialcare

tohealthfacility

Ageclassicaon

Healthassessment

Dispensinghealthteachings/

nutrion

Rounemedicalconsultaon

Targeng/priorizaon



Name of Alternave Service Seng for MS Delivery: ORPHANAGE


Conducted




Healthconsultaon Coordinatewiththeocialsfor

theconductofconsultaonvisit

oroutreachacvity


supplementaonprogramand

thenewguidelines

Conductofconsultaon/

outreachacvityincluding

provisionofmicronutrient

supplementsandhealth

informaoneducaon.

Referralofchildrenneeding

specialcare

Recordingandreporngof

childrengivenMS

Historytaking,screening,

assessment

Managementandtreatment

Nutrionandhealthcounselling

Healthandnutrioninformaon

andeducaon



Annex 4.2. Case Scenario for Demonstraon in the Plenary (Facilitator’s Copy)

Case Study for the Demonstraon

MarianaKilipis27yearsold,married,andahousewife.SheismarriedtoAntonioKilip,30years

old,ataxidriverandtheyhavetwochildren–theolderchild(daughter)is5yearsold(DOB–Dec 152005)andtheyounger(son)is3yearsand3months(DOB–November15,2007).

MarianavisitsthemidwifeattheBarangayHealthStaonforconsultaonaermissingher

periodfortwomonths–lastmenstrualperiodwasDecember18,2010.ShecomestotheBHS

withher3-yearoldsontaggingalong.

Overall,Marianafeelswellandisexcitedthatshewillbehavinganotherbaby.Sheisabletoeat

wellalthoughatmes,shefeelsnauseousandthisstartedtwoweekspriortovisingtheBHS.

Theirfamilyeatsthreemealsadayandtheseusuallyconsistofsteamedriceandvegetables

(kangkong,okra,squash,sitaw,upo,tomatoes)withmeatorsh2-3xaweek.Shedoesnothave

anyphysicalcomplaintsexceptthatshefrequentlyurinatesandfeelssleepymoreoftheme thanusual.

Mariana’sfamilyisnegavefordiseasesoffamilialorhereditarypaernslikeDM,TB,heart

disease,kidneydiseaseandothers.Shehasnothadanymajorillnessesinthepastandhadbeen

hospitalizedonlyfordeliveryofhertwochildren(byNormalSpontaneousVaginalDelivery).

Her3-yearoldson,Roberto,hasreceivedallthestandardimmunizaonsbeforereachingone

yearofage.Heisanacvechildandplayswellwithhiscousinsandotherchildrenofhisage.He

ispickyaboutfoodandsomemesskipsmealswhenhedoesnotlikethe‘ulam’(prefersmeat

andeatschipsandcandiesfrequently;helikestoeatfruits–bananas,guavaandotherseasonal

fruits)orwhenhesuersfromtoothache.

BasedonhisGrowthMonitoringChart(GMC),heisunderweight.Robertohashadsomeillnesses

inthepastincludingcoughingandLBM,butwashospitalizedonlyoncewhenhecontracted

dengueinOctober2010.Inthepastmonth,hehadoneboutofdiarrheathatlastedfor3days,

whichresolvedspontaneously.MarianaisawareofGPeveryAprilandOctoberandshemakesan

eorttobringRobertototheBHSforVitaminAanddewormingonthosemonths;however,in

October2010,RobertowasnotgivenVitaminAandtheotherGPservicesbecauseMarianawas

sobusywithherhousechoresshetotallyforgotaboutbringingRobertototheGPservicepoint.



Annex 4.3a. Case Scenarios for Small Group Exercises (Facilitator’s Copy)

CASE NO. 1 – ALIAH PUZON and GENESIS

AliahPuzonisa26yearsoldfemale,dressmaker,marriedtoJeryPuzon,29yearsold,

construconworkerandtheyhaveoneson,Genesis,whowasbornonJanuary15,2010.They

liveinaremotebarangayhighupinthemountainsoftheCordilleras.

AliahbringsGenesistotheRuralHealthUnit(RHU)some8kilometersawayfromwherethey

residebecausehehasbeencoughingfor10daysandnowfeelsverywarmtotouch.Genesis

startedrefusingsolidfoodsinthepasttwodaysbutdrinksuids.Hebreaseedsbutfrequently

stops.AliahgaveGenesisonedoseofparacetamolforthefever.BecauseGenesiswasnowhaving

dicultyofbreathing,AliahbroughthimtotheRHU.

OtherinformaonaboutGenesis:

Birthweightwas2.6kg;exclusivelybreasedfor6months;completedhisEPIvaccinaons

(BCG,HepB,OPV,DPTandMeaslesvaccines)before1yearofage;wasgivenVitaminA

100,000IUinOctober2010;weighthasincreasedsincebirthandiswithinnormalforhis

ageandsex;

InformaonaboutAliah(NB.tobemenonedonlyiftheServiceProviderasksAliahabout

herself):

LastMenstrualPeriodwasNovember30,2010;notusinganyFPmethod;eatswellbut

rarelyeatsanimalfoodproducts,moreofvegetablesandsh;thefamilydoesnotuse

iodizedsalt;atmesfeelsdizzyandlight-headed;nocedgengredeasilysincetwo

monthsago;friendstellherthatshelooksfrailandthin;shedoesnothavenight

blindness;sheadmitsthatatmes,herhusbandbeatsherwhenheisdrunk.





Annex 4.3a. Case Scenarios for Small Group Exercises (Facilitator’s Copy)

CASE NO. 3 – ISRAEL and MARIAM

IsraelMaePalpallatocwasbornonSeptember8,2007toparentsJoseandMariamRubio,both

33yearsold.Sheistheonlychild.MariambroughthertotheBHSonaWednesdaymorning

becauseshewashavingwaterydiarrheaandvomingthatstartedonedaybeforeconsultaon.

IsraelMaehashadsixbowelmovementandoneepisodeofvomingsincethen,butshecansll

takeinuids.Shewasgivenyoungcoconutwaterandoresolwhichshedrankandretainedwell.

MariamisworriedthatIsraelMae’scondionmightworsensoshebroughthertotheBHS.

InformaonaboutMariam:(TobemenonedonlyiftheServiceProviderasksaboutMariam

herself.)

Mariamsaysthatshehasnotbeenfeelingwellandfeelsredeasilysincethreemonthsago.She

hadbeenhavingheavymenstrualperiodssince4monthsagowhenshehadanIUDinserted,but

themenstrualowhasbeendecreasingthepasttwomonths.Herfriendstellherthatshe lookspale.



Annex 4.3b. Key / Possible Answers to Case Scenarios (Facilitator’s Copy)

CASE 1: Assessment and Management for Aliah and Genesis

A. For Genesis:

Serviceprovidershouldnotethatthechildbelongstothe12-59monthsagegroup

Serviceproviderchecksforclinicalsignsofanemia.

ServiceproviderasksifchildwasgivenVitaminAandwhen.AerascertainingthatVitaminAwas

givenmorethan4weeksago,givesVitaminA200,000IU.

TellsAliahtoconnuebreaseedingGenesisasbreastmilkissllthebestfoodforGenesisupto

2yearsandbeyond.

TellsAliahthatVitaminAincreasesherchild’sresistance(immunity)sohedoesnoteasilygetsick,

helpshimgrowanddevelop,andhiseyeswillfunconproperly(sight).

TellsAliahthatGenesisshouldbebroughttothehealthcenterevery6monthstoreceiveVitamin A,dewormingdrugsandotherservicesincludinggrowthmonitoring.

TellsAliahtomakesurethatGenesiseatavarietyoffoodseverydaycomingfromtheFood

Pyramidandconsumetherecommendedamount.

Serviceprovidermanageschildasacaseofseverepneumonia.

B. For Aliah:

ServiceproviderasksAliahaboutherself.

ServiceproviderdeterminesthatAliahispregnantandtellsherso.

ServiceprovidergivesAliahironfolicacidtabletsandtellshertotakeonetabletonceadayfor atotalof180tabletsallthroughouttheduraonofthepregnancy.ShetellsAliahthatbecause

sheispregnant,herneedforironandfolicacidcannotbemetbydietalone,sotheneedforher

totakedailyironfolicacidsupplementaon.

ServiceprovidergivesAliahiodinesupplementaon.

ServiceprovidertellsAliahtocomebackforaddionalprenatalcarevisits(atleast4duringthe

enrepregnancy).

TellsAliahthatshemayhavesideeectssuchasnausea,conspaon,gastricupsetandblack

stools,buttheseshouldnotcausehertoworryandwillusuallystopsoonexcepthavingblack

stools. TellsAliahsomepstominimizethesideeects.

TellsAliahtoeatavarietyoffoodsfromtheFoodPyramidandattherightamounts.



CASE 2: Assessment and Management for Amanda and the Baby:

A. For Amanda:

ServiceproviderassessesthatAmandaisatargetgroupforMS–PostpartumorLactangWoman

TellsAmandathatsheshouldconnuetotakeiron-folateonceweekly.

DiscussesfamilyplanningoponsofAmanda–tellsherthatforaslongassheexclusively

breaseedsherchildandthathermenseshavenotyetreturned,sheisprotectedfromgeng

pregnant.

TellsAmandathatsheisbreaseeding,shehasincreasednutrionalneedsthatcannotbemetby

dietalone,sotheneedformicronutrientsupplementaon.

TellsAmandatotakeinavarietyoffoodfromtheFoodPyramid–meat,liver,darkandgreen

leafyvegetablesthatarerichiniron,foodsrichinvitaminC,aswellasVitaminA.

B. For the Baby: (if assessed)

AskedaboutbirthweightandassessesthatthebabyisLBW.

TellsAmandatoconnueexclusivebreaseeding

Givesthebabyironsupplementtobegivenat15mgelementalirononcedailyuptosixmonths.

CASE NO 3: Assessment and Management for Israel Mae and Mariam:

A. For Israel Mae:

ServiceproviderassessesthatshebelongstoatargetgroupforMS.

AssessesIsraelMaeforsignsofdehydraon.

TreatsIsraelMaewithReformulatedORSandzinc.

TellsMariamthatsheshouldgivezinc20mgonceadaytoIsraelMaeforatleast10daysandthat

thiswillreducetheduraonandseverityofdiarrhea.

TellsMariamtoprepareappropriatefoodandconnuefeedingIsraelMae,andthatwhenher

childiswell,togiveextramealstoreplaceproteinandenergylostduringillnessandrestorethe

body’sreservesforconnuedgrowthanddevelopment.



B. For Mariam (if assessed):

ServiceProviderassessesMariamforanemia.

Ifassessedtobepale,theServiceProviderstellsMariamthatabloodexaminaontomeasure

herhemoglobinwillbedoneorwillreferhertoanotherfacilityfortheprocedure.

Ifassessedtobepale,ServiceProvidergivesironfolate60mgonetabletonceadayandthat

Mariamwillconnuetotakethisunlherhemoglobinreachesnormallevel.

ServiceprovidertellsMariamtoeatavarietyoffoodseveryday(referringtoFoodPyramid)andto

increaseintakeofiron-richfoods–animalproductslikeliver,kidney,spleen,shellsh;andplant

foodslikedarkgreenleafyvegetables.



Annex 4.4. OBSERVATION CHECKLIST (For Classroom Exercises)

Instrucon: Place a YiftheacvitywasobservedandNifnotobserved.PlaceNAifthedesiredacvityis

notapplicablegiventhecasescenario.

ACTIVITIES OBSERVATION REMARKS

A.Wasproviderabletodeveloprapportwiththeclient?Didtheprovider…..1.Greettheclient?

2.Introducehimself/herselftoclient?

3.Askclientherreasonforcoming?

4.Makeclientcomfortable?

5.Assureprivacy?

6.Assurecondenality?

B.Wasproviderabletocommunicateeecvelywiththeclient?Didtheprovider….

1.Maintaineyecontactwiththeclient?

2.Useanappropriatetoneofvoice?

3.Spokenwordsareclearanddeliveredwell?

4.Exhibitappropriatebodylanguage?

5.Listenaenvely?

6.Usesimplelanguage?

7.Useparaphrasingandclarifyingappropriately?

8.Asktheappropriatequesons?

9.Askopenendedquesonstoencourageclienttotalk?

10.Checkclient’slevelofunderstanding?

11.Useneutralstatements?

12.Focusaenontoclientduringthediscussion?

C.Wasproviderabletoexaminethefollowingadequately?

C.1ExaminaonoftheSkin

a.Inspectedthehandsandface

b.Inspectedandpalpatedtheskin,tooknoteof:

b.1.Color

b.2.Vascularityandevidenceofbleedingorbruising

b.3.Moisture

b.4.Temperature

b.5.Texture

c.Inspectedandpalpatedthengernailsandtoenails

•Nongthecolor,shapeandlesions

C.2ExaminaonoftheHead

a.Askedifthepaentnocedanythingwrongwithhis/herscalporhair.

b.Inspectedthehairnongquanty,distribuon,paernoflossifany

c.Palpatedthehair:Nongitstexture(ne,coarse)




C.3ExaminaonoftheEyes

a.Screenedforvisualacuitybyaskingthepaenttoreadanyprintmaterial.

b.Askedpaenttouseeacheyeseparately,coveringtheothereyewithan

opaquecard,notwithngers

c.UsedaSnelleneyechartwhenappropriate:

c.1.Posionedthepaent20feetfromthechartandaskhim/hertoreadthe

smallestlineofprintpossible

c.2.Testedeacheyeseparately

c.3.Determinedthesmallestlineofprintfromwhichpaentisabletoidenfy

correctlymorethanhalfofthegures.

c.4.Recordedthevisualacuitydesignatedatthesideofthisline.

d.ExaminedtheConjuncvaandSclera

d.1.Askedthepaenttolookupasthelowerlidofeacheyeisdepressedwith

thethumb,exposingthescleraandconjuncva

d.2Inspectedupperpalpebralconjuncva

e.ExaminedtheCorneaandLens

•Withobliquelighng,inspectthecorneaforopacies

f.ExaminedtheIris

C.5ExaminaonoftheMouth

a.Ifthepaentwearsdentures,oeredhim/herapapertowelandaskhim/her

toremovethem.

b.Inspectedthelipsforcolor,moisture,lumps,ulcersorcracking.

c.Askedpaenttoopenhis/hermouth.

•Withagoodlightandusingatongueblade,inspectthebuccalmucosafor

color,pigmentaon,ulcers,nodules.

.Inspectedthedorsumofthetongue,itscolorandpapillae.Noteany

abnormalsmoothness.

e.Inspectedthesidesandtheundersurfaceofthetonguetogetherwiththe

oorofthemouth.

C.6ExaminaonoftheNeck

a.Inspectedtheneckforsymmetry,massesandscars.

b.Inspectedthethyroid.

b.1.Askedthepaenttoextendhis/herneckslightlyandtoswallow.

b.2.Ifwithdicultyinswallowing,gavewater,instrucngher/himtoholdit

inher/hismouthandtoswallowwhenasked.

b.3Inspectedtheneckforanyvisiblethyroidssue,nongitscontourand

symmetry.

c.Palpatedthethyroid,nongitssize,shape,symmetry,tenderness,nodules.

c.1.Palpaonfrominfront.



Annex 4.4. OBSERVATION CHECKLIST (For Classroom Exercises)

Instrucon: Place a YiftheacvitywasobservedandNifnotobserved.PlaceNAifthedesiredacvityis



a.Withthepadsofindexandmiddlengers,feltbelowthecricoidcarlageforthethyroidisthmus.

b.Askedthepaenttoswallow.Feltfortheisthmusrisingupwardunderthengers.

c.Movedngerslaterallyanddeeptotheanteriorborderofthesternomastoid.Felt

foreachlaterallobebeforeandwhilethepaentswallows.

d.Askedthepaenttoexneckslightlyforwardandtohisright.

e.Placedrightthumbonthelowerporonofhis/herthyroidcarlageanddisplaced

ittothepaent’sright.

f.Hookedthepsoftheindexandmiddlengersoflehandbehindthesternomastoid

musclewhilefeelinginfrontofthismusclewiththethumb.

g.Palpangngersposionedbelowthelevelofthethyroidcarlage.Feltforthelaterallobeasthepaentswallows.

c.2Palpaonfrombehind.

a.Withthepaentseated,providerstoodbehindthepaent.

b.Restedthumbsonthenapeofthepaent’sneck.

c.Withindexandmiddlengersof bothhands,feltforthethyroidisthmusandfor

anteriorsurfacesofthelaterallobes.

d.Askedthepaenttoexneckslightlyforwardandtotheright.

e.Displacedthethyroidcarlagetotherightwiththengersoflehand.

f.Palapatedwithrighthand,placingthumbdeeptoandbehindthesternomastoid,

andindexandmiddlengersinfrontofit.

g.Askedthepaenttoswallow.

h.Ifthyroidglandisenlarged,listenedoverthelaterallobeswiththediaphragmofthe

stethoscopeforabruit.

D.Werethemessagesprovided……

1.Relevantandappropriatetothesituaon?

2.Directandeasilyunderstood?

3.Reinforcedbysucceedingstatements?

4.Complementedbyteaching/learningaids?

5.Smoothandwellorganized?

E.Wasproviderabletoshowcompassionandempathytotheclient?Didtheprovider……

1.Refrainedfrommakingjudgmentalremarks?




Demonstratedconcerntotheclientinthemannerofspeaking,gestures

andfacialexpression?

3.Allowedtheclienttotalkwithoutinterrupon?

. Respected the client’s ideas and decisions even if contrary to the

advice?

5.Askedpermissionfromclientpriortotheconductofanyprocedureor

examinaon?

6.Explainedtheprocedureproperly?

7.Involvedclient’spartnerand/orcompanioninthediscussion?

8.Explainedclient’scondion?

9.Addressedclient’sfears,concernsoranxiees?

10Helpedclientcomeupwithappropriatehealthcaredecisions?



Annex 4.5. OBSERVATION CHECKLIST (For Praccum)

Instrucon: Place a Yiftheacvitywasobservedand N ifnotobserved.PlaceNA ifthedesiredacvityis



A.Wasproviderabletodeveloprapportwiththeclient?Didtheprovider…..

1.Greettheclient?

2.Introducehimself/herselftoclient?

3.Askclientherreasonforcoming?

4.Makeclientcomfortable?

5.Assureprivacy?

6.Assurecondenality?

B.Wasproviderabletocommunicateeecvelywiththeclient?Didtheprovider….

1.Maintaineyecontactwiththeclient?2.Useanappropriatetoneofvoice?

3.Spokenwordsareclearanddeliveredwell?

4.Exhibitappropriatebodylanguage?

5.Listenaenvely?

6.Usesimplelanguage?

7.Useparaphrasingandclarifyingappropriately?

8.Asktheappropriatequesons?

9.Askopenendedquesonstoencourageclienttotalk?

10.Checkclient’slevelofunderstanding?

11.Useneutralstatements?12.Focusaenontoclientduringthediscussion?

C.Werethemessagesprovided……

1.Relevantandappropriatetothesituaon?

2.Directandeasilyunderstood?

3.Reinforcedbysucceedingstatements?

4.Complementedbyteaching/learningaids?

5.Smoothandwellorganized?

D.Wasproviderabletoshowcompassionandempathytotheclient?Didprovider……

1.Refrainfrommakingjudgmentalremarks?

2.Demonstrateconcerntotheclientinthemannerofspeaking,gesturesand

facialexpression?

3.Allowtheclienttotalkwithoutinterrupon?

4.Respectstheideasanddecisionsoftheclientevenifcontrarytotheadvice?

5.Seekpermissionfromclientpriortotheconductofanyprocedureor

examinaon?




6.Explaintheprocedureproperly?

7.Involveclient’spartnerand/orcompanioninthediscussion?

8.Explainclient’scondion?

9.Addressclient’sfears,concernsoranxiees?

10Helpclientcomeupwithappropriatehealthcaredecisions?



Annex 4.6. STAFF INTERVIEW CHECKLIST (For Praccum)

Name of Respondent: _____________________________________ Date: _________________

Name of Interviewer: _____________________________________

Quesons

Responses Assessment

YES NO

2–AppropriateMSgivento

clientsinrightspecs,dose,

duraon

1–atleast1elementnotmet

0–noelementmet

1.Doyouprovidethetargeted

clientswiththefollowing

supplementswhentheycon

sultyourhealthfacility?

1.1.Iron/folicacid

1.2.Iodizedoilcapsule

1.3.VACwithxerophthalmia

2.Areyouabletoprovideforthe

totalMSrequirementneeded?

Yes,Complete

No

3.Ifno,whyareyounotableto

providethetotalrequirement

needed?

Notawareof

protocol

Nosupply

availablelocallyNobudget/limited

funds

Others,specify

______________

________________

YES NO

4.Doesthelocalhealthfacility/LGU

procureMSsupply?

5.DotheMNsupplementsfollowthe

preparaonsspeciedbyDOH?

6.Doesitreceiveaugmentaonfrom

othersources?

6.1.DOH

6.2.Developmentpartners





Quesons


YES NO



duraon

1–atleast1elementnotmet0–noelementmet

22.Doesthehealthfacilityhave

copiesoftheMSstandardsand

protocols?

22.1.AOontheRevisedMS

Guidelines

22.2.MSManualof

Operaons

22.3.AOonZinc

Supplementaon23.Doesthehealthfacilityhave

copiesofMSIECmaterials

(specify)?

General Comments/Remarks: ___________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________ _____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________



Annex 4.7. RECORDS REVIEW CHECKLIST (For Praccum)

NameofFacilityVisited:_____________________________________ Date:__________________

Quesons


YES NO



duraon

1–atleast1elementnotmet

0–noelementmet

1.Selectatrandom3ITRsandcheck

iftheMSneedsofclientswere:

1.1.asked 1.2.recorded

2.ReviewTCLonMSandvalidateif

datarequiredarecompletelylled

up.

3.Askforcopiesofthemostrecent

reportsonGPaccomplishment

(October2010)

4.Askforcopyofthehealthfacility’s

annualprocurementplanand

checkifMSisincluded.

5.Askforacopyofthestock

inventoryandcheckifthisis

updated.

6.CheckifMSreceivedfromother

sourcesareincludedinthestock

inventory.

7.Checkifhealthfacilityhascopies

of:

7.1.AOsonMS

7.2.Policies

7.3.Manuals

7.4.IEConMS

8.Checkfordocumentaonof

orientaondoneamonghealth

staonMSAOandMOP.



General Comments/Remarks: ___________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________





Module 5:

Managing Service Delivery of

MS Intervenons






Module 5 – Managing Service Delivery of MS Intervenons

Session 1: Delivering Quality Micronutrient Supplementaon Services

OVERVIEW ServicedeliveryofMSintervenonsmustbebasedonthebasicprinciplesof

qualityandsafecare,humandignityandclients’rightsandneeds,andthe

roleoffamiliesandcommunies.Thevisionofpeople-centeredhealthcareis

forclientstobeservedinhumaneandholiscways(WHO,2007).Hence,theMicronutrientSupplementaonProgrammustbereectedinawellmanaged

healthservicedeliverysystemsupporvetoMSservicesforfamiliesand

communies.Assuch,clientsmusthaveregularaccesstohealthfacilieswith:

a)qualityandorganizedMSservices,b)competent,responsiveandsupervised

healthsta,c)regularMSsupplies,equipment,and,d)ecienthealth

informaonsystem.

Session1willfocusonProvisionofQualityMSservices,Session2onCompetent,

friendlyandresponsivehealthsta,Session3onSupporveEnvironmentforMS

servicedelivery,whichfocusesonlogiscmanagementandhealthinformaon

system.Supervisionwillbediscussedinsession4asthisisrelevantinallthe

sessionsabove.

Thissessionwillhighlightdiscussionondeliveryofservicesandworkinhealth

faciliesisimportantinprovidingqualityofcare.Thisiswellreectedifthe

programiswell-planned,andservicesareorganizedarebestperformedwith

lessinconvenienceandmorecomforttobothclientsandserviceproviders.


1.Describethequaliesofawell-managedMSprogram:

1.1.qualityandorganizedclientcareforMSservices1.2.competentandresponsivehealthserviceproviders

1.3.connuousavailabilityofMicronutrientsupplies

1.4.ecienthealthinformaonsystem

2.ExplainthebenetsofawellmanagedMSprograminhealthfacilies.

3.DiscusstherequirementsforqualityandorganizedMSservices.

3.1.Micronutrientsupplementaonidintegratedintorounehealthservices

3.2.MicronutrientsupplementaonisintegratedintheLGUplans

3.3.CompliantwithMicronutrientsupplementaonpolicy/guidelines

3.4.OrganizedMicronutrientsupplementaonservices

METHODOLOGY Lecture-discussion,smallgroupexercises


ADVANCE

PREPARATION

Readings/reviewonDOH-MOPpages86-104andannex13onpages216to219.


Listoffactors/barriersfromModule2

ChecklistonQualityMSCareandServices

109





Introducon

(05 min)


•Introducethemodule,sessionandpresenttheobjecves.

•Explainthatsession1willfocusonprovisionofqualityMSservices,Session2willbeoncompetentandresponsivehealthserviceproviders,Session3on

SupporveEnvironmentforMSservicedeliverywhichfocusesonlogiscsand

healthinformaonsystemandSession4onSupervisionofMSservices

delivery.

Quality of MS Services

(10min )

Lecture-discussion

AskeachparcipanttogivequaliesofawellmanagedMSProgram.

WritetheirresponsesinmetacardsandposttheminManilapaperandreferto

theseduringthenextdiscussion.Explainthatthesequaliescanbeclassied

intothefollowingqualies.

Qualiesofawell-managedMSprogram:

1.QualityandorganizedclientcareforMSservices

2.Competentandresponsivehealthserviceproviders

3.Connuousavailabilityofmicronutrientsupplies

4.Ecienthealthinformaonsystem

DiscussbrieytheimportanceofhavingawellmanagedMicronutrient

Supplementaonprogram.

1.AsktheparcipantstheimportanceofawellmanagedMicronutrientSupplementaonProgram.

2.PostthesecardsonabrownorManilapaperandsummarizetheanswers.

Compliance to

Micronutrient

Supplementaon

Program Policy and

Guidelines

( 15 min)

Lecture-discussion

•Presentpowerpointpresentaononthesecriteria,cingspecicpagesof

Secon7oftheMOP:ManagementofMSProgram.

1.Formulaon/CompliancetoMSPolicyandGuidelines(page93)

2.MSPlanning(page85-88)

3.OrganizedDeliveryofMicronutrientsServices(page92-93)

• ReviewtheparcipantsonthenewpolicyonMicronutrientSupplementaon.

• Discusshowthelocalgovernmentunitscansupportthenaonalpolicy.

• Ask:WhataresomeoftheresoluonsorordinancesthatLGUscansupport?

Usemetacardsandposttheirresponsesonthebrownormanilapaper.

• SummarizethediscussionwithapowerpointoncompliancetoMicronutrient

Supplementaon.




Organizaon of

Services and Acvies

in Health Facilies

(10 min)

Lecture-discussion

• Tell:thetopicisoneoftheoenneglectedrequirementsinorganizinghealth

facilies.

•Usingpowerpointslides,discussthefactorsthatshouldbeconsideredwhenplanningandorganizingthephysicalset-up:

1.Servicesoered/provided(availability)

2.Clientowwhenavailing/receivingservices

3.Scheduleofservices(accessibility)

4.Staresponsibiliesandtasks

•Emphasizethat,toprovidequalityMSservices,organizaonofthephysicalset-upshouldconsiderhowworkandservicesarebestperformedwithless

inconvenienceandmorecomforttobothclientsandserviceproviders.

•Askexamplesofchangesthatwillbeconsideredinthewaytheirhealth

centers/staonswillbeorganized.

•TellparcipantsthatPlanningwillbediscussedinanothersession.

Small group

discussion

(15 mins)

Small group discussion:

•Thesmallgroupdiscussionwillbealloed15minutes.

•Distributecopiesofthecasescenarioon“Gloria”andguidethegroupinadiscussion,answeringthesuggestedquesonsonthecase.

•Focusthecasediscussiononthefollowing;

-MakingMSservicesaccessibletoclients.

-Increasing/improvingMScoverage.

Synthesis

(5 min)

•Synthesizerelangtheresponsesfromthepreviousmodules(2,3,and4)

Tellparcipantsthatsession2(serviceproviders)andsession3(MSresources

andinformaonsystem)willprovideaddionallearningonhowqualityMS

servicescanbeprovided.

Linkthesessiontothesucceedingsessionsofmodule5.




Session 2: Delivering MS Services by Competent and Responsive Service Providers

OVERVIEW DeliveryofqualityMicronutrientSupplementaonservicesdependsonthecompetenceandresponsivenessofhealthserviceprovidersinassessing,administering,evaluanganddocumenngservicesforclients.Ulizaonof

healthandMSservicesisinuencedbyprofessionalandpersonalbehaviorsofserviceprovidersshowntowardsclients.Thus,thekindofstabehaviorsandworkperformancemayeitherenhanceorhinderserviceulizaonofclients.

Tofunconeecvely,threeaspectsareimportanttoconsider,thatis,serviceproviders:1)haveclearjobdescriponandroleexpectaon,2)havereceivedrelevantorientaonandtraining,and3)areprovidedwithappropriateadministraveandtechnicalsupervision.RegularsupporvesupervisionwillhelpimproveandsustainthecompetenceandresponsivenessofserviceproviderstodeliverqualityMSandhealthservices.

Session2willfocusonhelpinghealthworkerstobecompetentandresponsive

serviceprovidersforMSservices.

OBJECTIVES Attheendofthissession,theparcipantswillbeableto:1.Reviewthequaliesofawell-managedMicronutrientSupplementaonProgram.2.DiscussthecriteriafordeliveringqualityandorganizedMicronutrientSupplementaonbycompetentandresponsivehealthserviceproviders.3.Explainthefollowinghealthservicedeliveryskillsascharacteriscsofcompetent,compassionateandresponsiveserviceproviders:

3.1.Clinical/carecompetence3.2.Communicaonandcounsellingskills3.3.Cricalthinkinganddecisionmakingskills3.4.Managementskills

4.Explainwaysofimprovingand/ormaintainingcompetenceforqualityandsafepracceperformanceofserviceproviders:

4.1.Jobdescriponsandexpectaons4.2.Trainingintervenon4.3.SupporveSupervision

METHODOLOGY Lecture-discussionandsmallgroupdiscussionwithcasescenario


ADVANCE

PREPARATION

Readings/reviewonMSP-MOPpp.83

Casescenarioforthesmallgroupdiscussion

Powerpointpresentaonson:SessionObjecvesandtechnicalinputson:

a)Professionalandpersonalcharacteriscsofserviceproviders

b)Jobdescripon/expectaonsinprovidingMSservices

c)Training

Flashcardsonroles,funcons,performanceofservicesproviders,andsituaons

needingsupervision.





Introducon

(05 min)

Greettheparcipants.

•Reviewonthequaliesofwell-managedMicronutrientSupplementaon

Program.Introducethesessionandpresenttheobjecves.

Managing MS with

competent and

responsive Service

Providers

(20 min)

Lecture-discussion

•Askparcipantstheirknowledgeandconceptson:

1.HowdocompetentserviceprovidersmanageMSintervenons?

2.Whatshouldbethestarequirementsforafacilitythatisclient-friendlyandsupporvetoMSservices?

•Explainthatcompetenceofserviceprovidersrequiresthateachstapossessthefollowinghealthservicedelivery:

1.Clinicalcareskills2.Communicaonandcounsellingskills3.Cricalthinkinganddecisionmakingskills4.Managementskills

•Presentalistofminimumrequirementsforclient-friendlyhealthfacilityforqualityMSservices,emphasizingonthefollowing:

1.Stawithclearjobdescripons/expectaons2.Statrained/well-orientedstaonMicronutrientsupplementaon

3.Supporvesupervisionisprovided.

•Presentinputsontheotheritemsontheminimumrequirementsforaclient-

friendlyhealthfacilitythatdirectlyrelatetohealthserviceproviders.

•WordGame:Askeachparcipanttothinkofwordthatbestdescribesthe

qualiesofasupervisor.Thiswordcanbepersonalorprofessionalquality.

Eachoneshouldwriteinameta-card,onequalitytobepostedinthebrown

paper.Eachoneinthegroupwilltaketurninposngthemeta-cardwitha

“quality”.Thechallengeisthateachqualityshouldbegivenonlyonceandnot

toberepeatedwithinthegroup.Givenqualiesshouldbechanged.Thiswill

bedoneunlallmembersaregiventhechancetopostwithoutrepeonor

duplicaon.Anexampleisgiven:competentwhichmeansqualiedofcapable.

•Relatetheexerciseemphasizingthepersonalandprofessionalqualiesof

serviceprovidersfocusingonthefollowing:

1.Compassionate

2.Responsive

3.Responsible

•Tellparcipantsthataddionaldiscussiononthesetopicswillbetakenin

Session4ofthemodule.




Management of MS

Human Resources

(20 min)

Small group discussion


•UsethecasescenarioinSession1(“Gloria”),guideparcipantsintoagroup

discussion.

•Letthegroupsworkonthefollowingquesonsasprovidedintheexercise,

focusingonthefollowingquesons:

1.WhatcanbedonebytheRHMsothatclientscanreceiveMSservices

regularly?

2.WhatcantheRHMandcommunityvolunteers(BHWs/BNs)dotomovate/

encourageclientstoseekhealthservicesfromthehealthcenter?

3.Askwhatcharacteriscsorqualiesthattheserviceprovidersshould

possessthatcanbeconsideredorqualityandorganizedclientcareforMS

•Thegroupfacilitatormustensurethateachmemberofthegroupwillhavethe

opportunitytoparcipateinthediscussion.

•Synthesizeusingparcipants’responsesfocusingonthesecriteria:

1.Compassionateatudeandresponsivebehaviourofserviceproviders

towardtheclientswillimprovequalityofdeliveryofMSservices.

2.CompetenceinprovidingqualityhealthandMSservicescanbesustainedif

serviceproviders:

2.1.haveclearjobdescriponandroleexpectaon2.2.receivetrainingandupdatesonMSandrelatedservices

2.3.providedsupporvesupervision

Synthesis

(05 min)

Askparcipantstomenonsomeoftheirlearninginsightsfromthesession.



•Linkthesessiontothenextmodulewhichisonplanning.




Session 3: Managing Resources and Health Informaon System

OVERVIEW Connuousavailabilityofmicronutrientsupplementsinhealthfaciliesis

importantinprovidingqualityofcareandatoughjobtomanage.Itisensuring

thatmicronutrientrequirementsareavailableatallmesatthehealthfacilityat

therightmeandrightamount,kindandqualityandgiventotherightperson.

Inaddion,recordsareimportantforplanning,monitoringandevaluang

acviescarriedoutinservicedelivery.Anumberofrecordingformsexists

attheheathunitwhichshouldbeusedeecvelytocaptureinformaonon

servicedeliveryofmicronutrientsupplementaon.Accuraterecordkeeping

leadtopropermanagementofthemicronutrientservicesprovided.

Session3willfocusonManagingResourcesandHealthInformaonSystem


1.DiscusswaystoensureadequateMSsuppliesatthehealthfacility.

2.EsmateMicronutrientneedsofabarangay/Municipalitybasedon

recommendeddosageandduraon

3.Assessthestoragefacilityandhandlingofmicronutrientsupplementsofa

selectedhealthfacility

4.IdenfyaconsofkeepingMSresourcesandreportssafeandsecure.

5.Assesstherecordingandreporngsystemofselectedfacilies

6.Recommendwaysofensuringaccuraterecordingandpromptreporngof

MSservicesandresources.

METHODOLOGY Lecture-discussionandsmallgroupdiscussion


ADVANCE

PREPARATION

Readings/reviewonMSP-MOPpp.94to96,annexes10and13,pages172to

187,pages193-194


Listofsamplehealthfacilitysituaons/condionswithkeyanswersforthedrill

SamplerecordsandreportsonMSP:Correctly,incorrectly,incompletelylled-up.

Sampleexercisesforthecomputaonofrequirementsandthecorrectanswers





Introducon

(05 min)


•Linkthesession3withsession1and2ofmodule5.Tell:intheprevioustwosessions,wediscussedthetwoqualiesofaqualitymanagedMSProgram


Availability and

accessibility of

Micronutrient

supplements

(15 min)

Lecture-discussion

•Askparcipantstosharetheirwaysofensuringavailabilityofmicronutrient

suppliesinthehealthfacility.

•Aco-facilitatorwillwriteparcipants’responsesintoawhiteboardorManila

paper.

Possibleanswersmayincludethefollowing:

oCorrectcomputaonoftargetsoUpdatedmasterlist

oPresenceofanupdatedinventoryofsuppliesoMakerequestforlowlevelofsupply/nosupplyfrombarangay/MHO/

PHO/CHDoCoordinatewithpartners/individualsforaugmentaonofsupplements

oAvailabletransporttopickupsupplementsoCorrectrecordingofwhowereprovidedwithsupplements/needtobe

providedoMakemelyrequisionifsupplementsareatlowlevel

oProcuresupplementsthatarespeciedbyDOHbeforestockoutoProvidefeedbacktolocalocialsofcoverageregularlytogetnancial

supportmostofthemeoHealthfacilityisopeneveryday

oSupplementsareaccessibleifneededbyclientsandnotlockincabinetofmidwifeisawayfortraining

•Dependingonthelistgenerated,summarizeintomaincategories.

•PresentlistofrelatedrequirementsforqualityMScareinhealthfacilies:

Pointoutthosewhichwerenotinthelistgeneratedbytheparcipantsandits

importanceinensuringavailabilityofsupplements

1.UpdatedmasterlistforMS2.Ecientlogiscsmanagement(whichincludeinventory,correctcomputaonoftargetsandmicronutrientrequirements)

4.Timely,completeandaccuraterecordingandreporngsystemofMSservices and resources

5.Coordinaonwithpartnersandstakeholders




Availability and

accessibility of

Micronutrient

supplements

(15 min)

•Tell:Oneofthewaysofensuringavailablemicronutrientsupplementsisthe

correctcomputaonoftargetsandrequirements.Thenextacvitywillbeareviewonhowtocorrectlycomputethemicronutrientneedsofabarangay.

•UsingPowerpointslidesprovideinstruconsontheexercisesoncomputaon

oftargetsandMSrequirementsforagivenpopulaon.UsethecasebelowasexampleandrefertoMSP-MOPAnnex10.

oMunicipalNhaspopulaonof72,186,povertyindex29.88in2003(NCSB

2003CityMunicipalSAEpoverty).

oBarangayPhasapopulaonof7,902

oPrevalenceofhighriskcondions=20%

oPrevalenceofIDAamongpregnant=42.5

oPrevalenceofPostpartumorlactangwomen=31.4%

Computetherequirementinayearforthefollowing:

1.VitaminAsupplementaonforGPfortheyear

2.IronfolicAcidforPregnantwomen

3.IFAforPostpartumwomen

4.VitaminAforhighrisk12-59monthsoldchildren

5.Zincdropsforinfantsbelow6monthswithdiarrhea

•Requestavolunteertogivetheiranswersforthecases.

•Presentthecorrectanswerandcheckwiththeparcipantsiftheyhavethe

sameanswer.IfapplicablesharetheexcelformatinAnnex8.Aincompung

requirementusingacomputer.

•Askparcipantsifthereisanyclaricaon.Ifnone,requesttheparcipants

togototheirsmallgroupsforthepracceexercisesincompungMS

requirements.

Opon:InformparcipantsthattherewillbeaddionaldiscussionandexercisesduringthepraccesessiononModule5.

Forregional/provincial/city/Municipalparcipantsforthere-echotraining,

discussthecomputaonoftargetandrequirementusingtheexcelprogram.






2.Askparcipantsthereasonsontheobservaonsmenoned:

a)Correctlylled-up

b)Incorrectlylled-up

c)Incompletelylled-up

Askfeedbackonthepresenceofonly1listofchildrenprovidedwithvitaminA

everysixmonths?

•Ask:Whatistheimportanceofaccurateandcompletedocumentaonabout

theclients’healthstatusandintervenonsreceived,etc.

•Tell:Currently,theFHSIShastargetclientlistforpregnantandpostpartum

women,sickchildrenandunder1yearold.Thereisnotargetclientlistfor

12-59monthsoldchildren.Toaddressthis,atargetclientlistispresentedin

theMOP.

•Presentslidesontheproposedrecordingandreporngformslikemasterlist

for0-59monthsoldchildreninAnnex5.Apage143.Alsoremindthe

parcipantsofthereporngformsofGP.

Synthesis

(05 min)

6.Askparcipantstomenonsomeoftheirlearninginsightsfromthesession

and/orimplicaonstotheirworkstaonsandsharetwothingsthathe/she

willstartdoing.

7.Give1praccethatyouwill“connuedoing”,“stopdoing’and“start

doing”onstorageandhandlingandrecordingandreporngonmicronutrientsupplementaon.

8.Linkthesessiontothenextsessionandfuturesessions.




Session 4: Supervising Delivery of MS Services1

OVERVIEW GoodgovernancefortheMSProgramcanbereectedinawellmanagedhealth

servicedeliverysystemsupporvetoMSservicesforfamiliesandcommunies.

Assuch,clientsmusthaveregularaccesstohealthfacilieswith:a)qualityand

organizedMSservices,b)competent,responsiveandsupervisedhealthsta,c)regularMSsupplies,equipment,d)ecienthealthinformaonsystem,and

e)staprovidedwithtechnicalandadministravesupervisionfromsupporve

supervisors/agencies.

Session1focusedonProvisionofQualityMSservices,Session2onCompetent,

friendlyandresponsivehealthsta,andSession3onSupporveEnvironmentof

HealthfaciliesforMSservicedelivery.

Session4isanoverviewandinialstepdirectedtowardsprovidingSupporve

SupervisionofMSservicesdeliverytoimproveMSPimplementaonattherst

levelofserviceprovision.Forsupporvesupervisiontobeinplace,enhancing

thesupervisoryandmanagementskillsofsupervisorsisrecommended.

Supporvesupervisionisaprocessthatpromotessustainableandecient

programmanagementbyencouragingtwo-waycommunicaonbetweenhealth

providersandsupervisorsaswellasperformanceplanningandmonitoring2.

Supervisioncomplementstheorientaonandtrainingprovidedtohealthstain

enhancingtheirskillsandcompetencies.


1.Discussconceptsandprinciplesinsupporvesupervision.2.Enumeratethecharacteriscsofasupporvesupervision.

3.Explainsupervisoryfunconsfocusingonthefollowing:

3.1.Staandhealthvolunteers

3.2.MSservicesandresources

3.3.RecordingandreporngofMSservicesandresources

4.Enumeratetoolsthatcanbeusedforsupporvesupervision

5.DiscusswaysofimprovingthefollowingaspectstosupportMSP:

5.1.MSservicecoverage

5.2.StaperformanceonMSPimplementaon

5.3.Healthfacilityservicesandacvies

METHODOLOGY Lecture-discussion,smallgroupdiscussion(withcasescenario)anddrill


ADVANCE

PREPARATION

Readings/reviewonMSP-MOPpp.83-84andannexes15pp.196to202

Powerpointpresentaonson:

1.SessionObjecves

2.Technicalinputsonsupervision

1

2 MarquezandKean.2002

120





Introducon

(10 min)



Supervision of MS

services in Health

Facilies

(20 min)

Lecture-discussion

•Askparcipantsquesonsabouttheirexperiencesinprovidingandreceiving

supervisiononMSservices.

•Acknowledgeparcipants’responsesanduseasbasisforthelecture(power

point)presentaononthetopics.

•Presentinputsonthefollowing:

1.Denionofsupervisionandsupporvesupervision

2.Responsibilies,skillsandqualiesofasupervisor

3.Supervisoryfunconsonthefollowingaspects/areasofconcern:

3.1.Organizaonofservicesandfacility

-Integraontorouneservicesandnon-tradionalservicechannels

-Clientfriendlyphysicalset-up

-Recordingandreporngsystem

3.2.Stacompetenceandbehaviours

-CompetenceinprovisionofMSservices

-Supporvebehaviourstoclients3.3.AvailabilityofbasicMSresourcesandequipment

-Forecasngandprocurement

-Requisioningandallocaon

-Inventoryandmaintenance

-Handlingandstorage

4.SupervisoryTools

•Emphasizefunconsandrolesexpectedofthesupervisors

Supervision of Sta

performance on MS

services and unit

management

(40 min)

Small group discussion


•Providesuppliesneededforthegroupoutputs.

•Provideacasescenario(Facilitator’sGuideAnnex5.4a)onamunicipalitywith

“problems/concernsonperformancecoverageofhealthservicesandservice

providers.”




•Basedonthecasescenario,askparcipantstorespondtothefollowing:

1.Idenfy2mainproblemsthatthesupervisorshouldpriorizeinsolvingand

explainthereasons/basisforthedecision.

2.Idenfysomefactorsthatmayhavecontributedtotheproblem/spresented?

3.Whataretheimmediateaconsthatyoucanandwilldotoaddressthe

problemsandimprovethesituaon?

4.Giventhesituaonoflimitedhuman,materialandnancialresources,

idenfypossibleways/meansofaddressingtheconstraints.

•Thegroupfacilitatormustensurethateachmemberofthegroupwillbeable

toparcipateinthediscussion.

•Concludetheacvitybysummarizingthekeypointsshownintheoutputand

relatedissuescoveredinthediscussion.

•Reinforcewithappropriateinformaonasneeded.

Synthesis

(05 min)

•Askparcipantstomenonsomeoftheirlearninginsightsfromthesession.



•HighlighttheimportanceofsupervisioninimprovingimplementaonofMS

services,byharmonizingandstrengtheningserviceplanandsupervisoryplan.

•Linkthissessionandtheothersessionsinmodule5tothenextmodulewhich

isonaconplanning.

122



Annexes for

Module 5





Annex 5.1a. Case Scenario for Small Group Discussions for Session 1 and Session 2

Case Scenario (Parcipants copy)

Gloria,a26-yearoldmotherwhoispregnantforthe3rdmevisitedtheirBHSforaprenatalcheck-up.

ShelearnedfromthenewBHWassignedintheirareathatpregnantmotherscanavailoffreeironwith

folicacidsupplementsthatwaswhyshedecidestocometotheBHS.TheirBHSis6kmsfromtheirhouse

butpublictransportaonisavailableonly2xadayandwillcostP20oneway.

Themotherhasnotsoughtforprenatalcheck-upsduringherrst2pregnancies,butwasaendedby

atrainedandexperiencedHilotwhoprovidedhercarefrompregnancyunlaerherdeliveries.Her

reasonsfornotgoingtotheBHSare:1)itisveryfarandtransportaonisexpensive,2)alwaysnodrugs

available,and3)shedidnotliketheformermidwifebecausesheeasilygetsangryandscoldspaents.

TheBHWcounseledGloriaontheimportanceofprenatalcheck-upintheclinic,needandbenets

oftakingironsupplementsanditsavailabilityintheBHS,andassuredherthenewRHMis“okey.”

Movated,shedecidedtogototheBHS,borrowedP50fromherauntforherfareingoingtotheBHS.ShewentonaTuesday,whichthescheduleoftheBHSforprenatalcheck-ups.Whenshereachedthe

BHS,however,itwasclosebecausethemidwifewasaendingaseminar.Shewenthomewithoutgeng

anyMS/healthservice,notgivenprenatalcheck-upandaP50debt.Sheisnotsurewhenshecangoback

totheBHSagain.

Quesons for Parcipants to work in Session 1:

1)WhatarethehealthservicesthatGloriawouldhavereceivediftheRHMwaspresentintheBHS?

2)Whataretheotherproblemspresentedinthiscasescenario?

3)WhataretheintervenonsthatcanbedoneattheBHSandMHClevelstoaddresstheproblems

presented?

Guide Quesons

1.WhatarethecriteriaofawellmanagedMicronutrientsupplementaonprograminhealthcenters?

WhatwerethecriterianotpresentintheBHSinthecaseabove?

2.WhatareneededtomeettheminimumrequirementsforprovidingqualityandorganizedMicronutrientSupplementaonprogram?

3.PriorizeonitemsthatwillhavegreaterimpactonthegoalsofMicronutrientSupplementaon

Program.Refertothebenetsofthewellmanagedprogram.

125



Annex 5.1b. Possible Answers / notes on the Small Group Discussions for Session 1

ConsiderreviewwithinthesituaonalcontextoftypicalRHU/BHS.

1.ThehealthservicesGloriawillreceivemayincludethefollowing:

a)prenatalcheck-up

b)ironwithfolicacidsupplement

c)healthteachingandcounselingon:

-prenatalcare

-MSandnutrion,and

-familyplanning

2.Whataretheotherproblemspresentedbythiscase?

a)regularscheduleforspecicservicesarenotcompliedwith(prenatal)

b)clientsarenotawareaboutRHM’spresence/absencefromclinic

c)nooneisdesignatedtobeattheBHStoprovidebasicinformaontoclientswhenthe

RHMwillbeaway

3.WhataretheintervenonsthatcanbedoneattheBHSandMHClevelstoaddressthe

problemspresented?

a)themidwifeshouldtrainBNs/BHWsintheBHSonMS

b)themidwifedesignateaBHWtotakeresponsibilityofsafekeepingtheMSresourcesinthe

caseswhenthemidwifeisoutontrainingorwhenabsentfromthepost

c)provideadvanceinformaontoBNs/BHWsforanyscheduledtrainingorleaves

d)postannouncements/updateinformaoninthe“whereabouts”board

e)fordiculttoreachareas,designatetheBHWassignedintheareato:

-delivertheMSsupplementstopriorityclients

-givehealthteachingsonMS -encouragemothertoscheduleacliniccheck-up



Annex 5.2a. Guide Quesons for the Small Group Discussion in Session 2

BasedonthecasescenarioinSession1(thecaseof“Gloria”)andtheinformaonduringthesmallgroup

discussion,askparcipantstofocusonthefactorsand/orissuesthatdirectlyaecttheserviceproviders

whichisthetopicofSession2.

Askparcipantstorespondtothefollowingquesons:

1.WhatarethefactorsrelatedtothepresentRHMthataectedGlorianottofullyavailofthe

neededhealthandMSservices?

2.WhatarethefactorsrelatedtothepreviousRHMthataectedGloria’sdecisionnottocometothe

healthcentertoconsultandseekforhealthservices?

3.WhatcantheRHMdosothatclientswillbeencouragedtoseekhealthandMSservicesfromthehealthcenter?

4.TobecomemorecompetentandresponsiveserviceproviderforMSservices,whatwouldtheRHM

andthecommunityvolunteersneed?



Annex 5.2b. Possible Answers / Notes - Quesons for the Small Group Discussion

in Session 2

Possible Answers/ Notes

1.WhatarethefactorsrelatedtothepresentRHMthataectedGlorianottofullyavailoftheneededhealthandMSservices?

•RHMisnewtothearea,maynotbewellorientedyetwiththecommunity’sneedsand

condions

•TasksofBHWs/BNshavenotbeenorganizedyet

•Irregularscheduleofservices

•Shehadatrustedandreliableserviceprovider–trainedhilot

2.WhatarethefactorsrelatedtothepreviousRHMthataectedGloria’sdecisionnottocometo

thehealthcentertoconsultandseekforhealthservices?

•Lackofcompassion-RHMeasilygetsangry

•Lackofcourtesy/respect–RHMscoldsclientsinfrontofpeople

•Otherfactors–healthcenterisveryfarandalwaysnodrugsavailable

3.WhatcantheRHMsothatclientswillbeencouragedtoseekhealthandMSservicesfromthe

healthcenter?

•ConductregularmeengswithherBHWs/BNs

•Postandupdatethescheduleofthehealthcenter’sservicesandacvies

•WorkwithpolicalleaderstoimprovesupplyofMSanddrugs

•Improverelaonswithclientsandvolunteers:showrespectandcourtesytoclientsbemore

compassionateindealingwiththem

4.TobecomemorecompetentandresponsiveserviceproviderforMSservices,whatwouldthe

RHMandthecommunityvolunteersneed?

•RHMshouldbetrained/updatedonMSprogramandotherrelatedservices(e.g.maternal,

newbornandchildhealthservices)

•Improvedorientaonandguidanceaboutserviceprovider’s:

a.Jobdescriponandexpectaon

b.behaviourandatudeindealingwithclientsandvolunteers •Providedwithsupporvesupervision(tobediscussedmoreinSession4ofthisModule)



Annex 5.3a. Exercises on Managing MS Resources and Health Informaon System

A. Exercises on Compung MS needs for Barangay P (parcipants copy)

•MunicipalN–populaonis72,186,

•Povertyindex-29.88in2003(NCSB2003CityMunicipalSAEpoverty).

•BarangayP-populaonis7,902

•Incidenceofdiarrheaamonginfants=3.27%

•Prevalenceofhighriskcondions=20%

•IDAprevalenceamongpregnantwomen=42.5%

•IDAprevalenceamongpostpartum/lactangwomen=31.4%

B. Task: Compute the MN requirement for 2011 for Brgy. P:

1.VitaminAcapsuleforGP6-59months

2.IronfolicAcidforPregnantwomen

3.IronFolicacidforPostpartumwomen

4.VitaminAcapsuleforhighrisk12-59monthsoldchildren

5.Zincsupplement(drops)fordiarrheainfantforinfantsbelow6months



Annex 5.3b. Answers to Sample exercises on computaons of MS needs

(Facilitators copy)

VitaminAneedsforGPforBrgy.Pfor2011for6-11months=118capsules(100,000)

TotalPopulaon:7,902

•Esmatednumberof6-11monthold=7,902x0.0135(1.35%) =107infants

•VACrequirement=107x1capsule/infant/year

=107capsules(100,000I.U.)

•Buerstock=107capsulesx10%

=10.7or11capsules

•TotalVACrequirement=TotalVACrequirement+Buerstock

=107+11

=118capsules

VitaminAneedsforGPforBrgy.Pfor2011for12-59months=1,877capsules(200,000IU)

TotalPopulaon:7,902

•Esmatednumberof12-59monthold=7,902x0.108(10.8%)

=853children

•VACrequirement=853x2capsules/child/year

=1706capsules(200,000I.U.)

•Buerstock=1706capsulesx10%

=170.6or171capsules

•TotalVACrequirement=TotalVACrequirement+Buerstock

=1706+171

=1876.6or1877capsules

2.a.IronFolicAcidneedsforPregnantwomenforBrgy.Pfor2011-31,680tablets

•ExampleofTotalPopulaon/municipality:=7902

•Esmatednumberofpregnantwomen(withoutIDA)

=7,902x0.035(3.5%)x57.5%

=159.02or160

TotalIronrequirement=160x180tablets/woman/year=28,800tablets

•Buerstock=28,800tabletsx10%

=2880

•TotalIronrequirement=TotalIronrequirement+Buerstock

=28,800+2880

=31,680



2.a.IronFolicAcidneedsforPregnantwomenforBrgy.Pfor2011=9,490tablets

•IfPovertyIndextobeapplied

•TotalIron=TotalironrequirementxPovertyIncidence

=31,760x29.88%

=9489.88or9490tablets

2.b.IronFolicAcidneedsforPregnantwomenwithanemia=35,046tablets

•Esmatednumberofpregnantwomenclinicallydiagnosedwith

IDA=7902x0.035(3.5%)x42.5%

•=117.5or118women

•TotalIronrequirement=118x270tablets/woman/year

=31,860tablets


=3,186tablets


=31,860+3,186=35,046tablets

3.a.IronFolicAcidforPostPartumWomen(NonAnemic)=9,324tablets

•EsmatednumberofPostPartumorlactangwomen(nonanemic)=7,902x0.03(3%)x68.6%

=162.6or163women


=8,476tablets

Buerstock=8,476tabletsx10%=847.6or848tablets

TotalIronrequirement=TotalIronrequirement+Buerstock

=8,476+848

=9,324tablets

3.b.IronFolicAcidforPostPartumWomen(non-anemic)=2,786tablets

IfPovertyIndextobeapplied

•TotalIron=TotalironrequirementxPovertyIncidence

=9,324x29.88%

•=2,786tablets

3.c.Iron-folicacidneedsforPostPartum/lactangwomenwithIDA=14,850tablets

EsmatednumberofPostPartum/lactangwomenwithIDA

=7,902x0.03(3%)x31.4%

•=74.4or75women




=13,500tablets


=1,350


=13,500+1,350

=14,850tablets

4.VACneedsforHighRiskchildren12-59months=187capsules

•Esmatednumberof12-59montholdchildrenwithhighriskcondions

=7,902x0.108(10.8%)x20%

=170.7or171highriskchildren

•TotalVACrequirement=170x1capsules/child/year

=170capsulesBuerstock=170capsulesx10%

=17capsules

TotalVACrequirement=TotalVACrequirement+Buerstock

=170+17

=187capsules

5.Zincdropsneedsforinfantsbelow6months=5boles

•Esmatednumberofinfants(below6months)whowillhavediarrhea

=7,902x0.0135(1.35%)x3.27%

=3.4or4infants•TotalZincdropsneed=4x1bole(15mldrops/infant/year

=4boles

Buerstock=4bolesx10%

=0.4or1

•TotalZincrequirement=Totalzincneed+Buerstock

=4+1

=5boles



Annex 5.4a. Case Scenario for Session 4 - Supervision

A. For MHOs/PHNs:

1. General Case Descripon on San Juan Municipality

•Comprisedoften(10)barangays,withtotalpopulaon-27,325in2007

•Healthfaciliesinclude1mainhealthcenterand8barangayhealthstaons

•Nodoctor,with1PHNand8RHMstocover10barangays

•OneRHMcovers2barangays,bothwithlimitedaccesstoanyhealthfacility

2. Health status

•Hadone(1)maternaldeathin2006fromBrgy.Libutonandtwo(2)in2008fromPulo

Island;causesofdeaths-postpartumhemorrhage,hypertensivedisorderandpuerperal

sepsis.

•In2009,therewere4undervedeaths,2eachfromBrgy.LibasanandBrgy.NewVista;

nodeathfromBrgy.Poblacion.

•leadingcausesremaintheinfecousdiseasessuchaspneumoniaanddiarrhea.

3. Performance Coverage in selected programs in 2009 is shown below:

Performance Coverage of San Juan Municipality in 2009 Selected Programs

Selected

Barangays

Accessto

MHC/BHS

VACinPP

women

Iron/folate FIC VACin

Children

De-

worming

RHMstatus

1.Poblacion Good 95% 94% 97% 97% 90% 2RHMs

2.Sta.Ana Good 90% 90% 94% 95% 95% 1RHM

3.SanPablo Good 89% 90% 90% 87% 86% 1RHM

4.Magsaysay Good 93% 95% 96% 93% 89% 1RHM

5.PuloIsland GIDA 10% 20% 30% 30% 10% -

6.BatoIsland GIDA 15% 20% 40% 25% 10% -

7.NewVista Limited 40% 45% 60% 50% 35% ½RHM

Time

8.Libuton Limited 50% 50% 70% 60% 70% ½RHM

Time

9.Mt.Tubod GIDA 20% 20% 40% 30% 10% NewRHM

10.Libasan Limited 20% 25% 35% 30% 25% NewRHM

4. You are the Public Health Nurse (PHN) of this municipality for the last 6 years, aer workingfor one year in the nearby district hospital.

Anewmayorwaselectedinlastyear’selecon.Aerconducngaperformance

implementaonreviewforallbasicservices,heissuedinstruconsforallagenciestoimprove

themunicipality’sperformance.Forthehealthsector,hespecicallysetanimprovementofall

servicesinthenext12months.



5. Guide Quesons:

a.Whatwillbetheimmediatestepsthatyouwilltaketocomplywiththemayor’sinstrucon?Name

atleast3importantandimmediatesteps

b.Whatarethetop5problemsinMSservicedeliverythatyourmunicipalityispresenng?

c.Whatwillbeyourtop3priorityfocustoshowobservableimprovementsinhealthservice

coverage?Whydoyouthinkso?

d.WhatspecicplanswillyouhaveforyourRHMstoimprovetheirperformance?Name3most

importantintervenonsyouwilldoasasupervisor.

B. For RHMs:

1. General Case Descripon on Barangay San Juan:

•Comprisedoften(10)sios,withtotalpopulaon–4,755in2007

•Healthfacilityinclude1barangayhealthstaon(underthePoblacionRHU)•8BHWstocover10sios

2. Health status

•Hadone(1)maternaldeathin2006fromSioLibuton;causesofdeaths-postpartumhemorrhage

•In2009,therewere2undervedeaths,1eachfromSioLibasanandSionNewVista;

•leadingcausesremaintheinfecousdiseasessuchaspneumoniaanddiarrhea.

3. Performance Coverage in selected programs in 2009 is shown below:

Performance Coverage of San Juan Municipality in 2009 Selected Programs

Selected

Barangays

Accessto

MHC/BHS

VACinPP

women

Iron/folate FIC VACin

Children

De-

worming

RHMstatus

1.Karangalan Good 95% 94% 97% 97% 90% 2RHMs

2.Sta.Ana Good 90% 90% 94% 95% 95% 1RHM

3.SanPablo Good 89% 90% 90% 87% 86% 1RHM

4.Magsaysay Good 93% 95% 96% 93% 89% 1RHM

5.PuloIsland poor 10% 20% 30% 30% 10% -

6.BatoIsland poor 15% 20% 40% 25% 10% -

7.NewVista Limited 40% 45% 60% 50% 35% ½RHM

Time

8.Libuton Limited 50% 50% 70% 60% 70% ½RHM

Time

9.Mt.Tubod poor 20% 20% 40% 30% 10% NewRHM

10.Libasan Limited 20% 25% 35% 30% 25% NewRHM



4.YouaretheRuralHealthMidwife(RHM)ofthisbarangayforthelast6years,aerworkingforoneyear

inthenearbylying-inclinic.

Aerconducngaperformanceimplementaonreviewforallbasicservices,theBarangayCaptainofSan

JuangaveinstruconstoallBarangayCouncilmemberstoimprovethebarangay’sperformance.Forthe

healthsector,hespecicallysetanimprovementofallservicesinthenext12months.

5.GuideQuesons:

a.WhatwillbetheimmediatestepsthatyouwilltaketocomplywiththeBarangayCaptain’s

instrucon?Nameatleast3importantandimmediatesteps

b.Whatarethetop5problemsinMSservicedeliverythatyourbarangayispresenng?

c.Whatwillbeyourtop3priorityfocustoshowobservableimprovementsinhealthservice

coverage?Whydoyouthinkso?

d.WhatspecicplanswillyouhaveforyourBHWstoimprovetheirperformance?Name3mostimportantintervenonsyouwilldoasasupervisor.



Annex 5.4b. Possible answers / Notes on the Case Scenario for Session 4 –

A.ForMHOs/PHNs:

a. What will be the immediate steps that you will take to comply with the mayor’s instrucon? Name

at

least 3 important and immediate steps.

•Prepareallthereportandotherdocumentaonsontheservicedeliveryperformanceof

municipalityonthedierenthealthprogramsandmakearapidassessmentonthecausesaecng

performance.

MainOutput:Data-basedreportontheidenedpriorityhealthproblemsandpossiblecauses/

contributoryfactors.

•ConductameengofalltheRHMsandotherRHUstatoplanstrategiesonhowbesttomeetthe

healthservicetargetstosasfythemayor’sinstrucons.Mainoutputs: 1.Sengofperformancetargetsachievablewithin12months

2.Sengofstaagreements/commitmentstotargets

•PrepareanAconPlanworkable/feasibleinthenext6months

MainOutput:A6-monthAconPlanwithBudgetProposal

b. What are the top 5 problems in MS service delivery that your municipality is presenng?

•Reportedcasesofmaternalandundervemortality

•Inadequatenumberandtrainingofhealthhumanresources

•TwobarangaysdonothaveBarangayHealthstaons

•2barangays(PuloandBato)thatareGIDAareasandwithlowMScoveragedonothaveRHMs

•2barangays(NewVistaandLibuton)withlimitedaccessandlowMScoverageshareintheservices

ofonlyoneRHM

•2barangayswithlowMScoveragehavenewRHMs;Mt.TubodisaGIDAarea,whileLibasanhave

limitedaccess

c. What will be your top 3 priority focus to show observable improvements in health/ MS service

coverage? Why do you think so?

•ImprovingthecompetenciesinprovidingMSintervenonsofthe6RHMsidenedabove

•Selecngfocus/targetareaswithlowcoverageforstasupervision,MSresourcegeneraonand

increasing service coverage



•TrainingBHWs/BNsinMSprogramandorganizingasimplementaonteamsforstrategic/priority

areas(withlowservicecoverageinMS)

d. What specic plans will you have for your RHMs to improve their performance? Name 3 most

important intervenons you will do as a supervisor.

•ConductinformaltrainingtonewRHMson–MS,maternal,newbornandchildhealthandnutrion

•Providementoringandcoachingto“old”RHMsneedingtechnicalknowledgeand/orskillsupdate

onMSservices

•OrganizeRHMsinpairs(Iexperienced/1neworlowperforming)toset-upteamsupport.

•SchedulenewRHMstoreporttoMainHealthCenterduringclinic“highclientload”days2xa

monthtopracceskills,receivefeedbackandtechnical/supporvesupervision.



Annex 5.4b. Possible answers / Notes on the Case Scenario for Session 4 –

B.ForRHMs:

GuideQuesons:

a. What will be the immediate steps that you will take to comply with the Barangay Captain’s

instrucon? Name at least 3 important and immediate steps.

•Prepareallthereportandotherdocumentaonsontheservicedeliveryperformanceofbarangay

onthedierenthealthprogramsandmakearapidassessmentonthecausesaecngperformance.

MainOutput:Data-basedreportontheidenedpriorityhealthproblemsandpossiblecauses/

contributoryfactors.

•ConductameengofalltheBHWsandothervolunteerstoplanstrategiesonhowbesttomeetthe

healthservicetargetstosasfythebarangaycaptain’sinstrucons.

Mainoutputs: 1.Sengofperformancetargetsachievablewithin12months 2.Sengofstaagreements/commitmentstotargets

•PrepareanAconPlanworkable/feasibleinthenext6months

MainOutput:A6-monthAconPlanwithBudgetProposal

b. What are the top 5 problems in MS service delivery that your municipality is presenng?

•Reportedcasesofmaternalandundervemortality

•Inadequatenumberandtrainingofhealthhumanresources

•TwosiosdonothaveBarangayHealthWorkers

•2sios(PuloandBato)thatareareaswithpooraccessandwithlowMScoveragedonothave

BHWs

•2sios(NewVistaandLibuton)withlimitedaccessandlowMScoverageshareintheservicesof

onlyoneBHW

•2sioswithlowMScoveragehavenewBHWs;Mt.TubodandLibasanhavepoor/limitedaccess

c. What will be your top 3 priority focus to show observable improvements in health/ MS service

coverage? Why do you think so?

•ImprovingthecompetenciesinprovidingMSintervenonsofthe6BHWsidenedabove

•Selecngfocus/targetareaswithlowcoverageforstasupervision,MSresourcegeneraonand

increasing service coverage



•TrainingBHWs/BNsinMSprogramandorganizingasimplementaonteamsforstrategic/priority

areas(withlowservicecoverageinMS)

d. What specic plans will you have for your BHWs to improve their performance? Name 3 most

important intervenons you will do as a supervisor.

•ConductinformaltrainingtonewBHWon–MS,maternal,newbornandchildhealthandnutrion

•Providementoringandcoachingto“old”BHWsneedingtechnicalknowledgeand/orskillsupdate

onMSservices

•OrganizeBHWsinpairs(Iexperienced/1neworlowperforming)toset-upteamsupport.

•SchedulenewBHWstoreporttoMainHealthCenterduringclinic“highclientload”days2xa

monthtopracceskills,receivefeedbackandtechnical/supporvesupervision.





MODULE 6:

Planning for MS Program Implementaon




Module 6 – Acon Planning

Session 1: Planning for Improving MSP Implementaon

OVERVIEW GoodgovernancerequiresthatappropriateMSintervenonsareidened

andareresponsivetotheneedsofthecommunity,thevulnerablegroupsare

priorized,andtheirrequirementsareincludedintheplan.Italsonecessitates

improvedcoordinaonacrosslocalhealthsystems,enhancedpartnerships,ecientlogiscmanagement,andecientrecordingandreporngsystem.

Goodplansspecifyworkprioriesandhowtheworkwillbedone.Aplanis

readytobecommunicatedtothepeoplewhowillimplementit–onlywhenit

statesanobjecveandspeciesthemeandresourcesneededtoaccomplish

theobjecve.

Planningisancipangeventsthatwillaecttheworkofthehealthteam

andsengplansandobjecvesintodailyacvies.Thisrequiresthat

healthprovidersintegrateMSintervenonintheirdailyworkacviesin

healthfaciliesandthecommunity.TomeettheobjecveofintegrangMS

intervenonsintotherounehealthacviesandappropriateprograms,there

isaneedtoprepareshort-rangeplansinensurethatimprovementsinMS

servicesforclientsandtheirfamilieswilltakeplace.

Forthesechangestosucceed,serviceprovidersneedtechnicaland

administravesupportfromtheirimmediatemanagersandsupervisors.Thus,

thoseinthesupervisorylevelwillalsoneedtoplanhowtosupporttheplansof

improvingMSPimplementaon.


1.DiscussthebasicconceptsinPlanning.

2.DeterminepriorityareasinMSPforaconplanning.

3.ExplaintheimportanceofintegrangMSServicesintotheLGUplan.

4.DevelopanAconPlanfor:

4.1.ImplemenngMSintheirareaofassignment(serviceproviders)

4.2.SupervisingimplementaonofMSP(supervisors)

METHODOLOGY Lecture-discussion,Individual/groupacvity


ADVANCE

PREPARATION

Readings/reviewonMSP-MOPpp.74to84.


AconPlanTemplatesfor:Serviceproviders(Facilitator’sGuideAnnex6.1)and

Supervisors(Facilitator’sGuideAnnex6.2)

142





Introducon

(05 min)


•Introducethissessionbygivinganoverviewandpresenngtheobjecvesofthesession.

•Informparcipantsthatinthissession,theywilldevelopaplanofaconto

improveMSPimplementaonintheirhealthfacilityandcommunity

Planning for client-

friendly health

facilies supporve to

MS services

( 20 min)

Lecture discussion:

•AskparcipantsontheimportanceofplanningforMSprogram.

•Acknowledgeresponsesandwritethemonthewhiteboard.

•MakeapowerpointpresentaononPlanningforMSP:

1.Denion,concepts

2.Principlesandsteps

3.ImportanceforimprovingMSPimplementaon

4.Priorityareasinplanning

•Tell:specicdiscussiononthePlanningMSProgramunderGovernancecanbe

foundinSecon7ofMOPpp.74to92andAnnex6&17pp.152-153&pp.

207.NotethatProgramImplementaonReview(PIR)iscricalprocessfor

planning.ThisisfoundonMOPpp.90andannex16.

•AskparcipantswhattheyconsiderpriorityareasinplanningforMSandthe

importanceofintegrangtheirplanswiththeLGUplans.

•Relateappropriateresponsestotheneedandimportanceoftheirinclusionto

MSpoliciesandguidelinesforMSservicestobestrengthened.Discussthe

needforintegrangtheirMSplanwiththeirLGUplans.

Acon Planning

(30 min)

Lecturee-discussion

•Askparcipantsabouttheirexperiencesinplanning

•Informparcipantsthattheywillneedtomakeanaconplantouseasa

guideininiangimprovementsinMSPimplementaon.

•Forpurposesoflearninginteracontodrawideasfromothers,parcipants

canworkinsmallgroupseitheras:1)serviceprovidersand/or2)supervisors.

•Tellparcipantsthattheiraconplanswillalsoserveasinputstotheir

OperaonalHealthPlanningforthecomingyear.




Workshop

•Informtheparcipantsofthefollowingguidelines:

1.Parcipantsmaybegroupedaccordingtogeographicalaliaonfor

purposesofdiscussionandsharingcommonareaconcerns.

2.ProvideparcipantswiththeAconPlantemplate.

3.Informparcipantsthattheyworkwithinagroup,theymaytryto

produceindividualplanforhis/herfacility.

•Explaintheheadingsonthetemplate.

•Afacilitatorwillworkwithagrouptoprovideguidanceandasavailablereferenceforparcipants.

Synthesis

(10 min)

Conductinialdiscussionwithinthesmallandprovidefeedbackonplans

formulated.

Informparcipantsthatthenextsessionwillfocuson:

1.Harmonizingtheplanspreparedbytheserviceproviderswiththeplansof

thesupervisors

2.Plenarypresentaonsontheserviceandsupervisoryplans.

144



Module 6 – Acon Planning

Session 2: Harmonizing Acon Plans of Service Providers and Supervisors

OVERVIEW Goodplansspecifyworkprioriesandhowtheworkwillbedone.Aclearplanis

readytobecommunicatedtothepeoplewhowillimplementit.

Forchangestobeiniatedbyhealthworkerstosucceed,theywillneedtechnicalandadministravesupportfromtheirimmediatemanagersand

supervisors.Thus,thoseinthesupervisorylevelwillalsoneedtoplanhowto

supporttheplansofimprovingMSPimplementaon.

TocomplementtheeortsofimprovingMSPimplementaon,consistencyand

harmonyofplansisessenalforgreatersuccess.


1.Conferwitheachother’splansassuperviseeandsupervisor.

2.Exploreareasofagreementsintheplans.

3.Developa“harmonized”planbetweenasuperviseeandasupervisor.

METHODOLOGY Dyad:supervisor-superviseesharing

PlenaryDiscussion

ESTIMATED TIME 70minutes(30minfordyadconferenceand40minforplenarypresentaon)

ADVANCE

PREPARATION


AconPlanTemplatesfor:ServiceprovidersandSupervisors(Referto

Facilitator’sGuideAnnex6.2.)





Introducon

(05 min)


•Introducethesessionbygivinganoverviewandpresenngtheobjecvesof

thesession.•Informparcipantsthatthisisanacvitywherediscussionsontheirindividual

planswillbesharedwithapartner-apairwillconsistofasupervisoranda

supervisee.

Harmonizing Acon

Plans

(25 min)

Workshop

•Informtheparcipantsthattheywillworkinpairs:supervisor-supervisee

withinageographicalaliaonforpurposesofdiscussionandsharing

commonareaconcerns.

1.Explainthattheyneedtoshareandconferabouttheirplans.

4.Exploreareasofagreementsanddisagreementintheirplans.

5.Thepairwilldiscussandnegoatewhatagreementstheycanreachto

harmonize/reconciletheirplans.

6.Afacilitatorwillworkwithagrouptoprovideguidanceandasavailable

referenceforparcipants.

Plenary Presentaon

(40 min)

•Selectpresentersrepresenngtheserviceprovidersandselectpresenters

represenngthesupervisors.

•Groupfacilitatorshouldassistthegroupinpreparingforthepresentaonof

theplan.

•Onefacilitatorwillactasmoderator.•Thepresentaonwillbedoneinapairofserviceproviderandsupervisorfrom

thesamegeographicalarea.

•Limiteachpresentaonto5min.Allow5minfortheQ&A.

•Askparcipantsfromdierentgroupstoaskquesonsand/orgivecomments

onthepresentaon.

•Thankparcipantsfortheirpresentaonsandreacons.

•Informparcipantsthattheyshouldfocus

Synthesis

(05 min)

Summarizethedierentpresentaons.

•Highlighttheinnovaonsonserviceandsupervisoryplans

•Highlighttheagreements/recommendaons

Informparcipantsthattheplanspresentedmayserveasabasisformonitoring

MSPimplementaonintheircommunity.

Congratulateeachoftheparcipantsfortheeortexertedindevelopingaplan

ofacon.

146



Annexes for

Module 6





A n n e x 6 . 1 . P l a n n i n g f o r I m p r o v e m e n t s i n M S P I m p l e m e n t a o n f o r S e r v i c e P r o v i d e r s

6 - M o n t h A c o n P l a n

P r o v i n c e / M u n i c i p a l i t y :

O b j e c v e

S t r a t e g i e s / A c v i e s

P e r s o n R e s p o n s i b l e

T i m e F r a m e

O u t c o m e / W h a t t o M o n i t o r

A .

M S S e r v i c e s

B .

H e a l t h F a c i l i e s

C .

S e r v i c e P r o v i d e r s /

V o l u n t e e r s



A n n e x 6 .2 . S u p e r v i s o r y P l a n o n I m p r o v i n g P e r f o r m

a n c e o f S e r v i c e P r o v i d e r s o n M S P

6 - M o n t h A c o n P l a

n

P r o v i n c e / M u n i c i p a l i t y :

O b j e c v e

S t r a t e g i e s / A c v i e s

P e r s o n R e s p o n s i b l e

T i m e F r a m e

O

u t c o m e / W h a t t o M o n i t o r

A . I n c r e a s e / I m p r o v e

C o v e r a g e o f M S S e r v i c

e s

B . I m p r o v e H e a l t h

F a c i l i e s

C . I m p r o v e P a r c i p a o n

o f S e r v i c e P r o v i d e r s /

V o l u n t e e r s



A n n e x 6 . 3 . H a r m o n i z i n g A c o n P l a n s o f S e r v i c e P r o v i d e r s a n d S u p e r v i s o r s

6 - M o n t h S - S H a r m o n i z e d A c o n P l a n

T e a m O b j e c v e s

S u p e

r v i s e e s

S u p e r v i s o r s

A c v i e s

T i m e l i n e

A c v i e s

T i m e l i n e

A .

I n c r e a s e

/ I m p r o v e

C o v e r a g e o f M S S e r v i c e s

B .

I m p r o v e H e a l t h

F a c i l i e s

C .

I m p r o v e P a r c i p a

o n

o f S e r v i c e P r o v i d e r s /

V o l u n t e e r s






for: TRAINING OF TRAINERS/FACILITATORS





Training of Trainers (TOT) onTraining of Service Providers on the Implementaon

of the Micronutrient Supplementaon Program-

Background and Raonale

NutrionaldeciencyremainsaconnuingchallengeinthePhilippinesasitaectsclientsin

variousagegroupsandincertainphysiologicalstates.UsingtheWHOandnaonalstandards, only68%ofchildrenundervehavenormalweight-for-age.In2005,therewas24.6%prevalence ofunderweightpre-schoolchildren(0-5years),26.3%werestunted,4.8%wastedand2.0% overweight.Exclusivebreast-feedingislowat34%ofchildrenexclusivelybreast-feduptoagesix months.Inaddion,childrenfacetheproblemsof1)anemia–withprevalenceratesof66%in children6-12months;2)vitaminAdeciency–with40%inchildrenagedsixmonthstoveyears; and3)iodinedeciency–withesmated1.5millionschoolchildrenaged6-12yearsatriskof mentalretardaonduetoiodinedeciency.

MicronutrientdecienciesinVitaminA,ironandiodinehavereachedthelevelsofpublichealth signicance.Facedwitheconomic,agriculturalandchallengeslikeemergencies/disastersinmany areas,theproblemincreasesfurtherinmagnitudedueoflackoffoodandhighincidenceof

infeconsduetocongesonandpoorsanitaryenvironmentandhygiene.

TheissuanceofAdministraveOrder(AO)No.2010-0010bytheDepartmentofHealththisyear whichprovidedtheoverallpolicydireconontheMicronutrientSupplementaonProgram(MSP) willsignicantlycontributetoaccelerangeecveimplementaonoftheMSPinreaching moreclients.Thispavedthewayfortheneedtoupdateserviceworkersontheircompetencies inimplemenngtheMSP.Todate,thelasttrainingconductedonMicronutrientSupplementaon wasin1992,whiletechnicalupdateswereperiodicallyconductedwithintheinterimperiodto supportthehealthworkers.Hence,thecapacity-buildingtomeetthetrainingandinformaon needsofserviceproviderstoenablethemtoimproveimplementaonoftheMSP.

ToeecvelycarryouttheconductoftheTrainingofServiceProvidersonMSP,coursetrainers/

facilitatorsneedtocompletethebasiccoursefortheServiceProviderstolearntheupdatedscope ofthetechnicalcontentandcompetenciesindeliveringmicronutrientsupplementaonservices, andamoduleonTrainingofTrainers/Facilitatorsinordertolearnhoweachtrainingsessionwill beconductedtomeetthelearningobjecves,applyingthesuggestedmethodologiesand

guidelines.

General Objecve

Toassisthealthserviceprovidersenhancetheircompetenciesonimprovingimplementaonof

theMicronutrientSupplementaonProgram(MSP).

Specic Objecves

Duringthecourse,eachparcipantwillbeabletoachievethefollowinglearningobjecves:


1.1.Healthgoals,objecvesandtargetsonmicronutrientsupplementaon–naonal

andlocalbasedonthesetMDGforthecountry

1.2.TheMicronutrientSupplementaonProgram(MSP)

1.3.KeyprovisionsoftheMicronutrientSupplementaonGuidelines(AO2010-0010)

155



2.Discussthefollowing:

2.1.StatusofMicronutrientSupplementaon

2.2.Eectsofcommondecienciesonvulnerablepopulaon

2.3.Basicinformaon,roleandfunconofMicronutrients

2.4.WaysofimprovingimplementaonofMSProgram

2.5.ConceptsandprinciplesofSupervision

3.Demonstrateskillsinmanagingmicronutrientdeciencies:

3.1.Assessingsignsofmicronutrientdeciencies/riskfactors

3.2.Diagnosing/classifyingdeciencies

3.3.Idenfyingappropriateintervenons

3.4.DeterminingappropriateMSpackageforthedierentagegroupsandthoseinlife

stages/condionsrequiringMS.

3.5.IdenfyingkeymessagesonMSappropriatetoclients’need

4.DemonstrateskillsinimplemenngtheMicronutrientSupplementaonprogram:

4.1.ProvidingMSservicesinvariousdeliverychannels

4.2.IntegrangMSservicesinrounehealthservicesandprograms

4.3.FormulanganaconplanforeecveimplementaonofMNSprogram

*supervisoryaconplanforsupervisors 5.DemonstratecompetenciesintrainingandfacilitangintrainingofserviceprovidersinMSP

implementaon.

Course Content:

Module 1 –IntroductorySessions

Session1:“GengtoKnow”andFormingTeams

Session2:SharingExpectaonsandSengGroupNorms

Session3:OrientaontotheCourseandCourseMaterials

Module 2–UnderstandingtheMicronutrientSituaon Session1:BasicInformaon,roleandfunconofMicronutrients

Session2:Causes,ConsequencesandPrevenonofMicronutrientDeciencies

Session3:MagnitudeofMicronutrientDeciencyProblems

Module 3–TheMicronutrientSupplementaonProgram

Session1:MSPGoals,PolicyandImplementaonGuidelines

Session2:ProvidingEssenalMSPackageforInfantsandChildren

Session3:ProvidingEssenalMSPackageforWomen,MothersandOtherAdults

Session4:StrengtheningHealthPromoonIntervenonforMS

Module 4 –EnhancingIntegraonofMSIntervenonsinServiceDeliverySengs

Session1:DeliveryofMSinDierentSengs

Session2:MSIntervenoninRouneClinicServices

•PracceexercisesforModule4

PraccumSession–HealthCenter

Module 5 –ManagingServiceDeliveryofMSIntervenons



Session1:DeliveringQualityMSServices

Session2:DeliveringMSServicesCompetentandResponsiveServiceProviders

forMSServices

Session3:ManagingResourcesandHealthInformaonSystem

Session4:SupervisingDeliveryofMSServices

Module 6–PlanningforMSPImplementaon

Session1:AconPlanningonImprovingMSImplementaon

1.1. ServicePlan

1.2. SupervisoryPlan

Session2:HarmonizingAconsPlansofServiceProvidersandSupervisors

Module 7 –TrainingofFacilitators

Session1:OverviewontheConceptsandPrinciplesonTeaching-learningandTraining

Session2:ApplyingFacilitaonandPresentaonSkillsandTechniques

Session3:PracceSessiononFacilitaon

Session4:AconPlanningon“Roll-out”ofMSTraining

Training Methodology

Parcipatoryteaching-learningmethodssuchaslecture-discussion,smallgroupdiscussion,

roleplays,drills/games,praccesexercises.Onepraccumsessioninthemorningwillbe

conductedinselectedhealthcenters

Evaluaon Methods

Pre-testandPosttest

Completedwork/outputsduringsessions

Observaonofdemonstratedskills Post-trainingquesonnaire

Main Reference:TheDepartmentofHealthMicronutrientSupplementaonProgram-

ManualofOperaons

Operang Details

Parcipants:Trainers/SupervisorsofServiceProviders

Duraon: 5days(Live-in).

Venue/site:Provisionsforadequatespaceforinteracvelearningmethodslikeroleplays,

demonstraonsandsmallgroupacvies.Inaddion,arrangementswithnearby

healthcentersshouldbemadefortheonepraccumday(Day3AM).

Source of Funds:DOH-NCDPCandUSAIDA2Zproject

Training Schedule: Refertothenextpage.





Module 7:

Training of Facilitators / Trainers






Module 7: Training of Facilitators/Trainers

Session 1: Overview of the Concepts on Teaching-learning and Training

OVERVIEW Learninginhealthisthechangeinbehaviorinaposivedirecontosolve

praccal,social,culturalandpersonalproblemsinhealthencounteredby

individual,families,groupsandcommunies.Posivechangesinbehavior

canbeachievedthroughformalandinformaltraining.Toachievethedesiredbehavioraloutcomes,thefunconsoftrainingandfacilitanglearningarekeyto

thesuccessinthedevelopmentprocessofpeopleandinstuons/organizaons.

Trainingistheprocessofguidingthedevelopmentofaperson’sskills,

knowledgeandatude.Itfocusesonassisngthehealthworkerslearnspecic

workcompetencies/jobskillsinordertoimproveoverallperformanceonthe

job.

Eecveteachingrequirescarefulplanning.Baseduponthecorecompetencies

requiredofhealthcareprovidersintheeld,trainersareresponsibletodesign

coursessothattraineesacquiretheknowledgeanddeveloptheskillsand

atudesrelatedtothecorecompetenciesfortheprogram.

Carefulplanningforteachingandtrainingconsistsofa)developingacourse

syllabus,b)planningfortraineeassessment,c)selecngteachingmethods,d)

idenfyinglearningmaterials,ande)developingacourseschedule.


1.Explainthefollowing

1.1.training

1.2.teachingandlearning1.3.guidingprinciplesintrainingserviceproviders

2.Discussbasicconceptsandprinciplesinteachingandtraining.

3.Discussthecricalroleofthefollowingindesigningtrainingcourse

3.1.CourseObjecves

3.2.TeachingandAssessmentMethods


4.1.Skillsinhealthcaredelivery

4.2.Stepsinskillsdevelopment

METHODOLOGY Lecture-Discussion/Groupwork


ADVANCE

PREPARATION

TechnicalPresentaoninPowerpoint

Casescenario:SanJuanmunicipality(M5-S4)

ComputerandLCDoroverheadprojector

POWERPOINT

PRESENTATION


1.SessionObjecves

2.TeachingandTraining





Introducon

(5 min)

Greettheparcipants.

Askparcipantstheirconceptsorideasonthefollowing:1.Trainingofhealthcareworkers

2.Objecves/purposesoftraininghealthworkers

Userelevantresponsesandlearninginsightsfromtheprevioussessionsto

thepresentsessiontointroducethissessionandpresenttheobjecvesofthe

session.

Attheendofthissession,theparcipantswillbeableto:1.Explainthefollowing

1.1.training

1.2.teachingandlearning1.3.guidingprinciplesintrainingserviceproviders

2.Discussbasicconceptsandprinciplesinteachingandtraining.

3.Discussthecricalroleofthefollowingindesigningtrainingcourse3.1.CourseObjecves3.2.TeachingandAssessmentMethods

4.Explainthefollowing:4.1.Skillsinhealthcaredelivery4.2.Stepsinskillsdevelopment

Purpose of Training

and Process of Skills

Development

(20 min)

Group work / Group discussion

Divideparcipantsinto4-5groupsandletthemworkonthefollowing:

1.UsingtheCaseScenarioofSanJuanMunicipalityfromM5-S4,assigna

parcipantstoworkonimprovingtheperformanceonMSPimplementaon

throughtrainingand/orcapabilitybuildingintervenons.

2.Letthegroupperformthefollowingtasks:

2.1.IdenfycompetenciesofServiceProvidersthatneedimprovement2.2.Idenfythefactors/reasonstoconducttraining

2.3.Idenfyteachingandlearningapproaches/methodsthatwillbestresult

tothedesiredbehavioraloutcomesfortheServiceProviders

3.Aercomplengthegroupwork,thefacilitatorwilliniatea5min/short

discussionfocusingonthefollowingquesons:

3.1.Whatarethelearninginsightshaveyouidened?

3.2.Whataretheimplicaonsinconducngformalorinformaltraining?

162




Teaching-learning

Concepts and

Principles

(25 min)

Lecture-Discussion

Tell:Inhealth,posivebehaviorsareneededtohelphealthworkersandclients

promotehealthandsolveproblems.Posivebehaviorsareimportantinmaking

rightdecisionsforhealthworkers,clientsandtheirfamilies.

Trainingisaprocessinguidinghealthworkersdeveloptherightcompetencies

inprovidinggoodqualityofcareforclients,includinghelpingthemovercome

behavioralbarrierstohealthcare.

Askparcipantsaboutthetrainingexperiencestheylikebestandwhy.Takenote

ofideasrelatedtoteaching-learningconceptsandprinciples.

Present:Powerpointslidesonteachingandtraining

1.Guidingprinciplesandapproachesintraininghealthcareproviders2.Theoriesandconceptsofteachingandlearning

3.Trainingofhealthcareproviders

a.HCdeliveryskills

b.Stepsindevelopmentofskill

4.TrainingDesign–

a.Objecves

b.Trainingmethods

c.AssessmentMethods

Explaintheneedforfacilitator/trainertomonitortheprogressofeachparcipantduringatrainingcoursebytrackingwhatspecicexperienceswere

providedtoeachonethatwillcontributetotheirlearningobjecves.Introduce

thefollowingtoolswhichafacilitatorforeachsmallgroupmayuseforthe

purpose:

1.MonitoringForm1:Classroom(Facilitator’sGuideAnnex7.1)

2.MonitoringForm2:PraccumSession(Facilitator’sGuideAnnex7.2)

Letparcipantsparcipatebyinving/callingthemtorespondtoquesons

orpresenttheirideasonthetopics.

Synthesis/Summary of the

Session

(10 min)

Synthesizeby:

•Asking1-2parcipantstosummarizethelessonslearnedfromthesession

•Informingparcipantsthatthelearninginsightsgainedfromthissessionwill

beneededforthesucceedingpraccesessions.

Thankparcipantsfortheiracveparcipaon.

163




Session 2: Applying Facilitaon and Presentaon Skills and Techniques

OVERVIEW Thequalityofthelearningenvironmentisinuencedbyavarietyof

complemenngfactorsthatprovideasengconducivetotheobjecvesof

training.Facilitatorsareresponsibleforplanningandorganizingthetraining

environmenttomatchtheobjecvesandneedsofthetraining.

Traineeslearnbestwhentheyacvelyparcipateinthetrainingprocess.As

afacilitator,applyingfacilitaonskillsisencouraginginvolvementbyshowing

interestinthetrainees,allowingthemtoexpresstheirideasandaskquesons.

Facilitaonskillshelpthefacilitatorsbridgethegapbetweenthetraining

contentandthelearners.Italsoallowsfacilitatorstoobtainfeedbackfromthe

learnersregardingtheirtrainingexperienceandenableonetorespondtothe

learners’needsbyusingappropriatefacilitangtechniques.


1.Explaintheconceptsandskillsin:

1.1.Facilitaon

1.2.Presentaon

2.DiscusstheROPESmodelaccordingtoitsusefulnessintrainingservice

providers.

3.Describethefollowing:

3.1.Facilitangtechniquesusefulinthistraining

3.2.Methods/waysofmonitoringprogressofparcipants

4.Discusswaysofapplyingthedierentfacilitangtechniquesintraining

METHODOLOGY Lecture-Discussion/Groupwork–ServiceProvidersof“NolascoMunicipality”

ESTIMATED TIME 1hourand30minutes

ADVANCE

PREPARATION

Objecveswrienforpresentaononipchartorpowerpointpresentaon

FacilitatorChecklists–Facilitator’sGuideAnnex7.1.toAnnex7.4

GuidequesonsfortheGroupworkComputerandLCDoroverheadprojector

POWERPOINT

PRESENTATION


1.Facilitaonskillsandtechniques

2.Presentaonskills

3.ROPESModel

4.MonitoringProgressofParcipants

164





Introducon

(10 min)


•Introducethissessionbypresenngtheobjecvesofthesession.

Attheendofthissession,theparcipantswillbeableto:1.Explaintheconceptsandskillsin:

1.1.Facilitaon

1.2.Presentaon

2.DiscusstheusefulnessoftheROPESpresentaonmodelintrainingservice

providers.

3.Describethefollowing:

3.1.Facilitangtechniquesusefulinthistraining

3.2.Methods/waysofmonitoringprogressofparcipants

4.Discusswaysofapplyingthedierentfacilitangtechniquesintraining.

•Askparcipantsthefollowing:

1.Howmanyyearshaveyoubeenworking/intheservice?

2.Howmanytrainingcoursesinhealth/healthrelatedhaveyouaendedin

thepast5years.Anesmategureornumbercanbeaccepted.

•Tellparcipantsthatforthenextexercise,theywillhaveanothergroup

discussionsessionintheirsmallgroupsinrelaontotheirexperiencesand

ideasontraining.

Qualies and/or

Skills of a Training

Facilitator(25 min)

Group Discussion / Brainstorming Session -

1.Divideparcipantsinto3-4groupsbasedonthefollowing:

2.Electanewdiscussionleader,presenteranddocumenter.

3.Answerthefollowingquesonsin10minutes:

a.Whattypesoftrainingcoursesoracviesdidyoundfulllingand/or

meaningfulashealthcareprofessionalandwhy?

b.Whatwerethewaysthatthetrainingfacilitatorsdidorperformedthat

youndmovangandencouragingasparcipants?

c.Asafacilitator,howwouldyouwantyourparcipantstodescribeyou?

Why?

4.Aer10minutes,arepresentavefromeachgroupwillpresenttheoutputs

totheplenarysession.

5.Usetheoutputsand/orlearninginsightstolinktothesucceedingacvityby

idenfying/classifyingwhethertheanswersare:

a.Facilitaonskill

b.Facilitaontechniques

c.Facilitatorqualies/aributes

165




Facilitaon Skills and

Techniques

(20 min)

Lecture-Discussion

Tell:Organizingtrainingsessionsisoneofthemostexcingandchallenging

workfortrainingfacilitatorsformanyreasons.

Parcipantslearnbestwhentheyparcipateinthetrainingprocess.Asa

facilitator,applyingfacilitaonskillsisencouraginginvolvementbyshowinginterestinthetrainees,allowingthemtoexpresstheirideasandaskquesons.

Facilitaonskillshelpthefacilitatorsobtainfeedbackfromthelearners

regardingtheirtrainingexperienceandenableonetorespondtothelearners’

needsappropriately.Facilitaonskillshelpthefacilitator/trainerbridgethegap

betweenthetrainingcontentandthelearners.

Present:Powerpointpresentaonon

1.OverviewofFacilitaon

2.FacilitaonSkills

3.FacilitaonTechniques

Duringtheabovepresentaon:

•Parcipantsareaskedtoexplain/giveanexampleofhoweachskilland/or

techniqueisperformedorappliedtofacilitatebeerlearning.

•Askparcipantsfromdierentgroupstorespond

•IntroducetherelevantpartsincludedinthefollowingTools:

1.MonitoringForm2:FacilitangandPresentaonTechniques(Facilitator’s

GuideAnnex7.3)2.Observaon-ChecklistforTrainee-Facilitator(Facilitator’sGuideAnnex7.4)

Presentaon Skills

and the ROPES model

(25 min)

Lecture – discussion

Tell:Planningforaneecvepresentaonofatrainingsessionisessenalto

thesuccessofatrainingprogram.

Organizingthesessioninanorganizedandsystemacmannerwillensurethat

appropriatelearningmethodsandfacilitangtechniquesareselectedapplying

facilitaonskills.

ROPESmodelisawayoforganizingapresentaonofasessionplanthatwillprovideaninstruconalmapforfacilitatorstofollow.

Present:Powerpointpresentaonon:

1.PresentaonSkills

2.ROPESModel

Duringtheabovepresentaon,parcipantswillbeaskedtoreadandgivean

exampleofhoweachideainthepresentaonorstepinROPEScanfacilitate

beerlearning.

166




Demonstraon

Introducehowtouse/accomplishthePerformanceObservaonChecklistfor

Facilitator-Trainee

Explaintheimportanceoftheitemstotrainingobjecves.

Tellparcipantsthatthiswillbeasuggestedobservaontoolduringthepracce

sessionforfacilitator-traineetoprovidebasisforperformancefeedback

Synthesis/

Summary of the

Session

(10 min)

Synthesizeby:

•Askingparcipantsabouttheirlearninginsightsgainedfromthissession

•Informingparcipantsthattheywillhavethechancetopraccethefacilitaon

skillsandtechniquesanduseofthePerformanceObservaonToolinthenext

session.

Reviewthesessionobjecves.

Thankingparcipantsfortheiracveparcipaon.

167




Session 3: Pracce Session for Facilitator-Trainee

OVERVIEW Traineeslearnbestwhentheyacvelyparcipateinthetrainingprocess.As

afacilitator,applyingfacilitaonskillsisencouraginginvolvementbyshowing

interestinthetrainees,allowingthemtoexpresstheirideasandaskquesons.

Facilitaonskillshelpthefacilitatorsbridgethegapbetweenthetraining

contentandthelearners.Italsoallowsfacilitatorstoobtainfeedbackfromthe

learnersregardingtheirtrainingexperienceandenableonetorespondtothe

learners’needsbyusingappropriatefacilitangtechniques.


1.ApplyExplaintheconceptsandskillsinfacilitaon.

2.Describethedierentfacilitangtechniquesthatcanbeusedinthistraining.


4.Provideperformancefeedback

METHODOLOGY Lecture-Discussion/SocializedRecitaon

ESTIMATED TIME 1 hour

ADVANCE

PREPARATION

Objecveswrienforpresentaononipchartorpowerpointpresentaon

FacilitatorChecklist–Annex7.


POWERPOINT

PRESENTATION

PowerpointpresentaonsonFacilitangLearning

168





Introducon

(5 min)

Greettheparcipants.

Introducethissessionbygivinganoverviewandbypresenngtheobjecvesof

thesession.

Attheendofthissession,theparcipantswillbeableto:

1.Explaintheconceptsandskillsinfacilitaon.

2.Describethedierentfacilitangtechniquesthatcanbeusedinthis

training.


4.Provideperformancefeedback

Askparcipantsabouttheirtrainingexperiencesasparcipantsandas

facilitators.

Usetherelevantresponsesandlearninginsightsfromtheprevioussessionsto

thepresentsession.

Facilitang Techniques

(15 min)

Lecture-Discussion

Tell:Traineeslearnbestwhentheyparcipateinthetrainingprocess.Asa

facilitator,applyingfacilitaonskillsisencouraginginvolvementbyshowinginterestinthetrainees,allowingthemtoexpresstheirideasandaskquesons.

Facilitaonskillshelpthefacilitatorsobtainfeedbackfromthelearners

regardingtheirtrainingexperienceandenableonetorespondtothelearners’

needsappropriately.Facilitaonskillshelpthefacilitator/trainerbridgethegap

betweenthetrainingcontentandthelearnersasshownbelow:

Present:Powerpointpresentaonon

A.Facilitaon

B.FacilitaonSkills

a.Aending

b.Observing

c.Listening

d.Quesoning

Duringtheabovepresentaon,parcipantsareaskedtoexplain/givean

exampleofhoweachskillareperformedtofacilitatelearning.

169




(25 min) Present:PowerpointpresentaononFacilitangtechniques:

1.MovangParcipants

2.WorkingwithaCo-Facilitator3.ConducngaDemonstraon

4.ClinicalDemonstraon

5.CoordinangRolePlay

6.ProvidingPerformanceFeedback

7.WhenLeadingaGroupDiscussion

8.WhileParcipantsAreWorking

9.IntroducingandSummarizingtheSession

10.MonitoringSkillsPracceintheClinic

Duringtheabovepresentaon,parcipantsareaskedtoreadandgivean

exampleofhoweachthetechniquecanfacilitatelearning

Demonstraon

Introducehowtouse/accomplishthePerformanceObservaonChecklist

(Facilitator’sGuideAnnex7.4)

Explaintheimportanceoftheitemstotrainingobjecves.

Synthesis/

Summary of the

Session(10 min)

Synthesizeby:

•Askingparcipantsabouttheirlearninginsightsgainedfromthissession

•Informingparcipantsthattheywillhavethechancetopraccethefacilitang

techniquesanduseofthePerformanceObservaonToolinsucceeding

sessionsandtheactualclinicalsession.

Reviewthesessionobjecves.

Thankingparcipantsfortheiracveparcipaon.

170




Session 4: Acon Planning on Training of Service Providers (“Roll-out”)

OVERVIEW Planningistheprocessofthinkingthroughwherewearegoing,howwewillget

there,whatresourceswillberequiredbeforeweact.

Goodplansspecifyworkprioriesandhowtheworkwillbedone.Theyanswerthetwinquesons,“whatworkisreallyimportanttodonow?”and“howarewe

goingtogetthemdone?”

PlanstoimproveMSPbyimprovingitsimplementaonmustbeontopofthe

healthanddevelopmentagendaregardlessofthelevelofplanningmanagement

isinvolved.Attheserviceproviderandclientrelaonshiplevel,thereareacons

andiniavesthatmaybedonewhichmaybesimple,praccalanduseful.


1.ReviewthebarriersthatcontributetolowcoverageforMSP

2.Idenfykeystrategiesappropriateintheareasthatcanimprove:

2.1.Improvebehaviorsandpraccesofserviceproviders

2.2.Improvebehaviorsofclientsincareseeking.

METHODOLOGY Workshop

PlenaryDiscussion

ESTIMATED TIME 2hours

ADVANCE

PREPARATION

Objecveswrienforpresentaoneitheronipchartorpowerpoint

presentaon


AconPlanTemplate

POWERPOINT

PRESENTATION

Module4Objecves

AconPlan

171





Introducon

Greettheparcipants.

Introducethissessionbygivinganoverviewandpresenngtheobjecvesofthe

session.

Attheendofthissession,theparcipantswillbeableto:

1.ReviewthebarriersthatcontributetolowcoverageforMSP

2.Idenfykeystrategiesappropriateintheareasthatcanimprove:

2.1.Improvebehaviorsandpraccesofserviceproviders

2.2.Improvebehaviorsofclientsincareseekingandtreatment

compliance.

Acon Planning Tell:TherearenewinformaonandhealthcaredeliveryskillsonMSandrelated

healthservicesthatserviceprovidersneedtoperformand/orintegrateintheirperformancethatneedtobecommunicatedtothemifMSservicesneedtobe

improvedandfullyintegratedinallrelevantprogramsandservicesinthehealth

system.

Themainobjecveoftheaconplanaredirectedat:

1.ImprovingthequalityofMSservices

2.Improvingclientexperiencestoimprovetheircareseekingpracces

ChallengeparcipantstocomeupwithanAconPlanthat:

1.Willberelevantandpraccaltotheirareas

2.Givenlimitedfundingandtechnicalresources,whatstrategiescanbedonetoworkontheabove-menonedobjecves

•PresentthePlanningtemplateanditscomponents

•Askparcipantsforanyquesonsandclaricaon

•Letparcipantsworkasingroupsaccordingtogeographiccomposions

•Givethegroupsone(1)hourtocompletetheirplans

Plenary Presentaon •PrepareanorderofplenarypresentaonofAconPlansbygroup/individual

•Assignfacilitatorstoassistthegroupsandthepresenterinnalizingtheirplans.

•Limiteachpresentaontove(5)minutesandallowten(10)minutesforthe

QuesonandAnswer.

•Asessionfacilitatorwillprocessthepresentaon

172




Synthesis Summarizethedierentpresentaons.

•Highlightthecommonalies

•Highlighttheinnovaons

•Highlighttheagreements/recommendaons

Informparcipantsthattheplanspresentedanddevelopedwillserveasabasis

formonitoring:

oApplicaonofnewMSguidelines

oImprovementinMSservicesintheirhealthfacilityandcommunity.

Congratulateeachoftheparcipantsfortheeortexertedindevelopingaplanofacon.

173





Annexes for

Module 7





Annex 7.1. Possible Answers and Notes for Small Group Discussion on Training

Group work / Group discussion

UsingtheCaseScenarioofSanJuanMunicipalityfromM5-S4,assignparcipantstoworkin groupsonimprovingtheperformanceonMSPimplementaonthroughtrainingand/orcapability

buildingintervenons.

Quesons/tasks:

1.IdenfycompetenciesofServiceProvidersthatneedimprovement

c.healthcaredeliveryskillsinMSandhealthservices

d.cricalthinkingskillsinimprovingmanagementofMSandhealthservices,especiallyin

dicultareas(alternaveservicesengs)

e.communicaonskillsinrelangwithclientsandvolunteers f.managementskills–inensuringadequateMSresources,informaonsystemand

organizingtheworkandtasksofvolunteers(BHWs/BNs)

2.Idenfythefactors/reasonstoconducttraining

a.six(6)oftheten(10)barangayshaveverylowperformanceinhealthandMSservices

b.two(2)RHMsarenewtotheservice

c.ThereisaneedtoupdateallRHMson:

-newMSPpoliciesandguidelines

-ways/approachestoimprovetheoverallperformance

3.Idenfyteachingandlearningapproaches/methodsthatwillbestresulttothedesired

behavioraloutcomesfortheServiceProviders

a.Formal/organizedtrainingonMSandhealthservices

b.Informaltraining:

-Individualdemonstraonandcoaching(fortheold/currentRHMs)

-Smallgroupdemonstraonandcoaching(forthe2newRHMs)

-Parcipaoninactualclinicacvieswithobservaonandfeedbacksession

-Problem-solvingsessions

177



A n n e x 7 . 2 . M O N I T O R I N

G F O R M 1 : C L A S S R O O M S E S S I O N

1 3

N a m e s o f P a r c i p a n t s

R O L E P L A Y S

G R O U P W O R K

N O T E S / R E M A R K S

S e r v i c e

P r o v i d e r

C l i e n t /

F a m i l y

M e m b e r

O b s e r v e r

D i s c u s s i o n

L e a d e r

R

e p o r t e r /

P

r e s e n t o r

P a r c i p a n t

1 2 3 4 5 6 7 8

G u i d e f o r R e c o r d i n g

:

√ - p e r f o r m e d c o r r e c

t l y / s a s f a c t o r i l y

√ - p e r f o r m e d , i m p r o

v e m e n t / s n e e d e d – a n n o t a t e o n t h e N o t e s / R e m a r k s c o l u m n

X - n o t d o n e / n o o p p

o r t u n i t y

D a t e :_____________________

N a m e o f F a c i l i t a t o r :____________________

1 3 A

d a p t e d f r o m I M C I T r a i n i n g -

C o u r s e D i r e c t o r G u i d e

( W H O

, 1 9 9 9 ) .

178



A n n e x 7 .2 . A n n

e x 7 . 3 . M O N I T O R I N G F O R

M2 : P R A C T I C U M S E S S I O N

1 4

N a m e s o f P a r c i p a n t s

R O

L E P L A Y S

G R O U P W O R K

N O T E S / R E M A R K S

S e r v i c e

P r o v i d e r

C l i e n t /

F a m i l y

M e m b e r

O b s e r v e r

D i s c u s s i o n

L e a d

e r

R e p o r t e r /

P r e s e n t o r

P a r c i p a n t

1 2 3 4 5 6 7 8

G u i d e f o r R

e c o r d i n g :

√ - p e r f o r m e d c o r r e c t l y / s a s f a c t o r i l y

√ - p e r f o r m e d , i m p r o v e m e n t / s n e e d e d – a n n o t a t e o n t h e N o t e s / R e m a r k s

c o l u m n

X - n o t d o n e

/ n o o p p o r t u n i t y

D a t e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

N a m e o f F a

c i l i t a t o r : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _

1 4 A d a p t e d f r o m I M C I T r a i n

i n g- C o u r s eD i r e c t o r G u i d e ( W H O ,1 9 9 9 ) .



A n n e x 7 . 4 . M O N I T O R I N G F O R M 3 : F A C I L I T A T I N G A

N D P R E S E N T A T I O N T E C H N

I Q U E S

1 5

N a m e s o f F a c i l i t a t o r – T r a i n e e s

M a n a g i n g a

S e s s i o n

W o r k i n g

w i t h a C o -

F a c i l i t a t o r

F a c i l i t a n g

a

W o r k s h o p

F a c i l i t a n g

a G r o u p

D i s c u s s i o n

C o o

r d i n a n g

a R o l e P l a y

P r o v i d i n g

P e r f o r m a n c e

F e e d b a c k

C o o

r d i n a n g

P r a c c e

S e s s i o n

O r g a n i z i n g

a C l i n i c a l

S e s s i o n

1 2 3 4 5 6

G u i d e f o r R e c o r d i n g :

√ - p e r f o r m e d c o r r e c t l y / s a s f a c t o r i l y

√ - p e r f o r m e d , i m p r o v e m e n t / s n e e d e d – a n n o t a t e o n

t h e N o t e s / R e m a r k s c o l u m n

D a t e :_____________

________

N a m e o f F a c i l i t a t o r :_

___________________

1 5

A d a p t e d f r o m I M C I T r a i n i n g -

C o u r s e

D i r e c t o r G u i d e

( W H O

, 1 9 9 9 ) .

180



Annex 7.5. Facilitators’ Pracce Session

OBSERVATION CHECKLIST FOR TRAINEE-FACILITATOR 1

6

Name of Trainee-Facilitator: _______________________________________ Date: ________________

Use when observing facilitator/s conduct training session, demonstrate facilitator techniques and for Self-Assessment: use this

scale: E=Excellent, VS=Very Sasfactory, S=Sasfactory, NI-Needs Improvement and NO=no opportunity.

ASSESSMENT AREAS / TECHNIQUES RATING REMARKS

I. Planning and Implemenng Training Session

A. Management of a Training Session

1.Designs/usessessionplanproperly

2.Applies/observestheelementsoftheROPESmethod(forclassroomsession)

3.Appliespresentaonandfacilitaonskillseecvely

4.Usesvisualandotherteaching/trainingaidsappropriately

5.Encouragesacveparcipaon

6.Checksunderstanding(evaluateslearning)

7.Managessessionmeeecvely

B. Applicaon of Facilitaon Skills

1.AendingSkills

1.1.Facesthelearners

1.2.Maintainsappropriateeyecontact

1.3.Movestowardthelearners

1.4.Avoidsdistracngbehaviors

2.ObservingSkills

2.1.Looksattheperson’sface,bodyposion,andbodymovements.

2.2.Formulatesaninferenceoftheperson’sfeelingsbasedonwhatyou

haveobserved.

2.3.Takesappropriateaconbasedontheinferencesmade.

3.ListeningSkills

3.1.Listenstothewordsbeingexpressed.

3.2.Paraphraseswhatwassaidtodemonstrateunderstanding

4.QuesoningSkills

4.1.Asksquesons 4.2.Handlesparcipant’squesons

4.3.Respondstoparcipant’squesons

1

6 AdaptedfromtheFacilitatorGuideforAllModulesinIMCITraining(WHO,1999),DepartmentofHealth-TrainingInstuteforManage-

rialExcellence(TIME)TrainingofTrainersManual(1992))andDepartmentofHealth-TrainingInstuteforManagerialExcellence(TIME)

AdvanceTrainorsCourseBook(1995).

181




II. Applying Techniques in Facilitaon

A. Facilitator Technique: Introducing a Module / Session / Acvity

2.IncludespointssuggestedintheFacilitatorGuide

3.PointstoandexplainsrelevantseconsoftheGuide/Manualcontents

appropriately

B. Facilitator Technique: Leading a Discussion

1.Setsupthediscussionbyexplainingitspurposeandhowitwillproceed

2.Involvesallparcipantsinthediscussion

3.Reinforcesparcipantsbythankingthemforcomments,praisinggood

ideas,etc.

4.Handlesincorrectoro-the-subjectcommentsfromparcipantstacully

5.Asksquesonstokeepthediscussionacveandontrack

6.Respondsadequatelytounexpectedquesons;oerstoseekanswersif

notknown

7.Recordsideasontheipchartinaclear,usefulmanner

8.Attheendofthediscussion,summarizesthemajorpoints

C. Facilitator Technique: Coordinang Role Plays

1.Setsuproleplaycarefullybyobtainingnecessaryprops,brieng

parcipantswhowillplayroles,andallowingmetoprepare

2.Clearlyintroducesroleplaybyexplainingthepurpose,thesituaonbeing

enacted,backgroundinformaon,andtherolesbeingplayed.

3.Interruptsonlyifplayersarehavingdicultyorhavestrayedfromthe

purposeoftheroleplay

D. Facilitator Technique: Demonstraon1.Statestheobjecvesofthedemonstraon

2.FollowstheinstruconsintheFacilitatorGuide

3.Demonstratestheenrecorrectprocedure(noshortcuts)

4.Describesthestepsaloudwhiledoingthem

5.Projectsvoicewellsoallcanhear;standswhereeveryonecansee.

6.Encouragesquesonsfromparcipants

7.Askparcipantsquesonstocheckunderstanding

8.Attheendofthedemonstraon,summarizesandhighlightsmainpoints

EFacilitatorTechnique:ProvidingPerformanceFeedback1.Discusseswithparcipantsresultsofperformanceobservaon

1.1.Steps/skillsdonecorrectly/appropriately

1.2.Steps/skillsneedingcorrecons/improvements

2.Helpsparcipanttounderstandhis/hererrors

2.1.Givesclearexplanaonsandsuggesons

2.2.Asksparcipantideashowtoimproveperformance

182




3.Whenappropriate,asksquesonsabouttheparcipant’sownclinicand

howthelearningappliestotheirsituaon.

4.Encouragesandreinforcesparcipant’seorts

F. Facilitator Technique: While Parcipants are Working

1.Looksavailable,interestedandwillingtohelp

2.Encouragesquesons

3.Watchesparcipantsastheywork;oershelptoparcipantswho

appearconfused

4.Givesindividualhelpquietly,withoutdisturbingothers.

G. Facilitator Technique: Working with a Co-Facilitator

1.Sharestheworkinamodule/session/acvityinanorganizedway(e.g.

eachhasaroleinexercise,discussion,presentaon).

2.Showsexibilityinadjusngtotheroleasneeded

3.Politeandrespecul/taculwhenaddingcommentsormaking

suggesonswhilehis/herpartnerisleading4.Whenleading,inviteshis/herco-facilitatortoparcipatebyadding

commentsoranopinion.

H. Facilitator Technique: Summarizing a Module / Session / Acvity

1.Keepssummarybriefandclear

2.Includesthemajorpointstoberememberedfromthemodule

I. Facilitator Technique: Monitoring Pracce

1.Observesparcipantscarefullywhiletheywork

2.UsestheChecklistforMonitoringPracceSessions

3.Reviewsparcipants’performanceanddiscussesndingswiththem4.Triestogetparcipantstoseeandcorrecttheirownerrors(e.g.,by

askingthemtolook,askortryagain);providesassistanceonlyasneeded

5.Providesfeedbackonthingsdonewellandonthingsthatneed

improvement

GENERAL COMMENTS/REMARKS:

Name of Facilitator-Observer: __________________________________ Date: _______________

183



A n n e x 7 . 6 . A c o n P l a n n i n g f o r T r a i n i n g o f S e r v i c e P r o v i d e r s ( “ R o l l - o u t ” )

A c

o n P l a n n i n g f o r T r a i n i n g

O b j e c v e / s :

T y p e o f T r a i n i n g C o u r s e s /

A c v i e s

P e r s o n s / U n i t s

R e s p o n s i b l e /

I n v o l v e d

N o . o f C o u r s e s /

P a r c i p a n t s

T i m e F r a m e /

S c h e d

u l e

R e s o u r c e s

N e e d e d / B u d g e t

O

u t c o m e / W h a t t o

m o n i t o r

1 .

T r a i n i n g o f T r a i n e r s

1 . 1 …

1 . 2 . .

2 .

T r a i n i n g o f S e r v i c e P r o v i d e r s

2 . 1 .

2 . 2 .

3 .

O r i e n t a o n

3 . 1 . .

3 . 2 . .

184



REFERENCE GUIDE ON TRAINING

FOR TRAINERS/FACILITATORS





MODULE 7: TRAINING OF FACILITATORS

Session1: Overview on the Concepts of Teaching-Learning and Training

1.1. Overview

Healthcareprovidersplaykeyrolesintheimplementaonofanypublichealthprogramor

strategy.Experienceshowthatdistribuonofevidence-basedclinicalpracceguidelines,isnot

sucienttobringaboutchangeinhealthproviders’behaviorandpracces.

Learninginhealthisthechangeinbehaviortoaposivedirecontosolvepraccal,socialand

personalproblemsinhealthencounteredbyindividuals,familiesandcommunies.Behavior

isdenedastheatudes,ideas,valuesandskillsofaperson,whileposivedireconsreferto

whatenhancetheself,others,andcommunity.Posivechangesinbehaviorcanbedonethrough

formalandinformaltrainingwhichareessenaltothedevelopmentprocessofpeopleand

instuons.

1.2. Guiding Principles in Training Service Providers1

z

Healthstatusandhealthcareareinuencedbyprevailingsocial,polical,andeconomicrealies.

Thetrainingofhealthcareproviders,therefore,must

a)addressthepriorityhealthneedsandproblemsofasociety,

b)idenfynaonalpolicies,guidelines,andstandards,and

c)denethefollowingexpectedroleofhealthcareproviders:

•Caregiverswhowillconsideraclientasanindividual,partofafamilyandcommunity,

andwillprovidehigh-quality,comprehensive,connual,andpersonalizedcare.

•Decision-makers whowillchooseintervenonsandtechnologyinethicalandcost-

eecveway.

•Communicators whowillbeabletoaskappropriatequesons,listen,advise,encourage, counsel,andeducateindividualsandgroupstohelpthemimproveandprotecttheir

health

•Community leaderswhocanadvocateforhealthandacviesonbehalfofthe

community

•Managerswhowillworkeecvelywithcolleagues,sta,andotherorganizaonsand

whocollect,analyze,andusehealthdatatomeetthehealthneedsofindividualsand

communies

Indeningcorecompetencies,weshouldremember3cricalfacts:

1)healthcareshouldbedynamicandresponsivetochangingsocietalneeds;2)healthcareconnuallyevolveswithadvancesinhealthcareknowledgeandtechnology;

and

3)healthcareprovidersfulllmulpleroles.

Outcome competenciesmustincludecognive(knowledge),psychomotor(skills),andaecve

(valuesandbehaviors)domainsthatareobservableandcanbeappraised.

1

7 WHOandJHPIEGO.2005.EecveTeaching:AGuideforEducangHealthcareProviders.Geneva

187



1.3. Teaching and Learning Process

Theteachingandlearningprocessisascienceunderpinnedbyresearchandexperimentaon.

Itisanartinvolvingconstantexchangebetweenknowledgeandacon.Althoughsomepeople

maybenaturalteachers,itisgenerallyagreedthateecveteachingislearnedratherthaninnate

ability.

Teachingisaconsciousmanipulaonofthelearners’environmentthatallowacviesto

contributetotheirdevelopmentaspeopleandclinicians.Peoplelearnforthemselves.Good

teaching,however,supportslearning.

1.4. Training of Healthcare Providers

Trainingistheprocessofguidingthedevelopmentofaperson’sskills,knowledgeandatude.

Itfocusesonassisnghealthworkerslearnspecicworkcompetencies/jobskillstoimprove

overallperformanceonthejob.Trainingisneededwhenthereis/are:a)newevidence/bodyof

knowledgeessenaltotheproviders’rolesandresponsibilies,b)newways,proceduresor

techniquesofdoingthings,c)newtasks/assignmentsgiven,andd)newinstuonaldirecons totake.

Delivery of healthcare services requires a combinaon of the following skills (Fig 7.1) 1

8:

1.Communicaonskillsthatincludelistening,askingquesons,informing,advising,

counseling,andcheckingunderstanding.Healthcareprovidersneedcommunicaonskills

inrelangwithpaents,familiesandotherhealthcareproviders.

2.Clinicalcareskillsthatinvolvetheabiliestoassessapaent’ssituaon,decidewhat

aconisneeded,anddesignandimplementacarestrategy.

3.Cricalthinkingskillsthatentaildrawingonpastexperienceandseekingoutnew

informaontoanalyze,reason,reect,createideas,andclarifyinformaon.Cricalthinkingis

essenalforsolvingproblemsandmakingsounddecisions.4.Managementskillsthatincludeorganizing,regulang,orbeinginchargeofassigning

taskstosta,maintainingpaentrecords,andensuringavailabilityofessenalsuppliesand

equipment.

Figure 7-1. Synthesis of Skills into the Delivery of Healthcare Services

SKILL AREAS

- Communication(e.g.listening,

advising,counselling )

- Clinicalcare(e.g.clinical

assessment,treatment)

- Criticalthinking(e.g.reasoning,

reflecting,creating,clarifying)

- Management(e.g.record

kee in ,or anizationofwork

DELIVERY OF HEALTH SERVICES

(Examples of Tasks) - Organizeservices

- Manageequipmentandsupplies - Takehealthhistory

- Performphysicalexam

- Interpretdiagnostictests

- Prescribetreatments

- Advise/counselclients

- Keepaccurateclients/patientrecords

- Assigntaskstostaff

SYNTHESIS

Healthcare Delivery

Skills

1

8 WHOandJHPIEGO

188



Whenahealthcareproviderhasaskill,he/shehastheabilitytoperformagroupofstepsor

taskscorrectlyortoastandard.Itcanbeaphysicalacvitysuchasdemonstranghowtodo

counselingstepsoranintellectualacvitysuchascalculanghowmanyirontabletsareneeded

foronemonth.Askillmayinvolveasingleaconoraseriesofacons.Forexample,checkingfor

palmarpallorinayoungchildinvolvesjustoneacon,whilecounselingamotheronhowtofeed

hermalnourishedchildrequiresseveralsteps.

Healthcaredeliveryskillsarebestdevelopedbya)introducinganddemonstrangtheskill,b)

observingtraineesastheypraccetheskill,c)givingfeedbackonhowwelltheyperformedthe

skill,and,d)assessingtraineesforcompetencyintheskill.

1.5. Steps in Skills Development

Whentraineeslearnskills,theytypicallymovethroughthreestagesofskillsdevelopment:

Skill acquision. Traineesareawareoftheskillandknowhowitshouldbeperformed,butdonot

alwaysperformitcorrectly.

Skill competency. Traineesperformtheskillcorrectly,butmaynotalwaysprogressfromstepto stepeciently.Thisistheleveltypicallyreachedinthetrainingofhealthcareproviders.

Skill prociency. Thestageoccursaertraineesgraduatefromacourseandhavepraccedthe

skillatworkoverme.Procienthealthcareprovidersperformskillscorrectlyandeciently.

Skillscanbedemonstrated,pracced,andassessedinasimulatedorrealenvironment.

Dependingonthedicultyandcomplexityofaskill,traineesmayachievecompetencyin

dierentways.Ataminimum,traineesshouldseeademonstraonoftheskillineithera

simulatedorrealenvironment.Ideally,traineesshouldthenpraccetheskillandreceive

feedbackontheirperformance.

Theteachingmethodsofthiscoursearebasedonseveralassumponsaboutlearning1

9.

1.Instrucon should be performance-based.

Instruconshouldteachthetraineetaskshe/shewillbeexpectedtodoonthejob.The

courseisdevelopedbasedonananalysisoftasksandcompetenciesinvolvedinproviding

MSservicestoclients.

2. Acve parcipaon increases learning.

Traineeslearnhowtodoataskmorequicklyandecientlybyactuallydoingitthanby

justreadingorhearingaboutit.Retenonisgreaterinparcipantswhopraccea

skillthaninthosewhomerelyobserveit.Thecourseinvolvesthetraineesindoingwrien

exercises,parcipangingroupdiscussions,roleplays,andinactualpraccumsessions. 3.Immediate feedback increases learning.

Feedbackisinformaongiventoparcipantonhowwelloneisdoing.Ifhe/shedoeswell

onanexercise,andisreinforcedimmediately,he/sheismorelikelytoretainwhatis

learned.Immediatefeedbackallowsmisunderstandingstobecorrectedbeforethey

becomestrongbeliefs,orbeforetheparcipantbecomesfurtherconfused.

1

9 CourseDirectorGuideinIMCITraining.WHO,1999



4.Learning is increased when instrucon is individualized.

Parcipantslearnatdierentspeedsandindierentways.Formaximumlearningtooccur,

instruconmustalloweachparcipanttoproceedatapacethatiscomfortableforhim/her.

Eachparcipantshouldaskquesonsandreceiveexplanaonstounderstandandacquireskill

andknowledge.

5. Posive movaon is essenal if learning is to take place.

Forinstrucontobeeecve,parcipantsmustwanttolearn.Parcipantscometothecourse

highlymovatedtolearn.Facilitatorsshouldhelptheparcipantsmaintainthismovaonby

a)providingindividualaenon,b)givingpromptfeedback,c)reinforcingthemfortheirwork

ontheexercises,d)ensuringthattheyunderstandeachexercise,ande)encouragingthemin

individual/groupacvies.

1.7. Planning for Teaching and Training

Eecveteachingrequirescarefulplanning.Mostcoursesmayhaveboththeoryandpracce

componentsthatworktodeveloptrainees’knowledge,skills,andatudes.Coursesusually

beginintheclassroomwiththeorecalbackgroundandintroducon,demonstraon,and

pracceofrelatedconceptsandskills.Theymayconnueinasimulatedenvironment,wheretraineesconnuetodevelopknowledge,skills,andatudes.Finally,coursesmayprovide

opportuniestopraccekeyskillsanddemonstratekeyatudesinasupervisedclinical/

pracceseng.

Carefulplanningforteachingandtrainingconsistsofa)developingacoursesyllabus,b)

planningfortraineeassessment,c)selecngteachingmethods,d)idenfyinglearning

materials,ande)developingacourseschedule.

1.8. Developing a Course Syllabus and Course Objecves

Acourseconsistsofaseriesoflearningsessionsonaparculartopicwithinanacademic/courseprogram.Asyllabusservesasthedesigndocumentforacourse,providingallthebasic

informaonaboutthecourse,anddescribesthecoursecontentandobjecves.

Courseobjecvesrelatedirectlytothecorecompetenciesrequiredforanacademic

program.Acourseobjecveisfairlybroadandmayencompassknowledge,skill,andatude

components.Acourseobjecvemayhaveanevaluaoncriterion-adescriponofhowwell

theperformancemustbedemonstrated,ortheperformancestandard.Therearesomeskillsin

whichtraineesshouldshowahighdegreeofcompetenceandothersmayshowonlyfamiliarity.

Supporngobjecvesoutlinetheknowledge,skills,andatudesatraineemustmasterto

achieveacourseobjecve.Thesearealsousedtodeterminethecoursecontent,teaching

methodsandmaterialsneededtodeliverthecontent,andthemethodstoassessthe

competencyoftrainees.

Basedonthecorecompetenciesrequiredofhealthcareproviders,trainersareresponsible

todesigncoursessothattraineesacquiretheknowledgeanddeveloptheskillsandatudes

relatedtothecorecompetenciesfortheprogram.

190



Thedevelopmentofpreciseandmeasurableobjecvesistherststepindesigningyour

course.Objecvesarestatementsthatdescribewhattheparcipantswillknowandbeableto

doaercomplengthecourse.Clearobjecveshelpdeterminethecoursecontent,decide

howonewillteachthecourse,andidenfyhowlearningshouldbeassessed.Figure7-2illustrates

howobjecvesguidetheteachingprocessbyformingthebasisforcontent,methods,

andassessment.

Figure 7-2. How Objecves Guide Teaching

Learningoccursinthreedierentareasordomainsasshownwithsomeexamplesfor

eachdomain:

A. Knowledge Objecves-requiresunderstandingandprocessingoffacts,andoenrequires

recallinginformaonandsolvingproblems:

•Explainwhyspecicclientsneedmicronutrientssupplementaon •Listthenutrionalneedsofinfantsyoungerthan6monthsold

•Idenfygeneralbenetsofbreaseeding

B. Skill Objecves -refertotheacquisionofskillsortheabilitytoperformprocedures:

•Assessasickchildforcommonseriousillnessesandmalnutrion

•Performafullantenatalexaminaononapregnantwoman

•Demonstratetheabilitytoassessbreaseedingaachment

C. Atudinal Objecves-dealwithopinionsorfeelingsandaributesrelatedtoindividual,

professionalandinstuonalvalues.

•CounselclientsaboutMSusingnonjudgmentallanguage(bothverbalandnon-verbal)

•Obtainacomprehensivehistoryinasensiveandfriendlymanner,assuringclientof condenality

1.9. Training and Learning Methods

Eecveteachingconsidershowtraineeslearnbest.Althoughitisimpossibletoaccommodate

theindividuallearningstylesofagroupoftrainees,itisfeasibletoengagetheminavarietyof

learningacvies:tolisten,lookatvisualaids,askquesons,simulatesituaons,read,write,

praccewithequipment,anddiscusscricalissues.



Trainerscanusemethodssuchasvideoexercises,roleplays,casestudies,andsimulaonswhen

introducing,demonstrang,andpraccingskills.Forsomeskills,simpledemonstraonmaybe

sucient.Forcomplexskills,traineesneedtopracceandreceivefeedbackontheir

performance.

Table 7-1showcommonteachingmethodsandthepercentageofinformaonrecalledby

learnersaer3hoursandaer3daysrelatedtoeachteachingandlearningacvity.Theresults

conrmthattraineesretainmorewhenacombinaonofteachingmethodsisused(e.g.,verbal,

wrien,andvisual),andrecallmorewhentheyareacvelyinvolved(e.g.roleplay,casestudy,

pracce).

Table 7-1. Learning Recall Related to Type of Teaching Acvity

TYPE OF TEACHING ACTIVITY PERCENTAGE OF MATERIAL RECALLED

Aer 3 Hours Aer 3 Days

Verbal(one-way)lecture 25% 10–20%

Wrien(reading) 72% 10%

Visualandverbal(illustratedlecture)

80% 65%

Parcipatory(roleplay,case

study,pracce,etc)

90% 70%

Adaptedfrom:Dale1969

Seleconoftrainingmethodstouseinatrainingcourseisdeterminedbytheobjecvesofthe

courseneededforthehealthcareproviders’expectedcompetenciestobedeveloped.

192



MODULE 7: TRAINING OF FACILITATORSSession 2: Applying Facilitaon and Presentaon Skills and Techniques

2.1. Overview

Interacvepresentaonsmaintainparcipants’interestandaremorelikelytobesuccessful

inhelpingparcipantsreachthelearningobjecves.Itisimportanttouseappropriatevisual

aids,quesoningtechniques,andgroupacviestomakethepresentaonsmoreinteracve.

Whenplanningforteaching,reviewtheskillsthattraineesshouldmasterbytheendofthe

course.Foreachskillobjecve,considertheamountofmeneededtobecomecompetentin

thatskill.EnsuringintheTrainingSessionPlanstheuseandapplicaonoffacilitaonskillsand

techniqueswillsignicantlyincreaseandretenonoflearning.

2.2. Facilitang Teaching and Learning

FACILITATION SKILLS:

Traineeslearnbestwhentheyparcipateinthetrainingprocess.Asafacilitator,applying

facilitaonskillsisencouraginginvolvementbyshowinginterestinthetrainees,allowingthem

toexpresstheirideasandaskquesons.Facilitaonskillshelpthefacilitatorsobtainfeedback

fromthelearnersregardingtheirtrainingexperienceandenableonetorespondtothelearners’

needsappropriately.Tofacilitate,onewillneedtoperformacviesaccordingtothethree(3)

funcons:Instruct,MovateandManage(pleaserefertopage2-3oftheintroductorypartof

thisGuide).

Facilitaonskillshelpthefacilitator/trainerbridgethegapbetweenthetrainingcontentandthe

learnersasshownbelow:

Figure 7-3. Funcon of Facilitaon in Training

FACILITATION SKILLS

TRAINING CONTENT LEARNERS

ThefollowingarethetypesofFacilitaonskills:

A. ATTENDING SKILLS -showsthatyouarepayingaenontoyourlearners;buildsrapport withyourlearners;communicatesthatlearnersarevaluedasindividuals;enables

observaonofthelearners’responsestothetrainingacviesandencourageslearnersto

interactverballywiththefacilitator

Four Aending Behaviorsthatshowthefacilitatorisinterestedonparcipants:

1.Facingthelearners

2.Maintainingappropriateeyecontact



3.Movingtowardthelearners

4.Avoidingdistracngbehaviors

B. OBSERVING SKILLS-helpsassesshowtrainingisbeingreceived;helpsdecidewhetherto

connuethelearningprocessasplanned,or,modifyittorespondtothelearners’needs.

ThreestepsinusingObservingskills:

Step1:Lookattheperson’sface,bodyposion,andbodymovements.

Step2:Formulateaninferenceoftheperson’sfeelingsbasedonwhatyouhaveobserved.

Step3:Takeappropriateaconbasedontheinferencesmade.

C. LISTENING SKILLS-obtainsverbalinformaonandveriesthetrainees’understanding

oftheinformaon;demonstratesthefacilitator’sunderstandingofthelearner’s

perspecve;useasfeedbackinconsideringhowtoimprovethetrainingconduct.

TwokeystepsinListening:

1.Listentothewordsbeingexpressed. 2.Paraphrasewhatwassaidtodemonstrateunderstanding

D. QUESTIONING SKILLS–quesoningintraininghelpdeterminewhatthelearnersalready

knowandbedirectedonwhattheyneedtolearn;inviteslearnerparcipaonand

involvementinthetrainingprocess;providesfeedbackonhowthetrainingisbeing

received;andenablesthelearnerstoassesstheirlearning.

SkillsassociatedwithQuesoning

1.Askingquesons

2.Handlingparcipant’squesons

3.Respondingtoparcipant’squesons

FACILITATION TECHNIQUES

A. Facilitaon Techniques for Classroom Sessions

1.introducingamodule

2.givingindividualfeedback

3.workingwithaco-facilitator

4.doingademonstraonrequiredforamodule

5.leadingadiscussion

6.coordinangaroleplay

7.leadingoraldrills

8.summarizingamodule

B. Facilitaon Techniques for ClinicaL/Praccum Sessions

1.preparingfortheoutpaent/praccumsession

194



2.explainingsessionobjecvesandwhattodo

3.assigningtasksattheclinic

4.assigningclients/paentstoparcipants

5.monitoringastheywork

6.providingfeedbackandguidanceasneededintheclinic

7.leadingdiscussiontosummarizethesession

C. Techniques for Movang Parcipants

Encourage Interacon

1.Fromtherstday,takemetotalkwitheachparcipant.Ifyouarefriendlyandhelpful

duringtherstinteracons,parcipantswilllikelya)overcometheirshyness;andb)

interactwithmoreopenlyandproducvelythroughoutthecourse.

2.Lookcarefullyateachparcipant’swork.Checkifparcipantsarehavingproblems,evenif

theydonotaskforhelp.Iftheyknowthatsomeoneisinterestedinwhattheyaredoing,

theyarelikelytoaskforhelpwhenneeded.

Keep Parcipants Involved in Discussions 3.Askparcipantsquesonstochecktheirunderstandingandkeepthemacvelythinking

andparcipang.Quesonsthatbeginwith“what,”“why,”or“how”requiremorethan

justafewwordstoanswer.Avoidsimple“yes”or“no”quesons.

4.Acknowledgeparcipants’responseswithacomment,a“thankyou”oradenitenod.This

willmaketheparcipantsfeelvaluedandencourageparcipaon.

5.Donotfeelcompelledtoanswereveryquesonyourself.Youmayturnthequesonbackto

theparcipantorinviteotherparcipantstorespond.Youmayneedtodiscussthequeson

withco-facilitators.Bereadytosay“Idon’tknowbutI’lltrytondout.”

6.Usenameswhencallingparcipantstospeak,andwhenyougivethemcreditorthanks.

Usethespeaker’snamewhenyoureferbacktoapreviouscomment.

Keep the Session Focused and Lively

7.Keepyourpresentaonslively:

*Presentinformaonconversaonallyratherthanreadit.

*Speakclearly.Varythepitchandspeedofyourvoice.

*Useexamplesfromyourexperience,andaskparcipantsfromtheirexperience.

8.Writekeyideasonaipchartastheyareoered,usingtheparcipant’sownwordsif

possibleorparaphrasetheideaandcheckitwiththeparcipantbeforewringit.Youwant

tobesuretheparcipantfeelsyouunderstoodandrecordedhisideaaccurately.

9.Paraphraseandsummarizetokeepparcipantsfocused.Askforclaricaonofstatements

asneeded.Donotletseveralparcipantstalkatonce.Whenthisoccurs,stopthe‘talkers’ andassignanorderforspeaking.Thankparcipantswhosecommentsarebriefand

concise.

10.Encouragequietparcipantstotalk.Asktohearfromparcipantswhohasnotspoken.

Manage any Problems

11.Somesuggesonsonhowtohandleanoverlytalkaveparcipant:

*Donotcallonthispersonrstaeraskingaqueson.





*Pairsofparcipantwillbeassignedtoonedemonstraontopracceindividuallyand/or asapair.Thegroupwilldiscussthegoodaspectsofeachdemonstraon. *Praccethedemonstraonbeforedoingitinfrontoftheclass.Studytheguideand praccewhattosay,soyouwillnothavetoreadfromtheguide.Pracceusingvisual aidssoyoucandothedemonstraoncomfortablyandsmoothly.

D. Coordinang Role Plays

ExplainthatRolePlaysareusefulforpraccingskillsincommunicangwithclients,andareused incounseling,advising,instrucngandeducangonhomecare.Discussthefollowingpoints: *Roleplaysmaynotbeperfectlypreparedandrehearsedperformances.Thepointofrole playsistopraccedealingwithnewinformaonaboutMS. *The“healthworker”shouldnotbetoldinadvanceinformaonthanisrequired,and shouldbeencouragedtoreviewtherelevantseconsoftheReferenceGuide.The facilitatorshouldletthe“healthworker”understandthepurpose,stepsorpointsto coverintheroleplay. *“RolePlayers”shouldbehaverealiscallybasedontheinformaonabouttheirroles. *Itisimportanttolookaheadwhenroleplayswilloccurandprepareforthem. *Keeparecordofspecicroles/tasksexperiencedbyparcipants.

E. Providing Individual Feedback

Explainthatindividualfeedbackisdonebyafacilitatortoaparcipantaercomplengsome workorperformingalearningtask.Reviewthesepoints: *Individualfeedbackmaybefairlybriefanddirecttothepoint. *Forskilldemonstraon,refertoyourobservaonchecklistandinformhim/herofyour observaonresults.Askparcipantshowhe/shefeelsabouttheperformance. *Atmes,feedbackmaysuggestquesonsontheparcipant’sownclinicandits procedures: --HowdoyoumakesureadequacyofMSresourcesinyourhealthfacility? --Howdoyouteachand/orexplaintoaclientaboutmicronutrientsupplementaon?

F. When Leading a Group Discussion:

*Alwaysbeginthegroupdiscussionbytellingparcipantsthepurposeofthediscussion. *Oenthereisnosinglecorrectanswertobeagreedoninadiscussion.Besurethat groupconclusionsarereasonableandparcipantsunderstandhowconclusionswere reached. *Trytogetmostofthegroupinvolvedinthediscussion. *Alwayssummarize,oraskaparcipanttosummarize,whatwasdiscussed. *Reinforceparcipantsfortheirgoodworkby(forexample): -praisingthemforthecomplengtheexercises, -commenngontheircreaveorusefulsuggesonsforusingtheskillsonthejob, -praisingthemfortheirabilitytoworktogetherasagroup.

G. While Parcipants Are Working Helpingparcipantswithmodulesmeansmorethangivingfeedbackwhentheynishanexercise. Italsomeanshelpingastheywork,ifneeded.Reviewthefollowing: *Watchparcipantsstartanexercisetobesuretheyunderstandwhattodo.Ifittakes onealongmetofollowormisunderstandinstrucons,helptheparcipantrightaway. *Ifaparcipantisshowdiculty,quietlygivebriefhelp.Trynottodisturbother parcipants.



H. When monitoring Skills Pracce

*Teachinghaspriorityoverothertasks.Maximizethe“teachingmoment”tofull

advantageforparcipants.

*Sinceparcipantsarelearningchangesinprovidingcare,errorsareexpected.Ifyound

noerrors,youmaynotbepayingcloseaenon,ordismissingallproblemsasminor.On

theotherhand,donotbeoverlycrical,ndingfaultwiththeparcipant’sworkon

everystep.

2.3. Planning for Eecve Presentaon

Whendecidingtogivean“interacvepresentaon”,thismeansdeliveringinformaonthrough

aninteracveoralpresentaon,oenusingvisualaidstosupportthepresentaon.Thismaybe

doneformallyinaclassroomorinformallyduringaclinicalpraccesession.

Six “Keys” to a Successful Presentaon

1.Denetheobjecves.Decidewhatparcipantsshouldbeabletodoaerthepresentaon.

2.Planyourpresentaon.Createanoutlinebasedontheobjecvestohelporganizethe

contentandkeepfocused,thatincludekeypoints,quesons,visualaidsandsummary

points.

3.Introduceeachpresentaon.Agoodintroducongrabsaenonandcommunicatesthe

objecvesofthesession.Varyintroduconsusedindierentpresentaons.

4.Useeecvepresentaonskills.Involveparcipantsbyaskingquesons,movingaround

theroom,andmaintainingeyecontact.Providecleartransionsbetweentopicsand

summaries.

5.Usequesoningtechniques.Askingquesonsisessenaltomaintainingparcipants’

interest,checkingtheirunderstandinganddevelopingtheirproblem-solvingskills.6.Summarizeyourpresentaon.Agoodsummarysupportsthepresentaon’smainpoints

andreinforcesthemostimportantinformaon.

Sometechniquestomakepresentaoneecve:

•Followaplananduseanoutline.Anoutlineincludesthepresentaonobjecves,introducon,

keypoints,quesonstoaskstudents,visualreminders,andsummarypoints.

•Communicateinawaythatiseasytounderstand.Usefamiliarwordsandexpressions,explain

newterms,interactwithparcipants.projectyourvoiceandspeakclearly.

•Interactwithparcipants.Useeyecontacttomaintaintheiraenonandto“read”faces.Ask

botheasyandchallengingquesons.

•Displayenthusiasmaboutthetopicanditsimportance.Smile,movearoundtheroomwith

energy,andinteractwithparcipants.Yourenthusiasmwilldirectlyaecttheirenthusiasm.

•Useappropriatevisualaids.Visualaidswillhelpyouexplaincomplextopics,highlightkeypoints,

andaddsomevarietytoyourpresentaons.

•Provideposivefeedback.“Verygoodpoint,Ilka!”.“Annehasmadeanexcellentcomparison!”

•Providesmoothtransionsbetweentopics.Withinapresentaon,anumberofseparateyet

relatedtopicsmaybediscussed.Communicatehowthetopicsttogetherintoabiggerpicture.

198



2.4. Presentaon Using the ROPES Model

Whenplanningforapresentaon,rememberthe6KEYSandtechniquestosuccessful

presentaon.Usingaframeworkoramodel,suchastheROPESwillensurethatimportant

elementsareinplace.Itwillensurethatlearningobjecveswillbeachievedbypungtogether

inasystemacmannertheelementsofthetrainingcontent,methods,aidsandevaluaon.

TheROPESmodelprovidesaguideindevelopingandpresenngasessionasshownintable7-2.

Table 7-2. Presentaon Plan Using ROPES Model

Steps Purpose Acvies Percent of

Time

R–Review Toconductareviewof

theparcipants’general

knowledgeofandexperience

withthetopic.

•Introducethelesson/topic

•Havethelearnerssharetheir

knowledgeoforpastexperiences

•Recognizethepotenalresourceinthe

group

5-10%

O –Overview Toestablishaconnecon

betweentheparcipants

andthetrainingcontent.

•Giveanoverviewofthelessonandthe

acviesthatwilloccur

•Coverthelearningobjecve(s)

•Establishwhyitisimportanttolearn

aboutthetrainingcontent/topic.

5-10%

P –Presentaon Topresentthecontenttothe

parcipantsinwaysthathelp

themretaintheinformaon.

•CoverthetrainingCONTENTusingthe

TELLandSHOWapproach

•TELLthelearnerswhatistobedone

andhowtodoit.•Then,SHOWthemhowtodoitby

usingexamplesordemonstraon.

25-30%

E–Exercise Toenableparcipantsto

pracceusingthetraining

contenttobuildtheirskills.

•Havethelearnerspraccetheirnew

skills

•Providefeedbackontheir

performance.

35-50%

S –Summary S–Summary Tosummarize

andclarifywhatwaslearned.

•Synthesizethelesson,stressing

importantpoints•Makeatransiontothenextlesson,

orpreparethelearnerstoapplythe

skillsbackonthejob.

5%



2.5. Planning for Assessment of Trainees

Assessingtrainees’achievementisoneofthemostimportanttasksintraining.Themainpurpose

ofassessmentistoimprovetrainees’learning.Itisusedtodeterminewhethertraineesachieve

thelearningobjecvesforacourse,thatis,tondoutiftheyhaveacquiredtheexpected

knowledge,skills,andatudes.

Traineesmustbuildanddemonstratecompetenceinessenalskillstodeliverhigh-quality healthcareservicesaerthecourse.Thethree-stepprocessforskillsdevelopmenthasthese

steps:(1)introduceanddemonstrateaskill;(2)observetraineesastheypraccetheskillandgive

feedbacktohelpthemimproveperformance;and(3)assesstraineesforcompetencyintheskill.

Methods for Assessing Skills of Trainees

Foravalidassessment,acombinaonofmethodsandtechniquesshouldbeusedforformave

andsummaveassessmentofskills.Trainersmayformavelyassesstraineesbyobservingthem

duringclinicalpracceandgivingfeedbackthatwillhelptraineesprepareforsummave

evaluaon.Thefollowingaremethodsthatcanbeused:

1.DirectObservaonisthemostvalidwaytoassessskillswhichcanbeusedforboth

formaveandsummaveassessments,usingstandardizedchecklisttoreducevariaonsin

scoringbydierentobserversandincreasereliabilityoftheassessment.Quesoningduring

observaoncanalsoassesstheirabilitytointegrateknowledge,skills,andatudes.

2.StructuredFeedbackReportisastandardizedwaytogivefeedbacktotrainees,usefulin

assessingpersonalaributes,atudes,andvalues.Theyareecientandconsistent,

providestructureforformaveassessment,reinforceskills,andensurethattraineesreceive

feedback.

3.Checklistsareusefulforgivingfeedbacktotrainees.Achecklistisalistofstepsneededto

performaskillcorrectly,wheretheassessormayindicateifeachstepwasperformedornot

performedandmayindicatethequalityoftheperformance.

4.RangScalescanbeincorporatedintochecklists,orusedindependently.Theyaremore

eecveinassessingbroadskillsordemonstratedatudes,andingivingformave

feedback.

Remember this:

1.Trainingshouldalwaysincludepracceoftasks,insituaonssimilartothejobaspossible.

2.Beforepracceofthetask,learnersshouldreceiveanynecessaryinformaonand

examples

3.Learnersmustreceivefeedbackontheirpraccetoknowhowwelltheyweredoingatask

andhowtheycanimprove.

4.Evaluatetrainingbywatchinglearnersdotaskonthejob.Iftheysllcannotdoatask,nd

outwhy.Usetheresultsofevaluaontoimprovetraining.



Monitor Trainees’ Progress

Itisimportanttomonitortheprogressoftraineestoensurethatthesessionisproviding\

adequateandappropriatelearningacvies.Monitoringreferstofollowingeachtrainees’

acviesandexperiences.

1.Logbooks or monitoring recordsareveryusefultoolformonitoringtrainees’progress duringtheduraonofthecourse.Itcontainsalistofskillsortasksthattraineesshould

beabletoperformorexperience,providingastandardizedtoolfortrackingtheirskills

developmentthroughoutacourse.Thefacilitatorassignedwillrecord/checkoeachskill

ortaskinthelogbookaerthetraineeperformsorcompletesitcorrectly.The

facilitatorwilltakenote/annotatespecicskillsincorrectlydone,whichcanbeuseas

guideinprovidingperformancefeedback.Annexes7.__and7.__areexamplesadapted

forMSPTraining.

2.Performance Reportisastandardizedtoolthefacilitator/clinicalinstructorcanuseto

providefeedbackontrainees’performance.Ratherthanprovidinginformaononvery

specicskills,traineesperformancereportssummarizeperformanceingeneralareasand majorskills.Ageneralfeedbackformmaybeusedtoassesstrainees’overallperformance.

Annexes4.4and4.5areexamplesadaptedforMSPTraining.

Well-organizedtrainingcoursethatisstructuredbasedonthelearningobjecvesprovides

traineeswithimportantopportuniestodevelopskillsrelevanttotheirfutureworkin

thehealthcareseng.Oerparcipantsavarietyoflearningexperienceswithinthe

classroomandatpraccumsites.Monitortrainees’progresstoensurethateachsession

providesthemwithappropriatelearningacvies.

2.6. Using Results to Improve Performance

Skillsareassessedtodeterminewhethertraineesarecompetentinthecorelearningobjecves

neededforapplicaoninworksengs.Assessmentsaimtoimprovetheperformanceoftrainees.

Monitoringinformaonisusuallycollectedinfouraspectsofteaching:

A.Content.Doesthecontentmatchtheexpectedoutcomesforthecourse?Doesthe

contentbuildonexisngknowledge,atudes,andabiliesoftrainees?Dotrainees

believethenewknowledge,skills,andatudesareusefulandapplicable?

B.Context.Arenecessaryfacilies,resources,andequipmentavailableduringthe

training?Isteachingconsistentwithwhatisbeingtaughtinother,relatedcourses?

Isthereaclearlinkbetweentheclassroomandthepraccalorskillsdevelopment

componentsofthecourse?

C.Process.Wasthecourseorganizedandtaughtinalogicalway?Whatmethodsand

materialswereusedforteaching,learning,andtraineeassessment?Weretraineesable

topraccethecompetenciesandreceiveperformancefeedback?



D.ImmediateOutcomes.Whathavetraineesachievedasaresultofthecourse?Werethe

learningobjecvesachieved?Dotraineesdemonstratetheexpectedlevelsof

knowledge,skills,andatudes?

Monitoringisdenedasaconnual processofgatheringinformaonforpraccaljudgment

anddecision-making.Evaluaonistheperiodicassessmentoftheoverallprocessandnalresults ofatrainingcourse.Resultsofevaluaonsshouldbeusedtodemonstratetowhatextentthe

resourcesinvestedintrainingproducedtheexpectedeect.Thefollowingarethe4maintypesof

evaluaons:

202



EVALUATION TOOLS

PRE- AND POST-TEST

COURSE EVALUATION





Individual Assessment

Name/symbol: Date:

Posion:

I. True or false. Write true it the statement is correct and false if it is incorrect.

1.Micronutrientsareproducedbyourbody.

2.odinedeciencydisorderisthemostwidespreaddeciencyinthecountryandmostprevalentamonginfants,pregnant,nursingwomen,theolderpersons,

childrenandadolescentgirls.

3.AtrisktovitaminAdeciencyarenon-breasedinfants,underweightchildren,

andchildrenwithillnesses,childrenwithparasicinfestaonandpopulaon

groupsaectedbyemergencies/disasters.

4.Irondeciencyanemiainpregnantwomenwillleadtomiscarriages,premature

births,intrauterinegrowthretardaons,lowbirthweights,reducedabilityto

surviveprolongedbleeding

5.ZincandvitaminAsupportshealthyimmunesystemtopreventdiseasesand

infecons.

6.VADissllconsideredapublichealthproblemamong6monthsto5yearold

despitethedecreaseintheprevalence.

7.Childrenwithmeaslesshouldbegiven2vitaminAcapsules,1capsuleupon

diagnosisregardlesswhenthelastVACwasgivenandanothercapsuleaer24

hours.

8.Mild,moderateandseverelyunderweightchildrenshouldbegivenVACupon

diagnosesexceptwhenchildwasgivenlessthan4weeksbeforediagnosis

9.InfantsundersixmonthswithdiarrheashouldbegivenReformulatedORSand

20mgzinconceadayfornotlessthan10days.

10.Infants6-11monthsshouldbegiven15mgelementalirononceadayfor3

months.

11.Children12-23monthsoldarepriorizedforironsupplementaonbecauseof

thehighprevalenceofirondeciencyforthisagegroup.

12.Women10-49yearsoldmustbegivenironfolicacidsupplements1tabletonce

aweekoncemenarchestartsandunltheygetpregnant.

13.InMalariaendemicareas,womenshowingsignsandsymptomsofmalaria

shouldbetreatedwithmalariadrugsrstbeforegivingthemironsupplements.

14.Adultslivinginareaswithmoderatetosevereschistosomiasisshouldbegiven

irontabletswith400ugfolicacidtwiceadayfor30daysaeradministeringthe

praziquanteldrug.

15.Thegoalsofhealthpromoonandcommunicaonaretocreatesupporve

environment,provideaccessibleuserfriendlyMSservices,increasedemandfor

MSservices.

16.Deliveryofmicronutrientsupplementaonpackagesintegratedintoexisng

MNCHNservicesisdemonstratedbyprovisionofmicronutrientsupplements

forchildrenduringprenatal/postnatalcheckup.

205



17.ThemajordeliverysengsofMicronutrientSupplementaonpackageare

healthcarefacilies,outreachservices,campaignsandtemporaryshelters.

18.Noteveryoneisvulnerabletomicronutrientdeciency.

19.AhealthfacilitythatisClient–friendlyforMSservicesisonewhereinMSis

integratedintorounehealthservices.

20.Supporvesupervisioniscarriedoutinarespeculmannerusingsupervisory

visitsasopportuniestoimprovestaperformance.

21.Competenceofhealthserviceproviderscanbemetbyhavingclearjob

descriponandexpectaons,training/orientaonMSandsupporve

supervision.

22.Zincsulphatetablets/soluonsdonotrequirespecialstorage.

23.DecisionsinprovidingMSservicesarelessdependentonaccurateandproperly

recordedandreporteddata.

24.CompungtherequiredMSsuppliesandcommodiesisbasedonactual

populaon.

25.Folicacidshouldbegiventoawomanassoonasshegetspregnant.

II. Mulple choices. Encircle the best answer.

1.Thefollowingaresomeoftheguidingprinciplesinmicronutrientsupplementaonstatedinthe

AOonMicronutrientsupplementaonissuedonApril19,2010except:

a.Systemsapproachd.Integratedservicedelivery

b.Communityandpeopleparcipaone.Rightsbasedapproach

c.Evidenced-based

2.Micronutrientsupplementaonshallbeadoptedasanintervenontoaddressmicronutrient

malnutrioninwhichofthefollowingcondions:

a.Prevalenceforaparculargrouporenrecountryisatalevelofpublichealthsignicance

b.Economiccrisis

c.Inmesofdisastersoremergencies

d.a&b

e.a&c

3.Thefollowingshouldbepriorizedformicronutrientsupplementaonexcept

a.Lowbirthweightinfants d.Femaleadolescents(10-14yearsold)b.6-59monthsoldchildren e.Nonpregnant/nonlactangwomenof

c.6-9yearsoldchildrenreproducvehealth(15-49yearsold)

4.TheinialstepinintegrangMSservicesintotherounehealthcareservicesis:

a.historytaking d.monitoringandevaluaon

b.Assessment e.physicalexaminaon

c.validaon

206



5.Postpartumwomenshouldbegiven1tabletofironfolicacidonceaweekunlonegetspregnant

again.Theironfolicacidshouldcontainthefollowing:

a.60mgelementalironwith400ugfolicacid

b.60mgelementalironwith250ugfolicacid

c.60mgelementalironwith2.8mgfolicacid

d.60mgelementalironwith300mgfolicacide.60mgelementalironwith500mgfolicacid

6.Twoiodizedoilcapsuleswillbegiventopregnantwomenonceayearonlyexceptin

a.IDDPrevalenceisclassiedasmoderateorsevere

b.Crenismadneonatalhypothyroidismarepresent

c.Inareaswith100%iodizedsaltulizaon

d.Universalsaltiodizaonprogramwillnotreachwomenofreproducveagewithin2years

e.Inareaswherelessthan90%ofhouseholdsareusingiodizedsaltandmedianurinaryiodineis

100ug/lamongschoolchildren

7.ThephysicalexaminaononaclienttodetermineneedforMSortreatmentfocusonwhat

regions/partsofthebody.

a.abdomen d.b&c

b.headandneck e.a&c

c.skin

8.AlternaveservicedeliverysengsforMicronutrientsupplementsare:

a.ClinicsinWorkplace d.a&bb.Teencenters e.a&c

c.Hospitals

9.Micronutrientsupplementaonisbestprovidedduringdisastersandemergenciesby:

a.Deliveringthemicronutrientsupplementsindesignatedevacuaoncenters

b.Givingmicronutrientsupplementstoaectedfamiliesatthehealthcenter

c.Conducngfollowupoffamiliesnotinevacuaoncentersinhouseholdsorfamilieshosngthem

duringthedisasterperiod

d.a&b

e.a&c

10.Whichofthefollowingcontainsallofthesenutrients-vitaminA,iron,folate,iodineandzinc?

a.shd.meat

b.milke.shellsh

c.eggyolk

207



Individual Assessment (Answer Key)

Name/symbol: Date:

Posion:

I. True or false. Write true it the statement is correct and false if it is incorrect.

F 1.Micronutrientsareproducedbyourbody.

F 2.odinedeciencydisorderisthemostwidespreaddeciencyinthecountry

andmostprevalentamonginfants,pregnant,nursingwomen,theolderpersons,

childrenandadolescentgirls.

F 3.AtrisktovitaminAdeciencyarenon-breasedinfants,underweightchildren,

andchildrenwithillnesses,childrenwithparasicinfestaonandpopulaon

groupsaectedbyemergencies/disasters.

T 4.Irondeciencyanemiainpregnantwomenwillleadtomiscarriages,premature

births,intrauterinegrowthretardaons,lowbirthweights,reducedabilityto

surviveprolongedbleeding

T 5.ZincandvitaminAsupportshealthyimmunesystemtopreventdiseasesand

infecons.

T 6.VADissllconsideredapublichealthproblemamong6monthsto5yearold

despitethedecreaseintheprevalence.

T 7.Childrenwithmeaslesshouldbegiven2vitaminAcapsules,1capsuleupon

diagnosisregardlesswhenthelastVACwasgivenandanothercapsuleaer24

hours.

F 8.Mild,moderateandseverelyunderweightchildrenshouldbegivenVACupon

diagnosesexceptwhenchildwasgivenlessthan4weeksbeforediagnosis

F 9.InfantsundersixmonthswithdiarrheashouldbegivenReformulatedORSand

20mgzinconceadayfornotlessthan10days.

T 10.Infants6-11monthsshouldbegiven15mgelementalirononceadayfor3

months.

T 11.Children12-23monthsoldarepriorizedforironsupplementaonbecauseof

thehighprevalenceofirondeciencyforthisagegroup.

T 12.Women10-49yearsoldmustbegivenironfolicacidsupplements1tabletonce

aweekoncemenarchestartsandunltheygetpregnant.

T 13.InMalariaendemicareas,womenshowingsignsandsymptomsofmalaria

shouldbetreatedwithmalariadrugsrstbeforegivingthemironsupplements.

F 14.Adultslivinginareaswithmoderatetosevereschistosomiasisshouldbegiven

irontabletswith400ugfolicacidtwiceadayfor30daysaeradministeringthepraziquanteldrug.

T 15.Thegoalsofhealthpromoonandcommunicaonaretocreatesupporve

environment,provideaccessibleuserfriendlyMSservices,increasedemandfor

MSservices.

T 16.Deliveryofmicronutrientsupplementaonpackagesintegratedintoexisng

MNCHNservicesisdemonstratedbyprovisionofmicronutrientsupplements

forchildrenduringprenatal/postnatalcheckup.

208



T 17.ThemajordeliverysengsofMicronutrientSupplementaonpackageare

healthcarefacilies,outreachservices,campaignsandtemporaryshelters.

F 18.Noteveryoneisvulnerabletomicronutrientdeciency.

T 19.AhealthfacilitythatisClient–friendlyforMSservicesisonewhereinMSis

integratedintorounehealthservices.

T 20.Supporvesupervisioniscarriedoutinarespeculmannerusingsupervisory

visitsasopportuniestoimprovestaperformance.

T 21.Competenceofhealthserviceproviderscanbemetbyhavingclearjob

descriponandexpectaons,training/orientaonMSandsupporve

supervision.

F 22.Zincsulphatetablets/soluonsdonotrequirespecialstorage.

F 23.DecisionsinprovidingMSservicesarelessdependentonaccurateandproperly

recordedandreporteddata.

F 24.CompungtherequiredMSsuppliesandcommodiesisbasedonactual

populaon.

F 25.Folicacidshouldbegiventoawomanassoonasshegetspregnant.

II. Mulple choices. Encircle the best answer.

1.Thefollowingaresomeoftheguidingprinciplesinmicronutrientsupplementaonstatedinthe

AOonMicronutrientsupplementaonissuedonApril19,2010except:

a.Systemsapproachd.Integratedservicedelivery

b. Community and people parcipaone.Rightsbasedapproach

c.Evidenced-based

2.Micronutrientsupplementaonshallbeadoptedasanintervenontoaddressmicronutrient

malnutrioninwhichofthefollowingcondions:

a.Prevalenceforaparculargrouporenrecountryisatalevelofpublichealthsignicance

b.Economiccrisis

c.Inmesofdisastersoremergencies

d.a&b

e. a & c

3.Thefollowingshouldbepriorizedformicronutrientsupplementaonexcept

a.Lowbirthweightinfants d.Femaleadolescents(10-14yearsold)b.6-59monthsoldchildren e.Nonpregnant/nonlactangwomenof

c. 6-9 years old children reproducvehealth(15-49yearsold)

4.TheinialstepinintegrangMSservicesintotherounehealthcareservicesis:

a.historytaking d.monitoringandevaluaon

b. Assessment e.physicalexaminaon

c.validaon

209



5.Postpartumwomenshouldbegiven1tabletofironfolicacidonceaweekunlonegetspregnant

again.Theironfolicacidshouldcontainthefollowing:

a.60mgelementalironwith400ugfolicacid

b.60mgelementalironwith250ugfolicacid

c. 60 mg elemental iron with 2.8 mg folic acid

d.60mgelementalironwith300mgfolicacide.60mgelementalironwith500mgfolicacid

6.Twoiodizedoilcapsuleswillbegiventopregnantwomenonceayearonlyexceptin

a.IDDPrevalenceisclassiedasmoderateorsevere

b.Crenismadneonatalhypothyroidismarepresent

c. In areas with 100% iodized salt ulizaon

d.Universalsaltiodizaonprogramwillnotreachwomenofreproducveagewithin2years

e.Inareaswherelessthan90%ofhouseholdsareusingiodizedsaltandmedianurinaryiodineis

100ug/lamongschoolchildren

7.ThephysicalexaminaononaclienttodetermineneedforMSortreatmentfocusonwhat

regions/partsofthebody.

a.abdomen d. b & c

b.headandneck e.a&c

c.skin

8.AlternaveservicedeliverysengsforMicronutrientsupplementsare:

a.ClinicsinWorkplace d. a & b b.Teencenters e.a&c

c.Hospitals

9.Micronutrientsupplementaonisbestprovidedduringdisastersandemergenciesby:

a.Deliveringthemicronutrientsupplementsindesignatedevacuaoncenters

b.Givingmicronutrientsupplementstoaectedfamiliesatthehealthcenter

c.Conducngfollowupoffamiliesnotinevacuaoncentersinhouseholdsorfamilieshosngthem

duringthedisasterperiod

d.a&be. a & c

10.Whichofthefollowingcontainsallofthesenutrients-vitaminA,iron,folate,iodineandzinc?

a.shd.meat

b.milk e. shellsh

c.eggyolk

210



Training Evaluaon Form

Tohelpusimprovethequalityofourtraining,wewouldappreciateyourfeedback!

Pleaseindicateyourresponsetothequesonsbelowbycirclingtheappropriatenumber,with1=MOST

NEGATIVEand5=MOSTPOSITIVE:S+

Name/Symbol:

1. Was your interest held? 12345

2. Do you have a beer understanding of:

a)Healthgoals,objecvesandtargetsonmicronutrient

supplementaon

12345

b)TheMicronutrientSupplementaonProgram 12345

c)KeyprovisionsoftheMicronutrientSupplementaonGuidelines 12345

d)StatusofMicronutrientSupplementaon 12345

e)Eectsofcommondecienciesonvulnerablepopulaon 123453. Did the course give you ideas about how to: 12345

a)Assesssignsofmicronutrientdeciencies/riskfactors 12345

b)Diagnose/classifydeciencies 12345

c)DetermineappropriateMSpackageforthedierentagegroups

andthoseinlifestages/condionsrequiringMS

12345

d)IdenfykeymessagesonMSappropriatetoclients’need 12345

e)ProvideMSservicesinvariousdeliverysengs 12345

f)IntegrateMSservicesinrounehealthservicesandprograms 12345

g)FormulateanaconplanforeecveimplementaonofMS

program

12345

h)HarmonizeaconplansofServiceProvidersandSupervisors 12345

4. Overall, how would you rate the course? 12345

5. Would you recommend this course to others? 12345

6. What did you like most about the course?

7. What would you recommend changing about the course?

8. Now that you have completed this course, what addional training (if

any) would be helpful?

9. Other comments, observaons, suggesons:

Thank you for your feedback!

211



SAMPLE LETTER to Center for Health Development (CHD)

Date:______________________

To:________________________

RegionalDirector

CenterforHealthDevelopment____

Address:____________________

DearDirector_________________:

TheProvinceof____________________,withtechnicalassistancefromUSAID’sA2Zproject,will

conductaTrainingofServiceProvidersontheImplementaonofMicronutrientSupplementaon(MS)

Programin_________________on____________.Theobjecveofthetrainingistoassisthealthservice

providersenhancetheircompetenciesonimprovingimplementaonoftheMSprogramconsideringthe

newguidelinesissuedbytheDepartmentofHealth(DOH)anditsmanualofoperaons.Micronutrient

supplementaonisoneoftheeecveintervenonstoachievetheMillenniumDevelopmentGoals.

Inthisregard,maywerequest______________,_______________and______________,trainerson

MSintheregiontoassistintheconductofthetrainingaswellasaendthefacilitatorsmeengon

______________.

Thankyouverymuchforyourutmostsupporttothisacvityandbestregards.

Verytrulyyours,

_______________________

(NameofGovernor)

_________________

(Posion)



SAMPLE LETTER to City Health Oce (CHO)

Date:______________________

To:________________________CityMayor

CityHealthOce

Address:____________________

DearMayor_________________:

TheProvinceof_______________________,withtechnicalassistancefromUSAID’sA2Zproject,will

conductaTrainingofServiceProvidersontheImplementaonofMicronutrientSupplementaon

(MS)Programin____________on_____________________.Theobjecveofthetrainingistoassist

healthserviceprovidersenhancetheircompetenciesonimprovingimplementaonoftheMSprogramconsideringthenewguidelinesissuedbytheDepartmentofHealth(DOH)anditsmanualofoperaons.

MicronutrientsupplementaonisoneoftheeecveintervenonstoachievetheMillennium

DevelopmentGoals.

Inthisregard,maywerequest_____________________and_________________whoweretrainedon

thenewMSguidelinesanditsmanualofoperaonsbyDOH,withtechnicalassistancefromA2Zproject

ofUSAID,tobefacilitatorsduringthetrainingandaendthefacilitatorsmeengon_______________.

Maywealsorequestthemtofacilitatetheconductofeldpraccuminve(5)healthcentersof

__________on________________inthemorning.Therewillbe10-12parcipantsandfacilitators

visingperhealthcenter.Duringthepraccum,theparcipantswillsee2-3clientswithriskfactorsor

signsofmicronutrientdeciencies,providehealthpromoonandprevenonservices,interviewhealth

centersta,observeclinicset-up/clientowandreviewpernentrecordsandreports.


Verytrulyyours,

Verytrulyyours,

_______________________

(NameofMayor)

_________________

(Posion)



SAMPLE LETTER to Municipal Health Oce (MHO)

Date:______________________

To:________________________MunicipalMayor

Municipalityof________________

Address:____________________

DearMayor_______________:

TheissuanceofAdministraveOrder(AO)No.2010-0010bytheDepartmentofHealthin2010

whichprovidedtheoverallpolicydireconontheMicronutrientSupplementaonProgram(MSP)

willsignicantlycontributetoaccelerangeecveimplementaonoftheMSPinreachingmore

clients.Thus,contribungtothereduconofdeathsamongmothersandchildren.Thispavedthe

wayfortheneedtoupdateserviceworkersontheircompetenciesinimplemenngthemicronutrient

supplementaonprogram.Todate,thelasttrainingconductedonMicronutrientSupplementaonwas

in1992,whiletechnicalupdateswereperiodicallyconductedwithintheinterimperiodtosupportthe

healthworkers.Hence,thecapacity-buildingwasorganizedbytheprovincewithtechnicalassistance

fromCHD__,USAID’sA2Zprojectandtomeetthetrainingandinformaonneedsofserviceprovidersto

enablethemtoimproveimplementaonoftheMSP.

Inthisregard,maywerequestMs.___________________andMs.___________________toaend

thetrainingon_________________in_____________.


Verytrulyyours,

_______________________

(NameofMayor)

_________________

(Posion)



SAMPLE LETTER of Praccum

Date: ______________________

To: ________________________City Mayor

City of ________________

Address: ____________________

Dear Mayor _______________:

The _________________in coordinaon with CHD ________, with technical assistance from USAID’s

A2Z project, will conduct a Training of Service Providers on Implementaon of Micronutrient

Supplementaon Program in __________on ____________. The training modules use a variety of

teaching-learning methods including lectures, working in small groups using discussions, role-plays,pracce exercises and actual facility-based pracce sessions.

In this regard, may we request your permission to have the praccum exercises in three (5) health

centers of _________ in the morning of _______________. There will be 10- 12 parcipants and

facilitators vising per health center. During the praccum, the parcipants will see 2-3 clients with

risk factors or signs of micronutrient deciencies, provide health promoon and prevenon services,

interview health center sta, observe clinic set-up /client ow and review pernent records and

reports.

We are looking forward to a favorable response on this request.

Thank you and warm regards,

Very truly yours,

_______________________

(Name of Mayor)

_________________

(Posion)



CHECKLIST OF THINGS TO PREPARE FOR SUPPORT STAFF

NAME OF MODULE /

SESSION NUMBER

TEST QUESTIONS, CASE

SCENARIO, GAMES, CHECKLISTS,

ANSWER KEYS

EQUIPMENT, SUPPLIES,

FACILITATOR/JOB AIDS

NOTES/

REMARKS

Day 1

Arrival/Registraon AendanceIDTrainingkit

Pre-trainingAssessment Pretest

OpeningProgram LCDandLaptop

Prepare1boxofsuppliesforeachgroup(metacards,pentelpens,scissors,

maskingtape)

MODULE 1

Session1.“GengtoKnow”andFormaonofTeams

Game•Instruconsheet(pptpresentaon)•Pptpresentaononsessionobjecves

•HumanBingocards•LCDprojector•Laptop

Game,andgroupdiscussion

Distributebingocards

Session2.SharingExpectaonsandSengGroupNorms

•Expectaons/5quesons(TrainingManual)

•5colorsofmetacards(Green,Yellow,Pink,OrangeandBlue)

•Manilapaper(matrix)•Maskingtape•Pentelpens•Whiteboardmarkers•Whiteboard(foreachgroup)

Postthematrixinthewhiteboard/

wall

Session3.Orientaontothecourseandthecoursematerials

•Copiesoftrainingdesign•PptpresentaononsessionobjecvesTraining design

•LCDprojector•Laptop

Lectureanddiscussion

Distributetrainingdesign

MODULE 2

Session1.BasicInformaononMicronutrients

•MOP•Quesonsandguidelinesforthesessionexercises•Pptpresentaononsessionobjecvesandtechnicalinputs

•5Worksheets(FunconsandFoodSourcesofMicronutrients)•Markers•Manilapaper•LCDprojector•Laptop

Lecturediscussion,quesonandanswer

Postthematrixinthewhiteboard/wall



NAME OF MODULE /

SESSION NUMBER



ANSWER KEYS



NOTES/

REMARKS

Session2.Causes,consequencesandprevenonofMNdeciencies

•MOP•Quesonsandguidelinesfortheexercises•Pptpresentaononsessionobjecvesandtechnicalinputs

•5Worksheets(Idenfyvulnerable/mostaectedgroups,causesandconsequencesandwaystopreventdecienciesanddiarrhea)•Markers•Manilapapers•Maskingtape•LCDprojector•Laptop

3.MagnitudeofMNdeciencyproblem

•MOP•Currenthealth/stascaldataonnutrionandMSdeciencies(Casescenario:MunicipalN)

•Workshopguidelinesandworksheets•Pptpresentaon(sessionobjecvesandtechnicalinputs)•SelectedquesonsrelevanttoRHMlevel

•Worksheets(IdencaonofFactors/BarriersandPossibleSoluons)•Markers

•Manilapaper•Maskingtape•LCDprojector•Laptop

LecturediscussionGroupdiscussion

Workshop

Distributecopiesofcase scenariomunicipalNandindicatorsPostthematrix

Day 2

MODULE 3

Session1.MSPgoals,

policyandimplemenngguidelines

•DOH-AONo.2010-0010

•MOP•Latestdata/guresonMSnaonalgoalsandtargets•Instrucons,quesonsandkeyanswersforthegameexercise

•Workshopmatrix(Grp1

-GuidingPrinciples,Grp2and3–GeneralGuidelines,Grp4-RolesandFuncons)•Marker•Newsprint•Maskingtape•Whiteboard

Lecture

discussion,game(ndit)groupdiscussion/groupwork

Session2.ProvidingEssenalMSPackageforinfants,children,women,mothersand

otheradults

•MOP•DOH-AONo.2010-0010•Casescenariosfordiscussions(10-15quesonsfororaldrill)

•Oraldrill Lecturediscussion,quesonandanswer,oral

drill,gameSession3.HealthPromoonandPrevenononMS

•MOP•Pptpresentaononsessionobjecvesandtechnicalinputs•Scenarioswithkeyanswersforthegroupwork

•LCDprojector•Laptop•Copyofcasescenarios

Lecturediscussion andsmallgroupdiscussion

Distributecasescenario



NAME OF MODULE /

SESSION NUMBER



ANSWER KEYS



NOTES/

REMARKS

PRACTICESESSIONFORM-2&3

Prepare2-3Case/RolePlayScenariosforModules2&3+answerkeys

•Metacards•Maskingtape•Pentelpens

Prepare1boxofsuppliesforeachgroup(metacards,pentelpens,scissors,maskingtape)

MODULE 4

Session1.DeliveryofMSIntervenoninDierentSengs

•MOP•Pptpresentaononsessionobjecves,generalguidelinesandexampleofwaysonhowtointegrateMSPinalternaveservicesengs

•HumanBingocards•LCDprojector•Laptop

Lecturediscussion,roleplay,demonstraon,casestudies,smallgroupexercises anddiscussions

Session2.IntegrangMSIntervenoninRouneClinicServices

•Pptpresentaon•Observaonchecklist•Clientrecordform/ITR•Casescenario/studyforreturndemonstraonofassessment•Copiesofowchart

•LCDprojector•Laptop•Manilapaper•Markers•Tape•BPapparatus•Stethoscope•Alcohol•Handtowel

LecturediscussionDemonstraonandreturndemoSmallgroupdiscussion/work

Distributecopiesof

scenario andforms

PRACTICESESSIONFORM-4

Prepare2-3Case/RolePlayScenariosforModule4+answerkey

MODULE 5

Session1.Delivering

QualityMSservices

•MOP

•Pptpresentaononsession

objecvesandtechnicalinputs

•Listoffactors/barriersfrom

Module2•ChecklistonqualityMScare

and services


Lecture-discussion,smallgroupdiscussion anddrill

Distributecopiesofscenario

Day 3

Praccum •Forms(Observaonchecklist,stainterviewchecklist,recordsreview)

•Forms•a.m.snacks•vehicle/van•nameofhealthcenters

Preparesnacks(takeoutforpax)



NAME OF MODULE /

SESSION NUMBER



ANSWER KEYS



NOTES/

REMARKS

Printnameofhealthcenterpergroupandpostinfrontofvehicle(van)

Session2.DeliveringMSServicesbyCompetentandResponsiveServiceProviders

•MOP•Pptpresentaononsessionobjecvesandtechnicalinputson

job/roleclaricaoninprovidingMSservicesandtraining•Listofsamplehealthfacilitysituaons/condionswithkeyanswersforthedrill•Flashcardsonroles,funcons,performanceofservices

providersandsituaonsneedingsupervision

•Flashcards

•LCDProjector

•Laptop

Lecture-discussionSmallgroupdiscussion

Session3.HealthFacility

EnvironmentSupporve

toMSP

•MOP

•Pptpresentaononsession

objecvesandtechnicalinputs

•Listofsamplehealthfacility

situaons/condionswithkey

answersforthedrill

•Samplerecordsandreports

onMSP,correctly,incorrectly,

incompletelylled-up

•Sampleexercisesforthe

computaon

•LCDProjector

•Laptop

•Copiesofexercises

Lecturediscussion andsmallgroupdiscussions

Day 3.5

Session4.SupervisingDeliveryofMSService

•MOP•Pptpresentaon(sessionobjecvesandtechnicalinputsonsupervisionCasescenarioson1.FacilityservicesandperformanceinMS2.StaperformanceinMs

supp3.Clientconcernsonstabehaviorandpracces,MSservicesandfacilityorganizaon

•LCDProjector

•Laptop

Lecture

discussion and

smallgroup

discussions

Oral drill

PRACTICESESSIONFOR

M-5

Prepare2-3Case/RolePlayScenariosforModule5+answerkeys



NAME OF MODULE /

SESSION NUMBER



ANSWER KEYS



NOTES/

REMARKS

MODULE 6

Session1.Planning

forImprovingMSP

Implementaon

•MOP•Pptpresentaononsession

objecvesandtechnicalinputs•Aconplantemplatesforserviceprovidersandsupervisors


•Manilapaper(templateofaconplan)

Individual

acvity

Plenarydiscussion

Postthematrix

Session2.Harmonizing

AconPlansof

Service Providers and

Supervisors

•MOP•PptpresentaononsessionobjecvesandtechnicalinputsAconplantemplatesforserviceprovidersandsupervisors

•LCDprojector•Laptop•Manilapaper(templateofaconplan)

Dyad:supervisor-superviseesharingPlenarydiscussion

Postthematrix



REFERENCES

(Note:Thissllneedupdangand/orcorrecons)

BandaranayakeB.(2001).Studyskills,inAPraccalGuideforMedicalTeachers.DentJAandRMHarden

(eds).ChurchillLivingstone:NewYork,pp410–411.

BarrowsHS.(1990).Inquiry:Thepedagogicalimportanceofaskillcentraltoclinicalpracce.Medical

Educaon24:3–5.

BarrowsHSandRMTamblyn(1980).P-BL:AnApproachtoMedicalEducaon.SpringerPublishing

Company:NewYork.

Dale E (1969) Cone of experience in Educaonal Media Theory into Pracce Wiman RV (ed) Charles

Documents

Facilitator's Guide Draft 081811