Interpersonal Communication Skills for IPDs

Workshop Guide for Vaccination Teams, Supervisors & Community Social Mobilizers

Sara Krosch UNICEF/STOP Communication Consultant July 2010

Strengthening Routine Immunization: Interpersonal Communication (IPC) Skills for Immunization Plus Days Vaccination Teams, Supervisors & Community Social Mobilizers

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Table of Contents Why a Training Guide for IPC ........................................................................................................................ 3 Workshop Aim & Objectives ......................................................................................................................... 3 Workshop Participants & Facilitators ........................................................................................................... 3 Workshop Schedule ...................................................................................................................................... 4 IPC Skills Monitoring ..................................................................................................................................... 5 Session 1: Ways to Stop Polio (optional) ...................................................................................................... 6 Session 2: What are IPC Skills (mandatory) .................................................................................................. 7 Session 3: Three Parts to IPC Skills (mandatory) ........................................................................................... 9 Session 4: Answering Questions about Polio (mandatory) ......................................................................... 11 Session 5: Making Changes (optional) ........................................................................................................ 12 Handout: Three Parts to IPC ........................................................................................................................ 13 Checklist: IPC Monitoring ............................................................................................................................ 14 Developed by Sara Krosch, UNICEF/STOP Communication Consultant for Giwa LGA, Kaduna State, Nigeria July 2010 For more information contact sarakrosch@yahoo.com Illustrations courtesy of AIDS Alliance publication Tools Together Now.

Strengthening Routine Immunization: Interpersonal Communication (IPC) Skills for Immunization Plus Days Vaccination Teams, Supervisors & Community Social Mobilizers

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Why a training Guide for IPC- Individual and family health is very personal. If we are to eradicate polio from Nigeria, Africa, and the world, health care workers must actively engage caregivers and influential leaders. Interpersonal communication (IPC) skills are invaluable in gaining the voluntary and sustained acceptance of vaccine for many diseases that threaten to infect, disable or kill our children. Health care workers and Community Social Mobilizers must be respectful, confident , knowledgeable when interacting with caregivers and leaders. When IPC skills are not consistently and appropriately practiced, non-compliance in accepting polio vaccine and other health interventions is likely to occur. Recently, independent monitors have observed infrequent, incomplete and inappropriate interpersonal communication skills practiced during Immunization Plus Days (IPDs). All Vaccination Team Members, Supervisors, and Social Mobilizers must believe in the importance of IPC skills and practice them with every caregiver, in every setting in order to build meaningful partnerships. We can all develop and improve our IPC skills. After participating in this workshop, participants are to be monitored during IPDs using the IPC Evaluation Checklist. Staff failing to practice IPC skills completely and appropriately should receive supportive supervision. Failure to practice IPC skills with caregivers should result in dismissal from future IPDs. Workshop Aim- To strengthen the IPC skills of Vaccination Team Members, Supervisors and Community Social Mobilizers in order to encourage vaccination compliance during IPDs Workshop Objectives-

• Session 1- To discuss different strategies and roles needed to end polio in Nigeria • Session 2- To understand what IPC skills are and appreciate the benefits of using them • Session 3- To rehearse the 3 main components of good IPC skills for polio vaccination • Session 4- To practice answering common questions about polio and polio vaccine • Session 5- To assess changes needed for polio to be eradicated

Workshop Participants and Facilitators- The training sessions found in this guide are intended to be used with Vaccination Team Members (House-to-House Teams, Special Teams and Fixed Post Teams), Team Supervisors, and Community Social Mobilizers. It is assumed that participants will be aware of polio and have basic literacy skills. All participants are expected to confidently demonstrate the skills taught in the sessions during IPDs. The sessions in this guide are designed to actively involve attendees, so full participation in all sessions should be highly encouraged. Failure to engage in activities in the training setting is a strong indicator of failure to practice IPC skills with real caregivers.

Strengthening Routine Immunization: Interpersonal Communication (IPC) Skills for Immunization Plus Days Vaccination Teams, Supervisors & Community Social Mobilizers

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This training should be provided before each IPD for all regular and temporary staff. It is vital that the actual vaccination team members participate in these sessions--not only their Supervisors or Ward Focal Persons--to ensure those individuals interacting with caregivers have been provided the proper guidance in IPC skills. Participants may have limited or no English language skills so the sessions are best facilitated by someone who speaks the local language or co-facilitated by at least one person who is fluent in English and the local language. Facilitators should make the sessions as interactive as possible avoiding lectures. Workshop Schedule- This manual contains 3 mandatory sessions and 2 optional sessions. The entire workshop is meant to be completed in 1 day, over 5 hours. Begin the workshop with a prayer, introductions and an energizer activity. Explain the aim and objectives of the training. End the workshop by gathering feedback on the participants’ experience. Close with a prayer. Sessions can be adapted and additional content should be added as necessary.

Session Methods Materials Time Category 1) Ways to Stop Polio

brainstorming, discussion flipchart, markers 20 mins Optional

2) What are IPC Skills?

discussion flipchart, markers 40 mins Mandatory

3) Three Parts to IPC discussion, role playing peer assessment

handouts 90 mins Mandatory

4) Answering Questions about Polio

role playing, peer teaching none 90 mins Mandatory

5) Making Changes

debate/discussion signs, chalk 30 mins Optional

Possible Opening Energizers-

• Sing a song most participants know

• Polio Eradication Cheer: Give me a P-O-L-I-O. What are we going to do? Kick it out of Nigeria! (stand and kick)

Possible Closing Activities-

• Say one new thing you learned or a question you still have

• Ask what was the favorite or most useful session and why

• *Repeat opening energizer

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IPC Skills Monitoring- Following successful completion of the workshop, all Vaccination Team Members, Supervisors and Community Social Mobilizers should be monitored using the following IPC Skills Monitoring Checklist. Completed checklists and recommendations should be shared with observed staff so that immediate improvements can be made. Checklists should also be submitted through established channels for collation and analysis in State and National databases. (Participants will use this form for peer assessment when observing role plays during Session 3.)

IPC Monitoring Checklist State LGA Ward Observation Date

Monitor’s Name

Monitor’s Title Observation Location

Person Observed Role Vaccination Team Member Team Supervisor Community Social Mobilizer

DIRECTIONS- Observe staff member interacting with caregivers in 3 households. Do NOT offer any advice until AFTER you have observed 3 households. Then, share your 3 recommendations with the staff member. Household 1 Household 2 Household 3 1) Greets caregiver politely/respectfully

Yes No Yes No Yes No

2) Explains purpose for visit/campaign

Yes No Yes No Yes No

3) Asks each mother how many children they have are under 5 years (including visiting mothers)

Yes No Yes No Yes No

4) Asks if any children under 5 years are sleeping

Yes No Yes No Yes No

5) Asks if any children under 5 years are absent

Yes No Yes No Yes No

6) Asks if any children under 5 years are visiting

Yes No Yes No Yes No

7) Asks if there any children under 5 years who have never taken polio vaccine

Yes No Yes No Yes No

8) Asks if any children under 15 years in settlement who has weakness or is paralyzed

Yes No Yes No Yes No

9) Advises vaccination of all children under 5 years during every polio round for added protection

Yes No Yes No Yes No

10) Advises routine immunization of all children under 1 year at local health center (which days)

Yes No Yes No Yes No

11) Answers basic questions about polio and vaccine Yes No Yes No Yes No 12) Uses simple, clear, local language to ensure caregiver understanding

Yes No Yes No Yes No

13) Thanks caregivers for their cooperation

Yes No Yes No Yes No

Recommendations 1)____________________________________________________________________________________________ 2)____________________________________________________________________________________________ 3)____________________________________________________________________________________________

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Session 1-Ways to Stop Polio Purpose: To brainstorm a variety of ways polio can be stopped and to understand no one strategy will accomplish this goal. To stress the role participants have in stopping polio. Materials: flipchart markers, tape Time: 20 minutes OPTIONAL Session Steps: 1) Explain that several things are needed for polio to be stopped in Nigeria. 2) Brainstorm as a large group different things that can be done to help stop polio. Ask each participant to contribute at least one idea. 3) Record answers on flipchart paper. 4) Put the ideas in categories: health services, health education, healthy environment, healthy behaviors, advocacy, resources, etc. 5) Ask: How can Vaccination Teams, Supervisors and Social Mobilizers help stop polio? Note the role participants play in the strategies on the poster. 6) Display paper.

STOP POLIO

IPDs

Hand washing

Teach parents about importance of vaccines

RI

Enough vaccine

Leaders support

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Session 2-What are IPC Skills? Purpose: To understand what is meant by ‘IPC skills’ and to appreciate benefits of practicing good IPC skills to eradicate polio Materials: flipchart markers, tape Time: 40 minutes MANDATORY Session Steps: 1) Ask: What does IPC mean? 2) Discuss the following definition written on flipchart paper:

• Inter-personal: person-to-person, a conversation • Communication: 2-way, giving and receiving information with words and gestures • Skills: something that can be learned, practiced and improved

3) Ask participants to think of a person they know with good IPC skills. How would they describe this person? (friendly, good listener, knowledgeable, truthful, respectful, ect.) Record answers as WHAT IPC IS on flipchart paper. 4) Discuss these questions and record answers on flipchart paper: WHO should we use IPC skills with? WHEN should we use our IPC skills? WHERE should we use our IPC skills? WHY should we use good IPC skills? (Create cooperation, improve compliance, increase health knowledge, persuade caregivers, answer questions, reduce concerns, address rumors, respond to problems) 5) Decide what the Goal of IPDs is. 6) Ask Why are good IPC skills not used in RI and IPDs? Record these as obstacles on the IPC road towards reaching our goal. Discuss ways to remove these obstacles in order to reach the goal. 7) Ask What can happen if we do not overcome these obstacles and we do not practice good IPC skills? (Non-compliance, entire settlement is vulnerable, more polio cases, other diseases and death, our work becomes more difficult, etc.)

Strengthening Routine Immunization: Interpersonal Communication (IPC) Skills for Immunization Plus Days Vaccination Teams, Supervisors & Community Social Mobilizers

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WHAT

WHO

WHEN

WHERE

WHY

IPC

Goal Settlement ________________

IPC Road

NO IPC Settlement

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Session 3-Three Parts to Good IPC Skills Purpose: To understand and practice the 3 main components of good IPC skills for polio vaccination Materials: IPC handout, IPC Monitoring Checklist, flipchart paper, markers

Time: 90 minutes MANDATORY Session

Steps: 1) Explain that IPC has 3 main parts: WHAT you say, HOW you say it, and HOW you look 2) Ask participants- What do you say to a caregiver during an IPD? 3) Discuss the following and provide this information on a handout. WHAT you say-

A. Introduce yourself B. Explain you are vaccinating all children under 5 years for polio C. Explain polio causes paralysis or death (show picture) but it can be prevented with a safe vaccine D. Ask the 5 Key Questions:

Are there any children under 5 years here? vaccinate, finger-mark, give plus, record regular and zero dose Are any of these children visiting from another place? vaccinate, finger-mark, give plus, record as “other” Are any children sleeping? record as redo, return to house Are any children absent? record as redo, return to house Have you ever seen a paralyzed child in this settlement or a child who has trouble walking? record, report cases to Supervisor for AFP surveillance

E. Encourage RI services (vaccine schedule and HC days) F. Thank the caregiver for vaccinating their child.

4) Ask participants to turn handouts over and recall all necessary IPC steps/messages/questions (A-F). 5) Create a way of remembering the 5 key questions using fingers on one hand. 6) Explain that IPC is not just WHAT is said but HOW the message is delivered. Discuss the following:

HOW you say it- Be friendly, smile Use a polite and respectful tone of voice Speak in the language of the caregiver Use simple words Good eye contact Listen to the caregiver Answer questions Be patent 7) Finally, discuss the importance of how one should dress and appropriate body language with caregivers.

HOW you look- Wear clothing similar to community members

Wear IPD apron or other uniform Body language: welcoming, culturally appropriate Clean appearance, hands

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8) Practice: Divide participants into teams (house-to-house, special team, fixed post/RI clinic). Assign other participants to be caregivers and children under 5 years. Role play IPC skills in each setting. Explain the IPC Monitoring Checklist. Participants not involved in the action are to complete the checklist while they observe different groups role playing. 9) Monitors offer 3 recommendations to the role playing team after completing each scene. 10) Based on observations and experiences, make a list of things Vaccination Teams, Supervisors and Social Mobilizers should NOT say or do on flip chart paper and display.

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Session 4-Answering Questions about Polio Purpose: To practice answering common questions about polio and polio vaccine Materials: polio education slides Time: 90 minutes MANDATORY Session Steps: 1) Explain that many times caregivers will have questions about polio and polio vaccine. Just because a parent accepts vaccine for their child does not mean they have a good understanding of the disease or how to prevent it. It is our job to provide basic health education that caregivers can easily understand. Sometimes we must creative with simple drawings, photos, stories or songs to teach about health. 2) Brainstorm a list of common polio and polio vaccine questions OR add to the list below. Ask: Are other common questions caregivers ask about polio and vaccines? List these on flipchart paper. (I never see polio so why is it important?) How would you answer these questions and encourage compliance? 3) Assign individuals or pairs 1 question they will need to educate the others who will act as a group of caregivers. Provide 10 minutes to prepare. Encourage creativity in presentations and remind participants to use simple, clear language and continue to practice other good IPC skills. 4) After presentations, discuss how effective presenters were in answering the question and assess their IPC skills. Decide how vaccination teams will handle questions they do not know the answer to. What is polio? What causes polio? How can polio be stopped? What are the signs of polio? Is polio vaccine safe? Why is polio vaccine only for children under 5? Why must my child have many doses of OPV? What other vaccines are available for my child? Other Common Questions:

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Session 5-Making Changes Purpose: To assess changes needed for polio to be eradicated and leave participants feeling hopeful in their contributions Materials: chalk or tape, signs Time: 30 minutes OPTIONAL Session Steps: 1) Explain that several changes will need to happen for Nigeria to be free of polio. Some changes are easy for individuals, communities and countries to make and some changes are more difficult. 2) Draw a line on the floor or on a chalkboard. At one end write “easy” and at the other end write “difficult.” 3) Ask individuals or pairs of participants to stand for each statement. Read the ‘Polio Change Statement’ and ask the two participants to move along the line between ‘easy’ and ‘difficult’ to express their opinion. 4) Ask participants why they feel that change would be easy or hard? What support is needed to make these changes easier? How could they contribute to making this change possible? Change Statements 1) All households (in my Ward, in Giwa LGA…)to be compliant in accepting OPV during the next IPD. 2) All children under 5 years will receive OPV during the next IPD. 3) All settlements will have good sanitation (toilets) and clean water. 4) All households will practice regular hand washing with soap. 5) All children under 1 year will be fully immunized at Health Centers with all vaccines. 6) Vaccination Teams will practice good IPC skills with caregivers. 7) All mothers will receive health education about polio and other vaccine-preventable illnesses. 8) Nigeria will be polio-free.

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WHAT you say- A. Introduce yourself B. Polio vaccine for all children under 5 years C. Polio causes paralysis or death (show picture) but it can be prevented with a safe vaccine D. Ask the 5 Key Questions:

Are there any children… under 5 years here? vaccinate, finger-mark, give plus, record regular/zero dose sleeping? record as redo, return to house visiting? vaccinate, finger-mark, give plus, record as “other” absent? record location of child, record as redo, return to house with paralyzed arms or legs? record, report cases to Supervisor for AFP surveillance

E. Encourage RI services (vaccine schedule and HC days)

F. Thank the caregiver for vaccinating their child.

HOW you say it- Be friendly, smile Be patient, polite and respectful Speak in the language of the caregiver Use simple words Good eye contact Listen to the caregiver

HOW you look- Wear clothing similar to community members

Wear IPD apron or other uniform Body language: welcoming, culturally appropriate Clean clothing, hands, vaccine carrier, etc.

IPC HandoutWHAT you say HOW you say it HOW you look

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IPC Monitoring Checklist State LGA Ward Observation Date

Monitor’s Name

Monitor’s Title Observation Location

Person Observed Role Vaccination Team Member Team Supervisor Community Social Mobilizer

DIRECTIONS- Observe staff member interacting with caregivers in 3 households. Do NOT offer any advice until AFTER you have observed 3 households. Then, share your 3 recommendations with the staff member. Household 1 Household 2 Household 3 1) Greets caregiver politely/respectfully

Yes No Yes No Yes No

2) Explains purpose for visit/campaign

Yes No Yes No Yes No

3) Asks each mother how many children they have are under 5 years (including visiting mothers)

Yes No Yes No Yes No

4) Asks if any children under 5 years are sleeping

Yes No Yes No Yes No

5) Asks if any children under 5 years are absent

Yes No Yes No Yes No

6) Asks if any children under 5 years are visiting

Yes No Yes No Yes No

7) Asks if there any children under 5 years who have never taken polio vaccine

Yes No Yes No Yes No

8) Asks if any children under 15 years in settlement who has weakness or is paralyzed

Yes No Yes No Yes No

9) Advises vaccination of all children under 5 years during every polio round for added protection

Yes No Yes No Yes No

10) Advises routine immunization of all children under 1 year at local health center (which days)

Yes No Yes No Yes No

11) Answers basic questions about polio and vaccine

Yes No Yes No Yes No

12) Uses simple, clear, local language to ensure caregiver understanding

Yes No Yes No Yes No

13) Thanks caregivers for their cooperation

Yes No Yes No Yes No

Recommendations 1)___________________________________________________________________________________ 2)___________________________________________________________________________________ 3)___________________________________________________________________________________