TRAINING GUIDE
Item
- Title
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TRAINING GUIDE
- extracted text
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IN-SERVICE TRAINING
OF
BLOCK EXTENSION EDUCATORS
IN
COMMUNICATION AND COMMUNITY PARTICIPATION
RAINING GUI
r A1
DEVELOPED BY
THE HEALTH AND FAMILY WELFARE
TRAINING CENTRE, SAMBALPUR
IN COLLABORATION WITH
THE LIVERPOOL SCHOOL OF TROPICAL MEDICINE
UNDER THE
AREA DEVELOPMENT PROGRAMME
GOVERNMENT OF ORISSA
I i
A Guidebook for
In-service Training of Block Extension
Educators In Communication and Community
Participation
Developed by the
Health and Family Welfare Training Centre,
Sambalpur in collaboration with the
Liverpool School of Tropical Medicine, UK
under the
Area Development Programme, Government of
Orissa
Liverpool School of Tropical Medicine
Foreword
The Area Development Project in Orissa is a part of a country-wide programme undertaken by the
Government of India in 45 selected districts of different states. All area projects arc guided by a
model plan developed by Government of India. Following this model Government of Orissa had
identified 5 districts and worked out a five-ytiar project which in turn was implemented in the State
since the year 1980-81. The long-term objectives of the Area Development Programme were to
reduce birth rates and infant and child mortality rates by improving the health status of the people
through extensive provision of health and nutritional care, along with other Family Welfare
services. In order to achieve these objectives, it was necessary to strengthen the available
infrastructure, and develop human resources by provision of management training to the Medical
Officers and job-oriented skills to all categories of health personnel engaged in the delivery of
Primary Health Care in the State.
Though a formal training programme for health workers was continuing in the State long before
implementation of the Area Development Programme, soon after mid-term review in the year 1983
the need of a special input in the area was felt necessary. In order to develop a suitable training
programme for Medical Officers and key health workers through the health training institutions of
the State, Government of India, British Aid Agency (ODA) and the Government of Orissa took a
joint decision for collaboration with an external agency with expertise in the field. Accordingly the
Liverpool School of Tropical Medicine (UK) was identified, and with their consultancy service,
work has been going on in the State to develop and implement training courses for Medical
Officers, Health Assistants (male and female) and Block Extension Educators. The institutions
identified for training programmes are Rural Health Centre, Jagatsinghpur and Health and Family
Welfare Training Centre, Sambalpur. While the former institution is devoted to the training of
Medical Officers and Health Assistants, the latter is solely engaged for course development and
training of Block Extension Educators.
J'
Over the last 18 months, the courses have been implemented, evaluated, revised, modified and
improved and taught to many Medical Officers, Block Extension Educators and Health Assistants.
One of the fruitful achievements of this training programme has been the production of training
manuals for each course. These manuals are primarily intended for use by the staff of the Training
Centres for the training of the Primary Health Care Staff in Orissa. The manual for in-service
training of Block Extension Educators is a valuable and essential document for the training
institutes as a guide and reference manual. However, much of the material contained in this manual
may be of use to others who may recognise the need for pre-service and continuous training of field
staff in management and communications.
During the process of preparation of this manual willing help and assistance have been extended by
many institutions and individuals to whom the undersigned is grateful. Lastly, I also convey my
gratitude to Government of India, ODA and Professors and Consultants of Liverpool School of
Tropical Medicine for their support and participation in the success of this venture.
Signed
Director, Family Welfare, Orissa
6 September 1986
i i
Introduction
This simple training guide has been prepared to assist participants attending this short, intensive,
in-service training programme, to achieve maximum benefit, and also to help them to
follow easily the development of the training sequence.
It is divided into six units which, if carefully examined, will be found to be closely interconnected,
and designed to address the felt needs, which were established after institutional and field
investigations, involving Block Extension Educators, their supervisors, other PHC workers, and
the communities with which they intcr-rclate, and are directly related to the officially stated job
functions of the Block Extension Educators.
The guide incorporates a working manual for trainers and participants and a workbook for
participants, - a training guide which participants can use in due course for the preparation of their
educational training, and other motivational interventions for PHC staff and communities, and also
a source of reference material. It is therefore intended that it be reproduced and given to each
participant attending these courses, in parts as appropriate, depending on the length of time
allocated for this course and how the sessions were to be conducted as the course progressed, so
that at the end of the course each participant would have worked through the entire six units and,
in the process, compiled a complete guidebook. For shorter courses teachers would have the
choice of distributing the guidebook as a whole at the beginning of the course to help participants
in the preparation for sessions.
Early participant evaluations have consistently demanded more time - a lengthening of the in
service training period. This guide has therefore provided enough material, which, if suitably
modified in terms of the time given to each session, and the degree of depth of theoretical and
practical investigations, will also cater adequately for lengthened training periods.
To assist jn the process of continuing course evaluation and future modifications, participants arc
requested to complete carefully the course evaluation instrument provided at the back
of the guide.
All texts recommended for background and further reading arc available in the special course library
of this institution and participants arc encouraged to make full use of them during this course.
Dr (Mrs) K K Dei, Principal
Health and Family Welfare Training Centre
Sambalpur
Orissa
i 1
Acknowledgments
In the process of preparing this guidebook, several persons and agencies were approached and
contributed greatly to its completion. The Course Development Team at the Rural Health and
Family Welfare Training Centre, Sambalpur wishes to record its thanks to these contributors.
The production of the final text was a joint effort of the entire team.
1
Dr Kanak Swain MBBS
Medical Lecturer-cum-Dcmonstrator
2
Mr Dibakar Pradhan MA, M.Ed
Senior Health Inspector
3
Mr Girish Chandra Mohanta MA, DHE, DSSM
Social Science Instructor
4
Mr Surjyananda Singh Deo, Diploma in Sanitary Science
Senior Sanitarian
5
Mr Ranjanigandha Dei
Deputy Mass Education and Information Officer, Sambalpur
6
Sven C Stayers
Consultant, Liverpool School of Tropical Medicine
1J
Contents
Session
number
1
]Introduction to the course 9
2
The role of the Block Extension Educator in the promotion of Primary Health Care 10
Unit I Planning for Effective Communication
3
4
5
6
7
8
9
Purpose and value of Community Survey 16
Elements of Community Survey 18
Process of Community Survey 20
Preparation of mini-survey 22
Mini-Community Survey - Fieldwork 25
Preparation of Survey findings for presentation and analysis 26
Presentation and preliminary interpretation of survey data 31
Unit II Knowing Your Audience
10
11
12
Identification of the Target Groups 34
Communication modes and channels 37
Customs, Traditions and Folk Beliefs as they affect community
reaction to motivational programme 39
Unit III Talking to Clients
13
14
15
Barriers to effective communication 46
Techniques of Interviewing 54
Meeting and motivating hard-to-reach and resistant groups and individuals 59
Unit IV Working with Others
16
17
18
19
The value of inter-agency co-operation and co-ordination 62
Assessing EC in-service training needs for health service personnel 65
Training needs survey in nearby PHC facilities 68
Presentation of Survey Reports 70
Unit V Aids to Communication
20
21
22
23
24
25
26
27
28
29
Methods of Communication 72
Communication Aids 77
Using and Maintaining Audio-Visual equipment 90
Outlining EC Training plans for health personnel 91
Selection, design and pretest of methods and aids for EC community prevention 101
Preparation for micro-teaching exercise 106
Micro-teaching exercise 119
Health Worker Training 120
Community Motivational Intervention - Fieldwork 122
Evaluation of teaching motivational exercises 123
Unit VI Community Participation
30
31
32
33
34
Community dynamics and participation 126
Rationale for the involvment of the community in the provision
of its own health needs 130
Important enhancers and inhibitors to Community Participation 134
Community Participation - Case Studies I 142
Community Participation - Case Studies II144
i 1
Appendices
Subject
In-service training programme for Block Extension Educators in communication and
community participation: Design and Implementation Structure of Training Course 147
Sample questionnaire for collecting information needed for Health Education 153
II
Health UNIT (PHC, Dispensary etc) Utilisation questionnaire 157
in
Questionnaire to find out different attitudes towards Community Health 159
IV
Organisation of Opinion Leaders Training Camp 161
v
VI
Sample pre-test 165
vn Weekly Course Evaluation Form 169
vni Teaching Material - End of Course Evaluation Form 171
IX(i) Draft Plan for Post Training Follow-Up activities of BEEs
trained in Communication and Community participation 173
IX(ii) Post training follow-up activities schedule: Questionnaire 175
IX(iii) Post training follow-up evaluation schedule: Questionnaire 177
I
Abbreviations
CDT Course Development Team
IEC Information, Education, Communication
Community Participation
CP
CHV Community Health Volunteer
CHW Community Health Worker
TBA Traditional Birth Attendant
I i
Session 1
Introduction to course
Worksheet
Instructional objectives
At the end of this session participants should be able to :
understand the design and implementation structure of the course of training they arc about to
begin.
understand the assessment and evaluation procedures to be used during the course, and
afterwards during post-course follow-up activities.
appreciate the experience, interests, and expectations of other course participants with regard to
the training course.
Activities
1
Delivery of welcome statement (CDT)
2 Personal introductions by individual participants including brief statements on experience,
interests and expectations
successes, problems etc (5-10 minutes per person). (Participant expectations should be noted
by the Course Development Team.)
3 Issue of training guidebooks, course books, general information files, and stationery.
4 Discussion on :
- the general information file (containing information on such matters as registration, timetable,
accommodation, facilities, extra-curricular activities, assessment items, statement of overall course
objectives, and an outline of the design and implementation structure of the course).
the design and implementation structure of the training programme during evaluatory
meetings which ideally should be held by members of the CDT at the end of each day’s
proceedings; efforts should be made to modify course material wherever possible to cater for
relevant individual participant expectations (compare with stated participant expectations),
assessment and evaluation method to be employed.
5 Participant enquiries answered.
6 Pretest - 25 Multiple choice questions (45 mins).
Materials
Stationery, guidebooks (or relevant parts of), course books, MCQ papers.
Teaching Aids
General Information file.
Assessment
Questions and answers.
Background Reading
1 General information file which ideally should have been received by participants one week in
advance of the date of commencement of the course.
2 Design and Implementation Structure of the Training Course - (See Appendix 1).
9
i i
Session 2
The Role of the Block Extension Officer in the
Promotion of Primary Health Care
Worksheet
Instructional Objectives
At the end of this session the participants should be able to:
recognise officially stated job functions.
divide their job functions into appropriate operational categories.
clarify misconceptions with regard to what they might previously have considered to be their
job functions.
recognise the role these functions arc expected to play in the promotion of Primary Health
Care.
Activities
Distribute copies of official job functions for Block Extension Educators to participants.
Study and discuss (in pairs).
3
Exercise: (whole class with teacher, or small group activity)
divide stated official job functions into different operational categories :
planning
(P)
guidance and training
(gat)
implementation
(i)
co-ordination
(c)
evaluation
(e)
management of materials
(m)
reporting
(r)
Use handout provided - Handout I
4 Discuss : - Analysis of questionnaires completed by the Block Extension Educators during the
course development survey (Handout 2).
5 Short lecture:- Concept and structure of Primary Health Care in India (Handout 3).
6 Discussion :- Identify the role of the Block Extension Educator in the promotion of Primary
Health Care (small group).
1
2
Materials
Transparencies, felt tipped pens (for OHP).
Teaching Aids
Overhead projector, handouts.
Assessment
Small group production of statements on :
I
different functional categories.
II role of Block Extension Educator in the promotion of Primary Health Care.
Background Reading
Handout:
1 Official job description - Block Extension Educators.
2 Analysis from BEE's Field Survey Questionnaire regarding job functions.
3
Strategics for the implementation of PHC in India.
10
4 1
Handout 1
Job Description of Block Extension Educators
Working relationship
The Block Extension Educator will function under the technical supervision and guidance of
District Extension and Media Officer*. However, he would be under the immediate administrative
control of the Medical Officer I/C PHC. He will be responsible for providing support to all
National Health & Family Planning Programmes in the PHC, but his main functions will relate
to the promotion of FW & MCH Programmes.
Duties and functions
1 He will have with him all information relevant to development activities in the block,
particularly concerning Health and Family Welfare, and utilise the same for programme planning.
2 He will develop his work plan in consultation with the Medical Officer of his PHC and the
concerned Dy. Distt Extension and Media Officer*.
3 He will collect, analyse and interpret the data in respect of extension education work at the
block level.
4 He will be responsible for regular maintenance of records of educational activities, tour
programmes, daily diaries and other registers, and ensure preparation of display of relevant maps
and charts in the PHC.
5 He will assist the Medical Officer In-charge in conducting training of Health Workers under
various schemes.
6 He will be a member of the local Block Level Family Welfare Committee and act as a
resource person.
7 He will assist Block Medical Officer/MO of PHC in ensuring proper functioning of all
committees in the catchment area of the PHC.
8 He will organise orientation training for Health & Family Welfare workers, opinion leaders,
local medical practitioners, school teachers, dais and others involved in Health & Family Welfare
work.
9 He will organise mass communication programmes, like film shows, exhibitions, lectures
and dramas with the help of the Distt Extension and Media Officers.
10 He will monitor preparation and updating of eligible couples registering in PHC areas and
alert MO PHC of any deficiency existing so that correcting measures can be taken immediately.
11 He will be squarely responsible for all educational, motivational and communication
programmes in PHC area and his efficiency will be assessed on his output as far as these activities
are concerned.
12 He will supervise the work of field workers in the area of education motivation.
13 He will supply educational material to health workers in MPW districts and to FPHAS in the
non MPW districts.
14 He will tour for 15 days in a month with a minimum of one night halt in every field worker’s
area.
15 While on tour he will also check the available stock of conventional contraceptives with the
depot holders and the kit with MPWs and other health functionaries.
16 He will help field workers in winning over-resistant cases and drop-outs.
17 He will maintain a complete set of educational aids for his own use and for training purposes.
18 He will organise population education and health education sessions in schools and for out-of
school youth
19 He will maintain a list of prominent acceptors of family welfare methods and opinion leaders
village-wise and try to involve them in the promotion of health and family welfare programmes.
20 He will prepare a monthly report on the progress of educational activities in the block and
send it to the District EMO.
Source: Job responsibilities of Staff of the Primary Health Centre.
Rural Health Division,
Ministry of Health and Family Welfare,
Government of India.
New Delhi. 1986.
* District Extension and Media Officer (DEMO) is equivalent to Mass Education & Information
Officer (MEIO) in Orissa.
x Deputy District Extension and Media Office (DY.DEMO) is equivalent to Deputy Mass
Education and Information Officer (DY.MEIO) in Orissa State.
11
1 j
Handout 2
Analysis from BEE’s Field-survey
Questionnaire Regarding Job Functions
Misconception regarding job function
Supervision of lower level health workers in their medico-clinical functions (problem
especially with Health Assistants).
Demand for training in administration.
Sole organiser (most of the time) for sterilisation and other camps.
The work of the Health Assistants and lower cadres of PHC staff, technical and non-technical,
should be supervised by BEE's.
Responsible for the follow-up of post-operation cases of sterilisation.
Reasons for dissatisfaction
No teaching aids, models etc.
Availability of A/V equipment in working order not guaranteed.
Non co-operation of Dais,VHG’s and Opinion Leaders, Teachers, Block Development Officers
etc.
Low status in Health Service.
No clear idea of duties.
No one to take grievances to.
No clear lines of administrative communication eg with Mass Education and Information and
Education Officers.
No control over the Health Workers (male and female) - so they do not respect their directives.
Analysis from BEE's Field-survey Questionnaire Regarding Job Functions
Expressed need of BEE's
More technical knowledge in Public Health subjects.
Information about relevant developments in other slates in India and outside of India.
Training in treatment of minor ailments/first aid.
Regular refresher courses.
Opportunity for promotion (upward mobility in the service).
Job description should be officially established at central level.
Appropriate educational materials (kits and A/V aids) should be supplied.
Training in use of A/V aids.
Training in adult education techniques (especially for work with women).
How to overcome adverse propaganda agents in Family Wclfarc/Public Health and Maternal
and Child Health programmes.
12
...
11
Handout 3
Strategies for the implementation of Primary
Health Care programmes to move towards the
goal of Health for All by the Year 2000AD
in India
1 Universal provision of promotive, preventive and basic curative services. The preventive and
public health aspects shall have to be secured through well-organised programmes of
HEALTH EDUCATION, especially in connection with prevailing health problems.
2 Organising special plans to provide HEALTH CARE including FAMILY PLANNING to the
vulnerable groups, ie CHILDREN AND PREGNANT WOMEN.
3 Prevention and control of endemic COMMUNICABLE AND NON-COMMUNICABLE
diseases.
through immunisation (EPI target diseases);
through appropriate measures (LEPROSY, TUBERCULOSIS, GOITRE AND CURABLE
BLINDNESS);
interrupting of transmission of vcctor-bomc diseases (MALARIA, FILARIA AND KALAAZAR);
reduction of diarrhoeal-diseases mortality through application of oral rehydration therapy and
of INTESTINAL PARASITIC INFESTATION MORBIDITY THROUGH ENFORCEMENT
OF APPROPRIATE COMMUNITY MEASURES.
4
Activities directed toward the PROMOTION OF FOOD SUPPLY AND THE
IMPROVEMENT OF NUTRITIONAL STATUS.
5 Provision of PROTECTED WATER SUPPLY and SANITARY DISPOSAL of EXCRETA.
6 POPULATION EDUCATION to enable people to appreciate, adopt and consciously
PRACTISE THE SMALL FAMILY NORM as part of the way of life.
Source:
Report of the working group on Health for all by year 2000 AD in India.
Government of India
Ministry of Health & Family Welfare
25th March 1981.
13
Unit I
Planning for effective communication
y
15
Session 3
Planning for Effective Communication:
Purpose and Value of Community Survey
Worksheet
Instructional objectives
At the end of this session participants should be able to
list the purposes for community survey relevant to their job functions.
deduce the value of community survey to them as Health Educators and Communicators.
Activities
Teacher introduced discussion. Question and answer to introduce a rationale for community
1
health survey (whole class).
Small group discussion - production of written statement on purposes of community survey.
2
3 Individual group presentations - with the aid of prepared flip charts or transparencies.
4 Repeat 1 - 3, * produce written statements on *value1 of community survey
5 Summarise - using handout
Materials
Flipchart paper, transparencies, felt pens, markers.
Teaching Aids
Overhead projector, handout
Assessment
Oral or written responses - name six important factors which should be investigated in a small
community health survey.
Background Reading
Handout - Purpose and value of community survey.
Teaching for Better Learning - F.R. Abbatt. (Section 1 - Chapter 3)
Further Reading
Studying your Community R.L. Warren (Chap.18 p.p. 306 - 312)
Community Diagnosis and Health Action edited by Professor FJ. Bennett - (Section I).
16
11
Handout 1
Purpose and Value of Community Survey
Generally speaking, community surveys can be used for the purpose of analysing the community.
This means that we are able to look closely at any of several aspects of community life and habits,
and how these affect the community’s ability to control its own development.
More specifically with respect to the work of the Block Extension Educator, community survey
and subsequent diagnosis can be of value since it
1
2
3
Provides a basis for planning for IEC programmes.
Provides a structure for the design, implementation and supervision of EC programmes.
Provides a basis for the evaluation of EC programmes.
Such a survey should look at
- Demographic factors:
Which give a good overall picture of conditions and circumstances in the community.
- Educational factors:
To find out what the community knows and understands, and would like to know more about, with
respect to general public health matters.
- Social factors:
The functions which various groups and individuals perform in the community, interpersonal
relationships, the influence of rank and status.
- Economic factors:
What the community produces and trades with to earn its income.
- Cultural factors:
The effect that community traditions, cultural habits and folk beliefs have on the behaviour of the
people - the ways in which communication is accomplished in the community and the channels
through which communication travels.
- Agricultural factors:
What the community eats, how the food is produced, stored, prepared for eating and distributed.
- Health factors:
Common disease patterns, health services, utilisation of health services, felt needs of the
community etc.
- Environmental factors:
Water, housing, sanitation and vectors of communicable disease.
17
11
Session 4
Planning for Effective Communication:
Elements of Community Survey
Worksheet
Instructional objectives
At the end of this session participants should be able to
identify the different elements of community survey,
divide these elements down into separate functional tasks.
Activities
1
Lecture/discussion - identify elements.
2
Small group study - read handout and discuss.
Assessment
Question and answer.
Materiak
Transparencies, pens.
Teaching Aids
Handout, chalkboard, overhead projector.
Background Reading
Handout - ’Elements of Community Survey’.
Further Reading
Community Survey - Mini Manual: a separate instruction booklet has been prepared by the BEE
Course Development Team at Sambalpur RHFWTC.
18
11
Handout 1
Elements of Community Survey
1
Advance preparation
Selection of community (villagc/villages).
Notify date and time to community before commencement of survey.
Collect paper and other supplies.
Prepare survey instrument (Questionnaire usually)
Pretest for comprehension and suitability.
2
Sampling technique
Make decision about size of survey.
Either the whole population or chosen by sampling procedure.
Use a simple sampling method whenever possible (see Community Surveying - data
collection - survey and samples in Mini-Manual).
3
Data collection
Conduct field work for data collection.
Information collected should be recorded on questionnaire.
Interview respondent in a polite manner.
Ensure accuracy, completeness and reliability in data collection.
All facts and figures should be checked after recording.
4
Data tabulation and presentation
Tables should be as simple as possible.
Tables should be clearly labelled.
Totalling, averages and other statistical information should be incorporated in the report.
As far as possible they should be easily interpreted.
Presentation of data can also be in the form of histograms, frequency curve/polygon, maps,
charts etc.
5
Data analysis
Conversion of data into language, message, information.
Interpretation of findings should be clear and concise.
19
A1
Session 5
Planning for Effective Communication:
Process of Community Survey
Worksheet
Instructional Objectives
At the end of this session participants should be able to :
identify steps to be taken in conducting a community survey.
put them into a logical sequence.
describe the components of community diagnosis.
Activities
1
Brainstorming - identify 'steps', discuss, complete list.
2
Individual exercise - put into logical sequence.
3
Snowballing discussion - refine logical sequence.
4
Final process statement developed.
5
Summarise using handout
Alternatively
1
Individual exercise - give steps in handout on 'process' in disorganized sequence.
2
Ask participants to put into logical sequence.
Class Discussion
Using handout on 'Aspects of Community Diagnosis' - what aspects of the community should
come under scrutiny which would be of special interest to the Health Educator.
Assessment
Question and Answer - justify 'process' and 'components'.
Materials
Transparencies, flipchart paper, pens, markers.
Teaching Aids
OHP, handouts.
Background Reading
Handout 1 The Process of Community Diagnosis.
Handout 2 Aspects of Community Diagnosis.
Further Reading
1 Planning and organising a Health Survey. A guide for Health Workers - by W. Lutz for the
International Epidemiological Association, 'finding and using information'.
2 Community Diagnosis and Health Action - edited by Professor FJ. Bennett (Chapter 2).
20
u
Handout 1
The Process of Community Diagnosis
7
Steps:
Visit the community
Interact with members and community leaders.
Establish objectives of the survey.
Decide on the scope of the survey.
Plan the survey and prepare questionnaire (survey instrument).
Train survey team (use health staff especially. VHGs if possible).
Pretest survey instrument for comprehension and suitability.
Modify where necessary.
Rework survey instrument
Decide on sampling technique.
Execute survey (survey date informed to community well in advance).
Analyse data and decide on action to be taken.
Write report
Feedback to relevant individuals and groups and interpret jointly.
Follow-up in due course to keep in touch with, and record, changing conditions.
Handout 2
Aspects of Community Diagnosis
Examination of the following aspects of community life can help greatly towards diagnosing
problems related to community health.
Demography - which is the social science of people considered collectively eg Race,
1
Occupations, Habitation, Physical, cultural and intellectual conditions. Vital Rates.
The causes of sickness and death (by age and sex grouping).
2
Use of health facilities especially MCH.
3
4
Nutrition, diet and weaning practices.
Patterns of leadership.
5
The ways in which communication travels in the community.
6
Knowledge, attitude and practices of the population with regard to health related activities.
7
Conditions in the environment which have an effect on health eg water, housing and disease
8
causing organisms.
9
Diseases which are common to the specific environment.
10 The degree of community participation in the development of the community.
21
1i
1
Session 6
Planning for Effective Communication:
Preparation for Mini Survey
Worksheet
Instructional Objectives
At the end of this session participants should be able to :
prepare an appropriate checklist for organising and conducting a small community survey.
Activities
1
Revise - ’Process' (Session 5)
2
Establish survey groups. EXERCISE - Survey groups study, the examples of a
questionnaire designed to collect information which can be useful in planning IEC activities for
communities (Appendices III & IV). Discuss how such a questionnaire can be of benefit for the
planning of IEC interventions.
3
Survey groupwork - Prepare an appropriate checklist and questionnaire.
4
Individual small group PRESENTATION to rest of class. REVISE checklists and
questionnaire.
5
LECTURETTE - on ’Simple Sampling Techniques’ using Community Survey Mini
Manual.
6
Survey groups - Do exercise on sampling in Community Survey Mini Manual.
Materials
Flipchart paper, markers, transparencies, pens.
Teaching Aids
OHP, handouts. Community Survey Mini Manual.
Assessment
Construction of checklist and questionnaire.
Background Reading
1
Handout 1 - Brief checklist for organising and conducting a small community survey.
2
Handout 2 - Baseline information which can be collected by community survey relevant to
the planning for IEC intervention.
3
Handout 3 - Some simple hints on the preparation of questionnaires.
4
Sample questionnaire for collecting information needed in Health Education. (Appendix II).
5
Sample Health Unit Utilisation Questionnaire (Appendix III)
6
Community Survey Mini Manual.
7
Teaching for better learning - F.R. Abbatt. Chap. 3.
8
Requirements for good data collection - Community Survey Mini Manual.
Further Reading
Studying Your Community - R.L. Warren (Chap. 19);
Planning and Organising a Health Survey - W. Lutz for International Epidemiological Association.
22
i i
Handout 1
Brief Checklist for Organising and Conducting
a Small Community Survey
Establish scope and size.
Budget.
3
Staff required (if any). Use field staff who are familiar with and to the people.
4
Transportation.
Time (when, - for how long).
5
6
Check to see that time is appropriate.
7
Inform the community (especially the leaders) in advance and secure their sponsorship if
possible.
8
Prepare a survey instrument.
9
Conduct the field work - collect data.
10 Tabulate data.
11 Analyse data.
12 Write report.
1
2
Handout 2
Baseline Information which can be collected by
Community Survey relevant to Planning for
IEC Intervention
Demographic Information
Number of houses.
Population.
Sex ratio (by age).
Children under 5 years of age.
Education rates.
Economic status.
Birth and death rates.
Health and Family Welfare Status
Morbidity levels.
Infant and maternal mortality and morbidity levels.
Immunisation status.
Source of drinking water and the way in which it is protected (or not).
Number of wells.
Communicable disease prevalence.
Community utilisation of health facilities.
Nutritional status.
Availability of village health workers eg dais, community health workers and volunteers
Knowledge, attitudes and practices related to health and family welfare.
Communication Aspects
Radio and TV sets.
Newspapers.
Sites for posters.
Community meeting places.
Places where communication activities arc usually held.
Schools.
Cinemas.
Leaders - traditional formal and informal.
Leadership Patterns.
How information gets around in the community.
Common culture, tradition and folk beliefs.
Languagcs/dialccts.
Social groups.
23
4 i
Handout 3
Some Simple Hints on the Preparation of
Questionnaires
1
Decide as precisely as possible what you want to find out about the community.
2
Plan in advance the way in which you are going to present your findings, eg tables, maps
etc.
3
Draft individual questions for the questionnaire.
4
The questionnaire should be a blend of different types of questions. Some will be answered
simply by 'no' or 'yes', 'don't know’, 'undecided' or 'other'. In some cases however, it may be best
to give the respondent a chance to express an individual opinion. The first type has the advantage
of affording quick tabulation, but the second gets the interviewer much closer to the truth usually,
although it takes more time.
5
The wording of the individual questions should be simple and precise.
6
Avoid leading questions which would tend to make the respondent answer in a way you might
want him to.
7
Keep the questionnaire as short as possible.
8
Explain special terms which might be confusing to the respondent.
9
Pretest the questionnaire using persons preferably with similar characteristics to your intended
respondents.
10 Use the results to make necessary modifications which make the questions more
understandable and acceptable.
24
u
Session 7
Planning for Effective Communication:
Mini-Community Survey - Fieldwork Exercise
Worksheet
Instructional Objectives
At the end of this session the participants should be able to :
experience practically the process of community survey
as a member of a small team conduct a survey in a small village community.
Activities
1
Preliminary discussions with local health personnel (whose availability should be assured in
advance).
2
Examination of demographic data available at Primary Health Centre/ Sub-Centre or other
health facilities.
3 Examination of health data and records at health units.
4 Interviewing individuals from households by simple sampling technique and using prepared
questionnaires, with the assistance of local health personnel, especially locally selected
Community Health Workers.
5 Discussions with formal community leaders on relevant aspects of community life,
common customs, traditions and folk beliefs, felt health needs etc.
6 Identification of informal community leaders, discuss - for comparison with opinions of
formal leaders.
7 Take opportunity at every stage of these activities to educate health workers in the process,
purpose and value of community survey for possible IEC intervention.
Assessment
1
The way each group assigns duties to its members.
2
Individual participant performance in the conduct of survey assignments.
Team work attitude.
3
Materials
Papers, pens, questionnaires, demographic data available at health units.
Teaching Aids
Teacher prepared checklists to assess performance of survey group members.
Background Reading
1
Mini Manual - Community Surveying (Appendix II).
2
’BASELINE INFORMATION
’ (Handout 2 - Session 6).
Further Reading
Same as Sessions 5 and 6.
Community Health - J.H. Heiberg, MD (Data gathering p.34)
25
iI
Session 8
Planning for Effective Communication:
Preparation of Survey Findings for Presentation
and Analysis
Worksheet
Instructional Objectives
At the end of this session participants should be able to :
present data collected during the survey in appropriate form.
identify community needs from survey findings which could be addressed by IEC
interventions.
/
Activities
1
Study sections on data presentation, mapping, putting into tabular form, charting etc, in
Community Survey Mini-Manual.
2
Discussion (teacher led, whole class) on aspects of good examples of reports prepared by
previous course participants.
3
Display examples of such reports on the wall of the classroom for easy reference.
4
Summarise using handout on 'Format For Presentation and Analysis of Survey Report'
- Handout 1.
5
Survey groups - preparation of individual group reports.
Assessment
Group presentation
Materials
Chart paper, graph paper, transparencies, markers, colouring crayons, erasers, rulers.
Teaching Aids
Prepared transparencies on data presentation, OHP, blackboard, chartboard, Community Survey
Mini Manual, good examples of presentations from previous courses.
Background Reading
i Handout 1 - Format for presentation and analysis of survey report
2 Handout 2 - Basic Statistics.
3
Community Survey Mini Manual (presentation and interpretation of data).
26
I i
Handout 1
Format for Presentation and Analysis of Survey
Report
1
2
3
4
5
6
7
8
State objectives of the survey.
Area covered.
Sampling technique used.
Methodology used.
Instruments for data collection used.
Manpower employed.
General description of area (with a simple map).
Demographic features.
Prevailing Health and Family Welfare Status
1 Disease patterns.
2 Status of maternal and child health and family welfare programmes.
3
Status of communication programmes.
4 Existing channels and modes of communication.
5 Valuable resources.
6
Education status.
7 Description of socio-economic, cultural and ethnic factors.
8 Available voluntary and government agencies.
9 Welfare activities.
Summary and Conclusions
27
i i
Handout 2
Basic Statistics:
Some of the Rates commonly used in Vital
Statistics
1
Birth rate =
No. of live births in a year
x 1000
Mid-year population in same year
2
Crude death
rate =
No. of deaths in a year
-------------------------------------x 1000
Mid year population in same year
3
Perinatal
mortality rate =
No. of stillbirths & deaths in first seven days of life
----------------------------------------------------- — x 1000
Total births (live & still) in same year
4
Neonatal
mortality rate =
Number of deaths from birth to the age of 28 days
x 1000
No. of live births same year
5
Infant mortality
rate =
No. of deaths from birth to end of first year
----------------------------------------------x 1000
No. of live births same year
6
Stillbirth
rate =
No. of stillbirths in a year
x 1000
Total births (live & still) in same year
7
Under fives
mortality rate
No. of deaths in children aged 0-4 years
x 1000
No. of children aged 0 - 4 years in same year
8
Maternal
mortality rate =
No. of deaths in pregnancy, labour and puerperium
x 1000
No. of women aged 15 - 44 in that year
9
Fertility
rate =
No. of live births in a year
No. of women aged 15 - 44 in same year
10 Morbidity
rate =
No of persons suffering from a specific disease
-------------------------------------------------- x 1000
Population at risk* of the disease
eg Cancer of the testis excludes women in 'at risk'
11
Case mortality
rate =
No. of deaths from a specific disease
No of persons suffering from that disease
28
I
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12 Incidence
rate =
No. of new cases of a disease in a period
------------------------------------------- x 1000
Population at risk of the disease
13 Prevalence
rate =
Total no. of cases of a disease in a period
--------------------------------------------- x 1000
Population at risk of the disease
14 Population natural
increase =
Birth rate - Crude death rale
15 Population
doubling time
700
Population Natural Increase*
* for population doubling time, the Population Natural Increase (also referred to as Rate of Natural
Increase) is expressed only as the figure without the /1000
eg if Population Natural Increase is 20/1000 then population doubling =
700
= 35 years
20
Handout 3
Simple Maps
What can they illustrate which would be of interest for health communication activities?
1 Land use.
2 Depressed areas.
3 Density of population and housing.
4 Various social resources.
5 Health hazards.
6 Clusters of disease cases.
7 Traffic flow.
8 Main/subsiding roads.
9 Location of schools, recreational areas, meeting places.
10 Industrial areas.
11 Health facilities.
12 Water sources (wells, ponds, stand pipes etc).
13 Grazing area in livestock.
14 Agricultural cultivation areas.
15 Railway stations.
16 Post office.
Others (specify):
29
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Session 9
Planning for Effective Communication:
Presentation and Preliminary Interpretation
of Survey Data
Instructional Objectives
At the end of this session participants should be able to :
- present selectively the important data and information collected during the survey.
- realise the value of the exercise for the identification of areas of need which can be addressed by
EEC interventions in the communities surveyed.
Activities
1 Each survey group in turn presents its report using a chosen representative. This
representative must be supported by all other group members especially with regard to die
clarification of matters related to their special survey responsibilities.
2 Presenters use prepared transparencies, charts, maps etc to facilitate presentation.
3 Class discussion - question and answer - teacher controlled.
4 Teacher uses the opportunity to introduce techniques of clear and explicit communication of
information to a group of people.
5 Display group reports on wall boards.
Assessment
Individual group ability to present, report and defend preliminary conclusions about where EEC
interventions would be appropriate.
Materials
Transparencies, flip chart paper, felt lip pens, markers.
Teaching Aids
OHP, blackboards, prepared transparencies, flipcharts, charts, maps, graphs, etc.
Background Reading
1
Community Survey - Mini Manual.
2
Community Diagnosis and Health Action - FJ. Bennett - Feedback to the Community, p23.
31
Handout 1
Three Different Ways of Depicting the Same
Data
Age distribution of under 10 year old measles cases in an outbreak in
Rathiminda - August to December 1973
Age (Years)
Under 1
1
2
3
4
5
6
7
8
9
No. of Cases
37
73
67
36
14
29
18
8
6
2
TABLE
60
HISTOGRAM
40
20
L
L
,L
2
8
9
10
60
FREQUENCY
CURVE
40
20
32
0
1
2
3
4
5
6
7
8
9
10
'X
Unit II
Knowing your audience
y
33
Session 10
Knowing your audience:
Identification of target groups
Worksheet
Instructional Objectives
At the end of this session participants should be able to:identify target groups to which IEC programmes can ideally be directed.
use survey findings to identify priority target groups in the communities investigated.
Activities
1 Short lecturc/discussion - What is meant by a target group?
2 Small group discussion and written exercise - List all common target groups which can require
IEC intervention in the average village community.
3 Individual Group Presentations - Use the 'build-up' technique ic group reports, and the other
groups modify, eliminate from or add to this original list after discussion. Consensus - justify the
inclusion of each category on the list.
4 Finalise comprehensive list of target groups.
5 Individual participants to volunteer case studies from their own working experience. Discuss.
6 Survey groups (from Unit 1) - Identify priority target groups and individuals, from community
survey findings.
7 Note for future reference when programmes are to be formulated for IEC field work exercise.
8 Summarise referring to handout.
Assessment
Individual group ability to identify priority target groups from survey findings.
Materials
Transparencies, flipchart paper, pens, markers.
Teaching Aids
OHP, blackboard, group survey reports.
Background Reading
Handout 1 - Identifying target groups.
Handout 2 - Audience characteristics and sensitivities.
Further Reading
Talking Family Planning - A Field Workers' Handbook - International Planned Parenthood
Federation.
34
Handout 1
Identifying Target Groups
Ficldworkcrs have to be aware of differences between people so that they can make appropriate
adjustments to the way in which they send their messages, and prepare and deliver their
motivational talks to ensure effectiveness.
Some target groups for purposes of planning communication/motivational
strategies
Male groups (usually responsible for family’s economic well-being in developing countries).
Womens' groups and organisations (eg. Mahila Mandals).
Local leaders (formal and informal).
Mothers-in-law.
Grandmothers.
Traditional birth attendants (dais).
Opinion leaders.
School age groups.
Teenagers.
Young married people.
Resistant groups.
Organised labour groups.
All levels of health and family welfare personnel.
Personnel involved in other developmental agencies, government and voluntary.
Special ’at risk’ groups.
Others - (specify);
35
Handout 2
Audience characteristics and sensitivities
Characteristics
Wc can get an idea of how people think about matters which affect their lives by looking (ideally
at close quarters), at their overall environmental conditions and circumstances.
The obvious questions which must be considered arc therefore:
What arc the economic conditions of the community?
What is the major part of the work (ic income generating activity) of the community?
Is it a traditional, rural, urban, settled or nomadic community?
Is the composition of the community constantly being affected by outside influence?
How is information passed among people?
What is the level of education in the community?
What language/languagcs do they speak?
Who are the decision-makers in the family?
What arc the knowledge, attitudes and practices and preoccupation of the people at the precise
time that you are planning EC interventions?
Sensitivities
Techniques which are most likely to be successful in giving accurate and useful knowledge about a
community and which can be useful in the planning and implementation of EC programmes,
depend very much on the general attitude of the fieldworkers, which lead them to show respect for,
and a desire to understand, other people’s views and normal behaviour.
Things for fieldworker educators to remember.1 Do not enter a community with a feeling of superiority.
2 Convey an impression of 'I have come to find out, discuss, to learn’, rather than ’I have come to
tell you ...’.
3 Be patient especially in the beginning when ignorance may be demonstrated.
4 Give the impression that you are very interested in, and would like to find out as much as you
can about the language, traditions, customs and folk-beliefs of the community.
5 Do not be in too much of a hurry to gain sensitive information from people.
6 Show that you are sympathetic to individual problems.
7 Do not lose your temper in a conversation.
8 Leam how greetings and ’small talk’ should occupy a conversation before it turns to more
important matters.
9 Find out in advance when it is acceptable to invade upon the privacy of the individual.
10 Show strong respect for the attitudes of the elders in communities. They arc often very useful
in overcoming difficulties in reaching target individuals and groups.
11 Always seek appropriate acceptance into the local community by introducing yourself to formal
(and informal) leaders in the community.
The field-worker always needs to be thoroughly educated and informed about
prospective audiences in order to be able to communicate effectively.
36
Session 11
Knowing your audience:
Communication modes and channels
Worksheet
Instructional Objectives
At the end of this session participants should be able to:Identify common ways in which communication travels in local communities.
Discuss the importance of identifying and using community channels which facilitate the
passage of communication within the communities.
Activities
1 Introductory short lecture - explain ’modes' and 'channels' of communication.
2 Small group discussion - produce a list of common 'modes' and 'channels'.
3 Identify how many of these are commonly available in the communities you surveyed during
community survey field work exercise (Unit 1).
4 Discussion - (Teacher leads) The important role the community structure plays in the
dissemination of communication in communities'.
5 Summarise using Handout 2.
Assessment
Oral - questions and answers.
Materials
Flip chart paper, transparencies, markers, pens.
Teaching Aids
OHP, handouts.
Background Reading
Handout 1 - Communication modes and channels.
Handout 2 - The informal element in communities which can affect communication.
Further Reading
1 Community Participation in Family Health - Guy Roppa (pl 11)
2 Studying your Community - R L Warren (p352)
37
Handout 1
Communication modes and channels
Modes
Conversation
Discussion
Meetings
Gossip
Word-of-mouth (the ’grapevine'), idle comments
Reading
Folk media (shows, plays)
Mass media (radio, TV, filmshows)
Education media (written)
Channels
Opinion leaders (especially informal leaders)
Teachers
Satisfied beneficiaries of health services
Dissatisfied beneficiaries of health services
Mahila Mandals (women’s organisation)
Traditional health practitioners
Private medical practitioners
Social workers
Entertainers
Health personnel
Other organisations and programmes
Places
Community meeting places
Roadside teashops
Cinema houses
Wells
Market places
At home
At school
At religious gatherings
At recreational meetings (festivals, fairs etc.)
In the field, riverside, pond (at work)
At the bathing spots
Barber shops
Handout 2
The ’informal' element in community structure
which can influence communication
38
In every community there arc individuals, groups and leaders who have no formal base of influence,
but who distribute because of interest or inclination, vital information, which might not otherwise
be disseminated by the normal organised conventional mass media. This is usually done by
conversation, gossip, or idle comments and, depending on the intention of the source, can have a
positive effect of varying intensity.
These informal sources of information will have an effect upon the groups with which they
interact, usually through kinship or friendship, and so create an environment which influences to
varying degrees the climate of community opinion.
Sociological studies have demonstrated that when such individuals arc invited to events where the
intention is to test the degree to which information provided is transferred to the community, it
was found that this type of informal communication was highly effective.
Session 12
Knowing your audience:
Customs, traditions and folk beliefs as they
affect community reaction to motivational
programmes
Worksheet
Instructional Objectives
At the end of this session participants should be able to:apprcciate that useful knowledge about individuals and communities comes from a developed
ability to understand other people's customs, traditions and opinions.
relate community customs, traditions and beliefs to the development of IEC programmes.
Activities
Exercise 1
(Teacher carefully prepared - selected participants presenting.)
1 Role play - Depicting a conversation between two men on the subject of family planning. Try
to highlight as many prejudices which are associated with this sensitive issue. Ask participants to
concentrate on 'content' rather than 'acting*.
2 Record the proceedings (use tape recorder)
3 Small group exercise -1 - Play back and IDENTIFY 'positive' and 'negative' aspects of attitudes
towards this important topic.
4 Individual group reports 'Build up' technique. Produce comprehensive list
5 Small group exercise - II - Discuss ways and means of overcoming negative attitudes, and
reinforcing positive attitudes.
6 Small group exercise - III.
7 Report and discuss.
8 Exercise IV.
9 Discuss and report on questions after exercises.
Assessment
1 Group ability to identify significant customs, traditions and beliefs as they affect health
behaviour.
2 Group ability and attitude towards co-operation and problem-solving.
Materials
Suitable materials and 'props’ for the role play.
Teaching Aids
OHP, tape recorders, speakers, tape recorder cassettes, prepared role play scripts, video (if
available).
Background Reading
Handout 1 - Why are traditional values important for re-communication success?
Further Reading
Talking Family Planning - A fieldwork handbook - International Planned Parenthood Federation
Exercise III
From your experience with the local communities give examples of the following:Good customs which promote good health
Bad customs which arc harmful to health
Discuss
How good customs would be reinforced and harmful customs neutralised.
What would be your attitude towards harmless customs.
39
Exercise IV
A Baidya in a village under your supervision in your Block believes that children with fever should
be given a reduced amount of fluid especially water until the fever subsides. What are you to tell
the parents who have faith in the Baidya? How would you go about changing the belief of the
Baidya?
Other questions which can be discussed:
1 Arc there special historical festivals (melas), celebrations or memorials - occasions which excite
great community social interest, and which give vitality to community life?
2 Are there stories about customs which are practised in the local communities and about past
local events (legends) which tend to be passed on from generation to generation?
3 Are there colourful customs which are practised in the local communities by particular religious
or ethnic groups or by the communities as a whole?
40
Handout 1
Why are traditions and values important for
communication success?
1 Traditions and customs arc practices which reflect the bits of folklore which tell the story about
the history of the community.
2 They are usually passed on by word-of-mouth, mostly by the older members of the community,
and have a strong influence on the social community behaviour, which exists at any moment in
time.
3 They reflect the community’s way of looking at conventional behaviour, and those beliefs which
arc long established.
4 They help to give the community its special character which differentiates it from others.
5 They decide what situations and conditions the community finds most interesting and indicate
where the community places high values.
6 They arc important guides to ficldworkcrs (like BEEs) who are trying to motivate community
individuals to accept IEC messages.
7 Programmes can have much reduced chances of success if careful attention is not paid to
community sensitivities, traditions'and values.
41
Handout 2
Culture and Sickness
Every cultural group has its way of defining illness and disease and with this evolved the concept
of the sick role. Most of the descriptions of the sick role arc not applicable in developing
countries.
The behaviour of a family towards heal th-related matters is mainly governed by the mother's
knowledge about healthy living and also by the adherence to cultural attitudes related to health.
Health is not the mere absence of disease and informity, but as defined by the World Health
Organisation, it is a state of complete physical, social and mental well-being.
Culture defines actiological concepts of disease, methods of diagnosis and treatment. For instance,
some cultures believe that infant diarrhoea is caused by the teething process and all that the mother
need do is to boil leaves and give the potion to the infant to drink. A mother who adheres strictly
to such beliefs may fail to seek proper medical care for her baby when he gets an infection.
An educated mother on the other hand is more likely to spend a likely part of her income and time
on her children, feeding them on a properly balanced diet, clothing them suitably and looking after
their social and mental health as well. She will utilise fully the curative and preventive facilities
within her community both for herself and for her children.
Knowledge, attitudes and practices (KAP) in relation to illness
In community diagnosis, the investigator should be aware of the community beliefs and practices
about illness. Some diseases, such as epilepsy, tuberculosis, leprosy, infertility, skin conditions,
mental illness or sexually transmitted diseases, may have a stigma attached to them. Victims of
such diseases and conditions may sometimes be denied the privileges of the sick role by the
community.
The decision-making process
The investigator has to be familiar with the decision-making processes in a family and community.
In a family this is often the responsibility of the most senior male member of the household.
Women have very little influence in matters relating to the economy of the family, although they
are often the workers in the fields, and as such produce much of the food. A group of elders may
influence major decisions that affect the community. The local headmen are usually aware of this
informal power structure in their communities.
Women’s self-help groups have their own leadership patterns and an investigator needs to work
with these groups in a community. These in turn will help to communicate information from the
insvestigator to the community.
42
Handout 3
Practical aspects of investigating culture
In practice, real knowledge of a culture and society only comes after a lengthy personal exposure
with participation. The best practical suggestion is to live in the community while making the
community diagnosis (preferably with members of the community) and listen to as many people as
possible.
Another practical suggestion is to add a few questions to each questionnaire rather than to have a
separate sociocultural investigation. For example, insight into family structure can be obtained
from the demography and perhaps one or two extra questions could be asked. Information on food
and use of alcohol can be obtained within the context of the nutrition questionnaire and cultural
aspects of illness can be probed while investigating morbidity.
Extract from: Community Diagnosis and Health Action A Manual for Tropical and Rural Areas.
Edited by: Professor FJ. Bennet (available in course library)
43
Unit III
Talking to clients
45
Session 13
Talking to clients:
Barriers to effective communication
Worksheet
Instructional objectives
At the end of this session participants should be able to:~
- understand the elements of the basic communication mechanism.
- list factors which affect communication.
- state barriers to effective communication from field experience among local communities.
- practise the elementary skills of good communication.
Activities
1 Lecturette/discussion - Introduce the basic communication model.
2 Stress the importance of feedback.
3 Exercise I & II - Complete exercises and discuss their relevance to the usual interpersonal
relationships which health workers experienced with their clients. What these exercises arc designed
to teach about communication.
4 Slide Show - Slides nos. 1-15 selected from TALC set on ’Communication and Health’. Discuss
the implications on the situations depicted on each slide to the conduct of good communication.
5 Do 'Values Clarification’ exercise - In groups, discuss and answer questions which follow.
Assessment
Observation of individual and group performance during exercises.
Materials
Transparencies, markers, blackboard, chalk.
Teaching aids
OHP, blackboard, prepared transparencies on the basic communication model, printed exercises,
selected slides from TALC - ’Communication for Health’ set, slide projector.
Background reading
Handout 1 The basic communication model.
Handout 2 Barriers to effective communication.
Handout 3 The need to be clear of our own personal values.
Further reading
1 Talking Family Planning - A fieldwork handbook - International Planned Parenthood
Federation.
2 Teaching Health Care Workers - A practical guide - F.R. Abbatt and R. McMahon. (A method
for group discussion - pl68.)
46
Handout 1
The basic communication model
For effective communication, which is essential for the arrangement of IEC aspects of a health
service it is necessary that there be a two-way interaction between members of the health service
team and the community. This means that both parties should have ample opportunity to express
opinions and receive feedback.
In good communication a message is TRANSMU TED and RECEIVED.
Message
->
Receiver
Sender
Feedback
The receiver must always indicate in some way that the message has been received and understood.
It is not always most effective to send the message in the form of words: sometimes, depending on
the nature of the individual or community, other forms can be employed for example:- drama, folk
art, mime (a play without words), music and other audiovisual stimuli.
Handout 2
Barriers to effective communication
Poor communication is often the result of many different factors. The following are identified as
factors which can hinder good communication:
1 The sender has poor knowledge of the subject he is speaking about or is inadequately prepared.
2 The sender does not believe in the message, or the policy behind it
3 The sender/receiver is not interested in the subject.
4 The sender/receiver is temporarily preoccupied with some other urgent problem.
5 The unintentional failure of the sender/receiver to say clearly what they mean.
6 Sender and receiver have very different vocabularies.
7 Cultural differences between sender and receiver.
8 Sender and receiver understand the same things differently.
9 Sender/receiver has negative or hostile reaction to the other.
10 One of the communicators is ready at all times to say 'yes' to the other.
11 Lack of trust which causes the receiver to pull back from revealing personal opinions.
12 Outside interference or distractions.
13 Limited time in which to complete communication.
14 Inadequacy of vocabulary to express difficult ideas.
15 Some words having different meanings.
16 Inadequate feedback.
17 Difference in age between communicators.
18 Difference in sex between communicators.
19 Difference in culture between communicators.
20 Difference in religion between communicators.
Add others which reflect your experiences:
21
22
23
24
47
Exercise I
Purpose
To highlight the importance of certain elements especially FEEDBACK on the communication
process.
Time
As appropriate.
Group size
If possible use a minimum of 8 individuals.
Materials
One typed copy of a fairly complicated original message on a piece of paper or card (an example
related to health education could be used in this exercise).
Process
1 Select a participant in advance of the commencement of the exercise - give him the typed
message and ask him to read and memorise. Give him 5 minutes or so.
2 Arrange the other participants into a semi-circle.
3 Explain that only the sender should speak.
4 The sender speaks in a whisper into the car of the receiver, so that no one else can hear. The
receiver should not respond in any way (no gestures etc.)
5 The selected participant commences the exercise by whispering the message into the ear of the
next in the semi-circle.
6 The teacher should hurry the process along by giving a limited time for the message to be sent.
7 The process is repeated insisting on silence and non-rcaction from the receiver until the message
reaches the participant at the other end of the semi-circle.
8 Ask the final receiver to repeat the original message verbally (or write it on the blackboard).
9 REPEAT the entire process (1-8) but allow the receiver to ask questions to clarify before
attempting to convey the message to the next participant in the chain.
10 REPEAT AGAIN - but this time allowing much more time for discussion, questions for
clarification from the receiver and opportunities for the sender to repeat and clarify.
11 Compare the degree of accuracy of the messages eventually received at the end of the chain in
the three different situations.
Question - What can participants learn from this exercise?
Possible learnings
1 It is difficult to convey information in a limited time with too many unfamiliar facts and
names.
2 It is important that communications be kept as simple as possible in certain circumstances.
3 There should be enough time for the sender to deliver his message and for the receiver to ask
questions which would help understanding.
(Check 'Barriers' on p47 and list other learnings which arc highlighted by this exercise.)
Exercise 2
Purpose
To demonstrate the difficulty of choosing the correct, simple, appropriate, precise language for the
purpose of explaining and instructing.
Materials
Drawings of simple shapes, alone or in combination (examples given on p50).
Process
1 Ask the participants to sit in pairs, one person to act as sender of the information and the other
receiver.
2 Explain that the task is that the sender is to describe a simple drawing in such a way as to help
the receiver make a copy of iL
3 Ask the participants to arrange themselves into two concentric circles with the senders on the
inside and the receivers on the outside, back to back for each pair.
48
R
S
RS
RS
If there is an odd number of participants in the group, make a threesome and ask one to be sender
and the other two receivers.
Tell them:
Neither the sender nor the receiver may tum around to see each other’s paper until the end of the
exercise.
The receivers may not communicate back to the senders in any way.
There are 5 minutes to complete the task.
When instructed, the sender is to convey the necessary information to the receiver.
Keep a watch to see that no receiver can overlook another sender’s sheet and that the rules are being
followed.
Review the results as follows:
Ask the pairs, as soon as they have finished or after five minutes, to check how well they have
done.
Ask them to consider, still in pairs, the questions:
What helped the communication process?'
What hindered it?'
Invite the whole group to propose a set of guidelines on making communication of this kind more
effective. Write these on the blackboard.
Possible guidelines for explaining and instructing
- Have a clear picture of what you want the other person to understand.
- Try to understand what the other person may be thinking and feeling.
- Make a judgement of how clear it is possible to be.
- Give a general idea before developing the details.
- Make it clear when you are explaining as opposed to instructing.
- Make the message clear by using the other person’s language and terms.
- Only go as fast as the other person can manage.
- State ideas in the simplest possible terms.
- Develop one idea at a time, take one step at a time.
- Repeat your instructions when necessary.
- Summarise when necessary.
- Compare and contrast ideas - use analogies.
- Decide which ideas need special emphasis.
- Use your voice, your hands and your face to get your instructions across clearly.
When two-way communication is possible
- Watch for and encourage feedback from the other person in as many ways as possible.
49
50
Handout 3
The need to be clear on our own personal
values
We are usually unaware that in the process of constructing motivational exercises we
unconsciously and consciously seek to impose our values, beliefs and standards which were
transmitted to us throughout our lives especially when we were children through a continuous
process of communication. By the time we are adults we are hardly conscious of the origin of
these values, but they nevertheless affect our day to day decisions, and the way we react to other
people.
Since we can, therefore, tend to try to unconsciously impose these values on other individuals and
groups with sometimes negative or even disastrous consequences to EEC programmes, it is
important that as communicators, we examine our own value systems critically, and also become
acutely aware of our clients-value-systcms so that the consequences of such mistakes are avoided.
Values clarification
Values clarification helps individuals to build their own value system by examining critically all
the alternatives. It does not aim to establish any particular set of values, but helps individuals to
become aware of what is 'valuable' to them and why. It teaches them to weigh the 'pros' and 'cons'
and evaluate consequences, and helps them to harmonise beliefs and actions.
1 Prizing reliefs and behaviours
Cherishing values.
Publicly affirming, when appropriate.
2 Choosing one's reliefs and behaviours
Choosing from alternatives.
Making choices after due consideration of consequences.
Choosing freely, without external pressure or coercion.
3 Acting on one's reliefs
Acting with pattern and repetition.
Being consistent in action.
Exercise 3
Values clarification
Exercise: Identify your position.
Purpose: To bring to the conscious level, your position on any issue.
Rationale: Many times we are not aware of what our deep-seated attitudes or feelings are on issues,
unless we make conscious efforts to bring those attitudes and feeling to the forefront Sometimes,
it is only when we are asked what we think of an issue that we realize our position is not clear.
This exercise helps you to identify ’Where you are' on a scale of clear positioning, on a selection of
issues which are of great social and cultural importance in India.
Meanings of terms
Revolutionary: A passionate, intolerant, extreme 'left' position. Taking the extreme opposite
position to the prevailing norm. Believing that the norm has to be changed completely, and acting
upon the belief by trying to change others, through talking out, demonstrating, etc. Seeking and/or
causing upheaval and complete change or turnaround. Not allowing for other positions.
Radical: A Tcftish' position. Not accepting the norm. Favouring social reform but seeking it
through much talk and rhetoric. Trying to cause thorough change from the 'root' of the problem,
but doing so constitutionally. More tolerant than the revolutionary position.
Liberal: Not bound by traditional thinking. Advocating freedom of choice. Broad-minded and
tolerant of all thought on an issue.
Moderate: Believing in self-restraint and controlled action. Accepting authority and tradition except
in instances where almost total opinion has moved away from tradition. Keeping within bounds not rocking the boat. Safe.
Conservative: A passionate, intolerant, extreme 'right' position. Averse to any change. Totally
bound by tradition, and protective of it. Self appointed guardians of the mpi^status quo. Not
allowing for any change, or new thoughts on an issue.
•'\yjNITY
-
1library"
(
*nd
DOCUMENTATION
V.
unit
4 51
J r-ll
' #
Identify your position
Revolutionary Radical
Moderate
Liberal
Conservative
1 Contraception
2 Infertility
3 Marriage dowry
4 Early marriage
5 The caste system
6 Abortion
7 Education for females
8 Women’s liberation
9 Alcoholism
Exercise 2
Values clarification
This Values Grid helps us to go through the Values Clarification Process on issues which are
closely related to the health and welfare of the family.
Procedure: Focus on your position or your beliefs surrounding any particular issues. *When you
think you are clear on what your position is, use the question key, and mark in each of the seven
(7) columns a YES or NO answer to each question. One or more NO answers indicate that the
Value or Position you hold is questionable and/or weak. It means that your actions will not
always harmonise with your feelings and you will have problems developing a strong identity or
character. Reclarify your values until all answers are YES.
Values grid
Issues
1
2
3
4
5
6
7
1 Contraception
2 Infertility
3 Marriage dowry
4 Early marriage
5 The caste system
6 Abortion
7 Education for females
8 Women’s liberation
9 Alcoholism
*If positions are not clear, perform the Values Clarification exercise 'Identify your Position'.
52
Exercise 3
Purpose
To develop stronger and clearer values for ourselves.
Question key:
1 Are you proud of your position? Do you prize or cherish it?
2 Have you publicly affirmed your position?
3 Have you chosen your position from a series of alternatives?
4 Have you chosen your position after thoughtful consideration of the pros and cons and
consequences?
5 Have you chosen your position freely?
6 Have you acted upon or done anything about your beliefs?
7 Have you been consistent, acted with pattern and repetition?
Adapted from Values Clarification by Simon, Howe and Kirschenbaum.
Handout 4
The goal of counselling
The goal of counselling is not necessarily to solve problems of people for them, but rather to help
them to solve their own problems better. The counsellor should set out to help clients to
understand their own feelings and behaviour in connection with different social and psychological
issues which accept their own solutions.
Clients should be helped to examine the series of choices associated with the making of any
decision and to accept responsibility for the final choice.
53
Session 14
Talking to clients:
Techniques of interviewing
Worksheet
Instructional objectives
At the end of this session participants should be able to:Idcntify situations where interviewing skills are required for the conduct of their job functions.
Practice and demonstrate good interviewing technique.
Activities
1 Revise 'Barriers' (Handout 2).
2 Brainstorming - Name all the situations you can think of where the BEE conducts interviews
in the process of carrying out his work duties.
3 Make a list on the blackboard.
4 In small groups - make an appropriate checklist for the assessment of good interviewing
technique.
5 Study handouts 2 and 3 and refine checklists.
6
Each group prepares a short role play to demonstrate an interview for any of the normal
interview situations listed.
7 Each group presents a role play to the rest of the class. Rest of the class use checklist for
assessment and critical discussion.
8 Show and analyse a suitable demonstration film (if available).
Assessment
Checklist and role play analysis.
Materials
Suitable ’props’ for role plays, paper, markers.
Teaching aids
Blackboard, handouts, a demonstration film (if available).
Background reading
Handout 1 - Common Interviewing Situations.
Handout 2 - Interviewing Technique - Helpful Hints.
Handout 3 - Listening Techniques.
Handout 4 - Types of Questions.
Handout 5 - Talking to Groups.
Further reading
Studying Your Community - R.L. Warren (pp 342-343).
54
Handout 1
Common Interviewing Situations
Immunisation campaigns and follow-ups.
Acceptance of Family Planning.
Follow-up of family planning acceptors and defaulters.
Supervision of health personnel.
Environmental sanitation campaigns.
Defaulters from all Public Health programmes eg TB, leprosy, patients who do not come for
regular treatment.
7 Conducting community health surveys.
8 Assessing in-service training needs (EEC) for health personnel.
9 Motivation of opinion leaders.
10 Arranging health camps.
Others (specify):
11
12
13
14
i
2
3
4
5
6
Handout 2
Interviewing Technique - Helpful Hints
i
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Be prepared:- Have all the information and facts concerning the job and client at hand.
Know what you are hoping to achieve by the interview.
Plan seven or eight main questions for the interview.
Be aware of:- Your own prejudices and attitudes, making judgements as the result of first
impressions.
Conduct the interview in private.
Greet the interviewee warmly.
Begin with some introductory remarks to establish a relaxed atmosphere.
Use a comprehensive opening question to start the interview.
Use open-ended questions to encourage the interviewee to talk freely.
Listen - in a friendly but intelligently critical way.
Encourage the interviewee by praising past achievements mentioned.
Play down unfavourable information.
Avoid leading questions.
Avoid closed questions.
Watch for non-verbal communications.
Use facial expressions to reinforce the range and effect of your voice.
Be emphatic - try not to make the situation more authoritative than it already is.
Indicate to the interviewee that the interview is about to end.
Allow time for the interviewee to ask questions.
Close the interview by telling the interviewee how he will find out about the results of the
interview, or what
future action may result
55
Handout 3
Listening technique
56
Type
Purpose
Examples
1 Clarifying
1 To get at additional facts.
2 To help the person explore all
sides of the problem.
1 'Can you clarify this?'
2 'Do you mean this..?'
3 'Is the problem as you sec it
now?'
2 Restatement
1 To check out meaning and
interpretation with the person.
2 To show you arc listening and
that you understand what the
person is saying.
3 To encourage persons to
analyse other aspects of matters
being considered and to discuss
with you.
1 'As I understand it, then, you plan
to..?’
2 This is what you have decided to
do.'
3 Neutral
1 To convey that you are
interested and listening.
2 To encourage the person to
continue talking.
1 'I sec.'
2 ’Uh-huh.'Thik achi.'
3 That's very interesting.'
4 'I understand.'
4 Reflective
1 To show that you understand
how the person feels about
what he says.
2 To help the person to evaluate
his own feelings as expressed
by someone else.
unfairly.’
1 'You feel that..'
2 'It was a shocking thing as you
saw it’
3 'You felt you didn't get a fair
chance.'
4 'You feel that you were treated
5 Summarising
1 To bring all the discussion
into focus in terms of
summary.
2 To serve as a stimulant for
further discussion on a new
problem.
1 These are the ideas you have
expressed.'
2 'If you understand how you feel
about the situation.'
Handout 4
Types of questions
Type
Purpose
Examples
1 Factual
1 To get information.
2 To open discussions.
1 All the W’ questions what, why,
when, who, where and how?
2 Explanatory
1 To get reasons and explanations.
2 To broaden discussion.
3 To develop additional
information.
1 ’In what way would this help
solve the problem?'
2 ’What other aspects of this should
be considered.
3 'Just how would this be done?'
3 Justifying
1 To challenge old ideas.
2 To develop new ideas.
3 To get reasoning and proof.
1 Why do you think so?'
2 TIow do you know?'
3 What evidence do you have?'
4 Leading
1 To introduce a new idea.
2 To give a suggestion of your
own or others.
1 'Should we consider this as a
possible solution?'
2 Would this be a good
alternative?'
5 Hypothetical
1 To introduce a new idea.
2 To suggest another, possible,
unpopular.
1 'Suppose we did it this way ...
what would happen?'
2 'Another mother does this ...
would it work for you?'
6 Alternative
1 To make decisions between
alternatives.
2 To get agreement.
1 Which of these would be best?'
2 'Have we decided to do this or
that?'
7 Co-ordinating
1 To develop consensus.
2 To get agreement.
3 To take action.
1 'Have we decided that this is the
next step?'
2 'Are we in agreement then on this
part?'
57
Handout 5
Talking to groups
Every individual speaker has his/her own style of speaking, and it is thus important to be
aware of one’s style, if one is to be able to change those aspects which might detract from
public speaking.
In speaking with a group, one must be aware of the non-verbal signals being given, so as to
avoid those which might convey negative messages; be aware of facial expressions, tone of
voice etc.
It is important to dress appropriately for the occasion, eg for women in particular when going
to speak to male audiences especially on matters pertaining to sexuality or family planning in
order to ensure credibility or to have the talk taken seriously.
It is important to be well versed with the subject matter which is the topic of the talk.
It is also important to be emotionally comfortable with the topic eg if a person is not
comfortable giving a talk on sex-rehted matters then even if he or she is knowledgeable, the
effect is lost
The speaker should avoid entering into arguments with audience members, and imposing
dogmatically his/her points of view.
Continual eye-contact should be maintained if the talk is to hold the interest of all sections of
the audience.
58
Session 15
Talking to clients:
Meeting and motivating hard-to-reach and
resistant groups and individuals
Worksheet
Instructional objectives
At the end of this session participants should be able to:- identify the main characteristics of such groups and individuals.
- understand the need to be mindful of the beliefs, values and moral standards of such clients.
- discuss and practice the skills of overcoming tlic main difficulties of meeting and motivating
such individuals and groups.
Activities
1 Chosen participants present relevant CASE STUDIES from the field.
2 Small group discussions to identify main characteristics which arc common to such groups and
individuals.
3 Identify individual and special characteristics in ease studies.
4 Discuss (in groups) suitable approaches for overcoming barriers to meeting and motivating such
groups and individuals.
5 Individual group presentation for whole class discussion (or suitable role plays eg a family
planning motivational attempt with a resistant individual).
Assessment
Analysis of characteristics and approaches to solution of problems.
Materials
Tapes (for tape recorder). Other materials required for the presentation of the role play.
Teaching aids
Printed ease studies for group work (if participants arc chosen in advance), OHP, tape recorder.
Background reading
Handout 1 - Working with special individuals and groups who arc resistant or difficult to meet.
Handout 2 - Stages in the 'adoption' process.
Handout 3 - The distinctive qualities of family planning communication.
Further reading
Continuing education modules for PHC - Resources in the Community - Rural Health Division.
Ministry of Health and Family Welfare, Government of India 1983.
59
Handout 1
Working with special groups and individuals
who are resistant and difficult to meet
- Hard core resisters should be approached through a relative, satisfied acceptor, peer group, or
someone respected as an opinion leader.
- People cannot be blamed for the beliefs, values or moral standards.
- In bringing motivational messages to such groups it is important to understand their beliefs and
values.
- For groups where the opposition is non-verbal and more subtle (as is often found in teenagers
and illiterates, who cannot verbalise properly what their reasons are for their behaviour), it is
important to try to understand the psychology of their behaviour, and general characteristics, and
base the approach on this understanding.
- It is the understanding of the reason for beliefs that can serve as the main key to an effective
strategy in getting the motivational message across.
- It is important to understand the various stages through which a new idea usually travels (sec
Handout 2).
The important point must be made at this stage that people are much more likely to be motivated
if the motivator, as well as being interested in promoting his own developmental aspect ie health,
is also mindful of the need to be seen to be interested in - and capable of - solving other aspects
related to the social, economic or agricultural needs of individuals and groups. He therefore needs to
be aware of, and ready to use, help from other developmental sectors eg agriculture, education etc.
This will be treated more fully in Unit IV - Working with Others'.
Handout 2
Stages in the adoption process
1 Awareness stage. At the awareness stage the individual is exposed to a new idea but lacks
complete information about it. The individual is aware of the innovation, but is not yet motivated
to seek further information. The primary function of the awareness stage is to initiate the sequence
of later stages that lead to eventual adoption or rejection of the innovation.
2 Interest stage. At the interest stage the individual becomes interested in the new idea and
seeks additional information about it. The individual favours the innovation in a general way but
he has not yet judged its utility in terms of his own situation. The function of the interest stage is
mainly to increase the individual's information about the innovation.
3 Evaluation stage. At the evaluation stage the individual mentally applies the innovation to
this present and anticipated future situation, and then decides whether or not to try it. A sort of
'mental trial* occurs at the evaluation stage. If the individual feels the advantages of the innovation
outweigh the disadvantages, he will decide to try the innovation.
4 Trial stage. At the trial stage the individual uses the innovation on a small scale in order to
determine its utility in his own situation. The main function of the trial stage is to demonstrate the
new idea in the individual’s own situation and determine its usefulness for possible complete
adoption.
5 Adoption stage. At the adoption stage the individual decides to continue the full use of the
innovation. The main functions of the adoption stage are consideration of the trial results and the
decision to employ regular use of the innovation in future.
Handout 3
The distinctive qualities of family planning
communication
60
1 Family planning and fertility behaviour deal with beliefs that are central to individuals. We are
attempting to change intensely held altitudes and beliefs that are essential aspects of an individual's
personality structure which arc difficult to change.
2 These beliefs are extremely private and personal. Hence family planning ideas arc not easy to
discuss in public as they arc seen as part of a forbidden type of behaviour.
3 Many family planning decisions arc collective rather than individual. Both husband and wife are
typically involved in most decisions of this kind.
4 In the case of most family planning methods, the client behaviour that we want to change
involved sustained practice over a long period of time.
5 There arc often counter-campaigns against family planning. Frequently, these negative
messages, transmitted by word-of-mouth, have a considerable impact.
Unit IV
Working with others
X.
y
61
Session 16
Working with others:
The value of interagency co-operation and co
ordination
Worksheet
Instructional objectives
At the end of this session participants should be able to
- Realise the importance of involving as many relevant developmental sectors in IEC
interventions in the community as possible.
- Identify other relevant and useful agencies available to the community.
Activities
1 Short lecturc/discussion - ’Education is for Development'.
2 In pairs - List developmental agencies available to a normal rural Indian community.
3 In pairs - Identify agencies (governmental and voluntary) which can be of assistance for EEC
activities.
4 Small groups - Each group chooses a common health problem in rural communities, identifies
agencies and personnel which could be employed in EC interventions and describes generally how
they would incorporate their services to attack the problem.
5 Individual groups present for critical discussion.
Assessment
Group presentations, how groups defend plans of action.
Materials
Transparencies, markers, pens.
Teaching aids
OHP, handouts.
Background reading
Handout 1 - The intcrscctional approach.
Handout 2 - Community Leaders who can be helpful to BEEs for carrying out their IEC
activities.
Handout 3 - Components of the National School Health Services Programme.
Handout 4 - Steps for organising School Health Services.
Further reading
1 The Child to Child Health Programme - Institute of Child Health, London.
2 Helping Health Workers Learn - D. Wcmer & B. Bower. (Chapters 6 and 23).
62
Handout 1
Community leaders who can be helpful to the
BEEs for carrying out their IEC activities
1 Local authorities (sarpanch etc).
2 Officials sent or appointed from the outside (central government, state government).
3 Rcgligious leaders.
4 Traditional Healers.
5 Schoolteachers.
6 Extension workers (especially the Block Development Officers).
7 Club, group, union, political or co-operative leaders.
8 Women’s leaders (Mahila Mandals).
9 Children and young people’s leaders.
10 Committees (health committee, parcnt/teachers association).
11 Those who have much influence because of wealth.
12 Opinion leaders of the poor classes.
13 Opinion leaders of the rich classes.
Handout 2
The inter-sectoral approach
Poor socio-economic conditions make it extremely difficult for Governments in developing
countries to provide basic health care. It is therefore very important that elements which foster
preventive rather than the curative aspects of health care are emphasised.
If it is accepted that the provision of health is an important element in all socio-economic
development, it is necessary to understand that when we have different developmental sectors, eg.
agriculture which can support any programme, it is better that they all attack the problem
simultaneously. This will ensure better and more lasting results than if the different departments
undertake programmes in different areas independent of each other. This concept is not difficult to
understand. It is better to improve all the conditions in any set of villages at one time
simultaneously rather than taking up these programmes separately in the same villages at different
times. If all programmes are put into effect together, there will be a complementary or linkage
effect For example if a water supply programme is taken up in a village, there should be a
drainage and also a latrine programme as well. An Agricultural and Nutrition Education
programme would obviously be complementary.
It has already been agreed that EC interventions arc much more likely to succeed if an approach
which tackles all aspects of the problem, affecting the quality of life of the community, is
adopted.
Handout 3
Components of the school health programme
National School Health Services Programme Components
- School Health Education.
- Healthy environment of school.
- Accident prevention.
- Personal hygiene of school children.
- School nutrition programme (if present in State).
- Observation by teacher of school children for deviations from normal.
- Training in First Aid and simple treatment of minor ailments in school children for teachers.
- School medical examination.
- Students health record.
- School health committee.
- Child-to-Child health programme.
63
Handout 4
Steps for organising school health services
1 Prepare a list of schools in the area, with student population and number of teachers.
2 Divide the schools among the Medical Officers, Health Assistants, and Multipurpose Health
Workers.
3 Arrange for meetings with the Education Officer in the area along with principals,
headmasters. This is for enlisting the co-operation of the Education Department for taking
responsibility in the school for preliminary screening of children and health education and
sanitation.
4 Training programmes must be arranged for all the teachers in health inspection, health
education, treatment of minor ailments and first-aid in co-operation with MO, PHN/ANM, Multi
purpose Health Workers (Male & Female).
5 The health worker must be asked to provide a list of schools with the total number of students
in the class room. It is only through the teachers that any successful school health programme can
be attempted. It is impossible for the PHC staff to give complete coverage of schools either for
health inspection or health education. The training of the teachers should enable them to detect
defects, deficiencies and diseases. They should be able to refer the cases to the Health Staff. The
referral can be made to the sub-centre, on the days fixed for the visit for the Medical Officer or
Health Visitor.
64
Session 17
Working with others:
Assessing IEC in-service training needs for
health service personnel
Worksheet
Instructional objectives
At the end of this session participants should be able to:Practicc the process of assessing EC training needs of health personnel for PHC.
Prepare a suitable checklist for the assessment.
Activities
1 Study Handout 1 (assessing training needs for health service personnel). Discuss.
2 Study official job functions and curricula for training of PHC health staff which are usually
supervised by BEEs in their EEC functions.
3 Read carefully and discuss (in pairs) Task Analysis' in Teaching for Belter Learning - F.R.
Abbatt, Chapter 4.
4 Simple IEC task selected and done in detail on blackboard (whole class activity, teacher
controlled).
5 Small group exercise - select a simple IEC task and analyse.
6 Individual group presentation for class discussion.
7 Small group activity - prepare a suitable checklist for a training needs survey for PHC workers.
Assessment
Individual work on one task analysis (a participant course assessment item).
Materials
Transparencies, paper, pens, chalk.
Teaching aids
OHP, blackboard, handouts, copies of curricula and job description for PHC staff from Rural
Health Division, Ministry of Health and Family Welfare, Government of India.
Background reading
Handout 1 - Task Analysis.
Handout 2 - Assessing training needs for health service personnel.
Handout 3 - Survey of training needs.
Handout 4 - Training needs survey objectives.
Further reading
1 Teaching for Better Learning - F.R. Abbatt (Chapter 11).
2 Helping Health Workers Learn - D. Werner and B. Bower (Chapters 5 - 7).
65
Handout 1
Task Analysis
Task analysis is a method of looking at each part (or task) of a person's job and writing down
exactly what is donc.This description is then analysed (see example below) to find out what
students need to loam in order to do the job well.
Task Analysis Sheet
The task: introducing latrines
Stages of the tasks;
Actions (A),
Decisions (D),
Communications (C)
Knowledge and skillsWays to learn
needed
1
Find out community
interest (A) (C).
Ability to explain and listen.
2
Decide if latrine project Understanding of people
possible (D).
and customs.
3
Help people loam
importance of latrines
to health (A) (C).
Knowledge of how disease
spreads; teaching skills.
From observation, books and
discussions, practice teaching.
4
Decide where latrines
will be built (D).
Knowledge of safety
factors.
Books and discussions;
thinking it through with local
people.
5
Get materials needed
(A).
What local materials can be
used; what else is needed;
where to buy at low cost
etc.
Talk with local mason; trip to
market
6
Help people build the
latrines (A).
Dimensions of pit and
platform; how to mix, cast
reinforce and cure cement;
how to build outhouse and
Have students take part in
actually making latrines.
Talk with experienced health
workers; role plays, group
discussion.
Study of community dynamics;
discussion about traditions and
behaviour.
nd.
7
Encourage people to
Home visits; art of giving
use latrines and to
suggestions in a friendly
keep them covered and way.
clean (Q.
Practice, role plays and
discussion.
To collect the information you need to do a complete task analysis, you can use these sources:
- your own knowledge and experience
- books and information sheets
- observation of health workers in
action.
- discussion with other instructors or person
with the experience required.
- discussion with health workers.
Adapted from Helping Health Workers Learn - D. Wcmcr and B. Bower.
66
Handout 2
Assessing training needs for health service
personnel
1 Examine official job functions of the worker.
2 Passive observation of the worker while he is carrying out his functions. (Is he doing what he
is officially supposed to do?)
3 During supervision of the worker.
4 Interview fellow workers.
5 Interview his supervisor(s).
6 Enquire into the relationship the worker has with the people in the community.
7 Interview opinion leaders within the community.
8 Interview the worker.
9 Test the worker.
10 Find out about previous training in IEC techniques.
Handout 3
Survey of training needs
For each health unit, the following information must be collected before you
start your observation:
Find out how many workers there are.
What are the qualifications of each worker?
Where does each work (activities)? In what department/section?
What time do they start working?
What do they start with?
Try to discuss informally with the health workers the evening before. This will ease the tension as
well as helping you to plan how to observe them.
Allocate yourself where and what to observe.
Make sure each health worker, particularly the trained one, has been observed.
As you are observing try to relate the activity being observed to the training that the health worker
went through.
Try to discuss with the health workers (informally) by the end of the day to find out what they
think of their training and what they actually do.
Handout 4
Training needs (survey objectives)
1 To observe health workers and identify IEC tasks carried out, problems encountered, training
needs.
2 Collect information in these areas:
What does the worker do?
in the community.
in the clinic/centre/dispensary.
in his office.
in the Health Centre.
3 What problems does he encounter?
administrative (supervision),
transport
equipment
environmental/community.
personal.
4 What training needs can you identify?
supervision.
technical (skill).
management.
attitude.
general.
67
Session 18
Working with others:
Training needs survey in nearby
Primary Health Care facilities
Worksheet
Instructional objectives
At the end of this session the participants should be able to:- assess training needs (knowledge, attitudes, skill) of different PH/MCH/FW personnel for
continuing education in IEC aspects of Primary Health Care.
Activities
1 Field work exercise - Field survey in groups (max. 4) in selected communities through the PHC
unit in the area. (Use checklist.)
2 Concentrate mainly on PHC personnel which the BEE will supervise as part of his official job
functions.
3 Complete data.
4 Analyse and record using suggested format on Handout 1.
5 Study Handout 2. Participants should use the survey exercise to practise some subtle on-thespot motivation and training of health workers regarding their IEC activities.
Assessment
Group fieldwork.
Materials
Paper, pens, survey checklists.
Teaching aids
Fieldwork checklists; handout.
Background reading
Handout 1 - 'A framework for analysis’
Handout 2 - 'Motivation'
Further reading
Trainers/Trainecs investigate and suggest
68
Handout 1
A Framework for analysis
IEC tasks identified
Problems identified
Training needs identified
1
2
3
4
5
Handout 2
Motivation
Supervisors must motivate health workers so they will perform their work with enthusiasm and
achieve high standards of performance. As a supervisor, you must guide and encourage workers.
You must make assignments fair to both the workers and the health centre team. You must
support workers in their dealings with the Ministry of Health and with community leaders.
In addition you must:
- set a good example.
- reward good work and help to correct poor work.
- make workers feel they are doing an important job.
- make workers feel they are taking part in team decisions.
- give workers new knowledge, skills, and responsibilities.
As you review each of these five ways of motivating people, think how you might apply them
during the health workers community phase of training.
Set a good example
You must be motivated before you can motivate others. Exhibit a positive attitude when you work
with the health workers.
Reward good work and help to correct poor work
Praise and encouragement, when they are deserved, are two of the very best ways to motivate
workers. You will have many opportunities to evaluate workers' performance. When you do,
remember to praise what workers do well, as you correct what needs improvement.
Make workers feel they are doing an important job
Make sure the health workers know how the work they have been assigned contributes to the
district and national health care goals. Make sure workers feel their work is important in meeting
those goals.
Make workers feel they are taking part in team decisions
Include the health workers in planning and scheduling their activities. Listen to their suggestions
and use them whenever possible. Their workers will take satisfaction in knowing that they will be
consulted and that their suggestions and reactions will be considered before decisions are made.
Give workers new knowledge, skill and responsibilities
Give workers as much opportunity as possible to test the skills they have already practised and to
master new skills. Help them resolve any problems as they occur. Do not let them become
frustrated by struggling with a problem they arc unable to solve. Be a resource to whom the
workers may turn when they encounter a problem they cannot solve.
The workers will look to you as an example of how they ought to behave and how they ought to
carry out their work. They will turn to you when they need assistance. Make yourself available to
the workers and be prepared to help them.
69
Session 19
Working with others
Presentation of survey reports
Worksheet
Instructional objectives
At the end of this session participants should be able to:analyse from survey findings appropriate training needs for PHC personnel.
Activities
1 Survey groups present reports in turn. Using 'Framework for Analysis' format present EEC
tasks, problems and training needs identified.
2 Class discussion.
3 Small group exercise - 'From survey analysis write job description with regard to EC activities
for the cadres of health personnel you have surveyed'.
4 Post flipchart group presentations up on the wall board.
Assessment
Group presentations.
Materials
Flipchart paper, markers, transparencies, pens.
Teaching aids
OHP, blackboard.
Background reading
Trainers/Trainees investigate and suggest
70
Unit V
Aids to communication
71
Session 20
Aids to communication:
Methods of communication
Worksheet
Instructional objectives
At the end of this session participants should be able to:make a comprehensive list of various methods which would assist the
communication/leaming/motivational process during their normal working activities,
categorise these methods in terms of their applicability to promoting the acquisition of
knowledge, attitudes and skills to various individuals and groups, and in various
interpersonal situations.
Activities
Brainstorming exercise - list common methods which can be useful in IEC activitics:1
in the field,
in the clinic,
on home visits.
2 Exercise 1
In small groups, pairs or individually, categorise each method as to its appropriateness for the
teaching of
(K) - Knowledge.
(A) - Attitude.
(M) - Manual skills.
(C) - Communication skills.
3 Exercise 2
Complete list of advantages and disadvantages for each method.
4 Exercise 3
Categorise in terms of applicability for different interpersonal situations. This exercise can be
expanded to differentiate between approaches for children, young adults (adolescents), and adults
(male/female). (Remember cultural restraints.)
5 Discuss the character and limitation of each method and their possible application to identified
target groups from the community survey conducted during Unit 1 activities.
Assessment
Exercises 1-3.
Materials
Flipchart papers, markers, transparencies, pens.
Teaching aids
Printed exercise forms for 'Methods', blackboard, OHP.
Background reading
Handout 1 - Teaching/leaming/motivational methods.
Further reading
1 Teaching for Better Learning - F.R. Abbatt (Chapters 6 - 7).
2 Helping Health Workers Learn - D. Wcmer & B. Bower (Chapter 1 and 11 - 14).
72
Handout 1
Teaching/learning/motivational methods
Talks, lectures, lecturettes (active).
Discussion - large/small groups, plenary, panel, debates.
Brainstorming.
Snowballing.
Demonstration (observation), redemonstration, paired practice.
Exercises, programmed instruction.
Reading, self study.
Projects.
Dance, drama, song, streetplays.
Role play followed by discussion.
Supervised fieldwork.
Puppet shows.
Case studies.
Field exercises.
T
Workshops, seminars.
Meetings.
Competitions.
Folk media.
Others (specify):
f
9
’
■
■JJ '- ■.
♦?
73
Exercise 1
Methods - to teach
Method
74
Manual
skill
Comm
unication
skill
Attitude
Knowledge
Exercise 2
Methods
Method
Advantages
Disadvantages
75
Exercise 3
Methods - interpersonal situation
Methods
One
to one
Small
group
Large
group
Distance
./
If
76
..' X
Session 21
Aids to communication:
Communication aids
Worksheet
Instructional objectives
At the end of this session participants should be able to:
make a comprehensive list of various audio-visual aids which would assist the
communication/leaming/motivational process during their normal working activities,
categorise these audio-visual aids in terms of their applicability to promoting the acquisition
of knowledge, attitudes and skills to various individuals and groups, and in different
interpersonal situations.
Activities
As for 'methods' (see exercise forms).
Assessment
As for 'methods'.
Materials
As for ’methods’.
Teaching aids
As for 'methods'.
Background reading
Handout 1 - Useful audio-visual aids.
Handout 2 - Advantages and limitations of different media.
Further reading
As for ’methods'.
'll
Handout 1
Useful audio-visual aids
- Chalkboards
- Blackboards
- Clothboards
- Flannclgraphs
- Magnetic Boards
- Posters
- Pamphlets, booklets
- Flashcards
- Charts, maps, diagrams, flipcharts
- Slides
- Photographs, pictures, drawings, paintings
- Manuals, guidebooks, textbooks
- Games, puzzles
- Slide projectors
- Overhead projectors, transparencies
- Films, film strips
- Magic Lanterns
- Video
- TV, radio, loudspeakers
- Epidiascope
- Kits (eg BEE's)
- Actual objects, specimen
- One’s self
. - Models
- Books, handouts
- Cameras
- Tape recorders
- Notice boards
- Slogans
Others (specify):
78
Handout 2
Advantages and limitations of different media
For convenience of use, the list of media is divided into three main groups; non-projccted, projected
and sound. The 'projected' group is further subdivided into still and moving pictures: the 'sound'
group refers to sound alone (most of the moving picture goup incorporate sound).
1 Non-projcctcd media
Media
Advantages
Limitations
a) Books,
handouts and
other printed
matter.
1 Some learn best through
reading.
2 Allows self-pacing.
':
3 Good for reference and
revision.
5
4 Handouts easily produced,
duplicated for a large number
of students; can also be
associated with teaching to
reduce need for notes; can be
reproduced in local language;
1 Published textbooks expensive
and sometimes involve foreign
currency problems.
2 Published textbooks rapidly out
of date and only revised rarely.
3 Good manuals and handouts
demand good typing and
reproducing facilities.
b) Real objects and
specimens.
1 Present reality, not
1 May not be easily obtained,
substitutes.
: L 2 Inconvenience of size, danger in
2 Three dimensional.
use.
3 Permit use of all senses in • '‘ n 3 Costly or not uncxpcndablc.
study.
- •
4 Usually only usable in small
groups.
;
- • 51 Sometimes easily damaged.
°6 Problems in storage.
c) Models and
simulation
devices.
>1 Three dimensional and
concept of reality.
2 Size allows close examination.
3 Can be used to demonstrate
function as well as
construction.
4 Can permit learning and
practice of different
techniques.
5 Some can be made with local
materials.
■j
Craftsmanship required for local
construction.
2 Simulation models often
expensive.
3 Usable for small groups.
4 Models often easily damaged.
5 Never same as performing
technique on a patient (Beware
wrong learning.)
79
Media
80
Advantages
Limitations
d)
Graphics
(charts, diagrams,
schematic
drawings),
paintings,
photographic
prints.
1 For small audiences only (unless
1 Promote a correlation of
projected
with epidiascope).
information.
]
2' For effective use good
2 Assist organisation of
material.
<duplicating equipment and
trained
staff needed.
3 Photographs nearer to
I
reality than drawings but
association often difficult.
4 Usually easily produced and
duplicated (black arid white
photos).
5 Easy to store, catalogue and
retrieve.
c)
Chalkboard
(blackboard)
1 Inexpensive, can be made
locally.
2 Usable for wide range of
graphic representation.
3 Allows step-by-step build
up or organisation of
structure or concept
0
Flannclboard
(flannclgraph).
Note: most
comments also
refer to magnetic
board.
1 For limited audience only.
1 May be used repeatedly.
2 Difficult technique io use
2 Usually prcparable from
convincingly.
locally available materials.
3 Good for showing changing
relationship.
4 Hold attention if well used.
5 Can be adapted for goup
participation.
g)
Field trips (not
strictly media but
useful as
comparison of
factors).
1 Costly in time and transport.
1 Observation of a
2 For limited audience only.
participation in reality.
3 Requires careful planning for
2 Opportunity for co
effect
operative group work and
4 Distractors cannot be controlled.
sharing responsibilities.
3 Good method for individual
motivation.
1 Back to audience.
2 Audience limited to 50 or so.
3 Careful drawings erased not
preserved for future use.
4 Considerable skill required for
effective use.
2 Projectable media
Media
Advantages
Limitations
Still Pictures
1 Enlargement of drawn or 1 Demands total darkness for clear
a) Opaque projection
projection (except for expensive
, printed materials for large
(epidiascope).
models).
• audiences.
This is equipment
based on. method i. 2 Prevents need forproducing2 Bulky machine, difficult to
slides and transparencies. • v transport.
as all materials .
■ 3 For transferring enlarged 3 Electricity required.
selected from •
previous section 1 l. image to chart of b/board
-1.
for copying.
4 For projection of small
objects and specimens.
b)
Transparencies
for overhead
projection;
c)
Slides and
filmstrips.
1 Projectable in full daylight 1 Electricity required.
to large audience.
2 Equipment and materials for
2. Presented facing audience, making sophisticated
3< Relatively easy to prepare transparencies expensive.
with jocal materials.
3 Not usually suitable for photo4 Subjects can be drawn in graphic material due to cost
advance or developed by
(although adaptor available to
stages with the group. take 35mm slides).
5 Can demonstrate
• 4 Usually restricted to teacher use,
movements, processors etc ; as it is not easy to adapt for
with models.
h 0 learner.
4
, t. .1 Suitable for large audiences^! Fixed order of frames in film2 Relatively easy production .ftrip restrictive in use.
- and (in black and white)
2 Need partial darkness for
. o reproduction.
viewing unless rear screen or
• 3 Equipment availablc for ..daylight screen used.
r3 Duplication of colour slides
zi, viewing or projection,;
expensive (even impossible in
. J(, without electricity, i
, ,many countries).
. i
L
’:f
1;
L''. :
81
Media
Moving pictures
a) Films
(comments
include reference
to belli 16mm
and 8mm
formats).
82
Advantages
Limitations
1 Close to reality with
1 Does not permit self-pacing,
movement and sound.
2 Films costly and difficult to
2 Suitable for large audiences produce.
(15mm) and small groups
3 Individual films relatively
expensive.
(8mm).
3 Compression of time and 4 Electricity required.
and space.
5 Equipment difficult to transport
4 Brings out emotion, can
6 Darkness for viewing (except
rear screen use).
develop attitudes, pose
problems, demonstrate
7 Imported film may contain
inappropriate information (see
skills.
5 Good learning source if
proviso in advantage 5).
preceded by teacher’s
introduction followed by
discussion.
b)
Broadcast
(open circuit
television).
1 Adaptable to large and
1 Programme expensive to
produce and demands highly
small audiences in widely
distributed area.
skilled staff.
2 Capable of gaining and
2 Receiving equipment expensive
maintaining attention.
and difficult to maintain.
3 Can stimulat emotions,
3 Electricity required.
4 No immediate interaction or
build attitudes and
develop problems.
feedback.
4 Can conserve resources of 5 Learner must adapt to fixed
instructors by simultaneous schedule, never the other way
broadcast to many classes, round.
c)
Closed circuit
television and
videotape
(including
cassettes).
1 Adaptable to medium and 1 High initial cost of production
small audiences.
equipment and requirement of
2 Videotape repeatable to fit trained staff.
learning schedules.
2 Electricity required although
3 Film advantages 1, 3 above portable works off battery,
and 4 apply (see above).
this needs charging from power
4 Valuable for magnification source.
3 Receivers are expensive and
image, recording intimate
situations, microteaching,
require maintenance.
recording of developments
in clinical syndromes or in
scientific experiments in
’bringing the village into the
class room’ recording
emergencies.
5 Portable equipment can
function on battery for field
recording.
3 Sound media
Media
a)
Advantages
Broadcast Radio.
Limitations
1 Adaptable to large and
1 Special studio facilities and staff
small audiences in widely
required for broadcast
separated areas.
. . 2 Learners must adapt to fixed
• 2 Conserves resources of 1 schedule, not other way round,
instructors by broadcasting ■. 3 No immediate feedback and no
simultaneously to many
. audience inter-action.
classes.
< 3 Capable of gaining and mainlaining attention.
4 Reception equipment relatively
cheap and will function on
batteries.
5 If combined with prepared
materials (radio vision) can be
. improved learning tool.
a5
...J--:!
b) ’ Sound recording
(reel and cassette
tape, records/
discs).
/:
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-
R/iL!.-.
A Ji... •> •
.
70 ’ ’
!.
1 Use for individual loaming
demands - many playback units.
. 2 Good quality recording:
demands studio facilities.
‘2 Especially suited to
individual and small
. group learning.
3 Due to stop and playback
facilities of tape, can be
,, student paced.
.4 Cheap, battery operated
cassette players available and
relatively cheap cassettes.
5 Many uses - to provide sound—
, for slide sequences, for microj
; teaching, heart sounds; for ’o.
posing problems etc..-
I. ?1.;
r.i
•• 11
1 Adaptable to any size
. audience.
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83
Exorcise 1
Audio-visual aids - to teach
AV Aids
Manual
skill
-
84
Communication
skill
Attitude
Knowledge
Exercise 1 continued
Audio-visual aids - to teach
AV Aids
Manual
skill
Communication
skill
Altitude
Knowledge
85
Exercise 2
Audio-visual aids
AV aids
■..
’
■
~
■■■.
’■
_■
86
Advantages
Disadvantages
Exercise 2 continued
Audio-visual aids
AV aids
Advantages
Disadvantages
87
Exercise 3
Audjo-visua! aids interpersonal situation used in
AV aids
One to one
Small group
88
Large group
Distance
Exercise 3 continued
Audio-visual aids - interpersonal situation used in
AV aids
One to one1 •
Small group
■ Large group
Distance
89
Session 22
Aids to coiME’ T,n cation:
&
Using and mann
’g audio-visual aids
Worksheet
Instructional objectives
a At the end of this session p-. ticipanls should be able to:
- pra( dee using n.cs* of the common^ available audio-visual aids.
- effect simple rep. Is f<s aidio-visual aids.
•
!-
a.
a
Activities
1 /Arrange small grou^ 'ill
. :-C/
.
■
instructor at convenient points around the classroom with
■"'-A'
2 Partit,*— *...
ier close super rision eg changing projection lamps, bulbs,
unravcllir?g tang’
u
icplaeing/repairing fuses, plugs, projection procedures etc.
3 Change giwpd after a suitable period of time in clockwise rotation.
: < •'
: .. ioI ’ An. y.
Assessment
01 > waaon and praedcc.
<:•
frtatei;
-i rachiDg asi2s (If available)
OHP
Filmstrip projector.
Slide projector.
Cinefilm (8 and 16mm projector).
Tape Recorder.
CassciJcs/audio tapes.
Video recorder.
J/?.;]!'?
i
<•
Plugs.
Electrical wire.
Cinefilm.
Magic Lantern.
Screens,
.aU-^
• Uc
'Ai-H
Resource persons who can make a valuable contribution to this process
- Resident projectionist
- Resident electrician.
- Resident artisl/projecuorasi. yi; f 1 : . . .
- Any knowledgeable hiembdr of the teaching team.
f
.;j ;A:iSiT - L ’a. jcjH
Background reading ’ ■
• aA'-' - oiq :w2 - - oh-rv:.
1 Visual Communication Handbook - fl caching and learning using simple visual materials) Denys J. Saunders.
<
2 Helping Healih Worke/s Learn - D. Werner and B. Bower (Chapters 11 - 14).
ri-IuA ; Io
- 8 uebmai
lA - -■■<(
<•' I' -
A■ A
.
. T -Uqen-)' ava-H .2 bns ioiuoW .Cl - auuAaaHU AAaa5.
90
A r
n.?
• A
A z
r '
Session 23
Aids to communfca*h»: g j
Outlining lEf ^ning plans for health
personnel f m training survey findings
Worksheet
Instructional objectives
a-y/ih.■Ju .Enoi? )u ilajii
At the end of this Session participardS'should be able t^:- -j
r
understand the important stqps..in progrn^m^plannipg fpr IEC interventions.
identify suitable areas • where traiWBg
ar? demonstrated.
prepare an appropriate programme plan for the training of the identified health worker.
>A
..'p.i'.T'.A i
5f.U Laue Activities ..-ins- /.J.”.
r uiw - t (j\r
Problem Solving Process
1 Study Handouts 1 and 2
■. ;<q
ji.iiE1! f.
ud e-2qmsl uOLicxoiq
andTraining.
-i..
ieeds s^vry^y , (Session 18 Unit IV) now come
)
-q r.cii:/<;;2i<Ayorking-groups for the tieljiwb-*.;i..
together again. Review findings and analysis. fre^j <the syryey^ "
3 Select ONE important training need identified for any category of health worker (preferably
from the lower levels eg CHV or VHW).
4 Study example of Training programme design ^d implantation structure (Appendix I).
5 Do exercise Teaching on a Refresher Course (p92).
6 Using teaching plan format given as Handout 5 - pref^f? a s Stable teaching programme plan for
the health worker.
7 Groups present to whole class in turn. Programmej plaps jrpf \ed.
qj
Assessment , HohnoH
.’ujo-jipiq QruarrHf ■
Group training programme plans.
.•voi'jokuq oLil c.
; mmoi bn j 3) rnifio. ii )
.ni'jueJ oi ■•«!<]
Materials
5>p'''
Flipchart paper, markers, transparencies.
.v_ -. j’xn oobi\
Teaching aids
-: o . OHP, .blackboard, handouts. 3 O?- fn
Ou'/7
<
j
i/jooipiq
-
Background reading
adJ iu rJo JncbixeT Handout 1 - Steps in Programme Planning. Jpiq’nobixciyT Handout 2- The Problem Solving/nA Handout 3 - Training.
Handout 4 - Sample - Design and Implementation prpgi^mtne^planning structures.
Handout 6 - A simple way of making a curriQulun?i.;rg
./-I
a /noG
Handout 8 - Evaluation of training
Further reading
1 Teaching for Better Learning - F.R. Abbatt (Chapters 4-5).
2 Continuing Education for Health Workers - Training Dept African Medical and Research
Foundation (Chapter 2).
3 Helping Health Workers Learn - D. Wemer and B. Bower (chapter 3).
91
Exercise 1
Teaching on a refresher course
Here is a list of statements about leaching on a refresher course : Tick the ones you strongly agree with :
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Most of the sessions should be a review of participants' basic training.
The participants spend most of their time listening to the, facilitators.
The facilitators get participants to contribute from their own practical personal experience.
The participants already know most of what is being taught
There is a lol of practical work.
The teaching is closely related to the real problems participants face.
Most of the teaching is about applying knowledge rather than knowledge itself.
The participants do very well in the pre-test
The facilitators show the participants how little they know.
The participants are doing things in the sessions, rather than just listening.
The facilitators show the participants how much they (facilitators) know.
The participants are busy and confident that they arc learning.
The facilitators concentrate on theory rather than on practice.
The course is relevant and useful to the participants.
The participants go back from the course to do better work.
Ask these questions about your teaching:
Are most of my lessons a review of the trainees' basic training?
Do my trainees spend most of their time listening to me?
Do my trainees seem to know most of what I'm teaching?
Did my trainees do well in the pre-test?
Am I showing the trainees how little they know?
Am I showing the trainees how much I know?
Am I making sure the trainees know the theory, because it is so much more important than
practice?
If the answers to these questions is mostly ’yes', you are doing the wrong sort of
teacMnfg
Now ask these questions about your teaching:
- Do I get my trainees to contribute from their own, practical personal experience?
- Do I do as much practical work as possible?
- Is my teaching closely related to the real problems the trainees face?
- Is most of my teaching about applying knowledge, rather than knowledge itself?
- Are my trainees doing things in the lesson, rather than just listening?
- Are my trainees busy, interested and confident that they are learning?
- Is this course useful and relevant to them?
- Are they going to go back from this course and do better work?
If the answers to these questions are mostly ’Yes’, then you are running a good course.
If an answer is ’No', ask yourself why? And try and change it
I
92
Handout 1
■Z’^g-pHori-tics; •■
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S3
Handout 2
The problem solving process
Tasks related to health education within the community
1 Collect information
On the knowledge, attitudes and beliefs of the
community hi relation to particular health
problems. !,x';
3 Assdss ’the maiii health problems in terms of
frequency, mortality and community concern.
Identify leaders and opinion formers.
2 Interpret information■ TX r;
piscus^the problems with the people and identify
' areas of major concern.
Select for action a priority problem with the help
of representatives from all interested groups in
the comrhunity ^hi6h will respond to Health Education.
bn:;
3 Suggest solutions
fi
. '
a,.-
rba: •
iiisioq
-
Us; i ■
."j
*
Dcfihh the behavioural change which is needed to
impitive the health situation.
Outline a plan in discussing these changes with the
/“pedpleJ
/
“Aiiiiiyse the factors which might encourage and
discourage1 these Changes.
%• aim;-;/
e .
Lead gioup discussions concerning the prevention
of disease. ’
.gmii“a.; '? ■>
DeVise and use various aids and models (teaching
.fonn
bv l"
-^iAeihoW:-J J G: r
■
‘ ■
j.. ocj. ^‘p^vise other Suitable techniques.
4 Start and maintain activities
..
'.■aJfi-jU
;.:!j
si
5 Evaluation 1 .
.-r-.nr, .-.H xi; x.
.
.1:: •';■■.
94
!•
'' -'/J
,n
x. Lxti
.> -xj
jiborvz . txunp
?i
.-..vo<fc
u*.,.
Ji>:? i. /-aiJcva ‘C ho.<iv<x-. tv ;p
Uiuoxp'x.'. O!o
bAsSelssChanges in knowledge, skillsand
Estimbfe changes mhealth status over time.
'poci stnWr.vJ
bsiu:;/? c>:V (noil .ip';; .;•. .' Y.'ini'.- ;/'3I
"t "y-J '■ • /iw
; J no
. ■
Handouts.
Training
mslrfcnc. soT
kuouoeiH
;iC
Organising. .Li") .1100
Implementing^ .
■io
m
sup9ryising.
.mrz?.iQL-vliiiLtfif. .... bix
.. ' i
.ZTStrnui
b.:...
■•■'I'Micro-steps
';eho<f bo*,
o; L-iT'd'r.
• oicin. solhO i
(collect data}?’
^owIcdKe’ skiIls and attitudes.
°f
“« Programme.
Prepare the curriculum.
o; Lv ./ . si ...iri o. utfij Il-’WL^P^*?3110"'.iWucuJfM:^oW?programmc-
'■ Srd
.no^cba rbioi! <u r.uraa-i !S v
d -hi'v ^nefioo?::di gniazD.fMfe^Sii'jLQ.,. f
,v,
u
u
Assign the responsibility for each responsible person who may be asked to help.
bee
ty?:a"* aids.
10018 for ‘b® lraininSPrepare a detailed schedule for the field training eg
noihiovo-’q lxU 3{ii;ro'.' ..
"j: nlilnLrri bin- nd? b. practice. 7
-T;-; .d); ?-•■• )H1
yto committees for the training.
Involve ihe^HpYTC and district level personnel.
?• isph io^
advance about the commencement of the training programme.
1 Prepare the background materials.
apt j7.-c(got r(?dX
“d other materials for the lrainioft
hr>-- scvcnfeffiF
.ami: '.avo s-muz
311(1 flcId racully for the flcld lrainin8-
lhc lra,mn8- . J. „
Evaluate the naming programme periodically.
Remember that apart from the forma! arrangement suggested above, it is also possible to conduct
on-the-spot training whenever possible eg on supervision or evaluation visits to the workers.
HANDC'JT ^4
SAMPLE DESIGN AND IMPLEMENTATION PROGr...UML PLANNING CTRUC77E
*. >. i. 1
J .?j
STEP 2
.
STEP 1 y
BROAD OBJECTIVES
STEP 3
,
WORK to be DONE by
;
,
KNOW
-v ' • < .
STEP 4
,Wh,t ,ZHWBs?e^.Lo
VHW-;
FEEL &
..VHWs DO -n
1
1
Help to dispel taboos,
rejated Ao pr'egnyncV-
taboos related to
through accurate in-
maternity
!
the Vdl.ge
Cou,„ OulI(n.
,and the lelationship
i
Off J lO ?J-;f
2
Provide
relationship of
'between the health ol
needed by the mother i
ithe mother and the child ’
mother, and the
development of the
fetus.
,VHWs need to
‘
"Encourage better
'
'TEACH others moie
■
jljMlth-p-actiew in r
'
.Scientific ideas .on ■
' .J
, pregnancy by her
•town acceptance' oP ‘
,
'
^pregnancy and child
i these.
,
iabout'ehd'JEAtH
Xprar.ttcw^d antenatal
I
1i
1
.
d. Persuades
■
1
against tetanus.
■
■
signs indicating
J’ )pdssitth» tomplica '
1
I
*
of the new baby's body
'll. Relationship of Ante-
The baby in the mother's body
is also a member of her family,
along with the other children.
111 (5 The growth and development
■ '■'of her body depends on the
i11 '6. A pregnant woman should
L>5|
e. Keeps a record of
heart rate.
f. Fersuaties pre&h'ant
B. Nutritional 'equtrsments
:
Pelvic. measurements
'
XasTirhateiby.ht&ervation) i
>! ]
•7
A pregnant woman should
i'ieat some green leafy vegetables every day
of the mother.
F:D.
good nutrition
i Meat more than she eats normally *
/fhepjjftf^^ifeiMS.
J,
antenatal mother s weight. JQ
Height of fundus and f«tcf"(
11 l8 The state of the mother's
,1 ,health and the development ol
'i 'the baby in her body can be
i1 (known by keeping records of
oit: ({ogdi gj
■;
ii'.’-
danger; S!fln'?'. aifch,'
-.and refers these to the
certain measurements
(9. Tetanus can be prevented
'i 'in both the mother and the
■ ' (newborn by injections of tetanus toxoid.
> ,e I:
i Q• j I
small or malformed pelvis J KJ
■ ’.jbul? it
the
4
'i'(mother's
£]:;
>M!»n.:To ,accept'the
ij.
The physiological changes in
is 'necessary’ for the^ growth ?'
I
i
i
■ — preventive measures
3.
the propel formation and growth
of
i nirtaC
strong thioughout pregnancy
p-nough of. tlTt.proper foodsK
pf i the fetus./
,
By taking care of herself a
the woman s body provide lor
ij | .rfiLii;
. iun<..;xij.iiii®J; jucx , ; ■■■r . *
...Jb
i
Problems faced, by
. ;
whoV
vyomen
t2
woman can be healthy and
1J tpregnant- 'WoWtA. ‘
are'pregnahV'tHaf earing ' Ji
mothers'nutrition.
'
.'i'-jcb:
mir;' c::; ci: ■ LH..
rk
■
!1 !c.
ii. Having a baby is a normal
R■
53 8 Misconceptions and
ijjharr^yJ.PraiCftices.
gC-LFgiTHW iiQbti 'bejtlthfi},
Messages to De leerned by VHWs
•women
i
i' i customs.
JCges to both mother and
Jl-: esiwtiais m txi[n;
Jbaby::/'.)
Teaches about advanta
’|’baby in having antenatal
$ J care
I
Jand God-given) function of
\ lA^.'rJmriiod beliefs and
‘ ^pregnancy.
*VHWs need to KNOW
i
Xr Newborn.
J “ta>6 hfetseff (and ' fdr tiTfi^ri
i&tibft ohi the (care the*,
'Wltw needs in order J1
■!
(logical changes during
<ib
ibijh.lin&io ACCFPTML'I
i Give
Giy-i accurate inform-
(to have a healthy
antenatal care of the ,
■MCeze o.f.Mothera and
Vpregnancy
formation on the care'
I
for health I
education on'the
i Ji 'Social Aapacte of the
accurate ih&j'rma -
’
CURRICULUM
) f.. ii: br.b'n >
Itionrlo.wpmen ort pjtysiq
i.facts
J and new born infant.'
.. J Of'i HO-''
’i
J’vHVVs need to KNOW
■I
Dispel harmful
STEP 5
,-------------------------
.
. ..SPECiFlC OBJE’CIIVES-What
...
DO
vf’j do ?Jxv>qoij noh- ur;-.
practices red *beliefs,
J
Fi *10 Pregnant women who are
ll'ivery small and who have pelvic
"X
Ji ’bones which are not the right
up .
i
■ [ishape. should be shown to the Health Tea
.’jIT
a'c.'U'j-' ; .ig euiui ^.GL'p weiv:. gj
SAMPLE DESIGN AND IMPLEMENTATION PROGRAMME PLANNING STRUCTURE
STEP 1
STEP 2
WORK to be DONE by
WHAT VHWs needs io
SPECIFIC OBJECTIVES What
VHWs
KNOW. FEEL b 00
VHWs DO in the Village
BROAD OBJECTIVES
To provide lull
iniotnianon and
services (il requiied)
lor various operative
oi permanent
methods of limiting
the number al
children
J ; Indentify eligible couples
I
I
J ' who want to stop
’ having children
J' Give accurate
i, information about the
i1 operative methods
' of family planning
1 (MTP. vasectomy
11 tubectomy)
Bung couples leady
[ Ito accept operative
‘methods of family
i planning to the
’i jHoalth Team
STEP 3
■
.The VHW needs to know
■i
I
what operative methot.s
of family planning can
be carried out by the
doctor and
the indications,
advantages and
d>s advantages of each
The VHW ne-eds
sympathetic understanding
ol the doubts customs
fears end 'ehgious beinls
ol the people related to
the operative methods <>l
family olanning
The VHW needs to be
able to give assistance to
those who request it in
^arranging their operations
STEP 5 CURRICULUM
STEP 4
i
I
I
i
I
1
1
Identifies families who
may require more
permanent methods of
limiting family size
S'
rega'ding family
t
1
■operations
i
planning operations
which may he done
Jm Assists the parents
’
with sympathy and
I
undeistanding in
making a decision on
a
<!
•
Jn
acceptance <>< an
opr'alion on the liasis
ol need suitability
and compatible with
their religious beliefs
Brings lou|>I*'s ready
to ar cefit uiieiativc
(with the Health Team and i
(in follow up after the
Gives complete and
accurate information
methods ol Family
Planning to the Health
Team
Assists in any
follow up required
by those who h.ive
if
ar i-epied a Family
Planning operation
Course Outline
II
II
• HI Operative Methods m
Family Planning
,
1 A Medical Termination of
Piegnancy
t
J
■
0 and C
'
2 Vacuum method
‘B Ste'iiization
«
1
Vasectomy
,
2
Tubectomy
•C
Basis on which decision
,
'
1
Messages
I
11
2 No ol children
•
3 Family situation.
4
Giving ol information
1
2 Lessen doubt*, fears
3 MUST BE COUPLE'S
■
OWN CHOICE
■
4 Socul acceptance
'(
Follow u(i care after
>
patient returns home
F
VJtWs
Parents who make the decision that
minor operation to limit the number
12
Some operations end pregnancy while
Otheis prevent all future pregnancy
lor the mother
13
No operation should be accepted by
parents without a cleai undei standing
about whether pregnancy
(O'conception) can occur again after
the operation
4 a Common methods used in the village
to end a pregnancy are dengerous
lor the mothet
b The Health Team can help
decide on a safer method
>O Psychological support
•
J
leaded by
childien may choose to accept a
economic social etc
Religious belief
j
to be
they cannot afford to have more
is made <or the operations
Physical
i
■
1
T
IS If patents decide to end one
pregnancy they may still decide to
have a child later
6
A lathei who accepts a permanent
family planning opeiabon (vasectomy)
for himself will
not suffer from
weakness or impotency later.
7 A father should continue to use a
temporary family planning method
(abstinence safe period condom)
tor three months after the operation
18 A mother who accepts the permanent
family planning operation (lobectomy)
will not become pregnant again, but
she will not suffer hum weakness
or disability after the operation
’§6
Handout 5
Teaching plan format
.
W .^1
»>
<• • ••*• *»*.*r«U <
/-*»-
-
. -v- • If- -V. ■
*.
irw
-
•>., ..^ • •■*
'•
-
•
v
4...
Objectives •
•
. ; . .
.
Tht* objective^ in the teaching plan cover the same content as the objectives in the trainee guide.
- Each objective is stated... in terms of trainee performance^(ThcrntimJ^r pfTpbj?ctiyes that gre
included in a tcacing plan depends on the type and duration of the learning activities that the
instructors select.
,
Methods
v-w
;;ThisWiio-n sUmmaK^lhe instmcdoordut. arc included” in the leari.-^g activities, such as
selfdnstrucuon, diCtissipn, ipstnietdr^monstration, studenl.prescntations, gfpiip work-and
.
■ J-<"
1,> clinical practice’.'
.■O
• .: ,.’7 b;
^
’ 'o
Materials ■
tins sectiondists the equipment and. Written materials drat arje necessary to support the learning
• activities for-ftc teaclfiriX^
often makes reference to other parts of the
curriculum, wfere trainees will '-finiJ-Supporting'liyibffoatidn;-;
V- ‘/.A
<
r
rt’iW
™c'n
J
‘ij• Preparation
•
IWs
'is-adist^f'the
activities
that
thd'instructor^must
compiete
in
preparation
f<x
the
teaching
■ "JW.
sc$id#.Tljese^tiyiti&s ojten iiicfu^.preparing Materials to be used during;<tbci’session, selecting
* 5>S ..J,
clients ’for the students to visit and examine, and arrange for supervised, practice experiences.
• it JHWi
nsn-
,a»c*
■■
; •tub
'j
I'ipn »ir*’ io
•?
b.
yAS'
.
^Learning activities
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Answers to„r^View questions and review exercises
The answers to review questions and review exercises are included to guide discussions (Handouts).
?
> H-f'Z
■:
b
‘
:
• -onnfc
■■
' ’ This is a ste^KySstep descriptibn of the specific methods and techniques that the instructor will use
to teach die session. The learning activities described in- die teaching plans are summarised in the
trainee guid^^'that the trainees arc informed about the instructional process. Each activity is
;
assigned a specific block of time. y.;
',. r’. f ’ ‘,n
u:
:/»! t >
• ./•
u'. - •>
■
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mt'
Handout 6
tkuhnJi
A simple way of:making a curriculum
For the kind iof training die BEEs is expected to do as part of his job function, it is not always
necessary to become involved in precise objective-based curriculum development. The following
six steps will assist him to develop a satisfactory curriculum:1 Identify what the Icamcr will have ;lo do after training.;
2 Work out in detail what is involved in doing, this job;,:
3 Describe in detail every thing the learner; needs, to know, practise and learn in order to do his/her
job satisfactorily. .Lit
A;,
LiJ
4 Choose leaching/lcaming activities which will help learners to learn and practise.
5 Identify the resources which the learners will need in order to learn and practise.
6 Chdoie an eval.nation method which will help you to find out how well the trainees have
leamed:
y?
• /P;
’
.
■’ K
:
r:
eyu-ip. g ■41 ’
: nr yer?.:;iG J.
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■ri'” ‘
pUv...<;?y
u <•' r.ye qu, : .
' i' !
; ■?)
98
•
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1X :
Handout 7
.
°
In-service training checklist (for trainers)
Trainers use this checklisvto assess group activity while the group conducts in-service training.
! • -!
• ;j i■,
‘/J-'y
oi <•./'if J/ .’./.■•Lu: z
Yes
Did
the
group
study
the
background
of
the
trainees?
1
2 Did the group identify trainees’needs?
3 Did the group assess training needs?
4 Did the grou£ prepare objectives for training?
'
5 Did the group prepare cuiriculum for training?
6 Did the group prepare lesson plans?
7 Did the group prepare teaching aids and other training materials?
8 Did the group procure necessary teaching aids and training materials?
9 Did the group prepare for each lesson?
10 Did the group prepare a plan of evaluation in advance?
11 Did the group use appropriate teaching aids?
12 Did the group encourage trainees to participate?
13 Did the group explain technical terms in simple language?
14 Did the group communicate effectively?
No
Remarks
This checklist which is for trainers can be used to give participants an indication of what they
should include in the checklist which they must prepare.
99
Handout 8
Evaluation of training
Should examine:- «)► ^V..A
> 7iW^a‘ c°bte haY^hocn inet ned in tenns^hfinance di d.other Resources.
’* - What people have bpdn receiving Lo^crviccjd^nihg antThovy many.
'* ••’• ft itn^cthr^br in\sc..s’ici6iiaihmg’bmpioyed.Mete'sinu*ble/sucGCSsful.
- How much have the adminisLraLivc/managcrial/communicaljve ..procedures been strengthened.
- How far physical resources have been improved.
- How much have skills in course development and reading been improved.
- What impact on the provision/quality of health care has resulted.
- How future training should be modifie<V)toJx‘ta providcito identified needs.
oida co blot ii< sJa-Gqi-Jraiq noi:>2S-. zlrh lo bno
1A
id bo'/aviijd 2.;j;;vfrnn:o') orb nMdliods aad types c'’ evaiua ionoibs.a ojer.qoiqc^ jCJR...';
Methods:
.1J
- Observation (wi&id^kifcl) toh-oite: oldiJh.’a ii;;hob
.?\> .■.r-.ni)‘Cdrvidw*(Wilh'diO€k^r)^-i
^airbacj or?, i.ojoiq
- Questionnaire including Knowledge, Attitude, and Practice.
- Others - see Teaching for Better Learning - FJR. Abbad'(Section 3 Chapters 10-11).
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‘
jcAid bra 2f:;..Id7!q bc-Pbfi^pcsjlo? ,on3vjoxi 'tavij?. (jinummi moi? ’^luoig voviuZ
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Session 24
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Aids to Communication:
Selection, design'.hnd^pre^estof'inethods and
aids for lEC C ommun Sty Intervention
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At the end of this session participants should be able
select appropriate methods-atid aid&fiUr an IEC intervention in the communities surveyed in
Unit 1.
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design a suitable audio-visual tcaehing aid;-'/>
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pretest the teaching aid using suitable: target'individual/s/group/s.
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w ’ \y: 1 Revise Session 23.
2 Survey groups from community survey reconvene, select identified problems and target
individuals/groups in the communities?suryeyed.
3 Study handouts - ’Guidelines for Designing Teaching Aids’ and ‘Steps for Making Simple
Audio-Visual Aids’. Also, ’Pretesting - Whrt f6r2’ and Pretesting - How?’ Do Exercise
’Young/Old lady Picture’ individually. Discuss implications.i
4 Do Exercise II. Answer questions.
5 With the assistance of the resident artist (resource person) - design one teaching aid which will
be used in the community IEC intervention exercise in Session 28.
6 Pretest using suitable target individuals or groups in the immediate community (if
appropriate).
Assessment
Selection of methods and aids to address problems identified in communities.
Materials
Flipchart paper, cardboard, pens, markers, coloured crayons, scissors, ’tape’, glue etc.
Teaching aids
Handouts, some examples of simple teaching/motivational visual aids. BEE's (IEM) kit
Background reading
Handouts 1 and 2. Survey reports and analyses from Unit 1 - Community Survey.
Further reading
1 Communication Handbook - Denys J. Saunders.
2 Helping Health Workers Learn - D. Wemer and B. Bower (Part 2 - Chapters 11 -16).
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Young - Old iady picture
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Visual perception
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(the way we interpret things when -we see them)
When designing visual aids, it is important to be aware of the fact that because of different life
experienced, chVirohmerit* ciiitiire, lbv&d(6f education die; individuals are liable to interpret what
they see in different ways from each oilier.
Individual thoughts, feelings and perceptions vary from individual to individual, group to group.
These consideration are very important when making and using visual aids.
Exercise II
1 Small group formation.
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2 Select a commonly used poster/picture/pamphlet with pictures or drawings et|, which is used
with few written words or without Written words to attempt to transmit a health message
of any kind.
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3 Each group after discussion lists the various wtiys in which the visual aid carf be interpreted
(logically & illogically) by an illit&dte observe^ ’ \
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Each group presents lists which are then discu£,cd again and modified with the rest of the
class. ’
5 Each group discusses how each visual aid can. be re-designed to reduce or repiove
misunderstanding.
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6 Answer question - WhU do you think this
cise is attempting to teach?
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Possible answCiUO questions :1 Sec^use of different
__ ■» »•#•life experiences, levels of education, interests, culture etc!, we all perceive
things, in different
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2 We should always pretest visual communications to ensure comprehension arid relevance.
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Handout 1
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Guidelines for designing effective teaching aids
For a visual aid to be effective it must be
Relevant.
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5 PRETEST a sampler? the material with people from-Lie intended audience, or people who are
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7 PRETEST your material in final form.
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Handout 2
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Pre-tesCng theory
Pre-testing - what for?
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Pretesting of audio-visual IEC materia! is designed ?c Und pyt if
The message is interesting enough to hold the attention of the target audience.
The message is clearly understood.
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The message contains anything which offend?! thejlop^ sensitivities of the target audience.
The target audience feels that the message is dhecr d JA them.
The message is likely to cause the target audience tjO/aa in a desired way.
In other words the more attractive, comprehensible, acceptable and self-involving a communication
is, the more likely it is to persuad?. targcJrdjftJienceaitiLjiLrs.tlie desired action.
Pre-testing - how?
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How can we be sure4hat people will understand auu^-vLaal materials which have been prepared
for them - posters, pamphlets, slories,(puppet shows^role'plays/dramas, demonstrations and other
visual presentations?
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Test them under.conditions similar to. those of.thest^t-audience.
Offer the material to a small group'of the larger.audience and ask them these questions
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What is the purpose of the material?
What is the main message it is attempting to convey?
Is it clear?
Wnat kind of motivation is being used?
What action is being asked for?
Does the material make the target group want to act?
Is there anything about the communication which is confusing?
Does it offend community sensitivities in any way?
105
Session 2.5
Aids to communication:
Preparation for micro-teaching exercise
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Worksheet
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1 Instructional objectives '
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At the end of this session participants should be able to:- . recognise the appropriateness of using various techniques fo^ teaching and motivating.
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aPPrpPO^ interventions fof health worker IEC.training and community intervention.
,7 ■ . - ’ practice lhe use of'these prepare^ interventions in a simulated working situation.
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Activities
1 Study HandoyLsJ and 2. Discuss(in/pairs)..
2
Stiiiy prepared.slides (whole class) and prepared mounted photographs depicting actual field
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situations*. Discuss and critically analyse good and not so good examples depicted related to
tcach'ng/ntotiy^tional |cchn;.cue.
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CoipmunicatJon techniques
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prepared visual aids (from session 24) and any other appropriate method or aidj.
4 Relevant survey groups - prepare 3 JQ-minute presentation for a community intervention
exercise.
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Checklists for teaching/motivatjqpal-.exercises.,
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Materials
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Teaching aids
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Prepared slides/photographs. pn teaching mplivatioh'techniques, slide projector and screen handouts.
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Background reading
Handout 1 - Comip^nity edugalicnal. methods for individuals-apd groups.
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1 A Manual of Learning Exercises for use in health trailing programmes in India, R Hamar,
Voluntary Health Association of India.
2 Study Carefully Teaching!Jealth Care Workers F,R Abbatt and R McMahon. (Teaching
knowledge/communication/manual/dccision-making skills, chapters 10-14.)
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Handout 1
Community educational methods for individuals and
groups
Points to consider•. :
appropriate culture-oriented educational tools must be chosen for each programme.
nearly always a combination of educational techniques (methods and aids) are required to
achieve the desired behavioural changes.
effectiveness and cost must be considered when selecting techniques.
local culture, traditions and folk beliefs must influence the final choice of techniques,
methods must seek to promote confidence and self-reliance such as through the use of problem
solving.
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Home Visits Individual (one to one) educational methods
An effective home visit must be planned for just like a community meeting, a classroom teaching
session or a community programme. Important points to remember when preparing for and
conducting home visits are as follows:plan your home visit as you would a lesson.
make a family record (folder) for each hbme visited.
appropriate materials which have been carefully chosen to reach your motivational
‘ objective.
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remember that a very useful aid in a one to one teaching situation is a small handy flipchart
which is relevant to the topic you intend to discuss.
make the visit pleasant and put the family at ease (revise interviewing technique).
show respect to family elders.1L . .
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ensure privacy when intimate matters are being disetissed.
take every opportunity to compliment mothers for gdod family protection activities,
show interest in as many family activities as they wotiid want to talk about
keep everything you learn confidential so as not to lose- iiie trust of the family.
make sure to re-empha&e tue main issiies 6f what wds discussed.
be sure to thank the family for allowing you die Opportmiity to visit them at home.
Notes on tlie following information about each visit sft&ild'tje made and updated whenever re-visits
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Hie family name.
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The date of the visit
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The names and ages of all members of the household (be sensitive to local customs about
collecting such information).
What health problems does the family have?
What problems or related topics were discussed? Other?
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What did you suggest to the farAiiy? !r fr >;:i / !
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What did they agree to do?
What did you agree to do?
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When do you need to visit again?
Did you accomplish what you had hoped to do? ';
•’:,^atcah’fe?b6he"to m^ethe next vi^it worthwhile?J - ■
What approaches or techniques seem to woric well or poorly?
: Individual (one to one) educational methods c
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Remember :also,'that this one-totone inteipeisonaL Situation arises quite often in the confines of
your office and therefore presents a similar teaching/leaming opportunity as a home visit Much of
the information which can be obtained from a home-visit can be obtained in this way. Make carcftu
*'notes as-lor home visits; ?
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Demonstrations
Conducting demonstrations for tcaching/motivational purposes requires careful planning,
preparation and pre-demonstration practice. It is an effective teaching method because it can
point, sometimes dramatically, to a better, more successful way to do something as opposed to a
commonly employed less efficient way of doing something.
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107
The kind of demonstration you choose should
answer die needs of the community.
teach a sound practice - one you know is right
be timely - for example, when foods are in season (nutrition).
be given with readily available materials.
combine seeing and doing; the demonstration should involve members of the community in
preparing for it and canying it out.
show improvement over a method in current use.
cricourage ixx»ple to try the new'practice.
be so simple that anyone watching can copy what is done.
In preparing for the demonstration you and others who will make the presentation should
consult with co-workers about the choice of topic and the method you plan to use in giving
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know more about the subject than you plan to teach so you will be prepared to answer
questions;
publicise the demonstration (posters, talk with people, ask the local leaders to tell others);
outline the demonstration step-by-step and list key points;
assemble equipment and supplies;
practice (with co-workers).
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PRACTICE is very important if you are to give a successful demonstration. Do it exactly as you
plan to do it, but before someone tyho can evaluate it to help you be sure that your presentation
will be clear and understandable to your audience, and to be sure that the demonstration will run
more smoothly.Immediately before the demonstration, arrange your equipment and supplies. Check
that everything works properly. Be sure your audience will be comfortable and able to see and hear
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The demonstration may consist of four parts :
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Explain the need for the demonstration and why you aie showing it to this particular audience.
Acknowledge the present method but emphasise how the new practice will improve on it
Be short and clear while convincing your listeners tliat the subject is important
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Follow your outline and make it look so easy that everyone will want to to try it
Be sure everyone understands you.
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Speak loudly and clearly;
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Encourage discussion either during or at the end of the demonstration.
-: Ask them to demonstrate back to you or to explain the steps.
Ask them to help you as-often as possible.
If a step is rot understood, repeat it.
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Review the important steps and key points briefly and tell the audience where they can get any
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If this demonstration is to be followed by further sessions, tell the audience when and where
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Following the demonstration
evaluate it
did the audience learn how to do what was demonstrated?
what evidence was given that the audience plans to carry out this practice on their own?
visit members of the audience to see if they are using the new methods demonstrated,
how could your demonstration be improved?
108
Useful group educational methods
1
Meetings/group discussion
A general meeting is good for teaching something of importar.ee to a large group of pcople.You
can offer subject matter, questions can be discussed and the audience can participate,
lecturing is the most common educational method used, but used alone it is one of the poorest
Learning can be much easier if the audience can sec and take part in itVisual aids make meetings
more interesting and meaningful and will be discussed later .Plan your meeting. Outline your
talk.Think how you can emphasise each point visually. Then prepare all materials.
Consider, for example:
Actual objects. If you are talking about immunisation, show the syringe and vial of vaccine.
Drawing simple sketches on chalkboard.,
Using flipcharts.
Making a series of posters.
Using flash cards to tell a story;
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Using a flanncigraph.
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Points .to remember
Involve the people. This makes the meeting more interesting.
Here are some ways to involve them:-. .
Have a group act out some activity.
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. Use songs to reinforce learning. In Sierra Leone, women put the key points of a meeting to
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music and sing them.
r, Have enough reference materials which the people can. use or examine.
Stimulate discussion/ feedback by asking questions.
Make the group comfortable. Give some thought to the little things which you can do to help the
community see that this is their problem and project, not yours. For example, if people usually
chat while sitting on mats, follow their way. Let someone from thercommunity head the meeting
while you serve as a resource person. Ask for information more than you give information. The
j H g( j..meeting place and time should be convenient for the audience. Know the names of those who
a j ,T: • attend. Suggest to the leader (hat the meetings be short.
Seat the group in a circle. This is so everyone can see faces of the others. Give everyone a chance
to talk, and since viewpoints disagreeable to the group may come up, work to keep the atmosphere
friendly.
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Let the audience tell what the problem is. Your job- is to find out how they think, not to tell them
what to think. If there is a disagreement about the problem, help them to come to an understand
by asking the group questions that will clarify the issue. > -Il
Discourage speechmaking. Everyone in the group should be allowed to contribute, but you may
find one or two persons who want to do all the talking. If you say "Lefs hear what someone else
thinks", this may help to keep the discussion to other members. 5 '
Help All to take part. Ask questions. Show that their answers are good. Involve the shy person.
Nevpr laugh at or belittle anyone’s ideas. Group discussion Is a big conversation, moved by the
leader, but not monopoFzcd by-him/bcj;.
Guide the discussion to group action. Help the people to decide what the problem is and to act on
it This may be the hardest part It is easier to talk than to do what is necessary. At some point in
the discussion of the problem, summarize it with the group.. It is-^cry important that the group
members agree on the definition of the problent Jhcn they can discuss "How can we attack it?".
Help the group find technical information and help. At times, a problem will be too involved for
the villagers and they will need outside help. Help them to tpiderstand this and the importance of
knowing the problem before deciding-what they have, said so; they do not forget any important
information.
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Clubs
There arc many kinds of organisations to which women, men and young people belong. Mothers
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Clubs usually involve pregnant and fertile women for the purposes of education in maternal child
care. Youtli groups usually consist of both males and females and may be project-oriented or
’ involve education about such subjects as drug abuse, human reproduction or home-making. Farm
organisation can involve both men and women on projects.
Clubs arc becoming popular in many areas. They provide for a systematic way of teaching over an
extended period of time. The so-operative spirit developed through club work provides an excellent
, opportunity to teach that "we”, the members, are responsible citizens and working as a group for
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the betterment of "our" community. The spirit of greater whole-comjnunity unified participation
can be festered in such a social atmosphere.
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Village people like to sing and dance and almost every village has someone who can sign and put
words to music. Give this person ,a topic you want to make popular, such as
.1? The village without a safe well.
.? 3 ■ ;The sick children who got well with the proper food to eat ,
;u
The village girl who went to school to become the agricultural specialist
r.. The house where no flies,and mosquitoes breed.
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3:: ■: /-a4. The lesson is:learned best if the song covers one topic.
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The words can tell a story. A well-known tune can be used. L
or
Popular tillage artists can be employed to give the song more impact.
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Drama
' pm
'Drama is less common in villages, but it is a good means to interest people in a message. Most
people like to play the part of someone else, so involve several people'from the community. Ask
members of the community to help write the script Teachers might be of assistance. Maybe
'•
someone knows of some one-act plays already written which can be used or modified.
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.Any open space with .-a raised area-will do for .the performance. Have, adequate seating and lighting
fe’ -LG J J": :./(
g available if die drama is to occur, at night. Keep the script simple and. clear. Present the drama at a
convenient place and time. Say a few words at the beginning of the piay to introduce the subject
and give the reasons for the drama. At the end of the entertainment, answer questions and explain
anything the people did not understand.
'
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Encourage, discussion. Short introductory tall^ and pe-emphasis of the point, with questions at the
rn Cd :.f;O ■?
end; are essential if drama is to be an educational method and qot just entertainment. This is a
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useful way to involve clubs, youth groups and .schools. ■
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X! Role playing
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; Role p’ay ’is an informal p' y in which the members imagine a.situation and then act it out This
might be used *0 show bow different, people feel about a problem and what they should do about
it Role playing can be used to start off a discussion, to see what the possible consequence of a
certain action is, and to develop a better understanding of why people feel as they do.
The role-players might meet once to. decide , what points they wish to put across to decide which
characters will best show the issue and to assign the parts and to try a quick test-run. Too much
rehearsing or advance coaching ;will deaden the jxrfonnance thqugh. People like spontaneity. By
scmi-expcricncing a situation, both the actors and the audience gain a better understanding and
feeling for the problem.
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Role-playing should always be foHowpd by group discussion and never should be allowed to last
too long. How did the people feel? What were the issues? Why? Be wary about highlighting
controversial issues in a role play, as this may offend sensitivities^
'•r 33 .
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Puppetcplays 3 - ? .
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People like to be entertained afld puppetry car. be- a good.ipe:ans to both amuse and at die same time
leave a message with the audience. Even crudely made, puppets can keep an audience interested if
the action is lively and funny.
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For a puppet play to be effective, you must clearly define the points you wish to teach and limit
the lesson to the things you want your audience to remember. Keep it simple with only a few
points. Use a dramatic story and exaggerate the action of the characters because the villagers have
come for entertainment.
The good characters must be very good; the bad must be very bad. Avoid silent pauses. Have short
scenes with lots of action. The voices must be distinctive and new characters must be clearly
introduced so that everyone can follow the action. Do not preach. The audience is there to be
entertained. Be sure to try out your puppet play with a small group first to be certain your
110
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audience will understand the puppets and the messages you want to communicate.
The time spent in making the puppets, writing the play, rehearsing, testing, finding puppeteers,
and the secondary role of the actual health message would have to be weighed against the
comparative effect of this method in .health education., The simpler the message, the simpler it
will be to plan and carry it out Perhaps. a Mothers Chit or school could plan this kind of
programme.
!'
Visual aids and mass media
When selected and used properly,} visual aids can help to explain new concepts and relationships.
But more often, they are used in ways whith prevent discussion rather than discovery of such
relationships. They may entertain Or distract an audience but rarely educate. So use them wisely to
support a true educational approach, and test out their usefulness before you go too far.
. •>?
Leafkts/pamphlets
'
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Leaflets can be very appealing if their message is simple and clear, and if the language is
understood by the reader. Short sentences and paragraphs should be used, illustrated with simple
drawings or pictures that are easily understood. Make sure instructions are exactly right before
passing out the leaflets to viilagerslPretest them.
i
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Remember too, that many of the men arid'women in your village may be just learning to read.
They will appreciate having simple reading materials which are on topics that interest them and are
not written for children.
* •
Circular letters
You may have received information about the planned arrival of a much-needed vaccine in the
village and you want to notify the villagers and perhaps request the help of a few volunteers.
■.* . ■ ■.r:o ’ Occasionally, some communities can be reached through a circular letter.
4 '•
> o The tircnlar letter is duplicated so that many copies can be distributed, each containing the same
zj Hf : r information. The best ones are short, simple and cover one idea. If you have no access to a copying
machine, perhaps the school principal will allow a few pupils to assistyou, or you might ask for
volunteers from the Health Committee or Mothers Club. Make soft the message is understood.
i Pretest it
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Newspapers
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Newspapers might be of sdme help in rcaching lhe villagers. Announcements can be made
' 11
regarding health services, demonstrations or meetings planned; new?ideas can be presented.
Very often though, die national newspaper doe£ not reach smaller communities, or the people are
unable to read them. In this case, a newsletter, written by the villagers themselves, can become the
community's newspaper. Distribute it as you would a circular letter. Or place copies on a bulletin
1;.,
rns fbbard or wall in a public meeting plhce (imJ&t, well, bar, shops). People will see it and those
' ■ ■ YOf’. jE:’,7
who caii read will read it to others. The news urill spread rapidly. <n
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A poster will help get people interested in the topics it represents, 'but alone, it cannot teach them
J’n very niuch. It 'tfUl remind them' of a meeting to be held, or a procedure to be practiced, such as
c:
usifig well w&ef and not water from ihcuiver.
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Posters should
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be readable at a glance.
- 0 concern a topic that is important- to people. Jr Lfuor
;-z be easily understood.
be in accord with accepted ways of behaving. ;.i. •
have human interest
be placed where they will be seen by the intended audience.
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-y people can use posters for discussions. * ■
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What is the message? J /
How does this relate to us?
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111
Flash cards and flipcharts
Flash cards or flipcharts are a scries of pictures with a script that tell a story. (Similar to a
filmstrip).
HOW TO MAKE; Steps in making these, as with all visual aids, require good planning in
advance, First:
Make a list of points that need to be brought out
Write a story of the points to be made.
Break the story up into short sequences.
Decide what pictures or drawings or cut-offs or cartoons will help visualise the story.
Place side-by-side on a script:
A
B
Word Sequence
Picture
Test material on potential audience.
Revise.
Test again.
Put materials in final form.
Use heavy paper or medium cardboard cut to desired size. Size depends on the number of
people in the expected audience, seating arrangement for visibility, ease of transport, and on
ease of use.
Flash cards are most useful in groups of 30 people or less. For 30 people, each card should
measure about 22 x 28 inches. Flipcharts can be used in larger groups, say in the school,
clinic or at meetings.
Use simple line drawings, cartoons or photographs depicting the village in which you work. Try to
use no more than 12 cards. Anymore will be too lengthy and probably bore your audience. Let the
local people show the cards, or flip the charts as the audiences will relate better to its own
leadership.
At the beginning, tell what the story will be about and give a purpose for listening. When telling
the story, use simple local language. Held the flash cards against your body, chest high and turn
from side to side so that everyone can see. A flip chart might be placed on a table or held by you
as with the flash cards. Stack the cards in order. Explain number 1 with only it showing.Then
slip it behind the stack, or in the case of the flipchart, flip number 1 to the back and proceed to
ex; lain card number 2. For further suggestions about preparing flipcharts and flash cards, turn back
to the discussion on posters.
n.
Flannelgraphs
.•
.
The flanEelgraph is one of the most effective and easily used teaching aids because it is cheap and
portable. Except for trying to use this aid outdoors on a windy day, it has the same advantages as
flash cards. It. is veiy useful with people who do not read and in groups of less than 30 people.
. To make a good flannelgraph, you will need a piece of cotton flannel with thick nap. Other
materials you could use are burlap, a wool blanket, a thick towel, wool rugs, or almost any
cloth with rough fibres. A piece 30 to -0 inches should be large enough. Stretch the cloth over a
smooth board which is slightly smaller than the flannel and fasten the edges of the flannel to the
back side of the board.
Pieces of fell flannel, oid rug or sandpaper will stick on the flannel. Just press them against the
board and they will stay until you remove them. Tip the flar nelgraph back slightly if you have any
difficulty. Sumps’of flannel or sandpaper can be pasted on die back of photographs, drawings or
papers. Coursejof medium grain sandpaper- works better than fine grain.
To prepate a flainclgraph story, place thp title in large letters at the top of the board. Next, prepare
the drawings, photos or printed matends. Pre-test all of these figures to be sure your
audience will understand them. Cut them out and paste pieces of flannel or sandpaper on the back.
Put them in sequence and number them on the back.
Keep d:e story simple. Pictures should be kept in order and the words you use should tell one step
of your story at a time. Using common local names helps the audience identify with the lesson.
Blackboard (Chalk
The blackboard is most useful in situations where writing may aid in understanding an idea. It can
be used along with other teaching aids (flipcharts, flash cards, flannelgraph, film slides) to
summarise the essential points made, to draw diagrams, to clarify certain points, to write out
directions for further activities, to develop the lesson point by point and to highlight
and answer questions.
112
You must, of course, plan ahead when using the blackboard. Some things to keep in mind:
Write clearly in a large script
Keep drawings or diagrams simple.
Use the blackboard to clarify the lesson, not as a basis for it.
Stand so your audience can sec what you arc writing, do not keep your back to them.
If you have too much to write, then you are probably not using the blackboard effectively.
Anything put on the board ahead of time and not covered in the discussion will distract
attention.
Talking while writing on the beard is confusing.
If you make a drawing, always ask the group what it is, assure understanding.
You can make a blackboard from a 30 x 40 inch piece of plywood, cardboard or carton material.
Paint this board with a special paint made by using :1 to 1+parts of kerosene.
1 part of varnish.
1 part of lampblack (soot).
Enough powdered pumice to make the surface slightly gritty.
>. /"dv bilk;
Photographs, slides and filmstrips
Photographs are always of interest and can aid in education when they are also meaningful to
people. People can compare pictures taken of a house before and after improvements are made.
A very dramatic comparison can also be made between photos taken of malnourished children in
the village and after receiving treatment
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. R : A \filmstrip is a series of still pictures on one roll of - film tliat in sequence tells a story. You will
•c need.a projector for these, as well as for slides. Small, lightweight, inexpensive ones are available.
If you have a camera, you can lake pictures of good ways to do things, right in the village where
r .;.f
a: -you work, and have them made into a filmstrip, slides or photographs.
-tod-. There are definite advantages to photos :
'
-■ They can be photographed in the town or region where you’work thus assuring familiarity and
t a i d: b
recognition by the people.
i
> They may be in colour or black and white (colour would be especially important for foods,
, ‘ although you can always use the real thing or models ia place of photos if they are not
in true colour).
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They are relatively inexpensive and reproducible for different uses, (poster, flash cards).
The action, position, and characters or objects can be easily manipulated.
■ - . They can be simplified by the ’block out’ method to emphasize the point being made.
You can make them yourself.
With a 35mm camera, you can. produce filmstrips too, but this means planning well ahead
•1 for proper sequence (a filmstrip by definition's a scries of still pictures on one connected
roll of film).
..
'.
The same care should be taken with photography as drawings, taking into consideration the
familiarity with visual aids of ae group you are working with.
10 ?
Things to remember when using photos, slides and filmstrips.
. - ■ Try to make and select pictures in which all objects ; .are familiar to the people to whom you
/ are going to show.them.
• ■ ii
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- l > Try not to use pictures where only parts of important obj-xts arc shown.
: - 3; Make sure that all objects arc shown from the levefat. which they are normally seen.
;. • Try not to use photographs which show objects larger than they really arc.
.
Use natural colour photography whenever you can.
- ; Keep everything out of the picture which is not important to the message.
When showing pictures enc by one, remember that people need time to comprehend them;
: > ask them to say what Lheyiscc and explain if they make mistakes.
,
Filmstrips, must be photographed in.a logical sequence.
If you want to use photographs of people, be sure that those people understand how you arc
going to use their pictures, and give diofopermission for it.
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Films .
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People who will not attend you? lessons or any kind of meeting, may go to see films. For this
reason, yoii can use films as a way to get people interested. Showing a moving picture effectively
takes planning and forethought: You will need electricity or a generator, a projector and films.
Be sure that the projector is in good working order; know how to operate it
1
2 Have suitable physical arrangements. For example, seating arrangements, hearing and lighting
arrangements.
113
3 Always preview a film so that you may plan for its proper use. Involve a group of villagers
in previewing the film. Villagers can assist in presenting the film to the village.
4 Introduce the film: what is the film about? It is easier to understand the message of a film if
we have some idea of what it is about. Example, ’I am going to show you a film entitled 'How
Disease Spreads'. It will show very vividly how disease spreads in a village. It will show what
causes disease to spread and will show how disease can be prevented. This film presents a problem
which is very important in every part of the world and of very great importance to us here in
Rathimunda Village'.
5 Give a purpose : when viewers have a purpose for looking at a film they will understand and
remember more of the content of the film. A few questions given to the group in advance will give
them a purpose for viewing the film. For example, 'Does disease travel in our village the way it
docs in the film?' 'What are the ways disease travels?' 'What can we do about stopping the spread
of disease in this village?'.
6 Discussion : the questions given in advance can serve as the basis for discussion at the
conclusion of the film. Discussion will make the group think about the film and its meaning for
them. Discussion will help to fix the important points of the film in the minds of the audience.
Discussion can help in clarifying any points which are not clear or concerning which additional
information may be needed.
7 Show the film again: often it is desirable to look at the film again to get information which
may have been un-noticed in the first showing. People who are not accustomed to seeing a film
may have to see it several times before getting the point Avoid showing a number of films at
one time, particularly those which may be unrelated.
8 Never show a film without having a discussion.
Games and puzzles
Games and puzzles when used in the educational process show that learning can be fun as well;
and that training programmes do not always have to be dull and serious to be useful.
While being very popular and appropriate for work with younger children it can also be used
successfully with adolescents, youths and adult groups. For instance the game which can be
played by small children who are asked to identify different types of food using pictures,
inexpensive cut-outs from newspapers, magazines or made from pieces of paper or cardboard,
can also be used io help teach illiterate mothers to categorise them into different nutritional
groups, or plan balanced nutritional meals. After the initial lesson they can be presented with the
cards jumbled up in a paper bag and asked to categorise them. Other educational topics eg family
planning and immunisation games (also quite economical to make) which would involve hazards
and punishments, care and reward. With a little careful thought, many such simple but effective
games which are guaranteed to produce boisterous involvement and at the same time promote
important learning can be produced.
Adapted from Community Health Education in Developing Countries Peace Corp Information
Collection and Exchange Office and Training Programme Support, Washington, USA.
114
Handout 2
Fifty health messages which apply to India for a
healthier village - what people can do for themselves
What families can do
1 Dig a pit for rubbish. Compost this rubbish into valuable manure.
2 Grow a vegetable garden, using the manure from the rubbish pit, and the waste water from
the house.
3 Make a better latrine that the people will like to use, especially in all new houses.
What the village can do together
4 By group discussion, get group decision for group health actions (to begin with, choose a
problem where success is assured).
5 Clean village wells and keep them clean. Protect them by building up their sides.
6 Control the worst of tire village pests - snakes, stray dogs, lice, fleas, bed bugs, scabies,
mosquitoes, rats.
7 Make family planning methods known and available outside of clinics and health workers.
8 Plan how to feed the very thinnest of the toddler children with extra food per day during the
leanest months of the year.
9 Arrange with the nearest health centre to immunise all the children.
10 Get someone in the village trained in simple health care, and get her supervised regularly. Get
at least one village dai trained also.
Child care
11 Breast feed as long as possible.
12 Introduce semi-solid food from five to six months.
13 Feed young children five or six times a day.
14 Continue giving food in illness.
15 Use the health service available.
16 Get children immunised.
17 Keep yourself and your surroundings clean.
' 18 Drink clean water.
19 Have no more than two or three children,
20 Have children two to three years apart.
Can e of mothers
21 A woman who is pregnant or breast feeding, should eat more food than she normally eats.
And she should eat some green leafy vegetable daily.
22 A woman who is pregnant or breast feeding rieeds at least, one iron tablet daily, especially if
she is tired or pale.
23 Pregnant women and women with young babies need special care. They should visit a trained
health worker each month.
24 A pregnant women should have the delivery of her baby done by a trained health woricer. A
trained health worker washes her hands frequently. This protects the mother from fever afterwards.
25 Cut the cord of the newborn baby with a clean knife first held in the flame. This will protect
the baby from tetanus.
Care of the eyes
26 For healthy eyes, eat green vegetables, and plant a kitchen garden.
27 Stop infection spreading from eye to eye. (Trachoma and pus spreads from one eye to the next
by mother’s sari, common towel, kajal or surma).
28 See a trained health worker if a person
cannot see clearly in both eyes.
cannot see at night
has pain in one or both eyes.
29 If something has got into the eye, or if it is sticky, wash out the eye immediately with plenty
of water. Then show to a trained health worker.
30 Cataract is curable if operation is done early enough. Get operations done only by eye doctors
from well known hospitals.
115
Tuberculosis
31 Tuberculosis is a dangerous disease if it is not treated properly.
32 Proper treatment for tuberculosis means regular treatment for al least a year.
33 If the patient stops treatment as soon as he feels better, the disease will surely return. This
time the cure will be difficult and very expensive.
34 Take treatment only from trained health woikers.
35 Special foods arc not necessary, but regular treatment is essential.
36 Regular treatment soon makes the person non-infcctious.
37 Tuberculosis is a disease which is spread by sputum and cough.
38 Stop the disease spreading. Cover the mouth when coughing. Do not spit on the floor. Keep a
special container for sputum, and burn it in the fire.
39 If there is cough with sputum for more than two weeks, it might be tuberculosis. Get the
sputum tested at the nearest health centre. Show any thin child with cough to the health worker; it
might be tuberculosis.
40 Protect all children from tuberculosis by BCG injection.
Leprosy
Leprosy is not hereditary. It is a disease, and not a curse from God. It is not a venereal disease.
Do not be afraid of people with deformity. Usually they do not have infectious leprosy.
Leprosy can be cured with regular treatment
Take treatment only from trained health workers.
Start treatment as soon as possible.
Patients on treatment soon become non-infectious.
Slay on regular treatment
Deformity can be prevented with regular treatment
Deformity can often be cured with surgery.
Inspect unfeeling hands and feet each day for injury or bums; wear shoes to prevent injury to
the feet
41
42
43
44
45
46
47
48
49
50
Special messages for certain areas
Here arc some examples of extra messages for certain areas and local problems. Each person knows
his own area best: the message has to be short and cleai\
Western Orissa where violent
massage is practised.
Do not massage the baby's abdomen
after birth. This is harmful to
the baby.
Many rural areas where tetanus
is common despite branding of
the skin.
Do not brand the baby’s abdomen
af ter birth. Instead brand the
end of the cord and prevent
tetanus.
Areas where goitre is commom
as in hill areas of Assam
and Bhutan.
Iodised salt prevents goitre (if
iodised salt is available).
In Rajasthan where water
is scarce.
Purify wells weekly with bleach
ing powder.
In Assam where wood is
plentiful.
Boil all drinking water.
Acknowledgement
For a healthier village is radically adapted from Nine do-it-yourself Health Actions by Dr Sam
Street, WHO, Ethopia in UNICEF News 7/1976/1.
Child care - is from Child Care Education •• basic universal messages by Dr Peter Greaves
FOA/UNICEF Regional Adviser in Nutrition, card published by UNICEF Information Service,
New Delhi.
Care of mothers is adapted from Simple Nutrition Messages by VHAI.
Care of eyes, tuberculosis and leprosy sections arc adapted from the relevant patient-retained health
records published by VHAI, and from pamphlets on leprosy published by Dr R Thangaraj,
Leprosy Hospital, Salur, AP.
116
Handout 3
Community IEC intervention checklist
Group guides assess
A The groups.
B Individual trainees while their groups conduct the activities using the following checklist.
A
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Group assessment
Did the group contact identified
leaders who could help in
implementing the activities?
Did the group select the
appropriate target group for
education/motivation?
Did the group select an
appropriate place, date
and time?
Did the group give wide
publicity about the activities?
Did the group choose effective
audio-visual aids, media
and materials?
Did the groups choose
appropriate audio-visual aids and
media for the specific
target group?
Did the group have all
audio-visual aids, media and
materials ready?
Did the group check
the equipment before
using it?
Did the group use
audio-visual aids
effectively?
Did the group
mix media?
Was the group sensitive
to socio-cultural background
of people?
Did the group adopt the
contents to the background
of the specific target group
of people?
Did the group fully
cover the contents of
the lesson fully?
Did the group give
correct information?
Did the group encourage
participation by the people?
Did the group find out if
the contents and visuals were
understood by thepeoplc?
Did the group involve
voluntary workers?
Did the group involve
PHC or District Staff?
Did adequate number of people attend
the activities?
YES
NO
Remarks
117
B
Individual assessment
1
Did the individual member of
the group co-operate with others?
Was the individual selfish?
Did the individual complete
his work properly?
Did the individual complete
his work in lime?
Was the individual interested
in achieving the group goals?
2
3
4
5
118
YES
NO
Remarks
Session 26
Aids to Communication:
Micro-Teaching Exercise
Worksheet
Instructional objectives
At the end of this session participants should be able to
- practice good teaching/motivational technique.
- critically analyse good and bad teaching/motivational technique.
Activities
1 Each survey group in turn makes 10-minute presentation on a relevant topic for health
worker training for IEC.
2 Other groups observe using prepared checklists.
3 Discussion/critical analyses to follow each presentation immediately.
4 Repeat round for community interventions.
5 Unsatisfactory groups reteach (if time is available).
Assessment
Critical analyses of group presentation.
Materials
As required (each group to provide) BEE (IEM) kit
Teaching Aids
As required (each group to provide).
Background reading
As at session 25 (study carefully).
Further reading
As at session 25.
Teaching Health Care Workers - a practical guide - F.R.Abbatt and R. McMahon.Chapter 12
Teaching and Assessing Communication Skills
Comment
Good preparation and planning would have ensured that by this stage
Suitable candidates would have been carefully selected.
1
2 They would have been informed well in advance of the time of training.
3 Their supervisors would have been informed well in advance so that schedules could have
been adjusted.
4 A suitable place would have been chosen and prepared.
5 Transportation and finance would have been arranged (either for the trainers to go to
the trainees or the trainees to come to the centrally selected placed for training).
6 All training manuals would have been assembled.
7 Resource persons should have been provided with all relevant information.
REMEMBER that it was suggested previously that CHV's, VHW's and TBA's are the cadres of
health workers who can find such training most valuable, since they are in closest contact with
the communities. Nevertheless, any category of health workers can benefit from such in-service
training.
119
F
Session 27
Aids to communication:
Health Worker Training
1 day (Fieldwork) exercise
Worksheet
Instructional objectives
At the end of this session participants should be able to
effectively conduct appropriate IEC training session/s at a convenient health unit in the field,
or at a centrally selected place or institution.
combine and co-ordinate resources to ensure successful implementation of the IEC training
session/s.
Activities
1
Participants in groups of at least FOUR persons conduct training sessions for chosen
health workers
either individually or in small groups.
2 Trainers supervise and assess (using checklists).
3 Participants take every opportunity to observe, assist, facilitate and assess (using checklists)
the work of other members. Also make supplementary notes as necessary.
Assessment
Training sessions by checklists.
Materials
As required.
Teaching aids
As required
Background reading
Handout 1. Contrasting perspectives for school and adult health programmes.
Handout 2. Considerations for IEC interventions involving adults.
120
Handout 1
Contrasting perspectives for school and adult
community health education programmes
In the normal traditional approach to formal education learning about subjects is considered to be
useful for conducting later life. The time perspective is one of postponed application. Learning is
therefore considered to be a process of accumulation of facts and figures (information) which docs
not always add up to knowledge, some skill and attitudes may prove useful when children become
adults. The learners in this situation, enter educational activity in a subject centred frame of mind.
In contrast, adults engage in learning largely as a response to pressures imposed through current
life problems, and therefore their time perspective is one of immediate application. They therefore
regard loaming as a process of improving their ability to deal with pressing current problems, and
tend to enter any educational activity in a problem-centred frame of mind.
Handout 2
Consideration for IEC interventions involving
adults
Adults (learners) have a deep psychological need to be treated with respect They tend to
avoid, resist and resent being put into a situation in which they feel that they are being
treated like children.
2 They tend to resist learning in ’classroom’ situations like those of childhood.
3 Much attention must be given to the ’quality' of the learning environment The motivator
should try to be supportive rather than judgmental.
4 Adults should be allowed to contribute fully to the diagnosis of their own learning needs.
5 Adults should be involved in the planning and conducting of their own DEC experiences.
6
Adults should be allowed to evaluate their own progress.
The adult learner has the potential for assimilating new learnings more easily especially if
7
he can relate them to past experience.
8 Emphasis should be placed on tapping the experience of adults.
9 Special attention should be given to introductory activities which help adults to relax from
their fixed-habit patterns.
10 The starling point of all learning activities should be the problems.
11 IEC sessions should be applied to specific problem areas rather than 'subjects’.
12 The motivator should consider him/herself as a 'facilitator' rather than just a deliverer of
information.
1
121
Session 28
Aids to communication:
Community Interventions (Fieldwork) Exercise
Worksheet
Instructional objectives
At the end of this session participants should be able to
effectively conduct an appropriate IEC motivational intervention in the communities surveyed
in UNIT 1 coursework.
combine and co-ordinate resources to ensure successful implementation of the IEC
community motivational intervention.
Activities
1
Participants in groups of at least four persons conduct motivational sessions for each of the
following
- schools/teachcrs.
- women’s groups.
- clients at home.
- formal/informal leaders and any other.
2 Trainers (CDT) supervise and assess.
3 Participants take every opportunity to observe, assist, facilitate and assess (using checklist)
the work of other group members. Also make supplementary notes as necessary.
Assessment
As at session 27.
Materials
As required. Cameras, video, films (if available) to record fieldwork proceedings.
Teaching/motivational aids
As required.
Background reading
As per session 27.
122
Session 29
Aids to communication:
Evaluation of teaching/motivational exercises
(Sessions 27 and 28)
Worksheet
Instructional objectives
At the end of this session participants should be able to
systematically apply an evaluating instrument to training/motivational activities.
critically analyse his own performance and the performances of his fellow group members,
come to a satisfactory conclusion as to what could be done to improve his performance in the
future.
Activities
1 The fieldwork groups - discuss and critically analyse referring to assessment checklists, will)
the members of the Course Development Team who supervised the group. Use ’visual' recorded
examples if possible.
2 Answer these questions
What did the participants want his target individual/group to learn about or do?
Was the content of his presentation relevant, sufficient or correct?
Was he able to help his clients to loam?
I low did he do so? What was the evidence?
What tended to interfere with the tcaching/lcaming process? Why?
What could have been done to improve this process?
3 Make careful and comprehensive notes.
Assessment
Materials
Teaching aids
Completed checklists and observation notes. Photographs/slides/video film of field activities if
they can be prepared in time.
Background reading
Re-read Teaching Health Care Workers - F.R. Abbatt and R. McMahon. (Chapters 10 -13).
123
Unit VI
Community participation
125
Session 30
Community participation:
Community dynamics and participation
Worksheet
At the end of this session participants should be able to
understand the importance of the community power structure to co-operative community
action.
understand how the way we look at 'community' can strongly affect our approach to
participation.
recognise that as health workers they should analyse conflicting ideas and draw conclusions
drawn from their own experience.
Activities
1 Small group discussion - Define 'community' and 'participation'. Arrive at a consensus of
what is meant by 'community participation'.
2 Group representatives defend definitions with the help of other group members.
3 Small groups. STUDY carefully and discuss extensive Handout 'Community dynamics and
participation' (Handout 2 - pl28).
4 Teacher led whole class discussion to ensure that important points in handout are explained
and understood.
IMPORTANT QUESTION - Do we really believe in the ability of people to participate in
community development?
Assessment
Group definitions.
Materials
Transparencies, flipchart paper, markers, pens.
Teaching aids
Handouts.
Background reading
Handouts 1 and 2.
Further reading
1 Helping Health Workers Learn - D.Werner and B.Bower. Chapters 6-11.
2 Studying your Community - R.L.Warren.
Citizen Participation in Planning (Chapter V page 73).
3 Health Planning and Community Participation - S.Rifkin - The community development
approach' (page 13). Also 'Views about Community Participants' (pages 41 and 127).
126
Handout 1
Community participation
Definition
Community participation is the process by which individuals and families assume responsibility
for their own health and welfare and for those of the community, and develop the capacity to
contribute to their own and the community’s development. They come to know their own
situation belter and are motivated to solve their common problems. This enables them to become
agents of their own development instead of passive beneficiaries of development aid. They
therefore need to realise that they arc not obliged to accept conventional solutions that arc
unsuitable, but can improvise and innovate to find the solutions that arc most suitable for them.
Many studies have shown that the services provided by the Health Department arc not fully used by
the people. Some of the reasons arc accessibility, availability and sometimes affordability. But
another important reason for the under utilisation of services is the lack of awareness in the
community about what the programme is for and how it is beneficial to them. Health has not yet
become a fell need in the community.
To some extent the workers in the Health Department arc also to be blamed because they have been
carrying out their work in a routine manner and giving the services only to those who ask for them
and not inducing the entire community to demand services.
Unless a demand is created and people ask for it as a whole group, utilisation will continue to be
poor.
By community participation is meant that the people are gradually educated and encouraged to take
responsibility to tackle their own problems and seek the aid of Government resources. Needless to
say group sanction or support is necessary for new tilings to be adopted. For example for carrying
out an immunisation programme or for conducting a Family Planning camp or eye camp etc, if the
whole community has been involved right from the planning and also in the implementation, then
the result will be better than the Government agency merely putting up a camp and expecting all
the people to come and get their services. Why? If they create it, - it is theirs, and they will tend to
cherish and preserve it more.
There arc many ways to bring out community participation. Amongst them the two very useful
methods arc group discussion and planning and training of leaders. Leaders have to be identified
and given responsibility for carrying out the programme along with Government Agencies.
Informal groups formed from the community will have to be educated from time to time about
advantages of the programme and encouraged to give group support
127
Handout 2
Community dynamics and participation
To do their work effectively, health workers need to be aware of many aspects of community life:
people's customs, beliefs, health problems, and special abilities. But above all, (they need
to understand the community power structure): the ways in which different persons relate to, help,
and harm each oilier. In this handout we explore these aspects of community dynamics and what is
meant by community participation. As we shall sec 'community' and 'participation' mean
dangerously different things to different persons. In fact, the way we look al 'community' can
strongly affect our approach to 'participation'.
What is community?
Many health planners think of a community as 'a group of people living in a certain area (such as a
village) who have common interests and live in a similar way’. In this view, emphasis is
placed on what people have in common. Relationships between members of a community arc seen
as basically agreeable, or harmonious.
But in real life, persons living in the same village or neighbourhood do not always share the same
interest or gel along well with one another. Some may lend money or grain on unfair terms.
Olliers may have to borrow or beg. Some children may go to school. Other children may have to
work or stay at home to watch their younger sisters and brothers while their mothers work. Some
may speak loudly in village meetings. Others may fear to open their mouths. Some give orders.
Olliers follow orders. Some have power, influence and sclf-conridcncc.Othcrs have little or none.
In a community, even those who arc poorest and have the least power arc often divided among
themselves. Some defend the interests of those in power, in exchange for favours. Others survive
by cheating and stealing. Some quietly accept their fate. And some join with others to defend their
rights when they arc threatened. Some families fight, feud, or refuse to speak to each other sometimes for years. Others help each others, work together, and share in times of need. Many
families do all these things at once.
Most communities arc not HOMOGENEOUS (everybody the same). Often a community is a
small, local reflection of the larger society or country in which it exists. It will have similar
differences between the weak and the strong, similar patterns of justice and injustice, similar
problems and power struggles. The idea that people will work well together simply because they
live together is a myth.
Elements of harmony and shared interest exist in all communities, but so do elements of conflict.
Both have a big effect on people’s health and wellbeing. Both must be faced by the health worker
who wishes to help the weak grow stronger.
What is participation?
Two views have developed about people's participahon in health :
In ihc first more conventional
view, planners sec participation
as a way to improve the delivery
of standard service. By gelling
local people to carry out pre-defined
activities, health services can
be extended further and will be
better accepted.
In the second view,
participation in which
the poor work together
to overcome problems and
gain more control over
their health and lives.
The first view focuses on shared values and co-operation between persons at all levels of society.
Il assumes that common interests arc the basis of community dynamics - that if everyone works
together and co-operates with the health authorities, people's health will improve. The second
view recognises conflicts of interest both inside and outside the community. It secs those conflicts
as an important influence on people's health. It docs not deny the value of people organising and co
operating to solve common problems. But it realises that different persons and social groups have
different economic and political positions. Too much emphasis on common interests may prevent
people from recognising and working to resolve the conflicting interests underlying the social
causes of poor health. This second view would suggest dial
Any community programme should start by identifying the main conflicts of interest within die
community.
Il is also important to identify conflicts with forces outside die community and look at die way
diese relate to conflicts inside the community.
128
Which view of participation is taken by planners or programme leaders will depend largely on what
they believe is the cause of poverty and poor health.
Some believe that poverty
results from the personal
shortages or shortcomings of
the poor. Therefore, their
programme's goal is to change
people to function more effect
ively in society. They think
that if the poor are provided
with more services, greater
benefits and better habits,
their standard of living will
become healthier. The more
the people accept and partici
pate in this process, the
the better.
Others believe that poverty
results from a social and
economic system that favours
the strong at the expense of
the weak. Only by gaining
political power can the poor
face the wealthy as equals,
act to change the rules that
detennine their well-being.
Programmes with this view to
work change society to more
effectively meet the people's
needs. For this change to
take place, people's part
icipation is essential - but
on their terms.
Many of these ideas are taken from
On the Limitations of Community Health Programmes by Marin das Mcrccs G. Somarriba,
reprinted in CONTACT - Special Scries 3, Health : The Human Factor, Christian Medical
Commission, June 1980.
Helping Health Workers Learn by David Werner and Bill Bower.
129
Session 31
Community participation:
Rationale for the involvement of the community
in the provision of its own health needs
Worksheet
Instructional objectives
At the end of this session participants should be able to
identify the several good reasons for involving community members in the planning and
management of their own health needs.
identify health-related programmes which can benefit from community participation.
Activities
1 Small group discussion - List advantages and disadvantages for involving community members
in health planning and implementation.
2 One selected group presents its list, which is discussed and modified accordingly to the
contribution of the other groups.
3 A comprehensive list is agreed on, and posted on the wall.
4 In small groups - list as many health-related programmes which you think can benefit from
the co-ordinated participation of community members.
5 As in 2 and 3 above.
Assessment
Materials
Flipchart paper, markers, transparencies, pens.
Teaching aids
OHP, blackboard, handouts.
Background reading
\ Helping Health Workers Learn - D. Werner and B. Bower - Chapters 6 - 12.
2 Child-lo-Child Programme - Institute of Child Health, London.
130
Handout 1
The rationale for involving the people in
community health programmes
the community holds knowledge regarding its health needs.
the community contains within itself a wealth of resources, eg human, financial, physical
etc.
national financial resources are limited, therefore maximum utilisation of existing resources,
including appropriate technology is an absolute necessity.
it facilitates community cohesiveness.
it affords continuity of planned programmes and projects because of its involvement and
commitment
it facilitates personal development, self-help and self-esteem.
it affords sensitisation to an awareness of the community’s own capabilities and potentials
in identifying suitable solutions to problems.
it facilitates active participation in community and national development.
it tends to create a more culturally appropriate health service.
Others:
Disadvantages
Absolves the government from responsibility.
Potential threat to political authorities.
Undesirable support for local critics.
Others:
131
Handout 2
Some health related problems which can benefit
from community participation
Housing (building and improvements).
Latrine building.
Protection of water sources (springs etc).
Improvement of food production and storage.
Vector control.
Improvement of schools, and school health.
Mother and Child Nutrition.
Family Planning.
Road building.
Others (specify):
132
Handout 3
Benefits of community participation
It is not benefits of a programme which are of concern here but, the benefits obtained for the
programme because of active involvement of the community in every stage of activity.
The following are some of the illustrations of such benefits which are essential for the functioning
of Block Extension Educators.
Stages
1 Community diagnosis
Benefits
-Relevant data can be collected from respondents without hesitation
from their side.
-Felt need of the people can be assessed.
-Community awareness is created towards health activities.
-The resources available in the community for facilitating health
programming can be identified.
-Strange and hostile feelings towards giving information can be
overcome.
-Identification of appropriate community members to assist in
various programmes can be possible.
-At times the guidance of leaders are most beneficial which also
helps in proper planning.
2 Planning and conducting IEC activities
-Proper selection of place and timing suitable for community
activities can be ensured and followed.
-In planning visual aids the local products can be utilised which will
be liked and accepted by the community.
-Motivating resistant groups/individuals through leaders is most
beneficial to the programme.
-As everything cannot be caried from the health centre, use should be
made of community resources.
-Local folk media can be utilised. The same may be modified to
fulfill educational objectives.
-A leader speaking for the programme will generate response from
the target beneficiaries.
-Appropriate suggestions from the community members can be
available to improve the programme further.
3 Planning for health care
-By planning with the people, the ability of the community to
receive health care can be ensured. It will not disturb their
woit.
-Health Care as per the felt need of the community can be planned as
per priority.
-Response for receiving health care will be satisfactory.
-A suitable place to hold health campaigns can be arranged in the
community.
-Voluntary co-operation from the interested group can be obtained.
-The approach and attitude to work with the people will make them
feel that it is their programme.
-By planning with the people the demand for health services can be
created.
4 Up-keeping of health of the community
-Satisfaction derived from health care can be shared by the rest of
the members if the community is rightly involved.
-Some of the members may be entrusted and encouraged to follow up
the cases by timely reporting about the health care acceptors.
-Organisation of subsequent health programme will be easy through
people's participation.
-Persons involved may influence others to continue the practice.
133
Session 32
Community participation:
Important enhancers and inhibitors to
community participation
Worksheet
Instructional objectives
At the end of this session participants should be able to:rccognise agents and agencies which can assist or inhibit community participation in health
programmes.
recognise the importance of utilizing the community formal and informal leadership to
encourage participation.
Activities
1 Brainstorming - Name 'enhancers’ and inhibitors’.
2 List on the blackboard or OHP and say why classified as one or the other.
3 Villages and neighbourhoods usually have many kinds of leaders. Name as many as you can
(brainstorming). Discuss how each can enhance or inhibit
4 In small groups - list the different types of leaders in the villages and communities serviced by
group members. Make sure that unofficial or informal opinion leaders are named, as well as local
authorities.
5 Study Appendices V and VI.
Exercise
6 Answer these questions about each leadcr.How was this leader chosen, and by whom?
Does this leader fairly represent the interests of everyone in the community?
If not, for whom does he play favours?
From whom does he take orders or advice?
What has this leader done to benefit the village? To harm it? Who benefits or is harmed most?
In what ways do the actions or decisions of this leader affect people's health?
Which leaders should we try to work with? In what ways?
Should we include unfair leaders in our community health projects? If so, what might happen?
If not, what might happen? If we do (or do not) include them, what precautions should we
take?
If local leaders do not fairly represent the poor, what should we do?
Keep quiet and stay out of trouble?
Protest openly? (What would happen if we did?)
Help people become aware of the problems that exist and their own capacity to do something
about them? If so, how?
What else might we do?
Assessment
Questions and answers.
Materials
Transparencies, flipchart paper, markers, pens.
Teaching aids
OHP, blackboard, handouts.
Background reading
Handouts 1-6.
Further reading
1 On being in charge - A guide for middle level management in Primary Health Care - WHO
(Chapters 2 and 3).
2 Helping Health Workers Learn - D Werner and B Bower (Chapters 6, 26-27).
134
Handout 1
Community leadership
After training, health workers arc often exhorted to work closely with the leadership in the
communities which they serve to encourage co-operation and community involvement in
developmental projects which include health. However, it is necessary to look critically at
community leadership, because the interest of some leaders might not always coincide with the
interests of those in the majority whom the projects are designed to serve most.
Corruption of leadership, together with the resulting frustration of health workers responsible for
the encouragement of community projects, explains the lack of effectiveness of many health
projects.
Villages usually have many kinds of leaders:
local authorities (headmen, pradhans, munsiffs, panchayat members)
officials sent or appointed from the outside
political leaders
religious leaders
school teachers
extension workers
club, group, union, or co-operative leaders
women's leaders
children's and young people's leaders
committees (health committee or local school committee)
those who have powerful influence because of property or wealth
opinion leaders among the poor
opinion leaders among the rich
In nearly all communities there arc some leaders whose first concern is for the people. But there
may be others whose main concern is themselves and their families and friends - often at the
expense of the others in the community.
It is necessary for the health worker to decide after ascertaining by community investigations which
of these leaders are most acceptable to the community, and to seek the help of such leaders in the
implementation of community health prospects.
How do you discover the informal leaders?
The first step is to consider the responses you received when asking villagers ’Where would you go
for help if you have a health problem?' Other questions you might ask are:
'Who are the important people in the community?'
’Whose opinion do you respect?'
’Whose advice do you follow?'
'Who is wise?’
Who settles arguments within or between families?'
Whom do you think people would go to for advice when their children have fever? To organise a
special trip or event?'
You will probably find that the people named are those with leadership qualities and that the named
will differ according to the problem to be solved.
However, leaders may not be the persons who show the greatest interest at the beginning of a
project
You may not uncover obvious enthusiasm to help others, but people who express interest,
friendliness and willingness to work, or people whose name was mentioned often by neighbours,
may be your key to potential loaders. In your search to discover local leaders, do not bypass those
who appear to be against your work. Give them special attention and try to win their support and
cooperation.
Example of a local leader: the birth attendant
Birth attendants arc the most widely distributed of any category of health-related person. The reason
for this is that women usually wish for some assistance at the time of delivery and they are unable
to travel far or to wait long for someone to reach them when they go into labour. The birth
attendant is also working at a time which is especially appropriate for maternal and child health
education. Unfortunately, birth attendants are often untrained, but they are often very influential
with mothers.
Identifying and working with local birth attendants can be very effective in health education. In
fact, in some poor communities the entire standard of health, sanitation, infant and childhood death
rates and family planning have been revolutionised primarily through the work of birth attendants.
135
What leaders can do for the community
If an effort is made to give leaders a thorough understanding of how health problems affect
community well-being and how these problems can be solved, they can contribute immeasurably
to better understanding among die people. They can also become a powerful motivating force for
community unity and action. Through their own acceptance of improved health methods and
practices, they become a motivating force for change.
But, care must be used when deciding which leaders arc the influential ones related to the specific
community problem. In Tonga, an environmental sanitation project was initiated after preliminary
planning with the community leaders. In Tonga the women rank higher than the men according to
traditional Tonga Kinship systems; the men however, arc the heads of the households. The
organisation of the project was based on the men's support, and, at the request of the men, the
women were not involved in the planning. The health workers left the decisions about methods of
work to the male leaders but conducted the evaluation themselves. The project failed.
When a second project was planned in another Tongan community, an analysis was made of why
the first one failed. The conclusion was that both the male and female leaders should have been
involved. Both groups were given full control of the activities under guidance of the health worker.
The villagers were left to themselves to make the decisions and suggestions supported by the
majority were encouraged and used. Evaluation of the second project showed that every goal was
achieved.
Project success can be achieved through the efforts of the villagers themselves, providing the right
approach is used in promoting the active participation of the most influential community groups
and loaders.
Leaders can contribute to the success of a project if they arc persuaded to:Bring people to meetings.
1
2
Arrange for and find meeting places.
Help reach more people by telling others.
3
4
Help people in the community get to know and gain confidence in you.
Give general information about the programme and help interpret it to the people.
5
Help identify problems and resources in the community.
6
Help plan and organise programmes and community activities.
7
Help plan and organise any services which might be provided.
8
9
Give simple demonstrations.
10 Conduct meetings.
11 Lead youth groups and various individual projects.
12 Interest others in becoming leaders.
13 Help neighbours learn skills.
14 Share information with neighbours.
15 Serve as an officer in an organisation or chairman of the committee.
How can these potential resources of the community be mobilised? In discussions with leaders,
what have you discovered that is important to them? Maybe it is the protection of children's health.
Maybe it is convenience, privacy, or cleanliness. Maybe they arc moved by competition - 'Other
communities arc solving their health problems'. They might express pride in their community 'We have done so many other things in this village, but this problem remains'. Capitalise on
these motivations. Use them to guide you towards a belter understanding of the people of the
community.
136
Handout 2
Enhancers and inhibitors
Enhancers
- Satisfied beneficiaries
(of the health services)
- Health Staff
- Home visits
- Opinion leaders
- Community organisations
(eg Mahila Mandals)
- Village health committees
- Community Health Volunteers
- Social workers
- School teachers
- Private practitioners
- Traditional practitioners
Others (specify):
Inhibitors
- Dissatisfied users
(of the health services)
- Customs, traditions, beliefs,
- Illiteracy
- Poor knowledge of health programmes
- Poverty
- Rumour
- Misconception
- Fear
- Different priorities of different interest groups
137
Handout 3
Functions of a health committee
1 To represent the users of the community on the health problems in the community.
2 To decide whether health problems can be solved through community efforts, such as
improving water supply, sanitation, drainage etc.
3 Motivate the community to work together to solve these problems.
4 To help identify health problems which need individual family attention, such as the
improvement of the health of children through better nutrition and the prevention of diarrhoea.
5 To inform the community about health plans and activities.
6 To encourage the active participation of the community in the formulation of such plans and
the conduct of such activities.
7 To motivate members of the community to train as Volunteer Community Health Workers.
8 To monitor and help to supervise the work of the CHW as their ultimate responsibility to the
community.
9 To support the CHW (and other health staff), encouraging people to accept advice, teaching and
treatment given by the CHW.
10 To assist with the development of training, arrangement of health camps in each community.
11 To attend regular monthly meetings.
12 To liaise with other organisations in the community for the social development of the
community.
138
Handout 4
Steps in organising community participation
Identification of formal and informal leaders.
Formal leaders like Panchayat members, village munsiffs, teachers, village level workers etc.,
are required, to give their support through their departments. It is the informal leaders who arc
considered by the people themselves as influential and therefore more important for
undertaking responsibility for any programme:
Collect socio-economic data and information concerning social inter-relationships.
Identify common interests and areas of conflict.
Make a list of leaders as suggested.
Meet each of them individually.
Tabulate all the names gathered and find out the number of times each one of them has been
repeatedly mentioned by the interviewees.
Finalise the list of leaders.
Fix convenient date and time for the opinion leaders' (training camp) orientation meeting.
Explain the objective of the (camp) orientation meeting.
Discuss with them the health problems of the village.
Give information related to the solution of the health problems identified.
Prepare a plan of action programme and fix priorities. Arrange an orientation meeting for
opinion leaders.
Follow up up of the leaders' (training camp) orientation meeting.
The leaders should be asked to do a survey and identify the problems of the community.
Meetings should be held periodically to review progress. Statistical information should be provided
in the beginning and they should also be encouraged to collect and report relevant information. For
example, the Mahila Mandal can report births and deaths of infants with causes. This can lead to
discussion on to how the death of the infant could have been prevented. The mothers clubs can take
charge of MCH and FP workers. Welfare Committee and Youth Committee, for example, are
responsible for general sanitation, control of communicable diseases and other public health
activities.
139
Handout 5
Review meetings
Review meetings are very helpful for reviewing the progress, identifying the problems, and for
future planning.
Steps:Scnd information regarding the convenient date, time and place of the meeting.
Prepare an agenda.
Help participants (health workers, opinion leaders etc.) to review the work. In the morning
prepare a review minutes and make it available at the meeting in the afternoon.
Assess the performance in terms of process and progress checking of Records and Reports,
individually.
Allow the participants to express their ideas, feelings and problems.
List the problems of the participants.
Try to help the participants to arrive at commonly agreed solutions to problems.
Provide the latest programme information, new Government Orders and other relevant
information.
Provide instruction/training for developing skills for effective job performance.
Plan the activities to be carried out
Mobilise the resources of the activities from the PHC, Block, Village etc.
Supply the necessary materials.
Provide praise for good work.
140
Handout 6
Two examples of orientation courses for
community participation for two types of
opinion leaders
1 A course for community leaders - for example, attended by some 25 leaders from all villages in
the district (only a few of them former programming workshop participants) - would have the
following objcctivcs:General
Greater and effective participation of the community in the operation of health services through its
leaders.
Specific
(I) Increased leaders' knowledge of methods and techniques of community work: (intersectoral
co-operation Block Community Development Office).
(II) Increased basic knowledge of leaders about family health aspects: (BEE/Health Staff, PHC)
(III) Integration of community representatives in the activities of the health units in the
community.
(IV) Cooperation of the community and its leaders in the implementation of the
communication/cducation projects.
2 A course for school teachers, attended by 25 to 30 primary teachers from most schools in the
district, would have these objectives:General
Participation of teachers in the Intensive C/P Project being implemented in the village
community.
Specific
(I) General knowledge of teachers about the structure of the Ministry of Health at Central, staff
and local level, and about the Intensive C/P Project
(II) Knowledge of teachers about MCH and its components.
(III) Identification of problems affecting school children’s health in all the district; knowledge of
national norms on the subject and definition of the teacher’s role.
(IV) Development of a methodology for transmitting knowledge on mother and child health to
school children and their parents, in coordination with the activities of the Intensive C/P Projects.
(V) Development of a child-to-child health education transfer - the use of children as health scouts
and family health educators.
141
Session 33
Community participation:
Case studies I
Worksheet
Instructional objectives
At the end of this session participants should be able to:
recognise elements which contribute towards success or failure in CP programmes.
identify various important elements which can prevent success.
suggest ways and means of combating negative influences.
Activities
1 Selected experienced participants are invited to tell the entire group about their own successes
and disappointments in working situations which attempted to get communities to work co
operatively for their own health provision.
2 The class listens, makes notes, and asks questions whenever clarification is required.
3 These reports can be recorded on a tape recorder for later reference if required.
4 In small groups - the reports are discussed and suggestions developed as to how disappointments
could have been reversed. Also positive elements which were identified as enhancing forces are
noted. The reporters must be ready to provide clarification and further information if necessary to
facilitate this exercise.
5 Plenary discussion - groups present comments in turn. Comprehensive notes are to be made.
Assessment
Assignment (for next session) - In small groups prepare a plan for an orientation meeting for
opinion leaders in a village (use experiences and information from earlier fieldwork exercises) to
present ideas for a community IEC programme, and prepare a role play of what is likely to happen
at an actual meeting. Different groups must prepare plans and role plays to address different relevant
education programmes (refer to Handout 2 - Session 31).
Materials
Cassette tapes (other materials required for presenting reports and role plays).
Teaching aids
Tape recorders - (as required for presenting reports and role plays).
Background reading
Handout 1 - Role playing to motivate community action.
Further reading
Helping Health Workers Learn - D. Wcmcr and B. Bower
Wtfvc of getting people thinking and acting: village theatre and puppet shows - (Chapter 27).
142
Handout 1
Role playing to motivate community action
Role playing has sometimes been used as part of a process to get a whole community of people
thinking and taking action to meet their needs.
In Ghana, Africa, role plays were used to involve the people of Okorase in the town’s development.
To help with the role plays, health programme leaders invited a popular cultural group that often
performs at local ceremonies. First the group would help lead a ’one-day school' focusing on town
problems. Then the groups would stage role plays about one or two particular problems and their
possible solutions. The following description of these events (somewhat shortened and simplified)
is from an article by Larry Frankel in World Education Reports, April 1981.
The cultural group members (with help from the project) purchased food and palm wine to entertain
their guests. Then they invited the chief, his elders, and other members of the community to
attend the ’one-day school'. After the traditional ceremonies and welcoming speeches, they gave the
entire morning to small group discussions of the town's problems and their possible solutions.
Each group had a discussion leader whose job was to see that everyone participated freely so that
the 'big men’ didn't dominate.
Before stopping for lunch, each small group was asked to choose a single problem, one that they
considered serious but also solvable by the people’s own efforts. The small groups then joined
together to choose one or two problems and propose realistic solutions.
After lunch all the people were excused, except the cultural group members. Everyone thanked the
chief and elders for their attendance and their help in trying to make the problem's solution a
reality.
The cultural group spent the afternoon preparing and practising two role plays. They wanted to
show as dramatically and humorously as possible why each problem was important and what could
be done about it In the evening, the chief had the 'gong gong' beater call the entire town to a free
show. The role plays were performed along with drumming, singing and dancing.
The role plays in Okorase focused on two problems: unhealthy defecating habits and the lack of a
health clinic.
In the first role play, a big shot from Accra (the capital) returns to visit his birthplace, Okorase. He
has come to donate a large sum of money to the town development committee. Feeling nature's
call, he seeks a place to relieve himself. When he finds only bushes, he becomes increasingly
desperate. His distress amuses several villagers, who wonder aloud why the bush is no longer good
enough for him. The desperation of the actor playing the big shot had the people in the audience
laughing until they cried.
Finally, the big shot flees Okorase without donating any money.
Later, each of the people who laughed at him falls ill with some sort of sickness carried in human
faeces. So now the villagers become interested in trying a suggested solution: using low-cost waterscaled toilets to keep flics off the faeces.
In the second role play, a concerned group of villagers approaches the chief for help in starting a
new clinic. But the chief is not interested. He argues that medical attention is available in
Koforidua, only four miles away.
During the discussion, a messenger bursts in and throws himself at the chiefs feet The chiefs son
has just been bitten by a poisonous snake! Everyone rushes to find a way to get the boy to the
hospital in Koforidua, but before a vehicle can be located, the boy dies.
In his grief, the chief sees the error of his ways. He gathers the townspeople together and begs
them to contribute money and labour to build a clinic so that no other parent will have to suffer as
he has. He also appoints some villagers to negotiate with the regional medical officers for drugs
and personnel.
As it happened, the real village chief of Okorase had recently lost a very well-liked relative. This
made the role play extra powerful. The people of Okorase determined to build their own clinic and
to collect some money for medicines.
The new clinic was soon built. For the ceremony to celebrate its opening, officials from the
regional government and a foreign agency, as well as newspaper and television reporters, were
invited. On this occasion, the village cultural group put on another, more carefully planned play
telling the story of a young girl who died of a snake bite because the clinic had no electricity and
so could not refrigerate antitoxin. The play was presented as a community request to the authorities
and development agencies to introduce electricity into their town. As a result, negotiations are
presently taking place between the village and the Ministry. There is a possibility that electricity
may actually come to Okorase.
This example from Ghana shows how role plays were used to motivate villagers to take action to
meet their health needs. Finally, role plays were even used to activate the government on the
village's behalf.
143
Session 34
Community participation:
Case studies II
Worksheet
Instructional objectives (As at Session 33)
Al the end of this session participants should be able to:rccognise elements which contribute towards success or failure in CP programmes,
identify various important elements which can prevent success.
suggest ways and means of combating negative influences.
Activities
1 Groups present role plays individually.
2 Other groups obscrvc/listcn critically - make comprehensive notes on what they observe.
3 Post-presentation discussion and analysis. Consider these points:- Who was taking the lead?
In what ways was the leader different?
What were the main problems?
How were they overcome?
How was the leadership employed?
Could similar approaches be used for stimulating programmes involving CP in the
communities? If not, why?
What chance has the spirit of CP of being firmly rooted in the community attitude towards
community life, as a result of the situations presented and discussed.
4 Slide shows - Jamkhed (Maharastra - India) - Comprehensive Health Care and Agriculture
Developments - TALC. Institute of Child Health, London. Observe and follow activities 2 - 4
above.
Assessment
Questions and answers in plenary.
Materials
Slide projector, slides, screen, speakers.
Background reading
As at Session 33.
Further reading
As al Session 33.
Book review
A Each participant selects a book from the special course library for review. (Preferably early in
the training course period.)
B Objective:
1 To practice reviewing relevant books in terms of appropriateness for study or professional
upgrading.
2 To emphasise the need for continuous study and self-development.
C Use Book Assessment Form overleaf.
D Time permitting, each participant presents his book review to the group and gives in a written
version of it for assessment
144
Book Assessment Form
Medical
Nursing
Environmental
Community
Senior
Junior
Put C for a Course Book
Put R for a Reference Book
Title
Author
Published
Price
Subjcct(s) covered
Tick on the right for your assessment of each point.
Content
Mainly
Partly
Not at all
Mainly
Partly
Not at all
Is the subject matter based on
relevant health needs?
Is the subject matter based on
appropriate methods?
Is the subject matter based on
specific job description or a
specific curriculum?
Is the coverage complete and
well balanced?
Docs it describe ’what to do'
adequately?
Does it contain practical ins
tructions on 'how to do it'?
Docs it need any support
material?
Presentation
Is the language controlled?
Is the physical layout of the
material well presented?
- text; heading etc.
- pictures
145
-non-prosc formats
- diagrams and tables
Is the referencing system
adequate?
- index
- table of contents
- numbering
Docs it need training in
how to use it?
Other comments
Other resource material provided
1 A scrapbook of newspaper clippings from as many of the easily available local and national
newspapers, which is maintained by the Artist but contributed to regularly by the participants and
the Course Development Team.
Items of local, national and international happenings, which reflect professional and general health
interest to the work of the BEEs are depicted and discussed daily - preferably during the orientation
period at the beginning of each day's session.
The scrapbook is attractively labelled 'Keeping In Touch' and clippings are collected in the local
and national languages and English.
2 Comprehensive prepared handouts on several Public Health topics especially with regard to
Maternal and Child Health are provided to the BEEs to assist them to attach more precise and
accurate information and knowledge to the preparation for their IEC interventions.
Extra curricular professional updating (evening) sessions
1 The Family Welfare Programme in India - Impediments to progress and how they can be
challenged.
2 Maternal and Child Health - Recent promotional developments.
3 Management of Primary Health Care at Primary Health Centre level.
4 Malaria Eradication - The role of Community Participation.
5 Tuberculosis - Prevention and Control. The dimension of the programme locally and
nationally.
6 Family Planning - Improving promotion and acceptance.
Resource persons are chosen from the senior officers in charge of the national priority health
programme at the central district health offices, or from professionals at the various health
institutions in the immediately convenient locality.
Participant assessment
During the course participants will be continuously assessed with regard to their interest,
involvement and active participation.
Participant aptitude to course work will be assessed as follows:
1 A task analysis (written exercise)
2 A book review (project - self-development)
3 Teamwork attitude (attitude)
4 Fieldwork ability (skills)
5 General contribution to course
6 Post test (knowledge change over course period)
%
15
10
15
15
25
20
100
146
Appendix I
In-service training programme for
Block Extension Educators in communication
and community participation
Design and implementation structure
Overall objective
At the end of the training programme the BEE should be able to demonstrate:
1 An increased ability to ensure a high acceptance of PH/MCH/FW programmes by target
communities, by being able to apply appropriate measures of communication in several inter
personal situations and
2 Increased knowledge and skills which would be likely to generate a satisfactory degree of
community participation in the planning, implementation and maintenance of PH/MCH/FW
programmes in communtics.
Planning for effective communication - Unit I
Specific objective - as per job description
To develop ability to collect and use effectively, relevant information for the planning of effective
communication programmes.
Functional activities - as per job description
Social surveys
Operational research
Needs assessment
Formulation of strategics
Plan IEC activities at all levels
Devise a system for continuing survey
Functional tasks - as per job description
Plan surveys/assessments
Conduct surveys
Analysc/intcrpret/present findings
Draft stratcgies/plans, programmes and submit them to consultation/co-ordination procedure.
Undertake periodic reviews, evaluation, reprogramming (with consultation).
Instructional objectives
Participants should be able to:
Define the rationale behind the need to plan and conduct community survey.
Understand and practice the process of conducting, analysing, interpreting and depicting
survey findings.
Use survey analyses to prepare plans and programmes.
Understand the need for constant follow-up for the purpose of modifying programmes to suit
changing conditions in communities.
Content
A Why survey
purpose of community survey
value of community survey and follow-up
B What to survey
levels of awareness about health matters in communities
attitudes and beliefs as they affect behaviour
community health problems
147
C How to survey
process of community surveying for purpose of development of EC programmes
D Using survey findings
interpreting coUccted data (community diagnosis)
using for formulation of draft plans
the need to consult with others during plan formation
Learning activities
group discussion on purpose and value of DEC community survey and follow-up
production of statements on purpose and value
elements of community surveying
preparation of survey methodology to identify existing and potential opportunities for DEC
intervention in community (group activity)
conduct a mini-survey in a small nearby community (field work-group exercise)
draft plan for IEC intervention in the communities surveyed
Knowing your audience - Unit II
Specific objective - as per job description
To differentiate between target groups so as to be able to dehver the most suitable
information/cducation/motivational message in the most appropriate way by careful examination of
social norms in the community.
Functional activities - as per job description
identification of target groups
identifying community communication modes
evaluating customs, traditions, folk beliefs as they affect community sensitivities
Functional tasks - as per job description
plan surveys
conduct surveys
analysc/interpret/prcsent findings
study contents, relate to customs, traditions, beliefs
Instructional objectives
Participants should be able to:
identify target groups for motivational intervention
understand the importance of finding out how information travels within communities
investigate common communication channels in communities
relate community customs, traditions and beliefs to the development of appropriate IEC
interventions
Content
A Modes of communication
different ways in which information is transmitted in communities
the important disseminators of information
identification of target groups
B Channels of communication
personal characteristics commonly associated with innovators
opinion leaders
people who are slow to change
how customs, traditions, folk beliefs affect communication
Learning activities
group discussions and evaluation of the modes of communication commonly recognised in the
communities (how docs information get around)
examination of how survey findings can help to identify target groups
discussion on process of identifying innovators, opinion leaders, and inhibitors to change in
communities - list characteristics - group work
discussion on how custom, traditional beliefs can affect communication in communities
148
Talking to clients - Unit III
Specific objective - as per job description
To develop the ability to choose what to say and how to say it, so as to avoid possible
misconception and negative feelings about health promotion programmes
Functional activities - as per job description
mass meetings
group discussion
individual (one to one) contact
special gatherings and ICM sessions at PH/MCH/FP service delivery camps
health /population education programmes in schools, colleges, youth clubs and out of school
youth
Functional tasks - as per job description
plan EC activities at all levels (most communitics/individual)
arrange meetings, give presentations, conduct activities
hold EC activities in support of service provided at camps
conduct school/college authorities social and youth organisations, promote programmes
assist leaders in planning and conducting programmes, give talks and provide EC materials
Instructional objectives
Participants should be able to:
organise and conduct large and small groups, EC sessions and individual interviewing and
instruction.
be conscious of the need to be aware of audience sensitivities.
practice appropriate interviewing techniques.
Content
crucial barriers to overcome for successful communication
techniques in interviewing
meeting and motivating hard-to-reach or resistant groups and individuals
a comparison of school and adult education in community health education programmes
Learning activities
discuss, examine, test various inhibitors and enhancers to communication in communities
(group exercise)
interviewing practical/obscrvation/criticism
compare and contrast teaching/motivational techniques for different age groups
share studies of sterilisation acceptors from course development survey, and personal
experiences of course participants in the field (problem solving exercise in groups), discuss in
plenary session
Working with others - Unit IV
Specific objective - as per job description
To develop the ability to ensure efficiency in PH/MCH/FW and EC programmes through
communication flow, co-ordination and co-operation with other health workers and with related
governmental and voluntary organisations and individuals
Functional activities - as per job description
intcr-agency co-operation (govcmmental/voluntary)
IEC inputs in training courses for PH/MCH/FW services for personnel
in-service training of EC staff and their continuing education
orientation meetings with EC staff, service workers and volunteers
continuing guidance and supervision of staff
training camps for opinion leaders
Functional tasks - as per job description
assess training needs
develop in-service training and continuing education, strategies and programmes
149
Instructional objectives
Participants should be able to:
establish a rationale for the development of inter-agency co-opcration and co-ordination for
maximum outreach
assess in-service education, communication training needs of PH/MCH/FW service personnel
for continuing education programmes
practice good guidance and supervisory techniques with service personnel and community
agencies and volunteers
Content
the value of inter-agency co-opcration in the development of community programmes
ensuring improved performance of integrated PH/MCH/FW services through the development
of EC attitudes and skills of staff and volunteers
principles and practice of good supervision
using opinion leaders for maximum outreach
the value of follow-up in-service programmes for health staff and volunteers
Learning activities
Discuss:
identification and involvement of organisations which can aid the communication process
discussion and testing the various steps for determining in-service training needs for a PHC
staff
conduct survey in a H/Centre (field work)
develop draft in-service training programmes on findings (project work, group exercise)
discuss elements of good supervision
practical obscrvation/discussion
Aids to communication - Unit V
Specific objective - as per job description
To develop the ability to design, pretest and select for use appropriate aids for the attainment of
good communication in EC programmes.
Functional activities - as per job description
development of culture-based treatment of PH/MCH/FW programme contents for presentation
in different media forms
design, pretesting, production and distribution of printed audio-visual and crafted materials
adopt materials from their sources
utilisation of EC materials in combination with local participatory activities, film, slide and
video shows, folk plays and dramas, exhibitions, fairs, health days
integrated campaigns for intensive service promotion/dclivcry drives
Functional tasks - as per job description
relate treatments to customs and traditions; put into media form
plan/design; adopt
produce material
assist community production of materials
distribute to all relevant sources
arrange film shows etc in support of meetings and other participatory activities
organise and participate in intensive multi-media campaigns
assist in maintenance of equipment
Instructional objectives
Participants should be able to:
develop and present culture-based treatments to various priority PH/MCH/FW programmes
appreciate the need to promote such treatments during activities which involve members of
the community
150
Content
method of communication (sending the message)
tcaching/motivational methods; the importance of good listening in the communication
process
common A/V aids
designing, pretesting and producing culture based aids to communication
choosing the appropriate aid for different situations and audiences
use and maintenance of commonly available A/V equipment
Learning activities
discussion on tcaching/motivational methods and their appropriate application
critical examination of various aids normally available to government health programmes
case studies taken from course development field work
assessment of media to develop a critical attitude to selection of films and other teaching aids
for use in programmes
practice use and maintenance of A/V equipment normally available to participants
Community participation - Unit VI
Specific objective - as per job description
To develop techniques for involving the community in the promotion of its own health
Functional activities - as per job description
identification of opportunities for local involvement, development of strategics and
programmes
contact with community groups, officials and voluntary organisations
planning workshops/mcctings for local identification of health needs, helping in the
formulation of local objectives and action plans
formation and strengthening of local groups interested in PH/MCH/FW promotion
involvement in inter-agency co-operation within the concept of total community
development, nutrition, sanitation etc.
involvement in social/cultural structure and competitions on special local occasions
Functional tasks - as per job description
assess in circumstances of communities, develop, strengthen and guide local involvement
arrange and hold planning meetings
identify and motivate opinion leaders
arrange workshop, meetings and assist in the formulation of objectives and action plans
promote local PH/MCH/FW oriented communities/groups
provide EC support scheme with PH/MCH/FW component
promote and assist in social activities
provide EC materials, programmes etc.
Instructional objectives
Participants should be able to:
enumerate the benefits of having the community being fully involved at every step of
initiatives for PH/MCH/FW outreach.
organise opportunities for encouraging communities to request and support services for health
care.
educate the community to take responsibility for its own health.
Contents
the role of community participation in community development
the critical role women and women's organisations can play in community participation for
development programmes
the role of voluntary organisations in community participation programme
conducting meetings
techniques for stimulating community participation in PH/MCH/FW programmes
forces which can inhibit and enhance community
participation in communities
the need for periodic review and follow-up
Learning activities
discuss and establish a rationale for community involvement in health programme promotion
examine the forces which can aid/inhibit community participation in communities
identify opinion leaders in community
conduct meetings and follow-up (process)
organise and conduct an opinion leaders' camp (using prescribed training curriculum)
case studies of successful community participation programmes
LIBRARY
library
-1^0
f
c
AND
AND
>
DOCUMrNTATION
J ’
L6
151
Appendix II
A sample questionnaire
Collecting information needed in health education
Examples of questions which could be included in a community survey questionnaire arc given
below. If you are specifically interested in one area (for example in the field of child nutrition or
environmental sanitation or personal hygiene) you may want to add more questions related to the
area of interest. Remember to keep your questions as short and concise as possible. The sample
questions arc of the following types:
A Responses to questions 1 to 8 give personal information about the respondent and his/her
family. These arc easily answered questions for most people and can be placed at the beginning of
the questionnaire.
B Responses to questions 9 and 10 provide information about the occupation of the community
residents; unemployment and its causes.
C Responses to questions 11 to 15 show which diseases occur most frequently in the community;
beliefs and practices regarding health and illness; and the health needs felt by the residents.
D Responses to questions 16 to 18 give the reasons why local health services are or are not used
by the people and where they go for help.
E Responses to questions 19 and 20 give information about people’s beliefs and practices related
to the nutrition of children.
Example of a survey questionnaire:
1
What is your name?.
2
How old are you?
3
Sex: Male.
4
Address
5
Have you ever been married?
Female
(
) Yes
(
) No
If yes, ask:
6
How many children do you have?
7
How many are living with you?
8
Can you give their names and ages?
Name
Age
Sex
a.
b.
c.
Be cautious: if your respondent docs not want to give the names of the children, do not
insist.
153
9
Is your husband/wife working?
(
) Yes
(
) No
(
) Yes
(
) No
(
) No
If yes, ask: what is his/her occupation?
If no, ask: why not?
10
Arc you working?
If yes, ask: what is your occupation?
If no, ask: why not?
11
Docs your family have good health? Probe
12
What kind of health problems has your family had?
a. Who was sick?
name:
age:
sex:
b. Describe the illness:
c. Is the person still sick?
(
) Yes
d. What kind of treatment was given?
(Repeat for each sick member of the family.)
13
In your opinion, which illness causes the most sickness and death for the people in the
community?
a.
b.
c.
d.
(For the first illness mentioned, ask the following)
13a. 1 Are there other names that people use to describe
(mention the illness listed above under 13a.)
13a.2 What might cause people to get this disease?
What else might cause it?
13a.3 If you thought that someone in your family had this disease, what would you do?
If it still didn't help, what would you do?
154
13a.4 What can people do to protect themselves against this disease?
What else?
13a.5 (Repeat above series of questions for each disease or symptom listed in question 13).
14
In this section ask specifically about diseases which are common, but were not mentioned.
For example: 'Have you ever heard of a disease called tuberculosis?’ If the answer is 'yes',
ask scries of questions as in question 13. If answer is 'no', ask: 'Have you ever heard of a
disease which causes people to cough up blood?' If the answer is 'yes', ask series of
questions as in question 13.
15
What things do you believe arc most needed to improve the health of people in the
community?
16
Where do you usually go for help with your family’s problems?
17
Where is the nearest health centre?
18
Has any member of your family ever used it?
(
) Yes
(
) No
If no, ask: why has none of your family ever used the local health centre?.
If yes, ask: what do you think of the quality of services of the local health centre?
Now, we would like to ask a few questions about bringing up your children.
19
Did you/your wife breast feed your child?
(
) Yes
(
) No
(Note: for people who arc not parents, ask ’Do you feel that children should be breast fed?'
If no, ask: why did you not breast feed your child?
20
At what age do you begin to feed your child solid foods in addition to your milk (or
formula)?
21
months.
What are the first solid foods that should be given to a baby?
Add relevant questions if necessary.
155
Appendix III
Sample: Health unit (PHC, dispensary etc)
utilisation questionnaire
1
District
2
Village
3
House Number
4
Distance (km) from the Health Unit
5
Interviewer
6
Who was interviewed (mother, father etc.)
7
Number of people in household
8
Number of children under 5 in household
9
When did you last attend the health facility?
Date
10 For what reason?
(Some common health problems)
Coughs
Convulsions
Wounds
Bums
Fever
Diarrhoea
Vomiting
Cuts
Ear problems
Eye problems
Headaches
Malnutrition
Bites and stings
Sexually transmitted diseases
Backpain
Abdominal pains
Malaria
Scabies (or other skin infections)
Anaemia
Worms
Pneumonia
Tuberculosis
Leprosy
Pregnancy
Bleeding in pregnancy
Ante natal care
Family planning
Tetanus
Others (specify):
11 What services are available at the health unit?.
12 What services have you used at the Health Unit during the last 12 months?
13 Did you find them satisfactory?
14 What other services would you like the unit to provide?
157
15 Have you attended other health facilities for any reason during the last 12 months? If yes,
why?-------------------------------- --------------- --------------------------------------------16 Do you have a ’Road to Health’ Card for each child?
Yes
No
Yes
No
If yes, check the following:-
Arc the cards up to date?
Arc the cards showing weight readings within the normal range?
Arc the immunisations up to date?
Yes.
No
Yes
No
17 (For the Mother)
Did you attend ante-natal clinic during your last (or current) pregnancy?
Yes
No
If no, why not?
18 Where were you when your last baby was bom?
At home
158
At the PHC
In Hospital.
Appendix IV
Questionnaire to find out different attitudes
towards community health
(which could lead io an assessment of a community’s predisposition to involvement in community
participation)
This questionnaire is designed to help find out different attitudes about community health from
different kinds of people. You do not have to give your name. Also, it is not necessary to think
very deeply about the questions. It is your reaction to the statements which is required. There is no
right or wrong answer to any question in parts II and III.
Part I: Personal file
1 What is your age?
2 Sex (cross out as appropriate) Malc/Female.
3 What work are you doing now?
4 How long have you been doing this work?
Part II: General views about community health
1 Please tell me how you think the health of a poor community can be improved. Rank in order
die following statements using 1 as the most important
by having more clinics and more doctors.
a
b by improving the economic conditions of the people before attacking the health problems.
by giving people more information about Western medicine.
c
d by spending more money on research for cures for common diseases like cancer.
by having more equal distribution of health care resources.
c
by having the community control their own health programmes.
f
g other (please specify).
2 Please indicate in what way you think community health programmes can have the greatest
impact on the community. Rank in order the following statements using 1 as the most important
a strengthening the co-operation of all organisations working in the community,
b providing more medical services.
c gaining the support of the community for health activities.
d helping people to have control over programmes which affect their daily lives,
c helping people realise the link between health and other socio-economic problems,
improving environmental sanitation.
f
other
(please specify).
g
3 Please tell me which of the following criteria you would use to measure the success of a
community health programme.
the health centre has an increase in the number of patients.
a
b people in the community ask for more doctors and more clinics.
the programme receives more money to increase its activities.
c
d more people attend health education talks.
e community representatives set up a programme independent of the medical staff.
other (please specify).
f
Part III: Statements about community health programmes
The following arc statements about community health programmes. For each statement please put
a ring around one of the numbers to indicate the extent of your agreement or disagreement with the
statement Please use the following scale to indicate your response.
If you ’completely agree’ then ring number 1.
If you 'mostly agree' then ring number 2.
If you 'slightly agree’ then ring number 3.
If you 'slightly disagree’ then ring number 4.
If you 'mostly disagree' then ring number 5.
If you 'completely disagree' then ring number 6.
159
1 The major concern of a community health programme should be the
1
delivery of medical services.
2 A committee from the community responsible for community
health activities should be appointed by the medical staff at the
1
health centre.
3 It is necessary to carefully prepare both the health centre staff and
1
the community before starting a community health programme.
4 Community participation in health care is a temporary practice
1
that will soon pass.
5 Too much money for community health programmes ruins the
1
community initiative.
6 Community health workers (people who live in the community,
have another type of employment or tasks but do health work in their
spare time) should be primarily responsible to the medical staff at the
1
health centre.
7 Community participation should be considered mainly as a means
to improve sanitary conditions in poor areas.
1
8 Too much funding from outside the community should be avoided
because it creates programmes that cannot be maintained when the
1
money comes to an end.
9 The community should be consulted about what community
1
health workers should be taught
10 Community participation in health means that the community
1
carries out activities decided upon by the medical staff.
11 The medical staff at the health centre should handle all finances for
activities for health improvement in which the community participates. 1
12 Community health worker training should include communication
and organisation skills.
1
13 The most important source of financial support for the programme
1
comes from the community itself.
14 Surveys of the health conditions in the community should be
1
carried out only by professional staff.
15 Community participation in health care should be directed mainly
1
to health education activities.
16 Community development activities prevent medical professionals
1
from doing their work properly.
17 A community health programme needs a great deal of money
because it must provide high quality medical services to
1
the community.
18 A good community health programme must have community
1
development workers.
1
19 Mothers in the community should help run well baby clinics.
20 The best community health workers arc those who volunteer for
1
the programme.
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
2
3
3
4
4
5
5
6
6
2
3
4
5
6
Extracted from Health Training and Community Participation - Case Studies in South East Asia by Susan B. Rifkin.
160
1
Appendix V
Organisation of opinion leaders' training camp
Copy of letter circulated from Health Directorate, Bhubaneswar (1984)
Targets for organisation of Orientation Training Camp of opinion leaders along with the guide
lines have larcady been communicated to you via this Directorate letter referred to above.
The camps will henceforth be called "Family Welfare Leaders’ Camp" and may be organised more
effectively. This year there should be more emphasis on giving information on contraceptive
methods, services and removing misconceptions if any prevailing in the minds of the opinion
leaders.
The programme to hold camps should be planned without delay and copy of the same sent to this
Directorate.
’In addition to the guide lines already issued for organisation of camps, the following points may
please be strictly followed:T Free and frank discussions should be encouraged in the camp to remove the misgivings and
doubts which the opinion leaders may have.
2 The Family Welfare Leaders' Camp may be followed by service camps offering MCH
Immunisation, Nutrition and Family Planning Services on popular demand.
3 Short films 10-15 minutes duration on topics like MCH Care, Immunisation, Population
problems, Nutrition, Contraceptive Methods etc. may be shown in the camp.
4 Wherever the CHV’s are available they must be invited to participate in the camp. Later they
should be encouraged to form education groups in their village.
5 The District Mass Media Officers should be made responsible for evaluation of the camp in the
District. The camp may be evaluated with respect to the number of Family Welfare Leaders invited
and the number of actual numbers attending the camp, the subject covered in the discussion,
interest shown by the participants, the preparation of village action plan, the amount of support to
the Family Welfare Programme, actual efforts made by the participants in this direction etc.
Evaluation findings may be sent to PHC’s with specific suggestions for improvements.
6 Displays/Exhibitions on Health and Family Welfare topics may be arranged at the venue of the
camps.
7 News pertaining to the camps may be published in local newspapers and the cuttings kept in
records.
8 Photographs of the camps may also be taken for publicity purposes and records.
9 Every PHC should send a report of each camp to the District Family Welfare Bureau within 7
days in the proforma (Annexure A attached). The District Family Welfare Bureau should send
consolidated report to the State Family Welfare Bureau by the 5th of every month in the prescribed
proforma (Annexure B attached).
10 As you are aware, Orientation Training Camps of opinion leaders have been an important
component of the motivational strategy of the Family Welfare Programme during the past years.
1 .ast year the target was to hold nearly 50,000 such camps in different parts of the country. The
reports received from various sources indicate that these camps have helped in focusing people's
attention of the importance of FW Programme and in creating a health climate in favour of the
small family norm.
11 It is necessary that opinion leaders who participate in the camp are given educational materials
to read and carry home with them. In order to prepare locally relevant material for the use of
opinion leaders, we had suggested holding of workshops last year. Very few states have organised
such workshops. I suggest that this may be done early this year. The expenditure on these
workshops may be met out ot the funds allotted for camps.
12 The programme to hold the camps at various levels should be planned without delay. The
camps should be evenly spaced all through the year, though more camps may be held at the time of
special campaigns. A copy of the schedule of camps may please be sent to me. I would like my
officers to visit your Stale and participate in as many camps as possible.'
161
Annexure A
Report of Family Welfare Leaders’ camp - Proforma A
(To be compiled at PHC for onward transmission to District Family Welfare Bureau within seven
days from the dale of the camp).
1 Name of Primary Health Centre
2 Venue of the camp
3 Dale of the camp
4 Timings of the camp
5 Details of leaders who attend the camp:- Serial no.
- Name
- Official/social status
- Postal address
- Educational qualification
- Age
- Marital status
- No. of children
- FP methods being practised if any
- Remarks
6 Details of Government functionaries and representatives of voluntary agencies present in the
camp.
7 Particulars of other distinguished visitors to the camp.
- Name of distinguished visitor
- Position/slatus
8 List topics discussed.
9 Particulars of the audio-visual aids used during the course of discussion in the camp.
10 Details of publicity and educational materials distributed to the participants:- Serial no.
- Type
- No. of materials distributed:- postcrs/charts, booklcts/foldcrs, handbills/leaflcts, others.
(Attach five copies of each of the material.)
162
Annexure B
Report of Family Welfare Leaders' Camp for the month of
- Proforma B
(To be compiled at District Family Welfare Bureau for onward transmission to state Family
Welfare Bureau by the tenth of the following month.)
1 Name of the District
2 No. of Family Welfare Leaders' Camps planncd:during the month under report
- cumulative total from 1st April
3 No. of Family Welfare Leaders’ Camps actually hcld:cxclusivcly for men
mixed
exclusively for women
- total
4 Indicate reasons for difference in 2 and 3.
5 No. of Family Welfare Leaders attended the camp:- men
- women
- total
6 No. of cducational/publicity materials distributed in the camps:- posters/charts
- booklcts/foldcrs
- handbills/lcaflets
- others
(Please attach five copies of the material distributed in the camp.)
7 No. of camps in which recreational activities like filmshows, folk-art performances, etc. were
organised.
8 a) No. of District Level camps held
b) No. of participants in District Level camps.
9 Describe the new approaches (if any) tried in respect of participants, orientation content,
methodology, duration of the camp etc. in the organisation of camps.
10 Remarks if any.
Dalc:-
Signature
District Family Welfare Officer
163
Appendix VI
Sample - Pre-test
1
Choose the most suitable answer. Indicate with a tick (V).
Community survey will be very helpful to us for effective communication, especially if one
of the following is investigated:
a
Agricultural status
b
c
d
c
Socio-economic status
Nutrition, diet status
Modes and channels of communication
Educational factors.
2
Tick the odd one out of the following:- Elements of community survey includc:a Sampling techniques
b Advance preparation
c Data collection
d Number of houses
c Data presentation
3
Choose correct answers from the following which indicate steps in the process of conducting a
community survey:a Proper questionnaire
b Budget
c Conduct field work
d Prepare data presentation
c Draft a programme
4
Choose the most correct answer of the following:Communication and motivation for immediate immunisation are applicable to:a Slum dwellers
b Farmers
c Newly married couples without children
d Parents with young babies
c Already motivated groups
5
Choose the correct answer:Information spreads most quickly in the community through one of the following channcls:a Telephone
b Politician
c Informal leaders
d Newspapers
e Cinema films
6
Which is the odd answer of the following:A formal community group would have the following characteristics:a A constitution
b A name
c
Prescribed rights and duties
d Meets casually
c Controls members' actions through rules and regulations
165
7
Choose the best answer of the following:An enhancing agent for successful communication in a community health programme could
bc:a Poverty
b A satisfied client
c Low income
d Rumour
c Traditional belief
8
Which of the following steps arc to be followed for the planning of
information/cducational/motivational activitics:a Identification of needs
b Setting priorities
c Demonstration
d Sequencing activities
c Evaluation
9
Namc five barriers to communication:a
b
c
d
e
10 In trying to motivate hard-to-reach or resistant individuals one should use:a A politician
b Mass communication
c Visual aids
d Someone respected as an opinion leader
e A dissatisfied acceptor
11 Knowledge about use of conventional contraceptives can most effectively be given by:a Distributing contraceptives to a person
b Demonstrating the use of contraceptives
c Showing a chart of contraceptives
d Using a contraceptive kit-bag
e Conversation
12 Choose the wrong one of the following:Whcn interviewing:a Be factual
b Do not make a prior appointment
c Establish rapport
d Give a clear idea about your interview
e Make some notes on the interview
13 An adult health education programme should be mainly concerned with:a Acquisition of facts
b Increasing knowledge (passing examinations)
c Academic subject, topics dispensing information on academic subjects
d Personal problems which arc important to the respondents
e Leisure activities
14
166
List five components of a School Health Education Programmc:a
b
c
d
e
15 We should observe certain principles when talking to groups:Answer by indicating truc/falsc:-
True
False
a Every individual has his/her own style of speaking.
b In speaking with a group, non-verbal signals should not be given.
c One should behave as hc/shc likes when explaining matters related
to sex or Family Planning.
d II is important to have mastery of the subject matter of the talk.
c If one is not emotionally comfortable with the topic even if he is
knowledgeable, the effect is lost
16 Tick truc/false against the following statements:In-scrvice training needs of PHC personnel can be assessed by:True False
a
b
c
d
e
Target achievements
Interviewing the personnel
By asking community leaders
By verifying qualifications
By examining records
17 To resolve a conflict between two working personnel when you supervise, which of the
following actions would you consider to be most appropriate:a To scold one and support the other
b You keep quiet about it
c You are a good listener
d You wait for the result without being involved
c You report the conflict to higher authority
18 Name five Community Health Programmes which you think can bvenefit from community
panic ipation:a
b
c
d
c
19 Which one of the following audio/visual (A/V) aids is best suited for use in a one-to-one
interpersonal motivational situation:a TV
b Slide projector
c An illustrated manual
d Blackboard
c Poster
20 The ’Road to Health' Chart is a way of checking:a Weight for height
b Age for size
c Size for height
d Weight for age
e Weight for size
167
Appendix VII
Weekly course evaluation form
Please tick as appropriate.
1
Unit I
Objectives met
Partially met
Not met
If partially or not met, where did we fail? Comment
2
Unit II
Objectives met
Partially met
Not met
If partially or not met where did we fail? Comment
3
Unit ID
Objectives met
Partially met
Not met
If partially or not met where did we fail? Comment
4
Is the way the teaching material is organised relevant to your working needs?
All
Some
None
If some or none, where should it be modified? Comment
5
Is the way the teaching is organised likely to meet the learning objectives indicated on the
worksheets for sessions? If not please make detailed comments.
6
Is the atmosphere conducive to active participation?
169
Appendix VIII
Teaching material
End of course evaluation form
Please answer the following questions honestly, and in as much detail as you like. Use extra sheets
of paper if it is necessary to expand on any of the answers you give.
Please answer this section by putting a tick alongside the evaluation which gives your opinion.
1
How important for your work were the main topics in the guide?
extremely important
important
not very important
not at all important
2
Would you be able to apply the ideas discussed into your work activities?
all of them
most of them
some of them
none of them
Did the way the material was organised make it easy for you to follow the development of
3
the sessions?
very easy
fairly easy
manageable
difficult
4
Was the language used Difficult to understand
Understood with some difficulty
Fairly easy to understand
Easy to understand
5
Did the participant training guide provide you with enough basic material?
Too much
Enough
Just enough
Too little
6
How valuable was the material in the different units to you?
Extremely
Valuable
Of little
No value
Unitl
Unit 2
Unit 3
Unit 4
Unit 5
Unit 6
Background
Information
171
Answer in your own words:-
7
Do you think that this training programme achieved its objectives?
8
What part of the guide should be left out in the next issue (and why)?
9
What do you think should be added, (and why), to make it more useful for participants?
10 Comment on:
(i) the value of the handouts.
(ii) the use of audio-visual instructional media.
*Usc extra sheets of paper if necessary.
172
Appendix IX (i)
Draft plan for post training follow-up activities
of BEE's trained in communication and
community participation
Introduction
After the In-service Training Course for BEE’s on Communications and Community Participation
comes to a close we will monitor their progress in implementing the programmes assigned to
them and taught during the course. There are several ways we might choose to do this follow-up.
Post-training projects could be set to facilitate supervision and continuing education.
Schedule visits to PHCs to check on the progress of each BEE and help solve problems that
may arise.
District Supervisory authorities will be requested to contribute ideas about solving
problems.
Objectives
To assess the BEEs while working in the community as per their assignments, declared work
schedules will be ascertained in advance of leave.
To evaluate the involvement of community members in different projects conducted by the
BEEs.
To observe the IEC activities actually done by the BEE on the spot and guide him if necessary
and continue practical training in the field.
To assist the BEE in continuing education and solving problems and to lend support in
solving problems.
Selection of in-service BEEs for follow-up evaluation
From the first three courses of trained BEEs, at least 30% of the total number trained should
be evaluated.
Nearby districts ie Sambalpur, Bolangir, Dhcnkanal and Kconjhar may be taken in the first
phase and for the subsequent follow-up visits, selection of BEEs will be made from other
districts.
Duration of visit
Four days to be devoted for the follow-up work including two days for the journey.
Transportation
Institution jeep may be used for the journey.
Who will conduct the follow-up activities?
The Course Development Team members individually will conduct follow-up work according to
the instruments already prepared. The assistance and co-operation of all supervisory officers will be
solicited and utilised.
Plan of action
1 Monthly advance tour programme of BEEs to be brought from the Medical Officer I/C, PHC
or Assistant District Medical Officer (Family Welfare).
2 Advance intimation to the Chief District Medical Officer, Assistant District Medical Officer
(Family Welfare), and Deputy Mass Education and Information Officer, Medical Officer, PHC,
about the date and person (BEE) to be followed up and their co-operation to the persons who arc
going to do the follow-up.
4 Discussion with the District Level Officers about the follow-up activity, and their support and
co-operation as supervisors for better implementation of IEC activities by the concerned BEE, and
also for continuing these follow-up activities.
5 Discussion with the Medical Officer I/C, PHC to provide necessary scope to the BEE to
perform IEC activities in his area effectively if is felt or heard, by the officers concerned conducting
follow-up, that the BEE is not getting sufficient scope for organisation or implementation.
6 To prepare a checklist before going to conduct follow-up, as the list would be filled up then
and there, while observing different activities of the BEE and asking questions etc.
173
n
7 To observe activities of the BEE in his working situation, to ask some questions and go
through different records of the BEE about planning, organising and implementing IEC activities,
to find out improvements made after returning from training (Communication and Community
Participation).
8 Interviewing the Community Leaders, School Teachers, Local Voluntary agencies and other
supervisors and subordinate departmental personnel.
9 Discussion with the BEE regarding the probclsm relating to implementation of IEC activities;
problem solving with BEE.
10 Asking the BEE suggestions from his own experience and situation for belter implementation
of the same work.
11 Suggestions from the Medical Officer I/C, local leaders and voluntary agencies for better
implementation of the work. Il should be discussed with the Assistant District Medical
Officcr/Chicf District Medical Officer for solving those problems and the action taken relating to
that should be followed up repeatedly.
12 Instructions to the BEE for the continuance of IEC activities (continuing education).
13 Tell BEE that whenever he needs some help regarding planning, organising, implementing,
interviewing technique and subjects he should contact the Course Development Team of the
Training Centre through the Principal.
14 Regular feedback/correspondcncc with the Medical Officer I/C about the action taken for
solving the problems and, if necessary, correspondence to be done with the District Level and Slate
Level Officers concerned.
15 Writing up of follow-up particulars in detail after returning from the follow-up visit and
submit to the Principal for further action to be taken at his/her end and approved transmission to be
concerned authorities.
174
fI 1■
J
Appendix IX (ii)
Post training follow-up activities schedule:
Questionnaire
(for immediate supervisors to Block Extension Educators)
Category of Supervisors to be interviewed:
1 Medical Officer, responsible for BEE.
2 Deputy District Mass Education and Information Officer.
3 Assistant District Medical Officer (Family Welfare).
1
2
3
4
Date of interview.
Name and designation of supervisor.
Name and address of BEE who supervisor is responsible for.
Period of working of the Supervisor with the particular BEE.
Questionnaire
Docs the BEE perform his job satisfactorily - Yes/No.
1
la If no-Why?
lb If yes-How?
had undergone a training at the Health
2 It appears that BEE Sri
and Family Welfare Training Centre, Sambalpur, recently; what was that training for?
3 Has the BEE on his return from training discussed it with you? - Yes/No.
4 If not, have you had the occasion to ask the BEE for a similar discussion? - Yes/No.
4a If yes, what was the discussion?
5 Have you received a sort of work plan for conducting IEC (Information Education
Communication) programme from the BEE?
5a If yes, may the work plan for IEC activities be referred to as satisfactory/unsatisfactory?
6 Do you advocate community participation for carrying out health activities? - Yes/No.
6a If no - Reasons.
7 Do you think this training on communication and community participation for BEEs will
make an improvement in the Health programme? - Yes/No.
7a If no -Reasons.
8 Do you involve the BEE in programme planning? - Yes/No. If yes, all/few.
9 Do you think that audio-visual equipment is being properly maintained and utilised? Yes/No.
10 Have you ever been exposed to solve the work problems of BEE? - Yes/No.
10a If yes - How? (with specific instance)
11 What arc your suggestions to improve activities of BEE as per the training (note briefly).
Datc:-
Invcstigator
175
I’
n
Appendix X (iii)
Post training follow-up evaluation schedule:
Questionnaire
(for Block Extension Educators only)
1
2
3
4
5
Datc:Name of the PHC:DistricfName of the Respondentr
age
sex
M/F
Date of appointment in the present post:-
Post training activities
1 Training status:Typc of Training at the Health and Family Welfare Training Centre, Sambalpur.
From............
To
a
b
c
2
Do you think that the Training provided on Communication and Community Participation is
adequate to carry out the assigned duties? - Yes/No. If yes, how?
a To plan for effective communication.
b To know the audience.
c To talk with the clients.
d To work with others.
e To apply teaching and motivational methods.
f To identity and involve Community Manpower.
3 Do you collect data for planning EEC (Information, Education, Communication) in your
block? - Yes/No. If yes, how?
Average achievement during the month
a Community surveying.
b Data tabulation and interpretation.
c Summary findings.
d Draft Plan for IEC.
e Any other.
4
How do you select your audience for IEC activities?
a Identification of target groups.
b Identifying community communication modes.
c
d
iii
Studying customs, traditions and folk beliefs.
Identifying community channels.
e
iii
Any other.
iii
177
il
5
What methods do you follow to approach your clients?
Average monthly achievement
a
Mass meetings
b
Group meetings
Individual contact
c
Attending special gatherings and
d
IEC sessions at PH/MCH/FW
service delivery camps.
e
Health Education Programmes in
schools and out of school youth
f
Any other:
Organisations
How many limes
Topics
attended
per month
discussed
a
b
c
d
6
Do you work with others for IEC (Infonnation, Education and Communication) activity? If
yes - how?
Interagency co-operation - Ycs/No. If yes:a
Namc of Organisation Type of help
a
b
c
d
b
Assessment of In-service Training need of IEC staff:i Have you planned for conducting the Training Programme for your staff? If yes:- Category of staff to be trained
- Period of training
- Topic to be taught
- Resource person
- Method to be used
- Media to be used
ii Have you prepared a checklist for assessment?
Yes/No
Opinion Leaders Camp:c
Yes/No
d
Orientation Meeting with IEC staff and voluntccrs:Ycs/No
Any othcr:c
f
Are you following the principles of supervision:Yes/No
Have you prepared a checklist for supervision:Yes/No
g
7
For educational approaches (IEC) do you use audio-visual aids:Yes/No
If yes - How?
a
Preparation of different media forms on programmes:i Name of aid used
ii Place of use
iii Target group contact
iv No. of times per month
b Production and distribution of printed A.V. malcrials:c
Utilisation of IEC materials in communication (films, slides, radio, folk plays, drama
exhibition etc.)
d
Integrated campagins and drives.
Any other.
e
8
Are you involving the community in the promotion of its own health?
Ycs/No
If yes - How?
a
Identification of opportunities for local involvement in development of health
programmes.
b
Arrange and hold planning meeting with community programme.
c
Identify and motivate opinion leaders.
d
Arrange workshops/mcetings.
c
Promote local PH/MCH/FW oriented committees.
f
Promote and assist social activities; provide IEC materials and programmes.
178
1!
n
9
Do you follow the interview technique while talking to clients?
If yes - How?
a Self-introduction
b Rapport establishment
c Patient listening to the client
d Purpose of interview and talking to the respondent
Ycs/No
Ycs/No
Ycs/No
Ycs/No
Ycs/No
10 Any suggestions for effective communication - any community participation?
a
b
c
d
Dalc:Signature of the Investigator.
r
179
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