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Ministry cf Health and /
Family Welfare
Government of India
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It is envisaged that facilitators for ASHA learning programme will be drawn
from different development sectors with varying experiences. Some of these
facilitators will be from the Health department, while others could be from the
Women and Child Development department, Eduction department or from non
governmental agencies. It is crucial that facilitators have a shared
understanding on conduct of different sessions in the learning programme. It is
expected that this Facilitators Guide along with ASHA Book No. 1 will serve as
a useful resource for the facilitators.
Effectiveness of ASHA in fulfilling/delivering her functions will largely depend
on the quality of the learning programme she undergoes. In view of this,
facilitators need to be conscious of the learning needs of ASHA and encourage
them for acquisition of relevant knowledge and skills, In the process, facilitators
I .
I
I
I
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will also gain new knowledge from the participants.
This document is supposed to provide critical inputs for facilitating this
exchange of knowledge and thus create a health resource for the
communities. The major challenge for the facilitators is to conduct these
sessions in a manner, which is conducive to the flow of knowledge and at
the same time dispels certain myths and misconceptions through questions
and answers. Facilitators may be required to make an extra effort to organize
key exercises reflected for each session. However, this Guide should not
restrict any new ideas and innovations to facilitate the process of learning
in an effective manner.
I take this opportunity to thank UNFPA (United Nations Population Fund)
for developing this Guide to be used by the facilitators in ASHA
learning programme.
28th June 2005
Dr. D.C. Jain
Deputy Commissioner
Training Division
Ministry of Health and Family Welfare
Government of India
New Delhi
|||B
gRi
n
1
1 II
H
Pages
Lesson
S.No.
1.
ASHA's Facilitators’ Guide
1
2.
Staying healthy
12
3.
Personal Hygiene
15
4.
Water Safety at home
17
5.
Disposal of waste water
20
6.
Our health depends upon the foods we eat
22
7.
Body Mapping and overview of organs
25
8.
Women and health
27
9.
Organising a Group Meeting
30
10.
Know Health Services
32
11.
Anganwadi Centre
35
12.
Village Birth Attendant or DAI
38
13.
Illness and Healing
41
14.
Using Remedies
43
15.
Home Remedies
45
16.
Preventing Unwanted Pregnancies
47
17.
Condoms: an option for men
'
49
Lesson
S.No.
Pages
18.
Registration of Pregnant Women
51
19.
Janani Suraksha Yojana (JSY)
53
20.
HIV and AIDS
56
21.
Breast Feeding
58
22.
Infant Nutrition
60
23.
Immunization
62
24.
Diarrhoea
64
25.
Aches and Pains
66
26.
TB
68
27.
Snake Bite
70
28.
Davapeti
72
29.
Annexure
74
--
ASHA'S
Introduction to ASHA learning programme
The ASHA is the real hope for the health care of our villages. Village people have
very little village-based help to bank* on for health advice and primary care.
ASHA will fill that long felt space.
ASHA has eight roles to play in the promoting health of the village people. She is
not a subordinate of the health system, but a helping hand of the system at the
village. She is a link between the health care delivery system and the people.
ASHA may have schooling up to the Sth standard. In some villages she may have
somewhat less schooling. We equate schooling with learning skills and with
education. It is true that better schooling level means better learning abilities
especially for written material like books. But some ASHAs may have had less
opportunity for formal schooling. They can also do well if you help her properly. For
them we will have to give more time and attention. They may do as well as others
with this little extra help. As facilitators you have to be conscious of the learning
needs of such ASHAs and appropriately help them to learn.
ASHA is not a school-going girl, but she is a woman with some level of schooling.
She is an adult, taking all the troubles village women have to live with. She is our
equal. Sometimes we may be awed about how she copes up with the difficulties of
i 2 ) ASHA: FACILITATORS’ GUIDE
life in the village and the family. In many walks of life, she may have set an example
for others. Even when she is coming to attend this programme, she has set aside
several difficulties and problems. Let us respect these qualities and abilities. This is
what will transform her into a sort of village health activist. In the learning
programme, we have to boost her confidence, attitudes, abilities and skills for
solving health problems. She is going to give 1-2 hours of her everyday busy life.
She is expected to step in the role of a change agent for health in this new role. The
ASHA programme is to liberate her into this new role, not press her into a new form
of labour. She will achieve this with y(our) help.
This learning programme is based on principles of adult learning. It is for learners,
more than the trainers. We will have the learning programme in five exposures
spread over the entire year. As we complete one exposure we move to the next
and so on. In this way we move from simpler topics to more complex ones.
We have about 20 themes to learn about in the programme. Each theme has some
lessons. Each lesson is complete by itself. We learn the themes, lesson by lesson in
each exposure.
Each lesson is about 2-3 pages, and can be done in half an hour. In each lesson, you
have some knowledge parts, and some skills to learn. At the end we have some points
to think about. For skills, we will have the help of hands-on experience or
demonstrations. During the sessions, we can also practice some skills.
So after the first exposure, you have known something of most of the themes.
You can start doing a few activities after the first exposure of 7 days. Further
learning will be through the four exposures of 4 days each. Together it makes
23 days.
After completion of each learning camp, ASHAs will be working in the village with
help of nurse didi, the anganwadi behen and the MPW. They will have to complete
some assignments in the village, like water disinfection, or attending the ANC clinic.
This will give us hands on experience of tasks and activities. They are supposed to
keep records of this work and bring this with them during the next learning
exposure.
We can make it flexible. You can plan the sessions accordingly. So you can make
your own sequence. In the end you will complete most of the lessons in all the
topics. This makes the programme more learner-centric and flexible.
ASHA’S FACILITATORS’ GUIDE ( 7^')
The learning programme is participatory. ASHAs learn, and facilitators help them to
learn. Encourage ASHAs to ask questions and seek solutions to problems anticipated
by them.
Introduction to this guide
This guide, a small companion to the Learning Material ASHA, is in the form of five
books. This guide has general suggestions as well as lesson-plans for the first book
to be completed in the first learning exposure of seven days.
Use this guide with the lessons in the first book. Although there are many
principles and thoughts about how health worker programmes should be
conducted, we have kept it very simple. We have assumed that it is mainly
ANMs, MPWs, LHVs, ICDS functionaries and sometimes PHC doctors who will
help in this ASHA programme. Sometimes it will be voluntary organizations
and health activists in some districts or blocks.
One needs effort to be a good trainer. It rarely comes as a ready quality and
capability. In most cases we need to cultivate the temperament, strategies, the
skills, the techniques for good trainers. These are basically communication
skills. The guide will help you in systematically organizing learning
programmes so that learning objectives for each lesson are achieved. However
this is not cast in stone; you can freely decide and adapt different ways. We
all know that one size does not fit all and different learning techniques may
be used in diverse settings.
More important is the sincere wish to communicate. Most techniques cannot
replace the yearning to communicate. The unwilling or disinterested facilitators will
do more harm than any good to the learning programme, as has been observed in
♦
the past.
The first section of this guide is about general guidelines that are useful for
all the five learning exposures and even later. The second section deals
with conduct of the sessions based on the lessons reflected in the book
number 1.
There is a lesson plan for each session that needs to be adhered by the facilitators.
There are certain requirements in terms of equipment/material that needs to be
arranged. You may divide the responsibilities for organizing these materials before
the start of learning programmes.
U) ASHA: FACILITATORS' GUIDE
In some lessons, we feel demonstrations will be very useful. You are required to
set up these demos/visits before the start of the learning programme. In case
you need any official communication, the medical officer at the PHC may help
you out.
In each session there is one exercise. You need to explain this exercise to the group.
Help ASHAs in this exercise. They are more likely to develop knowledge and skills
once they have participated in the exercise.
The assignments are to be completed by the ASHAs before they come for the second
exposure. There may be several questions in their mind about these assignments.
We are confident that you will be able to respond to these questions, as you are
familiar with local situations. These assignments are also important as the lessons
themselves. In assignments, ASHA will learn to do things with the help of health
workers including you.
Elements of an effective learning programme
You may have heard the story of Eklavya, who learnt archery all by himself. He had
no guru (read facilitator!!), only the intense wish to learn. This alone can drive the
learning process. But it will help only few learners who are already focused and
driven by certain ideals. Similarly there may have been gurus who have made great
disciples out of ordinary people. Yet it will be difficult to get such gurus in largescale programmes.
For a large scale-learning training programme, we need to look at more systematic
learners, facilitators, physical conditions and learning aids.
The success of any learning programme depends upon all these factors working
in consonance:
The learning factors: the wish to learn, the need to learn, the motivation, abilities
to learn the current programme, state of body and mind (post-lunch sessions are
always difficult for learners), mother-tongue and dialect. Number of learners in the
group is also important.
ASHAs
are
selected
through
an
intensive
process
and
hopefully
selection process which takes in the cognizance of personal factors.
It is envisaged that no more than 30 ASHAs’will be participating in one
learning programme.
ASHA’S FACILITATORS’ GUIDE
The facilitator factors include: the subject knowledge, communication skills,
friendliness, delivery of messages, etc, how many trainers are available.
The profiles of the facilitators may change at different places. It is assumed that
majority of them will be drawn from health, nutrition sector and will have an
understanding of health-related issues. NGOs working in the health sector will also
have knowledge and skills in primary health care.
Physical factors: Space and sitting arrangements, sound and distractions, weather,
lighting, surroundings.
It is proposed to organize these learning programmes at the block level and the
programme should be residential in nature. Prior attention is needed to make the
training venue appropriate for learning. Attention should be given to the basic
amenities available at the training venue.
Learning material and aids: the content and layout, writing style, the use
of AV aids, models, pictures, story boards, and participatory methods are
all important.
Facilitators should try to organize learning aids in advance. It may be difficult to
organize all learning aids by one person. You need to divide responsibilities
amongst yourself. All these factors are important. But all need to be
in consonance. A good physical arrangement may not by itself create a
successful programme.
Some do's and don'ts for facilitators
A good programme will plan the timetable and activities so as to cover most of the
lessons in classroom and practical sessions. Facilitators' team should assign
responsibilities in the team. Flexibility is important, but a plan is necessary.
Keep the atmosphere happy and pleasant. This helps learning more than any
other mood. Any differences in opinions on how to approach a particular
session should be discussed before hand. Facilitators should present
themselves as a group with shared understanding on the issues being covered.
Angry/short tempered teachers are no good either for children or adults. Sad
teachers are also no good. The basic quality of a good facilitator is the
eagerness to help people. They also must have good faith in the programme
and approach.
6 ) ASHA: FACILITATORS’ GUIDE
Do not leave the ASHAs to 'read something on their own’ since you are engaged
in something else at that time. Keep yourself completely free for conduct of the
session. The sessions are for contact and academic help; do not make them into
mere reading out sessions. They can do their own reading in other times. The
planned time is for interactive learning and must be kept that way. Each session
requires some advance preparation on the part of the facilitators. If you are not
prepared, than this is a blow to effective learning. We feel that you may have to
go an extra mile to organize the session in the most effective manner. Same is
also true for any demos or visits to be organized during the course of the
programme. The ASHA programme is different. ASHA is the true centre of the
entire programme. We have to build the programme around ASHA. We help her
learn things. The programme is no doubt made beforehand. But the pace and
process, sequence and style should be decided in view of the ASHA. For instance,
the level of education in tribal districts may be much less as compared to other
districts. So, we have to slow down the pace, use different methods. This variation
of learners is the guiding principle for the programme. Following things are
important for this:
Physical set up for learning
Choose an airy and pleasant room. Find a place for all to share comfortably. Use
flowers and plants to create an ambience.
Chairs and benches are not a must. But they may make sitting comfortable. Plastic
chairs are available widely these days.
Sit at the same level, and do not take a high position. That makes listening painful
and authoritative. That is not helpful for participatory learning.
Make them sit in a circle rather than in rows as in school. A circle gives everyone
equal importance and attention.
Make available drinking water around, especially in hot days.
Food is a very important factor for making things comfortable. You may involve
ASHAs in making their meals in case they are interested.
Make other arrangements for sleeping, washing as comfortable as possible.
Again, take their help in arranging things.
ASHA’S FACILITATORS’ GUIDE { 7 )
Some people may need some extra help. For instance, some ASHAs may have
brought their children with them. If possible, arrange for a baby sitter through
the programme, with toys and feeds. This will really help the mothers learn
with attention.
If the training is in a PHC/CHC, medical help is available already. Should they need
help, arrange for a sensitive and sympathetic help. This will create bonds between
them and the CHC.
Use all possible events to help learning-diet planning, wastewater management,
exercise, etc.
The joy of ASHA learning sessions
The ASHA learning programme will be a source of enjoyment also. For the first time
these women are making friends with someone beyond their village. For the first
time may be they have left their daily chores behind, the cattle, the grinding work,
the compulsions of a village woman.
Women will enjoy this, as they do not have to cook and serve for these 4-5 days.
Somebody else is cooking and they are eating meals without bother.
They can sing and dance in the evenings and breathe freely like in their young days.
They will enjoy games and we need to plan for these events.
They will get time to talk to other ASHAs outside learning sessions, in the
mornings and evenings and late nights. This will help the programme as well
ASHAs themselves.
ASHAs could detect an important health problem in one of them while learning. This
i
gives them a great confidence and interest in learning. They will also reflect on their
own health, their family's health and seek solutions with interest. You may organize
health checkups for ASHAs during this period with assistance from the PHC medical
officer.
They will enjoy the future prospect of being a little else, little more than a
housewife. People will come to them for illness, health advice, for many more
things. That is empowerment. They will look at the village and neighbourhood with
a new and broader vision.
I
ASHA: FACILITATORS’ GUIDE
In some health programmes community-based health volunteers have been elected
later as village panchas and sarpanch. Most of the Panchayat problems are linked
to women's lives more tnan men Water, fuel, food, cleanliness, waste management,
toilets and security and so on. Men are no doubt responsible for these issues. But
women need to control these factors of village life. They will manage the issues
better and with greater application. So the ASHA learning event will empower them
with a new vision and alliances.
Various methods we can use in ASHA learning programme
We can use one or more of any conventional or participatory methods for each
lesson. The lesson also demands some kind of method. For instance, you cannot but
use a demonstration method for the lesson on a soak pit. Here is tabular summary
of methods we can use.
Comment
Technique
Good for
Examples where you
can use it
Limitations
Learning by
doing
Skills
Taking a blood film
Not for theoretical
topics like disease
causation
Field visits
Understanding
field realities/
projects/plants
Hand pump
safety/health
Takes time and travel
Problem
solving
Complex issues
Management of
village waste water
Not for
theoretical topics
Surveys
Community
health topics
Child nutrition,
sanitation, outbreaks
Experience
sharing
Practical life
based topics .
Exp. of visiting
a doctor/ hospital
admission/ childbirth
for women
Takes time,
Not for
plan as
sensitive issues
like domestic violence, assignments
stigmatized problems,
or abstract things
Make most
people
participate
and share
Experiment
To demonstrate
methods and
different
outcomes
Use of guppy fish
on mosquito larva
density in a pond
May not be possible
in all situations
Can be
planned after
or before the
day's work
You have
to design
simple and
effective
experiments;
predictable
outcomes
ASHA’S FACILITATORS’ GUIDE
Technique,
Gop’d-foj
Examples where you -Lim+tations
can-use it
Games
Comment- - “
“ ~
To understand
Risk factors and
variables in a
health problem,
care in childbirth
through a snakes
with fun
and ladder game
Skills-learning
Choose
imaginative
and
interesting
games, keep
changing
Recall and
Life experiences
reflective
analysis
exercise
Computer
Decision
Diagnosis of fever,
Resources/expertise
PowerPoint
based
training (CBT)
making, details
steps in treatment
may not be available
/steps for
actions etc
etc
shows can
combine
diagrams,
photos,
animations,
videos,
interactive
programmes,
sounds etc
plays/skits/
Mainly for BCC
on complex/
Like for acceptance
of spacing
satire
attitudinal
pregnancies. PNDT,
Dramas/role
Skill building topics
Needs some
preparation.
More useful
for
community
health issues
community
shows rather
than the
classroom
Event-based
discussion
For giving life
context to
learning,
Issues like alcohol,
domestic violence,
maternal death etc
attitudinal
issues
Mapping
Health planning
/problem solving
with community
Health determinants
like water, sanitation,
nutrition, vector
control etc, body
mapping
Not meant for
theoretical issues
9
10
ASHA: FACILITATORS’GUIDE
-Technique,
—_
Examples where you
Good for
Limitations
Comment
We may have
flip charts or
PowerPoint
shows for
ready made
pictures. Or
else we may
ask ASHAs to
draw on paper
or blackboard
can use it ~
i
Pictorial
presentation
Visual learning,
esp. for less
literate. For
knowledge,
attitudes, skills
Human biology, water,
sanitation, illnesses,
women’s health:
Universal method
Skill leah.ing needs,
actual action-ba^ed
programmes
Skill
demonstration
Steps in actions
and equipment
handling
Water disinfections,
BP recording,
wound care
May not be handy
where events can not
be planned (like home
birth care)
Videos Et
movies
Effective for
Knowledge,
attitudes, skills.
To capture
movement
essential for
the topic
birthing, ARI
Neonatal care,
ANC-birth-PNC
Costly. Needs pre
planned production
and equipment to
show. Avoid overuse,
as it can also
cause boredom
Discussion
For any topic,
after any mode
of learning
Types of practices
prevalent in your
area for snake
bite first aid
Some people ’stay out' Needs to be
participatory
of discussion
Songs
For memorizing
messages,
creating
emotional
bonds, changing
attitudes
We can make songs
about safe
motherhood, about
village cleanliness
drive, about domestic
violence, etc
Good songs are not so
common. They must be
made interesting,
inspiring
Select topics
and products
carefully. If
you feel it is
important-you
can also locally
produce films
with help of
video
cameramen
who are
shooting
marriages
The ASHA
programme in
the state
should have
some good
songs and
tunes to share
with people,
and amongst
ASHAs. Use
folk types
ASHA'S FACILITATORS’ GUIDE
Technique
Good for
Examples where you ’ Limitations. _
can useL_itL- ”
I
I Story
Comment
-
Stjties can work
News clippings can
Stories may become
Story should
as pegs for
knowledge and
work as stories, or
ends in themselves,
be closer to
narrations by
participants about
important issues
unless followed with
life, culture,
good discussion/
realistic. Great
men and
attitude
creation
reflection
women’s
stories for
specific issues
can be
helpful. For
instance
Gandhiji’s
‘obsession’ for
cleanliness
Lecture
Usual method
for theory topics
Cause and spread
Not the best
of malaria/ illnesses
method for
ASHA groups.
Use sparingly.
Add stories,
pictures,
discussion etc
Self reading
/writing
Mainly for
assignments in
Writing answers to
Do not leave ASHA
Necessary part
exercises/Qs given
students to 'read and
between
in books
write’ because you
of self
learning
have no time
during non
learning weeks
forma I times.
Reading
habits need to
be cultivated
11
2
Lesson Plan .
Equipment
Topics
Venue & time
Principle method
Health
Determinants
of Health
Assessment
Classroom (2hr)
Use the
Pictures of health
Banyan tree
determinants/
of health
questions and
discussion. Stimulate picture for a
holistic health
self-reflection/
perspective
experiences
of Health
'Suggestions
Let people put
words to ideas
and suggestions:
you can build
causes of
ill health
this way
Keywords
: Health, expenses, determinants, heredity.
Exercise
: Form 5-6 groups of ASHAs. Let them discuss health status of their
respective villages based on key parameters given in book 1. Let the
group present synthesis of the group discussions.
Assignment
: Prepare a snakes and ladder game on health determinants and share this
in the next learning exposure.
Activities
■
Explain session objectives
■
Start the discussion with who is sick today or had illness in the last week?
■
Inquire about common illnesses in their villages
■
Try to get responses about the possible causes of ill health
STAYING HEALTHY ( 13 J
■
Use "what do you think questions" for evoking discussion
■
Now show cards with pictures of (banyan tree of health) determinants of
health-like water, air, food, timely u^c of health services etc. If you can’t find
a ready picture, draw a banyan tree on the flip chart
■
Recap using keywords
■
Explain the exercise on health assessment and terms of reference for group
work. Examples given in the book for health assessment can be used. You may
also like to add some more examples
■
Explain the assignment after the learning camp
Think about this:
Why do people have to take loan for getting treatment in hospitals?
Cost of medical care is rising. Many of us like to go to private hospitals for treatment.
People consider the government hospitals as lower options. Therefore we spend on
hospitals. However, our incomes often do not match the cost of care. For instance a
C-section for complicated delivery costs Rs.10,000 in a private hospital. How does a
poor family cope with this emergency payment? First it may sell something - a bull,
some piece of land etc. But these are essential for livelihood. So the family takes loans.
The loans from private parties may have very high interest rates. The family is trapped
in a debt. Sickness in family is the common cause for indebtedness of rural families
Why do women feel hesitant to talk about their health problems with
male doctors?
In our society, women still suffer from male domination and are shy of talking to
male doctors about intimate matters. They are afraid of physical check up
by male doctors. On the doctors' side there are problems too. Often clinics
have no privacy for talking about private matters, leave alone a check up. Women
are naturally very sensitive to such situations. Doctors should ensure privacy and
confidentiality and should not be judgmental.
Why do people keep on waiting for days and months before
seeking treatment?
People do want to get treatment for illnesses. However different factors
including socio-cultural and economic factors influence treatment-seeking
behaviour. There are reasons for not taking treatment early enough:
a) some illnesses like TB and anaemia are slow type. One knows about the
illness only after a certain stage
14; ASHA: FACILITATORS’GUIDE
b) often there is no facility in the village or nearby for "right" treatment ’
c) There is no time in the daily struggle for livelihood and one may as well
pull on till it gets unbearable
d) there may be no money for travel, medicines, doctors fees etc.
e) some people feel the illness will be cured by local traditional healers or
faith healers, so they try out this option
f) Some people have different perceptions about illnesses-like god’s wrath or
evil spirits and believe that doctors could do little about it. Also, generally
women's illnesses are often neglected by the family members as these are
considered too "trivial” to merit any consultation or treatment.
P^T5C»n4
Lesson Plan
Suggestions
Venue & time
Principle method
Equipment
Personal health Classroom (2hr)
cleanliness,
personal
hygiene
practices
Picture-based
discussion, demo
if possible
Showcase
Soap, brush,
nail cutter,
good
fine comb, flip examples,
chart showing
not dirty ones.
germs-illnesses, Present then
hand-to mouth positively
spread of germs,
and 10 cleans
and related
infections
Topics
Keywords
: Germs, cleanliness, bath, nails, mouthwash, brushing, footwear, hair care,
toilet practices, hand wash.
Exercise
: Prepare your own hygiene 10-score card. Give 1 mark for each of:
brushing, toilet practice with after hand wash, hand wash before meal,
daily bath, hair care, nail care, no to tobacco, clean clothes, footwear.
Maximum 10 score. Compare scores and find three winners. Facilitators
a Iso pa rt ici pa te.
*__________________
Assignment : Use the score method in one classroom in the school/Anganwadi, take
help of AW.
Activities
■
Start the discussion with a song on cleanliness (one facilitator to work on local
song or encourage someone in the group to sing.)
16
ASHA: FACILITATORS' GUIDE
■
Discuss session objectives
■
Use ready flip chart or pictures for showing. Evoke a participatory discussion on
practices. Explain the importance of health. Ask how many of them lick their
fingers when turning pages in a bock or counting currency notes?
■
Demonstrate use of toothbrush, nail-cutter
■
Generate discussions on the questions listed below. Let them have sufficient
time to analyze the issues under discussion
Explain the scorecard for exercise. Keep scorecards ready. Very clearly explain
■
scoring system. Try to organize some recognition for the winners. Give some
time to the winner to explain about her personal hygiene habits
■
Explain the assignment after the learning camp to be completed by ASHAs
Think about this:
Long nails come in handy when someone is attacking you physically
Many girls and boys keep long nails as if it protects against physical attacks. It does
not in most cases. Some keep it for fashion and being trendy. However they do not
know that dirt collects under nails and may harbour germs and eggs of worms. At
times this dirt can go in our stomach along with food. This dirt can be a source of
illnesses like diarrhoea typhoid, dysentery, jaundice, worms etc. Hence it is always
better to keep nails trimmed.
One can remove food particles in between teeth by needles
Needles are no good for removing food particles stuck between teeth. Sharp needles
may cause injury to soft oral cavity. This may also lead to tetanus. Many people have
this habit of using alpines or needles and knowingly and unknowingly keep on using
this to clean teeth. The best way of removing food particles is by proper brushing or
dotoun. Immediate mouthwash after meals or snacks is necessary to wash out
particles. Brushing before sleep is also very important.
Lack of privacy for bath is a cause of skin illnesses
Skin infections (fungal infections) are common in women especially on the waist
and groins. This is because lack of privacy for bathing. This causes women to bathe
with clothes on and hence there is no cleaning of these parts, and also breasts. The
simple solution to this problem is to use bamboo or gunny bags to create privacy.
A simple door with a wire hook and nail can ensure privacy. The joy of bathing
(without clothes or minimal clothes) is enormous and women and men must enjoy
it and also keep themselves clean.
s'
Safety
Lesson Plan
Topics
Venue & time-
Importance of Classroom and
dining place,
clean water,
how to make (2hrs)
it safe
Keywords
-Principle method
--Equipment
Flip chart/pictures, Malka, ladle,
chlorine drops,
demonstration,
bleaching
discussion on
powder, empty
expenses on
water
bottle
water-borne illnesses
Suggestions
It may be
useful to visit a
neighborhood
house in
the evening
: Water-borne illnesses, contamination, germs, storage, ladle, alum,
chlorine, hand-pump, stock solution.
Exercise
: Check and ensure water safety at the training venue i.e., source,
collection, storage and withdrawal.
Assignment : Visit five houses in the village to check water safety measures at home
and advise them suitably.
Activities
■
Explain the learning objectives of this lesson
■
Start the discussion with health-importance of water. Give example of direct
»
and indirect expenses/losses due to diarrhoea and dysentery by families
(ask someone in the group to narrate experiences)
■
Share the questions at appropriate points
■
Talk of how a family can get already contaminated water - unsafe hand-pump,
water from streams and river, shallow and open wells
: 18 ; ASHA: FACILITATORS’ GUIDE
Explain methods of treating water at home-storage, chlorine drops, alum,
■
boiling etc
Explain how to prepare mother-solution in absence of chlorine drops.
■
Use demo
■
Take a 5-10 min break
■
Start another session. Discuss how water at home can get contaminated.
Explain the use of ladle. Use contrasting pictures/example of a boy dipping
hands directly in the matka
■
Ask participants about withdrawal of water from pitchers at their homes
■
Recap all the key words
■
Explain the exercise-checking water safety at the training venue
■
Explain the assignment after this learning camp
Think about this:
z Running water is safe and pure. There is no need to make it safe
Running water (behata pan!} can be unsafe, even when it is a large river like the
Ganga. This is because human/animal waste flows into the water bodies along its
course. Human habitations along the running water sources also make them
vulnerable for contamination. This contamination makes it a reservoir of several
germs like cholera, dysentery, jaundice, typhoid etc. Hence even running water
needs to be treated for safety.
Stale water should be thrown and fresh filled
Many families throw away stale water (yesterday's collection) stored for drinking
purpose. They may use it for any purpose except cooking and drinking. The truth is
exactly reverse. Stale water generally is safer than 'so called fresh water’. This is
because the germs in stored water settle down and die. Visible dirt i.e. turbidity also
settles down. Water becomes 99% safer in 24 hrs just by storing. Just cover the
water and keep still. Alum will hasten the process.
Hand pump water is always safe
Although safer than surface water, hand pump water may become unsafe due to
contamination from seepages. Look for latrines, septic tanks, cesspools etc within
50ft of the hand pump. These can make the hand pump water unsafe. Secondly, if
wash water stays and collects around the pump, it may also seep in the bore. This
is another source of germ contamination besides being an ideal breeding ground for
the mosquitoes.
WATHER SAFETY AT HOME
Hand pumps can have another type of problem - the salts and chemicals dissolved
in groundwater. This also can be harmful for health. It is better to periodically get
water samples checked for quality. This is the job of the water supply department.
ASHAs can work with Panchayats to get water samples checked as key quality
parameters. If a hand pump is declared as not providing potable water, people
should be advised not to use water from such sources.
Chiorine gives a strong smell to water, so people do not like it
Chlorine overdose gives a strong smell to the water for a longer time. Usually the
correct dose does not cause this problem. First of all, do not use the water for at
least half an hour since chlorine is still acting on impurities/germs. If the smell is
strong stir the water for a while and keep it open for some minutes. The smell will
get less with this. The smell is harmless by itself though one may not like it. Finally,
remember that chlorine makes a big difference to water safety and smell is only a
minor irritation for some time.
I
I
I
19
40^
IB
5
* Visposd. of
Lesson Plan
Topics -
Soak pit
'
Equipment
Suggestions ’ -
A model of
Discussion on site
On site, second
soak pitor a pictorial/
option is
classroom (2hrs) flip chart discussion
Try if you can
organize a
demonstration
in the classroom
Venue & time
Principle method .
of the
construction
of a soak pit
Try if we can
do it by the
side of a
kitchen garden
Kitchen garden A kitchen garden Participatory
discussion
(1 hr)
on vegetables and
the nutritive benefits
Keywords
: Pools, mosquitoes, illnesses, soak pit, kitchen garden, vegetables,
nutrition, village planning.___________ '
Exercise
________ __
: List the vegetables for KG. Discuss the benefit of each.
Assignment : Motivate a household to make a soak pit and KG at the village before
next learning camp.
___
/_________ • -- - '___ _______________
-•
Activities
■
Start the discussion with a picture/scene of village cess-pools (choose and keep
ready). Ask ASHAs about how common such.scenes are in their villages
■
Explain learning objectives
DISPOSAL OF WASTE WATER
■
Explain the ill health due to indiscriminate disposal of wastewater. You may ask
■
about malaria cases in the villages
Use ready flip chart or pictures for showing. Evoke a participatory discussion on
usual practices. Explain the health importance of each
■
Ask the questions listed at appropriate points
■
Show a model of a soak pit, explain how to make it
■
Take a small break for 5-10 minutes or walk to the kitchen garden spot
■
Show a ready kitchen garden nearby. Explain benefits. (Locate one beforehand)
■
Explain the exercise. Encourage them to come out with names of the vegetables
that can be grown in the kitchen garden
■
Explain assignment to be completed before next learning camp
Think about this:
Think of a village without pools of stagnated dirty water? Who will
help you in making this happen?
All the villages in India have cesspools and streams of dirty water flowing through
lanes, bylanes and roadsides. Villages with piped water supply and in the vicinity of
hand pumps also this scene. Even where drains are made by the Panchayats, the
water stagnates at places and overflows. One way of dealing with this problem is
to ensure the disposal of the wastewater effectively by each household. Soak pits
and kitchen gardens are a sure way of doing this. You can be a catalyst in making
your village free of cesspools or wastewater ditches. Multi-purpose worker,
Panchayat member, teachers, village level workers of other development
departments can join hands and make this happen.
How will you motivate villagers to construct soak pits or kitchen gardens.'
We must lead by example. Let us all try one at our house first. Prefer a kitchen
garden to a soak pit as far as possible. K-garden gives us vegetables that we
may not get in the village everyday. If the space for K-garden is not enough
soak pit is a sure solution. It needs small space to dispose water. You can plant
a fruit-bearing plant nearby-banana, lemon, custard apple, drumstick etc. Next
demonstrate this to other families, especially women. Plan a meeting at your
house or nearby for discussing this. Discuss the benefits. Village micro
planning will be the best way to do this. Take K-gardens and soak pits as a
major point of action in the village planning. Locate problem spots and
stimulate action. Take nurse didi, Panchayat members and Aanganwadi
behan’s help for this.
21)
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j
On hwlth
i^pon
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Lesson Plan
Topics
Venue & time
Classroom, plus
Functions of
the kitchen
food,
Balanced Diet, (2hrs)
Food Hygiene,
Malnutrition
Principle method
Equipment
The four colour
Demonstration,
discussion, flip chart foods, adult wt
machine and
measuring-tape
or marks on
the wall
SuggestionsCan also use
evening hours
before dinner
if participants
are staying
back
Keywords
: Food needs, balanced, 4-colour, healthy dietary practices, energy,
proteins, iron, vitamins, oils, junk foods, food hygiene, weight, obesity,
child-nutrition.
Exercise
: Make a colour-audit of the meals we get in the learning camp.
Assignment
: Make a colour audit of one week's meals at home, and write comments.
Activities
■
Start the discussion with individual weights (keep the weight machine ready
and wall-marks for height). Let everyone read out the height-weight Most
women weigh less, around 45 kg. Read out ideal weights for heights (from the
table at the end of book)
s
Talk of learning objectives for the lesson
OUR HEALTH DEPENDS UPON FOODS WE EAT ( 23
Show pictures of five women-labouring on road, adolescent girl, and woman
managing a village shop, pregnant mother, and breastfeeding mother. Talk of
■
different food needs for these women
Evoke a participatory discussion on usual dietary practices in rural households.
■
Explain the importance of health
■
Talk of necessity to eat enough food for health
■
Talk of four-colour meals, the types and importance of food
■
Reflect on practices back home
■
Ask what questions are appropriate
■
Explain the exercise
■
Explain the assignment after the learning camp
Think about this;
Some people think it is good to be fat. Others think it is good to be lean
Being fat is not healthy. Weight should be just right for height. Men gather fat in the
belly and women around waist. Nature made fat for going through famines. We almost
never have a famine now and the fat reserve stays put. It leads to illnesses like diabetes,
heart ailments, high blood pressure, joint pain etc. All these are serious chronic illnesses.
The natural tendency to gather fat is known as kafa prakriti in Ayurveda.
On the other hand, some people think being lean is good. It is fashionable to look
slim. Leanness may be due to small muscle mass or no fat. The tendency to be lean
is known in Ayurveda as Vata prakriti. Leanness any time is better than obesity. But
many Indian women are too lean to be healthy. Often their weight is between
35 kg. to 45 kg. That is chronic malnutrition starting from childhood.
Fasting does not kill. Gluttony does
Fasting is a common Indian tradition, common in Hindus, Jains and Muslims.
Fasting has religious value and some self-control measure. Fasting stimulates use
of body reserves of calories. In fat people it can be healthy. In already lean women,
it may cause further weakness. However it never kills, but may cause fainting due
to low blood level of glucose sugar.
Overeating can contribute to untimely death due to illnesses
mentioned above
Starvation is non-voluntary. It is forced by circumstances. It is often chronic. This
is the underlying cause of many deaths both for adults and children in
&
( 24) ASHA: FACILITATORS’ GUIDE
underdeveloped areas. We should all help in preventing this situation by ensuring
an efficient public distribution system.
Good stamina for work comes from food and exercise
How are we able to work? Food gives us the energy to work. The capacity to do
strenuous works-the stamina-cumes from food and exercise. Food alone cannot
confer stamina—it will give only fat. Exercise and physical work build our muscles
and heart-lung power.
A woman’s duty is to eat after everyone in the family
This is common practice and a rule in male dominated society. So it becomes a
woman's duty. She has to tolerate hunger and perhaps go hungry if food is not left
over. Often she eats what is left after every one else has finished. Ideally, she should
eat with all. She has every right to do so.
A pregnant mother should eat less to have a safe childbirth
This is a common belief, which is entirely wrong. For an adult mother, the birth
passage is roomy and a normal child can pass safely. We also have the facilities of
hospital birth and if necessary surgical relief. Modern medical science has made
birth safer and there is no reason to die during the process of giving birth to a baby.
But customs have continued. Now we should tell the mother to eat well to have a
healthy baby. The nutrition also makes mother healthier. She can survive pregnancy
and birth much better with better nutrition. The wounds heal faster. Overall there
is less risk for a mother who eats well than a starving mother.
Malnutrition comes from hunger and starvation. But some times even
rich people are malnourished
Malnutrition is often due to hunger and starvation, and the underlying cause is
mainly poverty. Poverty often leads to neglect of children. But some rich people also
suffer from food-related problems, such as obesity. This is because of food fads,
ignorance about nutritive values of foods, lack of exercise and faulty dietary habits.
.0
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(N&N\£^) of
Lesson Plan
Topics
Body organs
systems,
Body organs
functions
-
Principle method
Equipment.
Classroom (2hrs) Make a body
outline on floor
with chalk or coal.
Locate organs and
systems
Human body
charts. Paper
cutouts of
organs
Venue & time
- Suggestions-
Make this
session
interesting by
using local
names of
common body
organs
Keywords
: Body organs, systems, breathing-lungs, blood circulation-heart, digestion
gut, movement-muscles and bones, waste management-kidneys, control
brain and nerves. Reproduction-genital organs, blood, hormones.
Exercise
: Link organs in to systems/draw body parts on an outline yourself.
Or make a paper drawing.
Activities
■
Talk about the learning objectives
■
Start with the example of a house, various rooms, and other structures also.
Talk about the human body similarly
■
Ask participants to do things listed in the lesson-like swallowing water, taking
a deep breath, quick running and heart-beating, holding up urine even when
( 26 1 ASHA: FACILITATORS’ GUIDE
full, noticing the growling in hungry stomach, observing any joint in action.
Let participants question in their mind
■
Use a human body chart to show various body systems
■
Explain the exercise. Let someone lie down on the floor, and make 3 silhouette
with chalk or coal. Let participants draw organs and systems on that. If they
make mistakes, let others correct them (but avoid discouraging). You can also
use a body apron showing body in layers
■
Recap on keywords of organ and systems, the links, functions and names of
organ and systems, the links and functions
■
Explain the assignment
Think about this:
What are the functions of three openings in the woman’s peri-anal
region?
Anus (defecation), vagina (sexual and procreative), urethral (for passing urine).
In man penis serves both purpose of passing urine as well as sexual and
procreative functions.
Why is the brain the most complex organ of our body?
The brain has millions of cells and tracks. It is a like a complex electrical wiring
connection. Each part of the body has some station in the brain. It gets signals from
the body parts, thinks, feels emotions, stores facts and figures, links information
bits, takes decisions, gives orders to organs.
1
Lesson Plan
Topics
Women’s
Health,
Life cycle,
Health care
Venue & time
Principle method- I Equipment
Classroom (2hrs) Reflection on
life experiences
Suggestions
Flip chart on life Allow some
cycle problems women to
narrate real
life time
experiences on
discrimination
in health
Keywords
: Woman’s status, education, women’s work, pregnancy, childbirth, early
marriage, violence, income, less food, no health care, sex-selection,
toilet facilities.
Exercise
: Prepare score card for your family. Use these points: equal education of
girls, sharing of women’s work, rest in pregnancy, rest after childbirth,
opinion about age of marriage, wife-beating, access to woman’s income,
, enough food, timely health care, opinion on sex-selection before birth,
bath and toilet facilities. Give one mark for positive attribute and zero for
negative each. Discuss positive and negative attributes.
Assignment : Group meeting of 8-10 women and discuss above points.
Activities
■
Talk about the learning objectives
■
Start with discussion of women’s problems in different parts of life cycle.
Use flip chart and reflective experiences
28 / ASHA: FACILITATORS'GUIDE
Discuss why women suffer more ill health and neglect - use the flip chart and
■
lesson text
Explain the exercise of scorecard. Discuss scores. Explain as what is meant by
■
positive and negative attributes
■
Discuss how to improve situations. (Continue discussion in the evening if time is less)
■
Recap the keywords
3
Explain the assignment to be completed before next learning camp
■
Discuss "what do you think" questions?
Think about this:
Pregnancy and childcare can be shared by the couple
Pregnancy and
and childbirth
Pregnancy
childbirth are biological functions of a woman's life, but men can
share the feelings and care. Childcare is also a joint responsibility. The father as well
as the mother can do everything apart from breastfeeding.
Is it right to sex-select babies like some people do? Can our world be
without women?
Some families do go for sex-selection of the baby. They want only a son, especially
if the first baby is a girl. This is discrimination against half of humanity and also
against law of the land. It is an injustice to the unborn baby, to the mother who is
a woman herself and it will make society more strongly against the women. Women
will be insecure in the more-men less-women world of tomorrow. There will be
more violence against them within the four walls and outside. Violence against
women, especially sexual violence will increase, as there will be fewer women to be
courted by more men. Once we make an unequal world like this, it will take
superhuman efforts and decades to correct the balance.
Women and men are born equal. There are many goddesses in our
mythology. Then how came we ill-treat and abuse women?
Hindu mythology has several gods and goddesses Yet we find injustice and ill
treatment of women right from womb to tomb. Whatever the historical reasons for
subjugation of women, modern age has conferred unique opportunities for equal
treatment. Women can do almost all socio-economic functions men have done so
far. This is a reality in other countries. Early marriage, less education, low wages,
and violence are various forms of ill-treatment within and outside the family. We
can end all that. There is no more reason for their being treated as second-class
citizens.
WOMEN AND HEALTH ; 29
Why men don’t come forward to accept contraception?
Men think pregnancy and childbirth happen to women and hence contraception is
also her responsibility. Many men do not even think of contraception. Some even
oppose contraception when women ask for it. Condom and male vasectomy are two
things they can use. Both are a lot easier and safer for health. Yet they rarely use
these methods. The whispered reason behind non-use of condom is Tess pleasure in
sex'; which is not true. On the contrary condom may be seen as a sex-enhancing
accessory. The whispered reason behind less acceptance of vasectomy is ’impotence
or less libido. This is also incorrect. We should dispel these myths and explain
complete information about these methods.
I
Lesson Plan
Topics
Venue & time
Group Meeting, Classroom, or
Behaviour
under tree
Change,
outside the hall
communication, (2 hrs)
Participation of
group members
Principle method
Equipment.
Demonstration
Model of
improved
chuloh
Keywords
: Participation, problem solving.
Exercise
: Organising a group meeting on smokeless chulah.
" Suggestions
Ask participants
to summarise
key issues for
organizing and
effective group
meeting in
their villages
Assignment : Take a group meeting on any health related problem in the village. Write
notes later and follow up.
Activities
■
Talk about the learning objectives of this lesson
■
Start with a story of meeting for ASHA selection in village. Was it a good
meeting? Why and how was it good? What were the problems if any?
■
Explain the importance of behavioural change (as different from just
information sharing) for health improvement. Many health problems can be
solved by helping people to follow health practices.
ORGANISING A GROUP MEETING (31 J
Ask "what do you think" questions?
Take a 5-minute break, explain the exercise. This exercise is for the facilitators.
Group should split in 2-3 sub-groups, each sub-group to be accompanied by
■
.
one facilitator. Reach the pre-decided house with ordinary chulah.
Start the discussion on nuisance and health-problems of the traditional chulah
.
especially if firewood is not dry. Let people talk of problems and ideas.
Encourage the discussion. Now introduce the model/picture of the new chulah.
Explain how it works and the benefits. Ask if there are any difficult.es regardmg
changing to the new type. Write down the decisions made in the meeting.
■
Conclude the meeting with thanks.
Have a debriefing session back at the venue. Discuss with ASHAs as how group
meetings need to be organized
.
Explain the assignment: to take a group meeting in the village on a common
health issue
Think about this:
Some people dominate in group meetings, while some do not speak at
all. What should be done? .
This is a common problem one comes across in the group meetings. We have to
identify non-participants, especially those who keep mum and look for reasons why.
Some reasons could be: not concerned with the problem, not knowing enough
about the problem, shyness, fear of speaking out. too big a group to feel free,
presence of elders or troublesome people, no faith in the process of this meeting.
Yet they all may have something useful to say. We need to gently request the
dominating ones to allow others to speak and respect all viewpoints. One way of
doing it is to select the right leader for the meeting who will encourage people to
speak up. If all efforts fail, we must ask the silent ones after the meeting is over.
I lack confidence while speaking in a group. What should be done?
This happens to many people. But many a woman has changed themselves into
effective communicators and negotiators in months of being selected to
Panchayats and other community-based organizations. Once we know the issue,
we start talking and don't fumble. To start with, we may communicate with fnends
and colleagues, and get their feedback. Secondly, instead of 'giving answers we
may start with sincere questions. The most important thing is to g.ve up fears
slowly. And remember with continued practice, one cah develop confidence, wheni
14'.■<>
speaking in a group.
■
v.
A
pH' VO
(
)-
10
('Ou’ia) HaMi
Qrvices
Lesson Plan
Topics-
I Venue & time
Health services, The classroom
Health
(2 hrs)
institutions
Principle method
Equipment
_ Suggestions
Black board or ‘ Encourage
Request the
nurse didi, MPW, dai large sheet of
participants to
paper, colour
to come to class
come out with
names of other
chalks
service
providers in
their villages
Keywords
: Dai, Anganwadi, health sub centre, nurse didi, MPW [Swasthya Karmi).
Exercise
: An ANM explaining all activities she conducts during an average day.
Assignment : To visit an Anganwadi Centre and list all activitics/service providers by
Anqanwadi worker in your village.
Activities
■
Talk about the learning objectives of this lesson
■
Start with what they know of the block map and directions and distances of
their villages from the venue of the meeting. Draw a crude map of your block
on a big paper or blackboard or the floor
■
Now ask them where the health facilities like SC, PHC, CHC and private clinics are.
Mark each facility with different colour chalks
KNOW HEALTH SERVICES ( 33
■
Ask them if they have visited SC, PHC, CHC or private clinic/hospitals. Ask them
to recall a little bit about the experiences
■
Explain the links between the various heath facilities
■
Take a small break
■
Do a keywords recap
■
Explain the exercise
■
Explain the assignment
■
Read out questions: What do you think?
Think about this:
People say the nurse didi hardly stays at one place
Nurse didi works for a population of 3000 to 5000; hence she visits many villages
(5-10) and paras. She also has to attend meetings at the PHC. She also needs to
conduct immunization sessions and deliveries in the villages. So she cannot stay at
one place, all the time, as she has to serve the health care needs of the population
under her care.
People call the MPW the malaria worker
MPW are giving many services, but malaria work is the most visible and well known.
He takes blood smears, gives malaria tablets and helps the insecticides survey
teams. He also gives condom-contraceptives, motivates for vasectomy, works to
control illness-outbreaks, and helps the nurse didi in immunization work.
Village people don't support nurse didi in her work
Village people may think she is a ‘Govt worker rather than a community worker.
She is often equated with just immunization and FP work. People's needs in
health care are somewhat different. For this people go to private doctors and
meet the expenses. Few know that she can also give medicines for minor
illnesses and even some risky illnesses like pneumonia. If people know this, they
will also support her other works. ASHA can do this bridging role.
Is nurse didi doing only family planning work?
No, it is just one of her services. Immunization, care of pregnant mothers and
children, helping Anganwadi behen in her health work, assisting childbirth
and after, keeping records of health work are some of the important tasks
she does.
&
34 ' ASHA: FACILITATORS’ GUIDE
. people expect free services from a PHC?
Yes, and it is necessary that PHC services are all free. Sometimes the doctor may
write some medicines to be bought from a pharmacy as all drugs may not be
available with them. This is not always true. What is important is that nobody
charges fees for medical care of any type in the PHC. This is also written on the
board in many PHCs. However, in many states user charges are levied at CHCs and
hospitals. ASHAs should make people aware about the user charges as applicable
at different institutions.
How can we help improve the working of this centre?
The PHC has many roles to play, not just medical treatment. You can refer some
needy cases to the PHC for more care. For instance, risky childbirths should
always be done in the PHC/CHC and not at home. You can explain the JSY
scheme to mothers.
You can also reduce some workload of the PHC by preventive care at the village. For
instance, iron supplementation for pregnant mothers can reduce complications of
childbirth. Better and complete immunization coverage will reduce child illnesses.
ORS treatment will prevent diarrhoea deaths.
Many people complain about poor quality of drugs offered at PHCs.
Is this true?
This is not true. Drugs available at PHC are purchased after following a very
elaborate process, which completely eliminates chances of any substandard or
spurious/take drugs being supplied through PHCs. ASHA should dispel any myths
about poor quality of drugs/medicines at government health facilities. On the
contrary, some private practitioners may dispense drugs of doubtful quality.
Lesson Plan
■Venue & time
Principle method
Equipment
Classroom (1 hr)
ICDS
and then AW
AWC
Growth charts centre (1 hr)
Observation, demo,
do it (weigh,
charting)
AW centre equip ASHA scan
(Wt machines, interview AW
growth charts) behen, with
little help
from you
Topics
Keywords
: Anganwadi, birth registration, weighing, charting, feeding, U6 children,
mothers, malnutrition, U3 children, problems, pre-primary education,
AW helper.
Exercise
Suggestions
____
: Group work on what should be done to help Aanganwadi behen on
problems of non-attendance, and babies not doing well.
Assignment : Spend a day with AW in your village and assist her in all tasks.
Activities
■
Talk about the learning objectives of this lesson
■
Start with what they know of AWC. Are any of the ASHA-children attending
AW? What are their experience as mothers about services?
■
Explain the malnutrition and child ill health in our. society and why children
have faltering growth
it
1
36 ) ASHA: FACILITATORS’ GUIDE
■
Then talk of the role of AWC - what it can do for improving health of mother
and children
■
Take a break and walk to ihe village AW (plan it in within 15-20 minutes). If
there is more than one Anganwadi centre in big village or in vicinity, you may
like to split the group in 2-3 sub-groups, each to be accompanied by one
facilitator. Inform the Aanganwadi behen beforehand. If possible invite the
mukhya sevika to be around
5
Let the AW behen show the following: weight taking and charting, cards
showing faltering growth, supplementary meals
■
Talk of what happens about pre-primary education, health check ups, mother clinics
Let the group freely interact with Aanganwadi behen and mukhya sevika.
Chip in questions if necessary
■
Do a recap of what they saw and learnt, using key words
■
Explain the exercise
■
Explain assignment
Think about this:
Some people say Anganwadi is only a feeding centre
No, the anganwadi worker has at least these jobs to do: weigh all under six children
and chart their growth every month, give supplementary feeds to children and
mothers organising immunization, nutrition-feeding advice to mothers, pre-primary
education of U6 children, health care/check up of all under six children. In addition
they help nurse didi for MCH clinics, registration of birth and deaths, and soon they
will start helping in newborn care. Thus our anganwadi behen performs many
functions for improving health of under six children and mothers.
People complain about quality and quantity of food given to children
at centres!
This is a common problem. AW gets pre-cooked food or has to prepare some at AW.
The budget is also a constraint. Often she has short fuel supply. She needs to
improve this by preparing feeds with help of local SHGs. ASHAs can also help AW
behen in her work. Local varieties of foods have better acceptability!
Do children wash their hands before eating at centres?
Hand-wash before meals is essential for prevention of diarrhoea, worms and other
illnesses. It must become a lifelong habit for th*e child. There should be access to
sufficient water at Anganwadi centre.
F
ANGANWADI CENTRE ( 37 J
Some children take food back home. This food is shared at home with
others, is this, good?
Seme children take it home and may share with others. The feed is
supplementary—only a part of the child's needs. If it is shared, a small fraction will
come to the child. This defeats the purpose of AW. The child must eat at the
Anganwadi, as far as possible.
Many times nurse didi does not come on the scheduled health day?
MCH clinic at the AW must be a regular event organised once a month as a
scheduled day. But nurse didi may miss at times due to several problems:
meeting day at PHC, a childbirth somewhere in the villages, responsibility of two
sub centre areas when the other is on leave or post not filled, travel-difficulties
etc. Generally this should not happen. If nurse didi regularly misses scheduled
days, then ASHA should take up this with Panchayat members. The Anganwadi
behen should slowly learn to do essential tasks in MCH clinics to carry the day
in her absence. ASHA can help her.
|g|l
12
Ki
or VAI.
Lesson Plan
2 Topics
Venue & time
Dais Work,
Skilled Birth
Attendant
Classroom or in Interview,
Dai-ma’s house discussion,
(1 hr) or at the
kit-demo
house of a recent
childbirth. Can be
done in evening
(Ihr)
ftfnciple method _ Equipment
Dai-kit, DD kit
- Suggestions
LetASHAs
handle the
discussion,
help and add
when necessary
Keywords
: Homebirth, referral, dangers, Nursedidi, ANC, dai kit, DD kit, six cleans
(hands, place, cloth, blade, thread, perineal region), newborn care.
Exercise
: Recall the six cleans, the risks-dangers in childbirth.
Assignment : Attend a childbirth in the village with the Dai-ma.
Activities
■
Talk about the learning objectives of this lesson
■
Ask if they have met the village Dai? Ask about what she can do? How
many dais are in their villages? Are new girls joining Dais? Is she a paid
servant?
r*
■y
VILLAGE BIRTH ATTENDANT OR DAI ; 39 )
Introduce a trained Dai to the group. Dai should be in position to explain as
a
how she comes in contact with pregnant women and conduct deliveries. Use
this opportunity to highlight the purpose of training programmes for Dais
Let ASHAs aiso know, is done by Dai in case they come across complicated cases
a
at home. Do they accompany women in difficult labour to hospitals? How are
they treated in the hospitals?
a
Ask Dai to demonstrate contents of DD Kits
a
Explain exercise?
a
Explain assignment?
Think about this:
Childbirth looks a simple matter; anybody can do it. Nothing can
go wrong
This is what some women may tell you. Any childbirth can turn difficult and it is not
possible to predict in many cases. It can harm the mother or the baby or both, even
take a life. A skilled birth attendant is a well-trained nurse/doctor who can handle
emergency situations during labour and reach the CHC/hospital in good time. It is
better that she supervises the birth.
Old women say they never bothered about childbirth in the past
That was then. They have survived childbirths, but others have died in the process
and are not here to say how they died. Sometimes the mother-in-law does not want
to ‘pamper’ her daughter-in-law and so she says this to avoid expenses. But stories
still repeat if you look for. In every 1000 childbirths, 5-6 women may be dying just
before or after childbirth. You may not appreciate this as in a village there may not
be a maternal death each year or even in two/three years. In backward districts with
difficult roads, more die. Add many more stillbirths and newborn deaths to this. And
consider the health hazards due to difficult childbirth-blood loss, infection and
fever, womb-drop (prolapsed uterus), tears and inversion of uterus, damage to the
baby (fits, even mental retardation) and sepsis.
In some villages dais are considered as doing "dirty work"
Yes, some people consider it dirty work. In some villages, dai-ma is expected to just
clean up the place and dispose of the placenta and the actual care is done by family
women. The unfortunate caste system is linked with this ‘dirty work'. However
childbirth is not dirty work, but great event of the arrival of a new life on earth.
( 40) ASHA: FACILITATORS' GUIDE
We have now fewer dais in the village
New dais are not replacing old dais so often. In some villages therefore there are no
dais to talk of. In 20-30 years dais may be an outdated system. This is because many
families take the mother to a nearby hospital or call the nurse didi. The skills of Dai
are limited even after training. She can not use certain drugs which can be life
saving. For the family and the mother this is a difficult situation and often
dangerous. It is good if people resort to skilled birth attendants or better still to go
to good hospitals. Yet, so long we do not have enough birthing facilities and help,
Dais are here to stay and we must help in what they are doing. Dais should also
change their mindset for promoting safer hospital birth and use the JS Yojana to
everybody's advantage.
-
1
Lesson Plan
Topics
Venue 8rtime
Principle method
Causes of
illnesses
Classroom
Discussion
Immunity and
healing
Classroom
(Ihr)
Keywords
(1 hr)
Equipment
Suggestions
Let ASHA
narrate their
own experience
Picture-based
discussion, reflection
on personal
experiences
: Illnesses, causes - germs, microscope, water, sanitation, nutrition, injury,
pollution, unsafe sex, addictions, immunity, healing, insects-vectors.
Exercise
: Reflect on the illnesses your family/neighbours had in the last year, and
think of causes and how they healed.
Assignment : Follow five illnesses in the village, understand the causes and healing sequence.
Activities
■
Talk about learning objectives
.
Start the lesson with experiences of illness - 5-6 ASHAs (their families) having
illnesses in last one month
■
&
Discuss the causes of illnesses, in villages
42
ASHA: FACILITATORS’ GUIDE
■
Talk more about germs and worms as causes for some common illnesses
■
Discuss the multi-factorial causation
■
Discuss healing-how wounds and illnesses heal up
■
Discuss illnesses and immunity/body defence systems
■
Recap by keywords
■
Explain the exercise
■
Explain the assignments
Think about this:
How can we increase our resistance to illnesses so that we not fall ill?
Adequate and balanced diet, good habits like exercise and personal hygiene
practices, healthy living environment, positive attitude are necessary for building
resistance to illnesses. Timely immunization is important for strengthening the
body’s defence systems.
Why do we not see small pox these days?
Smallpox was a viral (very minute germs) illness. It vanished from the universe due
to a widespread and effective vaccine, the global campaign of vaccination and close
watch on virus. Several programmes are underway to eliminate some other diseases
such as Polio.
Do you come across hydrophobia patient in your village? Why are
people so afraid of a dog bite?
Dog bites are common. Hydrophobia is not so common and every dog bite does not
give rabies. We see it sometimes and in some villages. Yet people are afraid of dog
bite, as it can be the fatal rabies illness. Rabies has no cure except that timely after
vaccine may save cases before the germs reach the brain. These days highly
effective vaccines are available which need not be given in the abdominal wall, as
was the case with the conventional vaccines.
-I
14
■
Lesson Plan
-Suggestions
Topics
Venue & time
Principte_method
Equipment/
Healing
systems
Classroom (1 hr)
Discussion by
examples
Take examples
Medicines of
of local doctors
3-4 typesAllopathic, ISM, with different
pathies
homoeopath
Medicines
Classroom (1 hr)
Show drugs in the
kit one by one.
Discuss from book
Kit with
medicines
Keywords
: Allopathic, Ayurveda, Siddha, Unani, homoeopathy, non-drug healing,
side effects. Rational use medicines, injection, tonics, saline, anti-biotic,
costs, home remedies, self-medication.
Exercise
: Visit the pharmacy of the PHC/CHC.___________________
Assignment : Do a small survey of 10 households for unused medicines, list illnesses
for what the medicines were used, estimate costs.
Activities
■
Explain the learning objectives
■
Start the session with what they know. Allopathic (Angreji dava), Ayurveda,
Unani and homoeopathy etc. Can we heal some illnesses without medicines?
1
■
Explain the various healing systems in brief
■
Talk about overuse of injections, saline bottles, tonics and expenses
44
ASHA: FACILITATORS’ GUIDE
■
Take a break
■
Talk about misconceptions and questions listed
■
Recap using keywords
■
Explain the exercise
■
Explain the assignment
Think about this:
injection and saline are a must for cure
This is a myth spread by some drug companies and profit-seeking doctors. No
medicine/book ever carries such a message. In the last 10 years, most medicines are
available for oral use and they are very effective. Injections work in 2-5 minutes
while oral drugs may take little longer time for starting action. Some times
injections are also needed. Saline is just water with some salt and glucose. Village
people loose money in medicare mainly because of abuse of injections and saline
and tonics. We need to educate people about this.
Children need tonics for curing weakness
This is the most popular but wrong belief. Many parents from urban and rural India,
keeps on insisting that their children be prescribed tonics. No child needs tonics, but
every child needs good nutrition with calories, proteins, vitamins, and minerals. Diet
gives this all amply and no tonic, howsoever costly, can give these enough. Tonics
are needless exploitation and should be avoided. Tonics are not substitutes for
balanced diet.
There is a pill or injection for every illness
We have learnt from childhood that an injection or pill is necessary for the cure of
any illness. That is not true. Only some illnesses need such cures. Some illnesses
can be corrected by diet, some by specific exercises. Yoga, massage, acupressure
can help in some illnesses. Some illnesses will heal by themselves without doing
anything-cold for instance. There is a very popular saying, "If you take medicines,
cold will go away in one week, otherwise it will go in seven days". Some people
never take any medicines. But we should not be faddists. Use medicines with
scientific caution and care.
J
■
-1%
Lesson Plan
Principfe method
Topics
Venue
& time
—
Medicinal
plants
Classroom (1 hr) Discussion
and surroundings
Home
remedies
Classroom (1 hr)
Keywords
Equipment
Suggestions
-
Demo and discussion Bring the listed Do a free listing
home remedies of common
home remedies
: Ayurveda, tridosha, dincharya, ritucharya, swasthavritta, neem, tulsi,
kumari, adusa, kuda. Kadha, neem-tail, hadli, triphala, oil massage,
mulethi, aamla, lemon, honey, gulkand.
Exercise
: List the common medicinal plants-trees in the neighbourhood.
Assignment : Identify home remedies practioners in your village. What kinds of
remedies do they use?
Activities
■
Explain the learning objectives
■
Start the session with a case story - how when access to doctors is difficult,
families use home remedies. It can save money, time and often going to doctor
may be unnecessary (for example for wound care, common cold etc). Ask what
they do at home themselves. Ask them if they had any experience with home
remedies in their homes or in neighbourhood?
i
46
ASHA: FACILITATORS’ GUIDE
■
Explain the common medicinal plants as given in book 1. (Encourages ASHAs to
add to the list of medicinal plants)
■
Take a break
Discuss use of select home remedies
■
Talk of questions listed
■
Recap using keywords
■
Explain the exercise
■
Explain the assignment
Think about this:
Herbal remedies are for poor people
Herbal remedies are for all. Gradually there is recognition of the benefits of herbal
remedies. Even in the western countries, people are looking for herbal cures. If poor
people are using a herbal remedy, it is indeed good as it will save them some costs.
There are some NGOs working with herbal medicine practitioners. However, we
should popularize the use of herbal and home remedies in all sections of society.
Herbal remedies take long time to act
Not necessarily. It depends upon the illness, its duration and chosen remedy. Some
may act even quicker, like Haldi or Kumari for wounds.
For herbal treatment, you have to observe many apathyas (food not
allowed) and pothyas (food allowed)
For external herbal remedies the pothya apathya is not very important. However, for
any Ayurvedic way of healing we need to follow some rules of health-d/nc/iarya,
ritucharya, and dosha-vicahara. People already know some rules—like getting up
early helps bowel movements. Many people note the food rules by experience. For
example, chana increases gases or constipation or spices increase pitta.
r
Preventing Wn^z^nte^
Pre^incies
Lesson Plan
Topics
Venue & time " Principle method
Abortions,
unmet,
contraceptive
Classroom
(2hrs)
needs
Keywords
"Equipment
Demo and
discussion, self
reflection/
experience sharing
Suggestions
Condom, IUD,
OP, uterus
model
: Early marriage, teenage pregnancy, abortion, MTP, contraceptive,
spacing, unmet need, Condom, IUD, Oral pill, choice of method.
: Discuss experiences amongst yourselves about abortions and spacing.
Exercise
Assignment : Interview 10 eligible families about how they are spacing pregnancies
and how they got access to the methods.
Activities
■
Explain the learning objectives
■
Start with real life experiences when someone wants to prevent a pregnancy
but has no help
I
■
Explain how repeated abortions can harm women’s health
■
Explain the various ways of spacing and benefits
■
Talk about misconceptions and questions listed
48 } ASHA: FACILITATORS' GUIDE
■
Recap using keywords
■
Explain the exercise
■
Explain the assignment
Ii
Think about this:
Abortion is good family planning method
Abortion is NOT a family planning method and it is not to be used as one. Abortion
is for ending an ongoing unwanted early pregnancy; and contraceptive methods are
for preventing a pregnancy. Family planning methods are safe; abortion may be
risky in certain situations. Family planning is low cost or has no cost; abortion may
be expensive in private. However, people may still need access to safe abortion
services as there are failures also with contraceptives.
Decision about family planning method should be left with the nurse
d/di/doctor
No, the acceptor should decide and choose. The ASHAs, ANMs and doctor should give
them all the information about contraceptives and the pros and cons, and help the
acceptor to choose the method most appropriate for the individual/couple.
If the couples decide about the method then it is likely to be used for longer duration.
I
Government should give money for those accepting sterilization
Incentives do no good. Incentives also distort the choice of method as for some
money they may choose a method, which may not be of their liking. In the past,
incentives created bad practice and imbalance between spacing and terminal
methods. Often it led to malpractices. The couples and individuals should be
empowered to make their own informed choices about the method they would like
to use. We should empower them to make a decision.
k
1
17
Co^da^s-.
-for kiA^n
Lesson Plan
Topics
\/eriue-& time ' Principte method
Classroom,
Condom.
(Ihrs)
Correct and
consistent
use of condom
Keywords
Exercise
Demo and
discussion
Equipment
Suggestions
Condom, a raw
banana as
penis model
Respect the
sensitivities of
women
: Male condom, erect penis, teat, spill, spacing, HIV-STI prevention, sex
pleasure, promiscuity, female condom, spermicidal.
: Check expiry date, break open a condom pack and use it on a banana,
proper disposal.________________
Assignment : Counsel 2-3 women/couples about using condoms for contraception.
Activities
i
■
Explain the learning objectives
.
Start the session with what they know about condoms
■
Explain the right way of using condoms
■
Talk about uses of condoms-in unsafe period (and unsafe sex.)
■
Discuss different sources from where condoms can be obtained
■
Talk about misconceptions and questions listed
• 50 ) ASHA: FACILITATORS’ GUIDE
■
Recap using keywords
a
Explain ihe exercise
■
Explain the assignment
Think about this:
Free condoms are not of "good'’ quality
Government's free condoms are of the best quality and as per the standards laid
down. There are several checks conducted for quality of condoms before these are
released for use. Condoms available in shops are also good but have some extra
attractions like grainy surface, lubrication etc.
Nurse didi always talks about sterilizations of women
She should talk also about spacing methods, condom and other options. In the
changing situations of HIV AIDS epidemic, we have condom to halt the spread of
the illness in unsafe sex, as condoms offers protection from unwanted pregnancy
z. and sexually transmitted infections including HIV/AIDS. Information about all
available methods should be shared.
Men can’t use condoms properly under the influence of alcohol
This may be somewhat true depending upon the state of drunkenness. The woman
partner can however, insist and help him put on the condom. Women should be able
to negotiate use of condoms. Availability of female condoms will also help women
in such situations.
Fl
18
£
ifli
Lesson Plan
Topics
Risks during
pregnancy,
Why
registration
Keywords
Venue & time-
Principle method - I Equipment
Classroom + ANC Discussion
clinic at PHC
or AW centre
Use of
experiential
reflection may
help to
internalize
Flip chart,
ANC cards
(2 hr)
: Risks in pregnancy, childbirth, early registration, ANC card, AW centre,
MCH day.
Exercise
Suggestions
__________________
: Discussion points learnt in the classroom and ANC clinic.
Assignment : Study 2 ANC cards in the village, and interview the pregnant mothers.
Attend the ANC clinic and learn checking-eyes, tongue, breasts,
abdomen, feet, and the usual complaints.
Activities
■
Explain the learning objectives
■
Explain the possible risks in pregnancy and the importance of regular ANC. Use
flip chart/pictures. It is important to emphasize that each pregnancy carries
some risk
■
Highlight why it is important to register early during’pregnancy
■
Take a break and visit the ANC clinic
£££
L
\ I O
10VJ0
BA
52
ASHA: FACILITATORS’ GUIDE
■
Show how the nurse didi conducts ANC-in various trimesters, the ANC card
■
Recap using keywords
■
Explain the exercise
■
Explain the assignment
Think about this:
Many women feel that pregnancy check up is a waste of time
No. This is not a waste of time. On the contrary this investment in time is good for
health of mother and baby. Some never register and arrive at the PHC for childbirth
entirely unprepared and with much risk. About half of women take the registration
in 6-7 months. We need time (3-4 months) to take care and treat anaemia, which
is so common. Those who never register or register late, may end up suffering a
complicated childbirth or a weak baby. We should make sure that each pregnant
woman registers early during pregnancy.
Nurse didi does not come in time at centre and women have to wait
quite long
Yes people cannot waif for long as they have other work to do and the family will
not permit them to go the next time if it is late. The nurse didi should take care
about that. If it ever happens, we (ASHA) should start some work like taking
weights, talking about diet to the group, breastfeeding etc. That will save the
nurse didi's time and use the available time productively. If she is coming late
regularly for sessions then ASHAs should talk to her or take up this issue in
Panchayat meetings.
There is no privacy at AWC for abdominal check up
We can arrange for a saree-curtain if there is nothing else to give privacy. Or shift
to a house where some privacy is available. Women feel awkward in absence of
privacy. Both visual and audio privacy is important.
Many women go to private doctor for ANC
If people can afford the expenses, there is nothing wrong in seeking ANC for
qualified private doctors. At many places, women don't mind being examined by
male doctors.
t
Lesson Plan
Equipment
-Suggestions
Topics
- Venue & time
Principle method
Janani
Suraksha
Yojana,
Your role
The classroom
(1hr)
Discussion
Keywords
: Regular ANC checkup, childbirth, eligibility. BPL, above 19 yrs, Referral,
May encourage
ASHA to
share their
experiences of
getting benefits
under National
Maternity
Benefit
Scheme
hospital birth, transport costs, cash assistance, Panchayats.
Exercise
: Role play on common problems as why women don't go for
institutional deliveries?
Assignment : Motivate two ANC women in the village to use JSY facility.
A-
Activities
■
Explain the learning objectives
■
Start the discussion with any real story the group may have heard about,
difficulties families face while taking a mother with difficult childbirth to
a hospital
i
54
ASHA: FACILITATORS' GUIDE
■
Explain the scheme JSY-criteria, how to get help
■
Discuss the questions and answers when appropriate
■
Recap using keywords
■
Explain the exercise. Facilitators encourage ASHAs for a role play
■
Explain the assignment
Think about this:
Men usually run away when blood is required to be given to women
during delivery through operation
Blood donation, they think, weakens them. They start telling many reasons
why they can't donate and will pay for a bottle. The stated reasons are hollow
in most cases. One should not donate blood only if: the person is younger
than 16, above 50, has had jaundice, typhoid, HIV, AIDS, anaemia (less than
12gm) or any serious chronic illness like TB, cancer etc. Giving blood
is harmless. The 250 ml blood is replaced in 2-3 weeks time and is only 5%
of total blood volume in the body. As ASHA, you should explain the benefits
of blood donation to save someone's life, who may die in the process of
giving birth if blood was not made available in time. As they say "blood
donation is great donation” "Rakta dan Maha dan". Blood may also be required
for accident victims.
In hospital, employees demand money from delivery cases
Unfortunately, some government workers have these bad habits and they
especially exploit poor women First we should ask them if they can give us the
receipts of the money being asked. In case any money is to be paid officially
insist on a rate card or try to find out what are the official charges. Generally
user charges are exempted for the poor. Even if they insist on money inform
the MO in charge of the hospital about it. Nobody can take cash without a
receipt in any Govt hospital. With sustained public pressure this malpractice
will stop. You can also inform the Rogi Kalyan Samiti (advisory board) about
the grievance.
Remember your neglecting or ignoring this problem will make the next visiting
family's life difficult. Someone has to begin and start saying NO to such
unauthorized patients. Many times we are also responsible for promoting such
unauthorized payments.
JANANI SURAKSHA YOJANA (JSY)
Many poor families don't have a BPL card, while others who are well off
take advantage of BPL benefits
Unfortunately one comes across such situations quite often. We must make efforts
to get poor and deserving families registered for BPl benefits. The Panchayats
should be alert to this and gram sabha also should discuss about making these cards
available for genuine families. Poor people face enormous difficulties for years if
they have to pay for medical services by way of leans or stress sales of land, goats,
bulls etc.
Can women go to private hospitals and are they also entitled for benefits
under this scheme?
JSY is applicable for even private hospitals. The hospital must be registered with
the health dept, for this. What we need to do is get a certificate from the hospital
about the childbirth. It is possible that private hospitals may ask for money in
excess of what has been given in JSY. In such cases families should be ready to
give extra money. It is always advisable to collect receipts for money paid
to the hospital.
I •
I
i
HIV
.AIDS
I
Lesson Plan
Topics
Venue-& time.
Principle method
L Equipment
HIV
Transmission,
Prevention
Classroom (1 hr)
Pictorial discussion
Flip chart if
available
Keywords
Suggestions
: HIV, AIDS, unprotected sex, blood, womb-transmission, needles, women
more vulnerable, window period, safe behaviour, condoms, female
condom, adolescent health education.
: Discuss if compulsory HIV test for boys/girls before marriage.
Exercise
Assignment : In a meeting of SHGs, discuss how women are more vulnerable to get
HIV/AIDS infection and what can be done.
Activities
■
Explain the learning objectives
■
Start the discussion with any real AIDS case the group may have heard of (Or you
keep one usual story ready-the driver/worker -Mumbai connection-bringing back
infection-woman gets it-the new baby-they get ANC check up and HIV test)
■
Explain the causes of how one gets it, social situations behind the infection
■
Talk about how HIV is not transmitted
■
Explain how the illness shows up-symptoms and signs-use pictures
■
Use the questions for discussions
HIV AND AIDS
■
’How to prevent HIV-AIDS, mention new ways of treatment
■
Explain the issue of confidentiality when dealing with any AIDS patient or HIV
positive individual
■
Recap using keywords
■
Explain the exercise
■
Explain the assignment after the learning camp
i
Think about this:
Prevention is better than cure. HIV and AIDS is an example
Many illnesses are best prevented, and are difficult to cure. Small pox was an
example. Polio is another. It is cheaper to prevent some illnesses than to cure them.
HIV and AIDS have no permanent cure so far, no vaccine either. Safe sex practices,
safe blood transfusion, avoiding intravenous use of addictive drugs are the major
preventive measures we have.
Should HIV test be made compulsory before every marriage?
Compulsory testing is not a good idea and also it is really difficult to implement.
First there is this window period wherein we can get negative test. If it is made
compulsory, some people who suspect themselves to be positive may go
underground or resort to corrupt practices to escape the test. It is also possible that
I
I
those identified positive on testing are discriminated against and stigmatized. The
risk of unsafe sex remains the same even after marriage unless the person thinks,
knows, and behaves safely and responsibly. Pre-marriage counselling, along with
voluntary testing may be helpful.
People in city only indulge in having sex with multiple partners
This is not correct. Many villagers migrate to cities for work, and keep revisiting
I
their families in the countryside. In the villages also, pre-marriage and extra
marital sex is not uncommon. Whether village or city, people should avoid risky
sexual behaviour.
I
I
i
57
Lesson Plan
Topics
Venue & time-
L Principle method
Breast feeding The ward and
classroom (2hr)
Benefits,
Lactation,
Management
Keywords
Equipment
Demo, followed by Flip chart or
picturised discussion movie CD
Suggestions
Ask for consent
of the
breastfeeding
mother before
demo
: Early BF, one hour, colostrums, immunity, diarrhoea and ARI, nutrition,
milk flow, nipple, position, changing sides, nipple care, sunken nipple,
cracks, nipple care.
Exercise
: Do a group discussion on problems of breastfeeding based on your
own experiences.
Assignment : Observe and advise 2 pregnant mothers and 2 breastfeeding mothers on
correct breast feeding techniques, advise two pregnant women (also their
mothers-in-law) about advantages of initiating breast feeding early.
Activities
■
Explain the learning objectives
■
Start the session with picture of a happy mother breast-feeding a healthy baby
■
Ask and discuss about individual experiences from those who breast-fed their
babies and those who did not (5-10 min).
i
i
BREAST FEEDING ( 59 J
i
■
Explain the benefits of good breast-feeding practices for the baby and mother
s
Explain the correct ways of breast feeding-follow the key words
■
Take a break; take them into the ward with a recent childbirth
■
Show the correct technique-breast feeding basics
■
Explain possible problems of breastfeeding-nipple, swelling
■
Discuss the questions and answers at appropriate time
■
Recap with help of keywords
■
Explain the exercise
■
Explain the assignments
Think about this:
Often a baby is breastfed only after the third day. This starves the baby
and affects the milk flow
This is a very cruel practice to starve the baby of the milk that nature made for it.
The calf takes to the udder of the cow in few minutes and starts jumping around.
Why should human babies be denied the milk? Our society has many misgivings
about the thick breast milk in the first 1-3 days. The milk gives the baby its first
immunity. For the mother, early breast feeding starts the milk flow smoothly. As
soon as possible after delivery the baby should be allowed to breast-feed and
mothers should be encouraged to start breastfeeding.
Pre-lacteal foods are given to many newborn babies. Are these any good?
As a ritual and traditions, prelactal foods are given to the baby. There are
several formula preparations available in the market. They don’t serve any
specific purpose and compromises exclusive breast-feeding. Pre-lacteal feeds
don't serve any purpose. Complementary feeding must start after 6 months,
otherwise the baby gets undernourished. After 1 year, the child must eat what
the adults take.
Many mothers are not sure if her baby is being fed adequately and
hence they resort to top feeding
The best clue to good nutrition is the growth and weight monitoring. Top feeding
should start only after six months but breast feeding must not stop for two years.
Top feeding also may cause infections like diarrhoea. Cleanliness during preparation
of the baby's food is necessary in this regard.
22
In-font Wtrition
Lesson Plan
Topics
Venue & time.
Principle method
Equipment , - Suggestions- ~
Child Feeding
Practices
Classroom (1 hr)
Pictorial discussion
Pictures/flash
cards
If there is any
infant with any
ASHA,
discussions
can be
initiated for
the nutrition
Keywords
: 6 months, complementary, semi-solid, ghee-oil, frequent, hand wash, no
Exercise
market packs, weight.
________________
: Interview parents of 1 infant each in the OPD about feeding practices.
Assignment : Interview feeding practices of 5 infants in the village, tally their weights
on card.
Activities
■
Start the discussion with what ASHAs do for child feeding
■
Ask if the child is normal weight, has any problems in growth. How important
is it to attend to infant nutrition, as in 50 per cent of child deaths, malnutrition
is a contributory factor
■
Explain the learning objectives
I
INFANT NUTRITION { 61
9
Discuss the various good practices in complementary infant feeding after
six months
■
Discuss the questions and answers as they come
9
Discuss what ASHA can do to educate mothers about feeding infants
b
Recap with keywords
9
Explain the exercise
9
Explain the assignment
Think about this:
Many parents give top feed only after the baby is 1 year old
This is incorrect and the cause of faltering growth. A baby needs extra feeds
after six months of exclusive breast-feeding. The top feeds should be gradually
introduced, one at a time. Start with meshed dal, rice, banana, fruit juices, then
porridge etc.
Girl babies get less attention and feeds than male children
Unfortunately this is true in some families. Girl baby also needs the same nutrition
as the boy baby. This is an attitude problem, not a problem of poverty or ignorance.
We treat our daughters as if they are a burden or someone who has to go to her
house" one day. They must be treated equally and we have to talk to families about
this. This practice must be done away with.
Who feeds children when parents go to work?
It is often some old member of the family or the elder girl staying back at home.
Often there may be no one to do this. The child is left to play with a piece of
roti to eat. Anganwadi’s are unable to take care of very young children. The
parents may not be able take the child to work. Then a creche is the only
answer. ASHAs can help in setting up creches at places where several nursing
mothers go to work.
I
IwvwiizzJitic’rt
r
Lesson Plan
l Topics,
Venue &-time-_ Erinciple method
Immunisation The classroom &
PHC/CHC/SC
Benefits,
Immunisation Immunization
clinic (2hrs)
schedule
Discussion with
help of cards
Equipment-
Suggestion^
Pictures of six
illnesses, flip
chart, the
vaccine bottles
Show the cold
chain
equipment
also
clinic, cold chain, complete
Keywords
: BCG, Polio, DPT, Measles,
immunization, booster.
Exercise
: Memorize from the child-card the sequence of immunization and the
MCH
iIInesses they must be protected against.
Assignment : Survey in the neighbourhood about complete immunization of 10
children, between ages of 12-24 months. How many are completely
immunized, how many partially immunized and how many did not
receive any immunization?
Activities
■
Start the discussion with immunization memories of childhood. How many
ASHAs had mark of small pox vaccination on forearm or upper arm?
■
Ask if they have got BCG scar-how many do not have scar, why? What could
be the ill effects of no BCG immunization?
■
Explain the learning objectives
.
I
i
IMMUNIZATION
■
Discuss six major illnesses (Diptheria, Pertussis, Tetanus, TB, Polio, Measles)
■
Take a break and shift to the Immunization clinic
■
Discuss the schedules, show child card. Discuss the methods, problems
women have
■
Discuss the questions and answers as they come
■
Discuss what ASHA can do to increase immunization in the village
■
Recap with keywords
■
Explain the exercise
■
Explain the assignment
Think about this:
People feel that quality of vaccines offered in villages is not good
This is not true. The vaccines are of standard quality through public system facilities
and campaigns. These need to be stored/transported in a cold environment.
Sometimes we value something we pay for and hence consider a private doctor’s
vaccines more valuable.
Some people feel that despite complete immunization children get Polio?
Unfortunately polio-like illnesses may strike even if the baby is completely
immunized. In rare cases the baby is immunized but proper cold chain may not
be maintained, making the polio vaccine ineffective. All such children need to
be investigated.
63
I
Lesson Plan
Principle “method
Topics
Venue & time
Diarrhoea
symptoms,
Causes,
Dehydration
ORS
Classroom (2hrs) Pictorial discussion
plus demo on ORS
•—
Equipment
I
■_ 1
Suggestions
1__1Z
ORS packs,
bottle, spoon,
open a bottle
of DNS saline
for taste
Encourage
ASHAs to come
out with a list
of common
Home Available
Fluids that
can be used
Keywords
: Loose motions, dehydration, mild-moderate-severe dehydration, cause of
death, rehydration, ORS, HAF, skin fold, tongue, thirst, sunken eyes, talufontanel, urine, sleepy, floppy, referral to PHC-CHC, saline, no injection.
Exercise
: List HAF available in your home/village.
______________
Assignment : Find out how many families know about diarrhea treatment—ORS,
HAF, referral.
Activities
■
Start the discussion with a picture story/flip chart on loose motions
■
Ask the participants about personal and family experiences. How common is
childhood diarrhoea in villages?
■
Explain the learning objectives
DIARRHOEA ( 65 )
E
Discuss signs of dehydration and what causes deaths in diarrhoea
a
Take a break
a
Discuss HAF avai’nble in the community and are these used in diarrhoea; do
mothers stop feeding babies suffering from diarrhoea?
Demo ORS, compare with Saline taste
E
When to refer and where to refer
Discuss questions and answers as appropriate points as they come
■
Recap on key words
Think about this:
By knowing how to prevent diarrhoea and dehydration, you can save
children’s death
Yes you can do a great job of saving a child by simple ORS treatment. Diarrhoea
mortality is less in the country thanks to ORS; HAF practices and continued feeding.
It was thought once that only doctors could save babies.
Each child with diarrhoea needs saline bottles. Do you agree/
A saline bottle is necessary only for severe dehydration-sunken eyes, sleepy or
floppy baby, and skin fold staying for long. Refer such a baby for PHC-CHC.
Saline treatment is not necessary for every baby. Most dehydrations can be
managed by ORS.
How can houseflies transmit germs of diarrhoea?
Indeed difficult to believe. The small bristles on the tiny legs of a housefly carry
thousands of germs from spoilt food; faeces etc. when they sit on our food or on
child’s unclean mouth or hands, and the germs enter and cause infection. Few
germs are enough to start an illness that can threaten the baby’s life.
Young children put every thing inside the mouth and this leads
to diarrhoea
The baby has an oral stage in its development wherein every object/toys are put in
the mouth. If the objects are not clean, germs may get in its gut and start an illness.
Parents need to take care constantly.
Lesson Plan
I Principle method
Topics
Venue & time
Aches,
Remedies
Classroom, (1 hr) Participatory
discussion, use
pictures
Equipment
None
- Suggestions
Bring out life
experiences of
participants
Keywords
: Ache, pain, head, body, back, abdomen, cutting, burning, pricking,
stabbing, writhing, twisting, squeezing, throbbing, splitting, bursting,
dragging types of pain.
_
Exercise
: Write down from memory the type pf pains you felt in your life. What did
you do?
___ ___________
Assignment : None
Activities
■
Explain the learning objectives
■
Ask them which are the most sought after and sold medicines in the world?
Painkillers of various types. Allow them to name some common painkillers
■
Recount types and sites of pain from the participants—mark them on the body
map/black board
■
Explain briefly why pains occur
f
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I
5
Lesson Plan
Topics
Venue_& time
Classroom, TB
Early Detection, clinic (2 hrs)
TB,
DOTS
Keywords
Principle method.
Equipment
Pictorial discussion, Sputum test
slides , DOTS
demo by Lab
packs
Technicians
Suggestions
Use of
reflective
experiences
: Germs, air spread, BCG, immunity, nutrition, early detection, weight loss,
appetite, blood-spit, cough >3 wks, evening fever, sputum test, X-ray,
DOTs, AIDS._____________________-
Exercise
: None
;
;•
_
Assignment : Interview two TB patients in your village about their opinion and
problems, if any, on DOTS treatment. (Take prior consent)
Activities
■
Start the session with introduction to TB, with pictures and keywords
■
Ask them if any of their known relatives/friends are suffering from TB; let them
explain what problems they have. Discuss how it hurts the entire family
incomes, suffering, social problems if any
■
Work out how many TB patients are expected in the village (population 500,
1000, 2000 etc)
■
Talk of learning objectives
TB ( 69 ;
■
Talk of how to detect TB
■
Take a break, go to the TB clinic/OPD/Lab. Let LT make a demo on
sputum examination
■
Show how TB patients should take DOTS
■
Let them discuss with 2-3 patients about the experience and any
problems (assignment).
■
Discuss how ASHA can work as primary provider for TB in the village
■
Recap by keywords
Think about this:
Some people say TB is an incurable disease
It is completely untrue. Now it is completely and quickly curable. We need regular
treatment for six months. It is a great victory over a dangerous illness. It is like any
other common disease, which can be cured.
TB patients must eat eggs every day to recover
Not necessary, if they can that is fine. If they can t, enough of rice-do/ is just as
good. If the patient is on regular treatment, nutrition will cause weight gain and
that is the clue.
Why some patients of TB stop treatment before completion?
It is strange indeed. The treatment improves the condition rapidly-within 2-3
weeks. The patient starts feeling it is over and it was not TB. This is because the
medicines are too good to believe. However, this is the exact cause of worry. Let no
one give up treatment without completion. That is dangerous for the patient and
also the society. The germs become resistant to these good drugs just because
someone half-killed them with incomplete treatment. ASHAs can play a major role
in preventing dropouts.
Why patients go to private doctors though government gives
free treatment?
People like to be treated well and sometimes believe that quality is good in
private clinics, which is not always true. But the major reason for going to private
better. In reality the
doctors is the wrong belief that their medicines are always
;
government doctors give standard drugs for TB.
27
A few
Lesson Plan
1 Venue & time
Topics
Classroom, or
veranda (2hrs) .
Snake bite,.
First aid
measures
Principle method-
- Equipment
Suggestions
Elastic bandage, Make
Demo and
participants
discussion, pictorial stick,
do role play
Keywords
: Snake-bite, poisonous, first aid, reassurance, pressure-bandage,
immobilization, no cuts, no ligature-tourniquets, no temple.
Exercise
: Try it yourself on a friend.
Assignment : Identify village snakes as poisonous or other types.
Activities
■
Start the session with a story about death due to snakebite in a nearby village.
Encourage them to tell 2-3 experiences from their villages (restrict this to
5-10 minutes)
■
Talk of learning objectives
■
Explain them with flip charts or photos about the four poisonous types
of snakes
■
Explain the effects of poison and why it can be fatal
■
Ask what first aid they practice themselves, discuss unreliable or harmful practices
SNAKE BITE
■
Take a 10 min break, and let them break into discussions as happens so often
with such exciting topics
■
Now select a volunteer to act as the victim. Let her lie down in the middle
■
Talk of 2 fang marks as a definite sign, correlate it with the fangs of poisonous
snakes (use pictures)
■
Show the essential techniques step by step—reassurance, pressure bandage on
the whole limb, immobilization with a stick tied on the limb and referral to a
hospital. The total time taken for the pressure-immobilization should not be
more than 5-7 minutes
■
Discuss what if-we do not have elastic bandage (use dhoti/sari/turban), the
harmful practices of ligature, of cutting and bleeding
■
Explain the exercise-do it yourself on the friend (people enjoy this)
■
Explain the assignment
Think about this:
Some people kill every snake they see
Only few snakes are poisonous-just four types. We can identify them easily at
a glance. All snakes do us a favour-they devour rats and save our food. They
bite only if we do not take preventive care- shoes, and a light-source- when
moving in dark.
Snakes remember and identify a person
Impossible, they have a very hazy vision. They have a small brain that cannot
remember a person. Snake reacts only to blurred visual signals or vibrations. It
tracks temperature-signals left by its prey. So never worry that the snake will chase
you and kill. It is a myth from old times, which needs to discarded.
Snakes do take revenge
They can’t remember, so there is no possibility of revenge.
Snakes guard some treasures hidden underground
This is another myth. They have no use for treasures and priceless stones. They
need food and survival like any other animal does. They cannot buy food with
treasure. So it is myth perpetuated by old men and women from ages. Often these
treasures were hidden underground and snakes also stay in holes; so the two have
been put together.
k
71
Lesson Plan
Topics,
Venue & time J Principle method^ _| Equipment
Discussions on Classroom, 1 hr
drugs included
in Dawapeti
Demo, discussion
4 Suggestions
Plastic bottles,
labels
Distribute drugs
in this class
and let them
label drug
bottles
Keywords
: ORS, Chloroquine, Iron tablet, Paracetomol, dose, side effects, how many
times, precautions, stocks. __________________________
Exercise
: Sort and pack medicines, label the packs.
Activities
■
Open the davapeti and show all items, demonstrate the following and ask them
to do it themselves:
■
Check labels of all packs and bottles
■
Check expiry dates and separate any expired medicines
■
Inspect the contents if possible; mark out if any are damaged
■
Count if possible the item units as far as possible, but without opening the
packs (like count the strips etc)
■
Prepare labels and stick them on the bottles if necessary. Keep one dry label
inside the bottle
DAVAPETI f?3 )
■
Read out the instructions given in the lesson, holding each item separately. Ask
if anyone has difficulties and answer them satisfactorily. Explain the following:
■
Conditions for which the medicine is useful as mentioned in the book
■
How to give, how many times, and in what dose
■
When not to give the medicines
■
Side effects if any and what to do if they arise
■
How to keep them safely
■
How to recognize if they are getting damaged
■
How to order the drugs from the PHC/SC
■
Show them how to keep records of the medicine
Drug kit to be used for first learning exposure1
Medicines
Action & use
Dose
Side Effects
Paracetomol
Reduces fever and
pain: useful in fever,
headaches, backaches,
body aches etc
More than 12 years:
1 to 2 tablets 3 to 4
times a day_________
8 to 12 years:
1 tablet 3 to 4 times
a day
4 to 8 years: V2 tablet 3
to 4 times a day
_
Less than 4 years:
V4 tablet 3 to 4 times
a day. Crushed in honey
No side effects.
If too many tablets
taken at one time,
it can cause damage
to liver.
Keep the medicine
away from children.
Should be taken
only after meals.
1 For Ayurvedic and herbal remedies, see section on Ayush
(74) ASHA: FACILITATORS' GUIDE
Annexure
Table: 1
Men
Height
Average
Acceptable
cm
Weight
range
*
Women
Acceptable
Average
weight
range
145
46.0
37-53
148
46.5
37-54
150
39-58
47.0
38-55
152
40-59
48.5
39-57
156
43-62
49.5
39-58
158
55.8
44-64
50.4
40-58
160
57.6
44-65
51.3
41-59
162
58.6
46-66
52.6
42-61
164
59.6
47-67
54.0
43-62
166
60.6
48-69
55.4
44-64
168
61.7
49-71
56.8
45-65
170
63.5
51-73
58.1
45-66
172
65.0
52-74
60.0
46-67
174
66.5
53-75
61.3
48-69
176
68.0
54-77
62.6
49-7
178
69.4
55-79
64.0
51-72
180
71.0
58-80
65.3
52-74
182
72.6
59-82
184
74.2
60-84
186
188
75.8
7Z6
62-86
64-88
190
79.3
66-90
192
81.0
68-93
______ _ __________
(Source: Gupta and Mahajan: Text book of Preventive and Social Medicine 3rd Edition, 2003)
J
’T
ANNEXURE ( 75j
Table: 2
1
Weights indicating overweight and obesity
Women
Men
Height ern
136
139
142
145
148
150
152
156
158
160
162
164
166
168
170
172
174
176
i
<
!
(
(
?
Overweight
64
65
68
70
72
73
74
76
78
80
81
83
85
Obesity
Overweight
Obesity
70
71
74
77
78
79
80
83
85
88
89
90
92
52
54
56
58
59
61
63
64
64
65
67
68
70
72
73
74
76
77
56
59
61
64
65
66
68
70
70
71
73
74
77
78
79
80
83
84
Position: 2589 (2 views)