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A FACILITATOR’S GUIDE ON HOW TO EFFECTIVELY TRAIN FRONTLINE WORKERS ON COUNSELING & IPC SKILLS
An Introduction
This facilitator’s guide has been especially prepared for you. It will help
you teach interpersonal communication and required skill for counseling to the
CMCs.
The guide has three parts—
PART ONE
Reference materials on Interpersonal Communication:
•
What is communication?
•
Behavior change
•
I.P.C.
•
Counseling
•
How to conduct inter personal communication(IPC)
•
How to make mother meeting more effective
•
Facilitation, Facilitator’s qualities, how adults learn, training
methods being used, facilitators role, feedback check list and
evaluation questions
PART TWO
Reference Material on Health Message:
This part contains following information:
•
FAQs on Polio and Answers
•
Vaccine for six fatal diseases
•
Vitamin A
•
Diarrhoea- an example of seasonal disease
PART THREE
Reference Material on Mother-Child health care:
It discusses services and care at following times:
•
During pregnancy
•
During delivery
•
Birth to one month
•
Up til six months
•
Up til one year
•
Up til two years
Activities those are included:
A few activities have been included as here under:
•
Stories
•
Questionnaire
•
Games
How to use this Guide?
This guide has to be used for every CMC. Our objective is that every CMC
learns health messages and uses the information during their IPC. A new CMC
should have basic information. Give them additional information only after they
have taken in the experience of programme. Keeping this in mind, you may use
Part I, and II with new CMCs. When they are mature enough insofar as the
information regarding Polio and routine immunization is concerned, they should
be taught Part III.
How to use activities given in Guide?
•
Narrate the story to CMC first, whenever story is used. Put questions and
ask CMCs to discuss. Render correct information to them after discussion.
•
Ask CMC questions when using questionnaire, listen to her answer and
tell the right answer.
•
When using games, make them play first and then encapsulate results.
Use the guide repeatedly so that messages are repeated. This guide should
be mainly used as a on the job training tool.
PART- 1
The objective of the information given in this section is --1. Enhance understanding of IPC and counseling, and
2. Tips to conduct better IPC and counseling
You will find the following information in this section:
•
What is communication?
•
Behavioral change
•
Inter Personal Communication
•
Counseling
•
How to conduct IPC and counseling?
•
How to make mother meetings more effective?
•
Facilitation, Facilitator’s qualities, how adults learn, training
methods being used, facilitator’s role, feedback checklist and
evaluation questions.
Communication
Talking with one another or reaching out to the other person with one’s
view through any means is communication. It happens as a matter of routine in
our lives. e.g. A child, if hungry cries for her mother and the mother, upon
hearing her cries, feeds her.
There are five links to make communication effective:
•
The child cried to reach her message.
•
Message was carried by voice
•
The mother heard.
•
She reacted
•
The objective of communication fulfilled.
Similarly, when the CMC communicates with the service takers,
communication happens between two or more persons. There are various media
for communication. Viz. voice, signal, expressions, etc. Communication is of two
types:
•
One way
•
Two way
One way
Message giver
Message
Recipients of Message
Two way
Message
Message giver
Message
Recipients of Message
Feedback
Two-way communication is more effective because one person listens
when spoken to by other person and then speaks to let him know that his
message has been understood. Allow listeners to ask questions, watch their
expression and then take forward the communication. Usually, there is some
specific purpose of speaking. The CMC’s is to inform parents effectively, about
Polio & PEI, answer properly after listening to their questions, concerns thoughts
and change behavior. This is known as IPC or counseling.
Behavioral Change:
Worldwide research reveals that people undergo various stages when
they change behavior / attitudes. Come let’s see in how many stages does this
change occur…
Behavioral Change and Related Communication Process
5. Adopts
New
Behavior
•
•
•
.
IPC /
Counseling
useful for
these
Steps
4. Trying to Adopt
new
Behavior
3. Understand need
to adopt new
behavior and
constructive
information
2. benefit and risk of
new behavior
1. Do not know
properly
•
•
•
•
•
•
•
•
•
•
Encourage to
sustain new
behavior
Do not allow
relapse
Find
their
experience
Help people see and
praise its benefits
Encourage to hold
on
Help in problem solving so
that they may adopt.
Encourage
Make resources available
Give complete information and skill
Encourage
Find out what they know / do
Provide basic information
Explain profit and risk
Therefore, IPC / counseling plays vital role in behavior change.
Interpersonal Communication
As we observed above, IPC is all about understanding people’s thought
and doubts, providing information in order to bring about change in behavior.
Come let us see which media can be used for IPC & what are its qualities and
shortcomings?
Media of IPC
•
Person-to-person conversation
•
Making people understand through Flipbooks, pictures
•
Religious programme
•
Local meetings (with clear target groups)
Qualities
•
Direct contact with people and exchange of views
•
Explaining in detail and solving questions and doubts
•
Helping change behavior and retain new behavior
•
Allaying myths and fears
•
Reaching unknown people
•
Reinforcing of faith apropos health worker
•
Recognizing the need of information and providing it
•
Reaching services to people according to their need
Shortcomings
•
Answering personal questions
•
Difficulty in motivating towards people’s health facilities if CMC’s
behavior is not good
•
Information can not reach many people at once
•
Difficulty in carrying forth the message if CMC is not educated / well
trained
Counseling
It is a part of IPC. It is that process, in which two people sit face-to-face,
talk to each other, listen to each other carefully, and help the other take an
important decision through counseling. The other person acts on that advice.
For instance—
When the CMC visits mothers, she first tries to find out whether they are
taking their children for routine immunization. Then she talks to the mother
about immunization and at the same time dispels her fears / wrong beliefs. In
this manner, the CMC reaches the message / service by helping the mother.
The following should be remembered while counseling
•
Speak in easy to follow language
•
Make the mother feel that you care for her child
•
Make the mother feel that she knows her job well
•
Try and empathise with mother
•
Respect the feelings
•
Tell everything honestly. Do not conceal anything
•
Your expressions should be such that the mother feels you are listening
carefully
•
Allow the mother to speak and ask questions
•
Ask such questions the reply to which is detailed; not barely yes or no
•
Repeat what mother says
How to conduct-IPC and Counseling?
There are quite a few doubts regarding Polio amongst the community.
When our CMC speaks to the people in the community, she has to answer many
questions. In this, she sometimes faces problems. Come let us learn through
question and answers what challenges they are faced with and how can they
effect better communication.
Question (1) - How is counseling important in changing people’s negative
response to polio vaccine?
Answer:
People’s behavior towards the vaccine can be changed if their
doubts are addressed. A man doubts a certain thing when he does
not know the truth / facts. Counseling is immensely useful in
such a situation. During counseling, doubts regarding the polio
vaccine should be cleared, facts placed before a person to change
notion. However, prior to giving the message, the cause of one’s
doubts needs to be ascertained. Once the reason is clear, the
reality will have to be presented. A pertinent question that may
arise is- how to detect the reason for doubt? A few tips—
•
Find out about person / family from different sources.
•
Establish rapport with person / family. Talk mostly about
informal issues. Do not start talking about polio
straightaway and move gradually to the bottom of the
issue
•
Use open ended questions
•
Analyze person’s answers and find why did such things
happen?
•
In the end, the message should be related to the doubt, Use
examples to make message more lively so that the person
can connect it with his life.
Come, let us learn through a true story—
A person named Jamir bhai, 70 years, lives in my locality. Whenever the CMC spoke to him
about Polio, he started scolding her and even come to blows. As a result, the CMC started hesitating
to go to his house. One day, the CMC told me about Jamir bhai. I gathered as much information
about him from the CMC and others neighbors and reached his place. I saluted him and sat on the
charpai (cot) next to him. Initially, he appeared worried and kept asking me- who am I? Why I have
come? etc. I told him about my self. Talking about my objective, I said you are an elder of the
community. I want to meet such respected and older persons of the community and learn something
useful. I was passing and felt like talking to you for a while. Jamir bhai said- say what you want to.
Gradually, I started talking about informal issues with him. He narrated many incidents /
experiences from his life.
………….
…from previous page
After speaking to him for an hour, I said- chacha jaan, do you get polio drops administered
to your children or not? He looked at me for a few seconds and answered- no, I did not. I askedwhy? He was quiet again for some time. When asked again, he changed his stance to defiance and
said- ‘I will not do it’. So what? I placated him and asked him not to be agitated. There has to be
some reason. He was in a dodging mood and said that this medicine is being administered only to
Muslims. At that point, in time, I asked CMC to call five Hindu families. Children of all five were
administered the drops. Then, I made my point by saying disease / illness has no relation with
religion.
Jamir Bhai agreed for polio drops and now lends support to the team. This happened because the
principles of counseling were followed.
Question (2) If counseling is an art, can we have a few tips on how to use this
skill effectively during our house-to-house visit?
Answer:
Most certainly, counseling is a skill, which can be perfected by
delivering messages according to the situation and presenting them
well. Keep in mind the following while counseling.
Tips to counsel effectively prior to booth day•
Reinforce relations made during the house-to-house visit. If
you are a new CMC, you should build good relations/
rapport.
•
Behave according to local customs and manner and bring
openness in the interaction.
•
If the family is not comfortable divulging facts, try to lighten
the atmosphere. Give more time and create conducive
atmosphere.
•
If you get to know the reason, tell them about facts in order to
change behavior. Along with it, inform about forthcoming
Booth day, date, place during these visits.
•
Organize mother meeting and censure presence of these- all
those women from families that refuse, who can influence
decision making in the family.
•
Use all awareness and publicity material- poster, elan from
mosque, school contacts, FAQ books etc.
Tips for effective counseling during house-to-house visit—
•
Walk in front when visiting in a team and initiate conversation when you
enter a household
•
Go to (×) houses repeatedly. After building rapport with them, try to find
reason behind their coldness to the service. If you understand the reason,
use a message that strikes the right chord. If that family does not agree
still look for a proper influencer and with the help of the influencer,
explain to clarify doubts. This might be time taking but do not lose
patience. Analyze reasons and provide a reasonable alternative.
•
Use the FAQ book while counseling resistant families during house-tohouse visit.
•
Stay in touch with the resistant families even after they have administered
the dose. Try to present them as examples to the other resistant family in
the neighbour hood.
•
Confidence should show when you present your facts. This will help you
to win the confidence of others.
Question (3) During Counselling, how does one recognize family’s problem
and provide problem based Counselling?
Answer : Whenever you begin communication, ensure that its two way and not
one way only. Keep this in mind and ask open-ended questions.
These will compel others to talk. Always bear in mind the questions
asked during counselling and use them. Gradually the person will
come out with facts, which will give you adequate information
regarding problems.
Come let us understand this with an example:
If a person says that I will not administer the doses because
my child is sick, you should ask as to what is the child suffering
from. For instance, if he says that the child suffering from
Diarrhea, go to the child and ask lovingly as to how many times
has she passed stool. Also, ask whether any preliminary treatment
has been provided, you may give information about ORS. If the
condition is bad, refer the child to a nearby doctor. Similarly,
focus on whatever is the family health problem, as it will help you
win their confidence. Later, the same family will listen to each of
your instructions and accord primacy to your suggestions.
Question (4) What is the importance of booklet- Baaton- Baaton Main
(Yellow booklet)?
Answer:
This booklet is useful while explaining through visuals and
facts. The pictures given in the book make conservation with a
person, easier and the facts given behind these pictures tell us
about the subject. It helps keep the agenda on course and
pictures help reinforce facts as told to people; thus increasing
the possibility of agreement. You will have to develop a habit
of using this book during conversation.
Question (5) How to use this yellow booklet effectively?
Answer: Remember a few tips as hereunder:
• Memorize messages in flipbook thoroughly. This will
make it easy for you to communicate the message.
• Welcome people before you begin presentation. Your eyes
should be on every one. Look with confidence; praise them
for taking regular doses of OPV.
• Explain the objective of flipbook. Also, tell them how much
time it will take.
• Keep the pictures towards people and written page
towards self.
• Point out pictures with your fingers
• From time to time, you should encourage them to ask
questions so that you learn their fears and beliefs.
• Invite suggestions and comments in the end. Listen
patiently if a person is narrating real life incident. Do not
interrupt.
• Note the question that you are unable to answer and say
that you will consult an expert and get back.
•
•
Question (6).
Answer
•
•
•
•
Do not insult anyone because of religion, caste / language.
Use local reference points while conversing, so that people
can connect.
How to initiate discussion on impotency and deliver logical
message?
Usually, it is observed that the CMC hesitates in talking about
these issues, giving rise to suspicion in a person’s mind.
Therefore, bear in mind a few important points:
Who has fear and myth- the women member of family or the
male? If it is a female, she should be spoken in privacy and
in a conducive atmosphere. If it is a male, try to keep a male
associate and then speak to him.
Let the other person speak first. You try and decipher what
could be root cause.
Reply with confidence and maintain eye conduct. Give
proper reply and back it up with examples. E.g. say that if
the government wants to turn every one impotent through
this medicine, would it not have first administered it to
adults, rather than the children. The results with children
will be long term while they will show quickly in adults.
Another, logic is that the government could have saved a lot
of money by mixing the medicine with food items. Also, had
medicine been flawed, countries like Saudi Arabia,
Bangladesh etc would not have used it successfully to wipe
out polio. The medicine has been used for the last 40 years
and has proved its efficacy in wiping out Polio from 209
countries.
Present the teachings of Islam and appeals—
a) It is enough for a person to be untruthful that he
narrates whatever he hears. (Muslim, Muguadme
Hadis-6)
b) ‘O People’ if a prankster comes to you with news, you
must verify’. (Hajrat-6)
•
After discussion, obtain permission and administer medicine
immediately.
Question (7) What preplanned efforts are necessary to allay fears regarding
impotency amongst religious leaders / associates?
Answer :
Religious leaders enjoy the confidence of people as idols.
Therefore, we should clear their doubts first. Give the same
logic (as on last page) on impotency amongst associates. In
addition, make some pre-planned moves. e.g.
• The objective of associating religious leaders is to mobilize
popular support and make people follow. That is why it is
essential for CMC to reach influencers and inform them
correctly.
• Whenever meeting religious leaders / associates, invite SMO
/ NPSP or expert doctor. Through them, you may allay their
fears and inform about technical aspects of vaccine.
• Introduce SMNet districts, sub regions and state level
officials as well as external visitor and help eliminate fears.
• If a leader has appealed through newspaper etc. keep, it as
an example
• Introduce influencers to MOIC, DIO, CMO, DM etc. to
reinforce the belief that this program is a joint exercise.
• Build the relationship with associates based on trust. Be
open and share facts. Go with them during local festivals.
Question (8)
Answer:
How to obtain the assistance of local influencers in making
resistant families accept?
You should remember that the local associates are not your
subordinate who will do what you say. Their co-operation will
depend solely on the rapport that you have formed. This will
become possible if you share all your problems and ask for help.
You will have to take concrete steps, like;
•
•
•
•
•
Ensure their participation from the resource/ area map
formation stage itself.
Keep meeting them during festivals etc so that they do not
feel that you come there only for work.
Go to them during their free hours. Do not waste their
time.
Make them understand the difference between truth and
illusion. Share the problems of the area and present state of
polio. Also, remind them of their vital role so that they are
mentally prepared.
Today, the biggest challenge is to sustain influencers
interest. For this, it is necessary to give them space in the
program. e.g. Inauguration and conclusion of the Booth
day, prize distribution among the children of bulawa toli,
interface meetings etc. you can also give them certificate of
participation signed by DM or CMO.
•
Question (9)
Answer:
Do not forget to thank them for their assistance. Never
negate their importance.
How to make mother’s meet effective?
In order to fulfill the objective of our program, it is CMC’s
responsibility to organise mother’s meet especially for
mothers of up to 5 years children. Hereunder are a few tips to
make these meets a success:
Preparing for Meeting
•
•
•
•
•
Choose neighbourhood homes, which have under 5 children.
Give priority to houses in slums.
Select date, place and time (according to women’s
convenience) and place, Remember, the time should not be too
long. If there is female village head, include her.
Choose clear subject for the meeting.
Invite women
CMC should keep a prepared agenda
Important points for effective meeting
•
•
•
•
•
•
•
•
•
•
•
•
Welcome women in the meeting
Introduce your self as well as others
Ask about their welfare before coming to the subject
Talk a little about their routine & connect it to childcare. Then
tell them the day’s subject
Find out what they know about the subject
Ensure entire group’s participation. Let every one speak
Encourage experience sharing on relevant issues
Repeat discussion and disseminate information. Use story /
case study.
Ask open ended question and ensure that they know
Repeat main points with their help
Encourage them to share this information with others
Thank everyone and conclude
Note: Detailed information regarding Mother’s Meeting is
included in the section-2 (Diarrhoea).
FACILITATION
The action which removes (obstacles to make work easier) is called
facilitation. e.g. A cycle needs regular greasing in order to run smoothly. Grease
is the facilitator. Facilitation is an art, in order to perform which, skill is required.
This skill can be acquired through practice and experience. The one who
facilitates is called facilitator. Just like the grease that works as facilitator in case
of cycle. Our programme has two facilitators;
•
You are the principal facilitator insofar as the development of CMC skills
is concerned, and
•
The CMC also plays the role of facilitator so far as helping reach health
services in the community.
Under the programme you are a principal facilitator and you have to guide the
CMC from time to time. Therefore, the present context is about the qualities of
facilitators, training process for guidance of CMC and the role of facilitator. This
will help you in carrying out your job.
QUALITIES OF A FACILITATOR
Skilled Communication
One who puts forth clearly what he
wants to say and other should
understand it clearly
Patience to listen
Listening properly to stake holders
Soft spoken
There should be no aggression in
conversation.
Mild spoken
There should be no aggression in
conversation.
Cautious towards group behavior
Tolerant
Even if the participants say something
unreasonable or behave defiantly,
solve it quietly.
Some one who encourages others
Some one who inspires others
It is important for a good facilitator to
know how adults learn
How adults learn?
One of the big questions for the trainers is how to reach adult learners. A
whole lot of obstacles and failure have been faced during training adults and
developing their skills. One often gets to hear these adults cannot ever change,
cannot develop, and should thus be left alone. But adults do learn develop and
eventually change for the better. Despite this fact, many of us believe that adult
cannot learn and that the learning capacity of children is higher.
However it is important here that adults are trained and children are
taught. There is a huge difference between the two. A few helpful points and
obstacles are listed below and should be kept in mind while training adults.
Helpful points while training adults;
•
Adults seek new information according to need.
•
Adults learn only what is of interest to them.
•
Adults are participants in the process of learning-participatory method
help them learn and retain better.
•
Adults learn more effectively when learning is centered around their
experience.
•
There should be a respectful atmosphere while adults are learning.
•
There should be no hesitation, fear or tension.
•
When adults deduce according to their experience, they are able to use it
better while taking decisions later.
In the end, it is important to note that a facilitator should also keep in mind the
physical aspect of training:
•
All logistical arrangement (food, travel, etc) should be fine-tuned to avoid
worry.
•
Minor details like cleanliness within learning premises, advance
preparation for technical requirements/ infrastructure, arrangement of
small rooms for group work cutting noise and avoiding the entry and exit
of too many people are important; so that trainees are not disturbed.
Obstacles in the way of Adult’s Learning
•
When the information is of no use to the trainees
•
Non-participatory training methods, the trainer often learns after
delivering lecture. It is better to involve learners through various training
tools.
•
When the trainer fails to connect learnings with life, the new information
is lost on the trainees
•
Repeated correctional interventions with adults
•
Fear/hesitation/tension, i.e.,
o People will laugh if we commit mistakes.
o Will be scolded if commit mistake.
o Will be admonished if asks questions.
•
Since adults decide on the basis of their experience. If it is not conjoined
with the new learnings or if they have had little experience; it might
hamper the decision making process.
It is the facilitator’s job to disseminate in a conducive atmosphere. If the
training is participatory and experience based, the adults learn better.
Know the cycle of experience based learning:
Experience
Experiment
Deliberations
Conclusion
On the basis of experience, it can be said that the above is relevant both to
male and female adults. However, when we talk of training female adults, a few
additional issues should be born in mind:
•
Opportunities are rare for females in our social structure/ environment,
and that’s why they want to derive maximum benefit out of it.
•
A woman learns more at the emotional level. Keeping in view this fact, we
should try and maintain a sensitive atmosphere during training sessions.
•
A woman learns more when she’s away from her family and personal
responsibilities. Although this is not strictly true for women, yet, from the
social point of view, it’s important to free them from responsibilities to
facilitate proper learning.
•
In addition, small points, viz., selection of right training methodology. The
method should be such that it binds them to the information. Personal and
family based examples go a long way in helping them learn.
Apart from all this, a facilitator should ensure free feedback during the sessions.
Meaning of Feed Back
Telling the trainer about his strengths and weakness (during presentation)
is what is called Feedback. It’s an art to provide feedback. Whether or not there is
any improvement in the trainer’s style of functioning depends upon the way
Feedback is given.
How to provide creative Feedback?
The process of providing feed back should be creative. The objective of
feedback is to bring qualitative change in a practical manner. It should not
appear to be criticism. One should, therefore, talk about strengths and
weaknesses, likewise, during feedback. Appreciate the former while suggesting
ways to improve upon the later.
TRAINING METHODS AND ROLE OF FACILITATOR
PRESENTATION
Presentation pertains to that skill in a facilitator under which the trainer/
expert disseminates information personally. There are various forms of
presentation-lecture and Questionnaire. The onus of the subject matter is solely
the trainer’s, in this method. This is an effective tool when sizeable information
has to be disseminated, particularly to a large group.
A Presentation is used under following circumstances;
•
When a new subject has to be taken up
•
When an overview on a subject has to be given
•
When facts and figures have to be presented.
•
When a large group is being addressed
Phases / stages of Presentation:
•
Prepare a structure for presentation and ensure that all topics are included
in order.
•
Prepare visual flip charts.
•
Introduce subject and other points during the session and tell the
participants before and what you are going to say under each head
•
Include all main points while making a presentation.
•
Repeat main points briefly, particularly those points which appear
difficult to participants
•
Invite participants to ask questions.
Especially Remember
•
Presentation is based on one-way communication
•
It is not an experience based process
•
Participants are recipients (of information) in the process.
•
A trainer requires special skills to be effective
•
It’s not the ideal method to learn skills
•
Other participatory methods should need along with presentation.
Role of Facilitator:
•
Arranging all training material (flip charts, stands, marker pens and OHP
etc.)
•
Proper seating arrangements for all
•
Laying down / determining rules and ensuring compliance
•
Complete and correct information
•
Communicating with each learner
GROUP DISCUSSION
The main objective of group discussion is to find solutions to work related
problems; through discussion (exchange of experience and views). A Group
Discussion is usually conducted in groups of 4-7 persons each. Small group size
allows each participant to participate fully in the process. It is important for the
trainer to spend a little time with each sub group so that all participants are
encouraged to take part proactively and learn from each other.
A Group Discussion is conducted under following circumstances;
•
To provide an opportunity of self expression to all participants
•
To develop problem solving skills
•
To encourage learning from one another
•
To foster greater responsibility amongst participants while learning
•
To propel group work (team work)
Stages of Group Discussion;
•
Prepare the description of the problem to be discussed
•
Divide participants in to small sub-groups
•
Explain in detail the topic to be discussed / work to be done and ensure
that all participants understand well
•
Ask each group to select one controller, one reporter and one member for
making group presentation
•
Give time to sub-groups to discuss the topic
•
Invite each group for presentation
•
Encourage participants to explain what they have learnt though this
exercise and how are they going to adopt it while tackling working
situations
•
Conclude the discussion by repeating main points briefly.
Especially Remember;
•
Explain group work in detail.
•
Keep reminding the participants of the time limit.
•
Conduct the discussion through questions.
•
Trainees are not entirely dependent upon the trainer.
•
Several participants are able to express themselves clearly in smaller
groups.
Role of Facilitator
•
Forming group for the discussion and facilitating as per requirement.
•
Forming groups in such a manner that main points come to light
•
Fixing a time and informing before the discussion begins.
•
To give information regarding the subject and the way discussion will be
conducted
•
Determining rules and ensuring compliance
•
Creating the right / open environment for the discussion
•
Proper seating arrangement for the discussion
•
Encouraging everyone to speak/ to oversee that every one gets a chance
to express oneself
•
Compilation of all information after discussion and drawing a conclusion
•
Communicating with each trainee
QUIZ OR QUESTIONNAIRE
As a part of this participatory method, the trainer invites participants to
answer the questions raised during the discussion. All participants answer
according to individual comprehension and understanding. Later, the trainer
provides the correct answer.
When to use?
•
While evaluating participant’s knowledge/ information on any given
subject.
•
When many issues have to be repeated in limited time
Stages of Quiz
•
Ask subject specific questions.
•
Encourage each participant to answer questions.
•
Conclude by repeating right answers.
Especially Remember
•
Make it interesting through games.
•
Ensure the participation of all trainees.
•
Keep in mind the time limit.
•
The trainer should not get all excited/impatient to answer question
himself
Role of Facilitator
•
Prepare subject related question and answers beforehand.
•
Pre determine time for the quiz.
•
Appreciate participant for right answers and ask other to applause.
•
Ask question from each participant.
ROLE PLAY
Role Play is the training method, which entails the representation of the
solution to any given problem. As part of this tool, related acting is performed on
two or more issues. These interactive plays are prepared by the participants or
the facilitators. It is an interesting and motivating exercise that encourages
heightened participation. This method simplifies even the serious issues.
Therefore, the participants can easily work on related challenges.
Role Play is used under following circumstances:
•
To bring about behavioural change in the participants
•
To make them aware of the results of questions raised by them vis-à-vis
others
•
To make available an opportunity to the participants understands how
people behave under any given circumstances and they feel about others
•
To create an atmosphere where in serious issues can be raised and
discussed
•
As a different tool which explores solution to participants problem.
Stages of using Role Play activity;
•
Create an atmosphere for Role Play.
•
Prepare the description of participant’s role (which they will play).
•
The trainer does not need to tell the participants what to speak while
performing the Role Play.
•
Select participants keeping in mind various roles; explain their
circumstances and situation, ask one or two participants to note all
activities during the role-play so that they can be discussed later
•
Brief the spectators (other participants) about Role Play and ask them to
observe according to a checklist. Instruct them to be quiet during the role
play
•
Conduct the Role Play
•
Thank all participants after Role Play and quiz them how they felt during
performing
•
Encourage all participants to present their thought and reaction.
•
Conduct the discussion on Role Play according to checklist.
•
Ask for creative feedback from participants
•
Ask participants what they get to learn out this Role Play and how much
they resemble their work conditions
•
Discuss main point briefly and conclude the discussion
Especially Remember
•
The participants should play the role with ease and all participants should
have been introduced to each other before Role Play
•
There should be no written role for any one; dialogue should be prompted
•
The role should be chosen carefully and explained properly to
participants/ player
Role of Facilitator
•
Selection for circumstances for Role Play
•
Preparing roles for participants who have to perform Role Play
•
Explaining the circumstances to each participant and elaborating upon
role to be played
•
Telling other participants about the circumstances for the Role Play
and creating right atmosphere for the same
•
Ask the participants to observe Role Play and debrief after the role
play is over (for making observations, always use a checklist)
•
Discussing the activities of Role Play and drawing conclusions.
CASE STUDY
Case Studies are experience based examples, which are used for teaching
skill and effecting behavioural change. Case Studies may be oral or in written
form and may be used by the participants for discussion and analysis of
important issues. They are used by participants to generate interest in various
issues and bind them with their work and daily challenges. Therefore Case
Studies encourage participant to think about the effect of example / issues.
Another benefit is that Case Studies help participants reflect upon issues /
examples that were hitherto taboo subjects. Participants can do creative analysis
of issues with the help of Case Studies.
Case Studies are used in following Circumstances;
•
For analytical discussion on important issues
•
For discussion on difficult and controversial issues
•
Looking for solution through Group Discussion and Group Forms
Stages for the use of Case Study
•
Questions related to issues which shall be discussed should be presented
•
Now, the participants should be given time to look for answers of
questions.
•
Get a presentation and discussion by the participants conducted.
•
Encourage participant to tell what they learn from this exercise.
•
Ask the participants how much the given example tallies their
circumstances.
•
Repeat important issues briefly.
Especially Remember
•
Examples, causes should be connected and practical keeping in mind the
needs of participants.
•
The questions for the discussion are framed in such a manner that they
encourage the participants to discuss and look for answers.
•
If the case study is not proper and practical then it might leave wrong
impact and raise incorrect expectations.
Facilitator’s Role
•
Selection of reasonable Case Studies
•
Organizing sub-groups for analysis of case study in such a manner so
that major issues come to light
•
Introducing the Case Study
•
Exploring the Case Studies in depth in groups
•
Asking questions related to Case Study
•
Encouraging every one to speak
•
Drawing conclusions while compiling everyone’s knowledge
DEMONSTRATION
Demonstration is that form of expression, which shows the participants
the process of work. It is actually a practical exercise and it is all about teaching
in a phase wise manner. It gives opportunity to the trainee to assess self
knowledge and skill on the subject. After preliminary demonstration,
participants are invited to perform themselves. This encourages participatory
approach and provides right orientation to participants.
Under what circumstances demonstration should be used?
•
To teach special skill or technique
•
To teach those methods/ tools that appear difficult to the participants.
•
To demonstrate effectively the nature of work and its effect
•
To provide an opportunity to participants to evaluate themselves
Stages of Demonstration
•
Prepare required material for demonstration.
•
Introduce the topic and its objective.
•
Demonstrate.
•
Repeat the demonstration stepwise.
•
Invite participants to ask questions.
•
Ask participants to demonstrate themselves.
•
Discuss whether the participants found the process difficult or easy.
•
The issues learnt should be discussed briefly and the session concluded
Especially Remember
•
It is important to prepare before the demonstration.
•
It is important that there is availability of required material for each
participant.
•
A demonstration is not practical in large groups.
Facilitator’s Role
•
To arrange the required material for demonstration, to decide before the
field visit as to where to go, Pre determine what to see and oversee all
arrangements there.
•
Familiarize participants with demonstration’s objective.
•
Continually discussing those points for which the field visit has been
undertaken.
•
Allow participation to demonstrate.
•
Exchange of experience after visit and encapsulate learning.
EDUCATIONAL GAMES
As part of educational Games, participants play different roles in a group and
undergo a few activities. There are rules to control the activity. These games help
one connect daily problems and processes. Even the names are kept according to
there activity- in if you can, lion - goat, etc.
Educational Games are used in following circumstances:
•
To create atmosphere during training
•
To generate agility amongst participants
Stages
•
Choose game in tune with subject.
•
Provide information regarding game.
•
Include the concept of winning, losing so as to foster competition.
•
Draw lesson after game by analyzing.
Especially Remember
•
This process is used to reinforce faith, Human relations and community ties
•
It is all-inclusive and rejuvenating.
•
It is difficult to identify or innovate games.
•
Game become instructional sometime.
•
Since focus is important the trainer should conduct proper debriefing
•
All time these or only recreational if participants do not get a lesson
Facilitator’s Role
•
Selection of games should be in sync with subject
•
Ensure that every one participates.
•
To hasten the learning process
•
To bring to light new lesion after game
EDUCATIONAL STORY
This method is akin to case studies. However, it is not necessary that they
are based on true happenings. The trainer presents the story verbally and then
the participants take it up for discussion.
Story is used in following circumstances;
•
When one needs to draw participant’s attention to some special
circumstances
•
When there is need to make the group deliberate seriously on certain
issues.
Stages of Story
•
Prepare subject related story and remember that the beginning, middle
and end are clearly spelt out
•
Introduce the story and its background.
•
Present the story in an interesting manner.
•
Present the story orally during the session.
•
Double check with the participants whether they have understood the
story
•
Conduct analysis amongst the participants through points of discussion,
encourage everyone to look for solution, find answers.
Especially Remember
•
Story should be short, interesting and clear
•
Participant’s attention should be focused on the story
•
The story should not have to be repeated time and again
Facilitator’s Role
•
Advance preparation of subject related story and connected points for
discussion.
•
Narrating the story and ensuring that everyone pays attention.
•
Ensuring that everyone has understood the story
•
Asking questions from participants after narration
•
Repeating messages and solution after eliciting replies from participants.
SIMULATION
Simulation is the dramatic representation of real life.
Under which circumstances is Simulation used?
•
To make people realize how to take decisions without worrying about the
effects; in real life.
•
As a tool to check knowledge, skill and behavior in everyday context
•
To assist participant find solution and react on the same
•
To enhance participatory levels
•
To get quick / immediate feedback
Stages of its Use
•
Prepare participants to play their assigned role.
•
The objectives, rules and time should be told to the participants
•
Facilitate Simulation
•
Ask for participant’s reaction on simulation.
•
Construct principles and ask participants what they have learnt.
•
Ask participants how simulation is related to their real life
•
Conclude.
Especially Remember
•
Its time consuming
•
The trainer should be well prepared, particularly with material etc.
•
Simulation is often ordinary glimpse of the truth.
Facilitator’s Role
•
Selecting any circumstance for simulation
•
Preparing role-description for participants
•
Explaining role and circumstance to participant
•
Creating right atmosphere
circumstances of simulation
•
Do not allow anyone to speak during the activity.
•
Discussion and conclusion after activity
•
Ask participants how they will adopt this learning in real life.
apprising
other
participants
of
We can use following checklists to give creative feedback during practice
sessions.
CHECKLISTS FOR USE DUIRNG OBSERVATIONS
1. CHECKLIST FOR OVERALL TRAINING
Put a tick mark (√) against each work done and (×) against those which have
not been completed.
S.No. WORK
01.
Training Atmosphere
o Were the participants welcomed?
o Was the session announced?
o Was the utility of subject discussed?
02.
Subject
o Were the objectives outlined clearly?
o Was the information correct and complete?
o Did the subject develop in proper order?
03.
Mutual relation between Trainer and Trainee
o Was respectful behavior displayed?
Was the group kept active?
04.
Relations amongst trainers
o Was it respectable?
o Was it co operative?
05.
Training Process and Facilitation
o Was the training material used effectively?
o Were the participant’s encouraged to exchange
views?
o Was the language user friendly / easy to
follow?
o Was the elucidation method good?
06.
Time Management
I
II
III
Was the time divided judiciously for all stages of
presentation?
07.
Conclusion
o Was it ensured that the participants learnt
according to objective of session?
o Were all points related and session concluded
with the presentation of gist?
Presenter’s Name 1. _________________________________
2._________________________________
3._________________________________
Trainer’s Note: This checklist can be used for evaluation of 3 (three) sessions.
Trainers are requested to make copies for use during training.
2. ROLE PLAY CHECKLIST
S.No.
01.
Was the right atmosphere created
before Role Play?
02.
Did the trainer explain the
circumstances of role play to the
participants?
03.
Did the trainer ensure that all
participants can see and hear clearly
during the role play?
04.
Does the trainer discuss main points
so as to fulfill session objectives?
05.
Is the trainer able to keep
participants on course during the
role play?
06.
Was the trainer successful in
eliciting session main points in brief
from the participants?
07.
Did the trainer himself provide
creative feedback and was able to
extract the same from participants?
I
II
III
Yes No
Yes No
Yes NO
Presenter’s Name 1.________________________________
2.________________________________
3________________________________
Trainer’s Note: This check list can be used for evaluation of 3 (three) sessions of
Role Play. Trainers are requested to make copies for use during training.
3. DEMONSTRATION CHECKLIST
S.No.
01.
Did the trainer organise and exhibit
all the material?
02.
Did he display every thing well for
everyone to see?
03.
Did he complete all steps in order?
04.
Did he demonstrate
explaining clearly?
05.
Did the trainer repeat those steps
which are most mistake prone?
06.
After the demonstration, did the
trainer ask everyone to spell out all
steps?
07.
Did he ask questions, provide correct
answers and demonstrate again if
required?
while
I
II
III
Yes No
Yes No
Yes NO
also
Presenter’s Name 1.__________________________________
2.__________________________________
3.__________________________________
Trainer’s Note: This check list can be used for evaluation of 3 (three) sessions of
Demonstration. Trainers are requested to make copies for use during training.
EVALUATE YOURSELF AS FACILITATOR
FACILITATOR should evaluate understanding of training methods himself
•
Which training method you would prefer if you want to use the previous
experiences of the participants?
(a) lecture
(b) Case Studies
(c) Role Play and discussion in small / big group
(d) Educational Games
•
Which method would you choose, if you want to use participant’s
experiences generated during the training?
(a) Case Studies
(b) Discussion in small groups
(c) Lecture
(d) Educational Games and Simulation
•
What is the method in which the participants learn from other’s
experiences?
(a) Discussion in small / big group
(b) Educational Games
(c) Case Studies
(d) Role Play
•
Name the method in which participants learn by doing themselves?
(a) Role Play
(b) Educational Games
(c) Practice / Exercise.
(d) Case Studies
•
If the participant’s knowledge base has to be enhanced, which method
would be useful:
(a) Role Play
(b) Case Studies
(c) Lecture
(d) Discussion in small / big group
•
Which method would be appropriate to check participant’s awareness?
(a) Case study
(b) Role play
(c) Lecture
(d) Discussion in small groups
•
Which method would be useful if their skill has to be enhanced?
(a) Discussion in small group
(b) Lecture
(c) Case Studies
(d) Exercises
•
Name the method where in participants learn from watching the trainer
do a particular activity.
(a) Educational Games
(b) Lecture
(c) Demonstration
(d) Discussion in small group
•
Which method is useful to gauge participant’s feedback as well as
recapitulation?
(a) Lecture.
(b) Questionnaire / Quiz
(c) Demonstration
(d) Discussion in small group
•
What is the difference between Role Play and Simulation?
PART TWO
The reference has been compiled to help CMC’s practice Key Health Messages and
improve their skills. It contains, FAQs especially related to polio and routine
immunization.
This part discussed the following :
•
•
•
•
FAQs on Polio
6 fatal diseases and their vaccination for prevention.
Vitamin A
One example of seasonal disease-Diarrhea and its management
A few activities are also included to reinforce CMC’s understanding on Key Health
Messages. User’s instruction is included in the guide’s introduction. Do look up
carefully.
A representation of one seasonal disease (Diarrhea) is given towards the end of guide.
The CMC’s skills to replicate the same for other diseases have to be developed by you.
The booklet on related seasonal disease is already with you.
Main topic
Included information
•
•
•
Vaccination
Tetanus
Toxide
B.C.G
Polio birth
‘dose’
or
Zero Dose
DPT I,II,III
&
Polio
(OPV) I,II
& III
Vitamin A
(Syrup)
DPT
Booster
Age
Immunization Time Table
Disease against which immunization is
done.
FAQs and Answers
Protection/disease
Spot
of
Vaccination
Two doses at monthly interval during Mother and child On the arm of
pregnancy
both protected from pregnant
First immediately after detection of tetanus.
mother.
pregnancy and second after a month
(If a woman is pregnant within 3 years
of first delivery and has received T.T.
2 doses earlier, then in the present
pregnancy only one ‘booster’ TT is
given)
Within first month of life at birth(If Protects
baby is delivered in home or hospital ) T.B.
against On the upper
arm at shoulder
tip.
(this site is
universally used
and accepted
Within 15 days of birth
Protects
against Oral
(preferably wthin first 3-7 days of Polio
(2 drops of
birth but not later than 15days)
vaccine)
1 ½ month, 2 ½ month, and 3 ½ Whooping
DPT- injection
month
Cough,Diptheria,
on outer front
Tetanus and polio
upper/middle
thigh/OPV
oral–(2 drops)
At 9 months age
Night Blindness &
boosts
immunity
against
diarrhea
,during
measles,Pneumonia
etc.
16-24 Months
Diphtheria,
Injection given
Whooping
on thigh of a
Cough(Petusis)
child
outer
,Tetanus
middle part.
COME LET’S LEARN AND TRANSFER THESE MESSAGES
Question: If the BCG is not administered with in a month, how much longer can it be
done?
Answer: Preferably by one year age child should receive this vaccine. However in
individual case child it may be given even later but on doctor’s advice only.
Questions: Does the BCG harm the child; because of vesicle/nodule formation?
Answer: No, the vesicle/nodule like formation is a natural phenomenon which starts by 34 weeks after vaccination and it bursts/ulcerates on its own and the whole process
normally gets heals in 4-8 weeks leaving a life long mark at this site
Question: Does the child suffer from fever after DPT vaccination?
Answer: Yes, some child may get mild to moderate fever and painful discomfort. The
ANM gives a tablet Paracetamol and the fever subsides in 1 or 2 days. This affect may be
seen in most of the children. However if child gets high fever and keeps crying non-stop
after the vaccine, then you should advice mother /father to seek medical help.
Question: What should one do if the DPT Vaccine has not been administered in time?
Answer: Within the first year, the three doses may be taken(with a month’s gap between
each of the three doses) anytime. If the child is 2 years plus, she/he is administered only 2
doses of DT(and not DPT) one month apart.
Question: Is there no separate vaccine for whooping cough?
Answer: It is contained in DPT vaccine, component (Pertusis) is against whooping cough.
Very rarely ‘p’ component of the vaccine is not tolerated by an occasional child and this
reaction may manifest Groups convulsion, high fever nonstop cry (incessant cryagonizing cry.)Since such adverse reaction becomes more in older age, therefore after
two years only DT is given and not DPT.
Question: if a child has had whooping cough and is now cured, is there need to
administer vaccine again?
Answer: Since; the understanding of parents many coughing illness are similar to
“whooping cough”, it is difficult rely/depend on the history, therefore it is advisable to
vaccinate unless there is documented proof of the child having suffered and recovered
from (whooping cough) given by a medical practitioner.
Question: Is it certain that a DPT vaccinated will not suffer from whooping cough,
Diphtheria, Tetanus?
Answer: The chances of disease are reduced to a large extent if all the three doses are
taken, at prescribed intervals of one month each.
Question: Does the tetanus vaccine provide immunity life long?
Answer: Tetanus vaccine is done at 1 ½ ,2 ½ 3 ½ months followed by booster at 1 ½
year. The 2nd booster is advised at 5 year age followed by booster doses at 10years and
16 years of age. Subsequently in adult life only if one gets a mutilation injuries,
especially involving head/face and neck.
Question: Does it harm if tetanus vaccine is not administered on time?
Answer: If the mother is not vaccinate two doses of TT during pregnancy then at the
delivery time if unhygienic practices are used in cord cutting by ‘Dai’ or mother gets
infected then chances of either getting tetanus increases. In the New born baby Tetanus
manifests after 2-3 days of birth & child keeps his mouth tightly closed and doesn’t sucks
mother’s breast. It is called tetanus neonatorum.If untreated 75%-100% of these babis
die. If a child remains unprotected against tetanus then burn injuries, contamination
injuries on head, face, arm, neck, ear injections with pus discharge can also predispose
the child to suffer tetanus
Question: A child is six months old and has not been immunized; which vaccines should
be administered during the vaccination sessions?
Answer: B.C.G., DPT-I, OPV-I should be given followed by 2nd and 3rd doses of DPT at
one month interval each. This should be followed by measles injection and one ml of
Vitamin-A syrup at 9 months to one year of age; once.
Question: A child is more than 1 year old and has not been immunized for any of the
diseases; which vaccines should be administered during immunization?
Answer: Measles, DPT-I, OPV-I and Vitamin A 1st dose. Giving Measles and DPT on
the same day is not harmful.However, if the mother wants only one injection that day
then measles with Vitamin-A should be given first. She should then be asked to come on
the next day for completing DPT doses at one month interval each. For BCG she should
be asked to seek doctor’s advice.
NEW QUESTIONS AND ANSWERS
(The facilitators are guided to record all new questions, apprehensions, myths from
the fields and consult a competent resource person for answer. After getting, proper
answer, re-visit the CMC and community to adequately ally their specific fear and
myth.)
…………………………………………………………………………………………
…………………………………………………………………………………………
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POLIO
Included Information
• What is polio?
• Cause of spread.
• Symptoms.
• Prevention.
• FAQs and answers.
POLIO:
It is an infectious disease caused by polio virus/type1, 2, 3 or all the three in a given
child’s intestine/gut, through mouth. When he/she ingests/drinks contaminate water/food.
The source of contamination is sewage/ stools of an infected child, which gets transmitted
through poor personal hygiene(not washing hands after cleaning child’s stool/after
ablution) or virus picked up by flies from stool and contaminating food or through mixing
of sewage water in drinking water supply(in this case more than one child may get
infected within a short span of time, provided they are not adequately protected against
polio.
Spread• Through the excreta of sick child.
• Through water.
• Lack of personal hygiene.
Identify• Fever
• Sudden painful weakness of arms, legs, neck, breathing difficulty (Bulbar Polioaffecting Brain Cells controlling Heart and Lungs).
• Paralytic hand/leg with pain on touch.
Prevention:
It is advisable to get the child fully vaccinated at right age since polio disease once it
occurs, cannot be completely cured. Only symptomatic relief and complication
management is possible with rehabilitation for the whole life.
COME LET’S LEARN AND TRANSFER THESE MESSAGES
Question: What is polio eradication?
Answer: It means wiping out the polio virus from human environment completely not
just from state, but from the whole world. There will be no need to administer vaccine
afterwards. This is similar to the drive that eradicated small pox1946 (30 years) ago. A
glance at world, India and Uttar Pradesh figures- 3,50,000 children Polio affected
worldwide in 1998.
Year
2002
2004
2005
2006(till June 30)
Polio Cases
1241
82
29
85
Polio Case(India)
1561
134
66
100
The increase of cases this year indicates larger number of children missing their OPV
doses and also improved quality of reporting and detection.
Question: Up till what age can polio affect a child?
Answer: Most of the cases in our country occur in child below 5 years of age. However,
occasionally child above 5 years of age may also suffer Polio disease. Therefore, under
the polio eradication drive, the vaccine is being administered to 5 years children.
Question: Why is it necessary for fully immunized child to take vaccine?
Answer: Health workers administer 4 doses to every child in the first 3 ½ months during
routine immunization. Campaign doses are separate. It is essential to give these doses
because:
I. Due to child suffering repeated intestinal infections/gastro entities, fever,
vomiting and also due to child’s immune system not able to adjust to
environmental conditions. The intestinal polio immunity may get depleted
overtime. Thereby making him susceptible to infection again.
II. If a child is fully vaccinated but if ‘mild Polio’, virus enters his system either his
own protective viruses(friendly OPV viruses) gets replaced by the “enemy hold
viruses” thus making the child suffer, but yet he starts excreting these ‘mild Polio’
virus in stools, once they establish in his intestines, this endangering other
susceptible children in his neighborhood.
III. Therefore it is absolutely essential that each child should keep on getting ‘OPV’
as long as there is ‘mild Polio’ virus in the immediate environment.
Question: Why are child only upto 5 years administered the vaccine?
Answer: The reason is :• The Polio virus mainly afflicts this age group.
• Lack of understanding of personal hygiene by children is also an
important factor.
Question: How does the Polio spread?
Answer: The virus enters the intestines through contaminated water.It multiplies and
then excretes with excreta.If the excreta is not disposed properly or the mothers doesn’t
wash hands after cleaning the babies feces the virus is transmitted to othern and thecycle
goes on.
Question: Is there any cure for Polio?
Answer: Once affected, only marginal improvement can be brought about through
physical rehabilitation. The child never recovers completely. Therefore, parents are
advised to administer OPV Groups per dose schedule prescribed.
Question: Are the campaign OPV vaccines different from routine OPV vaccine?
Anwer: Both the vaccines are the same. Equally safe and effective. WHO and UNICEF
conduct concurrent monitoring of the vaccine manufacturing procedures for quality
assurance.
Question: What precautions should be taken while administering OPV?
Answer:
a) Health workers should clean hands before administering OPV.
b) The dropper on the vial should be kept away from child’s mouth.The same vial is
used for many children.
c) It should that full dose of 2 drops are actually given to each child. This is because
some children keep moving. Their head while in mother’s lap & drop falls outside
on face/chin etc.This is an important aspect.
Question: Can a child who is malnourished be administered the OPV?
Answer: A malnourished child may also be weak. Such children should certainly be
given OPV since they run high risk of Poilo.
NEW QUESTIONS AND ANSWERS
(The facilitators are guided to record all new questions, apprehensions, myths from
the fields and consult a competent resource person for answer. After getting, proper
answer, re-visit the CMC and community to adequately ally their specific fear and
myth.)
…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………
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Main Topic
Tuberculosis
Included information
• What is Tuberculosis?
• Symptoms.
• Prevention.
• Immunization.
• Cure/Treatment.
• FAQs and Answers.
Tuberculosis:
Tuberculosis is a bacterial highly infectious disease. Usually it affects the lungs. In
addition, it may involve the bones, brain and lymph nodes, blood(disseminate
tuberculosis/ miliary tuberculosis) & rarely kidney also.
HOW does it spread?
Tuberculosis transfers through bacteria in the air from one person to another person. It
can happen at any age and in any class of section of the society. Any person with weak
immunity (especially HIV/AIDS) is likely to get infected with TB also. A child after
suffering from Measles may become susceptible to TB due to lowered immunity.
Symptoms:
IN ADULTS:
•
•
•
•
•
Continual dry cough.
Mild fever, malaise, fatigue.
Weight loss and hunger loss (Anorexia)
Feeling tired with or with out sputum especially if it doesn’t occur by 2-3 weeks
of treatment.
Sputum tinged with blood.
IN CHILDREN:
•
•
•
•
Child not gaining weight or even has been loosing weight.
Running low grade fever.
Restless, irrestible, doesn’t play anymore, looking pale & anaemic, sweats on the
head during night/sleeping time.
Feels warm to touch, has swollen glands on the side of neck both side/one side.
Prevention:
• B.C.G(Bacillus Calmet fuerine Gyusi) within first month of life.
• Any child with above symptoms should be seen by a qualified doctor, so that
early diagnosis and treatment will prevent complications.
Time of Immunization:
Immediately after birth within one month to 1 ½ months.If not done by then it can
be done till 12 months of age.
Availability:
• Free of cost at all PHC’s, CHC’s, District Government hospitals and at village
SC/ICDS centre on Wednesday and Saturday.
•
COME LET’S LEARN AND TRANSFER THESE MESSAGES
Question: Is T.B a contagious(through touch etc.)
Answer: It spreads through breathing infected air, in closed rooms/ air spaces .The
bacteria spreads through coughing/sneezing and enters via droplets inhaled by healthy
persons in his lungs.
Question: Should a T.B. patient be kept away from home?
Answer: No, as long as patient is taking prescribed drugs and following simple
precautions of keeping handkerchief on his mouth/nose while coughing or sneezing not
sharing his personal effects with others and has adopted ventilator, there is no need for
keeping away from family.
Question: Is it necessary that the child will be affected if one of the two parents has
T.B.?
Answer: It is not congenital but may occur due to close proximity. Vaccination to child
at right age usually protects him despite one of the two parents suffering the disease.
Close relatives living in the same family should get themselves checked from time to
time.
NEW QUESTIONS AND ANSWERS
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Main Topic
Diphtheria
Included Information
• What is Diphtheria.
• How does it spread?
• Identification.
• Prevention.
• Immunization.
• FAQs and Answers.
Diphtheria
It is a deadly infectious disease caused by a bacteria.It is usual during cold season and
spreads easily in moist/ damp areas.It affects throat and breathing tubes and lungs
adversely through blocking air passage to the tissue/organs.
How does it spread?
This infection spreads through a sick person or a healthy carrier. The person gets infected
by direct contact or through sputum, air droplets /sneezing or sharing infected towel etc.
An infected person can remain infected for 4 weeks and can spread the disease, during
this time. This infection may be present in some healthy persons too, without actually
suffering the disease.
Identification:
• Coughing.
• Irritation in throat.
• Hunger loss.
• Swelling in neck lymph nodes.
• Difficulty in breathing.
• Difficulty in swallowing.
• Grayish Brown membrane in throat which can obstruct breathing.
• Child gets choked feeling or ‘air hunger’.
Prevention:
• Complete 3 doses of DPT vaccine gives 80 % protection to the child.
When to vaccinate:
• 1 ½ , 2 ½ ,3 ½ months from birth, Booster dose at 1 ½ years. If a child has not
received vaccine by two years age then 2 doses of DT only are given at one month
interval between each dose.
COME LET’S LEARN AND TRANSFER THESE MESSAGES
Question: Is death certain because of diphtheria?
Answer: In diphtheria, the breathing tubes gets a membrane like formation and breathing
is obstructed; thus affecting brain and heart. Timely treatment may save the child’s life.
Therefore, parents are requested to get their children immunized to prevent disease.
Question:Does this disease affect children genetically?
Answer: No, it is an infectious disease and not hereditary.
NEW QUESTIONS AND ANSWERS
(The facilitators are guided to record all new questions, apprehensions, myths from
the fields and consult a competent resource person for answer. After getting, proper
answer, re-visit the CMC and community to adequately ally their specific fear and
myth.)
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Main Topic
Whooping Cough
Included Information
• What is whooping cough?
• How does it spread?
• Symptoms.
• Prevention.
• Immunization.
• FAQs and Answers.
Whooping cough:
It is an extremely infectious disease, which is caused by bacteria.Usually,it is found in the
children less than 5 years of age. The younger the child, the higher the severity of
disease. A child is susceptible to the disease right from birth since the mother’s immunity
does not protect the child. This is the reason why DPT I has been prescribed at 1 ½
months, in the immunization program.
Spread
• This infection spreads chiefly from one sick child to another. The sources of this
spread are coughing, sneezing.
• This disease is airborne.
Prevention:
• DPT Vaccine.
Immunization:
The protection of the pertussis part of the DPT vaccine after 3 primary doses
is up to 70% -75%
COME LET’S LEARN AND TRANSFER THESE MESSAGES
•
Question: Is whooping cough an infectious disease?
Answer: Is an infectious disease that spreads from one sick child to other by breathing in
an infected air.Closed rooms with poor ventilation also helps in spread of infection.
Question: Is it treatable?
Answer: Treatment is available at PHC/CHC/District Hospitals.
Question:What are the complications after whooping cough?
Answer: Whooping Cough leads to excessive fatigue, exhaustion & air hunger. This
further complicates sometimes to lung tear/ lung collapse leading to death of the child.
Malnutrition and convulsions are other parts of the disease.
All the complications of the child is easily preventable through three dose of DPT at
the appropriate age.
Main topic
Included Information
• What is tetanus.
• How does it spreads?
• Prevention
• Identification.
• Immunization.
Tetanus
This disease spreads through bacteria.These bacteria atepresent in soil,cow dung,
intestine of animals & is excreted in th stool.This bacteria releases toxin/poisonous
substance in the blood of infected child which affects the brain adversely. Child can have
convulsions,spasms & rigidity in the body.He is unable to open mouth & swallow any
food item.Lungs complications can also happen in tetanus.
Spread:
•
•
•
•
It spreads through foul,contaminated wounds.
Through use of infected blades.
Cutting of Umbical cord and surgerical procedures.
Using dirty hans,used blades etc. during delivery.
Syptoms:
• Child finds it difficult to swallw food.
• Lock Jaw.
• The mouth doesnot opens easily.
• Child’s face acquires a smiling look due to pulled skin.
• In the end, the entire body looks stretched and rigid; the child becomes like a
bow.
• The child may die due to complication.
Prevention:
• Two injections of TT vaccines to mother during pregnancy to protect the child
from tetanus.
• 3 doses of DPT at recommended age protects the child from infection.
• It is treated with Tetanus immuno globin and antibiotics.
• The mortality rate inspite of treatment is high. Therefore prevention is the best
cure.
Main topic
Measles
Included information
• What is measles?
• How does it spreads?
• Prevention.
• Symptoms.
• Vaccination.
• FAQs and Answers.
Measles:
It is highly infectious disease that strikes during childhood. It occurs due to virus and is a
major cause of childhood deaths. The child is at the risk of spreading infection 4 days
before and five days after symptom appear. It occurs mainly during winters.
Spread: It spreads very fast in crowded population through sharing same air spaces for
breathing.
Identification:
• Coughing
• Running nose
• Reddening of eyes.
• Red spots/blotches begin behind ears and spreads to entire body.
Prevention:
• Lifelong immunity is developed once the disease has occurred.
• An extremely effective vaccine is available and given at 9 months.
Precautions:
• It reduces a child’s immunity due to which he/she suffers other infectious disease
like T.B., Diarrhea, Malnutrition, lung infection, brain inflammation and VitaminA deficiency.
COME LET’S LEARN AND TRANSFER THESE MESSAGES
Question: Is measles an infectious ?
Answer: It is extremely infectious disease and spreads rapidly in other children through
breathing and living in crowded places(closed rooms etc.)
Question: Is the treatment too expensive?
Answer:
Question: Is it necessary that all children will be infected, if one child has been infected
in the family?
Answer: It is an extremely infectious disease. If a child has not been immunized before
and has not been affected either, she runs a high risks of being infected.Also,it may
spread among those children in the vicinity who have not been immunized.
Question: Up till which age can measles occur?
Answer: 9 to 5 years of age.
Question: What should we do if the parents of the affected child are performing sorcery
etc.?
Answer: It is important to explain them that sorcery/witchcraft will not help unless fever
and diarrhea are controlled. Besides nutrition, ventilated room & not sharing personal
belongings with others in the family may help in constraining the disease from spreading.
NEW QUESTIONS AND ANSWERS
(The facilitators are guided to record all new questions, apprehensions, myths from
the fields and consult a competent resource person for answer. After getting, proper
answer, re-visit the CMC and community to adequately ally their specific fear and
myth.)
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Main Topic
Vitamin- A
Include Information
• Why is Vitamin A essential?
• How its deficiency affects us?
• What can we do?
• When Vitamin A dose should be
given.
• FAQs and Anwers.
Vitamin- A:
Why is Vitamin A essential?
• It produces protective ‘Mucosal tissues’ for safeguarding lungs , intestines and
corneal outer layer by producing .
• Keeps eyes healthy and active.
• Saves from diseases and infections.
• Facilitates physical growth and development.
• Cannot be prepared by the body and therefore is essential in food.
How its deficiency affects us?
•
•
•
•
Highest affected are < 5 years age children and pregnant mother.
Directly affects eyes. ( Cornea)
Reduces body capacity to fight disease.
Retards physical & mental development.
What can we do?
• Vitamin A dose should be given every 6 months to all 9 months & 3 years
children.
• Green leafy vegetables e.g. spinach, fenugreek, yellow fruits, carrots, mangoes
and eggs are good source of Vitamin A.
• The child should be given her mother’s milk (colostrum) immediately after birth.
COME LET’S LEARN AND TRANSFER THESE MESSAGES
Question: Does vitamin protects your eyes from all diseases?
Answer: It provides safeguard against night blindness.Also, it helps repairs tissues which
may have been damaged due to diseases like measles.
Question: Should one take vitamin A once or more than once?
Answer: Since children’s food does not have enough vitamin A and they frequently
suffer from Diarrhea, there is no harm in taking repeated doses. Still, it is our advice that
the dose should not be administered earlier than 6 months gap.This will help in
maintaining body’s immunity.
NEW QUESTIONS AND ANSWERS
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Main Topic
Diarrhea
Included information
•
•
•
•
•
What is Diarrhea?
Cause and spread
Symptoms.
Prevention.
FAQs and Answers.
Diarrhea:
This common illness in children which is caused by contaminated water and food,
along with poor personal hygiene.
Causes:
• Various types of Virus,bacteria and other organisms.
Spread:
• Drinking contaminated water.
• Contaminated milk, Ice-cream and milk products.
• Flies.
• Defecating in the open.
• If the vegetables and fruits have not been washed properly.
Symptoms:
• Child gets frequent watery stools and may have up to 20-30 stools in a day.
• Frequent stools sometimes lead to extreme dehydration, exhaustion, pain in the
abdomen and Malnutrition.
• The child has blood in stools, high fever, repeated vomitings, lethargic and
sluggish child, sunken eyes etc.
Prevention:
•
•
Patient should be given additional liquid diet like buttermilk, lemonade, and
starch from rice etc.
The patient should be given ORS solution,especially after loose stool.
PART THREE
Messages regarding mother and child health care are included in this part. Like part two
this section will also help in enhancing CMC information and skill
Health messages on mother and child health care includes following information:
•
•
•
•
During pregnancy.
During delivery.
From birth to one month.
Up till six months.
To use this part, it is important that CMC is not burdened with excess information.
Therefore, never use this part for a new CMC.
Main topics
Care and health advice during pregnancy
Why this is important?
Included Information
5 main services for pregnancy and
counseling.
• Fear of mother mortality.
• 707mothers per 11000 live birth die in
U.P. due to pregnancy and other related
causes and most of them can be saved.
• Important to identify dangers at right
time.
• Important for every mothers to receive
five services.
• FAQs and Answers.
Main Messages
• Groups soon Groups pregnancy is detected, register with ANM for all services.
• Two injections of TT at 1-month interval.
• IFA-100 tablets for pregnant women and 200 for severely iron deficient, women.
• Three essential check ups in fourth, seventh and ninth month of pregnancy to
detect any danger signs, assess growth in the foetus and counseling care to the
child Groups and when born.
• The pregnant mother should get sufficient rest and eat food that is more
nutritious. Red, yellow and green fruits, green leafy vegetables as well as dal ,
curd, tomatoes, dalia, Kheer, Khichdi etc.
COME LET’S LEARN AND TRANSFER THESE MESSAGES
Question: Why is it necessary to conduct checkups during pregnancy?
Answer: Check during pregnancy are necessary to identify dangers and take
precautions.
The mother should have detailed knowledge about pregnancy and delivery.
Question: Does one vomit because of IFA tablets?
Answer: Some women may feel nausea & vomiting but it can be avoided if the tablet is
not taken on an empty stomach and should be taken with water, after food meal.
Activity for repeating message
STORY AND DISCUSSION
Story # 1
•
The main lesson of the story is 5
services during pregnancy.
Rosie of Rajpur village ,is 4 ft 3 inch in height.During her fifth month of pregnancy
,CMC Sania goes to her house and asks some questions to Rosie’s mother-in-law. The
mother –in-law gives all information but hides the information regarding pregnancy. She
(mother-in-law) advises Rosie to eat less than her desire. So that her stomach does not
fattens up. Time passed and now its time for delivery .She is in acute pain, the ANM has
arrived and is trying to conduct delivery but the going is difficult. Rosie’s mother-in-law
and the TBA both are worried Groups what to do.
Discussion points:
•
•
•
•
What were the signs of danger to Rosie?
What services should be given to Rosie?
What are the benefits of getting delivery conducted by trained TBA?
What preparations the mother should have made to face danger?
Main topics
Danger and prevention during pregnancy.
•
•
•
•
•
Included information
• Identifying dangers during
pregnancy during pregnancy and
prevention.
• FAQs and Answers.
Small height less than 4’10”-delivery passage may be small and thus delivery is
difficult.
Age less than 18.
Age more than 35 and first child.
Anemia, yellowish palms gets easily tired and breathlessness.
Swelling in feet, headache, spasms,faint vision, high B.P, Vomiting .
•
•
Marks of operation on stomach-if the earlier child is through operationthis
delivery may also be difficult.
Premature pains or water discharge before time.
IF SUCH A WOMAN IS PREGNANT IN YOUR AREA, YOU SHOULD ADVISE
HER TO GO TO HOSPITAL FOR DELIVERY.
COME, LET’S LEARN AND TRANSFER THESE MESSAGES
Question: If girls could be married at 14 and become mother at 15 earlier what is the
problem now?
Answer: Earlier, many women use to die because of complications related to early age
pregnancy. A women’s body is not fit for reproduction before the age of 18.Now,with
rising awareness, people know and MMR(Maternal mortality rate has decreased.)
Question: What problem swelling in a pregnant woman indicates? The dangers aroused
with early pregnancy?
Answer: Swelling indicates dangerous symptoms-Anemia and high blood
pressure.Eventually, such women should be shown to a doctor or ANM, at the earliest.
Main topics
New born and care up till one month
Why is the age important ?
•
•
•
•
•
•
•
•
Included information.
• Importance of breast feeding.
• Protection against infection.
• Importance of weighing.
• High mortality in this age group.
• Highest risk of infection.
• Danger of decrease in body
temperature and high death rate,
• FAQs and Answers.
Cut the umbilical cord with clean and sterilized blade.Do not apply anything on it
save the child from infection.
Weigh the child soon after birth if the weight is less than 2kg,rush the child to the
hospital,after properly wrapping him/her in warm/cotton clothings.
Start breast feeding within half an hour of birth.Ordinarily, breast-feed when ever
the child wants ,preferably 8 times a day.Low birth weight child should be fed
more and frequently.Do not give anything apart from mother’s milk before six
months.
Give BCG vaccine doses at birth.It will protect against T.B.
The child should be given doses of OPV within 1st week of birth.
Ensure birth registration within 21 days.
Do not bathe the baby for first 7 days and keep her warm.
Tell the mother and family of danger signs in baby:Sluggish,unable to breast feed,
feeble or poor cry, fever or cold body, redness in cord, boils on body etc.Any of
these signs warrants seeking medical opinion.
COME, LET’S LEARN AND TRANSFER THESE MESSAGES
Question: How will the cord dry up unless we apply something?
Answer: Ordinarily, the cord dries up and falls off after 7-8 days. Any external
application would increase the risk of infection.
Question: Will pus form if no medicine is applied?
Answer: It is a wrong notion .It is best to keep the cord dry.
Question: What is the use of weighing when it might draw an evil eye?
Answer: One gets to know of child’s growth and development by weighing. If the child
is low weight special care can be given to the baby.
Question: We breast feed the child after 3 days, The thick yellow milk is dirty.
Answer: Mother’s milk is like nectar to the baby and pure. It has tremendous capacity to
combat diseases. This is like child’s first vaccination. Even cows and buffaloes give their
first milk to their offspring.
Question: What are the benefits of immediate breast feeding?
Answer: Both the mother and child benefit in the following ways:
• The newborn gets nutrition in sufficient quantities. It is the best food for
child holistic development.
• The child develops disease-fighting capacity. In addition, there is enough
• Vitamin-A in this milk.
• It prevents the body from loosing its temperature.
• Prevents excess blood loss of mother since the uterus shrinks properly.
• If the placenta has not come out after delivery, breast feeding facilitates in
easy placental delivery.
• Secretion of mother’s milk improves. Milk is formed in large quantity and is
nutritious.
• Breast feeding also prevents pregnancy through prolonging lactational
amenorrhea.
Question: Should breast feeding be stopped during diarrhoea?
Answer: No mother’s milk contains water and essential nutrition both of which are
essential in diarrhoea so that child maintains hydration and growth normally.
Question: Should the child be vaccinated if she is suffering from fever?
Answer:Mild fever, cough and cold are generally no contradiction for any vaccination.
However if mother feels child is not well then doctors/ANM’s opinion is advisable.
Question: Is it necessary to give birth dose separately even after administering OPV at
polio booth?
Answer: Routine dose of OPV+ Polio program dose are same in quantity. However
routine dose is for child’s own personal protection while the polio program dose is for
community elimination of poliomyelitis leading to polio eradication. Finally all children
in the society will be protected against polio.
NEW QUESTIONS AND ANSWERS
(The facilitators are guided to record all new questions, apprehensions, myths from
the fields and consult a competent resource person for answer. After getting, proper
answer, re-visit the CMC and community to adequately ally their specific fear and
myth.)
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Main topic
Care of child under one month
Included information
• How to take care of child less than
one month?
• How to take care of child after
birth?
• FAQs and Answers.
MAIN MESSAGE
•
•
•
Wrap the child in cloth according to season. Wipe only with cloth; do not bathe
till 7 days so that body temperature is maintained.
Breast feed exclusively for first 6 months, do not give glucose, water honey or
Ghutti.The child has to be protected from infection. All of child’s nutritional and
emotional need will be fulfilled by mother’s milk itself.
Keep people suffering from cough etc away from the child.
COME, LET’S LEARN AND TRANSFER THESE MESSAGES
Question: Will the child’s body develop boils ,if she is not bathed?
Answer: It is Groups important to keep the child warm Groups it is to keep it clean. If
bathed child is prone to many illness and infections. Child should be wiped off with clean
cotton cloth only.
Question: What is the harm if we always wrap child in a warm piece of cloth?
Answer: The wrapping the child in a warm cloth should be as per season. How will a
child tolerate warm cloth in summer if even the grown ups cannot do so. She may fall
sick.
Question: Will the child remain thirsty if no water is given?
Answer: Up until six months, all of child’s food and water needs are fulfilled by
mother’s milk.
Question: What is the harm in giving honey and Ghutti?
Answer: Anything other than mother’s milk may adversely affect the child’s mind and
body. Usually, Diarrhoea happens because of bottled milk and other things.
Question: Why to protect the child from cold and cough?
Answer: Because the threat of this disease and pneumonia increases in a child.
Question: What will be determined by assessing child’s response to sound?
Answer: The rate of physical and mental growth.
NEW QUESTIONS AND ANSWERS
(The facilitators are guided to record all new questions, apprehensions, myths from
the fields and consult a competent resource person for answer. After getting,proper
answer,re-visit the CMC and community to adequately ally their specific fear and
myth.)
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Main topics
New born care until six months
Included information
• Vaccination.
• Breast feeding.
• Weight
• Diet.
• FAQs and Answers.
Main Message
• 1 ½ , 2 ½ and 3 ½ Months-DPT injection on thighs.
• OPV must with every DPT dose.
• Child’s weight should be double of birth weight at six months age.
• Semi-solid substances like rice, dal, starch, mashed bananas and potatoes should
be introduced at six months of age and breast feeding must be continued.
COME, LET’S LEARN AND TRANSFER THESE MESSAGES
Question: A child will remain hungry if she is breast fed only for six months.
Answer: This is wrong notion Groups mother’s milk is the best diet until 6 months.It is
important that the mother takes care of her diet.
Question: Can child, not digest solid feed at this age?
Answer: The child has no teeth to facilitate digestion and moreover, mother’s milk is the
best diet.
Care of new born until one year.
Included information
• Child’s diet.
• Vaccination.
• FAQs and Answers.
MAIN MESSAGE
•
•
•
•
•
If the child is being breast fed, she should be porridge, rice-dal and vegetables in
balanced proportion thrice a day and five times if not breast feeding.
Measles vaccine on right arm after nine months.
Vitamin A dose essential with measles vaccine. It protects the child from night
blindness and enhance immune capacity.
It is important to vaccinate child completely and register with mother child card.
Pay full attention to child’s response to sound. A child should, by now, start
clapping and playing. By the time she is one year, she should hold bowl and
spoon, call out ,’PAPA’,MAMMA’,DADA’ etc. A child starts sitting from 8
months onwards.
COME, LET’S LEARN AND TRANSFER THESE MESSAGES
Question: Does the child starts digesting food?
Answer: A child needs cannot be fulfilled by mother’s milk alone after six months.
Therefore, home food is helpful.
Question: What is done if child is thin?
Answer: Along with breast feeding, child should be given additional food in sufficient
quantities. A child should be protected from all infections and shown o a doctor.
Question: Can the measles vaccine, not be given earlier?
Answer: No, because for nine months, disease fighting element from mother’s milk
protect the child.
Question: Will Vitamin-A harm child?
Answer: It enhances our bodies’ immune capacity. It reduces death due to measles
significantly. Repeated doses at fewer intervals can cause some toxicity harm to the child.
NEW QUESTIONS AND ANSWERS
(The facilitators are guided to record all new questions, apprehensions, myths from
the fields and consult a competent resource person for answer. After getting, proper
answer,re-visit the CMC and community to adequately ally their specific fear and
myth.)
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Main topics
Care for child up to two years
Included information
• Child’s development.
• FAQs and Answers
MAIN MESSAGE
• Give DPT booster dose between 16-24 months.
• OPV booster between 16-24 months whenever booth activity is organized.
• Vitamin-A 2nd -5th dose at this time 1 ½ years -3 years, every six months.
• 5-6 times balanced diet is essential.
• Child starts walking without support. Tries to climb stairs and run. Starts
combining words, viz., give water.
COME, LET’S LEARN AND TRANSFER THESE MESSAGES
Question: Is the danger of disease more at this age?
Answer: The danger of physical and mental complications increases if the child is
affected with polio, whooping cough and diphtheria, tetanus and measles.
Question: Should breastfeeding be continued?
Answer: It should continue until 2 years. Additional home cooked food after six months
is essential.
Question: What to do if no vaccination has been given?
Answer: Get those vaccines which are appropriate for the age. Contact the ANM/Doctor
for the rest.