Trainer's guide

I. Assumptions of the CCCD manual

The CCCD Manual, like other Peace Corps training manuals, reflects assumptions which are made about the PCV as a development worker. The following assumptions were adapted from The Role of the Volunteer in Development (Core Curriculum, Peace Corps) and apply to the PCV as a development worker in the area of primary health care:

Self Sufficiency:
PCVs help others to gain self sufficiency.

Skill Transfer and Role Model:
PCVs are assigned a role in which the skills they possess are transferred to others, enabling local people to continue to solve problems.

Training as the Example:
We teach others the way we are taught. The sessions in this manual are designed to promote critical thinking, personal responsibility, active problem solving, and thorough analysis of information.

Problem Solving and Project Management:
Volunteers are required to set goals, define tasks, and plan their day by day activities. Volunteers who are able to solve problems and manage themselves, possess a skill directly related to development work.

Gathering and using Information:
How information is gathered, sorted, filtered, verified, and put to use is critical to the process of understanding and defining development problems.

Role Definition:
Throughout the manual, focus is kept on the Volunteer's role as health educator in selective primary health interventions.

II. Organization of the CCCD manual

The CCCD Manual is divided into Volume I and Volume II. Each volume has sections, called modules, which focus on interrelated health content areas. Each module begins with a set of behavioral objectives and captains a sequence of sessions which address the specific context area. The modular format allows the trainer to combine various modules and sessions as needed given training objectives, time limitations, and other program parameters.

The modules and the sessions within each, are as follows.

VOLUME I
Module 1	Climate Setting and	Sessions 1-4
	Assessment
Module 2	Primary Health Care	Sessions 5-8
Module 3	Community Analysis and	Sessions 9-15
	Involvement
Module 4	Health Education	Sessions 16-28
VOLUME II
Module 5	Nutrition	Sessions 29-32
Module 6	Communicable Childhood	Sessions 33-44
	Diseases
Module 7	Training of Trainers	Sessions 45-55

For pre-service training, the modules in Primary Health Care, Community Analysis and Involvement, and Health Education are considered fundamental and essential in helping Trainees to develop basic communication and planning skills required in community-based development work.

Modules 5 and 6 contain sessions in nutrition and specific disease areas, the selection of sessions from these modules should be based on country-specific technical programming, and the experience and needs of the Trainees.

Module 7, Training of Trainers (TOT), should be used with Volunteers who will be involved in the design and facilitation of training courses for community and mid-level health workers. If the pre-service training program is tightly scheduled, the TOT module may be conducted as an in-service workshop.

Since most pre-service training programs consist of technical, language and cross-cultural/development training, the sessions in this manual include frequent cross-referencing. For example, the sessions in Module 3 on Community Analysis include a reference to and should be closely coordinated with cross-cultural training activities. The cross-referencing is meant to help the trainer recognize overlap and interface among training components. Making use of these references and suggestions will greatly enhance the opportunities for integrated training.

All of the sessions in the manual follow a consistent format which is briefly explained below. Sessions often have several purposes. For example, the activities may provide skill development on malaria and also provide participants with practice in nonformal education methods and materials development. It is important for the trainer to study and understand the multi-purpose design of each session before conducting it.

Allowance is made for break time in each session. As the module and sessions are modified, the trainer should always work in 5 minutes of bleak time for each hour of training and should decide when the actual breaks occur.

III. Training methodology

As designed, the CCCD Manual can be considered a modified a competency-based training. It aims to help Trainees attain and demonstrate health knowledge and skills (i.e. competencies) required of them on the job. "Competencies" to be achieved are stated as behavioral training objectives at the beginning of each module. These objectives were developed based on a detailed review and analysis of the tasks performed by Volunteers working in selective health areas.

At the beginning of the training, the trainers should provide participants with a complete list of those behavioral objectives they will be expected to achieve by the end of the program. Session 3 includes an activity in which trainers and Trainees examine and clarify the training objectives in relation to group needs and expectations.

For assessing how well they have accomplished the objectives, Trainees should be given a variety of opportunities throughout the program to demonstrate practical application of acquired knowledge and skills.

It is useful to note here that each of the sessions includes one to four learning objectives. For the purposes of this manual, a learning objective is defined as a sub-objective or intermediate objective that describes what the Trainee is doing along the way toward accomplishing the behavioral objective. The behavioral objective is terminal; it describes what the Trainee will be able to do by the end of the training program.

The trainer can best facilitate Trainees' acquisition of specific competencies by utilizing the experiential learning model. This approach to training includes a focus on learner-centered adult education and emphasizes in particular:

- the role of the trainer as facilitator of learning (rather than only as provider of information).

- the use of a variety of educational methods in meeting individual learning needs.

- learning goals, objectives, and activities which relate Trainees' previous knowledge/skills to that acquired during training and its application to the job.

- the assumption of responsibility by Trainees for their own learning.

- the active participation of Trainees in activities aimed at meeting learning objectives.

Experiential learning is exactly what the name implies learning from experience. Effective training strategies which incorporate experiential learning approaches build upon this precept by providing learners with situations and settings that stimulate the process of experiencing. Within the context of a training curriculum, learning experiences in these situations may take the form of classroom activities, simulations, or "real life" activities. Experiential learning occurs when a person engages in an activity, reviews the activity critically, abstracts some useful insight from the analysis, and applies the result in a practical situation. The experiential process follows the theoretical cycle shown below:

Theoretical cycle

The CCCD Manual makes use of the experiential learning approach in most sessions. me kinds of techniques used frequently to actively involve the learners include:

demonstration	role play
large group discussion	simulation
small group tasks	case studies
lecturettes	slide shows
community visits and interviews	readings
storytelling	skills practice

The trainer is encouraged to make use of an even wider range of training techniques to facilitate learning and enable Trainees to transfer health knowledge/skills. In facilitating learning, the trainer should also make use of and/or help create "learning environments" which are stimulating, relevant and effective. To the extent possible, the local community and resources (e.g. health personnel and facilities) should be utilized in conducting training.

When adapting the sessions from this manual to fit specific training situations care must be taken to retain all four steps in the experiential learning cycle. For example, if a session needs to be shortened from three hours to two, the trainer should modify the steps such that the Trainees can still experience, process, generalize and apply their [earnings. Cutting out the application step to shorten the session time is not a viable modification.

For a fuller description of the experiential learning model and other valuable information on training design and delivery, please refer to A Trainer's Resource Guide, (Peace Corps) and Module 7, Training of Trainers.

IV. Use and adaptation of the manual

The Manual is meant to serve as a model for the effective design of training sessions which promote a logical flow of learning. It is not meant to be used without first adapting sessions to focus on country-specific health problems and the learning needs of Trainees in their particular health assignments. m us, for example, role plays, character settings, problem situations and other aspects of training activities must be modified to fit local conditions. In addition, country-specific health and related cultural information must be included where appropriate.

In preparation for adapting the manual to meet specific training needs, the trainer should conduct the following steps:

1. Identify host country health problems, needs, and target groups to be addressed during training.

2. Collect country-specific health and other relevant information.

3. Determine the primary and secondary health functions which the Volunteer is being trained to perform (preferably utilizing a task analysis).

4. Determine the average level of health knowledge and skills of the group to be trained.

5. Outline desired training goals, objectives, content, activities and evaluation.

6. Determine resource needs and the availability of resources (e.g. personnel, materials, facilities, and time).

7. Review existing training manuals, designs and materials to determine their adequacy in meeting training objectives.

8. Select, sequence, and adapt specific sessions to be used in the program.

9. Be sure the training design includes:

- opening and closing activities (e.g. ice breakers, end-of-training dinner)
- climate-setting (e.g. sharing expectations, setting the agenda)
- group process (e.g. feedback sessions)

These steps are fairly standard for the design of any training program and can serve as a general guide. For a more detailed description of training design and organization, please read The Trainer's Resource Guide (Peace Corps) as well as Module 7, Training of Trainers.

The following subsections provide ideas for how the manual can be adapted to suit different training situations.

A. Adaptations Based on Trainee Needs and Experience

The more skill, knowledge, and practical experience participants bring, the more effective and enriching are the small group activities that allow them to pool their knowledge and resources to teach each other. The experiential nature of the sessions allows pre-service Trainees to draw on what they bring with them from their experiences in the U.S. (or other parts of the world). They begin with what they already know and apply it to the new culture and work. The trainer can use pre-training questionnaires, a needs assessment form (such as the sample in Trainer's Guide Attachment A), and interviews to assess entry level knowledge and skills and to become familiar with the Trainees' specific needs and expectations.

Once the training is underway, every effort should be made to adapt training activities such that they provide pre-service Trainees with experiences and "hands-on" skill practice in the local community and, if appropriate, in their future workplaces. (For example, participants can pretest visual aids with members of the surrounding community rather than conduct the exercise among themselves in the classroom.)

For cases where health specialists and health generalists are being trained together, the trainer should modify sessions so that the resources of one group are used to benefit the other. m rough well-organized peer teaching and small group discussions, the specialists can contribute their expertise to the skills acquisition of the generalists, while the generalists can help to broaden the community development perspective of the specialists. Throughout the CCCD Manual, specific reference is made to activities which represent opportunities for peer teaching.

B. Adaptations Based an Available Materials and Equipment

It is best to use the kinds of materials and equipment during the training that participants will also have available in their host communities. They may have access to more or less variety of materials and equipment than suggested in the manual and sessions should be modified on this basis. For example, you might want to use a film instead of a reading or discussion of a picture because particular health films are available in the country. Or you may want to substitute drawings and photographs where slides are suggested if slides are not available. Encourage participants to locate possible sources of materials and equipment from various agencies in the country.

Case studies, examples, stories and pictures will need to be modified to make them more appropriate for the local situation. If the trainer is not an artist, it is possible that someone in the community who has artistic skills would enjoy helping the staff adapt or design new materials.

C. Adaptations Based on the Size of the Training Group

The sessions and activities in this manual are designed to accommodate training groups of approximately 20 participants. If you anticipate a significantly larger number of participants, consider dividing them into two subgroups, each with its own technical trainer. If the larger group cannot be broken into smaller groups, time allowances for many of the activities will have to be extended. This is especially true in sessions which include small group tasks followed by reporting back to the large group.

D. Adaptations For In-Service Training Workshops

Prior to in-service workshops, a needs assessment and pre-test can be acne in the field to identify technical skill levels, perceived needs, and current project descriptions of the Volunteers scheduled to participate. Trainer's Guide Attachment A contains the Technical Health Training Needs Assessment which can be adapted for use in this manner.

During the training design stage, the trainer should adjust the sessions so that the "starting point" is the PCV's recent experience in the field working with the community. The generic case studies and examples included in the manual can be replaced with "real" examples provided by the group. In addition, Volunteers can bring to the workshop any visual aids, utensils, local clinic equipment and other items from their communities which would help to make the training as relevant as possible.

E. Adaptations Based on Previous Use of the Manual

Technical and educational information contained in this manual is current at the time of this writing. However, advancing technology means modification will be needed to keep the manual up-to-date. Trainers are encouraged to write notes in the margins of the manual where new information applies or an activity was changed and improved. Also note changes in the time required to conduct the sessions as the session times listed are only estimates. This kind of information will allow for improvement of the training over time.

V. Resources

The CCCD Manual has been specifically written for use in Africa but may be modified for application in a variety of countries. The complete collection of materials used in the sessions is listed in the Bibliography at the end of the manual. me primary technical resources are the followings

· WHO Supervisory Skills Modules for Controlling Diarrheal Diseases

· WHO Guidelines for Training Community Health Volunteers in Nutrition

· WHO Supervisory. Mid and Peripheral Level Training Manuals for the Expanded Program of Immunizations

· CCC "Training Course for Instructors in Combatting Childhood Communicable Diseases"

· Proceedings of the International Conference on Oral Rehydration Therapy, (AID)

· Pediatric Priorities in the Developing Countries

· See How They Grow

Technical materials from AID, CDC, WHO, and UNICEF have also served as sources of current guidelines, information and case examples.

Primary resources for Modules 3, 4, and 7 are; Community Culture and Care. Helping Health Workers Learn, Bridging the Gap, Teaching and Learning with Visual Aids, and Teaching For Better Learning.

The references, handouts and trainer attachments included with each session should be considered the major resources for the actual training. All of these materials are either available to Peace Corps trainers and Volunteers through the Information Collection and Exchange (ICE) or are attached to the sessions to which they pertain. ICE also provides an annotated listing of available health publications.

In addition to assembling written materials, the trainer should visit local agencies and groups and international organizations and obtain a variety of visual aids and support materials, for use by both trainers and Trainees during the program. Training staff should pay attention to the various items identified under "Materials" in each session and locate these at the be-tinning of the program. Many people find it helpful to photocopy and compile all of the handouts ahead of time to avoid last minute "crises" in preparation.

A final, but important note an reference materials:

In the course of developing this manual, extensive review of published data has revealed a significant variation in some technical information and recommendations. For example, there are several variations in the "correct" amounts of sugar and salt required for one liter of homemade rehydration solution. In some cases these variations represent differences in technical perspectives, and in other cases, outdated information. As of the final revision of the manual, all technical information is based on the most current and accurate data and guidelines available from WHO and CDC. Great care has been taken to ensure the quality of the technical material included in sessions, handouts, trainer attachments and suggested readings. As with any technical document, however, the content will have to be revised and up-dated in accordance with conclusions drawn from the most recent research.

Trainers and other users of the manual should always check with Peace Corps as well as host country health ministries to revalidate or modify material to ensure that it is consistent with country health policy and programming.

VII. Staff Preparation

The CCCD Manual includes detailed session procedures and explanatory trainer notes for the benefit of seasoned as well as less-experienced trainers; merely following the steps in the sessions however does not guarantee a successful program. The training staff who design and conduct the program outlined here should represent a balance of skill and experience in adult training methodology and technical expertise in the subject matter. The staff should be flexible and able to "let go" so that the participants are encouraged to take an active role in their education.

In addition to the trainers' background skills and expertise, program success depends on adequate preparation time. A "training of trainers" workshop should be scheduled before the program, to provide the staff an opportunity to practice their training skills and build a cohesive and supportive team. During the preparation time, trainers should review the designs, prepare lecturettes in their own words, and have a complete sense of exactly what a session is trying to accomplish. If at all possible, trainers should simulate or rehearse sessions in order to anticipate questions and gain a sense of session flow.

VI. Evaluation

Before discussing how we do evaluation, it is useful to first examine why we do it.

Evaluation is an integral part of every training program and should be designed from the start of planning. It includes an assessment of the conduct of the program (administrative organization and presentation of activities) as well as the outcomes (if the participants have accomplished the objectives). Evaluation is a learning process which allows both trainers and Trainees to:

- Test the knowledge and skills acquired during the course;
- Analyze the effectiveness of the activities used;
- Judge the appropriateness of the educational material used;
- Give participants and trainers a chance to express their criticisms and suggestions.

Constant evaluation during a training program is as important as a final evaluation. Comments, criticisms and suggestions can be solicited during periodic meetings, informal Conversations at the day's end, or by way of a suggestions box in the conference hall. These inputs aid trainers in modifying the course as the needs arise.

Evaluation Tools Included in the Manual

Several methods for assessing Trainee performance and evaluating the training programs are incorporated into the manual. These include:

- The Technical Health Training Needs Assessment which can be adapted and used to assess participants knowledge and skill levels prior to training design. m e sample form is found in Trainer's Guide Attachment A.

- Behavioral objectives for each module which state in measurable terms what the participants should be able to do by the end of the segment of training. The trainer can use this to assess participant performance and identify weaknesses in program content or process.

- A pretest/posttest system which assesses the participants' acquisition of knowledge, and to some extent, attitude change. The pretest is part of Session 2, General Assessment.

- Participant-led projects and presentations which assess learning and provide participants with the opportunity to immediately apply and practice what they have learned in a "safe" environment. These training events occur throughout the modules and enable Trainees to demonstrate both their technical knowledge and their teaching skills.

- The Health Day (Session 28) which challenges participants to bring together and apply many of the skills they've learned during the program. The Health Day is a two-day task in planning, organization and implementation, and is usually scheduled as a culminating activity of the training program.

- The program evaluation in Session 4 which provides for both a written and verbal discussion of the strengths and weaknesses of the training. For training programs of two weeks or more, an evaluation session should be conducted at the mid-point and at the end of the program. The information and recommendations from these evaluations should be synthesized and included in the trainer's end-of-training report to Peace Corps.

It should be noted that all of these evaluation measures reveal primarily the immediate reactions and changes in knowledge, skills and attitudes of participants. A more reliable test of program effectiveness can be made in the field where participants perform their daily tasks. Questionnaires, supervisory visits, and evaluation meetings three to six months after the training are several means of gaining greater insight into the utility of the course and future training needs of Volunteers.

For more detailed information on evaluation, please refer to Demystifying Evaluation (Clark and McCaffery) and Helping Health Workers Learn.

Trainer’s Guide, Attachment A: Technical health training needs assessment

VOLUNTEER:
Please fill out this form completely and return it to _______________ in the Peace Corps Office by __________.
Your training will be planned according to the responses we receive.
____________________________________________________________________________
____________________________________________________________________________

What additional technical skills/knowledge do you need to enhance your ability to perform your job? Indicate the level of your need by circling the appropriate number. The following are suggested topics; if you have additional topics include them under "Other".

	Not Needed	Needed	Strongly Needed	Essential
	0	1	2	3
TOPICS:
Primary Health Care (PHC)
· Host country PHC programs	0	1	2	3
· Role of PCV in PHC	0	1	2	3
Community Analysis & Involvement
· Methods for general community analysis	0	1	2	3
· Knowledge, Attitude and Practice Surveys	0	1	2	3
· Surveillance	0	1	2	3
· Community involvement	0	1	2	3 techniques
· Planning and working with a Counterpart	0	1	2	3
Health Education (HE)
· Writing objectives	0	1	2	3
· Selecting strategies	0	1	2	3
· Planning and implementing an HE project	0	1	2	3
· Monitoring and evaluating the project	0	1	2	3
· Making or adapting visual aids	0	1	2	3
· Mass media techniques in HE	0	1	2	3
· Pretesting techniques and materials	0	1	2	3
TOPICS
Nutrition
· Basic food groups	0	1	2	3
· Nutritional Assessment (anthropometric measures)	0	1	2	3
· Breastfeeding and weaning	0	1	2	3
· Nutrition counseling	0	1	2	3
Communicable Diseases
· Vaccine Preventable Diseases (measles, DPT, polio, tuberculosis)
- how to recognize	0	1	2	3
- how to prevent	0	1	2	3
· Malaria
- how to recognize	0	1	2	3
- how to treat with chloroquine	0	1	2	3
· Diarrhea and dehydration
- how to recognize	0	1	2	3
- how to treat with CRT	0	1	2	3
· Logistical planning for health services	0	1	2	3
Training of Trainers (TOT)
· Task analysis	0	1	2	3
· Experiential learning design	0	1	2	3
· Facilitation Skills	0	1	2	3
· Group dynamics	0	1	2	3
· Planning, conducting and	0	1	2	3
evaluating workshops	0	1	2	3
Other_________	0	1	2	3
Other_________	0	1	2	3