Facilitator's Guide Draft 081811

DOH and A2Z Manual; For pre-testing only.
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Training of Service Providers on the Implementation of the Micronutrient Supplementation Program

TRAINING MANUAL/FACILITATORS GUIDE
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DOH and A2Z Manual; For pre-testing only.
Foreword
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Acknowledgment
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TABLE OF CONTENTS
About the Course and the Course Materials Training Design and Schedule Training of Service Providers Course Content and Session Plans on Training of Service Providers Module 1 Introductory Sessions Session 1: Getting to Know and Forming Teams Session 2: Sharing Expectations and Setting Group Norms Session 3: Orientation to the Course and Course Materials Module 2 Understanding the Micronutrient Situation 1 2 4 7 Page vi xi
Module 3 The Micronutrient Supplementation Program
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Session 1: Delivery of MS Intervention in Different Settings Session 2: Integrating MS Intervention in Regular Health Services Practicum Session Health Center
Session 1: Basic Information, Functions and Food Sources of Micronutrients 13 Session 2: Causes, Consequences and Prevention of Micronutrient Deficiencies 16 Session 3: Magnitude of Micronutrient Deficiency Problems 19 29
Session 1: MSP Goals, Policy and Implementing Guidelines 30 Session 2: Providing Essential MS Package for Infants and Children, Women, Mothers and Other Adults 34 Session 3: Strengthening Health Promotion and Communication for MS 37 50 51 54 59 87 88 92 95 99
Module 4 Enhancing Integration of MS Interventions in Service Delivery Settings
Module 5 Managing Service Delivery of MS Intervention
Session 1: Delivering Quality Micronutrient Supplementation Services Session 2: Delivering MS Services by Competent and Responsive Service Providers Session 3: Managing Resources and Health Information System Session 4: Supervising Delivery of MS Services
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Module 6 Action Planning
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Session 1: Planning for Improving MSP Implementation for MSP Implementation 119 Session 2: Harmonizing Action Plans of Service Providers and Supervisors 122
Course Content and Session Plans on Training of Trainers / Facilitators Training Design and Schedule 129 133 134 137 141 144 156 157 163 172 180 188
Module 7 Training of Facilitators/ Trainers
Reference Guide on Training for Trainers/Facilitators
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Session 1: Overview of the Concepts on Teaching-learning and Training Session 2: Applying Facilitation and Presentation Skills and Techniques Session 3: Practice Session for Facilitator-Trainee Session 4: Action Planning on Training of Service Providers (Roll-out) Session1: Overview on the Concepts of Teaching-Learning and Training Session 2: Applying Facilitation and Presentation Skills and Techniques Sample Letters References
Evaluation Tools Pre-and Post Test- Course Evaluation
Annexes
Annex 1.1. Annex 1.2. Annex 2.1. Annex 2.2. Human Bingo Card 10 11 24
Matrix on Sharing Expectations and Setting Group Norms Matrix on Functions and Food Sources Of Micronutrients Matrix on Vulnerable/ most affected (at risk) Causes, Consequences and Prevention of Micronutrient Deficiencies /Diarrhea
Annex 2.3. Annex 2.4. Annex 2.5.
Annex 3.1a.
Annex 3.1b. Answer Keys to Question on General Guidelines on MSP Annex 3.2.
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Case Scenario on Magnitude of MN Deficiency Problem Matrix on Identification of Factors/Barriers and Possible Solution Maternal and Child Health Indicators Questions on MSP General Guidelines Workshop Matrix/Guide on Alternative Service Delivery Settings Case Scenario for Demonstration in the Plenary (Facilitators Copy) Case Scenarios for Small Group Exercises (Facilitators Copy) Observation Checklist (For Classroom Exercises) Observation Checklist (For Practicum) Staff Interview Checklist (Practicum) Records Review Checklist (Practicum)
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Oral Drill and Key Answers on MS Package for Infants, Children, Women, Mothers and Other Adults 43 48
Annex 3.3a. Case Scenarios on Health Promotion and Communication for MS
Annex 3.3b. Possible Answers and/or Key Points to Emphasize for each Case Scenario 49 Annex 4.1a. Annex 4.2. Annex 4.3a. 63 72 73 76 79 82 84 86 103 104 105
Annex 4.3b. Key / Possible Answers to Case Scenarios (Facilitators Copy) Annex 4.4. Annex 4.5. Annex 4.6. Annex 4.7.
Annex 5.1a. Case Scenario for Small Group Discussions for Session 1 and Session 2 Annex 5.1b. Possible Answers / notes on the Small Group Discussions for Session 1 Annex 5.2a. Guide Questions for the Small Group Discussion in Session 2
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Annexes
Annex 5.2b. Possible Answers / Notes - Questions for the Small Group Discussion in Session 2
106 107 108 111 125
Annex 5.3a. Exercises on Managing MS Resources and Health Information System Annex 5.3b. Answers to Sample exercises on computations of MS needs (Facilitators copy) Annex 5.4a. Case Scenario for Session 4 - Supervision Annex 6.1. Annex 6.2.
Annex 6.3. Harmonizing Action Plans of Service Providers and Supervisors
Annex 7.1. Possible Answers and Notes for Small Group Discussion on Training 148 Annex 7.2. Monitoring Form 1: Classroom Session Annex 7.3. Monitoring Form 2: Practicum Session 155 149 150 151 152
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Planning for Improvements in MSP Implementation for Service Providers Action Planning for Training Roll-out of MS Training
Supervisory Plan on Improving Performance of Service Providers on MSP 126 127
Annex 7.4. Monitoring Form 3 for Facilitating and Presentation Techniques Annex 7.5. Facilitators Practice Session Annex 7.6.
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ABOUT THE COURSE AND THE COURSE MATERIALS

I. II. III. Structure of the Course The Training of Service Providers on Improving Implementation of Micronutrient Supplementation Program is a 3.5-day course consisting of 6 modules, 17 sessions and 1 practicum session. It uses a variety of teaching-learning methods including lectures, actual facility-based practice session, working in small groups using discussions, role-plays and practice exercises. Participants progressively develop their competencies in classroom with practice sessions and in actual health center setting. To efficiently implement the Training of Service Providers in various areas of the country, it is necessary to conduct the Training of Trainers (TOT) for the course. This is a 5-day course divided into 2 parts: the first part is on the Training of Service Providers (modules 1 to 6); and the second part is the Training of Trainers (module 7). The complete course has a total of 7 modules, 21 sessions and 1 practicum session. It uses a variety of teaching-learning methods specified in the training design for the Training of Service Providers. In addition, each participant will undertake a practice session as a facilitator/trainer. The Trainers Manual/Facilitators Guide and Participants Support Materials
The (1) Trainers Manual/Facilitators Guide contains what a facilitator need in order to lead and guide participants through the course. It also contains the technical information, detailed instructions on how to teach each session, exercises that participants will do, case scenarios for discussions and role plays, forms/worksheets needed for practice exercises and practicum sessions. The facilitator should have his/her a copy of: (2) DOH Micronutrient Supplementation Program Manual of Operations (MSP-MOP) which is the main reference in the implementation of the MSP, and (3) Participants Support Materials. Being familiar with the participants support materials, the facilitator can lead participants at what points the sessions are threading and assist in locating information that participants must be familiar with as an effective implementer of the MS program. Each participant should have a copy of the (1) DOH Micronutrient Supplementation Manual of Operations (MSP-MOP) which is the main reference in the implementation of the MSP at various sectors and levels of management and service delivery. In addition, participants should be provided with (2) Participants Reference Guide and other training support references and materials that will be used during the different training sessions and practice exercises, including those of practicum activities Preparation of a facilitator for the TOT-MSP 1. The participant to the TOT needs to attend the Course on Training of Health Workers on Improving Implementation of the MS Program, in order to learn the scope of the technical content and competencies in delivering micronutrient supplementation services. Attendance to any MS course will be an added preference.
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IV.
2. On completion of the course, the participant need to attend the TOT and Facilitators Orientation sessions in order to learn how each training session will be conducted to meet the learning objectives, applying the suggested methodologies and guidelines. General Functions of a Facilitator A facilitator needs to be very familiar with the course and he/she is expected to: 1. Answer questions and talk to individual participants about their work on the training sessions, in performing learning and assessment activities; and, 2. Give participants any help needed to meet their requirements for the course. As a facilitator, one is expected not only to teach the content of the course through formal lectures, but also to assist participants develop the competencies with a high degree of satisfaction by taking whatever activities that will be helpful or needed by the participant. To facilitate, one will need to perform activities according to the three (3) functions: 1. Instruct
1.1. 1.2. 1.3. 1.4. 1.5. 1.6.
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Make sure that each participant understands how to work through the course and what he or she is expected to do in each module and training experience. Encourage participants to come to you at any time with questions or comments. Take time with each participant to answer the questions fully. Clarify any information that a participant finds confusing. Guide activities to make sure that the learning objectives are accomplished. Identify weaknesses in the participants understanding of the knowledge and the learning performance and provide appropriate training reinforcements.
2. Motivate 2.1. Encourage participant to relate how the topics apply to their work and how they can help serve their clients with MS deficiencies and promote good nutrition. 2.2. Provide appropriate and periodic feedback on learning progress made and offer suggestions to pursue further development of competencies. 3. Manage 1.1. 1.2. 1.3. 1.4. Provide participants access to the needed supplies, materials and equipment needed at the specified time and place. Make sure the sessions are conducted according to schedule by ensuring that: 1.2.1. Resource persons are present as scheduled 1.2.2. Participants, resource persons, facilitators observe time management 1.2.3. Training venue is prepared for the sessions Check that there are no major obstacles to learning (too much noise, not enough light, not enough work space, and supplies for the activities). Monitor the progress of each participant
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How does a Facilitator do these things?

* * * * * Show enthusiasm for the topics covered in the course and for the work that the participants are doing. Be attentive to each participants questions and needs. Encourage participants to come to you with questions or comments, being available at scheduled times. Watch participants as they work, and offer individual help if you see a participant looking troubled, staring into space, not writing answers, or not turning pages. Promote a friendly, cooperative relationship. Respond positively to questions. Try to address participants concerns, rather than rapidly giving the correct answer.
What NOT to do.....

* * * *
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Do not talk too much. Encourage the participants to talk. Read the module and to work on the exercises, Plan exactly how to work on the module and what major points to make,
Always take enough time with each participant to answer his/her questions completely (that is, so that both you and the participant are satisfied).
During times scheduled for course activities, do not work on other projects or discuss matters not related to the course. In discussions with participants, avoid facial expressions or making comments that could cause participants to feel embarrassed. Avoid being too much of a showman. Enthusiasm is great, but learning is most important. Ensure that participants understand the materials. Difficult points may require you to slow down and work carefully with individuals.
To prepare yourself for each module, a facilitator/trainer should: * * * * * * *
Read from the Trainers Manual/Facilitator Guide the information provided about the module/session,
Collect supplies for the exercises and prepare for any demonstrations or role plays, Think about sections that participants might find difficult and questions they may ask, and plan ways to help with difficult sections and answer possible questions, Think about the competencies and/or skills taught in the module and how they can be applied in participants own health facilities, Ask participants questions that will encourage them to think about using their learning in their workplace.
Functions of Facilitators During Practice and Practicum Sessions There should be (1) facilitator for every group of 4 to 5 participants. Detailed activities and instructions are contained in the Session Plans for Practice and Practicum Sessions The role of the facilitator during Practice and Practicum sessions is to: 1. Do all necessary preparations for carrying out the practice/practicum sessions. 2. Explain the session objectives and make sure the participants understand what to do during each practicum session. 3. Demonstrate skills exactly as participants should do them when they return to their own areas to conduct TOT and when they apply them in their own clinics. 4. Observe the participants progress throughout the practicum sessions and provide feedback and guidance as needed. 5. Be available to answer questions during the practicum sessions.
6. Lead discussions to summarize and monitor the participants performance.
7. Complete the Checklist for Monitoring Practice/Practicum Sessions to record the participants performance and the activities performed.
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Training Design and Schedule for: TRAINING OF SERVICE PROVIDERS
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Training of Service Providers on the Implementation of the Micronutrient Supplementation Program

Background and Rationale Nutritional deficiency remains a continuing challenge in the Philippines as it affects clients in various age groups and in certain physiological states. Using the WHO and national standards, only 68% of children under five have normal weight-for-age. In 2005, there was 24.6% prevalence of underweight pre-school children (0-5 years), 26.3% were stunted, 4.8% wasted and 2.0% overweight. Exclusive breast-feeding is low at 34% of children exclusively breast-fed up to age six months. In addition, children face the problems of 1) anemiawith prevalence rates of 66% in children 6-12 months; 2) vitamin A deficiencywith 40% in children aged six months to five years; and 3) iodine deficiencywith estimated 1.5 million schoolchildren aged 6-12 years at risk of mental retardation due to iodine deficiency. Micronutrient deficiencies in Vitamin A, iron and iodine have reached the levels of public health significance. Faced with economic, agricultural and challenges like emergencies/disasters in many areas, the problem increases further in magnitude due of lack of food and high incidence of infections due to congestion and poor sanitary environment and hygiene. The issuance of Administrative Order (AO) No. 2010-0010 by the Department of Health this year which provided the overall policy direction on the Micronutrient Supplementation Program (MSP) will significantly contribute to accelerating effective implementation of the MSP in reaching more clients. This paved the way for the need to update service workers on their competencies in implementing the MSP. To date, the last training conducted on Micronutrient Supplementation was in 1992, while technical updates were periodically conducted within the interim period to support the health workers. Hence, the capacity-building to meet the training and information needs of service providers to enable them to improve implementation of the MSP. General Objective To assist health service providers enhance their competencies on improving implementation of the Micronutrient Supplementation Program (MSP). Specific Objectives During the course, each participant will be able to achieve the following learning objectives: 1. Explain the following: 1.1. 1.2. 1.3. Health goals, objectives and targets on micronutrient supplementation national and local based on the set MDG for the country The Micronutrient Supplementation Program (MSP) Key provisions of the Micronutrient Supplementation Guidelines (AO 2010-0010)
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2. Discuss the following: 2.1. Status of Micronutrient Supplementation 2.2. Effects of common deficiencies on vulnerable population 2.3. Basic information, functions and food sources of Micronutrients
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2.4. Ways of improving implementation of MS Program 2.5. Concepts and principles of Supervision 3. Demonstrate skills in managing micronutrient deficiencies: 3.1. 3.2. 3.3. 3.4. 3.5. Assessing signs of micronutrient deficiencies/risk factors Diagnosing/classifying deficiencies Identifying appropriate interventions Determining appropriate MS package for the different age groups and those in life stages/ conditions requiring MS. Identifying key messages on MS appropriate to clients need
4. Demonstrate skills in implementing the Micronutrient Supplementation program: 4.1. Providing MS services in various delivery channels 4.2. Integrating MS services in routine health services and programs 4.3. Formulating an action plan for effective implementation of MNS program Course Content:
Module 1 Introductory Sessions
Module 2 Understanding the Micronutrient Situation
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Session 1: Getting to Know and Forming Teams Session 2: Sharing Expectations and Setting Group Norms Session 3: Orientation to the Course and Course Materials Session 1: Basic Information, Function and Food Sources of Micronutrients Session 2: Causes, Consequences and Prevention of Micronutrient Deficiencies Session 3: Magnitude of Micronutrient Deficiency Problems Session 1: MSP Goals, Policy and Implementing Guidelines Session 2: Providing Essential MS Package for Infants and Children, Mothers and Other Adults Session 3: Strengthening Health Promotion and Communication for MS Session 1: Delivery of MS in Different Settings Session 2: MS Intervention in Routine Clinic Services Session 1: Delivering Quality MS Services Session 2: Delivering MS Services by Competent and Responsive Service Providers Session 3: Managing Resources and Health Information System Session 4: Supervising Delivery of MS Services
Module 3 The Micronutrient Supplementation Program
Module 4 Enhancing Integration of MS Interventions in Service Delivery Settings
Practicum Session Health Center Module 5 Managing Service Delivery of MS Interventions
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Module 6 Action Planning Session 1: Planning for Improving MSP Implementation Session 2: Harmonizing Action Plans of Service Providers and Supervisors
Training Methodology Participatory teaching-learning methods such as lecture-discussion, small group discussion, role plays, drills/games, practices exercises. One practicum session in the morning will be conducted in selected health centers Evaluation Methods
Main Reference: The Department of Health Micronutrient Supplementation Program - Manual of Operations 2011 Operating Details Participants: Frontline Health Workers RMS, PHNs and MHOs/RHPs Duration: 3.5 days (Live-in). Venue/site: Provisions for adequate space for interactive learning methods like role plays, demonstrations and small group activities. In addition, arrangements with nearby health centers should be made for the one practicum day (Day 3 AM). Source of Funds: _______________________
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Pre-test and Post test Completed work/ outputs during sessions Observation of demonstrated skills Post-training questionnaire
Training Schedule: Refer to the next page.
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xviii Training of Service Providers on Improving Implementation of the MSP
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Module 1: Introductory Sessions
FACILITATOR GUIDE (SESSION PLANS)
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Module 1- Introductory Sessions Session 1: Getting to Know and Forming Teams

OVERVIEW Introducing participants and facilitators is essential in achieving a head start in any training activity. Getting acquainted with the people that one will work with during the course will help participants feel comfortable, help develop confidence with the group and approach the training activities positively. Teamwork has long been recognized as an effective method of improving organizational performance. In the same measure, group learning methods have also been accepted as effective means to achieving learning objectives. OBJECTIVES
METHODOLOGY
ESTIMATED TIME ADVANCE PREPARATION
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At the end of the learning session, the participants will be able to: 1. Get acquainted with each other 2. Disclose information about ones self to others 3. Organize as host teams 4. Agree on the roles and responsibilities of host teams Game: Human Bingo and group discussion 60 minutes Human Bingo cards (Refer to Facilitators Guide Annex 1.1) Instruction sheet (in power point slides or printed in manila paper) PowerPoint slides on Session Objectives
TEACHING-LEARNING PROCESS
TOPIC/TIME Introduction (05 min) METHODS / ACTIVITIES Greet the participants. Explain the objectives of the session. Explain the mechanics of the game Human Bingo with the aid of a human bingo card and an instruction sheet/ projected slides (PowerPoint). Game (10 min) Human Bingo Distribute a copy of the human bingo card (Facilitators Guide Annex 1.1.) to each participant. Give the following instructions: Read first all the descriptions found in your bingo cards boxes/cubes Each participant will approach a person whom you think best fit the descriptions or characteristics written in each of the boxes in your bingo card. The person meeting the description shall print his/her name and sign in the space provided for as acknowledgement. An individual may only sign on the participants BINGO card once. In order to win, an individual must have 5 signatures in a row, diagonally, horizontally or vertically. The individual should shout BINGO once she completes the needed lines. When they hear the word GO, the participants will start roaming around. Once someone shouts: BINGO, everyone returns to their seats and the person must introduce the people who signed his/her BINGO card. Processing (10 min) Request the participants to go back in their seats. Then the facilitator will initiate the group discussion, using the following guide questions: How did you find the activity? What did you discover from your co-participants? What did you discover something new about someone you already know? What are the learning insights that can be drawn from the exercise? After the group discussion, gather all participants in a plenary session.
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TOPIC/TIME Formation of Teams (10 min)
METHODS / ACTIVITIES Lecturette Acknowledge the participation of participants to the activities done and reinforce the importance of the experience and the insights drawn. Explain that participants help make learning fun and effective. In order for each day to run smoothly and make activities exciting, facilitators need the help and active participation of participants to work as host teams for each day. Inform the participants that they were divided into groups following a ratio of 1 facilitator for 7 participants. Present the groupings in plenary. Note: The facilitator should have grouped the participants prior to his/her session. In grouping the participants, ensure that each group is heterogeneous, composed of participants coming from the different municipalities, professions and have varied personalities. Designate a host team for each day. Depending on the needs of the training, host teams can be tasked to help: Lead ice breakers or unfreezing exercises
Orient on the roles/ responsibilities of Host Teams (05 min)
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Ensure that participants are present in the sessions. Set up physical arrangement of training room 1. Share and learn more from each other, and 2. Work together as a team
Recapitulate the activities/learning from the previous days training session Monitor the attendance and observance of participants to group norms
Synthesis (05 min)
Inform the participants that the session is a starting point to get to know each other and to work with one another better. The succeeding activities, exercises and working for outputs in the succeeding days will provide more opportunities for participants to:
Module 1- Introductory Sessions Session 2: Sharing Expectations and Setting Group Norms
OVERVIEW In any human resource development activity, it is important for participants and facilitators to have unity of purpose and common understanding of the training objectives. At the end of the activity, the participants will be able to: 1. Share their expectations about the training 2. Clarify their expectations in relation to the course objectives in terms of: a. Knowledge and skills b. Scope and/or limitations of the course 3. Agree on each participants learning role and the responsibilities 4. Establish group norms to observe during the training week Individual work, Group discussion 40 minutes
OBJECTIVES
METHODOLOGY
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Cartolina (5 colors) cut into meta-card sizes, markers (pentel pens), Manila papers (tear sheets), masking tapes, white board markers, and white board for each group. Prepare numbers 1 to 5 in a bowl enough to make 5 groups.
TOPIC/TIME Introduction (05 min) METHODS / ACTIVITIES Greet the participants. Provide appropriate link with session 1. Explain to the participants the objectives of the session. Individual work (10 minutes). Introduce the initial activity of the session by informing the participants to group based on the groupings presented in session 1. Give each participant at least 5 Meta cards, 1 card per color. Tell participants they can ask for more cards if they have more ideas to write. Give the following Instructions: 1. Ask each participant to think of 1-2 ideas as expectation from this training and write it in the idea/meta cards. Each one will share these ideas within the small group. 2. These expectation/s will include the 5 aspects as follows: 2.1. what (new) knowledge will you personally want to gain 2.2. what (new) skills will you be able to do after the course 2.3. what are your expectations from the facilitators 2.4. what contributions will you expect from co-participants to commit 2.5. what contributions can you personally commit to this training 3. The facilitator will assign a color of idea cards for each aspects of the expectation depending on the available colors during the training. 4. Remind the participants on the general rules of writing on idea/meta cards: 4.1. use only 5-7 words, 4.2. write in BIG, capital letters, 4.3. write one idea per card, and 4.4. be specific 5. Each participant in a group will post his/her expectations to the Manila paper provided for each group. 6. After everyone in the group has presented his/her expectations, the group will review the list and decide what will be the groups expectations to be shared to the big group. 7. Tell the groups to post their groups outputs to the designated poster areas for each of the 5 Idea/Expectation Boards.
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TOPIC/TIME Processing (10 min)
METHODS / ACTIVITIES Clarify the participants expectations about the training by: 1. Reviewing the list of expectations presented 2. Identifying what can be and cannot be achieved by the course 3. Presenting the objectives and scope of the course Recognize the important ideas/expectations presented Explain the limitations and constraints of the course, and the need to focus only the priority work areas in MS program.
Setting Group Norms/ Lecturette Learning agreement Explain the following points (10 min) 1. Learning activities will involve group work
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1. Ask participants to review the list of expectations presented. 5. If there are house rules, these may be added to the list. 7. Clarify from the group if the agreed list is complete or sufficient.
2. Success of the training depends on how each participant performs an activity 3. How group members interact and work with co-participants and with facilitators affect smooth flow of training process. From the results of the discussions on the training expectations presented
2. Ask from each group to mention ways that participants can commit to help to ensure smooth flow of activities. 3. A co-facilitator will write or mark on the board the answers given by the participants. 4. As each participant mentions an item already presented, mark the items to tally ideas.
6. After a sufficient list had been completed, go over each item one-by-one and ask participants if each statement is helpful and/or acceptable or not.
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METHODS / ACTIVITIES 8. With the approval of the group, declare the list as the norms for the group to observe for the duration of the training so that the group can work together effectively. Examples of group norms: Be on time in attendance and in performing work Speak one at a time Be open
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Be attentive and participate actively Be responsible for your learning Be supportive to the learning and development of others Be cooperative Have fun and enjoy Keep cell phones on silent mode Post the final list of norms agreed by the whole group. Synthesis (05 min) Confirm with participants the importance of sharing and unifying training expectations. Inform participants that the details on the course will be presented in the next session
Module 1: Introductory Sessions Session 3: Orientation to the Course and the Course Materials
OVERVIEW The Training of Trainers (TOT) on the Training of Service Providers on Improving Implementation of Micronutrient Supplementation Program is a 5-day course divided into 7 modules, 22 sessions and 1 practicum sessions. It uses a variety of teaching-learning methods including lectures, working in small groups using discussions, role-plays, games, practice exercises and facility-based practice sessions. Participants will progressively develop their competencies in classroom settings and practice them in health centers. This capacity-building activity intends to respond to the needs of trainers/ facilitators to facilitate in the training of service providers to effectively implement the Micronutrient Supplementation Program.
OBJECTIVES
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At the end of the activity, the participants will be able to: 1. Explain the key elements in the course design 1.1. Objectives and content 1.2. Methodology and activities 1.3. Expected outputs/outcomes 1.4. Overall structure of the course 3. Locate from the manual the technical section/contents on MSP Lecture-discussion and game 30 minutes Powepoint presentation of the session objectives
2. Familiarize on the content of the Micronutrient Supplementation Program- Manual of Operations
METHODOLOGY ESTIMATED TIME ADVANCE PREPARATION
Copies of the Training design (Refer to Facilitators Guide pp. xi-xiv) Micronutrient Supplementation Program-Manual of Operations, job aids and other support materials
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TOPIC/TIME Introduction (05 min) METHODS / ACTIVITIES Greet the participants. Recall related information discussed from the previous session such as the participants expectations, course objectives and scope of the course. Explain to the participants the objectives of the session. Course Design (10 minutes) Lecture-Discussion Present the objectives of the session Make a PowerPoint presentation about the Course 1. Objectives and content 2. Methodology and activities 3. Expected outputs/outcomes 4. Overall structure of the course
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MSP-MOP (10 min) Distribute a copy of the MS-MOP to each participant. 3) It will serve as guide to various stakeholders in various sectors.
Engage participants into a discussion about the course, relating the need for the present training to their competence in implementing the MSP. Present the overall schedule and explain the daily schedule-content, activities, preparations needed, etc. Align the expectations with the course objectives and desired outcomes. Introduce the MSP-MOP as the main reference and present the job aids and other support materials. Lecture-discussion Make a presentation on the overview on the Micronutrient Supplementation Program - Manual of Operations
Emphasize the following points 1) The MOP is a guide in implementing the micronutrient supplementation program in compliance with DOH-AO 2010-0010 2) It is aimed at integrating the micronutrient supplementation in the delivery of services for women, mothers and children as outlined in the MNCHN continuum of services based on life stages approach.
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TOPIC/TIME MSP-MOP (10 min)
METHODS / ACTIVITIES Inform participants that the MOP has the following sections: Section 1: The MS Program Guiding Principles, Policy and General Guidelines Section 2: The Essential Micronutrient and Common Deficiencies Section 3: Magnitude of the Micronutrient Deficiency Problems Section 4: Micronutrient Supplementation Interventions Section 5: Delivery of Micronutrient Supplementation Services Section 6: Health Promotion and Communication for Micronutrient Supplementation Program Section 9: Implementation Arrangements The manual aimed to train service providers and local implementers on the management of micronutrient program based on the contents on the MOP Inform participants that throughout the course, they will be using more the MOP and get more familiar with its content. Ask if the participants have question or clarifications about the session. To summarize, inform participants that being clear about the mechanics of the course and familiar with course materials will help the group be focused and be guided in the succeeding sessions.
Synthesis (05 min)
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Annexes for Module 1
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Annex 1.1. Human Bingo Card
Human Bingo Card

Trained on VADIDA-IDD Walks to work Received an award Achieved at least in the past year 95% VAC coverage for 6-59 months last GP round Celebrated her/ his birthday last month
Single
With one under five child
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Knows how to ballroom dance Currently taking iron supplements New Grandma (recently had first grandchild) Working in micronutrient supplementation for less than a year FREE Currently breastfeeding Rode a zip line Never rode a plane Involved in Seen the AO 2007micronutrient 0045 ( ZINC AO) supplementation work in the past 10 years
Fear of riding a boat
About to retire in the next 5 years
Not living in Has a home garden Does not drink soft her/his place of drinks assignment/ work
Married but childless
Knows about AO 2010-0010 (New policy on Micronutrient supplementation)
Trained on CBPMNP
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Annex 1. 2. Matrix on Sharing Expectations and Setting Group Norms

What (new) knowledge will you personally want to gain What (new) skills What are your will you be able to expectations from do after the course the facilitators What contributions will you expect from co-participants to commit What contributions can you personally commit
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MODULE 2: Understanding the Micronutrient Situation

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Module 2 Understanding the Micronutrient Situation Session 1: Basic Information, Functions and Food Sources of Micronutrients
OVERVIEW Micronutrients (vitamins and minerals) are substances that enable the body to produce enzymes, hormones and other substances essential for proper growth and development. Vitamin A, iron, folic acid and iodine, are important public health concerns because their lack represents major threats to the health and development of populations, particularly in children and pregnant women in low-income communities. The role of zinc as an add-on in the management of diarrhea has also been established.
OBJECTIVES
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At the end of the session, participants can: 1. Explain the basic information on micronutrients 2. Discuss the functions of micronutrients in the body 2.1. Vitamin A 2.2. Iron 2.3. Folic Acid 2.4. Iodine 2.5. Zinc 3. Identify the sources of micronutrients Lecture discussion , question and answer 45 minutes Read MSP-MOP pp. 5 to 17 and other references Questions and guidelines for the session exercises PowerPoint on the session objectives and technical inputs.
Micronutrients are taken from food since the body could not produce them.
Worksheets, markers, manila paper and other supplies for the exercises
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Module 2 Understanding the Micronutrient Situation Session 1: Basic Information, Functions and Food Sources of Micronutrients
TEACHING-LEARNING PROCESS TOPIC/TIME Introduction (05 min) METHODS / ACTIVITIES Greet the participants. Ask 2-3 participants about their knowledge on Micronutrients in the scale of 1-3, 3 being the highest. Make a brief overview on the scope of the session by saying that the session will discuss micronutrients as vitamins and minerals that enable the body to produce enzymes, hormones and other substances essential for proper growth and development. Vitamin A, iron, folic acid and iodine are the four most important micronutrients as their deficiency brings major threat to public health particularly to children and pregnant women. Introduce the session by presenting the session objectives. Ask participants When you hear micronutrients, what comes to your mind? The possible answers maybe : o Examples of micronutrients are vitamin A, iron, iodine, folate, zinc o Micronutrients can be vitamins and minerals o Micronutrients are needed by the body in small amounts o Lack of micronutrients in the body may lead to illnesses that can be detrimental to the health of a person. o Micronutrients are supplied by food because they are not produced by the body Tell: Use participants responses to confirm and emphasize the importance to have accurate information about micronutrients so that the HW can: 1. Explain better to clients the importance of micronutrients. 2. Help clients plan ways in promoting good health and nutrition particularly those with risk factors and when in certain predisposed life stages. Lecture-discussion Make a presentation on the basic information on Micronutrients. Use slides 7-9. Ask participants to share inputs about the topic focusing on: 1. Significant role and functions of micronutrients in ones health 2. Immediate problems when absent or deficient Inform participants that discussions on the topic will continue with the small group exercise.
Micronutrients (10 min)
DRAFT
Basic Information on MN (10 min)
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TOPIC/TIME
METHODS / ACTIVITIES
Exercises on Functions Introduction to the exercise/group work and Sources of MN The group exercise will focused on roles/functions in the body and food sources (15 min) of micronutrients. Group work/exercise Divide the participants into 5. Each group will be assigned a particular micronutrient to work on. Tell participants the following instructions: 1. The group is given 10 minutes to complete the task
DRAFT
Functions Food Sources
2. Every member must participate to accomplish the group task by answering these questions: 2.1.name at least 2 functions of each MN in the body 2.2.name at least 2 rich food sources of each MN 3. Write down all your answers in the idea card and post it in the worksheet (manila paper) provided 4. The group facilitator from other groups will be assigned to validate the correctness of the other groups output. Group Exercise 1: Functions and Food Sources of Micronutrients Micronutrient: ____________
A facilitator will be assigned to assist each group in accomplishing the task. After 10 minutes, the assigned facilitator for the group will validate the correctness of the other groups output. In plenary, request each group to present their final output and share difficulty in during the group work to be discussed in plenary. After the presentation per micronutrient, the main facilitator can point out the other functions and food sources of the micronutrient not identified by the group and correct any misinformation on the functions and food sources of the micronutrients that may arise in the presentations.
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TOPIC/TIME
METHODS / ACTIVITIES Declare the outputs of each group as satisfactory or needing improvements according to the criteria of speed and accuracy of answers. Acknowledge and compliment the active participation of all the groups and the participants in each group. Emphasize the importance of the following knowledge to effectively assist clients in meeting their needs and preventing MN problems: 1. Functions of the MNs and the 2. Food sources of each of the MNs.
Synthesis (05 min)
DRAFT
In closing the session, present the summary of functions and food sources of micronutrients Ask a member of each group to share about their experience and the important learning gained from Session 1 focusing on new things discovered. Ask participants if there are questions and/or clarifications they want to raise. Inform participants that this sessions learning will be further addressed in the succeeding 2 sessions as we focus on problems on MS.
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Module 1: Introductory Sessions Session 2: Causes, Consequences and Prevention of Micronutrient Deficiencies
OVERVIEW Micronutrient deficiencies are caused by inadequate food intake, decline of breastfeeding, frequent illness, high need for micronutrients and made worse during disasters/emergencies. Lack of vitamin A, iron, folate, iodine presents major threats to the health and development of populations, particularly in children and pregnant women in low-income communities. While only tiny amounts are needed, the consequences of their absence or deficiency are severe.
OBJECTIVES
DRAFT
Lecture discussion , group discussion/work 60 minutes Read MSP-MOP pp. 5 to 17 and other references Questions and guidelines for the exercises PowerPoint on the session objectives and technical inputs
Micronutrient deficiencies can be prevented through adequate dietary measures and other health, nutrition and environmental interventions. At the end of the session, participants can: 1. Enumerate the different micronutrient deficiencies 2. Identify the direct causes of micronutrient deficiencies and diarrhea 3. Identify population groups that are most vulnerable/high risk for specific MN deficiencies and diarrhea 4. Discuss consequences of specific MN deficiency and diarrhea for each population group 5. Identify ways to prevent MN deficiencies and diarrhea
Sample Pictures of clients with signs and symptoms of MN deficiencies
Worksheets, markers, manila papers, masking tape for the exercises, yellow idea cards where the population groups are written, one group per card
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TOPIC/TIME Introduction (15 min) METHODS / ACTIVITIES Greet the participants. Review relevant facts/information from Session 1. Introduce the session by presenting the session objectives and a short overview. Ask participants from their past knowledge, to name problems resulting from Micronutrient deficiencies. Possible answers may be anemia, blindness, frequent illness such as diarrhea, etc.
MN deficiencies and Diarrhea, vulnerable population, direct causes, consequences, prevention of deficiency and illness (35 min)
DRAFT
Acknowledge participants for sharing their answers. Group discussion/exercises a. Group 1- Vitamin A deficiency b. Group 2- Iron Deficiency Anemia c. Group 3- Iodine Deficiency Disorder d. Group 4- Folate Deficiency e. Group 5- Diarrhea a. Vulnerable population groups in column 1: b. Direct cause/s of MN deficiency/diarrhea in column 2; c. Consequences of MN deficiency /diarrhea in column 3; and d. Ways to prevent MN deficiency/diarrhea in column 4
Use participants responses to link with sessions objectives and topics. Tell participants that group exercises will be done to further appreciate effects of Micronutrient deficiency.
1. Divide the participants into small groups and assign to each group a specific problem to be addressed through group discussion. Group assignment maybe:
Each group will select a leader to lead in the discussion and ensure that the assigned tasks are accomplished within the time allotted. 2. Using the format/matrix shown below, each group will accomplish the tasks for each of the column for the assigned MN deficiency/diarrhea:
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TOPIC/TIME METHODS / ACTIVITIES MN deficiencies and Diarrhea, vulnerable Group Exercise : Identify vulnerable/most affected groups, causes and population, direct consequences and ways to prevent Deficiencies and Diarrhea causes, consequences, MN Deficiency:______________ prevention of deficiency and illness Vulnerable/ Consequences of Ways to prevent (35 min) most affected Causes MN deficiency/ MN deficiencies (at risk) (2) diarrhea and Diarrhea (1) (3) (4)
DRAFT
Processing Facilitate a short discussion
3. Each group member should help check and counter-check each entry to make sure that all the entries are correct. This step may require more discussion among the members to arrive at correct entries. 4. When a group has completed, the group members will clap their hands three times to let the facilitator know that they are done.
5. When all the groups had finished their outputs, the review of the outputs of each group will proceed in plenary. 6. This activity is given 15 minutes to complete. Each group is given 2 minutes to present the group output by reporting what is written in the manila paper only to save time. 7. After each group presentation, the Main facilitator may reinforce inputs on the topics by providing and clarifying technical information. The group facilitators may also be requested to provide additional information.
1. Ask participants from the different groups to share learning insights about the exercises 2. Encourage to ask questions and/or clarifications about the topics discussed.
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TOPIC/TIME Synthesis (10 min)
METHODS / ACTIVITIES Highlight these key points: All people need micronutrients, but certain life stages and conditions predispose some population groups to MN deficiency. The vulnerable groups are infants, children, pregnant and lactating women. In general, micronutrient deficiencies are caused by inadequate dietary intake, poor absorption due t infections and increased needs due to infections or physiological state MN deficiency is preventable
DRAFT
Simple and effective interventions can be provided and/or accessed like micronutrient supplementation, food fortification, Breastfeeding, complementary feeding, dietary diversification. These can be supported by the delivery of other health services like immunization, deworming, water, sanitation and hygiene (WASH), family planning and health and nutrition promotion. Important implications to their functions in their work places. Inform participants that this sessions learning will be further addressed in the succeeding sessions.
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Module 2 Understanding the Micronutrient Situation Session 3: Magnitude of Micronutrient Deficiency Problems
OVERVIEW Vitamin A deficiency, iron deficiency anemia and iodine deficiency disorders are problems in the Philippines that greatly affect infants, preschoolers, pregnant and lactating mothers. Micronutrient deficiencies have serious health consequences for individuals and negative impacts on their development and economic productivity. Micronutrient deficiencies in Vitamin A, iron and iodine have reached the levels of public health significance. Faced with economic, agricultural and challenges like emergencies/disasters in many areas, the problem increases further in magnitude due to lack of food and high incidence of infections due to congestion and poor sanitary environment and hygiene. At the end of the session, participants can:
OBJECTIVES
DRAFT
3. Classify factors and challenges presented. 4. Identify possible solutions to the barriers/gaps on MS program Lecture discussion, group discussion, workshop 90 minutes Read MSP-MOP pp. 18 to 27, annex 16 and other references Workshop guidelines and worksheets Markers, manila paper/flipchart, masking tapes PowerPoint on the session objectives and technical inputs Selected questions relevant to RHM level.
1. Discuss the status of Micronutrient Supplementation in relation to: 1.1. Prevalence rates of MN deficiencies 1.2. Performance coverage of Micronutrient Supplementation services 1.3. Level of public health significance 2. Enumerate the relevant factors/challenges common in their areas (municipal/ barangay) that present as barriers to Micronutrient Supplementation service goals and objectives.
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TOPIC/TIME Introduction (10 min) METHODS / ACTIVITIES Greet the participants. Review with participants the problems on MN deficiencies identified/ discussed in Session 2. From among the problems on MN deficiencies, ask participants: 1. What is/are the magnitude of each deficiency problem?
Current Status of MN Lecture-Discussion deficiencies (20 min) Tell: It is important for health workers to be updated on the current status of the problem on MN deficiency not only in their areas and also to the provincial/ regional areas where they are situated/belong. The present status is often used as the starting/take-off points in planning for improvements in provision of services. Present: PowerPoint slides on the current status of MN deficiencies and their contributory factors at the National/regional level. Emphasize to the participants that the micronutrient deficiency status presented are limited to the national and sometimes regional level only. This is because nutrition surveys are very expensive to conduct and a large number of people are needed to be surveyed to get a provincial or municipal prevalence. In the absence of a prevalence survey on micronutrient deficiencies most especially in the barangay, municipal, city or provincial levels, proxy indicators can be used to determine the risk for micronutrient deficiencies of a community or area. These proxy indicators include nutritional status, low birth weight, immunization coverage, supplementation coverage, illnesses like diarrhea, measles, access to health services and socio economic indicators. Present selected service performance coverage indicators for a sample municipality N. Inform the participants that additional profile of the municipality will be given as handout for the next activity ( situational analysis)
DRAFT
Compliment responses appropriately Present the session objectives
2. What were/are the possible reasons that contributed significantly to the magnitude of such problems?
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TOPIC/TIME
Contributory Factors/ Brainstorming /workshop/group discussion barriers to MSP implementation Tell: Let us now look deeper into the factors that contribute to the MN (30 min) deficiencies and the barriers in Micronutrient Supplementation Program implementation. o You will be working in small groups with a facilitator. The group compositions will be maintained for the succeeding activities, including the practicum sessions. o Identify factors and barriers that contributed to the micronutrient supplementation coverage of the Municipal N. Focus barriers that you can do something about instead of traditional barriers like TEV and high population, etc. o Some guide questions in Annex 6 of MOP which can be used to look into the situation of the municipality presented. o Distribute copies of the case scenario (Facilitators Guide Annex 2.3) and the form (Facilitators Guide Annex 2.4) shown below to participants. Provide each small group with flipchart/manila paper and markers. Workshop : Identification of Factors/Barriers and Possible Solutions Name of Sample Mun/Brgy___ Region: Factors/Barriers Possible Solutions
DRAFT
Guide questions/ Instructions: 1. The group is given 15 minutes to accomplish the workshop outputs. 2. Base on the given case scenario in Municipal N/barangay P (province/ municipality/barangay), what are the factors/barriers that contribute to high risk for Micronutrient deficiencies? 3. Apply the method of brainstorming for participants to come up with a list of these factors/barriers. 4. Remind participants some important rules in brainstorming: 4.1 The best output has a sufficient list of ideas from a wide range of perspective. 4.2 All ideas are accepted there is no right and wrong answers 4.3 Do not limit/fence-in the responses/ideas shared 4.4 Generating as many ideas possible is the idea of brainstorming.
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TOPIC/TIME
METHODS / ACTIVITIES 5. From your group list, identify those factors and barriers that you think have strong effects to risk of MN deficiencies in your area. 6. When identifying them, do not limit to those expressed by the clients. Include other factors that most service providers are encountering. 7. Clarify whether the expected outputs and the instructions are clear. 8. Remind the groups that clarifications and other concerns may be referred to their group facilitator.
DRAFT
A. Client-related (C) B. Service provider-related (SP) C. Health system-related (HS) D. Others, specify (O) Note: If low coverage, what are the barriers, if high- how to sustain WS outputs (20 min)
While participants are working, facilitators provide guidance to focus on barriers and challenges related to clients and service providers, without ignoring other contributory factors that contribute to MN deficiencies. Ensure that guide questions in Annex 6 are utilized for the brainstorming. After noting a substantial responses in their papers, mark the list according to the following category:
Fill-up the second column with possible solutions according to the identified factors/barriers to Micronutrient Supplementation Program
Select a member of the group to present the outputs in the plenary session. Plenary Discussion After noting that all groups have completed WS 1, invite everyone to a plenary session for presentation of each groups outputs. Presentation of WS Outputs: Ask for a volunteer reporter from any group to make the first presentation Encourage all participants to listen and focus their attention to the outputs presented. Inform the group that the open forum shall be conducted after all the groups had presented. Encourage participants to take note/write down their questions
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TOPIC/TIME
METHODS / ACTIVITIES Facilitate the WS presentation for all group presentations Encourage participants to ask questions to the presenters. The facilitator need to prepare questions to initiate and/or strengthen the outputs. Based on the presentations, state that the results will show that most of the barriers and challenges relate more to: e.g. clients and service providers (depending on the results of the WS). Highlight commonalities and/or differences of results between the different groups.
Synthesis (10 min)
DRAFT
Synthesize by telling that: 1. Clients and their families with adequate information on MS.
Recognize/acknowledge the work of all the groups and thank them for everyones participation.
In general, factors/barriers to success in MS implementation can have workable interventions. Majority of the causes/barriers identified can be modified by providing:
2. Health workers with adequate resources, technical updates and supportive supervision focused on MSP. Ask 2-3 participants to share important learning insights about the topics discussed and/or raise questions and/or clarifications. Inform participants that this sessions learning will be further addressed in the succeeding / future sessions.
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DRAFT
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DRAFT
Annex 2. 1. Matrix on Functions and Food Sources of Micronutrients

Functions and Sources of Micronutrients Micronutrient: ___________________ Functions Food Sources
DRAFT
34
Annex 2.2. Matrix on Vulnerable/ most affected (at risk) Causes, Consequences and Prevention of Micronutrient Deficiencies /Diarrhea
MN Deficiencies: ________________________ Vulnerable/ most affected (at risk) (1)
Causes (2)
Consequences of MN deficiency/diarrhea (3)
Ways to prevent MN deficiencies and Diarrhea (4)
DRAFT
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Annex 2.3. Case Scenario on Magnitude of Micronutrient Deficiency Problem

Case profile: Municipal N Comprised of twenty eight (28) barangays and 40 sitios. Total population - 67,365 in 2007 Of the 28 barangays, Barangay P which is the town proper has the highest population density with 2,338 persons per square kilometer. 68.5 percent of the total land area is predominantly occupied by agricultural lands utilized in various crops like coconut, banana, rice, corn, fruit crops, etc. Health Manpower and Facilities With 2 PHN and 18 RHMs, but no doctor staff With 22 BHS with OPB and TB-DOTS certified facilities in the municipalities No BEmONC facility in the province No RHU is MCP accredited No BHS with safe birthing facility
Health status 1. Maternal Deaths Had one (1) maternal death in 2006 and four (4) in 2008 Causes of maternal deaths-postpartum hemorrhage, hypertensive disorder and puerperal sepsis. In 2009, 97% of the postpartum women in the province received VAC and 99 % in Barangay P. In Municipal N, 88% of pregnant women were given complete iron and 93% in Barangay N. 2. Under five Mortality There were 4 under five deaths in the municipality in 2009, but no death from Barangay P. Leading causes remain the infectious diseases such as pneumonia and diarrhea. 3. Immunization and Nutrition FIC 92.4 % in 2009, an increase from 77.5% in 2007 to 88 percent in 2008. Municipal N is a green banner awardee with 1.95% prevalence of underweight. Provincial/municipal coverage for vitamin A supplementation is high but below national target. Deworming coverage for the municipality has achieved the national target of 85% with 93% and 91 % coverage for April and October. Two barangays with coverage of 73% and 74%. 4. General Health Seeking Behavior Only 25% of the population consulted in health facilities 50% of the population from the poblacion area consulted in health facilities 5. External Factors Province is among the poorer provinces in the country With some inaccessible areas for health services at the health centers. Many areas have access to health services (except in 5 areas which can be reached by foot). The province is a calamity prone area, with 4 incidents of landslides and flashfloods in 2008.
DRAFT
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Annex 2.4. Matrix on Identification of Factors/Barriers and Possible Solutions

Name of Sample Municipality/Barangay: Region:
Factors/Barriers
Possible Solutions
DRAFT
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Annex 2.5. Maternal and Child Health Indicators

Child Health Indicators (2009)
Indicators 6-11 months given VAS (April) 6-11 months given VAS (October) 12-59 months given VAS (April) 12-59 months given VAS (October) 2-59 months given iron supplements Diarrhea cases given ORS (0-59 months) Diarrhea cases given ORS and Zinc (0-59 months 100% Performance Standard 95% 95% 95% 95% Region D % 100 96 94 95 83 62 9 Province C % 90 89 88 88 93 50 15 Municipa lity N % 100 101 94 90 No Data No Data No Data Brgy. P % 99 95 87 90 No Data No Data No Data
DRAFT
Child Health Indicators
Performance Standard Region D % 77 47 6 Province C % Indicators Municipa lity N % No Data No Data No Data No Data 74 93 91 Brgy. P % High risk cases given VAS LBW given iron supplements LBW infants 68 56 8 No Data No Data No Data No Data No Data 73 74 FIC (0-11 months fully immunized) Infants exclusively breastfed Given Deworming meds (April) Given Deworming meds (October) 85% 85% 95% 87 69 86 88 83 59 84 85
Maternal Health Indicators

Performance Standard 80% 80% 80% Region D % 63 21 17 Province C % 61 24 24 Municip ality N % 97 88 74 Brgy. P % 99 93 No Data
Indicators PP women given VAS Pregnant women given iron Pregnant women 4 ANC visits
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Module 3: The Micronutrient Supplementation Program

DRAFT
DRAFT
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Module 3 The Micronutrient Supplementation Program (MSP) Session 1: MSP Goals, Policy and Implementing Guidelines
OVERVIEW Significant steps had been taken in reducing the prevalence of micronutrient deficiencies that will contribute to the achievement of the 2015 Millennium Development Goals (MDGs) of reducing under-five and maternal deaths. The Department of Health issued the Administrative Order No. 2010-0010 in April 19, 2010 with the aim to strengthen and accelerate the implementation of the MSP. The revised AO 119 incorporates relevant provisions of AO Nos. 2007-0045 (Zinc) and 2008-0029 (MNCHN). The new AO provides policy direction and guidelines on MSP.
OBJECTIVES
DRAFT
At the end of this session, the participants will be able to: 1. Enumerate the national goals and targets for the MS program 2. Discuss the main provisions of DOH-AO 2010-0010 2.1. Rationale, strategies and objectives 2.2. Guiding principles 2.3. General guidelines Lecture discussion, game 65 minutes Read DOH-AO No 2010-0010 in MSP-MOP Annex 1 pp. 105 to 112 Read MSP-MOP pp. 1 to 4 Latest data/figures on the MS national goals and targets
With the policy declaration of DOH-AO 2010-0010, a Manual of Operations was developed to provide implementing guidelines for various stakeholders.
3. Identify the sections in the Manual of Operations (MOP) that are useful for specific situations. 4. Explain the changes in the new MS packages based on the technical evidence 5. Explain the uses and/or importance of the MOP guidelines in improving the performance of health personnel at various levels. METHODOLOGY ESTIMATED TIME ADVANCE PREPARATION
Instructions, questions and key answers for the game/exercise (Refer to Facilitators Guide Annex 3.1a and 3.1b) Workshop matrix, marker, newsprint, masking tape, whiteboard 41
TOPIC/TIME Introduction (05 min) METHODS / ACTIVITIES Greet the participants. Ask the participants what they know about the previous MS guideline. Link the factors on MN deficiencies identified in Module 2, specifically on the Health Service Provider level, with the governments response - the MS program (AO 2010-0010) and its implementing guidelines (MOP). Introduce the session and present the session objectives. National goals, Lecture-discussion objectives and targets on MSP Engage participants in a discussion on the following: (10 min) 1. stating the national health goals and objectives set by the DOH 2. relating MSP goals and objectives to the relevant MDGs
DRAFT
Provide additional inputs to highlight the significant role of: 1. LGUs contributions to service performance/success of MSP 2. MSP in achieving national health and development goals. Lecture-discussion
Acknowledge correct responses and clarify incorrect responses Power point Presentation on MSP: National goals, objectives and targets Referring to the outputs in previous session, ask participants from different provinces/city and/or municipality their opinions on how close/far are their performance from the set goals and targets.
DOH-AO No. 20100010 (30 min)
Provide appropriate link from the discussion on the MSP goals and targets to the creation of DOH-AO 2010-0010. Ask who among the participants have seen or read the AO on 2010-0010. Ask 2-3 participants to enumerate and explain one (1) of the seven (7) guiding principles in micronutrient supplementation. The facilitator should write the responses on the board.
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TOPIC/TIME
METHODS / ACTIVITIES The facilitator will ensure to supplement the explanation of the participants and provide an example for each guiding principle for better understanding. The facilitator may use the table below as guide. Guiding Principles Rights-Based Description The government is obliged to assist the poor and marginalized to develop capacity or facilitate access to MS Performs in health service delivery, governance, financing and regulations shall be installed for clients to benefit from the delivery of quality and adequate micronutrient supplements Example Reaching out to IPs thru education and MS; Proper coordination with tribal leaders - Procurement of micronutrient supplements included in the procurement plan of the Municipality/ Barangay
DRAFT
Systems Approach Life-Cycle Based Interventions Micronutrient deficiencies early in life has impact on the health, nutritional status, economic productivity in adult life and the next generation Addition of other interventions to MS provision will ensure maximum results Studies have shown that micronutrient supplementation is one of the most effective intervention Complementation of Interventions Evidence Based interventions and Approaches
- MNCHN - PMC seminar - RPM classes - Iron Supp. (10yo-49yo)
Deworming + Food + MS
-NNS Result -Rapid Coverage assessment/ high or low performance
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TOPIC/TIME
METHODS / ACTIVITIES Guiding Principles Integrated Service Delivery Description Example
Including micronutrient MS + growth monitoring supplementation during MS + EPI premarital counseling is an example Give top priority to population groups with least capacity to access MS and those most vulnerable to the deficiency - Vulnerable groups regardless of geographical location, economic status, sex, age, disaster victims - Pregnant lactating women PS/SC in upland areas and poorer families - Geographical Isolated depressed areas (GIDA) are given being prioritized
Equity
DRAFT
1. Divide participants into 5 groups using the previous groupings. 2. Each group will form a circle or huddle.
The facilitator may opt to ask the participants for additional example to illustrate the guiding principle. Before proceeding to the other part of the AO, inform the participants that they will have an activity. Game: Divide participants into 5 groups the facilitator will give the instruction for the game. Instructions:
3. Each group is given metacards and pentel pens for them to write their answers. 4. The game master will read out a question pertaining to the general guidelines on Micronutrient supplementation. The group should come up with a consensus on the best answer and write the metacards provided. (Refer to Facilitators Guide Annex 3.1a-1b for the questions and answer keys).
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TOPIC/TIME
METHODS / ACTIVITIES 5. When the facilitator says cards up, one of the group members should raise the groups answer. 6. All those who showed the correct answer will get one point. Those with correct explanation will get another point. 7. After all questions were asked, the group with the highest point will be declared the winner. As a review of the answers, the facilitator will provide as short powerpoint presentation on the general guidelines on micronutrient supplementation.
The MSP-MOP (10 min)
DRAFT
Lecture-Discussion Link the policy discussed earlier (AO 2010-0010) to the topic.
The facilitator informs the participants that in addition to the guiding principles and general guidelines on micronutrient supplementation, the AO No. 2010 0010 also contains the roles and responsibilities of various stakeholders involved in implementing micronutrient interventions in the country. Refer to annex 1 of the manual of operations which will be distributed to them.
Explain that a MOP is a tool to guide health service providers in the implementation of the policy. Tell participants to open their copy of the MOP, as you go through the outline in the Table of Contents, orienting them to each of the sections. Ask participants if they have questions and/or clarifications on the topic. Inform participants that they will have ample time to read the MOP on their own time and pace.
Synthesis (05 min)
Emphasize the value/importance of the AO and MOP for MS program. Being aware and familiar with these documents will help HWs to: 1. Help clients take positive steps to seek/avail of MS services, and 2. Help advocate for support to the MS program from various partners. Note: 1 & 2 need to be emphasized in the processing and synthesis Inform participants that they will have more opportunities to use the contents of the MOP in the succeeding sessions and apply during practice and practicum sessions.
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Module 3 The Micronutrient Supplementation Program Session 2: Providing Essential MS Package for Infants and Children, Women, Mothers and Other Adults
OVERVIEW Micronutrient supplementation has been proven effective as an intervention in addressing micronutrient deficiency among vulnerable population groups. All people need micronutrients, but certain life stages and conditions predispose some population groups more to MN deficiency. Thus, MS intervention package vary according to the specific needs, requirements and conditions of the different population groups. Health Service Providers should understand the effectiveness of MS as an intervention that must be provided to the identified priority groups or those w ith physiological or clinical conditions and the possible side effects of MS. Session 3 will focus on the Essential MS Packages for infants and children, women, mothers and other adult clients. At the end of this session, the participants will be able to:
OBJECTIVES
DRAFT
1. Review the technical basis of micronutrient supplementation 4. Explain contraindications and side effects of MS Lecture discussion, question and answer, oral drill 60 minutes
2. The general guidelines in selecting age-appropriate MS package for: 2.1. Infants 0-11 months 2.2. Children 12-59 months old (1-<5years old) 2.3. Children 5-9 years old 2.4. Female adolescents 10-14 years old 3. Determine the correct MS intervention as preventive or therapeutic doses by specific client profile during life events: 3.1. Normal conditions 3.2. Emergency situations
Read MSP-MOP pp. 28 to 43 and DOH-AO No 2010-0010 Annex 1 pp. 105 to 112 25 questions with answer keys for Oral drill (Refer to Facilitators Guide Annex 3.2)
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TOPIC/TIME Introduction (05 min) Greet the participants. Ask participants questions or remarks in relation to the previous sessions. Introduce the session and present the session objectives. MS Package in Infants, Tell: Given the effectives of micronutrients discussed in module 2 the DOH has children come up with MS packages that should be given to infants, children, and adult and adults (45 min) METHODS / ACTIVITIES
DRAFT
Lecture-discussion
population groups to prevent and control micronutrient deficiency and increasing chances of survival.
Conduct a lecture-discussion focusing on the following essential information: 1. All people need micronutrients to meet the requirements to sustain physiologic functions and processes in the body. 2. Certain life stages and conditions predispose some population groups to MN deficiency 3. For infants and children, there is generally a higher MN requirements compared to adults, to meet their growth and developmental needs. 4. Other factors predispose infants and children more to MN deficiency (illnesses, poor infant and young child feeding practices, family, domestic and environmental conditions, etc.) 5. In like manner, some life stages, conditions and factors predispose some adults vulnerable to MN deficiency (age, illnesses, eating practices, family, domestic and environmental conditions, etc.) 6. MS intervention package need to vary based on the needs, requirements and conditions of the different population groups 7. Contraindications and side effects of MS in infants, children and adult population groups. A powerpoint presentation on the general guidelines in implementing age appropriate MS package Tell participants that for each to be better familiar with the current Essential MS packages for infants and children, women and other adult clients an oral drill will be conducted in small group sessions. Inform the participants to go to their group for the activity. A drill works best when chairs are arranged in a circle.
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TOPIC/TIME
METHODS / ACTIVITIES Oral Drill in Small groups (If time becomes limited, conduct the Oral Drill as part of the recap. The following are guides for the group facilitator for the conduct of Oral Drill. Prior to the start of the session, the group facilitator should have a copy of the 25 questions with key answers for the Oral Drill (Facilitators Guide Annex 3.2). Each group facilitator will conduct a 15-minute oral drill on the following: 1. Identifying the correct MS package 2. Stating correct dosages, preparation and duration of MS intervention
DRAFT
Synthesis (10 min) Inform participants that:
Provide the participants with the following instructions for the oral drill: 1. Tell them that a drill is not a test. It is an opportunity to practice a task or procedure to develop speed and confidence. 2. Each one may use their MOP to search for the answers to the drill questions. 3. Participants will be given 10 minutes to familiarize with the MOP before starting the drill. 4. A participant is given 2 seconds to give the answer to the question. The facilitator will ask the question directly to each participant in the group to answer in a round-robin fashion. If the participant cannot answer the question or answers incorrectly, ask the same question to the next participant. Continue asking questions to participants in order, going around the circle. Keep the pace lively and the mood cheerful. Congratulate the participants as they improve in their ability to answer correctly and/or more quickly. Summarize the activity by asking participants the following questions: 1. Which questions were easy? Which were difficult or vague? 2. What change/es did you notice in the new MS protocol? 3. When you go back to your work station, are there changes that you will do in implementing the MS program packages?
1. They should provide more time to read again and practice how to use/apply guidelines in providing MS packages to various population groups. 2. There will be more discussions about the topics during the practice and practicum sessions. 3. The next session will focus on providing health messages to clients when delivering MS services and when advocating for MSP to stakeholders.
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Module 3 The Micronutrient Supplementation Program Session 3: Strengthening Health Promotion and Communication for MS
OVERVIEW Health promotion is the process of enabling people to increase control over the determinants of health and thereby improve their health. Participation is essential to sustain health promotion action. Health communication is a key strategy to inform the public about health concerns and to maintain important health issues on the public agenda. [Reference: adapted from Communication, Education and Participation: A Framework and Guide to Action. WHO (AMRO/PAHO), Washington, 1996] HP uses various communication strategies to inform and influence the way clients think, feel, behave and make informed decisions about their health.
OBJECTIVES
DRAFT
At the end of this session, the participants will be able to: 1. Define health promotion and communication 2. Discuss the following: 2.1. Goals of health promotion and communication 2.2. 5 Action Areas of Health Promotion 2.3. Strategies of Health Promotion 3. Discuss Communication activities, tools and key messages 4. Apply strategies and key MS messages to target audience 4.1 Barangay Captain 4.2 Partners/stakeholders 4.3 Beneficiaries Lecture-discussion, role play and small group discussion 75 minutes
Good communication is essential to health care. Effectively communicating with clients result in significant benefits for both the health care providers and the clients. Conversely, poor communication can yield disastrous results to both. For MS interventions to succeed, it is important that communities become involved as partners in promoting the program for improved family practices on nutrition and must be supported by supportive community environment.
Readings/review on MSP-MOP pp. 53 to 73, and annexes 6-9 pp. 152 to 171 Powerpoint presentations on: Session Objectives and technical inputs Scenarios with key answers for the group work (Facilitators Guide Annex 3.3a)
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TOPIC/TIME Introduction (05 min) METHODS / ACTIVITIES Greet the participants. Ask participants questions about their experiences and/or activities in HPC being implemented in their health facilities and communities. Introduce the session and present the objectives. Goals & principles of Lecture-Discussion HPC (10 min) Use the relevant responses of participants to link to the new lesson.
Strategies and key messages per target audience (30 min)
DRAFT
1. Present the HPC goals and principles 2. Link the goals to the MS situation described in Module 2. Socialized discussion Discuss the 5 Action Areas of Health Promotion Discuss the messages from the MOP for various target audiences.
3.Discuss each principle briefly and give examples of its application in MSP
Discuss the HPC Strategies namely, advocacy, social mobilization and communication. Focus on the communication to further discuss communication activities and tools
Stress to the participants that the messages are all important to the performance of the desired behaviour of a particular target audience. Unnecessary messages or nice to know messages need not be communicated to minimize confusion on the part of the target audience. Explain that not all the messages need to be communicated to the target audience at one sitting or one IPC session. It will depend on the current concerns and needs of the client, hence, it is very critical for the health provider to listen carefully to the client and discuss the problem to be able to provide the appropriate messages.
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TOPIC/TIME Strategies of HPC (30 min) and Key MS messages for clients
METHODS / ACTIVITIES Lecture-Discussion Small group discussion and creative presentation Divide the participants into 5 groups. Each group will be assigned a strategy for a specific target audience to promote MS. Give the following instructions: 1. A case will be provided for discussion (Facilitators Guide Annex 3.3a) 2. Based on the case scenario, the group will identify and discuss the strategy and key messages on MS that are appropriate for the clients general profile and specific condition 3. In plenary, each group report through a role play. 4. Other groups will be asked to provide constructive comments and suggestions on what was portrayed. Summarize the main points discussed by presenting the powerpoint presentation. Link the session to the next session and future sessions.
Synthesis (05 min)
DRAFT
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DRAFT
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DRAFT
Annex 3.1a. Questions on MSP General Guidelines

1. What situations or conditions should micronutrient supplementation be given? 2. What are the five (5) population groups to be prioritized for Micronutrient Supplementation? 3. When micronutrient supplementation is recommended for the Children 5-9 years old, adult males < 50 years old, and Adults, > 50 years old? 4. What should be followed/ observed in giving micronutrient supplements to clients? 5. What ways/ places can we deliver MS aside from health facilities to widen reach and coverage? 6. What areas in implementing micronutrient supplementation at the LGU level should be improved? 7. In what way shall financing for micronutrient supplementation be secured and sustained at the local level? 8. How will you improve data recording and reporting in your health facility? 9. What should be the focus of promoting Micronutrient Supplementation?
10. What are the ways to improve the monitoring and supervision of the MS program?
DRAFT
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Annex 3.1b. Answer Keys to Question on General Guidelines

1. What situations or conditions should micronutrient supplementation be given? Answers: Micronutrient micronutrient supplementation shall be adopted as an intervention to address micronutrient malnutrition in any of the following conditions: a. prevalence of micronutrient malnutrition for a particular group or of the entire country is at a level of public health significance b. micronutrient needs of population groups cannot be met through current diets and inadequate use of fortified foods c. use of micronutrient supplements has been proven to be safe and effective in improving health at each stage in the life-cycle and on the next generation d. in times of disasters or emergencies e. in areas that are endemic to malaria and schistosomiasis f. when a person is diagnosed to be deficient in a micronutrient 2. What are the five (5) population groups to be prioritized for Micronutrient Supplementation? Answers: low birth weight infants, 6-59 months old children, pregnant and lactating women, female adolescents ( 10-14 y.o. old), and non-pregnant/non-lactating women of reproductive age(15-49 years old) 3. When is micronutrient supplementation recommended for the Children, 5-9 years old, Adult males < 50 years old, and Adults, > 50 years old? Answer: When deficiency exist in the individual. 4. What should be followed/ observed in giving micronutrient supplements to clients? Answer: right dosage, timing, and frequency and duration 5. What ways/ places can we deliver MS aside from health facilities to widen reach and coverage? Answer: Integrate into existing Maternal, Newborn and Child Health and Nutrition (MNCHN) service delivery channels as well as in schools and workplaces 6. What areas in implementing micronutrient supplementation at the LGU level should be i mproved? Answer: diagnosis, administration of micronutrient supplements, counseling, promotion, systems design, client referral, recording and reporting, follow-up and tracking. 7. In what way shall financing for micronutrient supplementation be secured and sustained at the local level? Answer: having a specific line item in the local budget.
DRAFT
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8. How will you improve data recording and reporting in your health facility? Answer: complete and accurate filling out of TCL, monthly, quarterly and annual FHSIS reports, timely submission of FHSIS report, regular updating of masterlists. 9. What should be the focus of promoting Micronutrient Supplementation? Answer: Behavior of accessing micronutrient supplements available in the regular market or the public health system and on improving the clients awareness and appreciation of MS benefits and its negative consequences. 10. What are the ways to improve the monitoring and supervision of the MS program? Answer: include tracking of indicators on the status of governance, financing and resulations in addition to service delivery indicators, integrating MS in the MNCHN monitoring and in the PIR
DRAFT
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Annex 3.2. Oral Drill and Key Answers on MS Package for Infants, Children, Women, Mothers and Other Adults
Question A. Low birth weight infants 1. What micronutrient to give? 2. What dosage? 3. How many ml? 4. Starting what month? 5. Up to what month 6. How frequent? B. infants 6 months old 1. What micronutrient to give? 2. What dosage of vitamin A? 3. How often? 4. How many ml? 5. For iron, what dosage to give? 6. How frequent? 7. How long? C. 7 month old Infant sick with measles 1. What to give? 2. What dosage? 3. How many capsules to give? 4. How to give? D. 4 month old Infant with diarrhea 1. What to give 2. What dosage? 3. How many ml? 4. If no drops, what other forms to give? 5. Dosage? 6. How many to give? 7. How long? E. Four year old have difficulty seeing in the dark upon diagnosis, 1. What to give 2. How many to give 3. How to give F. Two year old with measles 1. What to give 2. How many VA capsules to give? 3. How to give Answer Iron Drops 15 mg elemental iron/0.6 ml Give 0.3 ml starting at 2 months up to 6 months Once a day VA Capsule and iron, 100,000 IU, Once during the period of 6-11 months 15 mg elemental iron Give 0.6 ml once a day 3 months
DRAFT
VA Capsule, 100,000 IU, 2 capsules Give 1 capsule upon diagnosis regardless when the last dose of VAC was given. Give another capsule after 24 hours. Zinc drops Drops 27.5 mg/ml (equivalent to 10 mg elemental zinc) 1 ml Tablet, 10 mg elemental zinc. tablet Give 10 mg/day elemental zinc for not less than 10 days VA 3 VA Give 1 capsule of 200,000 IU upon diagnosis, 1 capsule the next day and another capsule 2 weeks after. VA capsule of 200,000 IU 2 VA capsules Give 1 VA upon diagnosis regardless when the last dose of vit. A was given. Give another VA after 24 hours
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Question G. 3 years old, was brought to the health center due to diarrhea. 1. What to give 2. What dosage 3. What other form to give? 4. How many to give? 5. For how long
Answer
Given zinc syrup 5 ml containing 55 mg zinc zinc tablet. give 1 tablet of 20 mg/day elemental zinc not less than 10 days
H. Leo is 12 months old and has severe Given 1 capsule of 200,000 IU upon diagnosis except when she pneumonia was given VAC less than 4 weeks before diagnosis. When weighed, he was found to be severely underweight. I. Adolescent girl 1. What to give 2. Dosage 3. How many to give 4. How frequent 5. When to start 6. For how long Previous MN given is sufficient
J. 11 years old girl with malaria 1. What to give 2. How many to give 3. How frequent 4. How long 5. How to administer
DRAFT
Iron Tablet, 60 mg elemental iron with 2.8mg folic acid 1 tablet Once a week Start of menarche Until one gets pregnant Iron Tablet Give 1 tablet Daily 2 months Give malaria drugs first and after at least 24 hours administered iron supplements. Iron Tablet 100 mg elemental iron Give 1 tablet daily for 30 days, Give iron supplement first before administering Praziquantel for severely anemic women 60 mg elemental iron with 400 ug folic acid 2 tablets daily 3 months or until hemoglobin reaches normal level
K. 14 year old girl with schistosomiasis 1. What MN to give 2. What Dosage 3. How many to give 4. How frequent 5. How long 6. How to administer L. 12 year old clinically diagnosed with IDA 1. What dosage to give 2. How many to give 3. How frequent 4. How long
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Question M. 10 years old boy clinically diagnosed with bitot spot 1. What to give 2. How many to give 3. When to give N. 15 year old Virgie 1. What to give 2. Dosage 3. How many to give 4. How frequent 5. When to start 6. For how long O. 34 year old woman with malaria 1. What to give 2. Dosage 3. How many to give 4. How frequent 5. For how long 6. How to give P. 25 years old clinically diagnosed with IDA 1. What dosage to give 2. How many to give 3. How frequent 4. How long Q. 27 year old clinically diagnosed with night blindness 1. What dosage to give 2. How many to give 3. How frequent 4. How long R. 4 months Pregnant woman What to give 1. Any other MN to give 2. What dosage 3. How many 4. How frequent
Answer
Give VAC 200,000 IU 3 capsules immediately upon diagnosis, another capsule the next day and another capsule 2 weeks after Iron Tablet, 60 mg elemental iron with 2.8mg folic acid 1 tablet Once a week Start of menarche Until one gets pregnant
DRAFT
Tablet, 60 mg elemental iron with 400 ug folic acid Give 1 tablet once a day until hemoglobin reaches normal level.
Iron Tablet, 60 mg elemental iron with 400 ug folic acid Give 1 tablet for once a day 2 months. Give malaria drugs first and after at least 24 hours administered iron supplements
200,000 IU Give immediately 1 capsule upon diagnosis, 1 capsule the next day and another capsule 2 weeks after
Tablet, 60 mg elemental iron with 400 ug folic acid Give 1 tablet once a day. Give a total of 180 tablets administered once a day to be taken for the whole duration of pregnancy. Iodized oil capsule 200 mg elemental iodine Give 2 capsules single oral dose once a year *Iodize supp should follow the criteria
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Question S. A woman who just gave birth a week ago 1. What MN to give 2. What dosage of iron 3. How many to give 4. How often 5. How long 6. How many VA to give 7. What dosage 8. she was given Iodized oil capsule when she was pregnant T. A nursing mother clinically diagnosed with iron-deficiency anemia 1. What dosage of iron 2. How many to give 3 How often 4. How long U. 1 month pregnant clinically diagnosed with xerophthalmia 1. What MN to give 2. What dosage of VA 3. What frequency to give VA 4. How long to give VA 5. currently taking multivitamins with VA V. Woman who delivered a baby 3 weeks ago diagnosed with night blindness 1. What MN to give 2. dosage 3. How often to give VA W. 61 years old is postmenopausal 1. What to give 2. Dosage of calcium to give 3. Dosage of vit D to give X. 56 year old living in malaria endemic area 1. What to give 2. Dosage 3. How often 4. How long 5. When to give 1st dose of iron
Answer Iron, VA, iodine 60 mg elemental iron with folic acid 2.8 mg Give 1 tablet once a week until one gets pregnant again. 1 Capsule 200,000 IU No need to give iodine
DRAFT
60 mg elemental iron with 400 ug folic acid Give 2 tablets once a day for 3 months Calcium and Vit D ~1000 g/d 400 to 900 IU/d iron supplement 60 mg. elemental iron with 400 mcg folic acid I tablet once a day 2 months After the first dose of the anti-malarial drugs is given.
VA, iron and iodine 10,000 IU once a day four weeks upon diagnosis regardless of age of gestation do not give the 10,000 IU VAC.
VA, iron and iodine Capsule, 200,000 IU Give 1 capsule upon diagnosis, 1 capsule the next day and another capsule 2 weeks after.
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Annex 3.3a. Case Scenarios on Health Promotion and Communication for MS

Case Scenario I - Integrating MS messages in the routine health services in the health center A teenage mother who gave birth at home, brought her child to Health Center to avail services for immunization. Her baby is 3 weeks old, Low Birth Weight and Premature. As a Health Service Provider, what (message) will you say?
Case Scenario 2 (Evacuation Center) Integrating information service in special situations A Health Team visited an Evacuation Center after Typhoon Bagyo. During the visit, they found Lilibeth, a 7 month old infant, suffering from diarrhea (soft watery stools). In the course of the interview the mother proudly shared that she is feeding her child other foods in addition to breastmilk. As a member of the health team, what (messages) will you tell the mother?
Case Scenario 3 (Alternative Delivery Setting) Introducing/ Integrating MS messages
Ciudad City, with a projected population of 97,380, has an estimated 3,408 pregnant women for 2009. According to reports, only 5 % of them have completed their iron with folic acid supplementation. The midwife has exhausted all their strategies to identify the pregnant women in the different barangays thru their BHWs. Advocacy meetings have been conducted to the Mayors to procure iron with folic acid for their pregnant women. Recording and reporting of data have been validated to ensure accuracy of data reported. In one of the Barangay meetings she attended, she met an NGO working with the public. If you are the supervisor of the midwife, how would you help the midwife handle this situation in terms of establishing public private partnership, considering that she learned that this NGO has been working with private companies which employ women of reproductive age. How will you involve the NGO in the MS program?
DRAFT
Case Scenario 4 Introducing MSP to an Local Chief Executive (LCE) for Support Manggahan is a third class barangay with a projected population of 5,814. The prevalence of underweight children is 15.5% or about 114 children out of the 739 estimated underfive children. The health center can only provide Vitamin A and iron to a small percentage of the target population. The other target groups like pregnant and lactating women and high risk children are not provided with MS especially iron and zinc. As a midwife how will you go about doing advocacy to your Barangay Captain for him to purchase MS supplements for your target populations.
Case Scenario 5 Giving Advice to an Older Person Aling Carmen is an older person aged 65 years of age. She consulted your health center because she feels she is not getting enough nutrition and is feeling weak because she lacks appetite and has difficulty eating because of loss of teeth. How would you advice Aling Carmen on her nutritional needs and concerns.
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Annex 3.3b. Possible Answers and/or Key Points to Emphasize for each Case Scenario
Case Scenario I - Integrating MS messages in the routine health services in the health center -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Case Scenario 2 (Evacuation Center) Integrating information service in special situations -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Case Scenario 3 (Alternative Delivery Setting) Introducing/ Integrating MS messages
Case Scenario 4 Introducing MSP to an Local Chief Executive (LCE) for Support
DRAFT
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Case Scenario 5 Giving Advice to an Older Person ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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Module 4: Enhancing Integration of MS Interventions in Service Delivery Settings

DRAFT
DRAFT
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Module 4 Enhancing Integration of MS Interventions in Service Delivery Settings Session 1: Delivery of MS Intervention in Different Settings
OVERVIEW MS deficiency increase childhood mortality from different diseases and is also associated with poor health among non-pregnant, pregnant and lactating women and other adults with predisposed health risks and conditions. This makes it a very important public health problem in the country. The DOH policy declaration recommends for MS interventions to be accessible and available in a timely and appropriate manner to the priority population groups in both routine and alternative service delivery settings. It supports the integration of MS into health programs as part of routine component of health care and in all potential service venues.
OBJECTIVES
DRAFT
At the end of this session, the participants will be able to: 1. Identify the current practices in providing MS services. Lecture-discussion, small group exercises 45 minutes 1. Session Objectives
Critical to reducing malnutrition and illnesses is the change of behaviors of caretakers and families. This requires changes in behaviors and practices of health providers and service provision practices in our health facilities, particularly on MS interventions.
2. Explain the MSP-MOP guiding principles and general guidelines on: 2.1. Integration of MS services 2.2. Provision of MS services in different settings 3. Discuss the following: 3.1. Alternative service delivery settings for MS services 3.2. Ways of integrating MS interventions in alternative service settings.
Read MSP-MOP Section 5 (pp. 44-52) (At the end of Day 1, instruct participants to read these sections as assignment.) Meta cards, masking tape and permanent marker pens Powerpoint presentations on:
2. General guidelines and examples of ways on how to integrate MSP in alternative service settings Assign and orient co-facilitators for the Small Group Discussion on integration to alternative settings
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TOPIC/TIME Introduction (05 min) METHODS / ACTIVITIES Greet the participants. Introduce the session objectives and present short overview. Tell participants that the focus of the session will be on : 1. The different service delivery settings, and 2. How provision of MS interventions can be improved by integrating these into routine health services and expanding the scope of service delivery settings. Small group exercise
Alternative Service Settings (45 min)
DRAFT
1. Divide the class into 5 small groups. 7. Each group is given 5 minutes presentation for each setting.
2. Assign each group 2 service settings to work on how to integrate MS provision 3. Ask participants to identify what other/alternative service settings where MS packages can be provided to clients. 4. Or, use the list of alternative service settings below for participants to be assigned to work on: Shopping mall Factory (agricultural or industrial) School (Elementary and high school) Birthing homes Teen centers Prison( women correctional facility) Day Care center Evacuation center Orphanage Temporary shelters 5. Give 15 minutes for the discussion. Identify activities that they can do in these service settings Give/enumerate the steps on how to integrate MS in the activities that they can do 6. Write the steps in metacards to be presented in the small group.
8. In plenary, each group will share learning insights for 2-3 minutes 66
TOPIC/TIME Alternative Service Settings (45 min)
METHODS / ACTIVITIES Provide inputs using a powerpoint presentation on the following: 1. Recommended ways and steps in integrating MS program in the different alternative settings. 2. If the alternative settings used during the group exercise were selected by the participants, provide additional slides to show other service settings that were not selected by participants.
Synthesis (10 min)
Emphasize the key points as noted in learning insights mentioned by the participants for the session. Inform participants that they will have opportunities to discuss about the topics and practice its application in succeeding sessions and at the practicum sites.
DRAFT
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Module 4 Enhancing Integration of MS Interventions in Service Delivery Settings Session 2: Integrating MS Intervention in Regular Health Services
OVERVIEW The DOH policy supports the integration of MS into the existing health programs service delivery system. Critical to integrating MS into the regular health services and achieving the goals of the MS program is a change in the practices of caretakers in service delivery and families in accessing the services. Micronutrient supplementation is not a stand-alone program and it can be provided in existing health facilities (hospitals and health centers) and communities through outreach. In hospitals, interactions of health service providers with both in- and out-patients are among the opportunities for providing micronutrient supplementation. Integrating MS in regular health services starts with a good assessment of each client, regardless of their reason for contacting a health service provider. During assessment, the service provider needs to identify risks, signs and symptoms of micronutrient deficiency and thereafter provide the appropriate service package, including information on micronutrients as part of quality service provision. At the end of this session, the participants will be able to: 1. Explain the importance of integrating MN interventions in regular client services. 2. Identify clients who need MN supplementation and/or treatment. 3. Identify signs of MN deficiencies through a directed physical examination on clients. 4. Explain ways of integrating the following MS interventions based on a good client assessment: 4.1. MS treatment/supplementation packages 4.2. Key messages on MS 4.3. MS Follow-up Lecture-discussion Demonstration and Return Demonstration Small group discussion/work 90 minutes Instruct participants one day before to read MSP-MOP (pp. 44-52) Powerpoint slides on Module 4 Session 2 Refer to Participant Reference Guide (pp. ___) Client Record Form/Individual Treatment Records Manila paper, markers, tape, BP apparatus, stethoscope, alcohol, hand towel Case scenarios for Demonstration (Facilitators Guide Annex 4.2) Return Demonstration of Assessment (Facilitators Guide Annex 4.3a and 4.3b) Observation checklist on Assessment (Facilitators Guide Annex 4.4)
OBJECTIVES
DRAFT
METHODOLOGY
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TOPIC/TIME Introduction (05 min) Greet the participants. Ask participants for questions or concerns regarding Session 1 of Module 4. Mention that in Session 1, various service delivery setting where MS can be integrated and provided were discussed Provide session overview and present the session objectives. Tell the clients that in the previous session, they learned that the first step in integrating MS into the regular health services is done during assessment of the client. This session will focus on how to properly conduct an assessment. METHODS / ACTIVITIES
Assessing a Client for Lecture-demonstration MS Using a Flowchart (10 min) Tell the participants that a good assessment of clients is needed because: 1. All clients can be or become MN deficient
DRAFT
3. Part of quality service provision Interactive Lecture-Discussion
2. Micronutrient deficiency and its consequences can easily be prevented if recognized early
4. A good assessment and history is a cost effective intervention to prevent MN deficiency Explain that assessing clients for MS can be guided by using a Flowchart. Distribute copies of the Assessment flowchart to each participant. Orient participants on the flowchart, showing how assessment for MS needs can be done at each point in the service flow. Discuss the components of each major area in the total assessment of a client. Ask for any questions or clarifications. Respond to each concern and query. Client Assessment integration point for MS services (20 min)
Tell the participants that assessing clients essentially is history taking and physical examination. History taking involves asking questions and this can be aided by using existing forms used by the service provider such as the Individual Treatment Records (ITR). 69
TOPIC/TIME a. History
METHODS / ACTIVITIES Flash powerpoint slides on questions to ask in the history to assess clients for MS and go over these, briefly explaining the use/s or purpose of the information obtained by asking the questions. Go through sample ITRs antenatal care, post-partum care, child and newborn care and point out what information will be useful for MS that can be are gathered from the general data, history and review of systems section. Point out as well that it is during history taking that questions related to MS should be asked.
b. Physical Examination
DRAFT
4. Ask co-facilitators to move around the room to assist the pairs.
Flash powerpoint slides that show the physical examination findings for some MN deficiencies: a. Vitamin A deficiency Bitot spots, keratomalacia, corneal dryness, hair discoloration, rough skin b. Anemia (as in IDA) palmar pallor, pale conjunctiva, pale oral mucosa c. IDD thyroid enlargement Tell the participants that doing a physical examination provides additional information that the service provider can use to make a more specific assessment of the need of a client for MS. The physical examination to be done may be directed at looking for the physical manifestations of MNDs. 1. For time consideration, the session will merely focus on specific parts of the body that are closely connected to MN deficiency. 2. Emphasize that a thorough and complete examination is encouraged as time permits. 3. Ask participants to pair off. As you discuss each key area of the body using the power point slides, ask each pair to look at each other and try to practice.
5. At this point, the facilitators need not ensure that the participants have grasped the skill. The activity is intended to provide them with the initial experience in preparation for the return demonstration. 6. After covering each specific area of the body, ask participants for any clarification or question before proceeding with the next area of examination following the same process.
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TOPIC/TIME Directed Physical Examination for MS assessment (20 min) Lecture-Demonstration
Essential to the conduct of this session is the preparation of the logistics that will be needed for the actual demonstration and briefing of the group facilitators on the overall process. This should be done a day before (Day 1) and will include the details below: Preparation: A day before the demonstration will be conducted, it is the responsibility of the facilitator/trainer to plan for the session in advance.
DRAFT
Actual Demonstration
This provides time to secure anything that may have been missed and/or to make the necessary adjustments. The preparation may include the following but is not limited to these: 1. Overall classroom arrangement plenary and small group sessions 2. Adequate lighting and sound system 3. Selection of case study for the demonstration. 4. Practice with co-facilitator on how to deliver the demonstration. 5. All the things (equipment, materials, supplies, forms) that will be needed during the actual and return demonstration
1. Distribute copies of the observation checklist. 2. Provide time for participants to be familiar with the contents of the checklist. 3. Tell participants that as you demonstrate how to assess and manage a client, they are supposed to observe if all those listed in the checklist were undertaken. 4. Ask for any question and/or clarification. 5. Demonstrate the procedure in a Role Play (service provision for a client using prepared scenario: Pregnant woman coming for ANC tagging along her 3 year old child). 6. After the demonstration, ask participants who acted as observers to share their observations in terms of what was done well, what was missed, what can be improved. 7. Inform participants that they will have opportunities to: 7.1. practice the demonstration procedure 7.2. be given feedback for confirmation and/or improvement of skills in client assessment enhanced with MS focused elements/steps, and 7.3. discuss concerns to properly integrate MS focused assessment steps. 8. Inform participants that the return demonstration will be conducted in small groups and they will be guided by their group facilitator. 9. The return demonstration session will be allotted 40-45 minutes. Note: The trainer may have the option to use a video presentation customized for the demonstration of MS focused assessment. 71
TOPIC/TIME (30 min) Return Demonstration
This activity will be conducted as Practice Exercises in the Small Groups. 1. Divide participants into the five groups as previously organized. 2. Remind assigned facilitator in each small group to provide the following instructions: 2.1. Select one participant to act as the service provider who will do the first return demonstration. 2.2. Provide pre-selected case scenarios to be used for return demonstration of participants within the small groups. 2.3. The rest of the group members will act as observers using the Skills Observation Checklist. As observers, look closely at what is being done and hear what the health worker is saying. 2.4. The participant demonstrating the procedure will be given seven-to-ten minutes to complete the return demonstration. 2.5. Five minutes will be spent to provide feedback to the participant after his/ her return-demonstration. 2.6. After processing the first return demonstration, select another participant to do the demonstration followed by the others, using new case scenario each time for another demonstration. 2.7. Conclude the group work, asking participants on their learning insights. 3. The session synthesis may be done either in plenary or in the small group session. 4. Ask participants to mention some of their learning insights from the session and/or implications to their work stations. 5. Emphasize the following points (from both Modules 4 Sessions 1 and 2): 1. MS services can be provided as part of routine health services in health facilities; in the community through outreach; and in alternative service sites. 2. Every client is a service opportunity for the service provider to assess for MN deficiency and/or the need for MS. With a good assessment, MS can be integrated into the regular service delivery of most health programs. 3. The important thing is to do a good assessment - complete history and good PE.
DRAFT
Synthesis (05 min)
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PRACTICUM SESSION (DAY 3 AM) Health Center

OVERVIEW The course is a response to update service providers in their competencies in implementing the newly-revised MOP on MSP. Learning and improving the competencies in providing MS services to clients is achieved better with experiences in practical sessions. In this session, participants will have the chance to practice these skills using the knowledge learned on MSP in providing MS services to clients seeking care in health facility settings. In addition, participants will avail of the opportunities to learn some insights on improving health facility practices for better MSP implementation. OBJECTIVES
DRAFT
At the end of the practicum session, participants should be able to: 3. Explain ways of improving health facility practices: 3.1. Integrating MS in routine services & other programs 3.2. Managing MS resources 3.3. Recording & reporting MS services & resources 2.5 to 3 Hours (Day 3- AM) including travel time.
1. Use the knowledge and skills in involved in providing MS services to clients. 2. Provide appropriate MS services, including the key MS messages needed by the clients.
4. Identify learning insights from the practicum experience useful in improving MSP implementation. METHODOLOGY Group discussion, participation in selected clinic activities on MS a) assessing and providing MS services to clients, b) staff interview, c) review of records on MS services; Health facility observation/checking a) record keeping, and b) storage of MS resources
1. Identification and ocular inspection of the health center/s 2. Coordination with health staff assigned in the health center for the specific activities/clients needed for the practicum. 3. Identify an area in the health center where the session shall be conducted. 4. Arrangements of: 4.1. Vehicle to ferry participants and facilitators to- and from-health center. 4.2. Take-out AM snacks for the schedule practicum session. 4.3. Provision of communication materials and job aids by group: (MOP, and forms on a) Staff Interview Guide, b) Records review Checklist, c) Client care/Observation Checklist.
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TEACHING-LEARNING PROCESS TOPIC/TIME Orientation-briefing on the Practicum (10 min) METHODS / ACTIVITIES Greet participants. Introduce the session by giving an overview and by presenting the objectives of the session to the participants. Conduct an Orientation-briefing for the Practicum session I. Inform participants that the they will undertake activities in the health center as assigned by the Facilitators: 1. Client service: 1.1. asess clients for MS needs 1.2. Provide needed MS services (package and key messages) 2. Staff Interview and review of records 2.1. Management of MS resources 2.2. Recording and reporting of MS
DRAFT
3. Health facility observation 3.1. Client/service flow 3.2. Storage of MS resources 3.3. Records keeping 3.4. Best Practices on MS delivery II. Remind participants on the following points: 1. Wear their training ID. 2. Greet/introduce self to staff and clients. 3. Seek clients permission/consent for the assessment/interview. 4. Thank clients and staff at the end of each activity. 5. Submit their fully accomplished forms/checklists to the facilitator at the end of the session. III. Entertain questions/clarifications from participants. Practicum Activities (60 min) Upon arrival at the health center, the facilitator will: 1. Greet and introduce self and participants to the head of the health center and other clinic staff.
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TOPIC/TIME
METHODS / ACTIVITIES 2. Explain the objectives of the practicum and the specific activities that participants will be doing, such as: 2.1. Assess clients for MS needs, give MS package (if needed and if available) and provide key MS messages 2.2. Endorse clients back to clinic staff for other services needed 2.3. Interview clinic staff (2-3) and review MS records 2.4. Check storage of MS resources and record-keeping system 3. Explain to clinic staff that the activity is a part of the training session on the new MSP-MOP guidelines and that training of service providers will soon be conducted by the concerned CHDs.
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5. Thank clients and staff after each activity. 1. Identify strengths and/or good practices observed 2. Identify areas needing improvements
4. Ask HC staff if time would allow at the end of the practicum session, will they welcome a short feedback from the participants learning insights from the experience. Assign activities to each participant, making sure that each will have assigned task and variety of experience: 1. Select clients for MS assessment and service. This may be done in pairs: 1.1. One participant assess and provide service, while the other participant observes, fills out the observation checklist and gives performance feedback to the partner. 1.2. Then, two participants will exchange roles 1.3. Endorse clients to clinic staff for other services needed. 2. Assign participant/s for staff interview and review of MS recording 3. Assign participant for facility checking on MS storage and recording keeping. 4. Observe participants while working and provide needed guidance and/or assistance.
Facilitate a feedback/post conference with clinic staff, guiding participants to:
3. Make suggestions/recommendations in accordance with the new MSP-MOP guidelines. 4. Thank and/or congratulate (as appropriate) the health center staff.
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TOPIC/TIME Post conference/ debriefing And Synthesis (20 min)
METHODS / ACTIVITIES Ask participants: 1. Their learning insights drawn from the practicum experience. 2. Encourage each participant to share their thoughts and feelings about their specific experiences. 3. HC practices/activities related to provision of MS services Review with the participants the learning objectives for the practicum and ask whether each objectives were achieved: 1. Which objective/s were met? Fully or partly? 2. Which objective/s were met? Why?
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3. What activities/changes will each consider doing in their health center to improve provision of MS service? Clarify with participants important learning as these relate with the new revised MSP MOP guidelines.
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Annexes for Module 4 and Practicum
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Annex 4.1a. Workshop Matrix/Guide on Alternative Service Delivery Settings

Name of Alternative Service Setting for MS Delivery: _______________________________________
Activities that can be Done/ Conducted
Steps on how to Integrate MS services in the Activities
Implementation Notes/Remarks
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Name of Alternative Service Setting for MS Delivery: SHOPPING MALL / FACTORY (Agricultural or Industrial)
Activities that can be Done/ Conducted Wellness clinic
Steps on how to Integrate MS services in the Activities Coordination meeting with Mall/ factory officials Orientation on the micronutrient supplementation program
Put up booths for GP
Give out flyers to mallers/ factory Presentation of findings with workers Mall officials Health promo and awareness campaign
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Agree on actions to take to address the problems and how to assist the DOH to address MN problems, e.g. cost schemes schemes, recording and recording Recording and reporting of MS activities
Assessment on the micronutrient status of the employees
Counselling
Referral
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Name of Alternative Service Setting for MS Delivery: SCHOOL (Elementary & High School)
Activities that can be Done/ Conducted Health education to include use of iron folic tablet once a week until pregnancy sets in
Steps on how to Integrate MS services in the Activities Coordination meeting with school officials
Fertility awareness lecture/ campaign
Assessment of children with MN Agree on actions to take to address the MN problem among their deficiency to be integrated the students e.g. health education, annual check of children training of school health staff on the MS guidelines, etc. Recording and reporting of MS activities
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Orientation on the micronutrient supplementation program
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Name of Alternative Service Setting for MS Delivery: BIRTHING HOMES
Activities that can be Done/ Conducted Consultation visit
Steps on how to Integrate MS services in the Activities Coordination meeting with birthing homes owners
Counselling session
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Agree on actions to take at the birthing facility to address the MN problem among partum women e.g. giving of iron f folic acid supplements before they leave the health facility as part of Philhealth benefit. Counselling of mother on the importance of taking the MS supplements, referral to HC for vitamin A supplementation or providing vitamin A capsules to birthing home, recording and reporting. Recording and reporting of MS activities Giving of iron folic and vitamin supplementation
Orientation on the micronutrient supplementation program and the new guidelines,
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Name of Alternative Service Setting for MS Delivery: PRISON (women correctional facilities)
1. Conduct of consultation visits Coordinate with the officials for Clinical/physical Assessment the conduct of consultation visit Referral or outreach activity
2. Micronutrient Services (Iron, Folate)
3. Counseling
4. Follow-up Visit
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Conduct of consultation/ outreach activity including provision of MS and health information education.
5. Distribution of IEC Materials
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Name of Alternative Service Setting for MS Delivery: TEEN CENTERS
1. Conduct of consultation visits Coordination meeting with the Clinical/physical Assessment Teen Center officials Referral
2. Micronutrient Services (Iron, Folate)
3. Counseling
4. Follow-up Visit
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Orientation of teen center staff on the MSP guidelines
Identity activities/programs of the center where MS can be integrated
5. Distribution of IEC Materials
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Name of Alternative Service Setting for MS Delivery: DAY-CARE CENTERS
Activities that can be Done/ Conducted GP ACTIVITIES
Steps on how to Integrate MS services in the Activities Coordinate with day-care teacher and the barangay captain regarding conduct of GP Request for the masterlist of pupils to include age and weight
Disseminate IEC
Distribute MS and other GP package
Record and report to school, RHU
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Establish a GP center in the day care center Recording in the growth chart, submit report to HC staff
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Name of Alternative Service Setting for MS Delivery: EVACUATION CENTERS /TEMPORARY SHELTER
Activities that can be Done/ Conducted Medical mission
Steps on how to Integrate MS services in the Activities Coordinate with evacuation center leaders or officials for the conduct of outreach/medical mission Request for the masterlist of children and pregnant and lactating women in the evacuation site.
Age classification Health assessment
Dispensing health teachings/ nutrition
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Provide MS do those high risk, provide messages on MS and record in appropriate individual record like growth chart, mother and baby book Refer clients needed special care to health facility
Routine medical consultation
Targeting/ prioritization
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Name of Alternative Service Setting for MS Delivery: ORPHANAGE
Activities that can be Done/ Conducted Health consultation
Steps on how to Integrate MS services in the Activities Coordinate with the officials for the conduct of consultation visit or outreach activity Orientation on the micronutrient supplementation program and the new guidelines
History taking, screening, assessment
Management and treatment
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Conduct of consultation/ outreach activity including provision of micronutrient supplements and health information education. Referral of children needing special care
Nutrition and health counselling
Recording and reporting of Health and nutrition information children given MS and education
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Annex 4.2. Case Scenario for Demonstration in the Plenary (Facilitators Copy)
Case Study for the Demonstration Mariana Kilip is 27 years old, married, and a housewife. She is married to Antonio Kilip, 30 years old, a taxi driver and they have two children the older child (daughter) is 5 years old (DOB Dec 15 2005) and the younger (son) is 3 years and 3 months (DOB November 15, 2007). Mariana visits the midwife at the Barangay Health Station for consultation after missing her period for two months last menstrual period was December 18, 2010. She comes to the BHS with her 3-year old son tagging along. Overall, Mariana feels well and is excited that she will be having another baby. She is able to eat well although at times, she feels nauseous and this started two weeks prior to visiting the BHS. Their family eats three meals a day and these usually consist of steamed rice and vegetables (kangkong, okra, squash, sitaw, upo, tomatoes) with meat or fish 2-3x a week. She does not have any physical complaints except that she frequently urinates and feels sleepy more of the time than usual. Marianas family is negative for diseases of familial or hereditary patterns like DM, TB, heart disease, kidney disease and others. She has not had any major illnesses in the past and had been hospitalized only for delivery of her two children (by Normal Spontaneous Vaginal Delivery). Her 3-year old son, Roberto, has received all the standard immunizations before reaching one year of age. He is an active child and plays well with his cousins and other children of his age. He is picky about food and sometimes skips meals when he does not like the ulam (prefers meat and eats chips and candies frequently; he likes to eat fruits bananas, guava and other seasonal fruits) or when he suffers from toothache. Based on his Growth Monitoring Chart (GMC), he is underweight. Roberto has had some illnesses in the past including coughing and LBM, but was hospitalized only once when he contracted dengue in October 2010. In the past month, he had one bout of diarrhea that lasted for 3 days, which resolved spontaneously. Mariana is aware of GP every April and October and she makes an effort to bring Roberto to the BHS for Vitamin A and deworming on those months; however, in October 2010, Roberto was not given Vitamin A and the other GP services because Mariana was so busy with her house chores she totally forgot about bringing Roberto to the GP service point.
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Annex 4.3a. Case Scenarios for Small Group Exercises (Facilitators Copy)
CASE NO. 1 ALIAH PUZON and GENESIS Aliah Puzon is a 26 years old female, dressmaker, married to Jeffry Puzon, 29 years old, construction worker and they have one son, Genesis, who was born on January 15, 2010. They live in a remote barangay high up in the mountains of the Cordilleras. Aliah brings Genesis to the Rural Health Unit (RHU) some 8 kilometers away from where they reside because he has been coughing for 10 days and now feels very warm to touch. Genesis started refusing solid foods in the past two days but drinks fluids. He breastfeeds but frequently stops. Aliah gave Genesis one dose of paracetamol for the fever. Because Genesis was now having difficulty of breathing, Aliah brought him to the RHU. Other information about Genesis:
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Birth weight was 2.6 kg; exclusively breastfed for 6 months; completed his EPI vaccinations (BCG, HepB, OPV, DPT and Measles vaccines) before 1 year of age; was given Vitamin A 100,000 IU in October 2010; weight has increased since birth and is within normal for his age and sex; Information about Aliah (NB. to be mentioned only if the Service Provider asks Aliah about herself): Last Menstrual Period was November 30, 2010; not using any FP method; eats well but rarely eats animal food products, more of vegetables and fish; the family does not use iodized salt; at times feels dizzy and light-headed; noticed getting tired easily since two months ago; friends tell her that she looks frail and thin; she does not have night blindness; she admits that at times, her husband beats her when he is drunk.
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CASE NO. 2 AMANDA and BABY Amanda Bacalzo is 40 years old, a housewife, and is married to Ramon Bacalzo, 36 years old, a soldier. Amanda gave birth to their 5th child, a boy, on December 21, 2010 at a local hospital. She visits the Rural Health Midwife (RHM) in their barangay for post-partum care. She brought along her newborn since she exclusively breastfeeds him, and who feeds well and is not being given any other food aside from breast milk. Amanda says that she was given Vitamin A 200,000 IU before she was discharged from the hospital when she gave birth to her youngest child. She is also taking Iron folic acid one tablet once every week. She says she feels well and she is interested to know what FP method to use because she and Ramon have reached the number of children they want. Amanda received one iodine capsule only when she was an adolescent during a medical mission to their barangay. Information on the Amandas Baby Boy: (To be mentioned only if the Service Provider asks about the baby.) Birth weight was 2.3 kg; not being given any medicine or supplement; has received BCG, DPT1, HepB1, and OPV1; weight is increasing but is below the normal weight for age and sex.
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Annex 4.3a. Case Scenarios for Small Group Exercises (Facilitators Copy)
CASE NO. 3 ISRAEL and MARIAM Israel Mae Palpallatoc was born on September 8, 2007 to parents Jose and Mariam Rubio, both 33 years old. She is the only child. Mariam brought her to the BHS on a Wednesday morning because she was having watery diarrhea and vomiting that started one day before consultation. Israel Mae has had six bowel movement and one episode of vomiting since then, but she can still take in fluids. She was given young coconut water and oresol which she drank and retained well. Mariam is worried that Israel Maes condition might worsen so she brought her to the BHS. Information about Mariam: (To be mentioned only if the Service Provider asks about Mariam herself.) Mariam says that she has not been feeling well and feels tired easily since three months ago. She had been having heavy menstrual periods since 4 months ago when she had an IUD inserted, but the menstrual flow has been decreasing the past two months. Her friends tell her that she looks pale.
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Annex 4.3b. Key / Possible Answers to Case Scenarios (Facilitators Copy)

CASE 1: Assessment and Management for Aliah and Genesis A. For Genesis: Service provider should note that the child belongs to the 12-59 months age group Service provider checks for clinical signs of anemia. Service provider asks if child was given Vitamin A and when. After ascertaining that Vitamin A was given more than 4 weeks ago, gives Vitamin A 200,000 IU. Tells Aliah to continue breastfeeding Genesis as breast milk is still the best food for Genesis up to 2 years and beyond. Tells Aliah that Vitamin A increases her childs resistance (immunity) so he does not easily get sick, helps him grow and develop, and his eyes will function properly (sight). Tells Aliah that Genesis should be brought to the health center every 6 months to receive Vitamin A, deworming drugs and other services including growth monitoring. Tells Aliah to make sure that Genesis eat a variety of foods everyday coming from the Food Pyramid and consume the recommended amount. Service provider manages child as a case of severe pneumonia. B. For Aliah:
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Service provider asks Aliah about herself. Service provider determines that Aliah is pregnant and tells her so. Service provider gives Aliah iron folic acid tablets and tells her to take one tablet once a day for a total of 180 tablets all throughout the duration of the pregnancy. She tells Aliah that because she is pregnant, her need for iron and folic acid cannot be met by diet alone, so the need for her to take daily iron folic acid supplementation. Service provider gives Aliah iodine supplementation. Service provider tells Aliah to come back for additional prenatal care visits (at least 4 during the entire pregnancy). Tells Aliah that she may have side effects such as nausea, constipation, gastric upset and black stools, but these should not cause her to worry and will usually stop soon except having black stools. Tells Aliah some tips to minimize the side effects. Tells Aliah to eat a variety of foods from the Food Pyramid and at the right amounts.
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CASE 2: Assessment and Management for Amanda and the Baby: A. For Amanda: Service provider assesses that Amanda is a target group for MS Postpartum or Lactating Woman Tells Amanda that she should continue to take iron-folate once weekly. Discusses family planning options of Amanda tells her that for as long as she exclusively breastfeeds her child and that her menses have not yet returned, she is protected from getting pregnant. Tells Amanda that she is breastfeeding, she has increased nutritional needs that cannot be met by diet alone, so the need for micronutrient supplementation. Tells Amanda to take in a variety of food from the Food Pyramid meat, liver, dark and green leafy vegetables that are rich in iron, foods rich in vitamin C, as well as Vitamin A. B. For the Baby: (if assessed)
Asked about birth weight and assesses that the baby is LBW. Tells Amanda to continue exclusive breastfeeding Gives the baby iron supplement to be given at 15 mg elemental iron once daily up to six months.
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CASE NO 3: Assessment and Management for Israel Mae and Mariam: A. For Israel Mae: Service provider assesses that she belongs to a target group for MS. Assesses Israel Mae for signs of dehydration. Treats Israel Mae with Reformulated ORS and zinc. Tells Mariam that she should give zinc 20 mg once a day to Israel Mae for at least 10 days and that this will reduce the duration and severity of diarrhea. Tells Mariam to prepare appropriate food and continue feeding Israel Mae, and that when her child is well, to give extra meals to replace protein and energy lost during illness and restore the bodys reserves for continued growth and development.
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B.
For Mariam (if assessed):
Service Provider assesses Mariam for anemia. If assessed to be pale, the Service Providers tells Mariam that a blood examination to measure her hemoglobin will be done or will refer her to another facility for the procedure. If assessed to be pale, Service Provider gives iron folate 60 mg one tablet once a day and that Mariam will continue to take this until her hemoglobin reaches normal level. Service provider tells Mariam to eat a variety of foods everyday (referring to Food Pyramid) and to increase intake of iron-rich foods animal products like liver, kidney, spleen, shellfish; and plant foods like dark green leafy vegetables.
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Annex 4.4. OBSERVATION CHECKLIST (For Classroom Exercises)

Instruction: Place a Y if the activity was observed and N if not observed. Place NA if the desired activity is not applicable given the case scenario. ACTIVITIES
A. Was provider able to develop rapport with the client? Did the provider.. 1. Greet the client? 2. Introduce himself/herself to client? 3. Ask client her reason for coming? 4. Make client comfortable? 5. Assure privacy? 6. Assure confidentiality? B. Was provider able to communicate effectively with the client? Did the provider. 1. Maintain eye contact with the client? 2. Use an appropriate tone of voice?
OBSERVATION
REMARKS
3. Spoken words are clear and delivered well? 4. Exhibit appropriate body language? 5. Listen attentively? 6. Use simple language?
7. Use paraphrasing and clarifying appropriately? 8. Ask the appropriate questions?
9. Ask open ended questions to encourage client to talk? 10. Check clients level of understanding? 11. Use neutral statements? 12. Focus attention to client during the discussion? C. Was provider able to examine the following adequately? C.1 Examination of the Skin a. Inspected the hands and face b. Inspected and palpated the skin, took note of: b.1. Color b.2. Vascularity and evidence of bleeding or bruising b.3. Moisture b.4. Temperature b.5. Texture c. Inspected and palpated the fingernails and toenails Noting the color, shape and lesions C.2 Examination of the Head
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a. Asked if the patient noticed anything wrong with his/her scalp or hair. b. Inspected the hair noting quantity, distribution, pattern of loss if any c. Palpated the hair: Noting its texture (fine, coarse)
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ACTIVITIES
C.3 Examination of the Eyes a. Screened for visual acuity by asking the patient to read any print material. b. Asked patient to use each eye separately, covering the other eye with an opaque card, not with fingers c. Used a Snellen eye chart when appropriate: c.1. Positioned the patient 20 feet from the chart and ask him/her to read the smallest line of print possible c.2. Tested each eye separately c.3. Determined the smallest line of print from which patient is able to identify correctly more than half of the figures. c.4. Recorded the visual acuity designated at the side of this line. d. Examined the Conjunctiva and Sclera d.1. Asked the patient to look up as the lower lid of each eye is depressed with the thumb, exposing the sclera and conjunctiva d.2 Inspected upper palpebral conjunctiva e. Examined the Cornea and Lens f. Examined the Iris
OBSERVATION
REMARKS
With oblique lighting, inspect the cornea for opacities C.5 Examination of the Mouth
a. If the patient wears dentures, offered him/her a paper towel and ask him/her to remove them. b. Inspected the lips for color, moisture, lumps, ulcers or cracking. c. Asked patient to open his/her mouth. With a good light and using a tongue blade, inspect the buccal mucosa for color, pigmentation, ulcers, nodules. . Inspected the dorsum of the tongue, its color and papillae. Note any abnormal smoothness. e. Inspected the sides and the undersurface of the tongue together with the floor of the mouth. C.6 Examination of the Neck a. Inspected the neck for symmetry, masses and scars. b. Inspected the thyroid. b.1. Asked the patient to extend his/her neck slightly and to swallow. b.2. If with difficulty in swallowing, gave water, instructing her/him to hold it in her/his mouth and to swallow when asked. b.3 Inspected the neck for any visible thyroid tissue, noting its contour and symmetry. c. Palpated the thyroid, noting its size, shape, symmetry, tenderness, nodules. c.1. Palpation from in front.
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Annex 4.4. OBSERVATION CHECKLIST (For Classroom Exercises)

a. With the pads of index and middle fingers, felt below the cricoid cartilage for the thyroid isthmus. b. Asked the patient to swallow. Felt for the isthmus rising upward under the fingers. c. Moved fingers laterally and deep to the anterior border of the sternomastoid. Felt for each lateral lobe before and while the patient swallows. d. Asked the patient to flex neck slightly forward and to his right. e. Placed right thumb on the lower portion of his/her thyroid cartilage and displaced it to the patients right.
OBSERVATION
REMARKS
f. Hooked the tips of the index and middle fingers of left hand behind the sternomastoid muscle while feeling infront of this muscle with the thumb.
g. Palpating fingers positioned below the level of the thyroid cartilage. Felt for the lateral lobe as the patient swallows. c.2 Palpation from behind. a. With the patient seated, provider stood behind the patient. b. Rested thumbs on the nape of the patients neck.
c. With index and middle fingers of both hands, felt for the thyroid isthmus and for anterior surfaces of the lateral lobes. d. Asked the patient to flex neck slightly forward and to the right. e. Displaced the thyroid cartilage to the right with the fingers of left hand. f. Palapated with right hand, placing thumb deep to and behind the sternomastoid, and index and middle fingers in front of it. g. Asked the patient to swallow. h. If thyroid gland is enlarged, listened over the lateral lobes with the diaphragm of the stethoscope for a bruit. D. Were the messages provided 1. Relevant and appropriate to the situation? 2. Direct and easily understood? 3. Reinforced by succeeding statements? 4. Complemented by teaching/learning aids? 5. Smooth and well organized?
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E. Was provider able to show compassion and empathy to the client? Did the provider 1. Refrained from making judgmental remarks?
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ACTIVITIES Demonstrated concern to the client in the manner of speaking, gestures and facial expression? 3. Allowed the client to talk without interruption? . Respected the clients ideas and decisions even if contrary to the advice? 5. Asked permission from client prior to the conduct of any procedure or examination? 6. Explained the procedure properly? 7. Involved clients partner and/or companion in the discussion? 8. Explained clients condition? 9. Addressed clients fears, concerns or anxieties? 10 Helped client come up with appropriate health care decisions?
OBSERVATION
REMARKS
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Annex 4.5. OBSERVATION CHECKLIST (For Practicum)

A. Was provider able to develop rapport with the client? Did the provider.. 1. Greet the client? 2. Introduce himself/herself to client? 3. Ask client her reason for coming? 4. Make client comfortable? 5. Assure privacy? 6. Assure confidentiality? B. Was provider able to communicate effectively with the client? Did the provider. 1. Maintain eye contact with the client? 2. Use an appropriate tone of voice?
OBSERVATION
REMARKS
3. Spoken words are clear and delivered well? 4. Exhibit appropriate body language? 5. Listen attentively? 6. Use simple language?
7. Use paraphrasing and clarifying appropriately? 8. Ask the appropriate questions?
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9. Ask open ended questions to encourage client to talk? 10. Check clients level of understanding? 11. Use neutral statements? 12. Focus attention to client during the discussion? C. Were the messages provided 1. Relevant and appropriate to the situation? 2. Direct and easily understood? 3. Reinforced by succeeding statements? 4. Complemented by teaching/learning aids? 5. Smooth and well organized? D. Was provider able to show compassion and empathy to the client? Did provider 1. Refrain from making judgmental remarks? 2. Demonstrate concern to the client in the manner of speaking, gestures and facial expression? 3. Allow the client to talk without interruption? 4. Respects the ideas and decisions of the client even if contrary to the advice? 5. Seek permission from client prior to the conduct of any procedure or examination?
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ACTIVITIES
6. Explain the procedure properly? 7. Involve clients partner and/or companion in the discussion? 8. Explain clients condition? 9. Address clients fears, concerns or anxieties? 10 Help client come up with appropriate health care decisions?
OBSERVATION
REMARKS
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Annex 4.6. STAFF INTERVIEW CHECKLIST (For Practicum)

Name of Respondent: _____________________________________ Name of Interviewer: _____________________________________ Date: _________________
Responses Questions YES NO
Assessment 2 Appropriate MS given to clients in right specs, dose, duration 1 at least 1 element not met 0 no element met
1. Do you provide the targeted clients with the following supplements when they con sult your health facility? 1.1. Iron / folic acid 1.2. Iodized oil capsule 1.3. VAC with xerophthalmia 2. Are you able to provide for the total MS requirement needed? 3. If no, why are you not able to provide the total requirement needed?
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Yes, Complete No Not aware of protocol No supply available locally No budget/ limited funds Others, specify ______________ ________________ YES NO
4. Does the local health facility/LGU procure MS supply? 5. Do the MN supplements follow the preparations specified by DOH? 6. Does it receive augmentation from other sources? 6.1. DOH 6.2. Development partners
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6.3. Others, specify 7. Does the health facility maintain and update stock inventory? 8. Are the existing stocks of MS adequate to meet at least a month need? 9. Are the MS stored properly? Check supply/storage room for: For Vitamin A, iron and Iodine 10. Stored in dark colored bottles? 11. Kept in cool, dry place away from heat and direct sunlight? 12. Not within reach of children? 13. Container labelled to include name of drug, dosage and expiry date? For Zinc 14. Kept in well- closed container? 15. Protected from light? 16. Do you repack micronutrients? Observe how micronutrients are repack write in the general comments section) 17. Are the Target Client Lists on MS complete and accurate? 18. Are the FHSIS reports on MS submitted on time? 19. Are GP reports submitted on time (as specified in memo)? 20. Does the health facility maintain records of GP accomplishments conducted twice a year? 21. Do you maintain only 1 list of underfive children to be provided with Vitamin A every 6 months?
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22. Does the health facility have copies of the MS standards and protocols? 22.1. AO on the Revised MS Guidelines 22.2. MS Manual of Operations 22.3. AO on Zinc Supplementation 23. Does the health facility have copies of MS IEC materials (specify)?
General Comments/Remarks: ___________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
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Annex 4.7. RECORDS REVIEW CHECKLIST (For Practicum)

Name of Facility Visited: _____________________________________ Date: __________________
1. Select at random 3 ITRs and check if the MS needs of clients were: 1.1. asked 1.2. recorded
2. Review TCL on MS and validate if data required are completely filled up. 3. Ask for copies of the most recent reports on GP accomplishment (October 2010) 4. Ask for copy of the health facilitys annual procurement plan and check if MS is included. 5. Ask for a copy of the stock inventory and check if this is updated. 6. Check if MS received from other sources are included in the stock inventory. 7. Check if health facility has copies of: 7.1. AOs on MS 7.2. Policies 7.3. Manuals 7.4. IEC on MS 8. Check for documentation of orientation done among health staff on MS AO and MOP.
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General Comments/Remarks: ___________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
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Module 5: Managing Service Delivery of MS Interventions
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Module 5 Managing Service Delivery of MS Interventions Session 1: Delivering Quality Micronutrient Supplementation Services
OVERVIEW Service delivery of MS interventions must be based on the basic principles of quality and safe care, human dignity and clients rights and needs, and the role of families and communities. The vision of people-centered health care is for clients to be served in humane and holistic ways (WHO, 2007). Hence, the Micronutrient Supplementation Program must be reflected in a well managed health service delivery system supportive to MS services for families and communities. As such, clients must have regular access to health facilities with: a) quality and organized MS services, b) competent, responsive and supervised health staff, c) regular MS supplies, equipment, and, d) efficient health information system.
OBJECTIVES
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At the end of this session, the participants will be able to: Lecture-discussion, small group exercises 60 minutes
Session 1 will focus on Provision of Quality MS services, Session 2 on Competent, friendly and responsive health staff, Session 3 on Supportive Environment for MS service delivery, which focuses on logistic management and health information system. Supervision will be discussed in session 4 as this is relevant in all the sessions above. This session will highlight discussion on delivery of services and work in health facilities is important in providing quality of care. This is well reflected if the program is well-planned, and services are organized are best performed with less inconvenience and more comfort to both clients and service providers.
1. Describe the qualities of a well-managed MS program: 1.1. quality and organized client care for MS services 1.2. competent and responsive health service providers 1.3. continuous availability of Micronutrient supplies 1.4. efficient health information system 2. Explain the benefits of a well managed MS program in health facilities. 3. Discuss the requirements for quality and organized MS services. 3.1. Micronutrient supplementation id integrated into routine health services 3.2. Micronutrient supplementation is integrated in the LGU plans 3.3. Compliant with Micronutrient supplementation policy/guidelines 3.4. Organized Micronutrient supplementation services METHODOLOGY ESTIMATED TIME ADVANCE PREPARATION
Readings/review on DOH-MOP pages 86-104 and annex 13 on pages 216 to 219. Power point presentations on: Session Objectives and technical inputs List of factors/barriers from Module 2 Checklist on Quality MS Care and Services
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TOPIC/TIME Introduction (05 min) METHODS / ACTIVITIES Greet the participants. Introduce the module, session and present the objectives. Explain that session 1 will focus on provision of quality MS services, Session 2 will be on competent and responsive health service providers, Session 3 on Supportive Environment for MS service delivery which focuses on logistics and health information system and Session 4 on Supervision of MS services delivery.
Quality of MS Services Lecture-discussion (10min ) Ask each participant to give qualities of a well managed MS Program. Write their responses in meta cards and post them in Manila paper and refer to these during the next discussion. Explain that these qualities can be classified into the following qualities.
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Qualities of a well-managed MS program: 1. Quality and organized client care for MS services 2. Competent and responsive health service providers 3. Continuous availability of micronutrient supplies 4. Efficient health information system Lecture-discussion
Discuss briefly the importance of having a well managed Micronutrient Supplementation program. 1. Ask the participants the importance of a well managed Micronutrient Supplementation Program. 2. Post these cards on a brown or Manila paper and summarize the answers. Compliance to Micronutrient Supplementation Program Policy and Guidelines ( 15 min)
Present powerpoint presentation on these criteria, citing specific pages of Section 7 of the MOP: Management of MS Program. 1. Formulation/Compliance to MS Policy and Guidelines (page 93) 2. MS Planning (page 85-88) 3. Organized Delivery of Micronutrients Services (page 92-93) Review the participants on the new policy on Micronutrient Supplementation. Discuss how the local government units can support the national policy. Ask: What are some of the resolutions or ordinances that LGUs can support? Use meta cards and post their responses on the brown or manila paper. Summarize the discussion with a power point on compliance to Micronutrient Supplementation.
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TOPIC/TIME
Organization of Lecture-discussion Services and Activities in Health Facilities Tell: the topic is one of the often neglected requirements in organizing health (10 min) facilities. Using power point slides, discuss the factors that should be considered when planning and organizing the physical set-up: 1. Services offered/provided (availability) 2. Client flow when availing/receiving services
Small group discussion (15 mins)
DRAFT
4. Staff responsibilities and tasks Small group discussion: Link the session to the succeeding sessions of module 5.
3. Schedule of services (accessibility)
Emphasize that, to provide quality MS services, organization of the physical set-up should consider how work and services are best performed with less inconvenience and more comfort to both clients and service providers. Ask examples of changes that will be considered in the way their health centers/stations will be organized. Tell participants that Planning will be discussed in another session.
The small group discussion will be allotted 15 minutes. Distribute copies of the case scenario on Gloria and guide the group in a discussion, answering the suggested questions on the case. Focus the case discussion on the following; -Making MS services accessible to clients. -Increasing/improving MS coverage. Synthesize relating the responses from the previous modules (2,3,and 4) Tell participants that session 2 (service providers) and session 3 (MS resources and information system) will provide additional learning on how quality MS services can be provided.
Synthesis (5 min)
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Module 5 Managing Service Delivery of MS Interventions Session 2: Delivering MS Services by Competent and Responsive Service Providers
OVERVIEW Delivery of quality Micronutrient Supplementation services depends on the competence and responsiveness of health service providers in assessing, administering, evaluating and documenting services for clients. Utilization of health and MS services is influenced by professional and personal behaviors of service providers shown towards clients. Thus, the kind of staff behaviors and work performance may either enhance or hinder service utilization of clients. To function effectively, three aspects are important to consider, that is, service providers: 1) have clear job description and role expectation, 2) have received relevant orientation and training, and 3) are provided with appropriate administrative and technical supervision. Regular supportive supervision will help improve and sustain the competence and responsiveness of service providers to deliver quality MS and health services. Session 2 will focus on helping health workers to be competent and responsive service providers for MS services. At the end of this session, the participants will be able to: 1. Review the qualities of a well- managed Micronutrient Supplementation Program. 2. Discuss the criteria for delivering quality and organized Micronutrient Supplementation by competent and responsive health service providers. 3. Explain the following health service delivery skills as characteristics of competent, compassionate and responsive service providers: 3.1. Clinical / care competence 3.2. Communication and counselling skills 3.3. Critical thinking and decision making skills 3.4. Management skills 4. Explain ways of improving and/or maintaining competence for quality and safe practice performance of service providers: 4.1. Job descriptions and expectations 4.2. Training intervention 4.3. Supportive Supervision Lecture-discussion and small group discussion with case scenario 50 minutes Readings/review on MSP-MOP pp. 83 Case scenario for the small group discussion Power point presentations on: Session Objectives and technical inputs on: a) Professional and personal characteristics of service providers b) Job description/expectations in providing MS services c) Training Flashcards on roles, functions, performance of services providers, and situations needing supervision.
OBJECTIVES
DRAFT
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TOPIC/TIME Introduction (05 min) METHODS / ACTIVITIES Greet the participants. Review on the qualities of well- managed Micronutrient Supplementation Program. Introduce the session and present the objectives. Lecture-discussion Ask participants their knowledge and concepts on: 1. How do competent service providers manage MS interventions? 2. What should be the staff requirements for a facility that is client-friendly and supportive to MS services? Explain that competence of service providers requires that each staff possess the following health service delivery: 1. Clinical care skills 2. Communication and counselling skills 3. Critical thinking and decision making skills 4. Management skills
Managing MS with competent and responsive Service Providers (20 min)
DRAFT
Present a list of minimum requirements for client-friendly health facility for quality MS services, emphasizing on the following: 1. Staff with clear job descriptions/expectations 2. Staff trained / well-oriented staff on Micronutrient supplementation 3. Supportive supervision is provided.
Present inputs on the other items on the minimum requirements for a client friendly health facility that directly relate to health service providers. Word Game: Ask each participant to think of word that best describes the qualities of a supervisor. This word can be personal or professional quality. Each one should write in a meta-card, one quality to be posted in the brown paper. Each one in the group will take turn in posting the meta-card with a quality. The challenge is that each quality should be given only once and not to be repeated within the group. Given qualities should be changed. This will be done until all members are given the chance to post without repetition or duplication. An example is given: competent which means qualified of capable. Relate the exercise emphasizing the personal and professional qualities of service providers focusing on the following: 1. Compassionate 2. Responsive 3. Responsible Tell participants that additional discussion on these topics will be taken in Session 4 of the module. 113
TOPIC/TIME Management of MS Human Resources (20 min)
METHODS / ACTIVITIES Small group discussion The small group discussion will be allotted 15 minutes. Use the case scenario in Session 1 (Gloria), guide participants into a group discussion. Let the groups work on the following questions as provided in the exercise, focusing on the following questions: 1. What can be done by the RHM so that clients can receive MS services regularly? 2. What can the RHM and community volunteers (BHWs/BNs) do to motivate/ encourage clients to seek health services from the health center? 3. Ask what characteristics or qualities that the service providers should possess that can be considered or quality and organized client care for MS
DRAFT
Synthesize using participants responses focusing on these criteria: Synthesis (05 min) Link the session to the next module which is on planning.
The group facilitator must ensure that each member of the group will have the opportunity to participate in the discussion.
1. Compassionate attitude and responsive behaviour of service providers toward the clients will improve quality of delivery of MS services. 2. Competence in providing quality health and MS services can be sustained if service providers: 2.1. have clear job description and role expectation 2.2. receive training and updates on MS and related services 2.3. provided supportive supervision
Ask participants to mention some of their learning insights from the session. Ask examples of changes that will be considered in the way their health centers/stations will be organized.
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Module 5 Managing Service Delivery of MS Interventions Session 3: Managing Resources and Health Information System
OVERVIEW Continuous availability of micronutrient supplements in health facilities is important in providing quality of care and a tough job to manage. It is ensuring that micronutrient requirements are available at all times at the health facility at the right time and right amount, kind and quality and given to the right person. In addition, records are important for planning, monitoring and evaluating activities carried out in service delivery. A number of recording forms exists at the heath unit which should be used effectively to capture information on service delivery of micronutrient supplementation. Accurate record keeping lead to proper management of the micronutrient services provided.
OBJECTIVES
DRAFT
At the end of this session, the participants will be able to: Lecture-discussion and small group discussion 60 minutes
Session 3 will focus on Managing Resources and Health Information System
1. Discuss ways to ensure adequate MS supplies at the health facility. 2. Estimate Micronutrient needs of a barangay/Municipality based on recommended dosage and duration 3. Assess the storage facility and handling of micronutrient supplements of a selected health facility 4. Identify actions of keeping MS resources and reports safe and secure. 5. Assess the recording and reporting system of selected facilities 6. Recommend ways of ensuring accurate recording and prompt reporting of MS services and resources.
Readings/review on MSP-MOP pp. 94 to 96, annexes 10 and 13, pages 172 to 187, pages 193-194 Power point presentations on: Session Objectives and technical inputs List of sample health facility situations/conditions with key answers for the drill Sample records and reports on MSP: Correctly, incorrectly, incompletely filledup. Sample exercises for the computation of requirements and the correct answers
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TOPIC/TIME Introduction (05 min) METHODS / ACTIVITIES Greet the participants. Link the session 3 with session 1 and 2 of module 5. Tell : in the previous two sessions, we discussed the two qualities of a quality managed MS Program Introduce the session and present the objectives. Availability and accessibility of Micronutrient supplements (15 min) Lecture-discussion Ask participants to share their ways of ensuring availability of micronutrient supplies in the health facility. A co-facilitator will write participants responses into a white board or Manila paper. Possible answers may include the following: o Correct computation of targets o Updated masterlist o Presence of an updated inventory of supplies o Make request for low level of supply/no supply from barangay/ MHO/ PHO/CHD o Coordinate with partners/individuals for augmentation of supplements o Available transport to pick up supplements o Correct recording of who were provided with supplements/need to be provided o Make timely requisition if supplements are at low level o Procure supplements that are specified by DOH before stock out o Provide feedback to local officials of coverage regularly to get financial support most of the time o Health facility is open everyday o Supplements are accessible if needed by clients and not lock in cabinet of midwife is away for training Depending on the list generated, summarize into main categories. Present list of related requirements for quality MS care in health facilities: Point out those which were not in the list generated by the participants and its importance in ensuring availability of supplements 1. Updated master list for MS 2. Efficient logistics management (which include inventory, correct computation of targets and micronutrient requirements) 4. Timely, complete and accurate recording and reporting system of MS services and resources 5. Coordination with partners and stakeholders 116
DRAFT
TOPIC/TIME Availability and accessibility of Micronutrient supplements (15 min)
METHODS / ACTIVITIES Tell: One of the ways of ensuring available micronutrient supplements is the correct computation of targets and requirements. The next activity will be a review on how to correctly compute the micronutrient needs of a barangay. Using Power point slides provide instructions on the exercises on computation of targets and MS requirements for a given population. Use the case below as example and refer to MSP-MOP Annex 10. o Municipal N has population of 72,186, poverty index 29.88 in 2003 (NCSB 2003 City Municipal SAE poverty). o Barangay P has a population of 7,902
DRAFT
o Prevalence of high risk conditions=20% o Prevalence of IDA among pregnant= 42.5 o Prevalence of Post partum or lactating women= 31.4% Compute the requirement in a year for the following: 1. Vitamin A supplementation for GP for the year 2. Iron folic Acid for Pregnant women 3. IFA for Postpartum women 4. Vitamin A for high risk 12-59 months old children 5. Zinc drops for infants below 6 months with diarrhea Request a volunteer to give their answers for the cases. Present the correct answer and check with the participants if they have the same answer. If applicable share the excel format in Annex 8.A in computing requirement using a computer. Ask participants if there is any clarification. If none, request the participants to go to their small groups for the practice exercises in computing MS requirements. Option: Inform participants that there will be additional discussion and exercises during the practice session on Module 5. For regional/provincial/city/ Municipal participants for the re-echo training, discuss the computation of target and requirement using the excel program.
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TOPIC/TIME Logistic Management (Inventory, requisition, storage and handling, securing storage area) (15 min)
METHODS / ACTIVITIES Feedback report of practicum Tell: The discussion will focus on the findings during the field practicum at the health center. Referring to the staff interview checklist of the field practicum and based on the feedback report, ask each group to give a 1 minute situation report of the MS supplies, inventory, storage and handling and the implication of the situation on providing quality care. Option: If time permits, tally the results of the field practicum and present it during the session. Ask the participants: o What can they say about the storage and handling practices of the health facility visited? o Are micronutrients available at the health facility? o Are Micronutrient supplements stored properly? o Are the health facility doing inventory? o Are micronutrients handled properly? Given the status of the storage and handling of micronutrients, what do you think is the effect in the provision of quality MS services? Thank all groups for their presentations. In closing the activity, emphasize that all the items looked into the checklist on inventory, storage and handling, securing storage should be observed in any health facility to provide quality MS services to clients. Refer the participants to pages 94-97 of MOP for further reading.
DRAFT
Managing Recording and Reporting of MS services (15 min) Lecture-discussion with exercises
Tell: Another important area in providing quality care is the maintenance of good recording and reporting system for micronutrient services which is the focus of the next activity. Present an input on importance of: 1. proper documentation of clients conditions and MS/other services provided 2. accurate, complete and timely reporting of facility services and resources on MS Project on the slides 2-3 examples of records/reports on MS. 1. Ask participants their comments on the example presented:
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TOPIC/TIME
METHODS / ACTIVITIES 2. Ask participants the reasons on the observations mentioned: a) Correctly filled-up b) Incorrectly filled-up c) Incompletely filled-up Ask feedback on the presence of only 1 list of children provided with vitamin A every six months? Ask: What is the importance of accurate and complete documentation about the clients health status and interventions received, etc.
Synthesis (05 min)
DRAFT
8. Link the session to the next session and future sessions.
Tell: Currently, the FHSIS has target client list for pregnant and post partum women, sick children and under 1 year old. There is no target client list for 12-59 months old children. To address this, a target client list is presented in the MOP. Present slides on the proposed recording and reporting forms like masterlist for 0-59 months old children in Annex 5.A page 143. Also remind the participants of the reporting forms of GP. 6. Ask participants to mention some of their learning insights from the session and/or implications to their work stations and share two things that he/she will start doing. 7. Give 1 practice that you will continue doing, stop doing and start doing on storage and handling and recording and reporting on micronutrient supplementation.
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Module 5 Managing Service Delivery of MS Interventions Session 4: Supervising Delivery of MS Services

1
OVERVIEW
Good governance for the MS Program can be reflected in a well managed health service delivery system supportive to MS services for families and communities. As such, clients must have regular access to health facilities with: a) quality and organized MS services, b) competent, responsive and supervised health staff, c) regular MS supplies, equipment, d) efficient health information system, and e) staff provided with technical and administrative supervision from supportive supervisors/agencies. Session 1 focused on Provision of Quality MS services, Session 2 on Competent, friendly and responsive health staff, and Session 3 on Supportive Environment of Health facilities for MS service delivery. Session 4 is an overview and initial step directed towards providing Supportive Supervision of MS services delivery to improve MSP implementation at the first level of service provision. For supportive supervision to be in place, enhancing the supervisory and management skills of supervisors is recommended. Supportive supervision is a process that promotes sustainable and efficient program management by encouraging two-way communication between health providers and supervisors as well as performance planning and monitoring2. Supervision complements the orientation and training provided to health staff in enhancing their skills and competencies. At the end of this session, the participants will be able to: 1. Discuss concepts and principles in supportive supervision. 2. Enumerate the characteristics of a supportive supervision. 3. Explain supervisory functions focusing on the following: 3.1. Staff and health volunteers 3.2. MS services and resources 3.3. Recording and reporting of MS services and resources 4. Enumerate tools that can be used for supportive supervision 5. Discuss ways of improving the following aspects to support MSP: 5.1. MS service coverage 5.2. Staff performance on MSP implementation 5.3. Health facility services and activities Lecture-discussion, small group discussion (with case scenario) and drill 75 minutes Readings/review on MSP-MOP pp. 83-84 and annexes 15 pp. 196 to 202 Powerpoint presentations on: 1. Session Objectives 2. Technical inputs on supervision
DRAFT
OBJECTIVES METHODOLOGY ESTIMATED TIME ADVANCE PREPARATION
2
1
Marquez and Kean. 2002
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TOPIC/TIME Introduction (10 min) METHODS / ACTIVITIES Greet the participants. Introduce the session and present the objectives. Lecture-discussion Ask participants questions about their experiences in providing and receiving supervision on MS services. Acknowledge participants responses and use as basis for the lecture (power point) presentation on the topics. Present inputs on the following:
Supervision of MS services in Health Facilities (20 min)
DRAFT
Emphasize functions and roles expected of the supervisors Supervision of Staff performance on MS services and unit management (40 min) Small group discussion The small group discussion will be allotted 20 minutes. Provide supplies needed for the group outputs.
1. Definition of supervision and supportive supervision 2. Responsibilities, skills and qualities of a supervisor 3. Supervisory functions on the following aspects/areas of concern: 3.1. Organization of services and facility -Integration to routine services and non-traditional service channels - Client friendly physical set-up -Recording and reporting system 3.2. Staff competence and behaviours -Competence in provision of MS services -Supportive behaviours to clients 3.3. Availability of basic MS resources and equipment -Forecasting and procurement -Requisitioning and allocation -Inventory and maintenance -Handling and storage 4. Supervisory Tools
Provide a case scenario (Facilitators Guide Annex 5.4a) on a municipality with problems/ concerns on performance coverage of health services and service providers.
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TOPIC/TIME
METHODS / ACTIVITIES Based on the case scenario, ask participants to respond to the following: 1. Identify 2 main problems that the supervisor should prioritize in solving and explain the reasons/basis for the decision. 2. Identify some factors that may have contributed to the problem/s presented? 3. What are the immediate actions that you can and will do to address the problems and improve the situation? 4. Given the situation of limited human, material and financial resources, identify possible ways/means of addressing the constraints.
Synthesis (05 min)
DRAFT
Reinforce with appropriate information as needed.
The group facilitator must ensure that each member of the group will be able to participate in the discussion. Conclude the activity by summarizing the key points shown in the output and related issues covered in the discussion.
Ask participants to mention some of their learning insights from the session. Ask examples of changes that will be considered in the way their health centers/stations will be organized. Highlight the importance of supervision in improving implementation of MS services, by harmonizing and strengthening service plan and supervisory plan. Link this session and the other sessions in module 5 to the next module which is on action planning.
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DRAFT
DRAFT
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Annex 5.1a. Case Scenario for Small Group Discussions for Session 1 and Session 2
Case Scenario (Participants copy) Gloria, a 26-year old mother who is pregnant for the 3rd time visited their BHS for a prenatal check-up. She learned from the new BHW assigned in their area that pregnant mothers can avail of free iron with folic acid supplements that was why she decides to come to the BHS. Their BHS is 6 kms from their house but public transportation is available only 2x a day and will cost P20 one way. The mother has not sought for prenatal check-ups during her first 2 pregnancies, but was attended by a trained and experienced Hilot who provided her care from pregnancy until after her deliveries. Her reasons for not going to the BHS are: 1) it is very far and transportation is expensive, 2) always no drugs available, and 3) she did not like the former midwife because she easily gets angry and scolds patients. The BHW counseled Gloria on the importance of prenatal check-up in the clinic, need and benefits of taking iron supplements and its availability in the BHS, and assured her the new RHM is okey. Motivated, she decided to go to the BHS, borrowed P50 from her aunt for her fare in going to the BHS. She went on a Tuesday, which the schedule of the BHS for prenatal check-ups. When she reached the BHS, however, it was close because the midwife was attending a seminar. She went home without getting any MS/health service, not given prenatal check-up and a P50 debt. She is not sure when she can go back to the BHS again. Questions for Participants to work in Session 1:
DRAFT
1) What are the health services that Gloria would have received if the RHM was present in the BHS? 2) What are the other problems presented in this case scenario? 3) What are the interventions that can be done at the BHS and MHC levels to address the problems presented? Guide Questions 1. What are the criteria of a well managed Micronutrient supplementation program in health centers? What were the criteria not present in the BHS in the case above? 2. What are needed to meet the minimum requirements for providing quality and organized Micronutrient Supplementation program? 3. Prioritize on items that will have greater impact on the goals of Micronutrient Supplementation Program. Refer to the benefits of the well managed program.
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Annex 5.1b. Possible Answers / notes on the Small Group Discussions for Session 1
Consider review within the situational context of typical RHU/BHS. 1. The health services Gloria will receive may include the following: a) prenatal check-up b) iron with folic acid supplement c) health teaching and counseling on: - prenatal care - MS and nutrition, and - family planning
2. What are the other problems presented by this case?
a) regular schedule for specific services are not complied with (prenatal) b) clients are not aware about RHMs presence / absence from clinic
c) no one is designated to be at the BHS to provide basic information to clients when the RHM will be away
3. What are the interventions that can be done at the BHS and MHC levels to address the problems presented? a) the midwife should train BNs/BHWs in the BHS on MS
DRAFT
b) the midwife designate a BHW to take responsibility of safekeeping the MS resources in the cases when the midwife is out on training or when absent from the post c) provide advance information to BNs/BHWs for any scheduled training or leaves d) post announcements / update information in the whereabouts board e) for difficult to reach areas, designate the BHW assigned in the area to: - deliver the MS supplements to priority clients - give health teachings on MS - encourage mother to schedule a clinic check-up
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Annex 5.2a. Guide Questions for the Small Group Discussion in Session 2
Based on the case scenario in Session 1 (the case of Gloria) and the information during the small group discussion, ask participants to focus on the factors and/or issues that directly affect the service providers which is the topic of Session 2. Ask participants to respond to the following questions: 1. What are the factors related to the present RHM that affected Gloria not to fully avail of the needed health and MS services? 2. What are the factors related to the previous RHM that affected Glorias decision not to come to the health center to consult and seek for health services? 3. What can the RHM do so that clients will be encouraged to seek health and MS services from the health center? 4. To become more competent and responsive service provider for MS services, what would the RHM and the community volunteers need?
DRAFT
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Annex 5.2b. Possible Answers / Notes - Questions for the Small Group Discussion in Session 2
Possible Answers/ Notes 1. What are the factors related to the present RHM that affected Gloria not to fully avail of the needed health and MS services? RHM is new to the area, may not be well oriented yet with the communitys needs and conditions Tasks of BHWs/BNs have not been organized yet Irregular schedule of services She had a trusted and reliable service provider trained hilot
2. What are the factors related to the previous RHM that affected Glorias decision not to come to the health center to consult and seek for health services? Lack of compassion - RHM easily gets angry Lack of courtesy/respect RHM scolds clients in front of people Other factors health center is very far and always no drugs available
3. What can the RHM so that clients will be encouraged to seek health and MS services from the health center? Conduct regular meetings with her BHWs/BNs Post and update the schedule of the health centers services and activities Work with political leaders to improve supply of MS and drugs Improve relations with clients and volunteers : show respect and courtesy to clients be more compassionate in dealing with them
DRAFT
4. To become more competent and responsive service provider for MS services, what would the RHM and the community volunteers need? RHM should be trained / updated on MS program and other related services (e.g. maternal, newborn and child health services) Improved orientation and guidance about service providers: a. Job description and expectation b. behaviour and attitude in dealing with clients and volunteers Provided with supportive supervision (to be discussed more in Session 4 of this Module)
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Annex 5.3a. Exercises on Managing MS Resources and Health Information System

A. B. Exercises on Computing MS needs for Barangay P (participants copy) Municipal N population is 72,186, Poverty index - 29.88 in 2003 (NCSB 2003 City Municipal SAE poverty). Barangay P - population is 7,902 Incidence of diarrhea among infants=3.27 % Prevalence of high risk conditions=20% IDA prevalence among pregnant women= 42.5% IDA prevalence among postpartum/lactating women=31.4% Task: Compute the MN requirement for 2011 for Brgy. P: 1. Vitamin A capsule for GP 6-59 months 2. Iron folic Acid for Pregnant women
3. Iron Folic acid for Postpartum women
4. Vitamin A capsule for high risk 12-59 months old children
5. Zinc supplement (drops) for diarrhea infant for infants below 6 months
DRAFT
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Annex 5.3b. Answers to Sample exercises on computations of MS needs (Facilitators copy)

Vitamin A needs for GP for Brgy.P for 2011 for 6-11 months = 118 capsules (100,000) Total Population: 7,902 Estimated number of 6-11 month old = 7,902 x 0.0135 (1.35%) = 107 infants VAC requirement = 107 x 1capsule/infant/year = 107 capsules (100,000 I.U.) Buffer stock = 107 capsules x 10% = 10.7 or 11 capsules Total VAC requirement = Total VAC requirement + Buffer stock = 107 + 11 = 118 capsules
Vitamin A needs for GP for Brgy.P for 2011 for 12-59 months = 1,877 capsules (200,000 IU)
Total Population: 7,902 Estimated number of 12-59 month old = 7,902 x 0.108 (10.8%) = 853 children VAC requirement = 853 x 2 capsules/child /year = 1706 capsules (200,000 I.U.) Buffer stock = 1706 capsules x 10% = 170.6 or 171 capsules Total VAC requirement = Total VAC requirement + Buffer stock = 1706 + 171 = 1876.6 or 1877 capsules 2.a.Iron Folic Acid needs for Pregnant women for Brgy. P for 2011 - 31,680 tablets Example of Total Population/municipality: = 7902 Estimated number of pregnant women ( without IDA) = 7,902 x 0.035(3.5%) x 57.5% = 159.02 or 160 Total Iron requirement = 160 x 180 tablets/ woman /year =28,800 tablets Buffer stock = 28,800 tablets x 10% = 2880 Total Iron requirement = Total Iron requirement + Buffer stock = 28,800 + 2880 = 31,680
DRAFT
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2.a. Iron Folic Acid needs for Pregnant women for Brgy. P for 2011 = 9,490 tablets If Poverty Index to be applied Total Iron = Total iron requirement x Poverty Incidence = 31,760 x 29.88% = 9489.88 or 9490 tablets 2. b. Iron Folic Acid needs for Pregnant women with anemia =35,046 tablets Estimated number of pregnant women clinically diagnosed with IDA = 7902 x 0.035 (3.5%) x 42.5% =117.5 or 118 women Total Iron requirement = 118 x 270 tablets/ woman /year = 31,860 tablets Buffer stock = 31,860 tablets x 10% = 3,186 tablets Total Iron requirement = Total Iron requirement + Buffer stock = 31,860 + 3,186 = 35,046 tablets
3. a.Iron Folic Acid for Post Partum Women ( Non Anemic) = 9,324 tablets
Estimated number of Post Partum or lactating women ( non anemic) = 7, 902 x 0.03(3%) x 68.6% = 162.6 or 163 women Total Iron requirement = 163 x 52 tablets/ woman /year = 8,476 tablets Buffer stock = 8,476 tablets x 10% = 847.6 or 848 tablets Total Iron requirement = Total Iron requirement + Buffer stock = 8,476 + 848 = 9,324 tablets 3.b.Iron Folic Acid for Post Partum Women ( non-anemic)= 2,786 tablets If Poverty Index to be applied Total Iron = Total iron requirement x Poverty Incidence = 9,324 x 29.88% = 2,786 tablets 3.c. Iron-folic acid needs for Post Partum/lactating women with IDA= 14,850 tablets Estimated number of Post Partum /lactating women with IDA = 7,902 x 0.03(3%) x 31.4 % = 74.4 or 75 women
DRAFT
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Total Iron requirement = 75 x 180 tablets/ woman /year = 13,500 tablets Buffer stock = 13,500 tablets x 10% = 1,350 Total Iron requirement = Total Iron requirement + Buffer stock = 13,500 + 1,350 = 14,850 tablets 4. VAC needs for High Risk children 12-59 months = 187 capsules Estimated number of 12-59 month old children with high risk conditions = 7,902 x 0.108 (10.8%) x 20% = 170.7 or 171 high risk children Total VAC requirement = 170 x 1 capsules/child /year = 170 capsules Buffer stock = 170 capsules x 10% = 17 capsules Total VAC requirement = Total VAC requirement + Buffer stock = 170 + 17 = 187 capsules 5. Zinc drops needs for infants below 6 months = 5 bottles
DRAFT
Estimated number of infants (below 6 months) who will have diarrhea = 7,902 x 0.0135 (1.35%) x 3.27% = 3.4 or 4 infants Total Zinc drops need = 4 x 1 bottle (15 ml drops/infant/year = 4 bottles Buffer stock = 4 bottles x 10% = 0.4 or 1 Total Zinc requirement = Total zinc need + Buffer stock = 4 + 1 = 5 bottles
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Annex 5.4a. Case Scenario for Session 4 - Supervision

A. For MHOs/PHNs: 1. General Case Description on San Juan Municipality Comprised of ten (10) barangays, with total population - 27,325 in 2007 Health facilities include 1 main health center and 8 barangay health stations No doctor, with 1 PHN and 8 RHMs to cover 10 barangays One RHM covers 2 barangays, both with limited access to any health facility 2. Health status Had one (1) maternal death in 2006 from Brgy. Libuton and two (2) in 2008 from Pulo Island; causes of deaths - postpartum hemorrhage, hypertensive disorder and puerperal sepsis. In 2009, there were 4 under five deaths, 2 each from Brgy. Libasan and Brgy. New Vista; no death from Brgy. Poblacion. leading causes remain the infectious diseases such as pneumonia and diarrhea. 3. Performance Coverage in selected programs in 2009 is shown below:
Selected Barangays 1. Poblacion 2. Sta. Ana 3. San Pablo 4.Magsaysay 5. Pulo Island 6. Bato Island 7. New Vista 8. Libuton 9. Mt. Tubod 10. Libasan
DRAFT
Performance Coverage of San Juan Municipality in 2009 Selected Programs Access to VAC in PP Iron/ folate FIC VAC in DeMHC/BHS women Children worming Good 95% 94% 97% 97% 90% Good 90% 90% 94% 95% 95% Good 89% 90% 90% 87% 86% Good 93% 95% 96% 93% 89% GIDA 10% 20% 30% 30% 10% GIDA 15% 20% 40% 25% 10% Limited 40% 45% 60% 50% 35% Limited GIDA Limited 50% 20% 20% 50% 20% 25% 70% 40% 35% 60% 30% 30% 70% 10% 25%
RHM status 2 RHMs 1 RHM 1 RHM 1 RHM RHM Time RHM Time New RHM New RHM
4. You are the Public Health Nurse (PHN) of this municipality for the last 6 years, after working for one year in the nearby district hospital. A new mayor was elected in last years election. After conducting a performance implementation review for all basic services, he issued instructions for all agencies to improve the municipalitys performance. For the health sector, he specifically set an improvement of all services in the next 12 months.
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5. Guide Questions: a. What will be the immediate steps that you will take to comply with the mayors instruction? Name at least 3 important and immediate steps b. What are the top 5 problems in MS service delivery that your municipality is presenting? c. What will be your top 3 priority focus to show observable improvements in health service coverage? Why do you think so? d. What specific plans will you have for your RHMs to improve their performance? Name 3 most important interventions you will do as a supervisor. B. For RHMs:
1. General Case Description on Barangay San Juan: Comprised of ten (10) sitios, with total population 4,755 in 2007 Health facility include 1 barangay health station (under the Poblacion RHU) 8 BHWs to cover 10 sitios
2. Health status Had one (1) maternal death in 2006 from Sitio Libuton ; causes of deaths - postpartum hemorrhage In 2009, there were 2 under five deaths, 1 each from Sitio Libasan and Sition New Vista; leading causes remain the infectious diseases such as pneumonia and diarrhea. 3. Performance Coverage in selected programs in 2009 is shown below: Performance Coverage of San Juan Municipality in 2009 Selected Programs Access to VAC in PP Iron/ folate FIC VAC in DeMHC/BHS women Children worming Good 95% 94% 97% 97% 90% Good 90% 90% 94% 95% 95% Good 89% 90% 90% 87% 86% Good 93% 95% 96% 93% 89% poor 10% 20% 30% 30% 10% poor 15% 20% 40% 25% 10% Limited 40% 45% 60% 50% 35% Limited poor Limited 50% 20% 20% 50% 20% 25% 70% 40% 35% 60% 30% 30% 70% 10% 25%
DRAFT
Selected Barangays 1.Karangalan 2. Sta. Ana 3. San Pablo 4.Magsaysay 5. Pulo Island 6. Bato Island 7. New Vista 8. Libuton 9. Mt. Tubod 10. Libasan
RHM status 2 RHMs 1 RHM 1 RHM 1 RHM RHM Time RHM Time New RHM New RHM
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4. You are the Rural Health Midwife (RHM) of this barangay for the last 6 years, after working for one year in the nearby lying-in clinic. After conducting a performance implementation review for all basic services, the Barangay Captain of San Juan gave instructions to all Barangay Council members to improve the barangays performance. For the health sector, he specifically set an improvement of all services in the next 12 months. 5. Guide Questions: a. What will be the immediate steps that you will take to comply with the Barangay Captains instruction? Name at least 3 important and immediate steps b. What are the top 5 problems in MS service delivery that your barangay is presenting? c. What will be your top 3 priority focus to show observable improvements in health service coverage? Why do you think so? d. What specific plans will you have for your BHWs to improve their performance? Name 3 most important interventions you will do as a supervisor.
DRAFT
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Annex 5.4b. Possible answers / Notes on the Case Scenario for Session 4
A. For MHOs/PHNs: a. What will be the immediate steps that you will take to comply with the mayors instruction? Name at least 3 important and immediate steps. Prepare all the report and other documentations on the service delivery performance of municipality on the different health programs and make a rapid assessment on the causes affecting performance. Main Output: Data-based report on the identified priority health problems and possible causes/ contributory factors. Conduct a meeting of all the RHMs and other RHU staff to plan strategies on how best to meet the health service targets to satisfy the mayors instructions. Main outputs: 1.Setting of performance targets achievable within 12 months 2.Setting of staff agreements/ commitments to targets Prepare an Action Plan workable/feasible in the next 6 months Main Output: A 6-month Action Plan with Budget Proposal
b. What are the top 5 problems in MS service delivery that your municipality is presenting? Reported cases of maternal and underfive mortality Inadequate number and training of health human resources Two barangays do not have Barangay Health stations
DRAFT
2 barangays (Pulo and Bato) that are GIDA areas and with low MS coverage do not have RHMs 2 barangays (New Vista and Libuton) with limited access and low MS coverage share in the services of only one RHM 2 barangays with low MS coverage have new RHMs; Mt. Tubod is a GIDA area, while Libasan have limited access c. What will be your top 3 priority focus to show observable improvements in health/ MS service coverage? Why do you think so? Improving the competencies in providing MS interventions of the 6 RHMs identified above Selecting focus/target areas with low coverage for staff supervision, MS resource generation and increasing service coverage
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Training BHWs/BNs in MS program and organizing as implementation teams for strategic / priority areas (with low service coverage in MS) d. What specific plans will you have for your RHMs to improve their performance? Name 3 most important interventions you will do as a supervisor. Conduct informal training to new RHMs on MS, maternal, newborn and child health and nutrition Provide mentoring and coaching to old RHMs needing technical knowledge and/or skills update on MS services Organize RHMs in pairs (I experienced/1new or low performing) to set-up team support. Schedule new RHMs to report to Main Health Center during clinic high client load days 2x a month to practice skills, receive feedback and technical/supportive supervision.
DRAFT
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Annex 5.4b. Possible answers / Notes on the Case Scenario for Session 4
B. For RHMs: Guide Questions: a. What will be the immediate steps that you will take to comply with the Barangay Captains instruction? Name at least 3 important and immediate steps. Prepare all the report and other documentations on the service delivery performance of barangay on the different health programs and make a rapid assessment on the causes affecting performance. Main Output: Data-based report on the identified priority health problems and possible causes/ contributory factors. Conduct a meeting of all the BHWs and other volunteers to plan strategies on how best to meet the health service targets to satisfy the barangay captains instructions. Main outputs: 1. Setting of performance targets achievable within 12 months 2. Setting of staff agreements/ commitments to targets Prepare an Action Plan workable/feasible in the next 6 months Main Output: A 6-month Action Plan with Budget Proposal
b. What are the top 5 problems in MS service delivery that your municipality is presenting? Reported cases of maternal and underfive mortality Inadequate number and training of health human resources Two sitios do not have Barangay Health Workers
DRAFT
2 sitios (Pulo and Bato) that are areas with poor access and with low MS coverage do not have BHWs 2 sitios (New Vista and Libuton) with limited access and low MS coverage share in the services of only one BHW 2 sitios with low MS coverage have new BHWs; Mt. Tubod and Libasan have poor/limited access c. What will be your top 3 priority focus to show observable improvements in health/ MS service coverage? Why do you think so? Improving the competencies in providing MS interventions of the 6 BHWs identified above Selecting focus/target areas with low coverage for staff supervision, MS resource generation and increasing service coverage
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Training BHWs/BNs in MS program and organizing as implementation teams for strategic / priority areas (with low service coverage in MS) d. What specific plans will you have for your BHWs to improve their performance? Name 3 most important interventions you will do as a supervisor. Conduct informal training to new BHW on MS, maternal, newborn and child health and nutrition Provide mentoring and coaching to old BHWs needing technical knowledge and/or skills update on MS services Organize BHWs in pairs (I experienced/1new or low performing) to set-up team support. Schedule new BHWs to report to Main Health Center during clinic high client load days 2x a month to practice skills, receive feedback and technical/supportive supervision.
DRAFT
139
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MODULE 6: Planning for MS Program Implementation

DRAFT
Module 6 Action Planning Session 1: Planning for Improving MSP Implementation

OVERVIEW Good governance requires that appropriate MS interventions are identified and are responsive to the needs of the community, the vulnerable groups are prioritized, and their requirements are included in the plan. It also necessitates improved coordination across local health systems, enhanced partnerships, efficient logistic management, and efficient recording and reporting system. Good plans specify work priorities and how the work will be done. A plan is ready to be communicated to the people who will implement it only when it states an objective and specifies the time and resources needed to accomplish the objective.
DRAFT
OBJECTIVES At the end of this session, the participants will be able to: METHODOLOGY ESTIMATED TIME ADVANCE PREPARATION Lecture-discussion, Individual / group activity 60 minutes
Planning is anticipating events that will affect the work of the health team and setting plans and objectives into daily activities. This requires that health providers integrate MS intervention in their daily work activities in health facilities and the community. To meet the objective of integrating MS interventions into the routine health activities and appropriate programs, there is a need to prepare short-range plans in ensure that improvements in MS services for clients and their families will take place. For these changes to succeed, service providers need technical and administrative support from their immediate managers and supervisors. Thus, those in the supervisory level will also need to plan how to support the plans of improving MSP implementation.
1. Discuss the basic concepts in Planning. 2. Determine priority areas in MSP for action planning. 3. Explain the importance of integrating MS Services into the LGU plan. 4. Develop an Action Plan for: 4.1. Implementing MS in their area of assignment (service providers) 4.2. Supervising implementation of MSP (supervisors)
Readings/review on MSP-MOP pp. 74 to 84. Powerpoint presentations on: Session Objectives and technical inputs Action Plan Templates for: Service providers (Facilitators Guide Annex 6.1) and Supervisors (Facilitators Guide Annex 6.2)
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TOPIC/TIME Introduction (05 min) METHODS / ACTIVITIES Greet the participants. Introduce this session by giving an overview and presenting the objectives of the session. Inform participants that in this session, they will develop a plan of action to improve MSP implementation in their health facility and community Planning for client- Lecture discussion: friendly health Ask participants on the importance of planning for MS program. facilities supportive to MS services Acknowledge responses and write them on the white board. ( 20 min) Make a power point presentation on Planning for MSP: 1. Definition, concepts 2. Principles and steps 3. Importance for improving MSP implementation 4. Priority areas in planning
DRAFT
Lecturette-discussion Ask participants about their experiences in planning
Tell: specific discussion on the Planning MS Program under Governance can be found in Section 7 of MOP pp. 74 to 92 and Annex 6 & 17 pp. 152-153 & pp. 207. Note that Program Implementation Review (PIR) is critical process for planning. This is found on MOP pp. 90 and annex 16. Ask participants what they consider priority areas in planning for MS and the importance of integrating their plans with the LGU plans. Relate appropriate responses to the need and importance of their inclusion to MS policies and guidelines for MS services to be strengthened. Discuss the need for integrating their MS plan with their LGU plans.
Action Planning (30 min)
Inform participants that they will need to make an action plan to use as a guide in initiating improvements in MSP implementation. For purposes of learning interaction to draw ideas from others, participants can work in small groups either as: 1) service providers and/or 2) supervisors. Tell participants that their action plans will also serve as inputs to their Operational Health Planning for the coming year. 143
TOPIC/TIME
METHODS / ACTIVITIES Workshop Inform the participants of the following guidelines: 1. Participants may be grouped according to geographical affiliation for purposes of discussion and sharing common area concerns. 2. Provide participants with the Action Plan template. 3. Inform participants that they work within a group, they may try to produce individual plan for his/her facility.
Synthesis (10 min)
DRAFT
Explain the headings on the template. Inform participants that the next session will focus on: 2. Plenary presentations on the service and supervisory plans.
A facilitator will work with a group to provide guidance and as available reference for participants. Conduct initial discussion within the small and provide feedback on plans formulated.
1. Harmonizing the plans prepared by the service providers with the plans of the supervisors
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Module 6 Action Planning Session 2: Harmonizing Action Plans of Service Providers and Supervisors
OVERVIEW Good plans specify work priorities and how the work will be done. A clear plan is ready to be communicated to the people who will implement it. For changes to be initiated by health workers to succeed, they will need technical and administrative support from their immediate managers and supervisors. Thus, those in the supervisory level will also need to plan how to support the plans of improving MSP implementation. To complement the efforts of improving MSP implementation, consistency and harmony of plans is essential for greater success. OBJECTIVES
METHODOLOGY
DRAFT
At the end of this session, the participants will be able to: 1. Confer with each others plans as supervisee and supervisor. 2. Explore areas of agreements in the plans. Dyad : supervisor-supervisee sharing Plenary Discussion
3. Develop a harmonized plan between a supervisee and a supervisor.
70 minutes (30 min for dyad conference and 40 min for plenary presentation) Powerpoint presentations on: Session Objectives and technical inputs Action Plan Templates for: Service providers and Supervisors (Refer to Facilitators Guide Annex 6.2.)
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TOPIC/TIME Introduction (05 min) METHODS / ACTIVITIES Greet the participants. Introduce the session by giving an overview and presenting the objectives of the session. Inform participants that this is an activity where discussions on their individual plans will be shared with a partner - a pair will consist of a supervisor and a supervisee. Workshop Inform the participants that they will work in pairs: supervisor-supervisee within a geographical affiliation for purposes of discussion and sharing common area concerns. 1. Explain that they need to share and confer about their plans. 4. Explore areas of agreements and disagreement in their plans. 5. The pair will discuss and negotiate what agreements they can reach to harmonize/reconcile their plans. 6. A facilitator will work with a group to provide guidance and as available reference for participants.
Harmonizing Action Plans (25 min)
Plenary Presentation (40 min)
DRAFT
Summarize the different presentations. Highlight the innovations on service and supervisory plans Highlight the agreements/recommendations
Select presenters representing the service providers and select presenters representing the supervisors. Group facilitator should assist the group in preparing for the presentation of the plan. One facilitator will act as moderator. The presentation will be done in a pair of service provider and supervisor from the same geographical area. Limit each presentation to 5 min. Allow 5 min for the Q & A. Ask participants from different groups to ask questions and/or give comments on the presentation. Thank participants for their presentations and reactions. Inform participants that they should focus
Synthesis (05 min)
Inform participants that the plans presented may serve as a basis for monitoring MSP implementation in their community. Congratulate each of the participants for the effort exerted in developing a plan of action.
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DRAFT
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Annex 6.1. Planning for Improvements in MSP Implementation for Service Providers 6-Month Action Plan
Province/Municipality: Objective A. MS Services Strategies/Activities Person Responsible Time Frame
Outcome/ What to Monitor
B. Health Facilities
DRAFT
C. Service Providers/ Volunteers
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Annex 6.2. Supervisory Plan on Improving Performance of Service Providers on MSP 6-Month Action Plan
Province/Municipality: Objective A. Increase/Improve Coverage of MS Services Strategies/Activities Person Responsible
DRAFT
Time Frame
Outcome/ What to Monitor
B. Improve Health Facilities
C. Improve Participation of Service Providers/ Volunteers
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Annex 6.3. Harmonizing Action Plans of Service Providers and Supervisors 6-Month S-S Harmonized Action Plan
Supervisees Activities Timeline Supervisors Activities
Team Objectives
Timeline
A. Increase/Improve Coverage of MS Services
B. Improve Health Facilities
DRAFT
C. Improve Participation of Service Providers/ Volunteers
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DRAFT
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Training Design and Schedule for: TRAINING OF TRAINERS/FACILITATORS
DRAFT
DRAFT
154
Training of Trainers (TOT) onTraining of Service Providers on the Implementation of the Micronutrient Supplementation ProgramBackground and Rationale Nutritional deficiency remains a continuing challenge in the Philippines as it affects clients in various age groups and in certain physiological states. Using the WHO and national standards, only 68% of children under five have normal weight-for-age. In 2005, there was 24.6% prevalence of underweight pre-school children (0-5 years), 26.3% were stunted, 4.8% wasted and 2.0% overweight. Exclusive breast-feeding is low at 34% of children exclusively breast-fed up to age six months. In addition, children face the problems of 1) anemiawith prevalence rates of 66% in children 6-12 months; 2) vitamin A deficiencywith 40% in children aged six months to five years; and 3) iodine deficiencywith estimated 1.5 million schoolchildren aged 6-12 years at risk of mental retardation due to iodine deficiency. Micronutrient deficiencies in Vitamin A, iron and iodine have reached the levels of public health significance. Faced with economic, agricultural and challenges like emergencies/disasters in many areas, the problem increases further in magnitude due of lack of food and high incidence of infections due to congestion and poor sanitary environment and hygiene. The issuance of Administrative Order (AO) No. 2010-0010 by the Department of Health this year which provided the overall policy direction on the Micronutrient Supplementation Program (MSP) will significantly contribute to accelerating effective implementation of the MSP in reaching more clients. This paved the way for the need to update service workers on their competencies in implementing the MSP. To date, the last training conducted on Micronutrient Supplementation was in 1992, while technical updates were periodically conducted within the interim period to support the health workers. Hence, the capacity-building to meet the training and information needs of service providers to enable them to improve implementation of the MSP. To effectively carry out the conduct of the Training of Service Providers on MSP, course trainers/ facilitators need to complete the basic course for the Service Providers to learn the updated scope of the technical content and competencies in delivering micronutrient supplementation services, and a module on Training of Trainers/Facilitators in order to learn how each training session will be conducted to meet the learning objectives, applying the suggested methodologies and guidelines. General Objective To assist health service providers enhance their competencies on improving implementation of the Micronutrient Supplementation Program (MSP). Specific Objectives During the course, each participant will be able to achieve the following learning objectives: 1. Explain the following: 1.1. Health goals, objectives and targets on micronutrient supplementation national and local based on the set MDG for the country 1.2. The Micronutrient Supplementation Program (MSP) 1.3. Key provisions of the Micronutrient Supplementation Guidelines (AO 2010-0010)
DRAFT
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2. Discuss the following: 2.1. Status of Micronutrient Supplementation 2.2. Effects of common deficiencies on vulnerable population 2.3. Basic information, role and function of Micronutrients 2.4. Ways of improving implementation of MS Program 2.5. Concepts and principles of Supervision 3. Demonstrate skills in managing micronutrient deficiencies: 3.1. Assessing signs of micronutrient deficiencies/risk factors 3.2. Diagnosing/classifying deficiencies 3.3. Identifying appropriate interventions 3.4. Determining appropriate MS package for the different age groups and those in life stages/conditions requiring MS. 3.5. Identifying key messages on MS appropriate to clients need 4. Demonstrate skills in implementing the Micronutrient Supplementation program: 4.1. Providing MS services in various delivery channels 4.2. Integrating MS services in routine health services and programs 4.3. Formulating an action plan for effective implementation of MNS program *supervisory action plan for supervisors 5. Demonstrate competencies in training and facilitating in training of service providers in MSP implementation. Course Content:
Module 1 Introductory Sessions Session 1: Getting to Know and Forming Teams Session 2: Sharing Expectations and Setting Group Norms Session 3: Orientation to the Course and Course Materials
DRAFT
Module 2 Understanding the Micronutrient Situation Session 1: Basic Information, role and function of Micronutrients Session 2: Causes, Consequences and Prevention of Micronutrient Deficiencies Session 3: Magnitude of Micronutrient Deficiency Problems Module 3 The Micronutrient Supplementation Program Session 1: MSP Goals, Policy and Implementation Guidelines Session 2: Providing Essential MS Package for Infants and Children Session 3: Providing Essential MS Package for Women, Mothers and Other Adults Session 4: Strengthening Health Promotion Intervention for MS Module 4 Enhancing Integration of MS Interventions in Service Delivery Settings Session 1: Delivery of MS in Different Settings Session 2: MS Intervention in Routine Clinic Services Practice exercises for Module 4 Practicum Session Health Center Module 5 Managing Service Delivery of MS Interventions
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Session 1: Delivering Quality MS Services Session 2: Delivering MS Services Competent and Responsive Service Providers for MS Services Session 3: Managing Resources and Health Information System Session 4: Supervising Delivery of MS Services
Module 6 Planning for MSP Implementation Session 1: Action Planning on Improving MS Implementation 1.1. Service Plan 1.2. Supervisory Plan Session 2: Harmonizing Actions Plans of Service Providers and Supervisors Module 7 Training of Facilitators Session 1: Overview on the Concepts and Principles on Teaching-learning and Training Session 2: Applying Facilitation and Presentation Skills and Techniques Session 3: Practice Session on Facilitation Session 4: Action Planning on Roll-out of MS Training Training Methodology
Participatory teaching-learning methods such as lecture-discussion, small group discussion, role plays, drills/games, practices exercises. One practicum session in the morning will be conducted in selected health centers Evaluation Methods
DRAFT
Pre-test and Post test Completed work/ outputs during sessions Observation of demonstrated skills Post-training questionnaire Main Reference: The Department of Health Micronutrient Supplementation Program - Manual of Operations Operating Details
Participants: Trainers/Supervisors of Service Providers Duration: 5 days (Live-in). Venue/site: Provisions for adequate space for interactive learning methods like role plays, demonstrations and small group activities. In addition, arrangements with nearby health centers should be made for the one practicum day (Day 3 AM). Source of Funds: DOH-NCDPC and USAID A2Z project Training Schedule: Refer to the next page.
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DRAFT
158
DRAFT
Module 7: Training of Facilitators / Trainers
DRAFT
160
Module 7: Training of Facilitators/Trainers Session 1: Overview of the Concepts on Teaching-learning and Training
OVERVIEW Learning in health is the change in behavior in a positive direction to solve practical, social, cultural and personal problems in health encountered by individual, families, groups and communities. Positive changes in behavior can be achieved through formal and informal training. To achieve the desired behavioral outcomes, the functions of training and facilitating learning are key to the success in the development process of people and institutions/organizations. Training is the process of guiding the development of a persons skills, knowledge and attitude. It focuses on assisting the health workers learn specific work competencies/job skills in order to improve overall performance on the job. Effective teaching requires careful planning. Based upon the core competencies required of healthcare providers in the field, trainers are responsible to design courses so that trainees acquire the knowledge and develop the skills and attitudes related to the core competencies for the program. Careful planning for teaching and training consists of a) developing a course syllabus, b) planning for trainee assessment, c) selecting teaching methods, d) identifying learning materials, and e) developing a course schedule. At the end of this session, the participants will be able to: 1. Explain the following 1.1. training 1.2. teaching and learning 1.3. guiding principles in training service providers 2. Discuss basic concepts and principles in teaching and training. 3. Discuss the critical role of the following in designing training course 3.1. Course Objectives 3.2. Teaching and Assessment Methods 4. Explain the following: 4.1. Skills in health care delivery 4.2. Steps in skills development Lecture-Discussion / Group work 60 minutes Technical Presentation in Powerpoint Case scenario : San Juan municipality (M5-S4) Computer and LCD or overhead projector Powerpoint presentations on: 1. Session Objectives 2. Teaching and Training
OBJECTIVES
DRAFT
POWERPOINT PRESENTATION
161
TOPIC/TIME Introduction (5 min) METHODS / ACTIVITIES Greet the participants. Ask participants their concepts or ideas on the following: 1. Training of healthcare workers 2. Objectives/purposes of training health workers Use relevant responses and learning insights from the previous sessions to the present session to introduce this session and present the objectives of the session. At the end of this session, the participants will be able to: 1. Explain the following 1.1. training 1.2. teaching and learning 1.3. guiding principles in training service providers 2. Discuss basic concepts and principles in teaching and training.
DRAFT
4. Explain the following: 4.1. Skills in health care delivery 4.2. Steps in skills development Purpose of Training and Process of Skills Development (20 min) Group work / Group discussion
3. Discuss the critical role of the following in designing training course 3.1. Course Objectives 3.2. Teaching and Assessment Methods
Divide participants into 4-5 groups and let them work on the following: 1. Using the Case Scenario of San Juan Municipality from M5-S 4, assign a participants to work on improving the performance on MSP implementation through training and/or capability building interventions. 2. Let the group perform the following tasks: 2.1. Identify competencies of Service Providers that need improvement 2.2. Identify the factors/reasons to conduct training 2.3. Identify teaching and learning approaches/methods that will best result to the desired behavioral outcomes for the Service Providers 3. After completing the group work, the facilitator will initiate a 5 min/short discussion focusing on the following questions: 3.1. What are the learning insights have you identified? 3.2. What are the implications in conducting formal or informal training?
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TOPIC/TIME Teaching-learning Concepts and Principles (25 min)
METHODS / ACTIVITIES Lecture-Discussion Tell: In health, positive behaviors are needed to help health workers and clients promote health and solve problems. Positive behaviors are important in making right decisions for health workers, clients and their families. Training is a process in guiding health workers develop the right competencies in providing good quality of care for clients, including helping them overcome behavioral barriers to health care. Ask participants about the training experiences they like best and why. Take note of ideas related to teaching-learning concepts and principles. Present: Powerpoint slides on teaching and training
DRAFT
Synthesis/ Summary of the Session (10 min) Synthesize by: Thank participants for their active participation.
1. Guiding principles and approaches in training healthcare providers 2. Theories and concepts of teaching and learning 3. Training of healthcare providers a. HC delivery skills b. Steps in development of skill 4. Training Design a. Objectives b. Training methods c. Assessment Methods
Explain the need for facilitator/trainer to monitor the progress of each participant during a training course by tracking what specific experiences were provided to each one that will contribute to their learning objectives. Introduce the following tools which a facilitator for each small group may use for the purpose: 1. Monitoring Form 1: Classroom (Facilitators Guide Annex 7.1) 2. Monitoring Form 2: Practicum Session (Facilitators Guide Annex 7.2) Let participants participate by inviting/calling them to respond to questions or present their ideas on the topics.
Asking 1-2 participants to summarize the lessons learned from the session Informing participants that the learning insights gained from this session will be needed for the succeeding practice sessions.
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Module 7: Training of Facilitators/Trainers Session 2: Applying Facilitation and Presentation Skills and Techniques
OVERVIEW The quality of the learning environment is influenced by a variety of complementing factors that provide a setting conducive to the objectives of training. Facilitators are responsible for planning and organizing the training environment to match the objectives and needs of the training. Trainees learn best when they actively participate in the training process. As a facilitator, applying facilitation skills is encouraging involvement by showing interest in the trainees, allowing them to express their ideas and ask questions. Facilitation skills help the facilitators bridge the gap between the training content and the learners. It also allows facilitators to obtain feedback from the learners regarding their training experience and enable one to respond to the learners needs by using appropriate facilitating techniques. At the end of this session, the participants will be able to: 1. Explain the concepts and skills in: 1.1. Facilitation 1.2. Presentation
OBJECTIVES
DRAFT
3. Describe the following: 3.1. Facilitating techniques useful in this training 3.2. Methods/ways of monitoring progress of participants 1 hour and 30 minutes Powerpoint presentations on: 1. Facilitation skills and techniques 2. Presentation skills 3. ROPES Model 4. Monitoring Progress of Participants
2. Discuss the ROPES model according to its usefulness in training service providers.
4. Discuss ways of applying the different facilitating techniques in training METHODOLOGY ESTIMATED TIME ADVANCE PREPARATION Lecture-Discussion / Group work Service Providers of Nolasco Municipality
Objectives written for presentation on flipchart or powerpoint presentation Facilitator Checklists Facilitators Guide Annex 7.1. to Annex 7.4 Guide questions for the Group work Computer and LCD or overhead projector
164
TOPIC/TIME Introduction (10 min) METHODS / ACTIVITIES Greet the participants. Introduce this session by presenting the objectives of the session. At the end of this session, the participants will be able to: 1. Explain the concepts and skills in: 1.1. Facilitation 1.2. Presentation 2. Discuss the usefulness of the ROPES presentation model in training service providers. 3. Describe the following: 3.1. Facilitating techniques useful in this training 3.2. Methods/ways of monitoring progress of participants 4. Discuss ways of applying the different facilitating techniques in training. Ask participants the following: 1. How many years have you been working/in the service? 2. How many training courses in health/health related have you attended in the past 5 years. An estimate figure or number can be accepted. Tell participants that for the next exercise, they will have another group discussion session in their small groups in relation to their experiences and ideas on training. Group Discussion / Brainstorming Session 1. Divide participants into 3-4 groups based on the following: 2. Elect a new discussion leader, presenter and documenter. 3. Answer the following questions in 10 minutes: a. What types of training courses or activities did you find fulfilling and/or meaningful as health care professional and why? b. What were the ways that the training facilitators did or performed that you find motivating and encouraging as participants? c. As a facilitator, how would you want your participants to describe you? Why? 4. After 10 minutes, a representative from each group will present the outputs to the plenary session. 5. Use the outputs and/or learning insights to link to the succeeding activity by identifying / classifying whether the answers are: a. Facilitation skill b. Facilitation techniques c. Facilitator qualities/attributes 165
DRAFT
Qualities and/or Skills of a Training Facilitator (25 min)
TOPIC/TIME
Facilitation Skills and Lecture-Discussion Techniques Tell: Organizing training sessions is one of the most exciting and challenging (20 min) work for training facilitators for many reasons. Participants learn best when they participate in the training process. As a facilitator, applying facilitation skills is encouraging involvement by showing interest in the trainees, allowing them to express their ideas and ask questions. Facilitation skills help the facilitators obtain feedback from the learners regarding their training experience and enable one to respond to the learners needs appropriately. Facilitation skills help the facilitator/trainer bridge the gap between the training content and the learners.
DRAFT
Present: Powerpoint presentation on 1. Overview of Facilitation 2. Facilitation Skills 3. Facilitation Techniques Ask participants from different groups to respond
During the above presentation: Participants are asked to explain/give an example of how each skill and/or technique is performed or applied to facilitate better learning.
Introduce the relevant parts included in the following Tools: 1. Monitoring Form 2: Facilitating and Presentation Techniques (Facilitators Guide Annex 7.3) 2. Observation-Checklist for Trainee-Facilitator (Facilitators Guide Annex 7.4) Presentation Skills Lecture discussion and the ROPES model (25 min) Tell : Planning for an effective presentation of a training session is essential to the success of a training program. Organizing the session in an organized and systematic manner will ensure that appropriate learning methods and facilitating techniques are selected applying facilitation skills. ROPES model is a way of organizing a presentation of a session plan that will provide an instructional map for facilitators to follow. Present: Powerpoint presentation on: 1. Presentation Skills 2. ROPES Model During the above presentation, participants will be asked to read and give an example of how each idea in the presentation or step in ROPES can facilitate better learning. 166
TOPIC/TIME Demonstration
Introduce how to use/accomplish the Performance Observation Checklist for Facilitator-Trainee Explain the importance of the items to training objectives. Tell participants that this will be a suggested observation tool during the practice session for facilitator-trainee to provide basis for performance feedback Synthesis/ Summary of the Session (10 min) Synthesize by: Asking participants about their learning insights gained from this session Informing participants that they will have the chance to practice the facilitation skills and techniques and use of the Performance Observation Tool in the next session. Review the session objectives. Thanking participants for their active participation.
DRAFT
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Module 7: Training of Facilitators/Trainers Session 3: Practice Session for Facilitator-Trainee

OVERVIEW Trainees learn best when they actively participate in the training process. As a facilitator, applying facilitation skills is encouraging involvement by showing interest in the trainees, allowing them to express their ideas and ask questions. Facilitation skills help the facilitators bridge the gap between the training content and the learners. It also allows facilitators to obtain feedback from the learners regarding their training experience and enable one to respond to the learners needs by using appropriate facilitating techniques. OBJECTIVES At the end of this session, the participants will be able to:
METHODOLOGY
DRAFT
1. Apply Explain the concepts and skills in facilitation. 4. Provide performance feedback Lecture-Discussion / Socialized Recitation 1 hour Powerpoint presentations on Facilitating Learning
2. Describe the different facilitating techniques that can be used in this training. 3. Discuss ways of applying the different facilitating techniques in training.
Objectives written for presentation on flipchart or powerpoint presentation Facilitator Checklist Annex 7. Computer and LCD or overhead projector
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TOPIC/TIME Introduction (5 min) METHODS / ACTIVITIES Greet the participants. Introduce this session by giving an overview and by presenting the objectives of the session. At the end of this session, the participants will be able to: 1. Explain the concepts and skills in facilitation. 2. Describe the different facilitating techniques that can be used in this training.
Facilitating Techniques Lecture-Discussion (15 min)
DRAFT
4. Provide performance feedback Present: Powerpoint presentation on A. Facilitation B. Facilitation Skills a. Attending b. Observing c. Listening d. Questioning
3. Discuss ways of applying the different facilitating techniques in training.
Ask participants about their training experiences as participants and as facilitators. Use the relevant responses and learning insights from the previous sessions to the present session.
Tell: Trainees learn best when they participate in the training process. As a facilitator, applying facilitation skills is encouraging involvement by showing interest in the trainees, allowing them to express their ideas and ask questions. Facilitation skills help the facilitators obtain feedback from the learners regarding their training experience and enable one to respond to the learners needs appropriately. Facilitation skills help the facilitator/trainer bridge the gap between the training content and the learners as shown below:
During the above presentation, participants are asked to explain/give an example of how each skill are performed to facilitate learning.
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TOPIC/TIME (25 min)
METHODS / ACTIVITIES Present: Powerpoint presentation on Facilitating techniques: 1. Motivating Participants 2. Working with a Co-Facilitator 3. Conducting a Demonstration 4. Clinical Demonstration 5. Coordinating Role Play 6. Providing Performance Feedback 7. When Leading a Group Discussion 8. While Participants Are Working 9. Introducing and Summarizing the Session 10. Monitoring Skills Practice in the Clinic
DRAFT
Synthesis/ Summary of the Session (10 min) Synthesize by: Review the session objectives. Thanking participants for their active participation.
During the above presentation, participants are asked to read and give an example of how each the technique can facilitate learning Demonstration Introduce how to use/accomplish the Performance Observation Checklist (Facilitators Guide Annex 7.4) Explain the importance of the items to training objectives.
Asking participants about their learning insights gained from this session Informing participants that they will have the chance to practice the facilitating techniques and use of the Performance Observation Tool in succeeding sessions and the actual clinical session.
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Module 7: Training of Facilitators/Trainers Session 4: Action Planning on Training of Service Providers (Roll-out)
OVERVIEW Planning is the process of thinking through where we are going, how we will get there, what resources will be required before we act. Good plans specify work priorities and how the work will be done. They answer the twin questions, what work is really important to do now? and how are we going to get them done? Plans to improve MSP by improving its implementation must be on top of the health and development agenda regardless of the level of planning management is involved. At the service provider and client relationship level, there are actions and initiatives that may be done which may be simple, practical and useful. At the end of this session, the participants will be able to:
OBJECTIVES
METHODOLOGY
DRAFT
1. Review the barriers that contribute to low coverage for MSP 2. Identify key strategies appropriate in the areas that can improve: 2.1. Improve behaviors and practices of service providers 2.2. Improve behaviors of clients in care seeking. Workshop Plenary Discussion 2 hours Module 4 Objectives Action Plan
Objectives written for presentation either on flipchart or powerpoint presentation Computer and LCD or overhead projector Action Plan Template
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TOPIC/TIME Introduction METHODS / ACTIVITIES Greet the participants. Introduce this session by giving an overview and presenting the objectives of the session. At the end of this session, the participants will be able to: 1. Review the barriers that contribute to low coverage for MSP 2. Identify key strategies appropriate in the areas that can improve: 2.1. Improve behaviors and practices of service providers 2.2. Improve behaviors of clients in care seeking and treatment compliance.
Action Planning
DRAFT
A session facilitator will process the presentation
Tell: There are new information and healthcare delivery skills on MS and related health services that service providers need to perform and/or integrate in their performance that need to be communicated to them if MS services need to be improved and fully integrated in all relevant programs and services in the health system. The main objective of the action plan are directed at: 1. Improving the quality of MS services 2. Improving client experiences to improve their care seeking practices Challenge participants to come up with an Action Plan that: 1. Will be relevant and practical to their areas 2. Given limited funding and technical resources, what strategies can be done to work on the above-mentioned objectives Present the Planning template and its components Ask participants for any questions and clarification Let participants work as in groups according to geographic compositions Give the groups one (1) hour to complete their plans
Plenary Presentation
Prepare an order of plenary presentation of Action Plans by group/individual Assign facilitators to assist the groups and the presenter in finalizing their plans. Limit each presentation to five (5) minutes and allow ten (10) minutes for the Question and Answer.
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TOPIC/TIME Synthesis
METHODS / ACTIVITIES Summarize the different presentations. Highlight the commonalities Highlight the innovations Highlight the agreements/recommendations Inform participants that the plans presented and developed will serve as a basis for monitoring:
DRAFT
o Application of new MS guidelines
o Improvement in MS services in their health facility and community.
Congratulate each of the participants for the effort exerted in developing a plan of action.
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DRAFT
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DRAFT
DRAFT
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Annex 7.1. Possible Answers and Notes for Small Group Discussion on Training
Group work / Group discussion Using the Case Scenario of San Juan Municipality from M5-S 4, assign participants to work in groups on improving the performance on MSP implementation through training and/or capability building interventions. Questions/tasks: 1. Identify competencies of Service Providers that need improvement
2. Identify the factors/reasons to conduct training
DRAFT
c. healthcare delivery skills in MS and health services d. critical thinking skills in improving management of MS and health services, especially in difficult areas (alternative service settings) e. communication skills in relating with clients and volunteers f. management skills in ensuring adequate MS resources, information system and organizing the work and tasks of volunteers (BHWs/BNs)
a. six (6 )of the ten (10) barangays have very low performance in health and MS services b. two (2) RHMs are new to the service c. There is a need to update all RHMs on: - new MSP policies and guidelines - ways/approaches to improve the overall performance
3. Identify teaching and learning approaches/methods that will best result to the desired behavioral outcomes for the Service Providers a. Formal/organized training on MS and health services b. Informal training: - Individual demonstration and coaching (for the old/current RHMs) - Small group demonstration and coaching (for the 2 new RHMs) - Participation in actual clinic activities with observation and feedback session - Problem-solving sessions
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Annex 7.2. MONITORING FORM 1: CLASSROOM SESSION3

1
Names of Participants Service Provider Observer
ROLE PLAYS Client / Family Member
GROUP WORK Discussion Reporter/ Participant Leader Presentor
NOTES/ REMARKS
1 2 3 4 5 6 7 8
Guide for Recording:
- performed correctly/satisfactorily - performed, improvement/s needed annotate on the Notes/Remarks column X - not done/ no opportunity
DRAFT
Date: _____________________ Name of Facilitator: ____________________
Adapted from IMCI Training - Course Director Guide (WHO, 1999).
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Annex 7.2. Annex 7.3. MONITORING FORM 2: PRACTICUM SESSION4

1
Service Provider 1 2 3 4 5 6 7 8
DRAFT
Observer Discussion Leader
Names of Participants
ROLE PLAYS Client / Family Member
GROUP WORK Reporter/ Participant Presentor
NOTES/ REMARKS
- performed correctly/satisfactorily - performed, improvement/s needed annotate on the Notes/Remarks column X - not done/ no opportunity
4
1
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Annex 7.4. MONITORING FORM 3: FACILITATING AND PRESENTATION TECHNIQUES5

1
Names of Facilitator Trainees
Managing a Session
Coordinating Organizing Working Facilitating Facilitating Coordinating Providing Practice a Clinical with a Coa a Group a Role Play Performance Session Session Facilitator Workshop Discussion Feedback
- performed correctly/satisfactorily - performed, improvement/s needed annotate on the Notes/Remarks column
DRAFT
Annex 7.5. Facilitators Practice Session

OBSERVATION CHECKLIST FOR TRAINEE-FACILITATOR6
1
Name of Trainee-Facilitator: _______________________________________ Date: ________________

Use when observing facilitator/s conduct training session, demonstrate facilitator techniques and for Self-Assessment: use this scale: E=Excellent, VS=Very Satisfactory, S=Satisfactory, NI-Needs Improvement and NO=no opportunity.
ASSESSMENT AREAS / TECHNIQUES I. Planning and Implementing Training Session A. Management of a Training Session 1. Designs/uses session plan properly 2. Applies/observes the elements of the ROPES method (for classroom session) 3. Applies presentation and facilitation skills effectively 4. Uses visual and other teaching/training aids appropriately 5. Encourages active participation 6. Checks understanding (evaluates learning) 7. Manages session time effectively B. Application of Facilitation Skills 1. Attending Skills 1.1. Faces the learners 1.2. Maintains appropriate eye contact 1.3. Moves toward the learners 1.4. Avoids distracting behaviors 2. Observing Skills 2.1. Looks at the persons face, body position, and body movements. 2.2. Formulates an inference of the persons feelings based on what you have observed. 2.3. Takes appropriate action based on the inferences made. 3. Listening Skills 3.1. Listens to the words being expressed. 3.2. Paraphrases what was said to demonstrate understanding 4. Questioning Skills 4.1. Asks questions 4.2. Handles participants questions 4.3. Responds to participants questions
RATING
REMARKS
DRAFT
6 Adapted from the Facilitator Guide for All Modules in IMCI Training (WHO, 1999), Department of Health-Training Institute for Managerial Excellence (TIME) Training of Trainers Manual (1992) ) and Department of Health-Training Institute for Managerial Excellence (TIME) Advance Trainors Course Book (1995).
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ASSESSMENT AREAS / TECHNIQUES II. Applying Techniques in Facilitation A. Facilitator Technique: Introducing a Module / Session / Activity 2. Includes points suggested in the Facilitator Guide 3. Points to and explains relevant sections of the Guide/Manual contents appropriately B. Facilitator Technique: Leading a Discussion 1. Sets up the discussion by explaining its purpose and how it will proceed 2. Involves all participants in the discussion 3. Reinforces participants by thanking them for comments, praising good ideas, etc. 4. Handles incorrect or off-the-subject comments from participants tactfully 5. Asks questions to keep the discussion active and on track 6. Responds adequately to unexpected questions; offers to seek answers if not known 7. Records ideas on the flipchart in a clear, useful manner 8. At the end of the discussion, summarizes the major points C. Facilitator Technique: Coordinating Role Plays 1. Sets up role play carefully by obtaining necessary props, briefing participants who will play roles, and allowing time to prepare 2. Clearly introduces role play by explaining the purpose, the situation being enacted, background information, and the roles being played. 3. Interrupts only if players are having difficulty or have strayed from the purpose of the role play D. Facilitator Technique: Demonstration 1. States the objectives of the demonstration 2. Follows the instructions in the Facilitator Guide 3. Demonstrates the entire correct procedure (no short cuts ) 4. Describes the steps aloud while doing them 5. Projects voice well so all can hear; stands where everyone can see. 6. Encourages questions from participants 7. Ask participants questions to check understanding 8. At the end of the demonstration, summarizes and highlights main points E Facilitator Technique: Providing Performance Feedback 1. Discusses with participants results of performance observation 1.1. Steps/skills done correctly/appropriately 1.2. Steps/skills needing corrections/improvements 2. Helps participant to understand his/her errors 2.1. Gives clear explanations and suggestions 2.2. Asks participant ideas how to improve performance
RATING
REMARKS
DRAFT
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ASSESSMENT AREAS / TECHNIQUES 3. When appropriate, asks questions about the participants own clinic and how the learning applies to their situation. 4. Encourages and reinforces participants efforts F. Facilitator Technique: While Participants are Working 1. Looks available, interested and willing to help 2. Encourages questions 3. Watches participants as they work; offers help to participants who appear confused 4. Gives individual help quietly, without disturbing others. G. Facilitator Technique: Working with a Co-Facilitator 1. Shares the work in a module/session/activity in an organized way (e.g. each has a role in exercise, discussion, presentation). 2. Shows flexibility in adjusting to the role as needed 3. Polite and respectful/tactful when adding comments or making suggestions while his/her partner is leading 4. When leading, invites his/her co-facilitator to participate by adding comments or an opinion. H. Facilitator Technique: Summarizing a Module / Session / Activity 1. Keeps summary brief and clear 2. Includes the major points to be remembered from the module I. Facilitator Technique: Monitoring Practice 1. Observes participants carefully while they work 2. Uses the Checklist for Monitoring Practice Sessions 3. Reviews participants performance and discusses findings with them 4. Tries to get participants to see and correct their own errors (e.g., by asking them to look, ask or try again); provides assistance only as needed 5. Provides feedback on things done well and on things that need improvement
RATING
REMARKS
DRAFT
GENERAL COMMENTS/REMARKS:
Name of Facilitator-Observer: __________________________________ Date: _______________
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Annex 7.6. Action Planning for Training of Service Providers (Roll-out)

Action Planning for Training
Objective/s: Persons/Units Responsible/ Involved No. of Courses/ Participants Time Frame/ Schedule Resources Needed/ Budget
Type of Training Courses/ Activities
Outcome/What to monitor
1. Training of Trainers 1.1
1.2..
2. Training of Service Providers 2.1.
2.2.
3. Orientation 3.1..
DRAFT
3.2..
DRAFT
REFERENCE GUIDE ON TRAINING FOR TRAINERS/FACILITATORS
DRAFT
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MODULE 7: TRAINING OF FACILITATORS

Session1: Overview on the Concepts of Teaching-Learning and Training 1.1. Overview
Healthcare providers play key roles in the implementation of any public health program or strategy. Experience show that distribution of evidence-based clinical practice guidelines, is not sufficient to bring about change in health providers behavior and practices. Learning in health is the change in behavior to a positive direction to solve practical, social and personal problems in health encountered by individuals, families and communities. Behavior is defined as the attitudes, ideas, values and skills of a person, while positive directions refer to what enhance the self, others, and community. Positive changes in behavior can be done through formal and informal training which are essential to the development process of people and institutions. 1.2.
Health status and healthcare are influenced by prevailing social, political, and economic realities. The training of healthcare providers, therefore, must a) address the priority health needs and problems of a society, b) identify national policies, guidelines, and standards, and c) define the following expected role of healthcare providers: Caregivers who will consider a client as an individual, part of a family and community, and will provide high-quality, comprehensive, continual, and personalized care. Decision-makers who will choose interventions and technology in ethical and cost effective way. Communicators who will be able to ask appropriate questions, listen, advise, encourage, counsel, and educate individuals and groups to help them improve and protect their health Community leaders who can advocate for health and activities on behalf of the community Managers who will work effectively with colleagues, staff, and other organizations and who collect, analyze, and use health data to meet the health needs of individuals and communities In defining core competencies, we should remember 3 critical facts: 1) healthcare should be dynamic and responsive to changing societal needs; 2) healthcare continually evolves with advances in healthcare knowledge and technology; and 3) healthcare providers fulfill multiple roles. Outcome competencies must include cognitive (knowledge), psychomotor (skills), and affective (values and behaviors) domains that are observable and can be appraised.
DRAFT
Guiding Principles in Training Service Providers z
1
7
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WHO and JHPIEGO. 2005. Effective Teaching: A Guide for Educating Healthcare Providers. Geneva
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1.3. Teaching and Learning Process The teaching and learning process is a science underpinned by research and experimentation. It is an art involving constant exchange between knowledge and action. Although some people may be natural teachers, it is generally agreed that effective teaching is learned rather than innate ability. Teaching is a conscious manipulation of the learners environment that allow activities to contribute to their development as people and clinicians. People learn for themselves. Good teaching, however, supports learning. 1.4. Training of Healthcare Providers Training is the process of guiding the development of a persons skills, knowledge and attitude. It focuses on assisting health workers learn specific work competencies/job skills to improve overall performance on the job. Training is needed when there is/are: a) new evidence/body of knowledge essential to the providers roles and responsibilities, b) new ways, procedures or techniques of doing things, c) new tasks /assignments given, and d) new institutional directions to take. Delivery of healthcare services requires a combination of the following skills (Fig 7.1)8: 1. Communication skills that include listening, asking questions, informing, advising, counseling, and checking understanding. Healthcare providers need communication skills in relating with patients, families and other healthcare providers. 2. Clinical care skills that involve the abilities to assess a patients situation, decide what action is needed, and design and implement a care strategy. 3. Critical thinking skills that entail drawing on past experience and seeking out new information to analyze, reason, reflect, create ideas, and clarify information. Critical thinking is essential for solving problems and making sound decisions. 4. Management skills that include organizing, regulating, or being in charge of assigning tasks to staff, maintaining patient records, and ensuring availability of essential supplies and equipment.
1
DRAFT
Figure 7-1. Synthesis of Skills into the Delivery of Healthcare Services
SYNTHESIS DELIVERY OF HEALTH SERVICES (Examples of Tasks)
SKILL AREAS
- Communication (e.g. listening, advising, counselling ) - Clinical care (e.g. clinical assessment, treatment) - Critical thinking (e.g. reasoning, reflecting, creating, clarifying) - Management (e.g. record keeping, organization of work)
Healthcare Delivery Skills
Organize services Manage equipment and supplies Take health history Perform physical exam Interpret diagnostic tests Prescribe treatments Advise/counsel clients Keep accurate clients/patient records Assign tasks to staff
8
1
WHO and JHPIEGO
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When a healthcare provider has a skill, he/she has the ability to perform a group of steps or tasks correctly or to a standard. It can be a physical activity such as demonstrating how to do counseling steps or an intellectual activity such as calculating how many iron tablets are needed for one month. A skill may involve a single action or a series of actions. For example, checking for palmar pallor in a young child involves just one action, while counseling a mother on how to feed her malnourished child requires several steps. Healthcare delivery skills are best developed by a) introducing and demonstrating the skill, b) observing trainees as they practice the skill, c) giving feedback on how well they performed the skill, and, d) assessing trainees for competency in the skill. 1.5. Steps in Skills Development
When trainees learn skills, they typically move through three stages of skills development: Skill acquisition. Trainees are aware of the skill and know how it should be performed, but do not always perform it correctly. Skill competency. Trainees perform the skill correctly, but may not always progress from step to step efficiently. This is the level typically reached in the training of healthcare providers. Skill proficiency. The stage occurs after trainees graduate from a course and have practiced the skill at work over time. Proficient healthcare providers perform skills correctly and efficiently. Skills can be demonstrated, practiced, and assessed in a simulated or real environment. Depending on the difficulty and complexity of a skill, trainees may achieve competency in different ways. At a minimum, trainees should see a demonstration of the skill in either a simulated or real environment. Ideally, trainees should then practice the skill and receive feedback on their performance. The teaching methods of this course are based on several assumptions about learning9.
1
DRAFT
1. Instruction should be performance-based. Instruction should teach the trainee tasks he/she will be expected to do on the job. The course is developed based on an analysis of tasks and competencies involved in providing MS services to clients. 2. Active participation increases learning. Trainees learn how to do a task more quickly and efficiently by actually doing it than by just reading or hearing about it. Retention is greater in participants who practice a skill than in those who merely observe it. The course involves the trainees in doing written exercises, participating in group discussions, role plays, and in actual practicum sessions. 3. Immediate feedback increases learning. Feedback is information given to participant on how well one is doing. If he/she does well on an exercise, and is reinforced immediately, he/she is more likely to retain what is learned. Immediate feedback allows misunderstandings to be corrected before they become strong beliefs, or before the participant becomes further confused.
9
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Course Director Guide in IMCI Training. WHO, 1999
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4. Learning is increased when instruction is individualized. Participants learn at different speeds and in different ways. For maximum learning to occur, instruction must allow each participant to proceed at a pace that is comfortable for him/her. Each participant should ask questions and receive explanations to understand and acquire skill and knowledge. 5. Positive motivation is essential if learning is to take place. For instruction to be effective, participants must want to learn. Participants come to the course highly motivated to learn. Facilitators should help the participants maintain this motivation by a) providing individual attention, b) giving prompt feedback, c) reinforcing them for their work on the exercises, d) ensuring that they understand each exercise, and e) encouraging them in individual/group activities. 1.7. Planning for Teaching and Training Effective teaching requires careful planning. Most courses may have both theory and practice components that work to develop trainees knowledge, skills, and attitudes. Courses usually begin in the classroom with theoretical background and introduction, demonstration, and practice of related concepts and skills. They may continue in a simulated environment, where trainees continue to develop knowledge, skills, and attitudes. Finally, courses may provide opportunities to practice key skills and demonstrate key attitudes in a supervised clinical/ practice setting. Careful planning for teaching and training consists of a) developing a course syllabus, b) planning for trainee assessment, c) selecting teaching methods, d) identifying learning materials, and e) developing a course schedule. 1.8. Developing a Course Syllabus and Course Objectives A course consists of a series of learning sessions on a particular topic within an academic/ course program. A syllabus serves as the design document for a course, providing all the basic information about the course, and describes the course content and objectives. Course objectives relate directly to the core competencies required for an academic program. A course objective is fairly broad and may encompass knowledge, skill, and attitude components. A course objective may have an evaluation criterion - a description of how well the performance must be demonstrated, or the performance standard. There are some skills in which trainees should show a high degree of competence and others may show only familiarity. Supporting objectives outline the knowledge, skills, and attitudes a trainee must master to achieve a course objective. These are also used to determine the course content, teaching methods and materials needed to deliver the content, and the methods to assess the competency of trainees. Based on the core competencies required of healthcare providers, trainers are responsible to design courses so that trainees acquire the knowledge and develop the skills and attitudes related to the core competencies for the program.
DRAFT
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The development of precise and measurable objectives is the first step in designing your course. Objectives are statements that describe what the participants will know and be able to do after completing the course. Clear objectives help determine the course content, decide how one will teach the course, and identify how learning should be assessed. Figure 7-2 illustrates how objectives guide the teaching process by forming the basis for content, methods, and assessment. Figure 7-2. How Objectives Guide Teaching
Learning occurs in three different areas or domains as shown with some examples for each domain:
DRAFT
A. Knowledge Objectives -requires understanding and processing of facts, and often requires recalling information and solving problems : Explain why specific clients need micronutrients supplementation List the nutritional needs of infants younger than 6 months old Identify general benefits of breastfeeding B. Skill Objectives - refer to the acquisition of skills or the ability to perform procedures: Assess a sick child for common serious illnesses and malnutrition Perform a full antenatal examination on a pregnant woman Demonstrate the ability to assess breastfeeding attachment C. Attitudinal Objectives - deal with opinions or feelings and attributes related to individual, professional and institutional values. Counsel clients about MS using nonjudgmental language (both verbal and non-verbal) Obtain a comprehensive history in a sensitive and friendly manner, assuring client of confidentiality 1.9. Training and Learning Methods
Effective teaching considers how trainees learn best. Although it is impossible to accommodate the individual learning styles of a group of trainees, it is feasible to engage them in a variety of learning activities: to listen, look at visual aids, ask questions, simulate situations, read, write, practice with equipment, and discuss critical issues.
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Trainers can use methods such as video exercises, role plays, case studies, and simulations when introducing, demonstrating, and practicing skills. For some skills, simple demonstration may be sufficient. For complex skills, trainees need to practice and receive feedback on their performance. Table 7-1 show common teaching methods and the percentage of information recalled by learners after 3 hours and after 3 days related to each teaching and learning activity. The results confirm that trainees retain more when a combination of teaching methods is used (e.g., verbal, written, and visual), and recall more when they are actively involved (e.g. role play, case study, practice). Table 7-1. Learning Recall Related to Type of Teaching Activity TYPE OF TEACHING ACTIVITY PERCENTAGE OF MATERIAL RECALLED After 3 Hours After 3 Days Verbal (one-way) lecture 25% 1020% Written (reading) 72% 10% Visual and verbal (illustrated 80% 65% lecture) Participatory (role play, case 90% 70% study, practice, etc) Adapted from: Dale 1969
Selection of training methods to use in a training course is determined by the objectives of the course needed for the healthcare providers expected competencies to be developed.
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Session 2: Applying Facilitation and Presentation Skills and Techniques 2.1. Overview Interactive presentations maintain participants interest and are more likely to be successful in helping participants reach the learning objectives. It is important to use appropriate visual aids, questioning techniques, and group activities to make the presentations more interactive. When planning for teaching, review the skills that trainees should master by the end of the course. For each skill objective, consider the amount of time needed to become competent in that skill. Ensuring in the Training Session Plans the use and application of facilitation skills and techniques will significantly increase and retention of learning.
MODULE 7: TRAINING OF FACILITATORS
2.2. Facilitating Teaching and Learning FACILITATION SKILLS:
Trainees learn best when they participate in the training process. As a facilitator, applying facilitation skills is encouraging involvement by showing interest in the trainees, allowing them to express their ideas and ask questions. Facilitation skills help the facilitators obtain feedback from the learners regarding their training experience and enable one to respond to the learners needs appropriately. To facilitate, one will need to perform activities according to the three (3) functions: Instruct, Motivate and Manage (please refer to page 2-3 of the introductory part of this Guide). Facilitation skills help the facilitator/trainer bridge the gap between the training content and the learners as shown below: Figure 7-3. Function of Facilitation in Training FACILITATION SKILLS TRAINING CONTENT LEARNERS
DRAFT
The following are the types of Facilitation skills: A. ATTENDING SKILLS - shows that you are paying attention to your learners; builds rapport with your learners; communicates that learners are valued as individuals; enables observation of the learners responses to the training activities and encourages learners to interact verbally with the facilitator Four Attending Behaviors that show the facilitator is interested on participants: 1. Facing the learners 2. Maintaining appropriate eye contact
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3. Moving toward the learners 4. Avoiding distracting behaviors
B. OBSERVING SKILLS - helps assess how training is being received; helps decide whether to continue the learning process as planned, or, modify it to respond to the learners needs. Three steps in using Observing skills: Step 1: Look at the persons face, body position, and body movements. Step 2: Formulate an inference of the persons feelings based on what you have observed. Step 3: Take appropriate action based on the inferences made.
C. LISTENING SKILLS - obtains verbal information and verifies the trainees understanding of the information; demonstrates the facilitators understanding of the learners perspective; use as feedback in considering how to improve the training conduct.
D. QUESTIONING SKILLS questioning in training help determine what the learners already know and be directed on what they need to learn; invites learner participation and involvement in the training process; provides feedback on how the training is being received; and enables the learners to assess their learning. Skills associated with Questioning 1. Asking questions 2. Handling participants questions 3. Responding to participants questions
DRAFT
Two key steps in Listening: 1. Listen to the words being expressed. 2. Paraphrase what was said to demonstrate understanding 1. introducing a module 2. giving individual feedback 3. working with a co-facilitator 4. doing a demonstration required for a module 5. leading a discussion 6. coordinating a role play 7. leading oral drills 8. summarizing a module 1. preparing for the outpatient/practicum session
FACILITATION TECHNIQUES A. Facilitation Techniques for Classroom Sessions
B. Facilitation Techniques for ClinicaL/Practicum Sessions
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C.
2. explaining session objectives and what to do 3. assigning tasks at the clinic 4. assigning clients/patients to participants 5. monitoring as they work 6. providing feedback and guidance as needed in the clinic 7. leading discussion to summarize the session Techniques for Motivating Participants
Encourage Interaction 1. From the first day, take time to talk with each participant. If you are friendly and helpful during the first interactions, participants will likely a) overcome their shyness; and b) interact with more openly and productively throughout the course. 2. Look carefully at each participants work. Check if participants are having problems, even if they do not ask for help. If they know that someone is interested in what they are doing, they are likely to ask for help when needed. Keep Participants Involved in Discussions 3. Ask participants questions to check their understanding and keep them actively thinking and participating. Questions that begin with what, why, or how require more than just a few words to answer. Avoid simple yes or no questions. 4. Acknowledge participants responses with a comment, a thank you or a definite nod. This will make the participants feel valued and encourage participation. 5. Do not feel compelled to answer every question yourself. You may turn the question back to the participant or invite other participants to respond. You may need to discuss the question with co-facilitators. Be ready to say I dont know but Ill try to find out. 6. Use names when calling participants to speak, and when you give them credit or thanks. Use the speakers name when you refer back to a previous comment. Keep the Session Focused and Lively 7. Keep your presentations lively: * Present information conversationally rather than read it. * Speak clearly. Vary the pitch and speed of your voice. * Use examples from your experience, and ask participants from their experience. 8. Write key ideas on a flipchart as they are offered, using the participants own words if possible or paraphrase the idea and check it with the participant before writing it. You want to be sure the participant feels you understood and recorded his idea accurately. 9. Paraphrase and summarize to keep participants focused. Ask for clarification of statements as needed. Do not let several participants talk at once. When this occurs, stop the talkers and assign an order for speaking. Thank participants whose comments are brief and concise. 10. Encourage quiet participants to talk. Ask to hear from participants who has not spoken. Manage any Problems 11. Some suggestions on how to handle an overly talkative participant: * Do not call on this person first after asking a question.
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* Record the participants main idea on the flipchart. As he/she continues to talk about the idea, point to it on the flipchart and say, Thank you, we have already covered your suggestion. Then ask the group for another idea. 13. Try to identify participants who have difficulty understanding or speaking the course language. Speak slowly and distinctly so you can be more easily understood and encourage the participant in his efforts to communicate. Reinforce Participants Efforts 14. As a facilitator, you have your own style of interacting with participants. However, a few techniques for reinforcing participants efforts include: * avoid facial expressions or comments that cause participants to feel embarrassed, * answer questions thoughtfully, rather than hurriedly, * encourage participants to speak to you by allowing them time, * show interested, saying Thats a good question/suggestion. 15. Reinforce participants who: * try hard and/or ask for an explanation of a confusing point * do a good job on an exercise and/or participate in group discussions B. Working with a Co-Facilitator
Co-facilitators can help each other as a team. For example, while one facilitator is leading a discussion or doing a demonstration, the co-facilitator can: a) record information on the flipchart b) operate the projector, or c) follow along in the Facilitator Guide to ensure that no important points are omitted, and politely add certain points if necessary. When assigned to work together, co-facilitators should take time to exchange information and agree on roles, responsibilities and how to work together. Here are some suggestions: 1. Discuss in advance how you will work together on exercises, demonstrations, etc. Review the teaching activities for the next day, and agree who will prepare for each activity. 2.Work together on each module rather than taking turns. Within a module or session, you will at times be the leader and other times assisting, writing on the flipchart, etc. 3. When you lead a discussion, always try to ask the opinion of your co-facilitator. For example, ask _____, do you have something to add?, 4. When assisting, be respectful and polite. Give your co-facilitator your full attention. If you need to add information, wait until a suitable point in the presentation. Then politely ask, May I add something here?. 5. If you think a co-facilitator is doing a demonstration incorrectly or giving incorrect information, avoid contradicting him/her in front of the group. It may be possible to say, Excuse me, may I clarify that? If the situation is complicated, excuse yourselves, discuss the error privately and decide how to clarify the explanation or demonstration to the group, who must be given correct information as soon as possible. C. Conducting a Demonstration
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Perform a procedure and discuss the technique of a demonstration, including these points: * It introduces something that participants will soon learn how to do. * It may be easier to understand for participants who have difficulty reading, or who are more used to listening to oral presentations than reading. * Speak clearly. Use a conversational tone, varying the pitch and speed of your voice.
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* Pairs of participant will be assigned to one demonstration to practice individually and/or as a pair. The group will discuss the good aspects of each demonstration. * Practice the demonstration before doing it in front of the class. Study the guide and practice what to say, so you will not have to read from the guide. Practice using visual aids so you can do the demonstration comfortably and smoothly.
D. Coordinating Role Plays Explain that Role Plays are useful for practicing skills in communicating with clients, and are used in counseling, advising, instructing and educating on home care. Discuss the following points: * Role plays may not be perfectly prepared and rehearsed performances. The point of role plays is to practice dealing with new information about MS. * The health worker should not be told in advance information than is required, and should be encouraged to review the relevant sections of the Reference Guide. The facilitator should let the health worker understand the purpose, steps or points to cover in the role play. * Role Players should behave realistically based on the information about their roles. * It is important to look ahead when role plays will occur and prepare for them. * Keep a record of specific roles/tasks experienced by participants. E. Providing Individual Feedback
Explain that individual feedback is done by a facilitator to a participant after completing some work or performing a learning task. Review these points: * Individual feedback may be fairly brief and direct to the point. * For skill demonstration, refer to your observation checklist and inform him/her of your observation results. Ask participants how he/she feels about the performance. * At times, feedback may suggest questions on the participants own clinic and its procedures: -- How do you make sure adequacy of MS resources in your health facility? -- How do you teach and/or explain to a client about micronutrient supplementation? F. When Leading a Group Discussion:
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* Always begin the group discussion by telling participants the purpose of the discussion. * Often there is no single correct answer to be agreed on in a discussion. Be sure that group conclusions are reasonable and participants understand how conclusions were reached. * Try to get most of the group involved in the discussion. * Always summarize, or ask a participant to summarize, what was discussed. * Reinforce participants for their good work by (for example): - praising them for the completing the exercises, - commenting on their creative or useful suggestions for using the skills on the job, - praising them for their ability to work together as a group.
G. While Participants Are Working Helping participants with modules means more than giving feedback when they finish an exercise. It also means helping as they work, if needed. Review the following: * Watch participants start an exercise to be sure they understand what to do. If it takes one a long time to follow or misunderstand instructions, help the participant right away. * If a participant is show difficulty, quietly give brief help. Try not to disturb other participants. 197
H. When monitoring Skills Practice * Teaching has priority over other tasks. Maximize the teaching moment to full advantage for participants. * Since participants are learning changes in providing care, errors are expected. If you find no errors, you may not be paying close attention, or dismissing all problems as minor. On the other hand, do not be overly critical, finding fault with the participants work on every step.
2.3. Planning for Effective Presentation When deciding to give an interactive presentation, this means delivering information through an interactive oral presentation, often using visual aids to support the presentation. This may be done formally in a classroom or informally during a clinical practice session. Six Keys to a Successful Presentation
1. Define the objectives. Decide what participants should be able to do after the presentation. 2. Plan your presentation. Create an outline based on the objectives to help organize the content and keep focused, that include key points, questions, visual aids and summary points. 3. Introduce each presentation. A good introduction grabs attention and communicates the objectives of the session. Vary introductions used in different presentations. 4. Use effective presentation skills. Involve participants by asking questions, moving around the room, and maintaining eye contact. Provide clear transitions between topics and summaries. 5. Use questioning techniques. Asking questions is essential to maintaining participants interest, checking their understanding and developing their problem-solving skills. 6. Summarize your presentation. A good summary supports the presentations main points and reinforces the most important information. Some techniques to make presentation effective: Follow a plan and use an outline. An outline includes the presentation objectives, introduction, key points, questions to ask students, visual reminders, and summary points. Communicate in a way that is easy to understand. Use familiar words and expressions, explain new terms, interact with participants. project your voice and speak clearly. Interact with participants. Use eye contact to maintain their attention and to read faces. Ask both easy and challenging questions. Display enthusiasm about the topic and its importance. Smile, move around the room with energy, and interact with participants. Your enthusiasm will directly affect their enthusiasm. Use appropriate visual aids. Visual aids will help you explain complex topics, highlight key points, and add some variety to your presentations. Provide positive feedback. Very good point, Ilka!. Anne has made an excellent comparison! Provide smooth transitions between topics. Within a presentation, a number of separate yet related topics may be discussed. Communicate how the topics fit together into a bigger picture.
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2.4. Presentation Using the ROPES Model When planning for a presentation, remember the 6 KEYS and techniques to successful presentation. Using a framework or a model, such as the ROPES will ensure that important elements are in place. It will ensure that learning objectives will be achieved by putting together in a systematic manner the elements of the training content, methods, aids and evaluation. The ROPES model provides a guide in developing and presenting a session as shown in table 7-2. Table 7-2. Presentation Plan Using ROPES Model Purpose Activities To conduct a review of the participants general knowledge of and experience with the topic. Introduce the lesson/topic Have the learners share their knowledge of or past experiences Recognize the potential resource in the group Give an overview of the lesson and the activities that will occur Cover the learning objective(s) Establish why it is important to learn about the training content/topic.
Steps R Review
Percent of Time 5-10%
O Overview
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To establish a connection between the participants and the training content. To present the content to the Cover the training CONTENT using the participants in ways that help TELL and SHOW approach them retain the information. TELL the learners what is to be done and how to do it. Then, SHOW them how to do it by using examples or demonstration. To enable participants to practice using the training content to build their skills. Have the learners practice their new skills Provide feedback on their performance. S Summary To summarize Synthesize the lesson, stressing and clarify what was learned. important points Make a transition to the next lesson, or prepare the learners to apply the skills back on the job.
5-10%
P Presentation
25-30%
E Exercise
35-50%
S Summary
5%
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2.5. Planning for Assessment of Trainees Assessing trainees achievement is one of the most important tasks in training. The main purpose of assessment is to improve trainees learning. It is used to determine whether trainees achieve the learning objectives for a course, that is, to find out if they have acquired the expected knowledge, skills, and attitudes. Trainees must build and demonstrate competence in essential skills to deliver high-quality healthcare services after the course. The three-step process for skills development has these steps: (1) introduce and demonstrate a skill; (2) observe trainees as they practice the skill and give feedback to help them improve performance; and (3) assess trainees for competency in the skill. Methods for Assessing Skills of Trainees For a valid assessment, a combination of methods and techniques should be used for formative and summative assessment of skills. Trainers may formatively assess trainees by observing them during clinical practice and giving feedback that will help trainees prepare for summative evaluation. The following are methods that can be used: 1. Direct Observation is the most valid way to assess skills which can be used for both formative and summative assessments, using standardized checklist to reduce variations in scoring by different observers and increase reliability of the assessment. Questioning during observation can also assess their ability to integrate knowledge, skills, and attitudes. 2. Structured Feedback Report is a standardized way to give feedback to trainees, useful in assessing personal attributes, attitudes, and values. They are efficient and consistent, provide structure for formative assessment, reinforce skills, and ensure that trainees receive feedback. 3.Checklists are useful for giving feedback to trainees. A checklist is a list of steps needed to perform a skill correctly, where the assessor may indicate if each step was performed or not performed and may indicate the quality of the performance. 4. Rating Scales can be incorporated into checklists, or used independently. They are more effective in assessing broad skills or demonstrated attitudes, and in giving formative feedback. Remember this: 1. Training should always include practice of tasks, in situations similar to the job as possible. 2. Before practice of the task, learners should receive any necessary information and examples 3. Learners must receive feedback on their practice to know how well they were doing a task and how they can improve. 4. Evaluate training by watching learners do task on the job. If they still cannot do a task, find out why. Use the results of evaluation to improve training.
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Monitor Trainees Progress It is important to monitor the progress of trainees to ensure that the session is providing \ adequate and appropriate learning activities. Monitoring refers to following each trainees activities and experiences. 1. Logbooks or monitoring records are very useful tool for monitoring trainees progress during the duration of the course. It contains a list of skills or tasks that trainees should be able to perform or experience, providing a standardized tool for tracking their skills development throughout a course. The facilitator assigned will record/check off each skill or task in the logbook after the trainee performs or completes it correctly. The facilitator will take note/annotate specific skills incorrectly done, which can be use as guide in providing performance feedback. Annexes 7.__and 7. __ are examples adapted for MSP Training. 2. Performance Report is a standardized tool the facilitator/clinical instructor can use to provide feedback on trainees performance. Rather than providing information on very specific skills, trainees performance reports summarize performance in general areas and major skills. A general feedback form may be used to assess trainees overall performance. Annexes 4.4 and 4.5 are examples adapted for MSP Training. Well-organized training course that is structured based on the learning objectives provides trainees with important opportunities to develop skills relevant to their future work in the healthcare setting. Offer participants a variety of learning experiences within the classroom and at practicum sites. Monitor trainees progress to ensure that each session provides them with appropriate learning activities.
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2.6. Using Results to Improve Performance Skills are assessed to determine whether trainees are competent in the core learning objectives needed for application in work settings. Assessments aim to improve the performance of trainees. Monitoring information is usually collected in four aspects of teaching: A. Content. Does the content match the expected outcomes for the course? Does the content build on existing knowledge, attitudes, and abilities of trainees? Do trainees believe the new knowledge, skills, and attitudes are useful and applicable? B. Context. Are necessary facilities, resources, and equipment available during the training? Is teaching consistent with what is being taught in other, related courses? Is there a clear link between the classroom and the practical or skills development components of the course? C. Process. Was the course organized and taught in a logical way? What methods and materials were used for teaching, learning, and trainee assessment? Were trainees able to practice the competencies and receive performance feedback?
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D. Immediate Outcomes. What have trainees achieved as a result of the course? Were the learning objectives achieved? Do trainees demonstrate the expected levels of knowledge, skills, and attitudes?
Monitoring is defined as a continual process of gathering information for practical judgment and decision-making. Evaluation is the periodic assessment of the overall process and final results of a training course. Results of evaluations should be used to demonstrate to what extent the resources invested in training produced the expected effect. The following are the 4 main types of evaluations:
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EVALUATION TOOLS
PRE- AND POST-TEST COURSE EVALUATION
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Individual Assessment Name/symbol: Date: Position: I. True or false. Write true it the statement is correct and false if it is incorrect. 1. Micronutrients are produced by our body. 2. odine deficiency disorder is the most widespread deficiency in the country and most prevalent among infants, pregnant, nursing women, the older persons, children and adolescent girls. 3. At risk to vitamin A deficiency are non-breastfed infants, underweight children, and children with illnesses, children with parasitic infestation and population groups affected by emergencies/disasters. 4. Iron deficiency anemia in pregnant women will lead to miscarriages, premature births, intrauterine growth retardations, low birth weights, reduced ability to survive prolonged bleeding 5. Zinc and vitamin A supports healthy immune system to prevent diseases and infections. 6. VAD is still considered a public health problem among 6 months to 5 year old despite the decrease in the prevalence. 7. Children with measles should be given 2 vitamin A capsules, 1 capsule upon diagnosis regardless when the last VAC was given and another capsule after 24 hours. 8. Mild, moderate and severely underweight children should be given VAC upon diagnoses except when child was given less than 4 weeks before diagnosis 9. Infants under six months with diarrhea should be given Reformulated ORS and 20 mg zinc once a day for not less than 10 days. 10. Infants 6-11 months should be given 15 mg elemental iron once a day for 3 months. 11. Children 12-23 months old are prioritized for iron supplementation because of the high prevalence of iron deficiency for this age group. 12. Women 10-49 years old must be given iron folic acid supplements 1 tablet once a week once menarche starts and until they get pregnant. 13. In Malaria endemic areas, women showing signs and symptoms of malaria should be treated with malaria drugs first before giving them iron supplements. 14. Adults living in areas with moderate to severe schistosomiasis should be given iron tablets with 400 ug folic acid twice a day for 30 days after administering the praziquantel drug. 15. The goals of health promotion and communication are to create supportive environment, provide accessible user friendly MS services, increase demand for MS services. 16. Delivery of micronutrient supplementation packages integrated into existing MNCHN services is demonstrated by provision of micronutrient supplements for children during prenatal / postnatal check up.
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II. Multiple choices. Encircle the best answer. 1. The following are some of the guiding principles in micronutrient supplementation stated in the AO on Micronutrient supplementation issued on April 19, 2010 except: a. Systems approach d. Integrated service delivery b. Community and people participation e. Rights based approach c. Evidenced-based
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d. monitoring and evaluation e. physical examination
17. The major delivery settings of Micronutrient Supplementation package are health care facilities, outreach services, campaigns and temporary shelters. 18. Not everyone is vulnerable to micronutrient deficiency. 19. A health facility that is Client friendly for MS services is one where in MS is integrated into routine health services. 20. Supportive supervision is carried out in a respectful manner using supervisory visits as opportunities to improve staff performance. 21. Competence of health service providers can be met by having clear job description and expectations, training/orientation MS and supportive supervision. 22. Zinc sulphate tablets/ solutions do not require special storage. 23. Decisions in providing MS services are less dependent on accurate and properly recorded and reported data. 24. Computing the required MS supplies and commodities is based on actual population. 25. Folic acid should be given to a woman as soon as she gets pregnant.
2. Micronutrient supplementation shall be adopted as an intervention to address micronutrient malnutrition in which of the following conditions: a. Prevalence for a particular group or entire country is at a level of public health significance b. Economic crisis c. In times of disasters or emergencies d. a & b e. a & c 3. The following should be prioritized for micronutrient supplementation except a. Low birth weight infants d. Female adolescents (10-14 years old) b. 6-59 months old children e. Non pregnant/non lactating women of c. 6-9 years old children reproductive health (15-49 years old) 4. The initial step in integrating MS services into the routine health care services is: a. history taking b. Assessment c. validation 206
5. Post partum women should be given 1 tablet of iron folic acid once a week until one gets pregnant again. The iron folic acid should contain the following: a. 60 mg elemental iron with 400 ug folic acid b. 60 mg elemental iron with 250 ug folic acid c. 60 mg elemental iron with 2.8 mg folic acid d. 60 mg elemental iron with 300 mg folic acid e. 60 mg elemental iron with 500 mg folic acid 6. Two iodized oil capsules will be given to pregnant women once a year only except in a. IDD Prevalence is classified as moderate or severe b. Cretinism ad neonatal hypothyroidism are present c. In areas with 100% iodized salt utilization d. Universal salt iodization program will not reach women of reproductive age within 2 years e. In areas where less than 90% of households are using iodized salt and median urinary iodine is 100ug/l among school children 7. The physical examination on a client to determine need for MS or treatment focus on what regions/ parts of the body. a. abdomen b. head and neck c. skin d. b & c e. a & c
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d. a & b e. a & c
8. Alternative service delivery settings for Micronutrient supplements are : a. Clinics in Workplace b. Teen centers c. Hospitals
9. Micronutrient supplementation is best provided during disasters and emergencies by: a. Delivering the micronutrient supplements in designated evacuation centers b. Giving micronutrient supplements to affected families at the health center c. Conducting follow up of families not in evacuation centers in households or families hosting them during the disaster period d. a & b e. a & c 10. Which of the following contains all of these nutrients- vitamin A, iron, folate, iodine and zinc? a. fish d. meat b. milk e. shellfish c. egg yolk
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Individual Assessment (Answer Key) Name/symbol: Date: Position: I. True or false. Write true it the statement is correct and false if it is incorrect. F 1. Micronutrients are produced by our body. F 2. odine deficiency disorder is the most widespread deficiency in the country and most prevalent among infants, pregnant, nursing women, the older persons, children and adolescent girls. F 3. At risk to vitamin A deficiency are non-breastfed infants, underweight children, and children with illnesses, children with parasitic infestation and population groups affected by emergencies/disasters. T 4. Iron deficiency anemia in pregnant women will lead to miscarriages, premature births, intrauterine growth retardations, low birth weights, reduced ability to survive prolonged bleeding T 5. Zinc and vitamin A supports healthy immune system to prevent diseases and infections. T 6. VAD is still considered a public health problem among 6 months to 5 year old despite the decrease in the prevalence. T 7. Children with measles should be given 2 vitamin A capsules, 1 capsule upon diagnosis regardless when the last VAC was given and another capsule after 24 hours. F 8. Mild, moderate and severely underweight children should be given VAC upon diagnoses except when child was given less than 4 weeks before diagnosis F 9. Infants under six months with diarrhea should be given Reformulated ORS and 20 mg zinc once a day for not less than 10 days. T 10. Infants 6-11 months should be given 15 mg elemental iron once a day for 3 months. T 11. Children 12-23 months old are prioritized for iron supplementation because of the high prevalence of iron deficiency for this age group. T 12. Women 10-49 years old must be given iron folic acid supplements 1 tablet once a week once menarche starts and until they get pregnant. T 13. In Malaria endemic areas, women showing signs and symptoms of malaria should be treated with malaria drugs first before giving them iron supplements. F 14. Adults living in areas with moderate to severe schistosomiasis should be given iron tablets with 400 ug folic acid twice a day for 30 days after administering the praziquantel drug. T 15. The goals of health promotion and communication are to create supportive environment, provide accessible user friendly MS services, increase demand for MS services. T 16. Delivery of micronutrient supplementation packages integrated into existing MNCHN services is demonstrated by provision of micronutrient supplements for children during prenatal / postnatal check up.
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T F T T T
F F F F
II. Multiple choices. Encircle the best answer. 1. The following are some of the guiding principles in micronutrient supplementation stated in the AO on Micronutrient supplementation issued on April 19, 2010 except: a. Systems approach d. Integrated service delivery b. Community and people participation e. Rights based approach c. Evidenced-based
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d. monitoring and evaluation e. physical examination
17. The major delivery settings of Micronutrient Supplementation package are health care facilities, outreach services, campaigns and temporary shelters. 18. Not everyone is vulnerable to micronutrient deficiency. 19. A health facility that is Client friendly for MS services is one where in MS is integrated into routine health services. 20. Supportive supervision is carried out in a respectful manner using supervisory visits as opportunities to improve staff performance. 21. Competence of health service providers can be met by having clear job description and expectations, training/orientation MS and supportive supervision. 22. Zinc sulphate tablets/ solutions do not require special storage. 23. Decisions in providing MS services are less dependent on accurate and properly recorded and reported data. 24.Computing the required MS supplies and commodities is based on actual population. 25. Folic acid should be given to a woman as soon as she gets pregnant.
2. Micronutrient supplementation shall be adopted as an intervention to address micronutrient malnutrition in which of the following conditions: a. Prevalence for a particular group or entire country is at a level of public health significance b. Economic crisis c. In times of disasters or emergencies d. a & b e. a & c 3. The following should be prioritized for micronutrient supplementation except a. Low birth weight infants d. Female adolescents (10-14 years old) b. 6-59 months old children e. Non pregnant/non lactating women of c. 6-9 years old children reproductive health (15-49 years old) 4. The initial step in integrating MS services into the routine health care services is: a. history taking b. Assessment c. validation
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5. Post partum women should be given 1 tablet of iron folic acid once a week until one gets pregnant again. The iron folic acid should contain the following: a. 60 mg elemental iron with 400 ug folic acid b. 60 mg elemental iron with 250 ug folic acid c. 60 mg elemental iron with 2.8 mg folic acid d. 60 mg elemental iron with 300 mg folic acid e. 60 mg elemental iron with 500 mg folic acid 6. Two iodized oil capsules will be given to pregnant women once a year only except in a. IDD Prevalence is classified as moderate or severe b. Cretinism ad neonatal hypothyroidism are present c. In areas with 100% iodized salt utilization d. Universal salt iodization program will not reach women of reproductive age within 2 years e. In areas where less than 90% of households are using iodized salt and median urinary iodine is 100ug/l among school children 7. The physical examination on a client to determine need for MS or treatment focus on what regions/ parts of the body. a. abdomen b. head and neck c. skin d. b & c e. a & c
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d. a & b e. a & c
8. Alternative service delivery settings for Micronutrient supplements are : a. Clinics in Workplace b. Teen centers c. Hospitals
9. Micronutrient supplementation is best provided during disasters and emergencies by: a. Delivering the micronutrient supplements in designated evacuation centers b. Giving micronutrient supplements to affected families at the health center c. Conducting follow up of families not in evacuation centers in households or families hosting them during the disaster period d. a & b e. a & c 10. Which of the following contains all of these nutrients- vitamin A, iron, folate, iodine and zinc? a. fish d. meat b. milk e. shellfish c. egg yolk
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Training Evaluation Form To help us improve the quality of our training, we would appreciate your feedback! Please indicate your response to the questions below by circling the appropriate number, with 1 = MOST NEGATIVE and 5 = MOST POSITIVE: S + Name/Symbol: 1. Was your interest held? 2. Do you have a better understanding of: a) Health goals, objectives and targets on micronutrient supplementation b) The Micronutrient Supplementation Program c) Key provisions of the Micronutrient Supplementation Guidelines d) Status of Micronutrient Supplementation e) Effects of common deficiencies on vulnerable population 3. Did the course give you ideas about how to: a) Assess signs of micronutrient deficiencies/risk factors b) Diagnose/classify deficiencies c) Determine appropriate MS package for the different age groups and those in life stages/conditions requiring MS d) Identify key messages on MS appropriate to clients need e) Provide MS services in various delivery settings f) Integrate MS services in routine health services and programs g) Formulate an action plan for effective implementation of MS program h) Harmonize action plans of Service Providers and Supervisors 4. Overall, how would you rate the course? 5. Would you recommend this course to others? 6. What did you like most about the course? 7. What would you recommend changing about the course? 8. Now that you have completed this course, what additional training (if any) would be helpful? 9. Other comments, observations, suggestions: Thank you for your feedback! 1 2 3 4 5 1 2 3 4 5
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1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
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SAMPLE LETTER to Center for Health Development (CHD)
Date: ______________________ To: ________________________ Regional Director Center for Health Development ____ Address: ____________________ Dear Director _________________:
The Province of ____________________, with technical assistance from USAIDs A2Z project, will conduct a Training of Service Providers on the Implementation of Micronutrient Supplementation (MS) Program in _________________ on ____________. The objective of the training is to assist health service providers enhance their competencies on improving implementation of the MS program considering the new guidelines issued by the Department of Health (DOH) and its manual of operations. Micronutrient supplementation is one of the effective interventions to achieve the Millennium Development Goals. In this regard, may we request ______________, _______________ and ______________, trainers on MS in the region to assist in the conduct of the training as well as attend the facilitators meeting on ______________. Thank you very much for your utmost support to this activity and best regards. Very truly yours, _______________________ (Name of Governor) _________________ (Position)
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SAMPLE LETTER to City Health Office (CHO)
Date: ______________________ To: ________________________ City Mayor City Health Office Address: ____________________ Dear Mayor _________________: The Province of _______________________, with technical assistance from USAIDs A2Z project, will conduct a Training of Service Providers on the Implementation of Micronutrient Supplementation (MS) Program in ____________ on _____________________. The objective of the training is to assist health service providers enhance their competencies on improving implementation of the MS program considering the new guidelines issued by the Department of Health (DOH) and its manual of operations. Micronutrient supplementation is one of the effective interventions to achieve the Millennium Development Goals. In this regard, may we request _____________________ and _________________ who were trained on the new MS guidelines and its manual of operations by DOH, with technical assistance from A2Z project of USAID, to be facilitators during the training and attend the facilitators meeting on _______________. May we also request them to facilitate the conduct of field practicum in five (5) health centers of __________ on ________________ in the morning. There will be 10- 12 participants and facilitators visiting per health center. During the practicum, the participants will see 2-3 clients with risk factors or signs of micronutrient deficiencies, provide health promotion and prevention services, interview health center staff, observe clinic set-up /client flow and review pertinent records and reports. Thank you very much for your utmost support to this activity and best regards. Very truly yours, Very truly yours, _______________________ (Name of Mayor) _________________ (Position)
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SAMPLE LETTER to Municipal Health Office (MHO)
Date: ______________________ To: ________________________ Municipal Mayor Municipality of ________________ Address: ____________________ Dear Mayor _______________: The issuance of Administrative Order (AO) No. 2010-0010 by the Department of Health in 2010 which provided the overall policy direction on the Micronutrient Supplementation Program (MSP) will significantly contribute to accelerating effective implementation of the MSP in reaching more clients. Thus, contributing to the reduction of deaths among mothers and children. This paved the way for the need to update service workers on their competencies in implementing the micronutrient supplementation program. To date, the last training conducted on Micronutrient Supplementation was in 1992, while technical updates were periodically conducted within the interim period to support the health workers. Hence, the capacity-building was organized by the province with technical assistance from CHD __ , USAIDs A2Z project and to meet the training and information needs of service providers to enable them to improve implementation of the MSP. In this regard, may we request Ms. ___________________ and Ms. ___________________ to attend the training on _________________ in _____________. Thank you very much for your utmost support to this activity and best regards.
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Very truly yours, _______________________ (Name of Mayor) _________________ (Position)
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SAMPLE LETTER of Practicum
Date: ______________________ To: ________________________ City Mayor City of ________________ Address: ____________________ Dear Mayor _______________: The _________________in coordination with CHD ________, with technical assistance from USAIDs A2Z project, will conduct a Training of Service Providers on Implementation of Micronutrient Supplementation Program in __________on ____________. The training modules use a variety of teaching-learning methods including lectures, working in small groups using discussions, role-plays, practice exercises and actual facility-based practice sessions. In this regard, may we request your permission to have the practicum exercises in three (5) health centers of _________ in the morning of _______________. There will be 10- 12 participants and facilitators visiting per health center. During the practicum, the participants will see 2-3 clients with risk factors or signs of micronutrient deficiencies, provide health promotion and prevention services, interview health center staff, observe clinic set-up /client flow and review pertinent records and reports. We are looking forward to a favorable response on this request. Thank you and warm regards, Very truly yours, _______________________ (Name of Mayor) _________________ (Position)
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CHECKLIST OF THINGS TO PREPARE FOR SUPPORT STAFF NAME OF MODULE / SESSION NUMBER Day 1 Arrival/Registration Pre-training Assessment Opening Program Attendance ID Training kit Pre test LCD and Laptop Prepare 1 box of supplies for each group (meta cards, pentel pens, scissors, masking tape) Game, and group discussion TEST QUESTIONS, CASE SCENARIO, GAMES, CHECKLISTS, ANSWER KEYS EQUIPMENT, SUPPLIES, FACILITATOR/JOB AIDS NOTES/ REMARKS
MODULE 1 Session 1. Getting to Game Know and Formation of Instruction sheet (ppt Teams presentation) Ppt presentation on session objectives Session 2. Sharing Expectations / 5 questions Expectations and Setting (Training Manual) Group Norms
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Human Bingo cards LCD projector Laptop Copies of training design Ppt presentation on session objectives Training design MOP Questions and guidelines for the session exercises Ppt presentation on session objectives and technical inputs 5 Worksheets (Functions and Food Sources of Micronutrients) Markers Manila paper LCD projector Laptop
Session 3. Orientation to the course and the course materials MODULE 2 Session 1. Basic Information on Micronutrients
Distribute bingo cards 5 colors of meta cards Post the (Green, Yellow, Pink, Orange matrix in the and Blue) whiteboard/ Manila paper (matrix) wall Masking tape Pentel pens White board markers White board (for each group) LCD projector Lecture and Laptop discussion Distribute training design Lecture discussion, question and answer Post the matrix in the whiteboard/ wall
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NAME OF MODULE / SESSION NUMBER Session 2. Causes, consequences and prevention of MN deficiencies
TEST QUESTIONS, CASE SCENARIO, GAMES, CHECKLISTS, ANSWER KEYS MOP Questions and guidelines for the exercises Ppt presentation on session objectives and technical inputs
EQUIPMENT, SUPPLIES, FACILITATOR/JOB AIDS 5 Worksheets (Identify vulnerable/most affected groups, causes and consequences and ways to prevent deficiencies and diarrhea) Markers Manila papers Masking tape LCD projector Laptop Worksheets (Identification of Factors/Barriers and Possible Solutions) Markers Manila paper Masking tape LCD projector Laptop
NOTES/ REMARKS
3. Magnitude of MN deficiency problem
Day 2 MODULE 3 Session 1. MSP goals, DOH-AO No. 2010-0010 policy and implementing MOP guidelines Latest data/figures on MS national goals and targets Instructions, questions and key answers for the game exercise Session 2. Providing Essential MS Package for infants, children, women, mothers and other adults Session 3. Health Promotion and Prevention on MS MOP DOH-AO No. 2010-0010 Case scenarios for discussions (10-15 questions for oral drill) MOP Ppt presentation on session objectives and technical inputs Scenarios with key answers for the group work
DRAFT
Workshop matrix (Grp 1 - Guiding Principles, Grp 2 and 3 General Guidelines, Grp 4 - Roles and Functions) Marker Newsprint Masking tape Whiteboard Oral drill LCD projector Laptop Copy of case scenarios
MOP Current health/statistical data on nutrition and MS deficiencies (Case scenario: Municipal N) Workshop guidelines and worksheets Ppt presentation (session objectives and technical inputs) Selected questions relevant to RHM level
Lecture discussion Group discussion Workshop Distribute copies of case scenario municipal N and indicators Post the matrix
Lecture discussion, game (find it) group discussion/ group work Lecture discussion, question and answer, oral drill, game Lecture discussion and small group discussion Distribute case scenario
217
TEST QUESTIONS, CASE EQUIPMENT, SUPPLIES, SCENARIO, GAMES, CHECKLISTS, FACILITATOR/JOB AIDS ANSWER KEYS PRACTICE SESSION FOR Prepare 2-3 Case / Role Play Meta cards M-2 & 3 Scenarios for Modules 2 & 3 + Masking tape answer keys Pentel pens
NAME OF MODULE / SESSION NUMBER
NOTES/ REMARKS Prepare 1 box of supplies for each group (meta cards, pentel pens, scissors, masking tape) Lecture discussion, role play, demonstration, case studies, small group exercises and discussions Lecture discussion Demonstration and return demo Small group discussion/work Distribute copies of scenario and forms
MODULE 4 Session 1. Delivery of MS Intervention in Different Settings
Session 2. Integrating MS Intervention in Routine Clinic Services
DRAFT
Ppt presentation Observation checklist Client record form/ ITR Case scenario/study for return demonstration of assessment Copies of flowchart LCD projector Laptop Manila paper Markers Tape BP apparatus Stethoscope Alcohol Hand towel Forms (Observation checklist, staff interview checklist, records review) Forms a.m. snacks vehicle/van name of health centers
MOP Ppt presentation on session objectives , general guidelines and example of ways on how to integrate MSP in alternative service settings
Human Bingo cards LCD projector Laptop
PRACTICE SESSION FOR Prepare 2-3 Case / Role Play M-4 Scenarios for Module 4 + answer key MODULE 5 Session 1. Delivering MOP LCD projector Laptop Quality MS services Ppt presentation on session objectives and technical inputs List of factors/barriers from Module 2 Checklist on quality MS care and services
Lecturediscussion, small group discussion and drill Distribute copies of scenario
Day 3 Practicum
Prepare snacks (take out for pax)
218
NAME OF MODULE / SESSION NUMBER
TEST QUESTIONS, CASE SCENARIO, GAMES, CHECKLISTS, ANSWER KEYS
EQUIPMENT, SUPPLIES, FACILITATOR/JOB AIDS
NOTES/ REMARKS Print name of health center per group and post in front of vehicle (van)
Session 2. Delivering MS Services by Competent and Responsive Service Providers
MOP Ppt presentation on session objectives and technical inputs on job/role clarification in providing MS services and training List of sample health facility situations/ conditions with key answers for the drill Flashcards on roles, functions, performance of services providers and situations needing supervision Session 3. Health Facility MOP Environment Supportive Ppt presentation on session to MSP objectives and technical inputs List of sample health facility situations/ conditions with key answers for the drill Sample records and reports on MSP, correctly, incorrectly, incompletely filled-up Sample exercises for the computation Day 3.5 Session 4. Supervising MOP Delivery of MS Service Ppt presentation (session objectives and technical inputs on supervision Case scenarios on 1. Facility services and performance in MS 2. Staff performance in Ms supp 3. Client concerns on staff behavior and practices, MS services and facility organization PRACTICE SESSION FOR Prepare 2-3 Case /Role Play Scenarios for Module 5 + answer M-5 keys
Flashcards LCD Projector Laptop
Lecturediscussion Small group discussion
DRAFT
LCD Projector Laptop Copies of exercises LCD Projector Laptop
Lecture discussion and small group discussions
Lecture discussion and small group discussions Oral drill
219
NAME OF MODULE / SESSION NUMBER MODULE 6 Session 1. Planning for Improving MSP Implementation
TEST QUESTIONS, CASE SCENARIO, GAMES, CHECKLISTS, ANSWER KEYS MOP Ppt presentation on session objectives and technical inputs Action plan templates for service providers and supervisors
EQUIPMENT, SUPPLIES, FACILITATOR/JOB AIDS
NOTES/ REMARKS
LCD projector Laptop Manila paper (template of action plan)
Individual activity Plenary discussion
Session 2. Harmonizing Action Plans of Service Providers and Supervisors
DRAFT
Post the matrix MOP LCD projector Dyad: Ppt presentation on session Laptop supervisorobjectives and technical inputs Manila paper (template of supervisee Action plan templates for service action plan) sharing providers and supervisors Plenary discussion Post the matrix
220
REFERENCES (Note : This still need updating and/or corrections) Bandaranayake B. (2001). Study skills, in A Practical Guide for Medical Teachers. Dent JA and RM Harden (eds). Churchill Livingstone: New York, pp 410411. Barrows HS. (1990). Inquiry: The pedagogical importance of a skill central to clinical practice. Medical Education 24: 35. Barrows HS and RM Tamblyn (1980). P-BL: An Approach to Medical Education. Springer Publishing Company: New York. Dale E. (1969). Cone of experience, in Educational Media: Theory into Practice. Wiman RV (ed). Charles Merrill: Columbus, Ohio. Department of Health (December 2010- final draft) Manual of Operations for Micronutrient Supplementation Program. Manila, DOH Entwistle NJ. (1988). Motivational factors in students approaches to learning, in Learning Strategies and Learning Styles. Schmeck RR (ed). Plenum: New York. Hand-outs from various training courses on Training of Trainers and Advance Trainers Program Knowles MS et al. (1984). Andragogy in Action: Applying Modern Principles of Adult Learning. JosseyBass: San Francisco. Kolb D. (1984). Experiential Learning. Prentice-Hall: Englewood Cliffs, NJ. Sims J and M Weinger (1995). Women, Health and Environment: A Teachers Guide. World Health Organization: Geneva. (Unpublished document WHO/EHG/95.1; available on request from the Protection of the Human Environment Department, World Health Organization, 1211 Geneva 27, Switzerland) Thompson J, R Kershbaumer, and M Krisman-Scott (2001). Educating Advanced Practice Nurses and Midwives: From Practice to Teaching. Springer Publishing Company: New York. Training Institute for Managerial Excellence, Inc. and Health Manpower Development and Training Service (1992). Train the Trainors Program A Coursebook for the DOH Trainor. Department of Health: Manila. Training Institute for Managerial Excellence, Inc. and Health Manpower Development and Training Service (1995). Advanced Trainors Course. Department of Health: Manila. Wood R. (1987). Aspects of the competence-performance distinction: Educational, psychological and measurement issues. Journal of Curriculum Studies 19: 409424. World Health Organization and JHPIEGO (2005). Effective Teaching A Guide for Educating Healthcare Providers. WHO, Geneva World Health Organization and UNICEF (2000). Facilitator Guide for Modules Integrated Management of Childhood Illness (IMCI). WHO: Geneva World Health Organization and UNICEF (1999). Course Directors Guide Integrated Management of Childhood Illness (IMCI). WHO: Geneva.
DRAFT
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Facilitator&#39;s Guide Draft 081811

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DOH and A2Z Manual; For pre-testing only.

Training of Service Providers on the Implementation of the Micronutrient Supplementation Program

DOH and A2Z Manual; For pre-testing only.

Module 3 The Micronutrient Supplementation Program

Module 4 Enhancing Integration of MS Interventions in Service Delivery Settings

Module 5 Managing Service Delivery of MS Intervention

Module 6 Action Planning

Module 7 Training of Facilitators/ Trainers

Reference Guide on Training for Trainers/Facilitators

Evaluation Tools Pre-and Post Test- Course Evaluation

Annex 2.3. Annex 2.4. Annex 2.5.

Annex 3.3a. Case Scenarios on Health Promotion and Communication for MS

106 107 108 111 125

Annex 6.3. Harmonizing Action Plans of Service Providers and Supervisors

Supervisory Plan on Improving Performance of Service Providers on MSP 126 127

ABOUT THE COURSE AND THE COURSE MATERIALS

1.1. 1.2. 1.3. 1.4. 1.5. 1.6.

How does a Facilitator do these things?

What NOT to do.....

To prepare yourself for each module, a facilitator/trainer should: * * * * * * *

6. Lead discussions to summarize and monitor the participants performance.

Training of Service Providers on the Implementation of the Micronutrient Supplementation Program

Module 1 Introductory Sessions

Module 2 Understanding the Micronutrient Situation

Module 3 The Micronutrient Supplementation Program

Module 4 Enhancing Integration of MS Interventions in Service Delivery Settings

Practicum Session Health Center Module 5 Managing Service Delivery of MS Interventions

Training Schedule: Refer to the next page.

xviii Training of Service Providers on Improving Implementation of the MSP

Module 1- Introductory Sessions Session 1: Getting to Know and Forming Teams

ESTIMATED TIME ADVANCE PREPARATION

TOPIC/TIME Formation of Teams (10 min)

Orient on the roles/ responsibilities of Host Teams (05 min)

Synthesis (05 min)

ESTIMATED TIME ADVANCE PREPARATION

TOPIC/TIME Processing (10 min)

2. Familiarize on the content of the Micronutrient Supplementation Program- Manual of Operations

METHODOLOGY ESTIMATED TIME ADVANCE PREPARATION

TOPIC/TIME MSP-MOP (10 min)

Synthesis (05 min)

Annex 1.1. Human Bingo Card

Human Bingo Card

With one under five child

Fear of riding a boat

About to retire in the next 5 years

Married but childless

Knows about AO 2010-0010 (New policy on Micronutrient supplementation)

Annex 1. 2. Matrix on Sharing Expectations and Setting Group Norms

MODULE 2: Understanding the Micronutrient Situation

METHODOLOGY ESTIMATED TIME ADVANCE PREPARATION

Micronutrients (10 min)

Basic Information on MN (10 min)

Synthesis (05 min)

METHODOLOGY ESTIMATED TIME ADVANCE PREPARATION

Sample Pictures of clients with signs and symptoms of MN deficiencies

TOPIC/TIME Synthesis (10 min)

METHODOLOGY ESTIMATED TIME ADVANCE PREPARATION

Synthesis (10 min)

Annex 2. 1. Matrix on Functions and Food Sources of Micronutrients

Consequences of MN deficiency/diarrhea (3)

Ways to prevent MN deficiencies and Diarrhea (4)

Annex 2.3. Case Scenario on Magnitude of Micronutrient Deficiency Problem

Annex 2.4. Matrix on Identification of Factors/Barriers and Possible Solutions

Facilitator's Guide Draft 081811

Facilitator's Guide Draft 081811