Volunteer community health workers (CHWs) are a major strategy for increasing access to and coverage of basic health interventions. Our village health worker training course reviews the process of training and continuing education of CHWs as an important component of involving communities in their own health service delivery. Participants will be guided through the steps of planning training and continuing education activities for village volunteers. The course draws on real-life examples from community-directed onchocerciasis control, village health worker programs, community case management efforts, peer educators programs and patent medicine vendor training programs, to name a few.
Lecture 10E: Continuing Education Revisited
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From the course by Johns Hopkins University
Training and Learning Programs for Volunteer Community Health Workers
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From the lesson
Program Evaluation and Follow-Up
In this module, we will focus on evaluation, performance, and supervision. There will be a quiz covering lectures 9-10 after completing the lectures in this module.
Meet the Instructors
William Brieger, DrPHProfessor, Health Systems Program of the Department of International Health
Bloomberg School of Public Health
As we noted in the early lectures,
training is a form of continuing education.
It's more of a formal activity that maybe taking
place in the work setting, but time set aside
for a day long session and it may occur
away from the workplace where people attend a workshop.
But continuing education occurs throughout the day, throughout the workweek.
We want to be sure that we integrate our continuing
education with the overall performance management system of the organization.
And in terms of the human resource elements of
management we want to Think back again on some
of the issues we considered earlier during our diagnostic
phase and look at the job description, making sure,
again, that there is a job description to base training and continuing education on.
That there are clear supervisory relationships
to find in the management system
of the organization, because as we
mentioned before, supervisors perform educational functions too.
We want to look at the scheduling of actual planning,
meetings, staff meetings where people can not only Try to
manage the resources in the organization but share
information and educate each other about the program.
Another important management function is related to our question of evaluation.
What kind of performance review activities go
on with the employees and their supervisors?
How can this be integrated into our training evaluation?
How can this be a source of information for future trainings?
And clearly an important issue for management and personnel
management that needs to be
institutionalized into the organization's policy
and function, is a clear statement that staff are eligible
and require opportunities for continuing education and staff development.
So again, we want to make sure
that the, environment where people work, does encourage
learning, does encourage training.
And therefore, we would like
to see, continuing education opportunities institutionalized.
To set up specific units or sections in an organization
that looks out for these opportunities and needs for continued learning.
These things won't happen on their own, someone has to be made responsible.
And this would happen, if there is such a thing as a continuing education unit.
I think
on-, during one of our earlier lectures we talked about the facility needs assessment
activity that CDC developed for the Child Survival program in Nigeria one time.
And this was linked into technical support by CDC to help several state
ministries of health to set up continuing education units within their organization.
They were fortunate in
many cases because the states ran pre-service training institutions, schools
of health technology, where lab
technicians, community health extension workers,
health inspectors, all these kinds of people were trained And
this facility, then in many cases house the continuing education unit.
So the same people would be coming back.
There would be facilities, etc. For continuing education
a Library and classroom.
Again, the idea of using the facility
needs assessment, finding out what people needed.
using that then to design training.
Bringing people in from the local
governments and local health departments, etc.
So this was institutionalized and an
expectation, that continuing education would happen,
it would be a important function, it would a budget line item,
etc., for the health department or ministry.
Again, as we said before, this continuing
education should be based on a needs assessment.
And we need to have simple instruments to do this.
This is again back to some of the activities
that we did in terms of diagnosing training needs.
We need to have ways of interviewing potential trainees.
We need observation checklists such as this facility needs assessment.
We can use focus
groups among the trainees.
But we want within the organization itself within the health department The capacity
to collect and analyze this information,
and then plan and deliver continuing education.
So that back on the job the trainees recognize that they will have
continued learning needs, and the organization will
have the capacity to provide for that.
Which leads us to the importance
of having in-house approaches to continuing education.
Clearly, challenging job assignments could prompt self-learning, the
desire of people to find out what they're doing.
Hopefully, people won't be left to their own
devices to figure out how to learn new tasks.
If there are new screening procedures, if there are new
record-keeping procedures you don't want people to learn trial and error.
So, when these things are introduced people
may feel excited about learning about them.
They may also feel threatened that they don't
have the capacity to carry out the new skills.
So it's important to let employees know, and provide an opportunity for structured,
on-the-job learning, for mentoring by co-workers and senior staff.
By having in-house technical presentations to the staff.
Having, maybe a special seminar each week. Or using staff meetings for this.
Another way of encouraging learning within the organization is rotational assignments
so people can learn the procedures and practices in different service units.
They can learn about child care in one unit.
They can learn about pharmacy management in another.
And then of course the organization could, either on its
own or linking up with other institutions, such as Johns Hopkins, provide
electronic training, internet training, and educational resources, having access.
One of the key issues that we found in terms of the latter, is a
survey that was done by some of my students in the southwest part of Nigeria.
They visited Both formal government health agencies,
as well as NGO health development organizations.
And to find out whether the employees had access to the Internet to
help them plan their health education, and also for their own continuing education.
And unfortunately it was discovered that even
though many donor agencies provide computers to
The government health departments the front line
you know the, the service delivery staff the
program staff usually did not have access to these.
They had to go out on their own to an
internet cafe that was unreliable and expensive to get email.
To do web searches, the computer, if it was linked up at all to the internet, was
primarily a tool for administration, the secretaries and the
budget staff used the computer, not the program staff.
It was a big contrast to the experience
of staff in NGO settings.
Many of those staff had computers on their desk.
They were linked up to a local server.
And they were using the internet to find out about new
programs and get educational information to plan their activities in the community.
To communicate with other people doing similar work in other parts
of the country and world so they could learn from each other.
So here again our examples that an organization
can do to enable a continuing education and self-learning.
And we need to encourage these kinds of approaches.
Another example of continuing education resource is a library or reading room.
How many health departments have that?
How many? Who, who would be running it?
Again, if there is a continuing education unit that could be
part of their function to maintain the organization's library or resource center.
And there are quite a number of free
publications that are available to people in developing countries.
There's appropriate health resources agency and
organization in Britain that publishes several newsletters.
There, there're quite a number of free newsletters that can be acquired.
There are also low cost books that are available from different agencies.
So, if, if one decides to set up a resource center, it's quite
possible to get free or reduced cost resources to put there.
And so, checking with all the various donor agencies to
help develop this in getting a grant, getting free publications.
Continuing education is also needed for volunteers.
They need to be encouraged, as we found
without supervision and opportunities to attend short courses many
of the village health workers that had been trained by the health departments in
the Ephai area of Ocean State in
Nigeria had dropped out, had become less functional.
So we need to continually excite,
stimulate, reinforce what the volunteers had learned.
In addition, recognizing that some people will move on or drop out, we
need to have a continued training
function within our organization to replace volunteers.
One thing that's important about volunteer training, as we mentioned before,
people, volunteers, cannot spend a lot of time away from home.
It's expensive, they have family
responsibilities, and therefore the initial
training of many types of community health volunteers is short.
What we did in one program is have a weekly training for ten to 12 weeks.
And a couple of hours each time, that's relatively short.
Sometimes people might attend a course in the evenings,
like we did for the pet medicine vendors for a week or two weeks.
But it's, it's a relatively short training, and you can't cover everything.
Therefore, what you ened to think about for volunteers, is bringing them back in
Occasionally, for refresher sessions, as new issues arise.
One thing that we found that was very encouraging with
the village health workers that we trained in, the town of
[UNKNOWN]
is that they formed their own Village Health Worker Association.
And, this Association took responsibility for continuing education of the members.
They had meetings each fortnight, every two weeks, and at these meetings, one
member was assigned to review the lesson that they had been taught during their
basic training. We also encourage them to invite
resource people or other people to talk to them about new topics.
The initial traning did not cover family planning and they ask about that,
so we link them up with the family planning unit at the health department.
They wanted to know about HIV.
This was something that was new at the time, in the, the late 80s.
And so, it was possible for them to
plan, continue education sessions for their own members.
And again, this show that they, these volunteers themselves, were
able to develop the capacity to sustain their own program.
They made arrangements for hosting new sessions, for example.
They recruited new people to cover other villages or
to replace people who had dropped out and then
they actually organized the lessons themselves then they were
able to incorporate these new people into their association.
So,
they were continuing to sustain themselves.
In closing this lecture and the course, want to just recall that in
terms of learning and training, people feel
motivated and challenged when they have opportunities
to learn, when they develop new competencies,
when the assume new responsibilities And when
they believe that these efforts, this learning
and these efforts will actually strengthen their
career, these are motivators in the workplace and we can see that providing
learning opportunities is a way of improving
the functioning and management of an organization,.
People value learning Providing learning opportunities can also be an important
way for an organization to recognize the worth and value of its employees.
And by participating in training and learning activities, we can increase
staff collaboration and teamwork, improve overall
performance and productivity in an organization.
Finally, we want to thank you for your participation in this course.
We value your input, the hard work that you've
done and we hope this will help you improve,
training and continuing education in your own organization.
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