WPRlRS/95/GElI8(FD) English only

REPORT

WORKSHOP ON TIlE CONTROL OF ACUTE RESPIRATORY INFECTIONS AND DIARRHOEAL DISEASES IN YOUNG CHILDREN

IN PACIFIC ISLAND COUNTRIES

Convened by:

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR THE WESTERN PACIFIC

Nadi. Fiji 31 July - 4 August 1995

Not for sale

Printed and distributed by:

World Health Organization Regional Office for the Western Pacific

Manila. Philippines

July 1996

WHO/l\"'PP0 r.IE}:':~T MaJ.1.iliJ.. ~ .. ~.~;-,:,;,.~~

NOTE

The views expressed in this report are those of the participants in the Workshop on the Control of Acute Respiratory Infections and Diarrhoeal Diseases in Young Children in Pacific Island Countries and do not necessarily reflect the policies of the Organization.

This report has been prepared by the Regional Office for the Western Pacific of the World Health Organization for the governments of Member States in the Region and for the participants in the Workshop on the Control of Acute Respiratory Infections and Diarrhoeal Diseases in Young Children in Pacific Island Countries, which was held in Nadi, Fiji, from 311uly to 4 August 1995.

CONTENTS

SUMMARY ............................................................................................. 1

1. INTRODUCTION .............................................•............ ·· ..... ··············.·.···· 1

1.1 Background .................................................. ············ ...•. ··········· .. ··· .. · .. 2 1.2 Objectives of the workshop .................................................................... 2 1.3 Participants .................................................................................... , ... 3 1.4 Organization of the workshop ................................................................. 3 1.5 Opening ceremony ............................................................................... 3

2. PROCEEDINGS ........................................................................................ 3

2.1 Overview of ARI/CDD programmes ......................................................... 3. 2.2 Country presentations ........................................................................... 3 2.3 School presentations ............................................................................. 4 2.4 Updates on new WHOIUNICEF materials .................................................. 4 . 2.5 Small group work ................................................................................ 4· 2.6 Technical updates ................................................................................ 4: 2.7 Introduction of ARI/CDD in curricula ....................................................... 4 2.8 Field trip to Lautoka ............................................................................. 4 2.9 Reviewing national policies and plans of action ............................................ 4 2.10 Conclusions and recommendations ........................................................... 5 2.11 Closing ceremony ................................................................................ 5

3. CONCLUSIONS AND RECOMMENDATIONS ................................................ 5

3.1 Planning, management, coordination and funding ......................................... 5 3.2 Training ............................................................................................ 6 3.3 Health education and communication ........................................................ 6 3.4 Monitoring, supervision and evaluation ...................................................... 7

4. ACKNOWLEDGEMENTS ........................................................................... 7

ANNEXES:

ANNEX I - LIST OF RESOURCE PERSONS AND PARTICIPANTS ................ 9

ANNEX 2 - WORKSHOP SCHEDULE OF ACTNITIES ............................... 15

ANNEX 3 - PRE-WORKSHOP PARTICIPANT QUESTIONNAIRE .................. 19

ANNEX 4 - SUMMARY OF COUNTRY AND SCHOOL PRESENTATION .... : .. 21

ANNEX 5 - SMALL GROUP GUIDELINES ............................................... 25

ANNEX6 - RESULTS OF PARTICIPANT EVALUATION ............................ 43

Key words:

Dian1lea - prevention and control I Respiratory tract infections - prevention and control I Pacific Islands

SUMMARY

A workshop for national diarrhoeal disease (CDD) and acute respiratory infections (ARI) control progranune managers and staff of key health training institutions was held in Nadi, Fiji, from 31 July to 4 August 1995. The workshop was attended by 22 participants from 10 Pacific countries, one consultant, three temporary advisers, one observer, one staff member from UNICEF and six WHO staff.

The objectives of the workshop were:

(1) to review the progress of the national ARI and CDD progranunes and to discuss and revise national ARI and CDD policies and plans of actions;

(2) to increase the awareness and understanding of national ARI and CDD programme managers and staff of key health training institutions on regional initiatives and targets set in the World Summit for Children relevant to ARI and CDD programmes and breast-feeding promotion; and

(3) to give an overview of the current content of curricula of health training institutions relevant to ARI and CDD progranunes, to familiarize participants with the availability of new WHO and UNICEF training and communication materials and evaluation tools, and to plan follow-up activities.

The workshop consisted of multiple formats including plenary sessions, small group work, country and school presentations and discussions, technical updates by advisers, a field trip and video sessions on ARI and CDD progranunes. The main topics focused on country policies and plans of action, the development of coordination between programme managers and staff of health training institutions and the updating of training materials for both programmes and trainers. The meeting recognised the progress achieved by all countries with the assistance of both WHO and UNICEF.

The main recommendations concerned the standardization and coordination of training and practice by regular collaboration between programme staff and those from training institutions. Country policies and plans of action required reviewing and updating on a regular basis. Priority training strategies were identified for the various types of health worker in the region. Existing and new methods and materials for information, education and communications were discussed and appropriately prioritized. Finally, the meeting acknowledged the importance of monitoring, supervision and evaluation activities and recommended various approaches for improvement.

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I. INTRODUCTION

1.1 Back&round

In most of the developing countries of the Western Pacific Region, acute respiratory infections (ARI) and diarrhoeal diseases remain the major causes of morbidity and mortality in young children. To address the challenge posed by the above diseases, national ARI and control of diarrhoeal diseases (COD) programmes have been established in the majority of the developing countries in the Pacific.

An intercountry ARI/CDD programme managers' training course was conducted in Suva, Fiji in October 1990. National programme managers from 13 countries and areas in the Pacific attended to enhance their knowledge and skills to plan, implement and evaluate ARI and COD programmes.

Two intercountry training of trainers (ToT) courses on clinical management of diarrhoeal diseases were conducted at the Colonial War Memorial Hospital, Suva, in 1992 and 1993 (a combined ARI/CDD course). Clinicians from eight Pacific island countries improved their training, communication and case-management skills during these courses.

To follow up on the plans developed during the above-mentioned activities and to review the progress of national ARI and COD programmes, it was decided to conduct an intercountry workshop. It was proposed that the workshop would be hosted by the Government of Fiji. Furthermore, it was decided that the workshop would be a jOint activity of UNICEF and WHO.

A meeting of resource persons was carried out from 25 to 28 July 1995. The meeting provided an opportunity to fmalize administrative arrangements, discuss workshop dynamics and finalize the agenda. The resource persons included one consultant, three temporary advisers and WHO staff from the South Pacific and the Western Pacific Regional Office. (A list of resource persons is provided in Annex I.)

1.2 Objectives of the workshop

The objectives of the workshop were:

(I) to review the progress of the national ARI and COD programmes and to discuss and revise national ARI and COD policies and plans of actions;

(2) to increase the awareness and understanding of national ARI and COD programme managers and staff of key health training institutions on regional initiatives and targets set in the World Summit for Children relevant to ARI and COD programmes and breast-feeding promotion; and

(3) to give an overview of the current content of curricula of health training institutions relevant to ARI and COD programmes, to familiarize participants with the availability of new WHO and UNICEF training and communication materials and evaluation tools, and to plan follow-up activities.

•

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1.3 Partjcipants

There were 22 participants from ten Pacific island countries. Participants were representatives from national ARl and COD programmes (i.e .• programme managers) and staff from health training institutions and medical schools. (A list of participants is provided in Annex 1.)

1.4 Or&aojzatjon of the workshop

The workshop was composed of various types of presentations delivered by the temporary advisers and the secretariat. country and school presentations. small group work. plenary sessions. a field visit and viewing of videos on ARl. COD. vitamin A deficiency and breast-feeding promotion. A schedule of activities is provided as Annex 2.

Prior to the workshop the participants completed a brief questionnaire to assess the need for COOl ARIlbreast-feeding/vitamin A deficiency materials. training and management. The results are provided in Annex 3.

1.5 QpeojO& ceremony

The participants were welcomed to Fiji by Mr Apisa10me Tudreu. the Permanent Secretary for Health. Ms Jane Paterson delivered the remarks on behalf of UNICEF. The workshop was officially opened by Dr Michael O'leary. who delivered the opening remarks on behalf of Dr S.T. Han. Regional Director of the WHO Regional Office for the Western Pacific .

The opening ceremony was followed by the election of officials. The group elected Dr Lepani Waqatairewa of Fiji as Chairperson. Dr Rita Mori of the Federated States of Micronesia as vice-chairperson and Dr Peter Howard (consultant) as rapporteur.

2. PROCEEDINGS

2.1 Overvjew of ARI/cDD prollrammes

A brief overview of the status of the ARI and COD programmes in the Region was given. This included information on the progress towards achieving World Summit for Children goals. key achievements in various programme areas, major problems encountered. as well as future challenges and direction of the two programmes. High priority was given to emphasizing an integrated approach for the planning and implementation of the two programmes. issues related to quality and fOllow-up of training. and the importance offurther strengthening interpersonal communication skills of health workers.

2.2 Country presentatjons

Each country provided a brief presentation to highlight the achievements of the programmes as well as the remaining challenges. It appeared that training and provision of health education have been the most common areas in which national programmes have been active. In most countries, in-service training is carried out in an integrated manner. including many maternal and child health topics. It also appeared that. due to small populations. lack of planning and other factors. most case-management training could not ensure adequate 'hands on' practice due to lack of patients during training. These are summarized in Annex 4.

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2.3 School presentatjons

Selected schools were requested to give a brief presentation on the activities carried out with regard to ARI and CDD programmes, vitamin A deficiency and promotion of breast-feeding. It appeared that in many cases, lack of communication and coordination between the health training institutions and national programme staff was a problem. There was a lack of &baring of national policies, training and reference materials used by the programme staff. (See Annex 4 for a summary.)

2.4 Updates on new WHO/uNICEF materials

Several brief presentations were given by the secretariat during the workshop to update participants on the new programme materials. These included materials for pre- and in-service training, health education and communication and conduct of surveys and other evaluation activities. Videos were shown during lunch hours to interested participants. Copies of the materials were available to the participants.

2.5 Small)!roup work

The participants were divided into three small groups on the second and third days of the workshop. The purpose of the small group work was to stimulate discussions in selected key programme areas of training and evaluation. The outcomes of the deliberations were presented in plenary sessions by the spokespersons of each of the groups. The small group guidelines are provided in Annex 5.

2.6 Technical updates

Technical updates were provided by the secretariat in the following areas: vitamin A, cholera, 'Sick Child Initiative' and breast-feeding. All presentations stimulated lively discussions and the comments made by the participants were noted and reflected in the workshop conclusions.

2.7 Introduction of ARI/cDD in curricula

Prior to the workshop, a questionnaire on how ARI and CDD are taught in health and training institutions was developed and sent to the participants. The Philippine experience in strengthening the teaching of CD D in nursing and midwifery schools was presented by Miss E. Sullesta (temporary adviser). During the fourth day of the workshop, the school representatives, during small group discussions; were able to prepare plans for future action.

2.8 Field trip to l.autoka

A field visit was paid to the Lautoka Hospital, which was recently accredited as a Baby-Friendly Hospital. The visit enabled participants to observe the physical set up of the hospital, meet the staff involved and learn from their experiences in the planning and implementation of the Baby-Friendly Hospital Initiative.

2.9 Reviewio& national policies and plans of action

During the fourth day of the workshop, participants reviewed and discussed their national policies and plans of action in small groups. Sample plans and policies were distributed and discussions took place on key issues related to the development or revision of policies for ARI, CDD, vitamin A deficiency and promoting breast-feeding. Each country and school prepared a draft plan, which outlined the key activities to be carried out in their respective countries. Selected plans of actions were presented on the last day of the workshop.

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2. 10 CoocJmjoos and recommendations

The participants provided feedback to the secretariat on the organization of the meeting and discussed the conclusions. A post-workshop questionnaire was completed by the panicipants as a fonn of evaluation. The results of this are presented in Annex 6.

2.11 CIQSini ceremony

Comments were received from two panicipants, Miss Mele Havea and Dr John Adams. Closing remarks were made by Dr Jimi Samisoni of the Fiji School of Medicine and Ms Jane Paterson, UNICEF. The workshop was officially closed by Dr Michael O'leary on behalf of Dr S.T. Han, Regional Director of the WHO Regional Office for the Western Pacific. Prayers were offered by Mr Kendick Solodi.

3. CONCLUSIONS AND RECOMMENDATIONS

3.1 Plannjnr manaremen& coordination apet fund ina

(1) Appropriate mechanisms should be developed at a national level to ensure coordination of activities, in panicular with regard to policy development, planning and training between national ARIlCDDlbreast-feeding programme staff and teaching staff from health training institutions. This could be achieved through the establishment of working groups, the joint conduct of planning and review meetings and other regular means of collaboration.

(2) Each country should ensure that national policies related to ARI/CDD and breast-feeding promotion are developed and regularly updated by an integrated coordination committee including programme managers, clinicians and staff from training institutions. These policies should be endorsed by relevant government bodies. High priority should be given to the wide distribution of the policies including all levels of the health care system, health training institutions, other branches of the government and nongovernmental organizations, etc.

(3) High priority should be given to the development and/or fmalization of national plans of action related to ARI/CDD, breast-feeding promotion and vitamin A deficiency where appropriate .

(4) In view of the goals of the World Summit of Children for the reduction of childhood morbidity and monality by the year 2000, activities to achieve these goals should be accelerated and political suppon mobilized accordingly.

(5) To ensure sustainability, consideration should be given to training national/subnational programme managers on programme management and supervision by using an integrated approach and the WHO/UNICEF ARl/CDDlbreast-feedinglvitamin A deficiency materials.

(6) High priority should be given to ensure that adequate funding is mobilized in suppon of ARI/CDD/vitamin A deficiency and breast-feeding promotion. Additional funding at national level should be actively sought from various sources, including national governments, nongovernmental organizations, private companies, fund raising, etc. Continued suppon from UNICEF, WHO, South Pacific Commission and other sources in the implementation of the activities should be requested.

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3.2 Trainiol

(1) Training of health workers is considered of utmost importance in achieving programme goals and targets. Each country should develop strategies relevant to their country situation. High priority should be given to the following poinls:

(a) planning of training;

(b) ensuring adequate and locally adapted training materials;

(c) ensuring quality of training;

(d) ensuring 'hands-{)n' practice in clinical management training when feasible;

(e) creating a pool of experienced trainers;

(f) conduct of integrated training (ARI/CDDlbreast-feeding/vitamin A deficiency and Interpersonal Communications);

(g) follow-up and support of trainees; and

(b) regional training courses for: (i) Medical OfficerlPrimary Care Practitioners and tutors; and (ii) nursing tutors.

(2) National prograrntnes should consider means to ensure that United Nations Volunteers, Overseas Development Agency-funded Medical Officers and other government contract workers, nongovernmental organization staff, etc., are familiar with national policies and case, management guidelines by allocating additional time for orientation prior to commencing duties in the country.

(3) Innovative means should be developed to train/update and orient health workers on technical topics; these could include continuing medical and nursing education meetings and the use of modem communication technology including radio. Consideration could be given to ' use WHO/CDD distance learning materials in remote outer islands in coontries where health workers do not have access to formal training and to develop similar materials for ARI, breast-feeding and vitamin A deficiency.

(4) All health training institutions should ensure that ARIICDDlBreast-feeding and vitatnin A deficiency are integrated into the curriculum. WHO/UNICEF materials and technical support in this regard would be appreciated.

(5) The development of breast-feeding/vitamin A deficiency modules for pre-service training would be useful.

3.3 Health education and communication

(1) Consideration should be given to explore new approaches to communications, including the use of radio, in disseminating messages related to ARIICDD/vitatnin A deficiency and breast-feeding. In this regard, a pool of experienced staff should be trained in the Pacific from countries where use of radio would be considered cost effective.

(2) All new Information, Education and Communication materials should be pre- and post­tested to ensure that they conform with national policies especially after translation into local languages where appropriate.

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(3) The inclusion of communication skills in the curricula of all pre-service institutions is essential.

3.4 MonjtorjnK. supervisioo apd eyaluation

(I) High priority should be given to monitoring am periodically evaluating activities. In this regard, a pool of health workers in the Pacific should be trained in the use of key evaluation tools (surveys) by organizing collaboration between coumries. During the conduct of surveys, observers from neighbouring countries could be invited.

(2) Attention should be given to further improve national surveillance systems am, in particular, to streamline data collection with regard to ARI, diarrhoeal diseases, breast-feeding, vitamin A deficiency and growth monitoring. This should include the rationalization and modification of routinely collected data to ensure 'local' ownership, analysis and use of information.

(3) As resources for evaluation are usually scarce within a country, innovative ways to use existing tools should be developed. These may include: (a) modifications of tools (not methods) to allow selective use of parts or sections of the various survey manuals; (b) the collection of qualitative data during supervisory visits; (c) approaches which address process evaluation, as well as those of outcome am impact; (d) the use of students to carry out supervised evaluations (with consent) as part of their pre-service training; and (e) the use of 'exit' surveys from health facilities to assess client satisfaction.

(4) Supervisory methods need to be standardized to allow integration of activities, provision of feedback am their use for the assessment and maintenance of professional standards.

5. ACKNOWLEDGEMENTS

The writers wish to thank the Government of Fiji for hosting the workshop and the staff of the Ministry of Health and UNICEF for the excellent collaboration.

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WORLD HEALTH

ORGANIZATION

ORGANISATION MONDIALE DE LA SANTE

COOK ISLANDS

FUI

GUAM

REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL

UST OF RESOURCE PERSONS AND PARTICIPANTS

1. PARTICIPANTS

Dr Tingika Tere Senior Medical Officer Health Departmem Rarotooaa

Ms Moeroa Samuel Senior Nurse Acting Charge Nurse Surgical and Paediatric Health Department Rarotogp.

Dr Shabnam Prakash Fiji School of Medicine Sun

Ms Tene Uluilakeba Fiji Nursing School Sun

Dr Lepani Waqatairewa National Progranune Manager Acute Respirator Infections and Diarrhoeal Diseases Control Sun

Ms Kathryn Mae Wood Instructor of Nursing College of Nursing and Health Sciences University of Guam Maoailao

Ms Kimberly Dawn Kaible Community Health Nurse Departmem of Public Health and Social Services Ap.oa

ANNEX 1

Annex]

KIRIBATI

MARSHALL ISLANDS. REPUBLIC OF THE

MICRONESIA. FEDERATED STATES OF

SAMOA

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Ms Temareiti loane Nursing Officer Ministry of Health and Family Planning Tarawa

Dr Louise Russel Paediatrician c/o Ministry of Health Tarawa

Ms Irima Tokataake Member of the Faculry Nurses and Medical Assistants Training School Tarawa

Ms Carmen A. Manalansan Staff Nurse Ebeye Hospital ~

Ms Florina J. Nathan Public Health Nurse Supervisor Ministry of Health and Environment Majuro

Dr Rita Mori . Staff Physician Chuuk Stale Hospital Wcwl. Chuuk

Dr May Okihiro Faculty Member (Paediatrics) Pacific Basic Medical Officer Training Programme Pobnpej

Dr John Adams Paediatrician National Hospital Ai!ia

Ms Naifoua Salu Asiata Nurse Manager ARl Unit National Hospital Ai!ia

SOWMON ISLANDS

TONGA

TUVALU

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Ms Tamaitala Poloie Lees Nurse Lecturer Advance Diploma of Nursing Programme School of Nuning Ai2ia

Ms Judith Seke Principal Nuning Officer Ministry of Health and Medical Services Honjara

Mr Kendrick Solodi Senior Lecturer School of Nuning SICHE Hooiara

Dr Siaosi' Abo Senior Medical officer In charge of Paediatrics Vaiola Hospital Nl1'm' alofa

Miss Mele Tilema Havea Tutor Sister Ministry of Health Vaiola Hospital Nllku I alofa

Ms Filoimanatu Leauma Junior Sister Health Departtnent Funafutj

2. CONSULTANT

Dr Peter Francis Howard MPH Program Medical School Univenity of Queensland Herston, Queensland 4006 Australia

Anocx J

Annex I

SOUTH PACIFIC COMMISSION

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3. TEMPORARY ADVISERS

Dr Cecilia Acuin Executive Director Centre for Indigenous Medicine De la Salle University Medical Research Centre Dasmarinas, Cavite Philippines

Miss Enriqueta Sullesta Retired Nurse Lot 30, Block 10 San Francisco Village Jaro, Iloilo CitY Philippines

Dr Lisi Tikoduadua Chief, Diarrhoea Training Unit Colonial War Memorial Hospital SuYa Fiji

4. OBSERVER/REPRESENTATIVE

Dr Yvan Souares Epidemiologist South Pacific Commission Noumea Cedex New Caledonia

5. SECRETARIAT

Dr Seppo Suomela (Operational Officer) Medical Officer Diarrhoeal Diseases Control WHO Regional Office for the Western Pacific Manila Philippines

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Dr Astrid Pennin Associate Professional Officer Acute Respiratory Infections WHO Regional Office for the Western Pacific Manila Philippines

Dr Michael O'leary Epidemiologist Epidemiological Surveillance Office of the WHO Representative 3rd Floor YWCA Building Sukuna Park SJm Fiji

Mr Frank Rousar Technical Officer Expanded Programme on Immunization Office of the WHO Representative 3rd Floor YWCA Building Sukuna Park SJm Fiji

Dr Dominique Lefevre Medical Officer Nutrition Services Office of the WHO Representative 3rd Floor YWCA Building Sukuna Park SJm Fiji

Dr Ruth Stark WHO Nurse Educator/Administrator Office of the WHO Representative 3rd Floor YWCA Building Sukuna Park SJm Fiji

Ms Jane Paterson Health and Nutrition Project Officer United Nations Children's Fund 3rd Floor, Fiji Development Bank Building 360 Victoria Parade SJm Fiji

Anne) J

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ANNEX 2

WORKSHOP SCHEDULE OF ACTIVITIES

311uly 1995 MQrxlay

08.30-09.30 am Registration

09.30-10.00 Opening ceremony

10.00-10.30 Coffee break

10.30-11.30 OVerview of ARI/CDD programmes

11.30-12.00 Country presentations

12.00-13.30 pm Lunch

13.30-15.00 Country presentations (continuation)

15.00-15.15 Coffee break

15.15·16.00 School presentations

16.00-17.00 Technical presentations (optional)

J Aneust 1995 Tuesday

08.00-08.45 am Sick child initiative

08.45-09.00 Introduction to training

09.00-10.00 Group work on training

10.00-10.30 Coffee break

10.30-11.30 Group on training (continuation)

11.30-12.00 Plenary on training

12.00-13.30 pm Lunch

13.30-14.00 Plenary on training (continuation)

14.00-14.30 Update on new training materials

14.30-15.00 Update on cholera

15.00-15.15 Coffee break

Annex 2

15.15-15.45

15.45-17.00

2 Ageus! J 995 Wednesday

08.00-08.30

08.30-09.00

09 .00-09.30

09.30-10.00

10.00-10.30

10.30-11.30

11.30-12.00

12.00-13.30

13.30-16.00

3 AgIIUS! J 995

08.00-09 .00

09.00-10.00

10.00-10.30

10.30-12.00

12.00-13.30

13.30-15.00

15.00-15.15

15.15-17.00

am

pm

Thursday

am

pm

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Update on Vitamin A

Update on communication activities

Update on new evaluation tools

Update on breast-feeding

Experiences in monitoring. supervision and evaluation activities

Small group discussion on evaluation activities

Coffee break

Small group discussion on evaluation activities (continuation)

Plenary on evaluation

Lunch

Field trip to Lautoka Hospital

Plenary on pre-service training

Group I: Introduc!ion of ARI/CDD in curricula Group 2: Revise/upda!e ARI/CD D plans and policies

Coffee break

Group J and 2 (con!inua!ion)

Lunch

Group 1 and 2 (continuation)

Coffee break

Drafting of conclusions (small groups) (after regrouping countries according to programme status)

4Aups! J295 Friday

08.00-10.00 am

10.00-10.30

10.30-12.00

12.00-13.30 pm

13.30-14.00

14.00-15.00

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Presentations of plans from both groups

Coffee break

Conclusions of workshop

Lunch

Evaluation

Closing ceremony

Annel2

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ANNEX 3

PRE-WORKSHOP PARTICIPANT QUESTIONNAIRE

~ .. One Answer 'y,,'

1. Have you seen any of these training materials?

a) cnn YIN 10

b) ARI YIN 6S

c) Breastfeeding YIN S1

2. Have you worked with any of these materials?

a) cnn YIN 6S

b) ARI YIN 6S

c) Breastfeeding YIN 3S

3. Have you received training with any of these materials?

a) cnn YIN 64

b) ARI YIN 61

c) Breastfeeding YIN 41

4. Have you given training with any of these materials?

a) cnn YIN 6S

b) ARI YIN 61

c) Breastfeeding YIN 30

5. Have you been involved with any of the following activities?

cnn Policy & Planning YIN 32 Monitoring and Supervision YIN 44 Evaluation YIN 3S Curriculum Development YIN 23

ARI Policy & Planning YIN 32 Monitoring and Supervision YIN 41 Evaluation YIN 21 Curriculum Development YIN 26

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Annex 3

Breastfeeding Policy & Planning Monitoring and Supervision Evaluation Curriculum Development

Comments on the above results

YIN YIN YIN YIN

30 3S 23 18

I. There was a very strong correlation between panicipaots who answered 'Yes' to the first two parts of questions 1-4. Those who had seen the CDD training materials, worked with them, received or given training with them were much more likely to have been exposed to the ARl materials as well (14122 (64") panicipants both versus 6122 (27") neither).

2. The proportion of participants who had been involved with CDD or ARI policy & planning and monitoring, supervision and evaluation was lower (approximately one third) than those who were familiar with the training materials (approximately two thirds).

3. Exposure to training materials, training and aspects of breastfeeding programme management were common than those to CDD or ARl.

4. Although not included in the questionnaire, DOne of the participants were familiar with materials or training concerning vitamin A deficiency.

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SUMMARY OF COUNTRY AND SCHOOL PRESENTATION

Federated States of Micronesia

Dr Rita Mori, Chuuk+ Scattered islands, Main bospital, Weoo Main problem: Lack of medicines, like to see doctor, esp at basp. ARIIDD main cause of mortlmorb US All nurses & docs to be trained, do not follow standard mxt

ANNEX 4

Malnutrition, early weaning, low FP, poor spacing, poor awareness of bealth/disease, traditional beliefs are fll'St preference.

Data: OPD, 117912827 Hosp, 2011290 Dispens, 115812341

Mort, '94: ARt 48 DD \0 IMR 30/1 ()()()

CDD Tx: in english!!!! Hlass 75%, nurses 25% CMxt Tx x2 in '95 + 3rd in 9/95 if funds available

BF h/education, EPI, FP nurses + MO's at clinics

PH unit - Rita; 4 days per week mothers 75% BF, of wbich 50% stop after 3 months: working mothers; 25 % no BF - single mothers, working, looked after grandmothers.

?? other FSM states; ??7

Kiribati

Irima Tokataake, Nurse Tx School

Small atol, 33 islands, 2 with people, Gilbert islands pop n395 capital 25()()() Influenza, sore throat, bronchitis, pneumonia; increasing eDD worsening?? WS&S, + dysentery BF 80% of mums ( not exclusive) duration 1 yr +; + IX being planned; new BF policy, + maternity unit -> BFHI

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Annel! 4

Western Samoa

Dr lohn Adams, paed; 4/9 islands populated; compact geography, lOO'Jli in 2hrs access to hospica1 aDd specialists.; 165,000, UIS= 4S'JIi, IMR 2511000 (120/1000 in 1970); due to good EPI coverage It measles down; and SES up and good WSItS to most homes, 8O'JIi hlw assisted deliveries; Apia Hospica1; with ORS available; ORS utilisation = 7S'JIi Low pop GR due to massive emigration; DOW returning! MMR '70= 10; '90 = 1 Decreasing CBR due to FP (SO'Jli) = 3S '80 DD > ARI, '9S ARI > DD; DD incidence down by half, ARI as before; Reduced health budget; returning pop; imports up, perceptions of more educated pop demand more sophisticated clinical services, ph is lower priority; BF since '94; new pollcy+ + + •••••••••• _ ••••••••••••••••••••••••••• Many new initiatives and activities at all levels of society; Objectives and targets .••• see lA BFHI + + + + Improving the opportunities for working mothers Fiji, 12 weeks mat leave (6+6)

Solomon Islands

Ken Solodi, Nursing School; scattered islands, 379000, 9 provs with hosp + 1 tertiary hosp; IMR 43/1000, CBR 42, CDR 9.6, CGR 3.S'JIi!!!!!!! Causes of death, ARI 27 'JIi Malaria 7 .6'J1i, DD 6.1 'JIi, birth complications 21 'JIi I-S mort=DD 16'J1i + malaria 42'J1i , + ARI 16'J1i ARI: 422311000 IDD= 80-290/1000 depending on severity; Main Problems = transport, lack of; scattered islands; + poor economy; + high CBR; inadequate manpower esp at periphery; remote areas only served by health aides; malnutrition + ARI; 2S'JIi under 80'Jli of international median. HIS developed; tx of hlw's and women, and NGO's + schools···""···"···

Tonga

Dr George 'Abo, paed; 98,000 on many islands; IMR= 12.2/1000; CBR 27; source: MCH Annual Review produced annually; probably reliable; Morb: ARI; SO% of paed admissions, DD= 21 %; (down in last IOyrs) Confusing data on morbidity; MORT; ? no ARiIDD deaths? CDDI ARI tx in pre-service institutions, some CMxt tx; need more up to date tx; Problem of better clinical service demand; evolution of drug resistance; IR of shigellosis is increasing. BF policy similar to Samoa; BFHI + , ambitious+ + +

Issue of signs It symptoms of ARI It dehydration and mod to sev malnutrition;

Issue of Asthma very important···· .. •• .. ••••• .. •

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Aoog4

Fiji

Dr Lepani Waqatairewa; 783,000 pop; IMR 15.9, melanesian:indian; 47:53 ratio of edmic groups Infant mortality: ARI is second at 20" of infant deaths, 1.4" =DD Also meningitis+ + + Morb ARI36"; DO 3" Very low DO incidence; ********************** No ARI data available today; 1993 HlFac surveyTn but XSSSS Antibiotic usage; poor caretaker knowledge and involvement; BF: Lautoka is first BFHI certified hospital in Pacific; but poor response from medical profession! A 'plan of (in)action' + a policy

Meningitis; 70" = Hib; need a natiooal Hib addition to EPI; BUT no funds to extend programme; needs evaluation; now 76" covecage; Nurse practitioners allowed to prescribe alb's in remote areas; Malnutrition: 15" in Indians & 9" in Melanesians:

Fiji School of Medicine

Dr Shabnam Prakash; Curriculum-based: aetiology and management; ARI and DO Tx includes PBL, ARI in yr 2, 4 & 6 (c1in rnxt) reinforcement; WHO guidelines Probs: tutors not trained in COOl ARI; few copies of the charts; very condensed course - only 2 hrs; Lack of pamphlets for students; no 'hands on' training; BF: greater emphasis needed

Federated States or Micronesia

Dr May Okihiro, Basic MO Tx Pgm; Pohnpei;

PBL orientated Probs; IVF used Xsively, Amoebiasis + + + +; inappropriate use of ORS, little parental education; need more inter-institutional collaboration.

Western Samoa School or Nursing

Tamaitala Lees; Diploma in Nursing (3yrs) (previously a 2-3 yr certificate) Focus on COD, ARI, BF prevention, simple management and referral skills. Advanced Diploma: primary clinical care emphasis; with clinical internship. Constraints: staff shortage throughout health services and Schools; but they have trained lecturers in WHO methods who are currently working with the students in both theoretical and practical scenarios.

- 24 -

Annex 4

Cook Islands

Moeroa Samuel: 3 yr tx to certificate level; Nothing in practice, all theoretical. Constraints: lack of tutors and materials, and energy?

- 25 -

SMALL GROUP GUIDELINES

Tuesday I August 1995

GROUP I (FACILITATORS)

ANNEXS

1. Description of thesituation

You are the subdivisiona1 medical officer in a bealth area. An outbreak of diarrhoea, fever aud cougb bas been reported to you from a number of villages along tbe bank of the main river aud ODe cbild bas died.

You, along witb the Subdivisiona1 Health Sister, visit the area medical station which is staffed by a nurse who graduated twenty years ago aud a young doctor recently transferred to the area from a divisiona1 bospital.

Each group is expected to identify the problems at the bealth centre aud make a community diagnosis. Some of the following problems that you find are:

!This acute situation uncovers fundamental deficiencies in CPDLARllBf activjties.)

Health Centre.

Knowledge on appropriate assessment aud management of sick children Availability of ORS aud antibiotics

Village levd.

Water and sanitation conditions; Knowledge on food values, breastfeeding aud weaning practices; Awareness of when a child is sick. Home management of diarrhoea and cougb.

2. Objective

By the end of the session the group will have identified the training needs and bave planned COD/ ARllBreastfeeding activities to address problems described.

3. IssUes: How to improve planning for training?

0 How planning is currentIy carried out? 0 Integration of training activities.

0 What different kind of training is 0 Venue for training (in particular planned/provided? CM training).

0 Types of plans prepared (action plan, 0 funding for training (government! directional plan)? externa1).

0 Period of planning (medium term! short term)?

TniaJDc documeat

- 26 -

Annex S

GROUP 2 (FACILITATORS)

1. Description of the situation

You are the subdivisiooal medical officer in a health area. An outbreak of diarrhoea, fever aDd cough bas been reported to you from a number of villages along the bank of the main river aDd one child bas died.

You, along with the Subdivisiooal Health Sister, visit the area medical station which is staffed by a nurse wbo graduated twenty years ago and a young doctor recendy transferred to the area from a divisional bospital.

Each group is espected to identify the probleDII at the health centre and make a community diagnosis.. Some of the following probleDII that you find are:

rIbis acute situation uncovers fundamental deficiencies in COOl ARJIBF activities.) Health Centre.

Knowledge on appropriate assessment and management of sick children Availability of ORS and antibiotics

Village leVel. Water and sanitation conditions; Knowledge on food values, breastfeeding and weaning practices; Awareness of when a child is sick. Home management of diarrhoea and cough.

Additional scenario for this group: following the visit by the SOMO and the SOHS and after discussions with COD, ARl and BF staff at all levels and with those responsible for training, it was decided to proceed with various levels of training but concentrating on in-service cl inical training of all bealth care workers and also to develop appropriate COOl ARlIBF components of all pre-service training curricula. The objective of the training is to resolve the problems described in the scenario above. and prevent them recurring.

2. Objective

By the end of the session the group will have identified the most appropriate training for the various levels of bealth care workers, with empbasis on 'best practice' .

3. Issues; How to improve Qyality and impact of training?

0 Development of good, realistic plans? 0 Incentives needed?

0 Selection of right participants 0 Adaptability of training to participants needs

0 Selection of appropriate venue 0 Training teams of participants from (I.e. CM training) one facility

0 Adaptation of training materials to 0 Correct participant/facilitator local conditions number

0 Enbancement of training skills (ToT courses) 0 Ensuring that training site (which is a model) follows "standard treatment"

0 Integration of training activities.

0 Venue for training (in particular CM)

Tnlala&d....-

- 27 -

AnMI'

GROUP 3 (FACIUTATORS)

1. Desc;ription Of the siulltign

You are the subdivisional medical officer in a health area. An outbreak of diarrhoea, fever and cou~ has been reported to you from a number of villages along the bank of !he main river and one child has died.

You. along with !he Subdivisional Health Sister, visit the area medical station which is staffed by a nurse who graduated twenty years ago and a YOUll8 doctor recently transferred to !he area from a divisiona1 hospital.

Each group is expected to identify the problems at !he health centre and make a community diagnosis.. Some of the following problems that you find are: ..

[This 'rI'le sjmarjgD uncqvers fuwlamcntal deticjeay;ies in CnD/ARI/Bf acCiyjtiel.j

Health Centre. Knowledge on appropriate assessment and management of sick children Availability of ORS and antibiotics

Village level. Water and sanitation conditions; Knowledge on food values. breastCeeding and weaning practices; Awareness of when a child is sick. Home management of diarrhoea and cough.

Additional scenario for this group: following !he establishment and implementation of in-service training for the clinical management of children with CC/ ARlIBF problems and of appropriate pre-service training for both nurses and doctors. a group of trainers. programme managers and supervisors meet and decide that post-training follow up and reinforcement is required to maximise the benefits of the training. This is required to ensure that the problem described above is addressed in a professional way and that the changes in 'practice' remain appropriate, feasible and sustainable.

2. Objectiye

By the end of the session, the group will have identified and planned the activities required to follow­up and reinforce the CDD/ ARllBreast-feeding training.

3. Issues"

0

0

0

0

How to follow-up and BUPp0rt participants after trajnjn&?

External Supervision

Internal supervision

Funding of follow-up visits

Can trainers visit and supervise trainees after courses?

o

o

o

o

Can participants implement what they have learned?

Are trainees provided with materia1s! skills and confidence?

Is there lack of supplies/equipment! drugs to carry out corrent CM?

Does "echo training" take place?

TraiaiD, docuBI,nt

- 28 -

Annex 5

GROUP 1 (pARTICIPANTS)

1. Description of the sihlatiQD

You are the subdivisional medical officer in I health area. An outbreak of diarrhoea, fever and cough has been reported to you from a number of villages along the bank of the main river and one child has died.

You, along witb the Subdivisional Health Sister, visit the area medical station which is staffed by a nurse who graduated twel)ty years ago and a young doctor recently transferred to the area from a divisional hospital.

Each group is expected to identify the problems at the health centre and make a conununity diagnosis. Some of the following problems that you find are:

Health Centre. D D D

Village level.

2. Obiective

D D D

By the end of the session the group will have identified the training needs and have planned CDDI ARl/Breastfeeding activities to address problems described.

3. Issues: How to improve planning for training

D

D D D

D

D D D

TnlDiDr document

- 29 -

AD"!,

GROUP 2 (pARTICIPANTS)

I. Desqiption of tho siWatioQ

You are the subdivisiooal medical officec io a health area. An outbreak of diarrhoea, fever and cough bas been reported to you from a number of villages along the bank of the maio river and one child has died.

You, along with the Subdivisiooal Health Sister, visit the area medical station which is staffed by a nurse wbo graduated twenty years ago and a young doc:tor recently transferred to the area from a diviaioaal hospital.

Each group is expected to identify the problems at the bealth centre and make a community diagnosis. Some of the following problems that you find are:

Health Centre.

D D D D

Village level.

2. Objective

D D D D D

By the end of the session the group will bave identified the most appropriate traioiog for the various levels of bealth care workers, with emphasis on 'best practice'.

3. JMPes· How to improve quality and imPACt of ttajning?

D

D

D

D

D

D

D

D

D

D

D D

- 30 -

Annex 5

GROUP 3 (pARTICIPANTS)

1. Description of the situation

You are the subdivisional medical officer in a health area. An outbreak: of diarrhoea, fever and cough has been reponed to you from a number of villages along the bank of the main river and one child has died.

You, along with the Subdivisional Health Sister, visit the area medical station which is staffed by I nurse who graduated twenty years ago and a young doctor recently transferred to the area from a divisional hospital.

Each group is expected to identify the problems at the health centre and make a community diagnosis. Some of the following problems that you find are:

Health Centre.

D D D D D D D D Village level.

D D D D D D D D

2. Objective

By the end of the session, the group will have identified and planned the activities required to follow-up and reinforce the COOl ARIlBreastfeeding training.

3. Issues:

D

D

D

D

D

how to follow-up and sypport participants after training?

D

D

D

D

D

TniniD r dOCllllleDt

- 31 -

AJ!M! $

GUIDEUNES FOR SMAll GROUP DISCUSSIONS ON MONITORING SUPERVISION AND EVALUATION

Wednesday, 2 August 1995

Scenario:

Your country has just established programmes fur ARIlCDD aod breastfeeding prolllOlioa. During the first year five ttaining courses were conducted on clinical management and communication skills. There is now a need to establish monitoring, supervision aod evaluation guidelines at different levels of activities.

Instructions:

I. Yau will be divided into three groups:

GROUP I:

GROUP 2:

GROUP 3:

Prepares the guidelines for monitoring, supervision aod evaluation of a health worker at the primary care level

Prepares the guidelines for monitoring. supervision and evaluation of a hospital or health facility at the middle operational level

Prepares the guidelines for the evaluation of activities and impact at the household aod community level

2. Each of the groups needs to answer the following questions based on their own country situations and giving specific examples whenever possible.

2.1 What baseline information is needed?

2.2 How can progress be measured? What issues/factors/items need to be tracked or monitored over time?

2.3 What problems/constraints are likely to be encountered?

2.4 What tools/methods are needed? What are the existing resources/information available (NGO's «£ ..... )? What are the uomet needs? What needs to be developed?

2.S Who is responsible for specific activities?

2.6 When do the different monitoring/supervision/evaluation activities happen? How often do they need to be done?

2.7 What are the outcomes?

2.8 Where will funding for the different activities come from?

2.9 How will these activities fit in with other programmes/activities?

Output:

Monitoring. supervising and evaluation guidelines for:

I) health workers at the primary care level 2) middle-level health facility or hospital level 3) household and community level

i i , / - 32 -

ADm! 5

Wednesday, 2 August, 1995, am.

1. Update on Evaluation & Monitoring Tools

a) Household Survey (HHS) - CDD/ARIIBF

b) Health Facility Survey (HFS) - two surveys, CDD & ARI

c) Monitoring: i) Standard Cue Management Training Quality

ii) Supervilors' Checldist- CDDI ARIIBF

d) Focused Programme Review (FPR) - CDD/ARI or other programmes

e) Multiple Indicator Cluster Survey (MICS)

2. Update on Breastfeeding

a) Advantages of breastfeeding

b) Differences between milks

c) Protection against infection

d) Differences between colostrum, foremilk and hindmilk

e) Colostrum

t) Psychological benefits of breastfeeding

g) Risks of morbidity and mortality by feeding modes

h) Breastfeeding in the second year

I) Disadvantages of artificial feeding

j) Recommendations to mothers

k) Breastfeeding advice in the clinic

I) Breastfeeding a sick baby

Questions:

Samoa: BF, prematurity, expression and AIDS? policy needs to address this issue.

Issue of lactose

Protection against morbidity from diarrhoeal diseases: ? changes with increasing age

Tnlh ,'" -, doeulDeDt

- 33 -

Annp5

3. Baby Friendly Hospital Initiative (BFHI)

a) bdroduction

b) Promotion of breastfeeding - teo steps to success

c) Nutrition indicators in the Pacific

d) Baby Friendly Hospital Initiative in the Pacific - progress as of 8.95

e) A baby-friendly checklist

t) The baby-friendly hospital designation process

g) BFHI users' guide to assessment documents

h) Age groups for measuring BF. indiCators

I) Training choices in breastfeeding promotion

j) The International Code of Marketing of Breastmilk Substitutes - a summary

k) Recognition of breast milk substitutes - criteria

Training materials: i) 18 hour course on BFHI for nurses and other staff

ii) course on breastfeeding counseling.

4. Group Work on Monitoring, Supervision and Evaluation

Group 1: At the Primary Health Care Facility Level

Prior to considering the requirements for M, S & E the group decided that these activities should be focused around specific objectives and targets. The objectives chosen were:

a) to increase the number of health workers at PHC level trained in the standard management of DD, ARI and BF by 20% by the end of 1996;

b) to increase the numbers of health workers at PHC level who can correctly manage cases of DD, ARI , VAD and BF to a total of 50% of the existing workforce by the end of 1996.

Issue 1.1: What baseline information is needed?

a) A list of all manpower at PHC level with lOCation, names and current training status; - > percentage of manpower trained; source: Health HQ; if not available do quick survey.

b) Proportion of total manpower at PHC level who can manages cases correctly; source: a baseline Health Facility Survey.

From this information targets were agreed upon using real data from Western Samoa.

-. ,"." '11'··

- 34 -

Annex 5

Targets:

a) Out of 100 staff, 80 had received CM training and 20 still required it. Train remaining 20 PHC level staff;

b) Out of the existing 80 staff who had received training only 10 were managing cases correctly; provide on the job training and closer supervision to 40 staff at PHC level.

ISsue 1.2: Progress of activities can be monitored by checking achievements against the schedule of the planned activities.

Issue 1.3: Problems/constraints: unrealistic objectives and targets, lack of resources (manpower, fundi, trainers, training materials, petrol etc), staff transfers, lack of suitable venues, political instability etc and lack of appropriately trained, experienced supervisors.

Issue 1.4: Tools required to monitor, supervise and evaluate: check lists, HFS survey manual.

Issue 1.5: Those responsible: country programme managers and regional level supervisors for a) plus district supervisors for b).

Issue 1.6: When should M,S & E & e activities take place? Monthly supervisory visits and HFS at beginning and end of planning period.

Issue 1.7: The outcomes are to be:

a) 20 extra staff trained in CM;

b) A total of 50% of existing trained staff to manage cases correctly.

Issue 1.8: Sources of funding to be Government with suppon from WHOIUNICEF and perhaps from NGO·s.

Issue 1.9: Training and supervision to be integrated across all programmes included in the Sick Child Initiative.

Group 2: At the Household/Community Levels

Issue a): Who will carry out the evaluation activities: district nurses, voluntary village health workers, other health workers (health assistants etc) with help from programme managers.

Issue b): Materials/tools: existing evaluation tools, modified to suit local circumstances but methodology essentially not changed; but evaluation may be carried out in ·parcels'. Also existing tools used in country e.g. monthly repons and monthly meetings.

Proposed evaluation strategy for Chuuk.

2.1 Baseline information needed: carry out a KAP survey with methods extracted from Household Survey questions (with questions adapted to local circumstances when necessary).

2.2 Repeat KAP survey on a regular basis (can the Family Cards be used as a data source?).

2.3 Constraints may be : lack of manpower and funding, local beliefs and attitudes, geographical and political issues.

2.4 Use survey manual but also provide basic medical services (assessment and basic medical supplies).

TniDIDc documeat

- 35 -

AIIDCJ ,

2.S Health workers and village people.

2.6 IEC

2.7 Decreased numbers of cases of diarrboea with dehydration; increased number of breastfeediug mothers; decrease in number of severe ARI cases.

2.8 Local Governments.

2.9 Incorporate into existing evaluation activities.

Group 3. M, S & E at Ihe IntennediatelReferral Level

- Current tools in use

1.

2.

3.

4.

check lists:

questionnaires,

surveys:

tests (examinations)

facility level

facility level

performance assessment (students) (tutors)

hospital community

training facilities (students)(KAP)

- Information Needs

1. Impact Of Programmes (Routine)

- HospilallMorbidity - SpecificlMortality

2. Staff Performance

- Chan Review (Routine & Surveys) - Students' Feedback From Field Posting - Patients' Satisfaction (Surveys) - Peripheral Staff Satisfaction

- Questionnaires - Interviews

3. Activities

Integrated Checklists - Staff

Spot Checks

Structure & Melhods

- Facilities - Activities

- 36 -

AnneJ 5

Structure &: MedJods

1. Definition Of Clear Procedures &: Linea Of Responsibilities

2. Actions To Be Taken Based On Monitoring; Supervision; Evaluation.

3. Feedback Information Disseminated To Data Providers

4. A Core (Pool) Of Evaluators To Be Established (d. Pool Of Trainers) (Task Force)

- 37 -

Annc;, S

GUIDEUNES FOR CONDUCTING GROUP WORK ON REVISING AND UPDATING NATIONAL PLANS AND POUCIES (THURSDAY, DAY 4)

1. Purpose

. The purpose of the group work is 10 review, discuss and update existins national policies and plDns of action related 10 ARI, CDD and breastfeeding promotion in the Pacific. The group work will also provide an opportunity to discuss means of colloboration between ARI, CDD and BF activities and health training institutions. In addition, collaboration with NOO's and schools should be considered.

The programme staff from ten countries will be divided into two groups, as follows

GROUP I

• Kiribati • Marshall Islands • Solomon Islands • Tuvalu

EMPHASIS in this group will be given 10 discuss and review basic programmatic aspects related 10 development of policies, planning and collaboration with training institutions. This should include review of key terms, rationale of policies and overall programme strategies,

GROUPO

• Guam • Cook Islands • Fiji ·FSM

• Samoa • Tonga

EMPHASIS in this group will be given more 10 review exjstjn& national policies and plans, how they could be improved and updated. What new approaches and activities (mentioned in this workshop) could be incorporated to existing plans? Special attention should be given 10 d~ means to improve .. collaboration with training institutions, in particular with reference 10 planning and development/revISion and implementation of policies and plans.

Trainina dOCUMent

- 38 -

AOneJ S

(2) Methodology:

Policy

(I) Briefly discuss why policies on ARIlCDDIBF are important. Do countries in your group have policies? How were they developed? To whom are they distributed? How is their implementation monitored? Do health workers follow these policies?

(ii) Review the CDD docwnent "The Selection of fluids and food for home therapy to prevent dehydration from diarrhoea: Guidelines for Developing a National Policy·. Point out that this docwnent can guide countries in developing national policies for CDD and provides the process in doing so.

Refer also to key policy issues relative to ARI and BF programmes.

(iii) Review and discuss a sample policy (ARIlCDD and/or on BF) with the group and ask if any changes or additions would be required if this policy would be used in participants own country?

(iv) Ask participants to review their respective ARIlCDDIBF policies (if applicable) and suggest changes, if needed.

Plans of action

(I) Lead q group discussion on the importance of planning. Refer to some key points that have come out on group work on training (How to improve planning). Refer to issues, such as planning for training, integrated approach, collaboration with training institutions, etc.

(ii) Particularly in Group I, focus on basic programmatic aspects and review/discuss the following terms:

• Strategy • Objective * Target/sub-target

Discuss briefly indicators, relevant to Mid-Decade goals, in both groups.

(iii) Review and discuss a sample plan (ARIlCDD and/or BF) and focus on the following points:

• Fortnat of the plan (Could it be improved?)

* Does the plan cover all important prograntme aspects? Could some activities be added? Ask how much of this plan has been implemented? Ask if this plan would be feasible and realistic to be implemented in other countries? Does it include any activities related to pre-service training and collaboration with health training institutions? Does it include collaboration with other agencies, NGOs, schools, etc?

TraiDiDI doe. meat

- 39 -

AmmS

(iv) Ask each COIIDIry to write down:

* new/additional activities they wish to implemenl (for example, radio guide, Multiple Indicator Cluster Survey (MICS), training on BFHI etc)

• means to collaborate with health training institutions in their respective countries

* means to collaborate with other NGOs, community groups etc.

(v) Ask selected countries to present their framework plans and recommendations for future changes on day 5 (provide transparencies)

(3) Materials required:

White board, markers, transparencies, plan forms, CDD documenl "1he Selection of fluids and ... " Sample policies and plans (copied to all group members)

(4) Expected outcome:

Revised/update ARVCDDIBF national policies and frameworks for programme planning with special emphasis on new initiatives (activities/use of materials) and collaboration with health trajnjor josliDJtinm and others.

TraiDiD, documODI

ACTIVITY TIME-FRAME PERSONS RESOURCES RESPONSIDLE NEEDED

PLAN OF ACTION

ESTIMATED EVALUATION COST/SOURCE INDICATORS

OF FUNDS

REMARKS

,

• o

1. Purpose

- 41 -

Guidelines for conducti...!!8 group work on BasiclPre-service Training (Thursday, Day 4)

Annex 5

The purpose of this group work is to review and discuss the teaching of CDDI ARIIBF in the basic curriculum of the schools. The participants will discuss how they can strengthen the teaching of these programs by familiarizing themselves with the training materials and will plan when, where and bow these materials could be used in the various courses and levels.

2. Situation

Your director had earlier attended a meeting with representatives from the Ministry of Health where the need to integrate CDD/ARIIBFNit.A in the school curriculum was agreed upon by the group.

Your director has now asked you to discuss and plan how you can strengthen the teaching of these programmes in your school.

3. Issues

Training Materials

Trained TutorslResource Persons

Curricula/teaching guides

CDDI ARiIEPI integrated in the curricula

Linkages with other agencies

Follow-up

Expected Output

By the end of the session, the participants would have discussed the importance of basic/pre-service training and identified what, when, where and how to integrate CDDI ARIIBF Nit.A in the curriculum. (Use the Action Plan format).

TralDlDg documenl

- 43 -

ANNEX 6

NADI WORKSHOP: RESULTS OF PARTICIPANT EVALUATION

Total number of participants - 22

1. Participant status:

a) Occupation type: From training institution: 37" From disease control program 18" From health facility 27" Missing 18"

b) Profession: Dodor 32" Nurse 59" Missing 9"

c) Attendance at previous ttaining:

CDD 27" ARI 27" Breastfeeding 9" None 37"

2. Were workshop objectives met?

Objective Completely Partially Not achieved? Missing achieved? achieved?

Review of national ARI/CDDIBF programmes, policies & Plans 90" 10" - 1

Awareness of regional initiatives and targets 73" 27" - 0

Overview of training institution curricula 75" 25" - 2

Availability of new WHOIUNiCEF training materials 86" 14" - I

Planning of follow up activities 65" 35" - 2

Participant's own objectives 64" 36" - II

- 44 -

Annex 6

3. Were workshop activities useful?

Activity Useful Partially Not useful Missing useful

Progranune overviews 100% - - 2

Pacific Island overview 90% 10% - 1

Country presentations 90% 10% - 2

School presentations 85% IS" - 2

Sick child initiative 85% 15% - 2

Training material update 85% 15" - 2

Cholera update 85% 15% - 2

Vitamin A deficiency update 90% 10% - 2

ConununicatiollS update 90% 10" - 3

Evaluation tools update 84% 16% - 3

Breastfeeding update· 100% - - 2

Pre-service training plenary 90% 10% - 2

Lautoka Hospital visit 85% 15% - 2

Group work on training 79% 21% - 3

Group work on monitoring. supervision and evaluation 85% 15% - 2

Group work on national policies & plans of action 94% 6% - 5

Group work on ARIlCDD & curricula 95% 5% - 3

Group work on country plans of action 94% 6% - 4

ARIlCDD technical updates 95% 5% - 3

Videos 95% 5% . - 2

. -. . . '.

4. Workshop activities and time allocation.

Activity Enough time

Programme overviews 90%

Pacific Island overview 95%

Country presentations 100%

School presentations 90%

Sick child initiative 74%

Training material update 84%

Cholera update 95%

Vitamin A deficiency update 95%

Communications update 89%

Evaluation tools update 83%

Breastfeeding update 89%

Pre-service training plenary 95%

Lautoka Hospital visit 95%

Group work on training 89%

Group work on monitoring. supervision and evaluation 85%

Group work on national policies & plans of action 84%

Group work on ARIlCDD & curricula 90%

Group work on country plans of action 83%

ARIlCDD technical updates 89%

Videos 90%

- 4S -

Annex 6

Not enough Too much Missing time time

10% - 2

5% - 3

- - 3

10% - 2

26% - 3

11% 5% 3

- 5% 3

5% - 3

6% 5% 4

17% - 4

11% - 3

5% - 3

5% - 3

11% - 4

15% - 2

16% - 4

10% - 3

17% - 4

11% - 3

10% - 2

( -1 " , .

- 46 -. ,

Annex 6

Sumnuuy of Comments

a) Materials: In plentiful supply and of high quality; some panicipams would have liIced copies of the materials presented at the technical updates; some participants would have preferred to be able to return with copies of the materials on display (Comment: Ibis may not be logistically possible because of the wealth of materials; participants were given a list of materials and WHO and UNICEF order forms).

b) Other Participants: Comments reflected the benefit of meeting with programme staff from other countries (especially those with more extensive ARIlCDD experience) and with pre-service training staff.

c) Resource persons: Helpful and knowledgeable.

d) Sequence: Appropriate

e) Venue: The majority thought that it was suitable and well set up.

f) Suggestions for future workshops:

g) Other comments:

- Most suggested that the same participants should attend future workshops. - Pre-service trainers should be included again. ~ Follow up workshop should beheld in 12-24 months - Follow up workshop should concentrate of reviewing and evaluating country

plans of action and reviewing the achievement of targets.

- Country programmes will continue to need WHOIUNiCEF suppon. - Workshop participants should be those who work in the Programmes and pre-

service trainers.