Training Course 1 WASH Hygiene Promotion Training for Field

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					Draft 1 of WASH Cluster Hygiene Promotion project, ToR9.1 Training package for HPs, peer consultation, comments to lurussell@oxfam.org.uk by 31 October 2007

DRAFT Training Course 1: WASH Hygiene Promotion Training for Field Hygiene Promoters
Introduction
The training course comprises the key aims and objectives and ideas and materials for training based on the requirements of the WASH Hygiene Promotion Job Description but these sessions can be adapted as the trainer sees fit or as the situation demands. An example job description for a hygiene promoter can be found in Appendix 1. It is important that the sessions in the Introductory Module are covered as early as possible and that newly recruited Hygiene Promoters are then supported and mentored as they carry out their work. The sessions in the other modules can then be run as and when time allows and according to the demands of the specific situation. However, where possible all the subjects should be covered within a period of six weeks. Training sessions can be run for a few hours each day, for one day a week or in blocks of two to three days. As far as possible the training must draw on examples from the existing situation and allow participants time to practice new skills in the field. In addition to the session outlines there are also accompanying handouts and power point slides containing useful material referred to in the session outlines. These are materials that can be used as handouts, developed into short power point presentations, where resources allow or copied onto flip charts. Where possible the photographs should be replaced by photographs from the actual situation. An assumption is made that the people using this training material will have experience of facilitating training or working with groups and will know how to structure and time a training session according to the learners needs.

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Draft 1 of WASH Cluster Hygiene Promotion project, ToR9.1 Training package for HPs, peer consultation, comments to lurussell@oxfam.org.uk by 31 October 2007

Introductory Module Hygiene Promotion in Emergencies Public Health in Emergencies Key Water and Sanitation Priorities Community Involvement in design of Facilities Selection of Volunteers Community Meetings Diarrhoea and Use of ORT Safe Water Chain and Hand washing Introduction to Communication Skills Assessment Overview How to run a focus group discussion Introduction to Participatory Methods Hygiene Kits: selection and distribution Introduction to Adult Learning Working with Children Carrying out a campaign Planning Training Module 1: Principles and Practice of Hygiene Promotion Continued Communication Skills II Participatory Methods II Community Participation Behaviour Change Issues Use of Visual Aids Other promotional methods (Social Marketing Ideas, Mass Media, Street Theatre) Water and Sanitation Related Diseases Mainstreaming Gender and Protection Community Management of facilities Training Practice Module 2: Data Collection and Monitoring Monitoring Introduction to Baseline Survey Questionnaire Survey Sphere

Overall Training Course Objectives

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Draft 1 of WASH Cluster Hygiene Promotion project, ToR9.1 Training package for HPs, peer consultation, comments to lurussell@oxfam.org.uk by 31 October 2007

To enable field practitioners to rapidly carry out effective hygiene promotion in an emergency in order to: Ensure that optimal, hygienic and consistent use is made of the water and sanitation facilities provided by WASH agencies  Ensure that action is taken to mitigate priority water and sanitation related health risks  Ensure that field practitioners are fully briefed in current approaches to hygiene promotion in emergencies  Ensure that the hardware and software aspects of a WASH response are integrated and work together to achieve a common goal Example timetable for three day introductory training and fieldwork Time Day 1 Day 2 Day 3
09.0009.45 09.4510.30 10.3011.15 Welcome and Introductions Hygiene Promotion in Emergencies Public Health in Emergencies Introduction to Communication Skills Assessment Overview How to run a focus group discussion Break Diarrhoea and ORT Safe water chain and hand washing Lunch 14.0014.45 14.4515.30 15.3016.15 16.1517.00 17.0017.30 Selection of Volunteers Community/Group/Key Informant Meetings Fieldwork Preparations for community/group meeting Feedback and Overview of Key Learning points Focus Group Discussion or group Meeting Fieldwork Carrying out a campaign Carrying out a campaign continued Planning Training Feedback on FGD/Community Meeting Overview of Key Learning points Training Practice on use of ORT Overview of Key Learning points and Evaluation Introduction to participatory methods Distribution of hygiene kits and follow up Adult Learning Working with Children

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11.3012.15 12.1513.00

Key water and sanitation priorities Community Involvement in provision of Facilities

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Draft 1 of WASH Cluster Hygiene Promotion project, ToR9.1 Training package for HPs, peer consultation, comments to lurussell@oxfam.org.uk by 31 October 2007

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Draft 1 of WASH Cluster Hygiene Promotion project, ToR9.1 Training package for HPs, peer consultation, comments to lurussell@oxfam.org.uk by 31 October 2007

Trainer/Facilitator Notes Facilitator’s Role1  Take responsibility for keeping participants on track. During exercises, discussions and practice sessions, it is important to circulate throughout the room to catch problems and assist or encourage people as needed. Be aware of the time. Make sure that presentations and exercises don‟t run on for too long. Several minutes before an exercise or practice session is to end, facilitators should alert participants about the amount of time left. Be aware of how teams are working together. It may take some time for the teams to get comfortable with each other if the participants do not know each other. However, if participants do know each other, experience has shown they may tend to spend time chatting and not keep on task. Be prepared to help the teams stay on task. Use real examples and anecdotes to make your points come alive. Encourage participants to share relevant experiences as well. Create a safe, comfortable learning environment. Participants should enjoy the sessions and feel that they can speak their mind without being made to feel that they are inadequate. Encourage participants to get acquainted during breaks. Tea breaks and meals allow participants to network and learn from each other and compare notes. Help participants review the content of each day’s activities. An important aspect of training is providing participants with the “big picture” of what they‟re learning. Be sure to allow a few minutes at the end of each day to summarize key points so that participants recognize how much they have learned and done.

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Suggestions for energisers2 Energisers can be used to stimulate participants following a particularly long session or to break sessions up. They may be particularly useful to re-energise participants during the afternoon when they may start to find it difficult to concentrate fully. Energisers can also be used as a useful way to divide the
Adapted from Spot on Malaria, Facilitator‟s manual for adapting, developing and producing effective radio spots 2 Several examples adapted from International HIV/AIDS Alliance, 100 ways to energise groups
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Draft 1 of WASH Cluster Hygiene Promotion project, ToR9.1 Training package for HPs, peer consultation, comments to lurussell@oxfam.org.uk by 31 October 2007

participants into smaller groups for the group work activities. Often participants will have attended other training courses and they may have their own favourite energisers that can be used. o The facilitator chooses a number of well known phrases, and writes half of each phrase on a piece of paper or card. For example, they write „Happy‟ on one piece of paper and „Birthday‟ on another. (The number of pieces of paper should match the number of participants in the group.) The folded pieces of paper are put into a hat. Each participant takes a piece of paper from the hat and tries to find the member of the group with the matching half of the phrase. o Ask the group to move around the room, loosely swinging their arms and gently relaxing their heads and necks. After a short while, shout out a word. The group must form themselves into statues that describe the word. For example, the facilitator shouts “peace”. All the participants have to instantly adopt, without talking, poses that show what „peace‟ means to them. Repeat the exercise several times. o The group pretends that they are attending a football game. The facilitator allocates specific cheers to various sections of the circle, such as „Pass‟, „Kick‟, „Dribble‟ or „Header‟. When the facilitator points at a section, that section shouts their cheer. When the facilitator raises his/her hands in the air, everyone shouts “Goal!” Suggestions for Introductions and icebreakers Icebreakers can be used at the start of a training course where participants do not yet know each other well. They can help participants to feel more at ease and not be self conscious about offering suggestions and ideas. o Everyone writes their name, along with four pieces of information about themselves on a large sheet of paper. For example, „Alfonse likes singing, loves football, has five wives and loves PRA‟. Participants then circulate with their sheets of paper. They meet in pairs, show their paper to each other, and try to guess which of the „facts‟ is a lie. o Participants think of an adjective to describe how they are feeling or how they are. The adjective must start with the same letter as their name, for instance, “I‟m Henri and I‟m happy”. Or, “I‟m Arun and I‟m amazing.” As they introduce themselves, they can also mime an action that describes the adjective.

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Draft 1 of WASH Cluster Hygiene Promotion project, ToR9.1 Training package for HPs, peer consultation, comments to lurussell@oxfam.org.uk by 31 October 2007

o Invite each participant to come to the front of the room and write their name on the board or on flip chart paper so that everyone can see it. They are then asked to say a few things about their name e.g. the origin of it or what they liked being called or common mistakes in spelling or pronunciation.

References Action Contre La Faim, Sri Lanka: Leonie Barnes, An Integrated WatSan/Hygiene Promotion Manual in the Post-Tsunami context Action Contre La Faim A Manual for implementing health education in the field, Deborah Tsuchida June 2002 Health and Hygiene Manual (no date) UNICEF Pakistan RWSSP Ferron S., Morgan, J. and O‟Reilly, M. (2000). Hygiene Promotion. A Practical Manual for Relief & Development London ITDG IRC. Environmental Health Field Guide, 3rd Edition. 2007. IRC Hygiene Committee Training Manual, Bujumbura Rural UNICEF Hygiene Promotion. Towards Better Programming. UNICEF Behaviour change communication. Tearfund. Child Health Club Trainers Guide. Caritas CHAST Almedom et al, Hygiene Evaluation Procedures. PHAST in emergencies Participatory approach in fighting against diseases with faecal-oral transmission 2005 (ed: Dr Maigul Turatbekova) UNICEF Pakistan Wateraid – Participatory Approaches and Facilitation Skills.

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Introductory Module: Hygiene Promotion In Emergencies Aims: This session is designed to: Ensure that participants have an overview of their work and understand their roles and responsibilities in the water and sanitation programme and provide participants with an overview of the project cycle and their responsibilities at different stages of the project Outcomes: By the end of the session participants will be able to:  Explain the aims and objectives of a WASH programme  Describe the stages of the project cycle  List the roles and responsibilities of a hygiene promoter Time: 45 minutes Methods:  Discussion  Presentation  Group Work Background Reading: Hygiene Promotion Briefing Paper Hygiene Promotion Guidelines (agency defined) Resources/Handouts: Hygiene Promotion Job Description Handout Paper slips with one HP task per slip of paper Session Plan: Introduction to session with aims and outcomes In plenary ask participants to call out the aims and objectives of a Water and Sanitation Programme On flipchart or powerpoint list key aims and objectives (see example Logical Framework) and show Hygiene Improvement Framework diagram Ask participants for a definition of Hygiene Promotion and show powerpoint/flip chart In small groups ask participants to rank HP Tasks on job description in order of importance and justify their choice Feedback to larger group and discuss choices made Brainstorm the key qualities that are needed to perform the tasks Once completed circle the qualities that emphasise communication and 8

facilitation skills Show powerpoint/Flip Chart on why do we need hygiene promotion Provide handout of job descriptions for participants to review and ask specific questions about their role. Ask participants to explain what is meant by the project cycle. Show diagram of the project cycle and explain how in an emergency especially events cannot take place in a linear fashion one after the other but will often need to take place in parallel with each other. Explain that during the training the different stages of the project cycle will be covered and give examples of each stage. Facilitators Notes/Key Learning Points:  Aim of WASH intervention to promote improved hygiene in order to prevent water and sanitation related diseases  Emphasise the optimal use of facilities and key hygiene practices  Emphasise the importance of enabling improved hygiene  The key qualities of the hygiene promoter are communication and facilitation  Ensure that participants are aware of their role in enabling participation of those affected and in making the response accountable to them Introductory Module: Public Health in Emergencies Aims: This session is designed to: Ensure that participants understand the broader health context in which they will be working Outcomes: By the end of the session participants will be able to:  Describe the factors influencing Public Health in an emergency situation  List the priority areas of intervention  Explain why it is important for the different sectors to co-ordinate their interventions Time: 45 minutes Methods: Presentation Group Work Discussion Background Reading: Sphere Manual

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Resources/Handouts: Flip chart paper Scissors Handout of Public Health Model Session Plan: Introduction with aims and objectives In small groups ask participants to brainstorm and then prioritise the factors that influence health in the situation they are working in. One group should feedback in plenary and the other groups add their suggestions and comments Show the powerpoint slide/flipchart of the simple public health model and discuss. Ask for/provide examples for each area from the current situation if possible. Divide the group into 6-10 smaller groups. Give each group a large sheet of flip chart paper with a part of the body written on it. Ask them to draw this (life size) body part and then to cut it out. Ask each group in turn to come and assemble the body together. Discuss the importance of co-ordination of very different parts if the body is to work effectively. Ask participants to consider the role they have to play in co-ordination Facilitators Notes/Key Learning Points:  Emphasise the interrelationship of health and the different sectors working in an emergency  Stress the importance of co-ordination between sectors to achieve impact on health especially on the incidence of diarrhoea and other water and sanitation related diseases Introductory Module: Key Water and Sanitation Priorities Aims: This session is designed to: Ensure that participants are familiar with the different aspects of a water and sanitation programme and understand the priority interventions for the specific context in which they are working Outcomes: By the end of the session participants will be able to:  List the key components of a water and sanitation programme  Describe the priority hygiene issues that will have the biggest impact on public health and the reasons for this  Explain how they can work in conjunction with engineers to ensure that these issues are addressed  List the key areas of hygiene promotion focus for the particular context in 10

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which they are working Describe the hardware and software elements of the programme on which they are now working and how they work together to achieve an impact on health

Time: 45 minutes Methods: Presentation Group Work Discussion Background Reading: Sphere Hygiene Promotion Guidelines (agency defined) Resources/Handouts: Four pieces of A4 labelled as described below Priority Interventions Handout Session Plan: Label the four corners of the room with: 1. Clean Water, 2. Large Quantity of Water, 3. Good Hygiene, 4. Disposal of Faeces. Ask participants to go to a corner of the room depending on what they think is the most important priority in a WASH programme and in groups discuss why they have chosen their particular „corner‟ Interview each group and ask them to give two reasons for their choice. Show the Fewtrell et al powerpoint/flip chart on relative impact of different WASH interventions and the research on hand washing. Ask how does this relate to the current situation? Show the key priorities for the specific context and phase of the current intervention are written up in bold and discuss how these priorities are to be addressed. Divide participants into small groups and give each group a specific area to focus on e.g. excreta disposal, children‟s excreta disposal, hand washing, clean drinking water. Ask each group to think about what activities and inputs are required for each area of intervention and how the „hardware‟ and „software‟ need to work together. Ask each group to present a summary of their discussions and clarify misconceptions or points of contention. Draw out key learning points.

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Facilitators Notes/Key Learning Points:  It is important not to try to promote change in too many areas at the same time but to focus on areas that will have the biggest impact: in many cases this will be hand washing (if not currently practiced) and effective excreta disposal.  In some places, people may be used to washing hands but this may become difficult when living in a camp situation and when water and soap are not easily available. Whatever the hygiene promotion focus, sensitivity is required when dealing with people‟s hygiene habits.  However, some issues such as rubbish disposal or the disposal of dead animal carcasses may not pose an immediate public health risk compared to the above issues (although it will encourage fly breeding and will need to be addressed at some point) but can affect people‟s psychological wellbeing. Additional resources may need to be found to address these issues earlier in the programme – depending on the situation.  Software and hardware need to work together to achieve impact – one without the other will not succeed in an emergency context Introductory Module: Community Involvement in Design of Facilities3 Aims: This session is designed to: Ensure that participants are aware of their role in supporting the design, siting and modification of facilities for water and sanitation Outcomes: By the end of the session participants will be able to:  Describe how they can involve men, women and children in assessing the acceptability of facilities  Explain why facilities might not be acceptable and how this can influence the impact of the programme Time: 45 minutes Methods: Presentation Group Work Discussion Resources/Handouts: Photographs of different latrine/water point/laundry/hand washing facilities etc.(see example power point slides) Session Plan: Show three or four pictures of water and sanitation facilities and point out some of the feedback received from users e.g. latrine too narrow, hole too big for
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This session will need to be designed in conjunction with the engineers and technicians working on the WASH programme

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children to use, shower next to latrine, stairs too steep etc. The following feedback for the designs in the accompanying powerpoint was received from users: Picture 1 – Two toilets are adjacent to two bathrooms and a washing slab. People complained that when washing clothes the dirty water from the bathing cubicles drained out onto the washing slab. Similarly the dirty water from first bathing cubicles drained into second. People in the bathing cubicles were bothered by the sound of people going to the toilet and people in the toilet were embarrassed by the fact that there were people having showers next to them. Picture 2 – The metal sheeting used for these latrines meant that they were very hot in Summer (40 degrees outside and hotter in!). The pump was meant to be for anal cleansing only but sometimes children used it for drinking water. These toilets were meant for men and women but people wanted separate toilets. Ask participants to think about the design of the water and sanitation facilities that they currently use. In pairs ask them to discuss the pros and cons of the current design and what they would like to see improved. If they are not part of the affected population, ask them to step inside the shoes of the men, women and children affected by the emergency and think of some of the problems they might have with the current facilities (or lack of them) and what needs to be considered when providing new facilities. Divide participants into small groups and ask each group to think of what modifications in the design of water and sanitation facilities might be possible/necessary for the following groups:     Men and women with physical disabilities Children Elderly men and women People with HIV or AIDS

Each group should feedback their suggestions in plenary. Discuss what is possible in this specific context and clarify the responsibilities of the hygiene promoters in ensuring community participation/consultation in the design of facilities. Facilitators Notes/Key Learning Points:  Some issues in design may be pre-empted but there is always a need to consult with the users to find the most acceptable design.  Even where the initial facilities are pre-designed, it is important to get an idea of how well they are working and how they can be modified  Feedback on community satisfaction with facilities should be a part of the monitoring process.  The needs of different groups e.g. those with disabilities or the elderly will also need to be considered. Bedpans, urinals, commodes or potties may be useful where mobility is particularly poor or for use at night.

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Introductory Module: Selection of Community Volunteers Aims: This session is designed to: Ensure that hygiene promoters know how to select the most appropriate community volunteers for the hygiene promotion programme. Outcomes: By the end of the session participants will be able to:  List the important criteria to take into consideration when selecting community volunteers for the programme  Describe how they will enable the selection of community volunteers in the current situation Time:  45 minutes Methods:  Brainstorm  Group Work  Discussion Background Reading:  Hygiene Promotion. A Practical Manual for Relief & Development  Environmental Health Field Guide Resources/Handouts: Example Job Description for Community Volunteers Session Plan: Introduction to session aims and outcomes. Brainstorm to ask participants who they would choose from their own communities when selecting volunteers and why. In small groups ask participants to write a job description for Community Volunteers and decide the most important criteria for selecting Volunteers. Feedback to the larger group and discuss the criteria selected and summarise on a flipchart. Provide handout of the actual Job Description of a Community Volunteer for participants to discuss and compare with their own. Facilitators Notes/Key Learning Points:  It is important to take into consideration whether a separate cadre of community facilitators will be selected for this emergency programme, or existing local health or extension workers will be used, promoting a more integrated approach.  Identify the advantages and disadvantages of the above methods. 14

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Identify the skills needed for community volunteers, as set out in the job description. It is useful to consider in selection of volunteers including: gender, age, literacy and numeracy, whether they are community members, able to communicate in the local language, able to communicate well, respected figures in the community and anticipated remuneration. It is important to calculate the total number of community volunteers which need to be selected in the affected area (one volunteer for every 1,000 people)

Introductory Module: Communication Skills I Aims: This session is designed to: Familiarise participants with some of the key principles of communication Outcomes: By the end of the session participants will be able to:  List different ways of communicating with large populations  Describe some of the factors that are necessary for effective communication  Apply principles of effective communication to their work as hygiene promoters Time: 45 minutes Methods:  Discussion  Role Play Resources/Handouts: Communication Skills handout Communicating with different age groups handout Johari‟s Window pictures Session Plan: Post up four pictures (Johari‟s Window pictures) on the board and place four labels (Open, Blind, Hidden and Unknown) in random order to one side of board. Briefly explain what the labels refer to but do not link the explanation to the pictures i.e. fieldworker assumes that the community member knows nothing (BLIND), the community member deliberately keeps things HIDDEN from the fieldworker, Neither party knows or understands the other (UNKNOWN), OPEN communication exists between the two. Ask people to consider how these labels might apply to communication between community members and fieldworkers and to give examples from their own experience. Ask for volunteers to attach the labels to each picture and explain what 15

communication issues they need to think about when working with the affected population Tell participants the story of the aid worker below:
Charity came from the city but had trained to be a social worker. She wanted to help her people and went to work in a rural village near to a large lake, deep in the interior of the country. She had always been fond of swimming and was excited that in her free time she would be able to go swimming in the lake. One day on her return from swimming she was told by an old man that she passed that she should not go into the lake because there were evil spirits there. Charity had studied at university and she didn’t believe in witches and evil spirits but knew that people in the rural areas were very superstitious. In part she felt that this superstition was a severe handicap to their development. She told the old man that she didn’t believe in evil spirits and so she would be OK to carry on swimming there. Several months later and following many enjoyable swimming sessions on the weekends she was talking to one of the teachers at the local school and the issue of evil spirits and superstition came up. She told the teacher about what the old man had said. ‘Ah’ – said the teacher – ‘sometimes those evil spirits are also known as crocodiles!’

Ask for participants‟ reactions and discuss how we can often make assumptions without fully understanding the situation. Hygiene Promoters need to try and get into the situation of the individuals and groups they are talking to and see the world through their eyes. Divide participants into small groups and ask 2 groups to think up a role play depicting good communication skills and 2 to highlight poor communication skills (ask them to make this as realistic as possible without exaggerating too much!) Ask them how they would communicate with someone who was grieving because of the loss of loved ones or their homes and possessions. Review Key Learning Points Facilitators Notes/Key Learning Points:  Many people in the affected population may be grieving and may not want to engage with assessment or other activities. Hygiene Promoters must show sensitivity and empathy when communicating with the population  There will, however, be many people who are focussed on adapting and improving the situation and who are in a better position to engage with mobilisation activities  Listening is a key communication skill and hygiene promoters must always be thinking how they can „listen‟ better  Too much information or information that is ambiguous may confuse people  Developing good communication skills cannot be learned in one 45 minute session and this issue will be addressed in subsequent meetings and trainings

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Introductory Session: Assessment Overview Aims: This session is designed to: Provide participants with an overview of the assessment process and their role in ensuring a comprehensive assessment Outcomes: By the end of the session participants will be able to:  Explain their role in carrying out ongoing assessment activities  Explain the importance of collecting both qualitative and quantitative information Time: 45 minutes Methods:  Pair work  Group work  Discussion Background Reading: Sphere Manual Resources/Handouts: Qualitative and Quantitative Assessment Handout Leading Questions Exercise Assessment Methods Handout Overview of Data Collection for Hygiene Promotion Handout Example Rapid Assessment Checklist Example Observation Guide for an Exploratory Walk Session Plan: Briefly introduce the aim of the session Ask the group what are the key qualities needed when carrying out an assessment. Show the powerpoint/flip chart on listening and observing. Ask the group why we need to assess and what we will be looking for when we assess. Ask the group what is the difference between qualitative and quantitative assessment and what methods might be used for both. Distribute the handout on qualitative and quantitative data and clarify any questions. In pairs hand out the „Leading Questions‟ exercise and give them time to discuss the questions and then ask for feedback. Explain the difference between different types of questions e.g. „open‟ and „closed‟ questions and when you might them. (see powerpoint slides: That‟s a good 17

question!) In pairs, ask the participants to think of three qualitative assessment questions for hygiene promotion and three questions they might use in a simple questionnaire survey. Ask the group to shout out examples of these questions and record them. As each question is called out ask if the rest of the group agrees and try to ensure that the questions are as clear and useful as possible. Ask the group what assessment methods they are familiar with and ask for a brief explanation of each method suggested. Provide handout on assessment methods and exploratory walk and overview of data collection. Ask the group what they will do with the assessment data? Answers should include:  Record it  Share it  Use it to inform intervention and change or adapt style of working Provide an example of the assessment format that will be used in the current situation and ensure that the group has practice filling this in. Facilitators Notes/Key Learning Points:  Ongoing assessment is an important aspect of the HP‟s everyday work  Observation and Listening Skills are key to good assessment  Recording and capturing information in a systematic way is necessary – even when informally assessing the situation  Overlap between assessment and monitoring – monitoring forms and reports provide a useful means of systematically recording data but must interpret and use data also Introductory Module: Running a Focus Group Discussion Aims: This session is designed to: Provide participants with practice in running a focus group discussion Outcomes: By the end of the session participants will be able to:  Identify participants for a focus group discussion  Involve all members of the group in discussing water, sanitation and hygiene issues  Manage a FGD so that one or two members do not dominate the discussion  Use probing questions to explore issues in more depth  Record data from the focus group discussion  Analyse data from the FGD Time: 45 minutes (plus 3 hours for fieldwork and feedback) 18

Methods:  Role Play  Discussion Resources/Handouts: Focus Group Discussion Handout Focus Group Discussion – sample questions (aide memoire) Analysing Qualitative Data and Reporting Handout Session Plan: Provide a brief overview of how to run a focus group (see handout). Think up an appropriate topic that all participants are interested in, for example, arranged marriages or are computer games bad for you? Prepare three or four „roles‟ beforehand and write the details on separate pieces of paper (see below). Ask for four volunteers: two people to observe, one to lead the session and the other to take notes. The remainder of the group will be participants (if a large group divide into male and female groups). Give out the four „roles‟ to different participants. Allow fifteen minutes for the group to discuss the topic and then discuss in plenary. Ensure that the volunteers consider the following factors: putting people at ease, explaining the task, asking open ended questions, listening, probing, summing up. Who participated? How did the facilitator deal with trouble makers? What could have made the session better? Example roles: 1. You want to be first to answer every question and have a point of view on everything. You disagree with what most other people have to say…2. You are very unsure of yourself and feel intimidated by even a small group but if asked you will give your point of view…3. You are the leader of a women‟s group and keep trying to turn the discussion round to the issues that concern you…. Provide participants with a list of questions for water and sanitation but explain that this is only meant to help to jog their memory and should not be used as a question and answer session. Divide the group into pairs and ask them to practise using the questions on each other. End the session by explaining how the fieldwork will be carried out Fieldwork and Feedback Fieldwork practice should be relatively short (about 30 minutes) but may take a long time to organise. Participants should work in groups of 2-3 people and must clarify the responsibilities of each person. Ensure that each facilitation group feeds back on both the process and the content of the session afterwards. It is also useful to try to get them to define how they will do it differently next time. Briefly explain how to analyse qualitative data and what will be expected from Hygiene Promoters in terms of reporting. Provide handout on analysing and reporting data.

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Facilitators Notes/Key Learning Points:  FGD‟s can easily become question and answer sessions and Hygiene Promoters will need to practice running groups to ensure an effective and interactive discussion  Ensure that the note taker takes as detailed notes as possible and records key quotes from the FGD participants  Question and answer sessions may be unavoidable in the first few weeks and useful information can still be obtained from these  The fieldwork will need to be prepared at least a day before. It may not always be possible to organise a proper focus group and a mixed community group may have to suffice  Ideally pairs of participants should work with a „coach‟ to conduct the fieldwork practice. However, there will rarely be enough trained people available to do this. Try to pair Hygiene Promoters with someone who has previous experience where possible. Introductory Module: Diarrhoea and Oral Rehydration Therapy Aims: This session is designed to: Ensure that hygiene promoters know how to manage diarrhoea including how to prepare and use oral rehydration solution made from oral rehydration sachets and salt and sugar solution (where appropriate). Outcomes: By the end of the session participants will be able to:  Describe the definition of diarrhoea and its causes  Describe how to identify dehydration and diarrhoea danger signs in children  Correctly demonstrate how to prepare and administer oral rehydration solution made from oral rehydration salts (sachets) and salt & sugar  Explain other ways of managing diarrhoea  Explain ways of how to prevent diarrhoea Time:  45 minutes Methods:  Question & answer  Demonstration  Group Work  Discussion Background Reading:  Hygiene Promotion: A Manual for Relief & Development  Where There is No Doctor  Child Health Club Trainer‟s Manual Resources/Handouts:  Picture of dehydrated baby handout  Wilted plant 20

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„F‟ Diagram handout Oral rehydration salt sachets, boiled water, measuring utensils, bowl Items for making up oral rehydration solution - salt, sugar, water, bowl. Oral Rehydration Handout Example of key messages for diarrhoea ARCHI Volunteer Toolkits and Guide

Session Plan: Introduction to session aims and outcomes. In plenary question and answer to assess what participants already know about the definition of diarrhoea and its causes. Introduction to why oral rehydration is so effective in the management of diarrhoea. Use of Wilted Plant Experiment to demonstrate that water is necessary for life and how fluid is lost through episodes of diarrhoea. Demonstration of the preparation of oral rehydration solution (using sachets salt and sugar). In 3 groups ask them to discuss different issues including: Group 1: to prepare and undertake a demonstration of how to make up oral rehydration salts using packets. To make up a song about this.  Group 2: to prepare and undertake a demonstration of how to make up oral rehydration solution using water, salt and sugar. To make up a song about this.  Group 3: to discuss the main issues in managing diarrhoea including cholera. Feedback to larger group and discuss any problems encountered in the different Preparations. Also discussion on the management of diarrhoea. Show printed materials of how to make oral rehydration solution. Facilitators Notes/Key Learning Points:  Diarrhoea is defined as the passage of three or more watery stools in 24 hours. Dysentery is indicated by the passage of blood or mucus in the stools.  Diarrhoea and dysentery are spread through the faecal oral route, and diarrhoea can be prevented.  Diarrhoea can cause dehydration, which can be especially serious in children, the elderly and those who are malnourished. It is important to know the danger signs of dehydration.  An adult needs to drink 3 or more litres of water per day.  It is important to understand that ORT will not necessarily stop the diarrhoea straight away but will replace the lost fluid.  Administer the solution in small amounts (a teaspoon at a time) if a baby or small child is vomiting. They will still keep down some of the fluid  Demonstrate how to correctly make up ORS sachets and a home made 21

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oral rehydration solution using clean boiled water, salt and sugar (ensure that you promote the locally accepted quantities and measuring materials for home made solution e.g. the use of a clean soda bottle). The actual amount of salt and sugar may vary according to country, and it is important to refer to the national country guidelines. It is also important to give other fluids and to continue feeding – including breast milk for babies Hygiene Promoters/community workers should encourage attendance at a health clinic if there are any signs of dehydration, if there is blood or mucus in the diarrhoea, or if diarrhoea continues for longer than 7 days. Diarrhoea can be prevented by (the use of latrine or burying stools, hand washing with soap after using latrine & before eating, by reducing flies, by drinking safe water, keeping the compound clean from animals and faeces, eating well cooked and clean food and breastfeeding babies and small children). Depending on the situation it may be necessary to ensure that participants are aware of specific diarrhoeal diseases such as cholera and how to manage this. It is useful to be able to make up songs about making oral rehydration fluid using oral rehydration salts from packets and salt & sugar.

Introductory Module: Safe Water Chain and Hand washing Aims: This session is designed to: Deepen participants‟ understanding of the chain of contamination and the role they have to play in promoting hand washing and ensuring that drinking water is kept clean at the household level Outcomes: By the end of the session participants will be able to:  Explain how drinking water may become contaminated  Describe how disease can be transmitted through the lack of hand washing  Describe key activities that they can undertake to prevent the transmission of disease (especially diarrhoea) Time: 45 minutes Methods: Presentation Group Work Discussion Resources/Handouts: Flip Chart Paper F diagram Powerpoint/pictures of possible hand washing facilities

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Session Plan: Introduction In plenary brainstorm the ways in which water can become contaminated (ask participants to think about their own situation unless they all have piped water at home!) In pairs ask participants to think about how they keep drinking water clean in their own home and ask for examples from several pairs. In small groups ask participants to consider what people can do in the present situation to prevent the contamination of water: 1. at the source 2. during transportation 3. at home Each group should list the points on flip chart paper. Then groups should rotate to review each others points. When reviewing ask them to consider how feasible these suggestions are and what can be done to make these suggestions happen. Ask each group to feedback on one important method of contamination and suggestions for addressing this until the most important methods have been covered. Encourage discussion about how to enable changes in practice in order to prevent contamination. Show powerpoint/pictures/demonstration of how contamination takes place, possible hand washing facilities and hand washing technique. Also give an example of a handwashing song e.g. handwashing rap. Review key learning points Facilitators Notes/Key Learning Points:  Once again software and hardware should be working together: hardware could include the distribution of household water filters, chlorine solution or clean water collection and storage containers; software is ensuring that these are used appropriately. In this instance the hygiene promoters may be responsible for some of the hardware interventions  When discussing safe water, the focus should be on drinking water rather than water for all purposes – people may collect/store water from a variety of sources for different purposes  Hand washing with soap or an abrasive substance is required rather than just water.  Participants should consider how they can enable people to prevent water contamination e.g. hand washing containers by the latrine, group discussions with households to motivate them etc.

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Introductory Module: Use of Participatory Methods I Aims: This session is designed to: To introduce the participants to participatory methods and how to use them Outcomes: By the end of the session participants will be able to:  Describe why participatory methods can be appropriate for hygiene promotion.  Facilitate the following participatory methods: 3 pile sorting, chain of contamination and Take 2 children.  Explain how these methodologies can be applied at all stages of the hygiene promotion project cycle including assessment, programme implementation and monitoring. Time:  45 minutes Methods:  Brainstorming  Presentation  Group Work  Demonstration  Discussion Background Reading:  Hygiene Promotion. A Practical Manual for Relief & Development  WASH Cluster Hygiene Promotion Toolkit  PHAST for Emergencies  CHAST. Manual and accompanying drawings of hygiene behaviour  Child Health Club Trainers Guide Resources/Handouts:  Three pile Sorting pictures (sets of pictures for other activities to be developed)  Three Pile Sorting Instructions  Core Facilitation Skills Handout Session Plan: Introduction to session aims and outcomes. Brainstorming on why participatory methods are useful for learning. Presentation on the theory of how participatory methods work. Presentation of how to undertake 3 pile sorting, chain of contamination and the take 2 children exercise. The larger group is divided into 3 smaller groups and each is given 2 participatory methods which they are asked to practice and discuss the steps. 24

The groups are asked to demonstrate how they used participatory methodologies to everyone. Discussion in plenary on the benefits and constraints of using participatory methods, including the trade off between reaching a larger number of people and effectiveness. Also the limitations of message dissemination. Facilitators Notes/Key Learning Points:  The key differences between didactic and participatory methodologies and the advantages and disadvantages of each. The philosophy behind the use of participatory methodologies is that people learn better in an interactive way, by sharing experiences and when an issue is relevant to them. Also that participatory methods can help people to develop a creative approach to problem solving  Participatory methodologies are very useful at all stages of the hygiene promotion project cycle, in particular for learning about the transmission and prevention of diarrhoea. They are particularly useful for communities where literacy is low.  Participatory methods can include focus group discussion, pocket voting, 3 pile sorting, chain of contamination, blocking the routes and ranking.  It is important to use a broad range of methods for promoting hygiene promotion to maintain interest and provide broader experiences.  Issues to consider when conducting a participatory exercise include4:  selection of appropriate participatory tools and knowing the resources to use.  that people know what the aim of the exercise is.  participants should take as much control as possible without allowing them to dominate.  probe deeper if the outcome is unclear  record on paper the outcome of the exercises including what happened and when.  It is important to know how to gather and manage information which is generated during these discussions and arising from participatory methods.  It is useful to know at which stage of emergencies participatory methods may be most effective. Introductory Module: Selection and Distribution of Hygiene Kits and Hygiene items Aims: This session is designed to: Ensure that participants understand their role in the selection, distribution and follow up of hygiene items Outcomes: By the end of the session participants will be able to:  Describe how to identify the need for specific hygiene items
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Ferron, S et al. Hygiene Promotion. A Manual for Relief & Development

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Explain how the distribution of hygiene items will be carried out Describe the activities that are necessary to ensure effective use of hygiene items

Time: 45 minutes Methods:  Group work  Discussion Resources/Handouts: NFI and Hygiene Kits briefing Paper Hygiene Kit monitoring form Session Plan: Ask participants to list the non food items that have already been distributed in the current situation. Ask them if they have heard of any feedback on these items or on the way the distribution was carried out and discuss this. Are there any mechanisms in place for people to register complaints or to ensure their rights are being upheld? In small groups ask them to list the items that might be necessary to enable better hygiene in the current situation. Once they have completed their list, provide each group with a few examples of hygiene materials that might be distributed and ask them to assess their suitability and the quality of the product. In plenary compile a list of items. Explain that funding restrictions might mean that not everything can be distributed and ask them to rank the most important items and why they are important. In pairs ask the participants to think of how they would monitor the distribution of hygiene kits and invite suggestions. Provide example of Hygiene Kit monitoring form Facilitators Notes/Key Learning Points:  Important to discuss with affected men and women to determine most appropriate items  Cannot just assume that people will use the items for their intended purpose  Need to monitor use and satisfaction with items Introductory Module: Adult Learning Aims: This session is designed to: Ensure that participants know how to organise effective training sessions 26

Outcomes: By the end of the session participants will be able to:  Describe the key principles of adult learning  Plan and execute training courses for community volunteers that are informed by adult learning principles Time: 45 minutes Methods:  Group work  Discussion  Role Play Resources/Handouts: How adults learn handout Session Plan: Briefly introduce the session Participants are asked to close their eyes and think back to when they were at school or training events that they have attended. In groups of three they should list the positive and negative factors about their trainers or teachers. The positive list may have included the following:      The teacher made everyone feel at ease The sessions were well organised There was lots of discussion and activities The sessions made you think for yourself You felt that you had learnt something useful

The negative list may have included the following:  The teacher lectured the group for too long  You were made to feel embarrassed in front of others  It was difficult to know how to use the information subsequently  The trainer didn‟t ask what the participants already knew  There were too many tests Participants need to think about these factors when they are planning training sessions for others. Explain that it is important that they do not simply try to fill people up with knowledge. Show powerpoint slide/picture. Ask participants to imagine they are training in front of a large group and how they would look to the group. What other attributes are useful for training?   Expressions Body language 27

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Voice Heart Brain

Divide the participants into groups and ask each group to make up a role play of a good and bad teacher. Ask each group to perform their role play and ask other participants to make a mental note of the key qualities necessary for a good teacher or trainer. Ask the group to brainstorm the most important qualities in a trainer and highlight the lessons and examples from the role plays they have just performed The list may include the following:  Confidence and knowledge about subject  Plans session and is prepared  Able to listen well to what participants have to say  Uses and builds on the existing knowledge of the group  Able to clarify points of contention  Does not embarrass participants or make them feel small  Puts participants at their ease  Makes learning fun Explain that later on they will have a chance to practice some training and facilitation skills and that they should try to keep these issues in mind. Facilitators Notes/Key Learning Points:  Participants need to develop their skills of facilitation and training in order to effectively carry out training with volunteers and community groups Introductory Module: Working with Children Aims: This session is designed to: Ensure that participants are able to plan and safely carry out HP activities with children Outcomes: By the end of the session participants will be able to:  Explain the key differences between child and adult learning 28

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Describe the different developmental stages that will influence children‟s learning Describe some of the HP methods that can be used with children Explain the responsibilities of hygiene promoters to ensure that children are protected from harm

Time: 45 minutes Methods:  Group work  Discussion  Games Background Reading: Child to Child Part 1 Tearfund 2007 Child Health Club Trainers Guide. Caritas CHAST….. Resources/Handouts: Child Protection Good Practice Guide Child Protection Scenarios Child to Child Activity Sheets Example activities for working with children Children and Learning Session Plan: Discuss with participants what they understand by child rights, protection and abuse. Ask how children could be vulnerable to abuse in this situation. Show the powerpoint slide/flip chart with the WHO definition of abuse and discuss Divide participants into small groups and give each a scenario on child rights/abuse. Ask them to identify and discuss the key issues in the scenario and what should be done to prevent and address these issues. In pairs ask participants to think of how adult and children are different in the way that they learn. The list might include the following:    Children more flexible and open to new ideas Children are very inquisitive Children learn through play

Ask participants what is the best way to motivate children Use powerpoint slides/printed handouts to provide an overview of the child to child and CHAST approaches. Provide handouts of child to child activity sheets 29

explaining that they may not be exactly pertinent to the situation but that they can provide ideas of activities that can be carried out with children. Facilitate a discussion on how to include work with children in the current context e.g. work through schools/teachers/youth groups, train children‟s facilitators Facilitators Notes/Key Learning Points:  Large percentage of population are often children (under 18)  In many countries, children are often caretakers of other children and can be influential in promoting hygiene  Under fives are most vulnerable to disease and death, may be scared to use latrines, latrines may not be appropriate for under fives  Need specific sanitation solutions at household level, but also in schools e.g. adapted latrines, potties and nappies etc.  Youth groups may already exist and may provide a useful entry point for activities with older children  Any intervention with children must not put them at risk of abuse – those working with children need to adhere to the Child Protection Good Practice Guide Introductory Module: Carrying out a Hygiene Promotion Campaign Aims: This session is designed to: Inform participants about how to carry out a hygiene campaign in an emergency. Outcomes: By the end of the session participants will be able to:  Describe the key elements of a hygiene education campaign  Describe communication methods which can be used Time:  45 minutes Methods:  Brainstorming  Group Work  Discussion Background Reading:  Hygiene Promotion. A Practical Manual for Relief & Development Resources/Handouts: Flipchart and pens Session Plan: Introduction to session aims and outcomes. 30

Brainstorm to find out how participants would plan a campaign and what they consider important activities. On a flipchart list these important activities. In small groups ask participants to discuss some of the methods and messages suitable for use in emergency hygiene promotion projects and how they would carry them out. Feedback to larger group and discuss the choices made. Facilitators Notes/Key Learning Points:  Campaign activities are often based on hygiene education principles.  The main steps in implementing a hygiene promotion campaign include selecting key hygiene promotion messages, selecting appropriate communication methods, preparing communication materials, promoting the messages.  Remember it is possible to plan and implement an information campaign focussed on a specific health topic over a short time span targeted at a large number of people or specific groups of people.  It is important to know how to select the most effective method or mixture of methods for the campaign including announcements with loudspeakers, posters (including cloth or on walls), street theatre (drama, puppets), slides, films & videos, games, community radio broadcasts, household visits (faceto-face communication), large and small group discussions, child to child methodologies.  It is important to recognise the importance having a few important messages rather than too many messages e.g. excreta disposal, handwashing with soap and keeping water clean. Introductory Module: Planning Training and Training Practice on Use of ORT Aims: This session is designed to: Ensure that participants are equipped to provide well organised and interactive training sessions for community members Outcomes: By the end of the session participants will be able to:  List the requirements for carrying out a training course for volunteers  Define aims and objectives for carrying out training  Describe how to facilitate training and ensure the involvement of participants  Compile a session plan for training community members on the use of ORT Time: 1 Hour 30 minutes 31

Methods:  Group work  Discussion  Training Practice Background Reading: Participatory Learning and Action: A Trainer‟s Guide IIED: London Resources/Handouts: WASH Training Package for Community Mobilisers/Volunteers Session Plan: Explain to participants that a major part of their work will be training others and they will need to feel comfortable organising training courses and sessions. Divide participants into small groups and brainstorm the requirements for carrying out a training course. Ask them to imagine that they will need to do this in the next few days. Ask one group to feedback and others to supplement their suggestions once they have finished. Suggestions might include:  Training venue  Training plans  Equipment (ask them for examples – flipchart/board and pens, plain paper, certificates etc.)  Demonstration materials  Flip charts/visual aids  Handouts  Evaluation sheets  Refreshments Explain to the group that it is important to be able to monitor the learning of the participants and to do this, objectives should be set for each session in the form of „learning outcomes‟. Give an example of this. In pairs ask participants to come up with 2-3 „learning outcomes‟ for a training session on managing diarrhoea. Ask for examples and write these on the board/flipchart. Clarify/simplify where necessary. Provide each pair with the training material on diarrhoea and ORT and ask them to prepare a 20 minute training session for the volunteers (they will have to decide what they can leave out of the session).

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Ask two groups to present their session to the other participants – pretending that the other participants are community members Ask for feedback from the group and provide constructive criticism where improvements can be made. Facilitators Notes/Key Learning Points:  The hygiene promoters will need to familiarise themselves with the whole training package for the community volunteers in preparation for the subsequent training they will be doing. This session provides an opportunity to encourage the trainers to „facilitate‟ rather than to simply provide information.  The session also provides an assessment of the Hygiene Promoters Knowledge and understanding of previous sessions

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Section II: Follow on Training
The follow on training will need to be designed according to an assessment of the Hygiene Promoters work following the Introductory Module. The timetable provided on the next page is given only as an example and session plans are not provided for every session. Review and Refresher sessions should be tailored to meet the specific needs of the Hygiene Promoters. An important part of the follow on training will also be the provision of more practice in training to prepare Hygiene Promoters to run training sessions for Community Volunteers. The training sessions can be run flexibly to meet the demands of the specific situation and carried out on consecutive days or even weekly. However, the training only provides a basis for working in HP in emergencies and continual support in the field, mentoring and coaching will be necessary especially where Hygiene Promoters are inexperienced. The example training sessions for carrying out the baseline survey should be adapted according to the methodology used and are given only as an example (see Information Toolkit/Data Collection Toolkit). An example of how to run an Overview Session is also provided and frequent review and consolidation are important aspects of the training process. Separate training session plans are available for Community Volunteer Training that should be used to structure the training practice sessions.

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Example Timetable: Hygiene promotion in emergencies follow on training5
Time 09.00- 09.45 09.45-10.30 10.30-11.15 11.30-12.15 12.15-13.00 14.00-14.45 14.45-15.30 15.45-16.30 16.30-17.15 17.15-17.45 Review of Adult Learning and Training Practice Overview of day and Key Learning Communication Skills II Monitoring Monitoring continued Participatory Methods II Piloting of questionnaire in the field Piloting of questionnaire Feedback and amending questionnaire Questionnaire Survey Break Collating and Behaviour analysing Change Issues questionnaire data Lunch Interpretation Training of data and Practice planning response Break Qualitative Training assessment II Practice Overview of day and Key Learning Overview of day and Key Learning Day 1 Review of activities to date Day 2 Introduction to baseline survey Questionnaire Survey Day 3 Collating and analysing questionnaire data Day 4 Community Participation Day 5 Using other Promotional Methods (Social Marketing, Mass Media and Street Theatre) Day 6 Community Management of Facilities Day 7 Hygiene Promoters Presentations and discussion

Using other Promotional Methods continued Water and Sanitation related diseases Mainstreaming gender and protection

Review Working with Children and plan activities Using Visual Aids

Refresher session

Refresher session

Sphere

Overview of Training and Key Learning Evaluation

Evaluation/need Overview of for refresher day and Key sessions Learning Overview of day and Key Learning

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This training course is not designed to be run over consecutive days but as and when time allows. The sessions chosen should also reflect the specific situation.

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Module 1 Further Principles and Practice of Hygiene Promotion: Communication II6 Aims: This session is designed to: Further participants understanding and practice of effective communication Outcomes: By the end of the session participants will be able to:  Explain how communication can be enhanced when working with groups  Identify at least one way they can improve their own communication skills Time: 45 minutes Methods:  Discussion  Group work Resources/Handouts: Communication Worksheet Session Plan: Briefly introduce the aims and objectives of the session and ask for examples of good and bad communication that the Hygiene Promoters have come across so far in their work. Divide the group into small groups of three and follow the instructions for the exercise below: Role-play – the disrupter7 The purpose of this exercise is to show how communication in groups can be disrupted and to help participants to think about how they might handle different group situations. At the end of the session the participants should be able to discuss the ways in which the behaviour of individuals can influence groups, suggest how they might manage disruptive or distracting behaviour and describe ways of maximizing the participation of less forthcoming individuals.  One person will be the speaker, another, the listener and a third will play the role of the disrupter.  The speaker is asked to talk to the listener about some aspect of their life, while the disrupter has to try to interrupt the session (without using violence!)  The disrupters can move around the different groups. After a couple of minutes everyone should change roles until each person has had an opportunity to try each role.

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Ideally this session should be devised following observation of hygiene promoters in the field and of the weaknesses in communication 7 Adapted from Pretty et al., 1995

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Discuss with the group afterwards. Ask everyone how they felt about being interrupted and what other experience they have had of this in the past? Discuss ways of dealing with difficult people in groups, e.g. ignoring them, confronting them, distracting or diverting them, politely interrupting them. Ask them what other types of individual can help or hinder a group discussion? Using the same groups give each group the communication worksheet and ask them to think about the scenarios and what is wrong with the styles of communication and how they might handle this differently. Ask them to think of times when they might have communicated badly - especially when working with the community. Ask them how they would do this differently. Recap on the outcomes of the session and ask them to try and make a record of examples of good and bad communication to bring to the next meeting or training session. Facilitators Notes/Key Learning Points:  If possible try to identify communication scenarios that have actually taken place recently for the communication worksheet  Debrief the participants and allow them to disengage from their role characters. This can be done by asking each participant in turn to introduce themselves. If this is not done, uncomfortable feelings brought out by the roles and between the actors may cause problems later.  Further role-plays could develop from this session. The group could act out how they might help a shy person to participate in the discussion, or ensure that particular people, e.g. women, or people with disabilities are not marginalized. Module 1 Further Principles and Practice of Hygiene Promotion: Participatory Methods II Aims: This session is designed to: Make sure hygiene promoters are aware of and able to use other participatory methods. Outcomes: By the end of the session participants will be able to:  Explain why participatory methods are useful in hygiene promotion  Facilitate a Mapping and Pocket Chart exercise  Explain when and how they might use these methods in the current context Time:  45 minutes Methods:  Demonstration  Group Work 37

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Discussion

Background Reading:  Tools for Community Participation:  Participatory Learning and Action: A Trainer‟s Guide Resources/Handouts:  Pocket chart/containers  Use of Pocket Chart Handout  Pictures of hygiene practices  Voting slips  Large stick  Locally gathered resources that can serve as symbols on the map Session Plan: Introduction to session aims and outcomes. Review why participatory methods are useful for learning and ask what experience the hygiene promoters have had of using these since the last training The pocket chart can be used in various ways e.g. pictures of hygiene practices along the top of the chart and three symbols depicting „sometimes, always and never. Participants are then invited to „cast‟ their vote for each hygiene practice according to what they currently do e.g. do they wash their hands after using the latrine sometimes, always or never? Describe how to use the pocket chart and ask for 4- 5 volunteers to try voting (explain that normally this is done in private so no one else knows what has been chosen). Ask for questions and clarifications. Describe how to do a Mapping exercise and show the example of a community map with key landmarks and water and sanitation problems highlighted. Ask for questions and clarifications. Divide participants into two groups and ask them to either experiment with doing a Community Map or using the Pocket Chart. Ask one person to facilitate each session. The others should try to observe the facilitation skills as well as trying out the exercise. Ask each group to feedback on how the exercise went including facilitation. Suggest that they focus on the good aspects of facilitation first and then make constructive suggestions for doing it differently. Ask the facilitator to explain how easy it was to facilitate the others in the group and how they would do it differently next time. Ask the group how and when they might use these methods in the current context. Facilitators Notes/Key Learning Points:  When using the pocket chart with community members who have limited 38

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literacy/schooling, it is wise to just vote on one variable at a time When using the pocket chart, the main discussion is initiated when the votes are counted and this should be done with the group as a whole

Module 1 Further Principles and Practice of Hygiene Promotion: Community Participation Aims: This session is designed to: Identify ways to ensure the participation of all sections of the affected population in the emergency response Outcomes: By the end of the session participants will be able to:  Explain what is meant by community participation  Describe how and why certain groups may be particularly vulnerable in an emergency and the importance of their participation  Explain the different levels of participation  Describe the opportunities and constraints to participation in this context Time: 1 hour 30 minutes Methods: Group Work Discussion Background Reading: World Bank, Participatory Evaluation Resources/Handouts: Community Participation Handout Gender and Community Participation Worksheet Participation Ladder Exercise How to do a Venn Diagram Handout Powerpoint slides/pictures Example Gender Guidelines Power Walk Handout (optional exercise) Session Plan: Introduction: Copy the following quote onto flip chart paper: "When hundreds of refugees come flooding across the border, you don't think about whether they are men or women, girls or boys, you see a mass of miserable people who are suffering great loss and trauma and who are in dire need of shelter, food, water and medical care". Ask participants to discuss this statement and whether they agree with it or not.

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Divide participants into small groups and ask them to complete the community participation and gender worksheet on large flipchart paper. Ask one group to feedback and others to add their suggestions and comments. Ask participants to consider the meaning of participation and provide examples from their own experience. Participants may provide the following suggestions/examples for the meaning of participation:          Gives manual labour when requested Member of the health committee but does not often attend meetings Gives monetary contribution when requested but does not wish to take part in activities NGO consults with the community and then decides on latrine design NGO plans to install hand pumps in a village/camp Community member attends planning meetings, takes part in work and helps to encourage and organize friends and neighbours Marginalised members of community help to identify problems, organize resources and mobilizes others to become involved in project Community member becomes a volunteer committee member and actively carries out his/her responsibilities NGO provides a range of options to do with the design and long term management of the protected water system and allows men and women in the community to choose what suits them best

Ask whether participation is possible in an emergency. Show „participation ladder‟ powerpoint/flip chart and discuss the different levels of participation. Hand out the participation exercise sheet and ask participants, in pairs, to see where each box fits onto the participation ladder. They may want to invent their own examples for the blank boxes. Show relevant key indicators of participation from Sphere. Ask each group to then construct a Venn diagram (provide handout as an additional explanation) representing the different groups in the existing situation and indicating the level of participation/ vulnerability by the size of the circle. Ask one group to present their Venn diagram and discuss what the hygiene promoters can do to facilitate the participation of the various groups. Provide Example Gender guidelines (or agency gender guidelines/policy) and explain that „Mainstreaming Gender‟ will be discussed more in a subsequent session. Review key learning from the session.

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Facilitators Notes/Key Learning Points:  People often have a variety of concepts of participation and what it means. Participation is based on the assumption that people have a right to control their own lives and be part of the process of change. Participation is ultimately about creating a situation where people can reflect, analyse, plan and take action having been given the knowledge to do so and at the same time drawing on existing skills and experience.  The affected population will consist of many different individuals and groups who will have different perspectives and needs. Some marginalised or minority groups may be more vulnerable because their perspective may not be „heard‟ and it may be difficult for them to access facilities and services. The hygiene promoter needs to continually be trying to access these different and varied perspectives e.g. of men and women, girls and boys, those who are elderly or who have disabilities, those belonging to minority clans, tribes or religions etc.  Different levels of participation are possible at different stages of an emergency  There is always some space for participation – even if it is only a basic attempt at consultation and the provision of information to the affected population Supplementary Activities Power Walk (see handout) Explain to participants they are going to do an exercise called the Power Walk. Hand out one piece of paper containing a role to each participant. Say that they are not allowed to show or tell others what their role is. Ask participants to stand in a line facing in the same direction. Make sure that there is enough space to allow them to take at least ten steps forward (this activity made need to be conducted outside) Say that they must now act out the role of the person on their piece of paper. You are going to make a series of statements. If you think that the person in your role can answer yes to a statement, take one step forward. For example: I wear shoes. Read out the statements one by one, allowing time for the characters to think and act. After reading these statements, ask those who have taken the most steps forward who they are. Then ask those who have stayed behind or taken no steps at all who they are. How did they feel when they watched all the others going forward? Provoke a discussion on what they learn from this. Point out that the most important people to reach are precisely the ones who remain behind. Often we only talk to those who are at the front. Discuss how we can make sure that this does not happen. Lessons from the power walk  Who comes to the front in any participatory process in the community  Who benefits from any projects  The „target group‟ will often not be reached because they remain hidden  Those who are left behind become more and more frustrated  Need to find methodologies to make sure that all participate. 41

Module 1 Further Principles and Practice of Hygiene Promotion: Behaviour Change Aims: This session is designed to: Ensure that participants understand how behaviour change comes about and how they can help to enable behaviour change Outcomes: By the end of the session participants will be able to:  Describe the factors influencing behaviour change  Explain what can be done to enable behaviour change in the context they are working in Time: 1 hour 30 minutes Methods: Presentation Group Work Discussion Resources/Handouts: Behaviour Change Overview Handout Hubley Model Catalyse Model Flip chart paper and pens Session Plan: Introduction Ask participants to brainstorm some key health behaviours and health messages – from the current situation and/or their own experience and record these on the flip chart/board. In pairs ask participants to think of an example of a health message that has helped them to change their behaviour and one that has not. Discuss the reasons for this. Ask participants to volunteer their examples and discuss. Ask participants if behaviour change can happen quickly and if they can think of examples of this. Examples might be:     When user fees are abolished at the clinic (and drugs are available) an overnight increase in numbers is often observed When piped water is provided to people‟s homes – immediate increase in amount of water used Where people feel that the problem is very serious e.g. SARS outbreak and wearing face masks to try and prevent contamination Adverse publicity about a particular vaccine for children often leads people to boycott it very quickly

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Explain that there are several models that have been designed over the years to explain how people change behaviour and what they need in order to do so. In this session they will look at one very simple model. Distribute handout and give participants ten minutes to look through the handout and diagram of the Hubley behaviour change model. Ask if there are any questions. Divide participants into small groups and ask each group to think of examples from the current situation that relate to a specific component of the Hubley model. Discuss the examples provided in plenary. Provide handout of the Catalyse diagram and ask if there are any questions. Ask them to provide examples of how this diagram might relate to the current situation. Explain the concept of „positive deviance‟ (people/families who manage to engage in „healthy behaviours‟ despite the fact that they are also struggling with limited resources (a lack of resources is often cited as the main reason why people cannot practice healthy behaviours). Ask if they know of any examples of such families or individuals. Divide participants into small groups and ask them use the models provided to formulate a plan for working with the affected community to promote change. Ask each group to feedback and discuss and clarify their suggestions. Review Key learning points Facilitators Notes/Key Learning Points:  It is important to unpick the term behaviour change -people often assume that behaviour change takes a long time and isn‟t possible in an emergency but experience says otherwise  The emphasis on action rather than behaviour change may be easier to accept – you are not necessarily looking for long term changes in an emergency but the short term mitigation of public health risks  Behaviour change models can help to explain what is required for either action or long term behaviour change  Interactive approaches may be more useful and effective than one way communication methods (message dissemination) in supporting behaviour change and action  Trade off between reach and effectiveness – using a variety of approaches will ensure that at least people receive information but interactive methods are probably more effective.  There will always be some people who are ready to engage with taking action even early on in the emergency although many people will be grieving and mobilisation may be difficult at first. Showing support and empathy for individuals at this time can make the HP work easier as time progresses.

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Module 1 Further Principles and practice of Hygiene Promotion: Using Visual Aids Aims: This session is designed to: Ensure that participants know how to use visual aids appropriately Outcomes: By the end of the session participants will be able to:  Explain the term visual literacy and why it is relevant to their work  Describe how they can use and adapt visual aids in their work Time: 45 minutes Methods:  Presentation  Question and Answer  Group work  Discussion Background Reading: Linney, B. Pictures, People and Power Rohr-Rouendaal, P. Development drawings and How to use them Resources/Handouts: Example pictures (see powerpoint slides – these could be printed out or copied onto flipchart paper) Session Plan: Ask participants to define Visual Literacy. Present examples of some of the pictures that people often have difficulty in recognising (see powerpoint). Ask participants to identify what is in the picture and how it might be interpreted. Show research results on the presentation of common pictures Explain how people have to „learn‟ visual literacy and learn the conventions that the visually literate take for granted e.g. perspective. Visual literacy can be learnt quite quickly but pictures may need to be explained to people with no formal education. In pairs ask participants to discuss how they would pre-test a visual aid and what the benefits of pre-testing might be. Ask for feedback from the group and discuss. Explain that pre-testing is critical when using stand alone materials but not as important when using visual aids in an interactive exercise to stimulate 44

discussion. It is preferable to use materials that depict the people and context that you are working in but using materials from a different context may even reveal some very interesting findings for the facilitator – especially during the assessment stage of the programme. Divide participants into small groups and provide each group with a set of pictures and ask them to identify potential problems with interpretation. Ask them to make up a very short role play (5 minutes) to show how they would use the pictures in a group hygiene promotion activity of their choosing. (remind them to think of the new activities that they have learn about). Each group should present their role play in plenary and other groups offer one positive and one negative comments or suggestion. Review key learning points. Facilitators Notes/Key Learning Points:  People may not be familiar with pictorial conventions and may have to learn to „read‟ pictures  Conventions that are familiar in the West may not be understood by people from other cultures  People can learn to „read‟ pictures quite quickly and that is why interactive visual aids are more useful than stand alone visual aids – especially in an emergency when time for pre-testing may be limited  If using stand alone pictures these will need to be piloted/pre-tested  Using pictures as discussion starters or in interactive ways reduces the need for pre-testing and community members can even prepare their own pictures for discussion Module 1 Further Principles and Practice of Hygiene Promotion: Use of Other Promotional Methods Aims: This session is designed to: Ensure that hygiene promoters understand the value and range of promotional methodologies for hygiene promotion and how to undertake them. Outcomes: By the end of the session participants will be able to:  Describe the value and range of hygiene promotional methods which can be used during emergencies.  Demonstrate how to facilitate drama/street theatre for hygiene promotion.  Explain how posters, leaflets and local community radio can be used for hygiene promotion in emergencies.  Explain how the principles of social marketing can be used in an emergency Time:  45 minutes

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Methods:  Question and answer  Group Work  Discussion Background Reading:  Hygiene Promotion. A Manual for Relief & Development  Health on Air. A Guide to Creative Radio for Development Resources/Handouts:  A pair of hand puppets  Example posters and leaflets Session Plan: Introduction to session aims and outcomes. Question and answer on other relevant methods which can be used for hygiene promotion in emergencies. List these above methods on a flipchart. In small groups ask participants the way they would promote a key hygiene message using one of the following: Street theatre  local radio slot  use of hand puppets for drama Feedback to larger group to discuss. Facilitators Notes/Key Learning Points:  There is great value in using a broad range of promotional methodologies during an emergency.  It is useful to have some knowledge of how to undertake drama/street theatre and soap operas, as well as story with a gap, talks, use of hand puppets and a slot on the local radio (slogans, jingles, interviews). In addition to also know some of the practical do‟s and don‟ts of each of these methods.  It is important to try and create posters locally where possible for hygiene promotion, and in collaboration with local people. To also know a few simple guidelines for making posters. Module 1 Further Principles and Practice of Hygiene Promotion: Community Management of Facilities Aims: This session is designed to: Ensure that hygiene promoters understand how to promote the community management of facilities.

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Outcomes: By the end of the session participants will be able to:  Explain the importance of the community effectively managing facilities (including water and sanitation facilities) during emergencies.  Describe how to promote effective community management of facilities. Time:  45 minutes Methods:  Brainstorm  Group Work  Discussion Background Reading:  Hygiene Promotion. A Practical Manual for Relief & Development Resources/Handouts: Oxfam Briefing Document Handout Session Plan: Introduction to session aims and outcomes. Brainstorm to find out whether the communities from which participants originate have community managed water and sanitation facilities. In small groups ask each to discuss the following:  why community management of facilities is so important during emergencies how this can be best achieved

One of the groups is asked to feedback to plenary and the rest to contribute and to discuss. Summarise on flipchart the main ways to help communities to manage their facilities. Facilitators Notes/Key Learning Points:  Community management may not take place after construction of facilities due to the lack of sufficient community ownership.  It is important to know the importance of the community being involved at all stages of the decision-making process when installing and managing facilities.  Remember that communities should be encouraged to adopt a longer term problem-solving approach when thinking about the management of facilities, even if this is difficult in the early acute stages of an emergency.  It may be useful to take into consideration the following when promoting community management of facilities:47

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whether the community feels that the construction of facilities is what they need and want. o whether all community sections/groups have been consulted in plans to construct facilities, including the involvement of women. o whether the local government and leaders support the project. o whether discussions on community management have taken place within the community, and between those implementing the community management of facilities, as well as those involved in hygiene promotion and engineering. o planning for meetings to be held in places which are easy for people to get to, or where they may naturally gather e.g. water source. The important issues to think about for long-term maintenance of facilities include: how repairs will be managed  who will do the repairs (and training required)  who will pay for spare parts and where will they be obtained  the establishment of water committees for water point maintenance.  the introduction of user fees for facilities, and the subsequent need for financial accountability (and training required) Formal agreements regarding the roles of different community members in maintenance are important, in particular the adaptation of such an agreement to suit the specific needs. The important objectives and indicators for monitoring and evaluating community management include: whether facilities are functioning.  whether repairs of facilities take place regularly.  whether those undertaking repairs have received adequate training.  whether spare parts for facilities are available.  whether community members are undertaking agreed tasks.  whether water committees have been established. o

Module 1 Further Principles and Practice of Hygiene Promotion: Training Practice Using Training Package for Community Volunteers Aims: This session is designed to: Ensure that trainers are familiar with using the training materials for volunteers. Outcomes: By the end of the session participants will be able to:  Use the training materials available to best use - including those for participatory methods including 3 pile sorting, pocket voting, chain of contamination, story with a gap, blocking the routes, ranking, puppet theatre. Materials may include posters, flashcards, pictures, pocket charts, games, hand puppets.

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Time:  45 minute sessions for a total of 4.5 hours Methods:  Question and Answer  Group Work  Demonstration of training  Discussion Background Reading:  Hygiene Promotion. A Practical Manual for Relief & Development  PHAST. Step-by-Step Guide. A Participatory Approach for the Control of Diarrhoeal Diseases.  Behaviour Change Communication in Emergencies. A Toolkit Resources/Handouts:  WASH Cluster Hygiene Promotion Project. Training of Community Volunteers.  Puppets for puppet theatre  Visual aids sets Session Plan: Introduction to aims and outcomes. Brief refresher and summary of best ways of using training materials for Community Volunteers available including for: 3 pile sorting  Take 2 Children  Pocket voting  Chain of contamination and blocking the routes  Puppet theatre Participants are divided into pairs and each allocated a training session in the Training Package for Community Volunteers and asked to practice using accompanying materials. They should aim to prepare a 10 minute mini training session to the rest of the group. Ask two groups to present their training demonstration in each session. Ask for comments from the rest of the group ensuring that they build of the positive points first. Ask each group to write down two things they will do differently when they are next training. Facilitators Notes/Key Learning Points:  It is important that participants get a feel for how long some of the training methods may take, as well as which materials fit best with each method and how to involve those being trained.

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Module 1 Further Principles and Practice of Hygiene Promotion: Water & Sanitation Related Diseases Aims: This session is designed to: Ensure that hygiene promoters know the main water, sanitation and hygiene related diseases and how to prevent them during emergencies Outcomes: By the end of the session participants will be able to:  List the main water, sanitation and hygiene related diseases.  Explain the „FFF‟ diagram  Describe the link between malnutrition and disease  Prioritise water, sanitation and hygiene interventions Time  45 minutes Methods:  Question & answer  Group Work  Discussion Background Reading:  Where there is no doctor  Hygiene Promotion: A practical manual for relief and development.  Cholera outbreak management IFRC Resources/Handouts:  F diagram  Table of transmission of diseases  Disease fact sheets (ERU MSM)  Cholera toolkit for volunteers Session Plan: Introduction to session aims and outcomes. Question and answer on water and sanitation related diseases which are common in emergency situations. In small groups ask participants to provide the signs, symptoms and main prevention methods for the following diseases including:Faecal-oral diseases including diarrhoea, dysentery, cholera, typhoid, giardia and hepatitis A (or whatever is most common in the area) Scabies Conjunctivitis Malaria

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Feedback to larger group and discuss. Facilitators Notes/Key Learning Points:  Poor water, sanitation and hygiene practices can cause diarrhoea which is spread by the faeco-oral route.  There is an important link between malnutrition and diarrhoea.  There is a need to prioritise the water, sanitation and hygiene practices which will make the most difference in reducing disease, and these include excreta disposal, handwashing with soap, and the use of safe water.  It is important to know the key messages on sanitation, hand washing with soap and safe water use. Module 1 Further Principles and Practice of Hygiene Promotion: Mainstreaming Gender and Protection8 Aims: This session is designed to: Ensure participants have an overview of how to mainstream aspects of gender and protection into hygiene promotion programmes/projects in emergencies. Outcomes: By the end of the session participants will be able to:  Explain the meaning of mainstreaming  Describe what gender is (giving examples of roles & responsibilities of men & women relating to water and sanitation), and how it can be mainstreamed in hygiene promotion programmes.  Describe what protection is and how it can be mainstreamed Time: 45 minutes Methods:  Brainstorming  Group Work  Discussion Background Reading:  Improving the Safety of Civilians: A Protection Training Pack  Gender Training Manual Resources/Handouts:  Gender roles exercise (Hygiene Promotion. A Practical Manual for Relief & Development).  Protection Handout

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This training session is adapted from OXFAM Improving the safety of civilians

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Session Plan: Introduction to aims and outcomes. Ask the group to define the term „mainstreaming‟. Explain that „mainstreaming‟ refers to „the way that things are always done‟. „Mainstreaming Protection‟ means that the programme should automatically analyse protection issues and plan the intervention with these in mind (or analyse gender issues and plan the response accordingly etc.) Ask the group what they think Protection means or if anyone has experience of protection. Explain that Protection is about improving the safety of people for example in Darfur, Sudan women collecting water or firewood outside of an IDP camp have been the object of attacks. There are two sides to protection – reducing the negative consequences of our actions, and proactively helping people stay safer. We will focus on the latter. Humanitarian organisations help people stay safer by reducing risk. Risk exists when there is a threat, such as the threat of violence or exploitation, and people are vulnerable because, for example, they are a woman, are from a certain ethnic group, or because they have to leave their village to get water. The longer the time people are exposed to a threat the greater the risk – for example collecting water four times a day is riskier than collecting it twice a week. There are three types of threats: Violence – deliberate killing, wounding, sexual violence, rape, torture and the threat of any of these. Coercion (forcing someone to do something against their will) – forced prostitution, sexual slavery, sexual exploitation, forced or compulsory labour, forced displacement or return, restriction of movement, prevention of return, forced recruitment, being forced to commit acts of violence against others. Deliberate Deprivation – destruction of homes, wells and clinics; preventing access to land or markets; preventing delivery of relief supplies; deliberate discrimination in getting jobs, education, land or services; illegal „taxes‟ or tolls. NGOs try to improve the safety of people by doing one or more of:  reducing the level of threat  reducing the level of vulnerability  reducing the amount of time exposed to the risk. Ask the participants to think about ways that an organisation might try to protect the woman collecting water. Write up the suggestions on a flip chart. Explain that there are various actions an organisation might take, and pick an example of each from the flip chart: To reduce the threat 52

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Advocacy: convincing those with power to protect people or getting others to put pressure on them to protect people Capacity-building: supporting the authorities to protect civilians Presence: using physical presence to deter attacks on civilians

To reduce vulnerability  Assistance: directly providing services or goods so that people can avoid threats  Voice: helping people to negotiate their own safety  Information: providing impartial information to help people make informed decisions about their safety Ask the group what they understand by the term „Gender‟. Explain that gender refers to the different socially defined roles and responsibilities associated with being a man or a woman and that these often change over time and in different places. Ask them to think about how their lives have changed compared to their mothers or fathers in terms of what is expected of them as a man or a woman? Divide the participants into smaller groups and give them the sets of activity/role pictures and ask them to decide whether these are done by men or women or both. Feedback to larger group and discuss the implications this has for the current programme e.g. are we consulting enough with men and women? How do we encourage women‟s participation if they are not allowed to come to meetings or do not have the confidence to speak out? Are men and women willing to dig latrines, work as labourers, work as water point/latrine attendants (don‟t be afraid to challenge preconceptions and suggest asking women themselves)? Are some men engaged in caretaking of family members – have they been forced to take on these roles because mothers/women have died (as in the Asian Tsunami)? Do men and women have specific needs in relation to maintaining hygiene e.g. sanitary protection or razors? End the session by reviewing what the participants have understood from the session. Facilitators Notes/Key Learning Points:  The session tries to cover a lot in a short space of time and subsequent more detailed training would be beneficial to ensure that participants have a better grasp of the issues.  Where possible concentrate on specific approaches that are possible in the current context and stress the role of the hygiene promoters is to try to assess the current context and identify threats, vulnerability and the different perspectives of men and women  It is important to take gender into account when planning hygiene promotion programmes, and in particular to involve women by seeking their input (as women are usually the main water carriers and users and have responsibilities for children and families). The key roles women & men play are different and there can be barriers to their participation.  Protection is a rights based approach to humanitarian response which 53

is concerned with addressing the broader threats to human health and wellbeing in an emergency rather than just their physical wellbeing. The threats identified include violence, coercion and deprivation. Module 2 Data Collection and Monitoring: Monitoring Aims: This session is designed to: Ensure that hygiene promoters understand the importance of monitoring and evaluation of hygiene practices and how to undertake monitoring. Outcomes: By the end of the session participants will be able to:  Describe why monitoring and evaluation are necessary.  List the essential hygiene practices to monitor including safe excreta disposal, hand washing with soap and safe water practices.  List the indicators which should be used to monitor the essential hygiene practices and understand the term SMART.  Be able to explain how to use a simple monitoring framework.  Be familiar with monitoring forms for use by community volunteers. Time:  45 minutes Methods:  Brainstorming  Group Work  Discussion Background Reading:  WASH Cluster Hygiene Promotion. Monitoring paper  WASH Cluster Hygiene Promotion. Toolkit Resources/Handouts:  Example of a WASH logical framework matrix  Examples of Hygiene Promotion Monitoring Form  Example Volunteer Hygiene Promotion Monitoring Form  Examples of PHAST monitoring forms  Monitoring Exercise Session Plan: Introduction to session aims and outcomes. Brainstorming on why monitoring and evaluation is important. In small groups participants are asked to discuss how they would attempt to monitor and record data on the 3 essential hygiene practices  excreta disposal.  handwashing with soap. 54

 use of safe water. and the indicators to monitor these. Feedback to larger group and introduction of examples of monitoring forms for use by Community Volunteers. Discussion on how to use a simple monitoring framework. Facilitators Notes/Key Learning Points:  It is important to undertake monitoring and evaluation and recognise its contribution to feedback into future planning to adjust project objectives, and help identify strengths and weaknesses.  Monitoring is the systematic and continuous process of collecting and using information throughout the programme cycle.  It is useful to understand that the logical framework is an active tool to guide monitoring.  There is a difference between impact indicators (to measure if project purpose has been achieved) and process indicators (to measure how project is being developed).  The 3 essential indicators for monitoring in emergencies are:  Use of latrines  Hand washing with soap at key times (after contact with faecal matter and before handling food)  Use of safe water for drinking  To be aware of other priority indicators for emergencies including: Safe excreta disposal  Water supply  Hygiene practices  Environment  Community participation and representation  Community volunteers can monitor the impact of hygiene practices and how the project is progressing (number of community sessions, attendance of these sessions). Module 2 Data Collection and Monitoring: Introduction to Baseline Survey Aims: This session is designed to: Ensure that participants know how to carry out a baseline survey in an emergency context Outcomes: By the end of the session participants will be able to:  Explain why a baseline survey is necessary  Explain why it is necessary to collect both qualitative and quantitative data  Explain how a baseline survey is carried out Time: 45 minutes

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Methods:  Question and Answer  Group work  Discussion Background Reading: WASH HP Data Collection Toolkit (or Information Management Toolkit) Resources/Handouts: Designing baseline study Session Plan: Briefly introduce the session Ask the group what they understand by baseline data. Explain that sometimes the term is used to refer to the pre emergency setting but here it will concern the collection of data against which the progress of the Water, Sanitation and Hygiene Promotion programme can be measured: a baseline is a detailed assessment of the current situation. Ask the group why they need to collect more information when an assessment has already been made? Explain that the initial rapid assessment will feed into the baseline but the baseline that will now be collected will be more detailed and will try to provide more quantitative data to ensure that the programme can be monitored and evaluated effectively ( the initial rapid assessment relies predominantly on qualitative data and estimates of quantitative data). Explain that although changes have already taken place so that the „baseline‟ may be different from the immediate post emergency situation, this is unavoidable in an emergency and it is still important to collect a baseline. Ask the group what ways they know of to collect quantitative data. Ask if any have had experience of carrying out a questionnaire survey and ask them to explain how they did this. Ask for an explanation of sampling and why this is necessary when carrying out a questionnaire survey. Explain the difference in sampling for quantitative data collection and qualitative (random versus purposive sampling). Ask why it is important or necessary to collect qualitative data also as part of the baseline (gives greater understanding of problem, helps to define questions to ask in questionnaire survey, acts as a means of crosschecking information e.g. on hand washing) Divide the participants into small groups and ask each group to plan how they would carry out a baseline survey in the current context to collect both quantitative and qualitative data. Ask them to list the necessary steps on flip chart paper. Ask one group to feedback their plan to the large group and ask for questions, comments and additions from the other participants. 56

Provide handout on designing a baseline survey. Ensure that any misconceptions are clarified. Facilitators Notes/Key Learning Points:  This session may need to be modified according to the specific approach of the individual agency  The meaning of baseline here refers to the current situation and practices with regard to water, sanitation and hygiene although it may be useful to understand the pre emergency context when doing an assessment e.g. are people used to using latrines or washing hands? Module 2 Data Collection and Monitoring: Questionnaire Survey Aims: This session is designed to: Ensure that participants are trained to carry out a questionnaire survey and that the questionnaire is piloted prior to use Outcomes: By the end of the session participants will be able to:  Explain the importance of carrying out a questionnaire survey  Randomly select households for administration of questionnaire  Administer and complete questionnaire appropriately  Collate and analyse data collected Time: Approximately 2 days Methods:  Question and Answer  Presentation  Group Work  Pair Work  Role Play  Discussion Background Reading: WASH HP Data Collection Toolkit Resources/Handouts: Example questionnaire Guidance Notes for carrying out surveys Clipboards, pencils, rubbers Session Plan: The session will need to cover:  Familiarisation with questionnaire and how to ask questions (when to probe etc.) 57

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Importance of standardisation of approach when asking questions (asking the same question in different ways can elicit different responses in a questionnaire survey – unlike a focus group where this approach may be desirable) Data Collectors etiquette and behaviour with community Importance of random sampling and random sampling method Piloting of questionnaire and feedback on results – including verification of questionnaires (to ensure that these are filled in correctly, that necessary changes in questions or wording of questions are incorporated, that data collectors are confident to identify households and administer questionnaire – this should usually be done in pairs) Rapid input and collation of data using either excel programme (in data collection toolkit) or by using hand tabulation and collation Analysis of data - converting to percentages and interpretation of these How data will be used Feedback of data to community involved

Facilitators Notes/Key Learning Points:  This session will need to be planned according to the specific methodology adopted by each agency but the above session plan gives an idea of what needs to be covered  Unlike longer term programmes it is not possible to obtain all the necessary information before initiating an emergency response – the baseline will usually be collected after the programme begins  Initial assessment data should feed into the baseline study  Carrying out a questionnaire survey may not always be appropriate if the situation is rapidly changing and people are on the move  It is also not appropriate if you do not have time to train and support the survey team and analyse the data  Questionnaires should be kept as short as possible and should be complemented with qualitative information  Piloting the questionnaire, staff training and support are vital  Programme staff should be involved in collating and analysing the data  The outlined survey approach, presented here, represents an attempt to be as rigorous as possible given the constraints and is a „good enough‟ technique Module 2 Data Collection and Monitoring: The Sphere Project Aims: This session is designed to: Provide participants with an overview of the Sphere minimum standards that relate to water, sanitation and hygiene promotion Outcomes: By the end of the session participants will be able to:  Explain the importance of Sphere for monitoring and accountability  List the minimum standards for hygiene promotion  Give examples of key indicators that relate to hygiene promotion

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Time: 45 minutes Methods:  Presentation  Group work  Discussion Background Reading: Sphere Manual Sphere Introductory and Water and Sanitation Training Modules Resources/Handouts: Minimum standards for water, sanitation and hygiene promotion Minimum standards for shelter and non food items Session Plan: Briefly introduce the session Ask what Sphere is and if participants have experience of using Sphere Use the powerpoint or copy the powerpoint slides onto flip chart paper and present these to the group ensuring that they ask questions where necessary Divide participants into 3-4 groups and give each group a set of the standards for water, sanitation and hygiene and for (Shelter and) non food items Ask each group to think about how the standards apply to the current situation and whether they are being met. Provide each group with 2-3 relevant standards and indicators and prepare a presentation to the rest of the group on the current situation. Ask each group to provide a 5 minute feedback in plenary and ask for comments and questions from the rest of the group. Try to clarify any misunderstandings. Explain that there are also general standards that apply to all sectors which include assessment, participation and monitoring and they should try to find time to read up on these also. Facilitators Notes/Key Learning Points:  Explain that the standards are usually couched in general terms and should apply to every situation.  The indicators provide an example of how the standard can be measured but will not always be feasible in a short space of time. The standards and indicators provide a benchmark against which the progress of the progress of the intervention can be measured.  In addition, the satisfaction of the affected population with the facilities and services provided is crucial.  As a supplementary or additional session the Sphere Quiz can be used 59

to help familiarise the group with the Sphere Manual Example Overview Session Aims: This session is designed to: Consolidate learning on Hygiene Promotion Outcomes: By the end of the session participants will be able to:  Explain key points from the day‟s learning  Describe how they will use the knowledge and skills gained Time: 30 minutes – 45 minutes Methods:  Quiz  Role Play  Mini demonstration teaching session  Presentation by participants Resources/Handouts: Quiz sheets and answers Flip chart paper and pens Visual aids Session Plan: For these sessions the following ideas might be helpful: Divide participants into small teams (2-3 people) and either:    provide written quiz for teams to fill out and then swap the papers so that another group marks them call out quiz questions and each group records these on paper call out quiz questions to each group in turn

Divide participants into groups of 3-4 people and ask them to compile a mini role play or drama that highlights one important learning point from the day. It is hoped that the subsequent presentations will then cover several key learning points In groups of 2 ask participants to prepare and present a 5-10 minute teaching session on a key point of learning using interactive facilitation skills. Ensure that you provide time for preparation. In group of 2 ask the participants to prepare an overview of the days learning that they will then present to the large group. Only one to two groups per day will be chosen but all must prepare. Ask for questions and feedback from the rest of the group. 60

Facilitators Notes/Key Learning Points:   Continual review and clarification is useful in all training courses as participants will often forget things very quickly As an alternative to one long session, it is possible to have mini review sessions at key points during the day

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Appendix 1 WASH Cluster Generic Job Description: Hygiene Promoter Introduction This generic job description is intended to inform Cluster Coordinators and guide implementing agencies. It outlines key activities and competencies and promotes minimum standards for the rapid recruitment of hygiene promotion staff. The Hygiene Promoter is primarily responsible for hygiene promotion outputs of an operational agency’s WASH response. They manage the day-to-day hygiene promotion activities, with each Hygiene Promoter working with Community Volunteers in a specific location or sector of the disaster-affected population. A common staffing structure for a hygiene promotion programme is shown below, though other structures may be appropriate in certain contexts.
Hygiene Promotion Co-ordinator

Hygiene Promoter

Hygiene Promoter

Hygiene Promoter

Hygiene Promoter

Community Volunteers

Community Volunteers

Community Volunteers

Community Volunteers

The way in which responsibilities are divided between the Hygiene Promotion Coordinator, Hygiene Promoters and Community Volunteers will depend on their level of skills and experience. In most circumstances the Hygiene Promoters are likely to carry out the day-to-day implementation and monitoring activities suggested here. But in many cases the Hygiene Promoters will be able to hand over a growing number of activities to Community Volunteers as their skills and confidence develop.

Job title: Reports to: Manages:

Hygiene Promoter Hygiene Promotion Coordinator Community Volunteers

Purpose: As part of the WASH intervention, to safeguard and improve the public health of the affected population by:   promoting safe WASH practices, including appropriate use and maintenance of WASH facilities and services; ensuring appropriate community involvement in the design and delivery of essential WASH services and facilities.

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Key tasks and responsibilities:

Information management  Help plan and carry out needs assessments, baseline studies and periodic studies and feed back findings to stakeholders.      Help plan activities to reduce WASH-related risks. Collate data from Community Volunteers and prepare regular reports on activities and WASH conditions for monitoring. Coordinate with water supply and sanitation field staff to ensure that the various aspects of the WASH response are integrated. Liaise with community leaders and other sectors and agencies working locally in order to coordinate within the WASH sector and between sectors such as health and shelter. Keep proper records of field expenditures and report on these to the Hygiene Promotion Coordinator.

Implementation  Identify key hygiene practices to be addressed and help develop an appropriate communications strategy to promote safe practices. Activities in support of the strategy may include the following:  communications activities such as community meetings, drama, information campaigns, use of educational materials etc.;  support to water-point committees, hygiene committees, latrine attendants etc.   Mobilise disaster-affected communities as appropriate for participation in planning, construction, operation and maintenance of WASH facilities and services. Create channels for dialogue between the WASH response and the affected population to ensure appropriate and acceptable technical interventions; allow the agency to be held to account for the quality of the WASH programme. Help identify needs for non-food items relevant to hygiene, participate in the choice of items, targeting strategy, promotion of effective use and post-distribution monitoring.



Resources management  Recruit, train and manage Community Volunteers or other hygiene outreach workers.  Organise day-to-day logistics, administration and personnel activities together with the Hygiene Promotion Coordinator. Programme approach  Supervise hygiene promotion activities in line with relevant standards, codes of conduct and humanitarian principles.   Use participatory approaches as a far as possible throughout the programme cycle, in training, and in the use of toolkits and other materials. Supervise hygiene promotion activities and resources so that they are implemented and handed over or ended in a way that promotes local capacities and sustainable operations. 63



Take account of gender, protection, HIV, environment and other important cross-cutting concerns in programme design, implementation and reporting and carry out activities in a way that reflects the needs of specific groups and individuals e.g. the elderly, children, the disabled.

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Person specification:

1. Knowledge of one or more of the following: public health, health or hygiene promotion, community development, education, community water supply and sanitation. 2. At least two years of practical experience in the country concerned in relevant community development, health, WASH or similar programmes. 3. Good knowledge and experience of working with local partner agencies. 4. Experience and understanding of hygiene promotion and community mobilisation in relation to water and sanitation activities. 5. Sensitivity to the needs and priorities of different sectors of a community. 6. Familiarity with the culture of the affected population, ability to develop respect from a wide range of people and strong ability to communicate effectively on hygiene matters. 7. Fluency in the language of the affected population and the international language used in the humanitarian operation. 8. Assessment, analytical and planning skills. 9. Good oral and written reporting skills. 10. Diplomacy, tact and negotiating skills. 11. Training/counterpart development skills. 12. Personnel management skills. 13. Ability to work well in a team in difficult circumstances.

Other information: Brief background on context, humanitarian response and organisation’s role, reporting lines, terms and conditions etc.

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Appendix 2 Example Certificate for training Community Volunteers

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