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IPC training module _FINAL_

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IPC training module _FINAL_ Powered By Docstoc
					                                TABLE OF CONTENTS


Introduction

Do's and Don'ts of training

How to use the manual

Training goals and objectives

Training Schedule

Day one session plans

Day two session plans



References




                                                    1
                                       INTRODUCTION

This manual is designed to be used by a group of trainers. It will facilitate to prepare a group of
volunteers to act as Interpersonal Communicators (IPCs) in the community who will work to
increase awareness of the community on the usage of water disinfectant to decontaminate
water and thereby contribute to decrease the incidence of diarrhea. This manual has been
developed by PSI for the project social marketing for the prevention of diarrheal diseases in five
districts of Orissa funded by AIDSMARK/ USAID.

The overall objective of this project is water quality improvement and chlorination of water. Also
promoting and increasing access to chlorine based water disinfectants and promoting and increasing
access to Oral Rehydration Salts. (ORS)

This manual will be a tool for trainers and will enable them to implement interactive training
using learner-centered methods. Researchers have proved that adult learners want to participate in
the learning process, learn from their experiences, be challenged and draw their own conclusions
from learning experiences. This manual follows the principles of the „Experiential Learning Cycle‟ so
that participants can effectively internalize learning.




                                                                                                   2
DO'S AND DON'TS OF TRAINING
The following "do's and don'ts" should ALWAYS be kept in mind by the trainer during any learning
session.

                                             DO's

   Maintain good eye contact
                                                       Use good time management
   Prepare in advance
                                                       K.I.S (keep it simple)
   Involve participants
                                                       Give feedback
   Use visual aids
                                                       Position visuals so everyone can see them
   Speak clearly
                                                       Avoid distracting mannerisms and
   Speak loud enough                                   distractions in the room

   Encourage questions                                Be aware of the trainees' body language

   Recap at the end of each session                   Keep the group focused on the task

   Bridge one topic to the next                       Provide clear instructions

   Encourage participation                            Check to see if your instructions are
                                                        understood
   Write clearly and boldly
                                                       Evaluate as you go
   Summarize
                                                       Be patient
   Use logical sequencing of topics
                                           DON'TS

   Don't talk to the flipchart                        Don't ignore the participants' comments
                                                        and feedback (verbal and non-verbal)
   Don't block visual aids
                                                       Don't read from the curriculum
   Don't stand in one spot. Move around
    the room                                           Don't shout at participants




                                                                                                  3
HOW TO USE THE MANUAL

This manual is to be used by the trainer for training the IPCs. The manual includes a training
schedule for the two days training, clear suggestions on how each session should be presented along
with the supporting material (appendices), which has been provided for the facilitator's convenience.

Training schedule: suggests how the training is to be organized. The schedule shows which topics
will be covered on each day within a stipulated time frame.

In-depth look at each session:
For each session, the following components are provided.

Topic - indicates the topic of the session

Time - indicates the approximate time devoted to the session

Session objectives - Describes what trainees will be able to do by the end of the session to
demonstrate increased knowledge and improved skills.

Content - provide a pointer to the sub-topics and important points to be covered during the session

Training materials - provides a list to remind the trainer of the required training material for the
session.

Steps, duration and training methods – provides a window to see the steps during the session
process alongwith specific timings and suggests appropriate training methods for the session.

Pre training preparation - indicates any arrangements that the facilitator needs to make prior to
the session.

Appendix - contains additional information to explain or support the messages of the session. They
are placed after the session wherever required.




                                                         IPC training manual, PSI Orissa, November 2004
OBJECTIVES OF IPC TRAINING:

By the end of the training, the IPCs will be able to:
    Describe the objective and strategy of the project for which they will work.
    Explain their roles and responsibilities as envisaged in the project.
    Explain the causes of water borne diseases and how to reduce their occurrence.
    Explain the need for counselling the community members to use water disinfectant to treat
       water for safe use.
    Demonstrate how to test water quality.
    Understand and explain the product safewat and neotral and the dosing pattern.
    Use the IPC tools for promoting usage of safewat and neotral effectively.
    List the reporting and follow -up mechanisms.

Profile of IPCs: Age: - 25 and above (all males)
                          Graduate in any discipline.

Other essential requirements:

        Good communication skills with excellent comprehension ability
        Willing to move around in the villages and meet with community members irrespective
       of caste, creed
        Ability to work hard and under the instructions of a team leader and should be an active
       person
        Good leadership and motivational qualities
        Fairly good idea about the local region where he is supposed to work
        Fluency in the local language both reading and writing




                                                        IPC training manual, PSI Orissa, November 2004
        Training schedule:
Day one                                           Day two

9.00-9.20.a.m.                                    9.00-9.15.a.m
Welcome and introduction                          Recap

9.20-9.30.a.m.                                    9.15- 10.15.a.m.
Expectation and objectives                        How to use the kits for water quality testing for
                                                  turbidity, PH, residual chlorine and presence or
                                                  absence of coliform bacteria.
9.30-9.45.a.m.                                    10.15-11.15.p.m.
Why IPCs are required?                            Introduction to safewat
Roles and responsibilities of IPCs

9.45 –10.45.a.m.                                  11.15-1.15.p.m.
Pre-test
(Knowledge and skills)                            Practicum with feedback

10.45-11.00.a.m.                                  Practicum with feedback
Introduction to PSI, the project objectives and
strategy

11.00-11.15.a.m.                                  Practicum with feedback
Tea break
11.15-12.15. p.m.
What is diarrhea, causes of diarrhea and          Practicum with feedback
prevention of Diarrhea
12.15-1.45.p.m.                                   1.15-2.15.p.m.
Diarrhea management                               Lunch break
                                                  2.15-2.45.p.m.
                                                  Sharing follow-up plan and preparing action
                                                  plan

1.45 -2.45.p.m.                                   2.45-3.45.p.m.
Lunch break                                       Post-test
                                                  (Knowledge and skills)
2.45- 3.30.p.m.
Introduction to Interpersonal skills and the
Communication materials that would be used
during the field visits

3.30-4.15.p.m.                                    3.45-4.00.p.m.
Screening of film on IPC skills and discussion    Evaluation
on key points

4.15.- 4.30.p.m.                                  4.00-4.15.p.m.
Synthesis                                         Synthesis and Closure




                                                         IPC training manual, PSI Orissa, November 2004
                                              Day one
Session number:                1

Topic:                         Introductory Session

Duration:                      20 minutes


Objectives: At the end of the session, the participants will be able to:

                               1. Know each other a little more than their names.

Content:
                  Game- differentiator

Training Materials:

                  Flip chart, pens

Steps, duration and methods:

                       Steps                                 Duration           Method
1) Getting to know each other                                20 minutes     Game-
                                                                            Differentiator

                                          Learning Process

   Step-1                          Getting to know each other                                  20
                                                                                             minutes

1.1 Inform participants that we are going to conduct an exercise by which we all will get to know
    each other more than just our names.

1.2 Make pairs of participants using chits on which the names of colors or fruits are written. Ensure
    that the chits should always be in pairs and should be sufficient for all those in the training
    room. Facilitator should also join the introductory round.

1.3 Ask each pair to discuss amongst each other regarding the following:
            Favorite food
            One quality about self which you are proud of
            What they like to do during free time and
            What attracted them to work as IPC


                                                          IPC training manual, PSI Orissa, November 2004
1.4 Give the pairs 5 minutes to discuss amongst each other to find the details. After that ask each
pair to come forward and share the pair name and then introduce the partner. Once each pair is
through with their introduction, thank them for the active part they took.

Pre-training preparation:
-Read the scheme of the session thoroughly.
-Prepare a flipchart on which the questions are written




                                                          IPC training manual, PSI Orissa, November 2004
                                                 Day one

Session number:                  2

Topic:                    Asking expectations and sharing objectives of
                                                    IPCs training

Duration:                        10 minutes

Objectives:         At the end of the session, the participants will be able to:

                                        1. List their expectation from the training
                                        2. Explain the objectives of IPCs training

Content:
                    Objectives of training

Training Materials:

                    Flip chart, pens

Steps, duration and method:

                           Steps                                Duration                Method
1. List expectations from training and share the                10 minutes         Brainstorming,
objectives of IPCs training                                                        presentation

                                            Learning Process

   Step-1                   Expectations and objectives of IPCs training                      10 minutes

1.1 Inform participants that the active participation of all of them can only lead to the achievement
    of the training objectives.

1.2 Facilitator to let the participants brainstorm on their expectations from the training. Quickly list
    their responses on the flipchart.

1.3 Now share the objectives of the IPCs training from a pre-prepared flipchart. (Refer to
    appendix 2.1: Objectives of IPC training.) Facilitator to clarify those expectations, if any of
    the participants that cannot be achieved during the training and focus on those that will be
    achieved through their active participation.



                                                             IPC training manual, PSI Orissa, November 2004
1.4 Also list some working norms for the group that would be followed by all during the two days
    of training.

Pre-training preparation:
-Read the scheme of the session and the appendices thoroughly.
-Prepare a flipchart on which objectives of IPCs training are written.


Appendix 2.1:


OBJECTIVES OF IPC TRAINING

By the end of the training, the IPCs will be able to:
    Describe the objective and strategy of the project for which they will work.
    Explain their roles and responsibilities as envisaged in the project.
    Explain the causes of water borne diseases and how to reduce their occurrence.
    Explain the need for counselling the community members to use water disinfectant to treat
       water for safe use.
    Demonstrate how to test water quality.
    Understand and explain the product safewat and neotral and the dosing pattern.
    Use the IPC tools for promoting usage of safewat and neotral effectively.
    List the reporting and follow -up mechanisms.




                                                          IPC training manual, PSI Orissa, November 2004
                                                  Day one

Session number:                          3

Topic:                                   Pre-test

Duration:                                1 hour

Objectives: At the end of the session, the participants will be able to:
            1. Assess their knowledge regarding hygiene and its importance to control water borne
            diseases and the role of water disinfectant to control the same.
            2. Assess their skills on sharing information with the community members regarding
            water disinfectant, oral rehydration salts and its use.

Content:
                   Knowledge and skills assessment

Training Materials:

                   Flip chart, pens, questionnaire, and checklist for how to conduct VAT on water
                    disinfectant especially safewat.

Steps, duration and method:

                      Steps                                      Duration           Method
1. Knowledge assessment                                         30 minutes       Questionnaire
2. Skill assessment- How to conduct VAT on water                30 minutes       Demonstration
disinfectant especially safewat?

                                             Learning Process

   Step-1                                       Pre-test                                      30 minutes

1.1 Inform participants that they will be given a questionnaire, (refer to appendix 3.1 for details) which
needs to be filled according to whatever their present level of understanding is. The same
questionnaire will be administered to them at the end of the training in order to assess their post
training learning. The answer key is also given below. Facilitators can refer to the key to score the
answers.

1.2 Distribute the questionnaire and clarify that there are a number of responses given after each
question. Each answer has to be read carefully and marked right or wrong as the case may be. No
answers should be left unanswered as that would account for negative marking. (In order to clarify it


                                                              IPC training manual, PSI Orissa, November 2004
further an example can be shared on the board so that all the participants are clear) Also share that
this is pre-test so they need not worry too much as there could be answers which one may not be
sure of. During the training all the relevant inputs will be provided to you and during post-test you
all should try to score very well.

1.3 After the participants have completed filling it, collect the same back and do the scoring. By the
end of the day, the facilitators need to share with the participants the maximum and minimum
scores obtained and the areas that need to be improved.


   Step-2       Skill assessment- How to conduct VAT shows on usage of water              30 minutes
                                  disinfectant especially safewat

2.1 Facilitator to ask each participant to address the group of participants in the training room on
safewat, the water disinfectant. Using the relevant checklists (Refer to appendix 3.1 for details)
assess each participant‟s present level of skills with regard to how to conduct VAT on safewat. Share
that this is pre-test. So they need not worry about what will they say and how they will facilitate a
Visibility Accessibility Touchability (VAT) on water disinfectant. Share that during the training;
relevant inputs will be given to them so that they are able to develop the necessary skills. At the end
of the training, there will be a post- test to assess what they have gained during training.

2.2 Facilitator to ensure that the pre and post test assessment form for all the participants is
tabulated and kept for records. The details of what percentage had good skills and what percentage
had poor skills should be shared with the participants by the end of the session. Highlight that by
the end of the training all of them will be able to improve their skills on how to conduct VAT on
water disinfectant. Hence they need to pay good attention when the information will be shared
during the specific sessions for the same.

Pre-training preparation:
-Read the scheme of the session thoroughly.
-Prepare enough photocopies of the pre-test questionnaire for all the participants. Ensure that the
answer key part is not photocopied alongwith the pre/post- test form.




                                                           IPC training manual, PSI Orissa, November 2004
Appendix 3.1


KNOWLEDGE ASSESSMENT QUESTIONNAIRE

(Causes and prevention of Diarrhea, usage of water disinfectant especially safewat, usage of
                                            ORS)

Name of IPC :________________

Name of person conducting training/follow-up: _____________

Date of training/follow-up: __________

Share the questionnaire with the IPC and inform him that this questionnaire will be used during
training and follow-up. Inform him that this is to assess the retention level of knowledge that he
gained during the training and has maintained after training. Ask him to tick all correct
response/s for each question in 30 minutes.

1) Diarrhea means the following:
   a) Occurrence of loose watery stools once
   b) Occurrence of loose watery stools more than twice
   c) Occurrence of loose watery stools more than three or more times

2) During diarrhea the body gets depleted of the following:
   a) Only nutrients
   b) Only salts
   c) Only water
   d) Nutrients, salts and water and this leads to dehydration

3) The most common reasons of diarrheal diseases are:
     a) Eating food that is dirty or stale
     b) Drinking dirty water
     c) Eating with dirty hands
     d) Using dirty vessels, utensils and equipments
     e) Dirt and garbage in around your house

4) Water gets contaminated in the following ways:
   a) Human faeces gets into open water sources or gets mixed into wells that are not deep enough.
   b) Pipes that have holes in it due to which dirt gets into the pipes and makes the water
   contaminated
   c. After defecation, hands that have not been washed properly gets in contact with water
   d. Touching utensils with dirty hands and pouring water into such a container

5) Hand washing is extremely important during the following instances:


                                                          IPC training manual, PSI Orissa, November 2004
           a.   Before cooking food
           b.   Before eating food
           c.   Before feeding children
           d.   After touching animals
           e.   After defecation
           f.   After cleaning the child‟s defecation
           g.   After touching dirty objects

6) Most cases of diarrhea in children can be prevented by:
           a. Taking appropriate antibiotics
           b. Stopping all food and water
           c. Stopping breastfeeding
           d. Using clean water for drinking, washing hands after toilet and before eating food
           e. None of the above
           f. All of the above

7) Diarrhea with some dehydration in children is managed by:
    a) Appropriate antibiotics
    b) Stopping all food and water and giving antibiotics
    c) Stopping all food and water, giving antibiotics and ORS.
    d) Treating with ORS, providing home care and advising mother when to return immediately
    e) All of the above
    f) None of the above

8)The home available fluids which can be given to a child suffering from diarrhea are as follows:
   a) Milk
   b) Yoghurt
   c) Fruit juices (sweetened)
   d) Lemon drink
   e) Soft drinks
   f) Dal and vegetable soup
   g) Coffee
   h) Fruit juice (Unsweetened)
   i) Plain clean water

9) Water is safe to drink if it is:
                a) Boiled
                b) Treated with water disinfectant
                c) From government water supply system
                d) All of the above

10) Safewat is a water disinfectant that contains:
a) Chlorine in recommended dosage.
b) Potassium permanganate in recommended dosage
c) Bleaching solution in recommended dosage




                                                          IPC training manual, PSI Orissa, November 2004
11) Safewat is to be used in the following ways:
    a)   One drop for 10 litres
    b) One drop per litre of water
    c)   Two drops per litre of water
    d) 10 drops per litre of water


12) The shelf life of safewat is as follows:
    a)   Five months from the date of manufacture
    b) Six months from the date of manufacture
    c)   Seven months from the date of manufacture
    d) Twelve months from the date of manufacture

13) Some of the precautions to using safewat are as follows:
    a)  Always use it in recommended dosage
    b) Keep it in a cool and dry place
    c)  Do not keep safewat under direct sunlight
    d) Keep safewat away from reach of children

14) Oral Rehydration Therapy (ORT) means the following:
    a.   Giving water with lemon and salt
    b.   Giving only water with medicine
    c.   Giving home available fluids such as milk, yoghurt drink, lemon drink, dal, vegetable soup,
                              fruit juice (unsweetened) plain clean water and ORS


15) Home available fluid that are harmful during diarrhea are:
    a. Soft drink (coca cola, pepsi, limca etc), fruit juices (sweetened) coffee
    b. Milk, yoghurt drink, lemon drink
    c. Vegetable soup, dal, fruit juices (unsweetened) ,plain clean water

                                                   END




                                                            IPC training manual, PSI Orissa, November 2004
    SCORING INSTRUCTIONS TO THE TRAINER /PERSON WHO CONDUCTS
                      TRAINING/FOLLOW -UPs

(Causes and prevention of Diarrhea, usage of water disinfectant especially safewat, usage of
                                            ORS)

Evaluate every right answer with +1 and every wrong answer with –1, the maximum score
being 37 for 15 questions. Use the correct answers given below to score each question.
Complete the following scoring table to score each question and to derive the total score and
percentage. A trainee has retained the Required Level of Knowledge (RLK) if he/she scores
80% or above.

TO BE FILLED BY THE TRAINER AND THE PERSON WHO CONDUCTS FOLLOW-UPs

Qn.      1     2       3     4 5 6   7    8 9      10   11    12   13     14     15      Total    %
No.
Score


RLK: YES/NO


Correct Answers for scoring

        1. c
        2. d
        3. a, b, c, d, e
        4. a, b, c, d
        5. a, b, c, d, e, f, g
        6. d
        7. d
        8. a, b, d, f, h, i
        9. A, b
        10.a
        11.b
        12.d
        13. a, b, c, d
        14. c
        15.a




                                                         IPC training manual, PSI Orissa, November 2004
        Skills Checklist for how to conduct Visibility Accessibility Touchability (VAT)
                               on Safewat (the water disinfectant)

Name of trainee:     ________________ Dates of Training _________________

Pre –test score (%): ------------         Post –test score (%): -----------

 No                                 TASK/ ACTIVITY                                  Observations

 1        IPC has put up a stall at a place where a small group can gather
 2        IPC makes an enthusiastic and clear audio announcement regarding
          the message to pull the crowd together
 3        Once the crowd starts gathering greets them and introduces self
 4        Makes eye contact, smiles and appears relaxed and confident
 5        Introduces the topic of discussion, shares the following statistics on
          Orissa.
          At any given point of time 3 out of 10 children are suffering from
          diarrhea. (Source: NFHS-2)
          Highlight that one of the major causes of diarrhea is consuming
          contaminated water. Also shares that by decontaminating water we
          can change the situation
 6        Tone of voice is maintained
 7        Shows samples of water and does testing of water and shares results
          to establish the fact that your eyes may see the water as clean and fit
          to drink but it may not be clean and fit to drink
 8        Asks following types of questions: both open ended, close ended
          and probing types to the participants to assess their understanding
 9        Uses the flipbook to draw the attention of the participants to the
          topic of discussion. Discusses the message given in the flipbook by
          drawing the attention of the participants
 10       Encourages the individuals to talk
 11       Listens actively, ie; pays attention to both verbal as well as non-
          verbal communication
 12       Remains non-judgemental and understands the clients perspective
          and the reason behind why the client thought so
 13       Provides and discusses the correct information on water
          disinfectant- i.e; safewat also observes the emotions of the
          participants and reflects back to him/her
 14       Appropriately uses visual aids
 15       Highlights that contaminated water as shown above in the testing
          sample is one of the main causes of diarrhea and it can be controlled
          by the usage of water disinfectant such as safewat
 16       Shares that safewat is a water disinfectant and contains -chlorine in
          recommended dosage


                                                            IPC training manual, PSI Orissa, November 2004
17   Shows a bottle of safewat and clarifies that one bottle will cost Rs.
     10/- and will be enough to disinfect 1000 litres of water. Lets the
     participants touch and see the bottle.
18   Clarifies that one needs to use only - 1 drop per litre of water

19   Shares that any vessel can be used for this purpose

20   Clearly specifies the steps of purifying water using disinfectant-
     (Safewat):
     1. Clean the jar/ container in which you will fill the water.
     2. From a clean source fill the water in the jar/container
     3. Open the Safewat bottle carefully.
         Add 1 drop of liquid from Safewat bottle for every 1 litre of
         water
     4. Shake the water jar/ container well, in which you have added
         safewat.
     5. Use water after 30 minutes.
     6. Use a ladle with long stem to take the water from the jar
21   Shares that safewat will be available with retailers
22   Highlights that the shelf life of safewat is -12 months from date of
     manufacturing
23   Shares that you can use the safewat disinfected water for the
     following-
                          Drinking
                          For making ice
                          For washing hands
                          To wash vegetables and fruits
                          For preparing ORS
                          For cleaning teeth.

24   Highlights the following precautions with the community-
     -Always use safewat in water in recommended dosage
     -Keep safewat in a cool and dry place
      -Do not keep safewat under direct sunlight
     -Keep safewat away from reach of children
25   Shares that by using safewat, there will be some difference in taste
     and smell of water but this is a positive indication that water is pure
     for drinking
26   Also shares that other ways of disinfecting water are by either using
     a filter or by boiling water for 20 minutes.
27   Now shares a packet of Neotral, (Oral Rehydration Salts) and
     clarifies that it is to be used for controlling dehydration in the body
     during diarrhea. Shares a sample of neotral and explains the price of
     a packet and where it will be available and how to use it.
28   Gives away flyers and product leaflet to the participants
29   Thanks the participants and asks who would be interested to buy the
     product safewat or Neotral, if yes again clarifies where it would be


                                                       IPC training manual, PSI Orissa, November 2004
           available.
 30        Participants appears relaxed and they are clear on the next step
           % SCORED
           PTS – YES/NO
CALCULATION OF SCORES AND PERCENTAGES
Each correct task in the checklist receives 1 point. The possible scores are 1 or 0. For the question, which has sub-
bullets, all sub-bullets need to be covered to score 1 point for that question. Total eligible scores are 30. For example if a
trainee has performed satisfactorily on 24 tasks, she/he will score 24 points. To calculate the percentage, the formula
will be (24/30)*100 = >80%. A trainee performed to standards (PTS) if she/he scores 80% or above.




                                                                        IPC training manual, PSI Orissa, November 2004
                                               Day one
Session number:                        4


Topic:                         Introduction to PSI, the water project objectives and strategy

Duration:                      15 minutes


Objectives: At the end of the session, the participants will be able to:
             1. Explain briefly about PSI as an organization.
             2. Explain the objectives and strategy of the water project for which they will be
                                                          working.
Content:
              Introduction to PSI
              Water project objectives and strategy

Training Materials:

                   Flip chart, pens

Steps, duration and method:

Steps                                                Duration               Method
1. Introduction to PSI, water project objectives and 15 minutes             Presentation,
strategy                                                                    question-answer


                                           Learning Process

Step-1       Introduction to PSI                                                        15 minutes

1.1 Facilitators to make a brief presentation on the following.


                  Key message:

         PSI‟s mission is to empower low-income people to lead healthy lives through the
         informed use of health products and services, made accessible and affordable to
         them.

         PSI social markets the following products:


                                                          IPC training manual, PSI Orissa, November 2004
        Masti and deluxe Nirodh condoms
        Pearl and Mala-D low dose contraceptive pills for women
        Neotral and Neotral orange (WHO recommended formulation) oral rehydration
         salts
        Safewat water purification solution
        Vitalet Multivitamins and vitalet –Preg Iron Folic Acid tablets
        Newborn clean delivery kits (for home deliveries)
        Depo- provera injectable contraceptives
        STI kits
        Emergency contraception




1.2 Now share with the participants the following details of the water project. Give participants an
    opportunity to ask questions, if any. Clarify the doubts of participants. Now share the different
    activities under this project. Also share handouts on it with the participants.


                 Key message:
Details of water project:

Goal: The goal of this project is to improve the quality of water thereby contribute to
decrease the occurrence of water borne diseases in the project area especially diarrhea.

Objectives:




group

Area of Operation:
    Puri
    Cuttack
    Khurda
    Jagatsinghpur
    Kendrapara
Area of operation:
Rural (Pradeep,Kindly add the total number of villages)--------------
Urban slum


                                                           IPC training manual, PSI Orissa, November 2004
Program Target:
Parents of children under 5 years of age and the influencers who can contribute to bring
about desired behaviour change in the households

Activities:
                                        (priority focus should be on parents of children under 5 and
influencers)



Advocacy
One to one contact with school teachers and sarpanch/influencers/panchayat members


Pre-training preparation:
-Read the scheme of the session and the appendices thoroughly.
-Prepare a flipchart on which the program objectives, goals and strategy are written.




                                                             IPC training manual, PSI Orissa, November 2004
                                        Day one

Session number:                   5

Topic:                          Why IPCs are required
                                Roles and responsibilities of project supervisor and IPCs

Duration:                       15 minutes

Objectives: At the end of the session, the participants will be able to:
                                     1. Explain where they fit into the project
                                     2. Explain the specific responsibilities as envisaged for them
                                          in the project
Content:
              Why IPCs are required
              Roles and responsibilities of project supervisor and IPCs

Training Materials:

                   Flip chart, pens, handouts

Steps, duration and method:

  Steps                                                      Duration           Method
1. Introduction to why IPCs are required                     5 minutes     Interactive
                                                                           presentation,
                                                                           question-answer
2. Specific responsibilities of IPCs and project          10 minutes       Interactive
supervisors                                                                presentation


                                          Learning Process

   Step-1                     Introduction to why IPCs are required                      5 minutes

1.1 Facilitator to ask participants regarding their comprehension of why they were recruited as IPCs
    in the project. Listen to their responses and then share the rationale for having IPCs in the
    community.

1.2 Clarify that as shared earlier, in order to improve the usage of water disinfectant they need to
    work towards generating awareness of the community.




                                                         IPC training manual, PSI Orissa, November 2004
1.3 Also share that in order to achieve this the IPCs will be required to conduct VAT, and convey
    key messages on use of water disinfectant to all those who participate in VAT. Since they will be
    in direct day-to-day contact with the community, they can act as ambassadors of change.

      Step-2           Specific responsibilities of IPCs and project supervisor             10 minutes

2.1     Now inform the participants that each of them will be expected to carry out a specific set of
        responsibilities in their role as project supervisor and IPCs. Share the specific responsibilities
        that will be expected from each of them. (Refer to appendix 5.1 for details)

2.2     Ask participants to clarify any doubts they may have. Share handouts on it.

Pre-training preparation:
-Read the scheme of the session and the appendices thoroughly.
-Prepare a flipchart on which the roles and responsibilities of project supervisor and the IPCs are
written.
-Photocopy handouts for all participants.




                                                             IPC training manual, PSI Orissa, November 2004
Appendix 5.1:

Roles and responsibilities of IPCs and project supervisors:

IPCs
    1. Each IPC will attend the training of IPCs conducted by PSI and clarify the role they have to
       play in the community.

    2. Each IPC will primarily be responsible to conduct agreed number of VATs in the
       community and utilize IPC tools alongwith flyers and samples of SAFEWAT to
       communicate key messages to the community members.

    3. They will also be responsible to use inter-personal communication materials in the most
       effective manner during the advocacy visits and during VAT to communicate the key
       messages.

    4. Each IPC will be responsible to fill the relevant form during the VAT

    5. They will also be expected to conduct advocacy with the schoolteachers and sarpanch and
       other panchayat members, and other key influencers to promote the idea and make the
       community aware of the interventions.

    6. IPCs will work under a supervisor who will provide on the ground support to solve
       problems


    7. They will be responsible for organizing VATs for promoting and generating demand of
       water disinfectants.

    8. To document and report to the project supervisor on a regular basis.

    9. To participate in meetings and training as and when required.

    10. Meet with Project Supervisor weekly and submit reports and share experiences and learning.

Project supervisor
1.Participate actively during the training of IPCs.

2.Follow-up the IPCs on a regular basis.

3.Provide mentoring support to the IPCs on a regular basis

4.Assist the IPCs during VAT and during advocacy meetings to effectively
  use IPC materials.



                                                          IPC training manual, PSI Orissa, November 2004
5. To plan and co-ordinate the activities of IPCs within their area of operations.

6. Plan, fix schedules and help IPCs in organizing VAT shows and in organizing advocacy meetings.

7. Accompany PSI staff during visits and research activities.

8. To document reports received from IPCs and prepare progress report stating clearly the
achievements and the constraints faced during the implementation of the activities.




                                                           IPC training manual, PSI Orissa, November 2004
                                               Day one

Session number            :      6

Topic                     : What is diarrhea , causes of diarrhea and prevention of Diarrhea


Duration                 : 1 hour

Objectives: At the end of the session, the participants will be able to:

            1. Explain what is diarrhea.
            2. Explain the meaning of dehydration.
            3. Explain the causes of diarrhea and how it spreads.
            4. Explain how it can be prevented.

Content:
                     What is diarrhea
                     What is dehydration
                     How diarrhea spreads- the causes
                     How to prevent diarrhea

Training Materials:

                     Flip chart, pens, plant one which has been watered everyday and other one,
                      which has not been watered for few days.

Steps, duration and methods:

Steps                                                         Duration       Method
   1.What is diarrhea and dehydration                         15 minutes     Interactive
                                                                             discussion,
                                                                             demonstration
    2. How does diarrhea spread- the causes                   15 minutes     Story telling
    3. How it can be prevented                                20 minutes     Brainstorming
                                                                             and     interactive
                                                                             presentation
    4. Evaluation                                             10 minutes     Question- answer



                                           Learning Process



                                                           IPC training manual, PSI Orissa, November 2004
Step-1        What is diarrhea and dehydration                                           15 minutes



1.2   Ask participants for what do they understand by diarrhea. Listen to the responses and
      then share the following:

      Diarrhea is defined by all as “more than normal” i.e more than three times in a day and
      “thinner than normal” (liquid form) stools.


                        Key Message 1:

      What is diarrhea?
      Diarrhea is passing loose stools ( liquid form) more than three times in a day.



1.1 Also ask what happens to the body during diarrhea? Listen to responses. Share that
   due to diarrhea there is loss of fluids, nutrients and salts from the body. And in case we do not
   immediately replace the vital elements, the body starts to shrink and gets dehydrated and mal
   nutrition happens.

1.2 Ask what do they understand by dehydration. Listen to their responses and show the
    participants two plants one which has not been watered for few days and the other one, which is
    fresh and green as adequate and timely water was being given. Ask the participants what
    differences can they see between the two. Listen to the responses and share that just like the
    plant looked dry and lifeless due to lack of water, the human body also during diarrhea goes
    through the same situation and becomes dehydrated and if it is not controlled timely,
    dehydration due to diarrhea can also become one of the causes of death.


       Message 2:

      What happens to the body during diarrhea?

      Body gets depleted of vital fluids, salts (i.e gets dehydrated) and nutrients hence mal
      nourished.

      What is dehydration?
      Loss of fluids, salts from the body which when not replaced the body shrinks and gets
      dehydrated.


1.3 Now ask the participants what can be the consequences of diarrhea. Listen to their
    responses then share the following information.


                                                           IPC training manual, PSI Orissa, November 2004
           Message 3:

             Consequences of diarrhea:

             1. The child’s health - for example, child gets malnourished, dehydrated and
             hence the immunity power of the body decreases and becomes vulnerable.

             2. The child’s development -physically the child will be weak which will have an
             effect on the mental development and a child who is always sick will have a poor
             social life.

             3. The socio- economic effect- there will be extra expenditure on the parents as
             repeated consultation with doctor, the burden of care will be more and the
             likelihood of siblings getting infected is high too.



1.4 Now ask participants for their comprehension of the above messages. Listen to their responses.
Add, clarify wherever required.



Step-2           Causes for diarrhea                                                      15 minutes


2.1 Share that during baseline survey conducted in five coastal districts of Orissa, all parents of child
    under the age of 5 years were asked the linkage between water quality and likelihood of getting
    diarrhea and treatment given in case of diarrhea.

          Among the stated causes of diarrhea, contaminated food is mentioned by 77.3% followed by
          contaminated water 59.3% and flies 24.5%.

  Highlight that the above statistics states that there is a pressing need to bring awareness in the
  community regarding the above causes of diarrhea and hence the need to take appropriate
  measures to control and stop its occurrence.

2.2 Now share that we will together identify the reasons due to which diarrhea happens.

       Ask the participants the following questions:
       Have they ever heard that at a particular point of time many people in their community
        suffer from diarrhea?
       Have they observed that many members of a family simultaneously suffer from diarrhea?
       What in their opinion is responsible for several people living together in a family or in a
        community suffering simultaneously with diarrhea?



                                                            IPC training manual, PSI Orissa, November 2004
Write all the responses from the group on the flipchart.

     Now share the following story with the participants. Facilitator to ensure that all the participants
     are following the story. Hence read it slowly.



Story of the community in which you will work:
Rani is the resident of an urban slum. The common source of water is the public tap where all the
nearby residents come to take water. The usual practice is to fill the water in cans and buckets. The
pipeline is usually not checked for months together by the municipality. There is a leak in the pipe
and at the point of leak, cowdung and other animal faeces is lying, which is slowly getting mixed
with the water. However as long as the community is getting water people are not bothered to get
the leak repaired. Rani also as usual goes with her neighbour Krishna to fetch water from the pipe.
Rani‟s son Shyam comes home from play and takes a glass and dips in the bucket and takes water
to drink. After drinking this water Shyam runs back to play. However after sometime he comes
back home sharing that he has acute pain in the tummy and that he has passed loose stools. Rani
also suffers from diarrhea. To her surprise Rani finds that Krishna‟s family also gets affected by
diarrhea. Shyam relieves himself behind his house. Flies sit on his stools and the germs, which
cause diarrhea, stick to their legs. Some of these flies enter a sweet shop and sit on the sweets.
People who buy and eat sweets from this shop also get diarrhea.



2.3 Now ask the group the following questions one at a time. Listen to answers and clarify before
moving to the next question.

1.   What was the reason due to which both Rani and Krishna‟s family gets diarrhea?
2.   Could anyone control the situation and prevent diarrhea? If yes, how?
3.   How does diarrhea spread in the community?
4.   Could the spread of diarrhea in the community be controlled. If yes, how?

2.4 Highlight that diarrhea spreads through consumption of contaminated water and food. Germs
are passed by the thousands and carried from contaminated water and food to the body of the
person. It could happen through dirty hands, fingernails, dirty utensils, consuming contaminated
water and food etc.



 Message 3:

Causes of diarrhea:

Drinking contaminated water: Pipe water is not always safe. Drinking water, if it is left open
gets contaminated. Also the drinking water should be handled properly by using a clean ladle
with long stem.



                                                            IPC training manual, PSI Orissa, November 2004
 Consuming contaminated food: flies sit on dirt and when they sit on the open food, the food
 also gets contaminated.
 Using dirty hands: if we do not wash our hands prior to cooking, feeding children or eating
 food and after defecation, the food we handle can get contaminated.
 Dirty environment: unclean toilet as germs are present in stools and if toilet is not kept clean
 flies will sit on the stool and spread the germs, lack of proper disposal of garbage and water
 leads to filthy environment around the house.

 2.5 Now share that all the above causes of diarrhea can be prevented through spreading awareness
     about the need to prevent such situations to occur. IPCs have a major role to play in doing this.

 2.6 Ask participants questions on the above. Listen to responses. Add, clarify as required.

  Step-3      Prevention of diarrhea                                                     20 minutes



3.1 Now ask participants what can they do as IPCs in the community to prevent diarrhea. Listen to
    their responses and then share that you can provide useful and practical messages on healthy
    behavior designed to prevent diarrhea in the future.

3.2 Share that you can do this by sharing information on how to prevent diarrhea.



  Message 3:
 Prevention of diarrhea:

    1. Handwashing- always wash hands with soap and clean water before cooking, before
       feeding children, before eating food, after defecation, after touching animals or dirty
       objects.
    2. Clean drinking water-ensure that water is taken from a clean source and is treated
       before consumption. The treatment of water could be either by using chlorine in
       recommended dosage, or by using a water filter or by boiling the water before
       consumption.
    3. Personal hygiene-keep yourself clean, take bath everyday, wear clean clothes.
    4. Clean environment- ensure proper disposal of faeces through usage of latrines. Do
       not defecate out in the open. Proper disposal of garbage and waste water should also
       be ensured.
    5. Cooking and storage of food- proper care to be given while you deal with food at
       each stage one needs to ensure that the food being handled in a clean manner. The
       storage of food should also be properly taken care of. It should not get contaminated
       by contact with rats, lizards, cockroaches, dust, flies etc.
    6. Exclusive breastfeeding upto 5-6 months- clean water (i.e; either boiled, filtered or
       chlorinated) should be given to the child after this age. Bottle-feeding should be
       avoided.



                                                           IPC training manual, PSI Orissa, November 2004
Step-4       Evaluation                                                                    10
                                                                                           minutes


4.1Now ask participants the following questions:
       What is diarrhea? What happens to our body when we suffer from diarrhea?
       Causes of diarrhea?
       How can we prevent diarrhea?
Listen to responses, clarify the answers as required.


Pre-training preparation:
-Go through the sessions properly in advance
-Prepare flipcharts for all the relevant points that needs to be shared during training.
- Get all the training materials required.




                                                            IPC training manual, PSI Orissa, November 2004
                                              Day one

Session number:                 7

Topic:                          Diarrhea Management

Duration:                       1 hour and 30 minutes

Objectives:      At the end of the session, the participants will be able to:
                         1. Explain how to manage a child with diarrhea
                         2. Explain the meaning of Oral Rehydration Therapy (ORT)
                         3. Demonstrate the preparation of ORS and specify the amount of ORS to
                            be given to children.

Content:
Diarrhea management with ORT/ ORS
How to prepare ORS

Training Materials:

        Flipchart, marker pens, samples of Neotral (ORS), one litre jug, water and spoon

Steps, duration and methods:

 Steps                                                       Duration       Method
 1. Diarrhea management- What is ORT?                        20 minutes     Interactive
                                                                            presentation

 2. Demonstrate the preparation of ORS                       30 minutes     Demonstration,
                                                                            Interactive
                                                                            discussion

 3. Practicum                                                30 minutes     Role-play
 4. Evaluation                                               10 minutes     Question-answer

                                          Learning Process

Step-1        Diarrhea management- What is Oral Rehydration Therapy (ORT)               20 minutes

1.1 Facilitator to ask the participants to share their experiences of what they have
    seen in the community in cases of diarrhea. What do people generally do when a child gets
    diarrhea? Listen to their responses.



                                                          IPC training manual, PSI Orissa, November 2004
Now share the findings during baseline survey in the five coastal districts of Orissa:

   Contrary to recommendations, children under 5 who had diarrhea every 3rd child was given
  less to drink during a diarrheal episode (significantly more in urban than in rural).
  Though use of antibiotics and anti-diarrheal drugs is not recommended, 3 out of 4 children
  were given pills and syrups as a treatment while only 1 out of 6 children were given ORS.


1.2 Now share that the basic principle to manage diarrhea is to replace the loss of fluids, and
    salt and to maintain adequate diet. Loose –motions may take its own time and will stop in due
    course. Oral Rehydration Therapy is the best way to manage diarrhea and during the
    initial stages of diarrhea, if ORT is done, there is no need to give anti-biotics or pill or
    syrups. Also share that most cases of diarrhea can be managed at home through Oral
    Rehydration Therapy (ORT).

1.3. Now clarify the meaning of Oral Rehydration Therapy. Share a packet of Oral Rehydration Salt
    (ORS) with the group. Share that ORS is used to replenish the vital salts that are lost from the
    body during diarrhea. However alongwith ORS home available fluids such as milk, yoghurt drink
    (Dahi ki lassi), lemon drink, dal, vegetable soup, fruit juice (unsweetened), plain clean water
    should also be given. This process of administering both ORS and the home available fluids is
    called the ORT.

          Key message:

What is Oral Rehydration Therapy (ORT)?

Administration of home available fluids such as milk, yoghurt drink (dahi ki lassi), lemon
drink, dal, vegetable soup, fruit juice (unsweetened), plain clean water.

     and

Oral Rehydration Salts (ORS)



1.4 Now share the following information with the participants to sensitize them to the severity of
    diarrhea. Share that during the baseline survey done in the five coastal districts of Orissa, the
    following information was found. Share the information as given in the table below:

     Situation assessed         Present situation in five       Ideal situation
                                coastal districts of Orissa
     How many used pills/       3 out of 4 children             None
     syrup during diarrhea
     How many were given        2 out of 5 children             0
     nothing to eat during
     diarrhea


                                                          IPC training manual, PSI Orissa, November 2004
     How many used ORS          1 out of 6 children             6
     during diarrhea
     How many persons           3 out of 5 children             5
     were taking ORT


1.5 Share that the above statistics states that there is a gap between the ideal situation and the
    present situation. The IPCs can contribute to improve this situation through VAT and advocacy
    by sharing the correct information regarding diarrhea management and usage of water
    disinfectant.

1.6 Now share that diarrhea can be managed properly if dehydration can be controlled. The process
    of replenishment of fluid in the body through ORT (i.e; home available fluids and ORS) is called
    rehydration. The deaths due to diarrhea can be prevented if managed promptly and correctly.
    Stress that you can contribute to improving the situation by sharing information on correct
    assessment and proper management of diarrhea. Clarify that you will be working in this situation
    where awareness regarding how to manage diarrhea is very low. During VAT you will get a very
    good chance to meet with the parents of children under 5 years. By sharing correct information
    you can play a vital role in bringing about the desired awareness in the community.

1.7 Remind the participants that diarrhea is passage of watery stools frequently. Mothers generally
    know that their children are suffering from diarrhea and are crucial to taking decisions to
    manage it. Clarify that if the diarrhea is of more than 2 weeks duration, the child has persistent
    diarrhea. This child needs special advice and care otherwise the disease can produce
    malnutrition. This child needs referral to a pediatrician or hospital. Also share that if the child
    has blood in the stool, it indicates dysentery and the child needs to be referred to the district
    hospital.

1.8 Now highlight that it is important to understand that only cases who have some dehydration
    during diarrhea can be treated with ORS. Also highlight that it is de-hydration during that needs
    to be treated and is a cause of concern. Hence there is the need to emphasize on ORT/ORS.




                                                                                    contd----------


                                                          IPC training manual, PSI Orissa, November 2004
        Key message:
             Rehydration at home
                                                1.   ORS is given
                                                2.   Home available fluids should be continued
                                                3.   Refer cases if the case does not improve
                                                      within 24 hours or the following situations
 ALWAYS ENSURE                                       occur-
                                                      Every 1 or 2 hour loose stools are
                                                         passed
                                                      Unable to take fluid or breastfeed or
                                                         take semi-solid or vomits
                                                      Less urination
                                                      Fever
                                                      Excessive thirst
                                                      Blood in stool (dysentry)
                                                      Roughness of face and tongue
                                                      Repeated vomiting




1.9 Now ask how would you look for signs of dehydration. Remind the participants what we saw in
    the two types of plants. Highlight that one plant was dehydrated and looked almost dead, while
    the other one looked fresh and green. Share that it is important that the mother of the child is
    able to look and feel for signs of dehydration. In order to identify signs of dehydration one can
    do the following:

               Key message
Signs of dehydration:

    Look at the child’s general condition. Is the child “lethargic” or “unconscious”?
     Is the child restless and irritable?
    Assess the child’s ability to drink.
     If the child does not take any water at all or vomits it out completely or is not able to
     keep any water down, the child is not able to drink. This is a general danger
     sign.
     If the child reaches out for the cup or the glass or if the child opens his/her mouth
     when water is offered or if the child begins to cry when the water is taken away,
     it means that the child is drinking eagerly.


                                                           IPC training manual, PSI Orissa, November 2004
    One needs to check for sunken eyes. Look for sunken eyes: eyes are sunken or not
     sunken. Determine the normal appearance of the child‟s eyes by asking the mother.
     Ask the mother if she thinks her child‟s eyes look normal or unusual. Her opinion
     helps to confirm that the child‟s eyes are sunken. The eyes of a child who is
     dehydrated may look sunken.




Step-2       Demonstration of how to prepare ORS                                       30 minutes


2.1 Now share that all those who suffer from diarrhea should be given ORS from the time they
    detect they have diarrhea. This is the best way to manage diarrhea. Highlight the ability of
    ORS to save the child – among 100 dehydrated children who would have died from
    diarrhea 95 could be saved by administering ORS timely. Now ask where can you obtain
    ORS. Listen to responses and share the following:

   ORS packets are available free of cost from government health facilities. ORS packets (Neotral)
   can be purchased from retail outlets in subsidized prices. A one litre plain pack of neotral costs
   Rs. 5.00/- and orange flavored sachets consisting of 5 sachet (each meant for one glass of water)
   will cost Rs. 7.50/- These can also be purchased from chemist shops. Also share that if anyone
   purchases an ORS packet from the market, it is also important to check that the packet
   conforms to WHO formula or composition.

   Major brands of ORS, WHO composition in the market: Electrobion, Woodwards ORS,
   Punnarjal, Relyte and Peditral, Neotral also conforms to WHO composition.

2.2 Share with the participants how to prepare ORS. Familiarize the participants to the checklist for
    demonstration of ORS preparation. Share a copy of the checklist with all the participants. (Refer
    to appendix 7.1 for details) Use a packet of ORS and demonstrate how to prepare.

   1. Wash hands thoroughly with soap and water
   2. Pour all the ORS powder from a 1-litre packet into a clean container
   3. Measure 1 litre of clean/ safewat cleaned/boiled drinking water and pour it into the
       container in which you poured ORS
   4. Stir using a clean spoon until all the powder in the container has been mixed with water
      and none is remaining at the bottom of the container


               Key message:
                    How to prepare ORS-

   1. Wash hands thoroughly with soap and water
   2. Pour all the ORS powder from a 1-litre packet into a clean container
   3. Measure 1 litre of clean/ safewat cleaned/boiled drinking water and pour it into the
      container in which you poured ORS


                                                         IPC training manual, PSI Orissa, November 2004
   4. Stir using a clean spoon until all the powder in the container has been mixed with
      water and none is remaining at the bottom of the container


2.3 Now share the following points, which should be remembered while administering ORS.
     Prepare fresh ORS each day
     Ensure that small children are given ORS with the help of spoon and cup rather than bottle
     Ask the mother to give 1 teaspoon of the solution to the child. This should be repeated
      every 1-2 minutes (An older child can drink it in sips should be given one sip every 1-2
      minutes)
     If the child vomits the ORS tell the mother to wait for 10 minutes and
      resume giving the ORS but this time more slowly than before.
          Breastfed babies should continue to be given breast milk in between ORS.
          Any ORS which is left over after 24 hours should be thrown away.
          After about 4 hours of giving ORS, reassess the child for dehydration. If the child is
           better,tell the mother to give fluids that are available at home the same way she gave
           ORS and give ½- 1 cup ORS after every motion. Begin feeding the child even if
           dehydration persists, continue ORS. If the child’s condition deteriorates, immediately
           take the child to the hospital. On the way to the hospital, the mother should continue
           to give ORS to the child.

2.4 Now share the following additional information regarding ORS that needs to be shared with the
    community-
        Keep ORS covered, if not using it
        Till diarrhea stops keep giving additional fluids, it can take 3-5 days for it to stop
        Without consulting a doctor, please do not provide the person suffering from diarrhea
       any medicine, only give ORS,
        Also remember that ORS is used only for replenishing vital fluids and nutrients in the
       body.
        Do not mix ORS in milk, Sharbat, soft drink etc,
        Keep giving ORS till diarrhea stops.

2.5 Clarify that the mother can continue to give home available fluids apart from ORS. The useful
and harmful fluids as given below should however be kept in mind. Keep giving the child extra fluid
at regular intervals till he/ she can take. As soon as stools are passed fluid should be replaced in the
body through ORS and other home available fluids as given below. Share that certain home available
fluids are harmful during diarrhea and hence extra care should be given on avoiding them.

Home available fluids
          Useful/ can give                        Harmful/should’nt give
  1. Milk                                       1. Soft drinks (Coca Cola, Pepsi,
  2. Yoghurt drink (Dahi ki lassi)                 Limca etc.)
  3. Lemon drink                                2. Fruit juices (sweetened)
  4. Rice, Kanji, Mand                          3. Coffee
  5. Dal
  6. Vegetable soup



                                                           IPC training manual, PSI Orissa, November 2004
    7. Fruit juice (unsweetened)
    8. Plain clean water

2.5 Apart from fluid intake the child should also be fed as much as the child would take. The
     semi-solid food such as mashed potato, and kichdi can be given. If the child is reluctant to eat
    then feed small quantities more often than before. As soon as the child recovers the child‟s
    appetite would return and the mother should feed extra foods to make up for the excessive
    losses during the disease.

       Advise the mother to consult a doctor in case she finds that her child is :
      -Not able to drink or breast feed, becomes sicker
      -Has blood in the stool; or drinks poorly.


Step- 3      Evaluation                                                                    10
                                                                                           minutes


3.1 Now ask participants the following questions:
     What is ORS? How much does it cost?
     What is it used for? Where will it be available?
     How would you prepare it? What are the key points that need to be shared with the
         community members regarding ORS?
Facilitator to listen to the responses, add, clarify wherever required.


Pre-training preparation:
-Read the scheme of the session thoroughly.
-Obtains enough packets of ORS samples, one litre jug, spoon and water to demonstrate preparation
of ORS to the participants.
-Prepare flipcharts for all the relevant points that needs to be shared during training.




                                                            IPC training manual, PSI Orissa, November 2004
Appendix 7.1

                              Checklist for demonstration of ORS

Name of trainee   :________________ Dates of Training ___________________


 No                                    TASK/ ACTIVITY                                          FU
 1      Explored local perceptions about ORS and clarified misconceptions
        -Shares that if the doctor advises your child ORS he is a good doctor and doing
        the right thing
 2      Explains to the mother and family the importance of ORS to prevent diarrhea
        -Highlights the important role ORS plays in controlling dehydration.
 3      Demonstrates how to prepare ORS in the following manner
            1. wash hands thoroughly with soap and water
            2. pour all of ORS powder from the packet into a clean container
            3. measure 1 litre of clean drinking water and pour it into the container in
                which you poured ORS
            4. stir until all the powder in the container has been mixed with water and
                none is remaining at the bottom of the container
            5. ensures re-demonstration of the above

 4      Advises the mother on the following points to be remembered while
        administering ORS:

           1.Prepare fresh ORS every day.
           2. Ensure that small children are given ORS with the help of spoon and cup
           rather than bottle.
           3.The mother should give 1 teaspoon of the solution to the child. This
           should be repeated every 1-2 minutes (an older child can drink it in sips
           should be given one sip every 1-2 minutes)
           4. If the child vomits the ORS tell the mother to wait for 10
           Minutes and resume giving the ORS but this time more slowly than before
           5.Breastfed babies should continue to be given breast milk in
           between ORS
           6.Any ORS which is left over after 24 hours should be thrown away
           7.After about 4 hours of giving ORS, reassess the child for dehydration. If
           the child is better, tells the mother to give fluids that are available at home
           the same way she gave ORS and continue to give ORS after every motion.
          8.Begin feeding the child even if dehydration persists, continue ORS. If the
             child‟s condition deteriorates; take the child to the district hospital. On the
             way to the hospital, the mother should continue to give ORS to the child.
 5      Shares the following additional information regarding ORS -
            1.Keep ORS covered, if not using it
            2.Till diarrhea stops keep giving additional home available useful fluids, it



                                                          IPC training manual, PSI Orissa, November 2004
             can take 3-5 days for it to stop
             3.Without consulting a doctor, please do not provide the person suffering
             from diarrhea any medicine, only give ORS,
             4.Also remember that ORS is used only for replenishing vital fluids and
             nutrients in the body.
             5.Do not mix ORS in milk, Sharbat, soft drink etc,
             6.Keep giving ORS till diarrhea stops.

         Total Scores obtained (Maximum 5 Point)
         % SCORED
         PTS – YES/NO

CALCULATION OF SCORES AND PERCENTAGES
Each correct task in the checklist receives 1 point. The possible scores are 1 or 0. For the question,
which has sub-bullets, all sub-bullets need to be covered to score 1 point for that question. Total
eligible scores are 5. For example if a trainee has performed satisfactorily on 4 tasks, she/he will
score 4 points. To calculate the percentage, the formula will be (4/5)*100 = 80%. A trainee
performed to standards (PTS) if she/he scores 80% or above.




                                                           IPC training manual, PSI Orissa, November 2004
                                              Day One
Session number       :   8

Topic                : Introduction to Interpersonal skills and the Communication materials
                        that would be used during VAT

Duration             : 45 minutes

Objectives: At the end of the session, the participants will be able to:

1.Explain the communication materials that will be used by them during such IPC meetings.

2.Explain what is Interpersonal Communication (IPC) and list the essential techniques required for
interpersonal communication

3.Demonstrate how to communicate with the community on the key health issues for which they
will work

Content:
IPC skills

Training Materials:
Flip chart, pens, IPC skills assessment checklist, T.V, CD player, CD on IPC film.

Steps, duration and methods:

                             Steps                           Duration            Method
  1. Introduction to IPC materials that would be used        10 minutes     Interactive
  during such meetings.                                                     discussion

  2.What is Inter Personal Communication and the             20 minutes     Role-play and
  essential techniques for it.                                              discussion
  3. Demonstration of how to do a VAT using the key          15 minutes     Role-play and
  IPC skills                                                                discussion
  4. Screening film on IPC skills and discussion             45 minutes     Film viewing and
                                                                            discussion




                                                          IPC training manual, PSI Orissa, November 2004
                                          Learning Process

   Step-1      Introduction to IPC materials that would be used during such                10 minutes
                                        meetings.

1.1 Facilitator to share all the IPC materials with the participants. Ensure that each participant gets a
copy of the entire materials that will be used by IPC.

1.2 Facilitator to let the participants understand the usage of each of the IPC material. Let the
    participants ask questions, clarify the doubts.


                 Key message:

IPC communication materials available for IPCs are as follows:
         Flipbook and product (safewat/neotral) and Handwash flyers
         Posters and product leaflet



   Step-2         What is Interpersonal Communication and the essential                    20 minutes
                                     techniques for it.

2.1 Facilitator to ask the participants regarding what do they understand by Interpersonal
Communication. Listen to their responses.

2.2 Now share that Inter-personal communication is a face-to-face verbal or non-verbal exchange of
information and feelings between two or more people.

2.3 Clarify that all the participants in their role, as IPCs will essentially have to do a lot of Inter
Personal Communication. Share that during IPC they will be using the communication materials as
shared above. However to ensure that they use the materials effectively, they need to be familiar
with the essential IPC skills.

2.4 Now ask what are the key things that they need to be careful on in order to ensure that effective
    communication happens. Share the essential IPC skills as given in appendix 8.1.




                                                            IPC training manual, PSI Orissa, November 2004
                Key message:

                                       Essential IPC skills-

Effective questioning

  Asking questions for which you will get answer which are not pre-coded/pre-designed or pre-
   thought responses i.e open-ended questions
  Also asking some questions for which you get a pre-coded/pre-designed or pre-thought answer
   i.e close ended questions
  Asking questions which encourages the respondent to give further information than you already
   have i.e; probing questions

Listening is as important as sharing information. Through listening to community members
you can find out information you need to assist them with problems, and help them to make
decisions.

When you listen do active listening which is characterized by paying attention to what is being
said and also observing non-verbal communication of the community member. Giving full attention
is demonstrated by actions such as having eye contact and nodding.

Reflection is observing the emotions and reflecting them back to him/her. Reflection helps the IPC
check whether the emotions observed are correct.

Also repeating back to the community member what you heard him/her say in a short form.
For example: I heard you say that Safewat will be a very effective method for disinfecting water. I
hope I heard it right? Repeating what you heard helps in clarifying the understanding between the
two parties.
To prevent miscommunication when listening to a community member‟s problem or when sharing
information with a community member, it is useful to summarize or paraphrase what has been
said.

It is important for IPCs to use words that motivate and ensure a community member of
approval. Praise and encouragement help build a community members sense of confidence and
reinforces desired behaviour.

Information should be given clearly and in simple language so that the community member
understands.

Using visual aids and other IEC materials effectively-
People understand more from what they see than they hear. There is a saying that a “picture is worth
a thousand words”. So, when talking with community members use visual aids (example, the
flipbook, posters, flyers etc) and other IEC materials whenever possible.




                                                         IPC training manual, PSI Orissa, November 2004
   Step-3       Demonstration of how to do a VAT using the key IPC skills                  30 minutes


3.1 Now let the facilitator role-play a situation to demonstrate how to conduct a VAT using the key
IPC skills. Facilitators to let the participants refer to the checklist on how to conduct VAT while
facilitating the process (refer to appendix 8.2 Skills Checklist for how to conduct Visibility
Accessibility Touchability (VAT) on Safewat (the water disinfectant). During role-play
facilitator should make use of all the relevant IPC materials. For example; to demonstrate how to
use safewat, they need to use a sample of a bottle and demonstrate its use in water.

3.2 After the role-play ask participants to provide feedback using the VAT skills checklist on what
were the specific IPC skills that were done well by them and specific points that need improvement
with respect to usage of IPC material, content delivery, communication style etc. Facilitator to let the
participants know that they will be given enough practice sessions on day two to practice the same.


   Step-4                Screening film on IPC skills and discussion                       45 minutes


4.1. Share that all of you are about to watch a film on the above IPC skills put to action. Ask the
participants to watch the film carefully so that post viewing, a good discussion on the key points
observed can be done.

4.2 After the screening of the film ask participants the following questions:
         What made the communication different? List responses.
         Which style of communication was good? Why?
         What was done well in the film that we usually forget to do?
         Now ask do you think if you were to adopt the second style of communication as
        depicted in the film, your communication efforts will bring better results, if yes, ask why?

4.3 After a good discussion is done on the film, highlight that as IPCs each of them should follow
the key points as discussed above.


Pre-training preparation:
-Read the scheme of the session and the appendices thoroughly.
-Prepare flipcharts for all the relevant points that needs to be shared during training.
-Photocopy the IPC skills checklist for all the participants.




                                                            IPC training manual, PSI Orissa, November 2004
Appendix: 8.1

Essential IPC skills-

Effective questioning- will help to obtain useful information from the community member.
Questioning is a way to determine what service the community member wants or how he/she is
feeling, what the community member already may know, or what problem he/she may have.

Open-ended questions- encourage the client to offer information, concerns and feelings freely.
For example: Who told you about diarrhea management? What did you learn from the exercise?
When did you first hear about it? How did you learn it? etc. The basic point is you get answers,
which are more than a yes or no. There is usually some explanation, which also accompanies the
answer.

Close-ended questions are useful for obtaining specific information. They can be answered in just
a few words or sentences. Usually the answer ends with either a yes or a no. Examples are as
follows: Do you like the taste? Is any member of your house suffering from diarrhea?

Probing questions encourage the respondent to give further information (i.e; knowing beyond
what you already know from the respondent), and to clarify an earlier point. They require tact in
wording and tone used so as to not be judgemental. For example: How do you know that? Why do
you think that happens? What made you think like that?

IPCs should be good listeners. Listening is as important as sharing information. As an IPC, who is
providing people with information, it may be difficult to remember that it is important to listen.
Through listening to community members you can find out information you need to assist them
with problems, and help them to make decisions. When listening to community members, listen
actively.

Active listening is characterized by paying attention to what is being said and also observing non-
verbal communication of the community member. Giving full attention is demonstrated by actions
such as having eye contact and nodding.

Reflection is observing the emotions and reflecting them back to him/her. Reflection helps the IPC
check whether the emotions observed are correct.

Summarizing and paraphrasing means repeating back to the community member what you heard
him/her say in a short form. For example: I heard you say that Safewat will be a very effective
method for disinfecting water. I hope I heard it right? Repeating what you heard helps in clarifying
the understanding between the two parties.

Miscommunication can happen very easily when two people discuss something. A community
member may tell you something that you understand in quite a different way from the way he/she
meant it. To prevent miscommunication when listening to a community member‟s problem or when
sharing information with a community member, it is useful to summarize or paraphrase what has
been said.



                                                         IPC training manual, PSI Orissa, November 2004
It is important for IPCs to use words that motivate and ensure a community member of approval.
Praise and encouragement help build a community members sense of confidence and reinforces
desired behaviour. Praise elicits feelings of self-worth, which in turn empowers them to better meet
their health care needs. A kind, encouraging word from someone like an IPC, goes a long way in
helping make change and reinforce positive behaviour.

Information should be given clearly and in simple language so that the community member
understands.


Using visual aids and other IEC materials effectively-
People understand more from what they see than they hear. There is a saying that a “picture is worth
a thousand words”. So, when talking with community members use visual aids (example, the
flipbook, posters, flyers etc) and other IEC materials whenever possible.

Benefits of using visual aids/IEC materials
    Helps to remember
    Makes complex information or tasks easier for the provider to explain and for the
       community members to comprehend
    Makes small things big enough to be seen
    Captures interest and attention
    Helps to point out similarities and differences
    Can make discussion of sensitive terms and issues easier
    Generates discussion
    Re-enforces key points and health messages
    Prompts and reminds IPCs of important information points
    Take home materials helps to disseminate accurate information when materials are shared
       with others.
    Reduces information overload, by allowing community members to learn at their own pace
       and leisure.

Types of visual aids and IEC materials available
    Posters
    Flipbook
    Pamphlets
    Samples and models
    Videos
    Flyers

When to use visual aids /IEC materials
   VAT
   Community events
   Home visits



                                                          IPC training manual, PSI Orissa, November 2004
Using a variety of visual aids and IEC materials enhances the effectiveness of interpersonal
communication.


Appendix 8.2

Skills Checklist for how to conduct Visibility Accessibility Touchability (VAT) on Safewat
(the water disinfectant)

Name of trainee:     ________________ Dates of Training _________________

Pre –test score (%): ------------          Post –test score (%): -----------

 No                                 TASK/ ACTIVITY                                   Observations

 1        IPC has put up a stall at a place where a small group can gather
 2        IPC makes an enthusiastic and clear audio announcement regarding
          the message to pull the crowd together
 3        Once the crowd starts gathering greets them and introduces self
 4        Makes eye contact, smiles and appears relaxed and confident
 5        Introduces the topic of discussion, shares the following statistics on
          Orissa.
          At any given point of time 3 out of 10 children are suffering from
          diarrhea. (Source: NFHS-2)
          Highlight that one of the major causes of diarrhea is consuming
          contaminated water. Also shares that by decontaminating water we
          can change the situation
 6        Tone of voice is maintained
 7        Shows samples of water and does testing of water and shares results
          to establish the fact that your eyes may see the water as clean and fit
          to drink but it may not be clean and fit to drink
 8        Asks following types of questions: both open ended, close ended
          and probing types to the participants to assess their understanding
 9        Uses the flipbook to draw the attention of the participants to the
          topic of discussion. Discusses the message given in the flipbook by
          drawing the attention of the participants
 10       Encourages the individuals to talk
 11       Listens actively, ie; pays attention to both verbal as well as non-
          verbal communication
 12       Remains non-judgemental and understands the clients perspective
          and the reason behind why the client thought so
 13       Provides and discusses the correct information on water
          disinfectant- i.e; safewat also observes the emotions of the
          participants and reflects back to him/her
 14       Appropriately uses visual aids
 15       Highlights that contaminated water as shown above in the testing


                                                             IPC training manual, PSI Orissa, November 2004
     sample is one of the main causes of diarrhea and it can be controlled
     by the usage of water disinfectant such as safewat
16   Shares that safewat is a water disinfectant and contains -chlorine in
     recommended dosage
17   Shows a bottle of safewat and clarifies that one bottle will cost Rs.
     10/- and will be enough to disinfect 1000 litres of water. Lets the
     participants touch and see the bottle.
18   Clarifies that one needs to use only - 1 drop per litre of water

19   Shares that any vessel can be used for this purpose

20   Clearly specifies the steps of purifying water using disinfectant-
     (Safewat):
     7. Clean the jar/ container in which you will fill the water.
     8. From a clean source fill the water in the jar/container
     9. Open the Safewat bottle carefully.
         Add 1 drop of liquid from Safewat bottle for every 1 litre of
         water
     10. Shake the water jar/ container well, in which you have added
         safewat.
     11. Use water after 30 minutes.
     12. Use a ladle with long stem to take the water from the jar
21   Shares that safewat will be available with retailers
22   Highlights that the shelf life of safewat is -12 months from date of
     manufacturing
23   Shares that you can use the safewat disinfected water for the
     following-
                          Drinking
                          For making ice
                          For washing hands
                          To wash vegetables and fruits
                          For preparing ORS
                          For cleaning teeth.

24   Highlights the following precautions with the community-
     -Always use safewat in water in recommended dosage
     -Keep safewat in a cool and dry place
      -Do not keep safewat under direct sunlight
     -Keep safewat away from reach of children
25   Shares that by using safewat, there will be some difference in taste
     and smell of water but this is a positive indication that water is pure
     for drinking
26   Also shares that other ways of disinfecting water are by either using
     a filter or by boiling water for 20 minutes.
27   Now shares a packet of Neotral, (Oral Rehydration Salts) and
     clarifies that it is to be used for controlling dehydration in the body.
     Shares a sample of neotral and explains the price of a packet and


                                                        IPC training manual, PSI Orissa, November 2004
           where it will be available
 28        Gives away flyers and product leaflet to the participants
 29        Thanks the participants and asks who would be interested to buy the
           product safewat or Neotral, if yes also clarifies where it would be
           available.
 30        Participants appears relaxed and they are clear on the next step
           % SCORED
           PTS – YES/NO
CALCULATION OF SCORES AND PERCENTAGES
Each correct task in the checklist receives 1 point. The possible scores are 1 or 0. For the question, which has sub-
bullets, all sub-bullets need to be covered to score 1 point for that question. Total eligible scores are 30. For example if a
trainee has performed satisfactorily on 24 tasks, she/he will score 24 points. To calculate the percentage, the formula
will be (24/30)*100 = >80%. A trainee performed to standards (PTS) if she/he scores 80% or above.




                                                                        IPC training manual, PSI Orissa, November 2004
                                              Day One

Session number:         9

Topic:                   Synthesis

Duration:               15 minutes

Objectives: At the end of the session, the participants will be able to:
          1. List the key learning points for the day

Content:
   Learning points for the day

Training Materials:

                  Flip chart, pens

Steps, duration and method:

                          Steps                              Duration             Method
1. Key learning points for the day                           15 minutes      Interactive
                                                                             discussion


                                         Learning Process

   Step-1                        Key learning points for the day                          15 minutes

1.1 Facilitator to ask the participants to come up with the key learning points for the day. Listen to
    the responses of the participants and add, clarify wherever required.

1.2 Also share with the participants that tomorrow we will begin the day with recapitulation of the
   key learnings so they need to come prepared for it. Share that they can use any creative method
   to present the learnings for the day. Ask for volunteers who will present the key learnings for the
   day.




                                                           IPC training manual, PSI Orissa, November 2004
                                              Day two

Session number             :      1

Topic                      :      Recap

Duration                   :      15 minutes


Objectives     : At the end of the session, the participants will be able to:
                 1. List the learning points from the previous day and clarify their
                 understanding.

Content:
Participants responses

Training Materials:

                     Flip chart, pens

Steps, duration and methods:

                               Steps                                Duration              Method
  1. Recapitulation                                                 15 minutes       Creative
                                                                                     (upto the
                                                                                     participants)


                                         Learning Process

  Step-1                                 Recapitulation                                    15 minutes

1.1 Ask the volunteers to present the key learning points from the previous day. Facilitator
    to add clarify any points that were not understood properly. Also ask participants
    regarding any suggestions they have from the previous day to make the training more
    useful for them. For example, were the facilitators going too fast or too slow, any
    suggestion for improvement? etc. Facilitators to listen to responses and take necessary
    actions accordingly.




                                          IPC training manual, PSI Orissa, November 2004
                                            Day two

Session number           :                       2

Topic                   : How to use the kits for water quality testing for
                          turbidity, PH, residual chlorine and presence or absence of coliform
                          bacteria.

Duration                : 1 hour

Objectives           : At the end of the session, the participants will be able to:
                       1. Demonstrate how to use the kits for water testing for turbidity,
                       PH, residual chlorine and presence and absence of coliform bacteria
                       in a sample.

Content:
Usage of water testing kit

Training Materials:

Samples of water testing kits, samples of water from different sources for testing

Steps, duration and methods:

                           Steps                                  Duration              Method
  1. Usage of water testing kits                                  30 minutes       Demonstration
                                                                                   and interactive
                                                                                   discussion
  2. Practicum by participants                                    30 minutes       Demonstration


                                        Learning Process

  Step-1                         Usage of water testing kits                             30 minutes

1.1 Facilitator to explain what the water testing kit is all about. Let each participant see the
    kit properly.

1.2 Highlight that during baseline survey an overwhelming majority of respondents
    5 out of 10 people contacted shared that they usually assess water quality through
    appearance only and that only water that looks dirty needs to be treated.




                                        IPC training manual, PSI Orissa, November 2004
1.3 Now show the participants clearly that by using the kit, water would be tested for the
    following: PH (this helps to get an idea of the intensity of acidic or basic nature of
    water sample), residual chlorine (chlorine is used to disinfect water and hence
    residual chlorine helps to know water quality), presence or absence of coliform
    bacteria (drinking water containing coliform bacteria is considered to be
    biologically contaminated) in a sample. Explain the above terminology in simpler
    terms so as to enable the participants to understand the same.

1.4 Now share how for each particular input, the testing is to be done. (Refer to appendix
    7.1 for details) Also share that the water testing kit will be used by the IPCs on a regular
    interval to check the contamination in water and also to sensitize the people on water
    and sanitation related issues.

1.5 Now the facilitator to demonstrate the use of each of the water testing kit to the
    participants carefully mentioning how to assess each component in the water that will be
    tested. Let participants ask questions to clarify their doubts. (refer to appendix 7.1 for details)

1.6 Now let participants have a testing kit along with water samples. Facilitator to ensure
    that the participants are able to demonstrate the use of the water testing kits properly.
    Clarify any doubt the participants may have.

  Step-2                   Practicum on usage of water testing kits                        30 minutes

2.1 Now the facilitator to ask few participants to role-play a VAT situation where they try to
    sensitize the community to the quality of water through testing and thereby highlight the
    importance and need of disinfecting drinking water.

2.2 After the role-play ask for feedback from the observers and then the facilitator also to
    share feedback on what was done well and where there was possibility for improvement.

Pre-training preparation:
-Read the scheme of the session thoroughly.
-Ensure different samples of water and the testing kits prior to the training
-Prepare flipcharts for all the relevant points that needs to be shared during training.




                                          IPC training manual, PSI Orissa, November 2004
Appendix 9.1
                                   Procedure for pH Testing

pH value gives an idea of the intensity of the acidic or basic nature of a water
sample. pH scale for aqueous solutions lie between 0 – 14. A pH below 4.0 gives sour
taste and above 8.0 an alkaline taste. Water having higher values of pH increases
scale formation in water heating apparatus. Disinfectant capacity of chlorine reduces
if the water is alkaline.

                                                pH Scale

0        1      2    3    4    5     6      7      8      9      10     11     12     13    14




Highly Acidic
                                         Neutral                               Highly Alkaline



You Need
1.   pH Paper
2.   Sample collection bottle

How to do it :

    1.       Fill sample collection bottle with water sample.
    2.       Take small piece of pH paper.
    3.       Dip pH paper into bottle.
    4.       Let it dry for few seconds.
    5.       Compare the colour with pH colour chart.
    6.       Record corresponding pH value.

Permissible Limits:
Potable water = 6.5 to 8.5
Fresh water (aquatic life) = 6.5 to 9.0
Irrigation water = 4.5 to 9.0
Marine water (aquatic life) = 6.5 to 8.5

                                Procedure for Residual Chlorine




                                           IPC training manual, PSI Orissa, November 2004
Chlorine is widely used for disinfection of water. For effective disinfection, dose of
chlorine, optimum contact period and residual chlorine are required to be known.

You Need:
  Sample Collection bottle and pH Paper
  Cylinder
  Ortho Toludine Solution
  Whatman filter paper

How to find out Residual Chlorine :

If the sample is coloured or turbid try to get a clear sample by passing the sample
through the whatman filter paper given in the kit.

   1. Transfer 10 ml of water sample.
   2. Check pH of the solution.
   3. If pH is less than 9 add 4 drops of Ortho – Toludine if pH is more than 9 add 8 – 10
      drops.
   4. Compare the colour with standard colour chart as below : (Residual Chlorine (mg/l)




               0.1                        0.5                                   1.0

                                Permissible Limits
Drinking water = 0.2 mg/l minimum

Precautions :
  Ortho-Toludine is a hazardous chemical. Handle it carefully.
  Avoid its contact with skin, eyes or any other sensitive body parts.
  In case of accidental contact, wash it immediately with a large amount of water.


                                     Coliform Testing




                                      IPC training manual, PSI Orissa, November 2004
Coliforms are a group of bacteria, which are readily found in soil, decaying vegetation,
animal feces, and raw surface water. This indicator of presence of coliform bacteria during
the test may or may not be accompanied by pathogens (i.e., disease-causing organisms).
Coliforms, rather than the actual pathogens, are used to assess water quality because their
detection is more reliable. Pathogens appear in smaller numbers than coliforms, so are less
likely to be isolated. Drinking water found to contain coliforms is considered biologically
contaminated.

   The Coliform Bottles gives the preliminary information of presence or absence of
    coliform bacteria.
   It does not differentiate the faecal coliform and coliform bacteria.
   It does not detect the particular species of bacteria present in the sample.
   It gives the idea about the presence of bacteria in the given sample.
   It is for instantaneous monitoring of sample.
   It gives the idea about the water quality that the water is drinkable or not.
   It is mainly based on field-testing, where one cannot take all the sophisticated
    instruments for bacterial check. So once the confirmation will come out that the
    sample is contaminated or not, one can go for detailed laboratory tests.

How to test:
1.    Fill the coliform bottle with sample water, directly from the source, till the arrow
       mark on the sticker of the bottle.
2.    Close the lid tightly and shake.
3.    Keep the bottle at 35* C temperature for 48 hours.
4.    If the bottle turns black within this period, the water is contaminated with
       coliform bacteria.




                                      IPC training manual, PSI Orissa, November 2004
                                          Day two


Session number                 :      3

Topic                          : Introduction to water disinfectant
                                                               Safewat

Duration                       :      1 hour


Objectives: At the end of the session, the participants will be able to:
          1. Explain the role water disinfectant such as Safewat can
               play to reduce water borne diseases
          2. Demonstrate how it is to be used and where it will be available.
          3. Explain the shelf life and clarify the misconceptions regarding it.



                                      IPC training manual, PSI Orissa, November 2004
Content:
    Cause of water borne disease
    What is Safewat water disinfectant, its use, shelf life
    Where will Safewat be available
    Misconceptions regarding Safewat smell and taste

Training Materials:

                   Flip chart, pens, samples of Safewat, vessel and water, safewat
                    demonstration checklist

Steps, duration and methods:

                             Steps                                Duration              Method
  1. Causes of water borne diseases, What is Safewat,             30 minutes       Interactive
  how it is to be used, where it will be available, explain                        presentation,
  the shelf life and clarify misconceptions.                                       demonstration

  2.Practicum by participants                                     30 minutes       Role-play and
                                                                                   large group
                                                                                   discussion




                                       Learning Process


  Step-1    What is Safewat, how it is to be used, where it will be available,           30 minutes
            explain the shelf life and clarify misconceptions.



1.1 Facilitator to ask participants to name a few water borne diseases? List them. (Such as
    typhoid, gastroenteritis, diarrhea etc) Now ask them what are the reasons due to which
    one gets such diseases. Listen to responses and then clarify that due to intake of
    contaminated water, one gets such diseases. Highlight that we can control the occurrence
    of such diseases through disinfecting water. Also share that contaminated water may not
    always be visible through naked eyes.




                                        IPC training manual, PSI Orissa, November 2004
1.2 Facilitator to introduce the participants to the product named Safewat. Share a sample of
    the bottle with all the participants. Clarify that Safewat is basically a water disinfectant
    that contains chlorine in recommended dosage. It is an effective and inexpensive
    intervention to provide safe drinking water. Share samples of the products with the
    participants and let them all have a look.


                 Key message:

What is safewat-
It is a water disinfectant that contains chlorine in recommended dosage.




1.3 Now share that during baseline survey it was found that the awareness regarding
    contaminated water could be one of the causes of diarrhea was very low.

1.4 Now share that safewat would be available with the retailers. The cost of one bottle of
    safewat would be Rs. 9.00 + sales tax+ local tax. (Approximately Rs.10/- per bottle).
    Highlight that this bottle will be enough for disinfecting 1000 litres of water.

1.5 Now the facilitator should demonstrate the use of Safewat. Share the copy of the
    checklist with the participants. (refer to appendix 3.1 for the same) Highlight that this
    checklist will enable them to remember the steps to demonstration of safewat and can be
    used to learn the steps in future. Share a copy of the checklist with all participants.
    Ensure that actual sample is used with one litre of water. Facilitator to ensure that during
    the demonstration the participants are clear about the following:
 Contents of safewat-chlorine in recommended dosage
 Dosage pattern- 1 drop / litre of water
 Vessel to be used- any vessel can be used

 Steps of purifying water using disinfectant-( Safewat):
 Clean the jar/ container in which you will fill the water.
 From a clean source fill the water in the jar/container
 Open the Safewat bottle carefully.
 Add 1 drop of liquid from Safewat bottle for every 1 liters of water, for 5 litre- 0.5 ml
(5-6 drops), 10 litre- 1ml, 20 litres (2 ml).
 Shake the water jar/ container well, in which you have added safewat.
 Use water after 30 minutes.
 Use a ladle with long stem to take the water from the jar
 Available with retailers
 Shelf life-12 months from date of manufacturing




                                       IPC training manual, PSI Orissa, November 2004
   Share that you can use the safewat disinfected water for the following- drinking and for
       making ice, for washing hands, to wash vegetables and fruits, for preparing ORS, for
       cleaning teeth.

    Precautions- Do‟s and Don‟t of safewat-

    Do’s (Safewat)                                 Don’t (Safewat)
    Always use safewat in water in                 Do not keep safewat under direct sunlight
    recommended dosage
    Keep safewat in a cool and dry place           Keep safewat away from reach of children


Also share that during VAT each IPC will be expected to demonstrate the use of safewat.
Ensure that the precautions are also shared carefully with the participants.


                Key message:
Dosage for safewat- 1 drop per litre of clean water
Steps of purifying water using disinfectant- (Safewat):
   1. Clean the jar/ container in which you will fill the water.
   2. From a clean source fill the water in the jar/container
   3. Open the Safewat bottle carefully.
   4. Add 1 drop of liquid from Safewat bottle for every 1 litres of water
   5. Shake the water jar/ container well, in which you have added safewat.
   6. Use water after 30 minutes.
   7. Use a ladle with long stem to take the water from the jar.

Where is safewat available- with retailers.

What is the shelf life of safewat- 12 month from the date of manufacturing.

Precautions to using safewat-
Always use it in recommended dosage
Keep it in a cool and dry place
Do not keep safewat under direct sunlight
Keep safewat away from reach of children


1.6 Now ask few volunteers among the participants to re-demonstrate the use of water
    disinfectant to improve the quality of drinking water and explain the key message that
    needs to be communicated during demonstration. Let the participant complete the
    demonstration and then the facilitator should invite feedback from the large group. Add
    / clarify points that have not come up during the discussion.




                                      IPC training manual, PSI Orissa, November 2004
   Also share that there are other ways of purifying water such as by boiling the
   water for 20 minutes after the first boil starts or by filtering the water using a
   water filter.

1.7 Now share that after adding Safewat to water, there is going to be a slight difference
    in smell and taste of water due to the chlorine content. Share that if we consider the
    health benefits of Safewat, one should and will get used to the slight change in smell and
    taste. It is highly essential for the IPCs to share this with the community as due to the
    initial difference in smell and taste of water, some of them may discontinue to use it.
    Whereas if they are mentally prepared and aware of the difference in smell and taste, the
    chances are high that they will continue to use it and also propagate it to others.

                Key message:
Does using safewat cause change in taste and smell of water-
Yes, it does. The slight difference in taste and smell of water is an indication that water is
pure to drink.


1.7 Now ask the participants, whether they would be ready to demonstrate the steps to the
community members? Also ask the following questions:

          What is safewat? How much does it cost?
          What is the recommended dosage?
          Where would it be available? What is the shelf life?
          What are the steps to purifying water using safewat?
          What the precautions to using safewat?
          How would you deal with the change in smell and taste of water?

  Step-2    Practicum                                                                  30 minutes



2.1 Ask few participants to role-play a situation where they try to do VAT to convince the
community regarding the benefits of using safewat, the water disinfectant. (Use the skills
checklist as given in pre-test to assess the same)
2.2 After the role-play the facilitator to invite feedback from the observers regarding what
was done well and where there were chances of improvement. Facilitator to add to this once
the feedback from all others have been elicited.


Pre-training preparation:
-Read the scheme of the session thoroughly.
-Ensure samples of safewat, container and water are available for demonstration.



                                      IPC training manual, PSI Orissa, November 2004
-Prepare flipcharts for all the relevant points that needs to be shared during training.


Appendix 3.1

            Checklist for demonstration of Safewat (the water disinfectant)

Name of trainee    :________________ Dates of Training ___________________

Pre –test score (%): ------------

Post –test score (%): -----------

 No                                     TASK/ ACTIVITY                                         FU
 1       Shares that safewat is a water disinfectant and contains -chlorine in
         recommended dosage
 2       Shows a bottle of safewat and clarifies that one bottle will cost Rs. 10/- and will
         be enough to disinfect 1000 litres of water. Lets the participants touch and see
         the bottle.
 3       Clarifies that one needs to use only - 1 drop / litre of water

 4       Shares that any vessel can be used for this purpose

 5       Clearly specifies the steps of purifying water using disinfectant- (Safewat):
                  Clean the jar/ container in which you will fill the water.
                  From a clean source fill the water in the jar/container
                  Open the Safewat bottle carefully.
                  Add 1 drop of liquid from Safewat bottle for every 1 litre of water
                  Shake the water jar/ container well, in which you have added
                 safewat.
                  Use water after 30 minutes.
                  Use a ladle with long stem to take the water from the jar

 6           Shares that safewat will be available with retailers

 7           Highlights that the shelf life of safewat is -12 months from date of
             manufacturing

 8           Shares that you can use the safewat disinfected water for the following-
                             Drinking
                             For making ice
                             For washing hands
                             To wash vegetables and fruits



                                       IPC training manual, PSI Orissa, November 2004
                              For preparing ORS
                              For cleaning teeth.

 9       Highlights the following precautions with the community-
         -Always use safewat in water in recommended dosage
         -Keep safewat in a cool and dry place
          -Do not keep safewat under direct sunlight
         -Keep safewat away from reach of children
 10      Shares that by using safewat, there will be some difference in taste and smell of
         water but this is a positive indication that water is pure for drinking
 11      Also shares that other ways of disinfecting water are by either using a filter or by
         boiling water for 20 minutes.
         % SCORED
         PTS – YES/NO

CALCULATION OF SCORES AND PERCENTAGES
Each correct task in the checklist receives 1 point. The possible scores are 1 or 0. For the
question, which has sub-bullets, all sub-bullets need to be covered to score 1 point for that
question. Total eligible scores are 11. For example if a trainee has performed satisfactorily on
9 tasks, she/he will score 9 points. To calculate the percentage, the formula will be
(9/11)*100 = >80%. A trainee performed to standards (PTS) if she/he scores 80% or
above.




                                           Day two

Session number           :      4




                                       IPC training manual, PSI Orissa, November 2004
Topic                    :      Practicum

Duration                 :      2 hours


Objectives      : At the end of the session, the participants will be able to:
                  1. Demonstrate how they will be facilitating VAT to promote usage of
                  Safewat and ORS.

Content:
Simulated sessions on VAT

Training Materials:

                   Flip chart, pens, samples of safewat, neotral and water testing kits

Steps, duration and methods:

                         Steps                                    Duration             Method
  1. Simulations of VAT on safewat and Neotral                     2 hours        Simulation,
                                                                                  discussion


                                      Learning Process

  Step-1     Simulations of VAT on safewat and Neotral                                  2 hours

1.1     Let each participant prepare for 20 minutes on how they would facilitate a VAT On
        safewat and Neotral use.

1.2     Provide relevant checklist so that participants know what steps to follow. Share that
        both their IPC skills and the technical input on water disinfectant and ORS will be
        assessed during the simulations.

1.3     Provide participants with simulated practice sessions. After each IPC facilitates a
        group discussion, provide feedback using appropriate checklist for the same.


After the training is over all IPCs need to constantly brush up their skills before they start
going to the actual field.




                                       IPC training manual, PSI Orissa, November 2004
                                            Day two

Session number         :    5

Topic               : Follow –up mechanism

Duration            :30 minutes


Objectives: At the end of the session, the participants will be able to:

1.Explain the follow-up mechanism as visualized for the project.

2. Demonstrate a follow-up situation

Content:
Follow up plan, tools

Training Materials:

                     Flip chart, pens, handouts on follow-up plan and relevant checklists that
                      will be used.

Steps, duration and methods:

                        Steps                                     Duration              Method
  1. Follow-up mechanism                                          10 minutes       Interactive
                                                                                   discussion
  2. Role-play a follow up situation                              20 minutes       Role-play,
                                                                                   discussion


                                       Learning Process

  Step-1                            Follow-up mechanism                                    10
                                                                                         minutes

1.1 Facilitator to share with the participants the follow-up mechanism as planned in the
    project. Share the objective of follow-up and the specific activities as planned for follow-
    up. (refer to appendix 4.1 for details) Clarify any doubts the participants may have. Share
    handouts on each of them.




                                        IPC training manual, PSI Orissa, November 2004
1.2 Now share the follow –up tools that would be used to assess their knowledge and skills.
    (refer to appendix 4.1 for details) Familiarise the participants to the tool and clarify that these
    are the same tools which are being used during the training too. Also give them a
    handout on it. Share that they can use this tool to practice and improve their knowledge
    and skills.

    Step-2                      Role-play a follow-up situation                            20 minutes

2.1 Share with the participants what is meant by feedback. Clarify that during follow-up the
    supervisor will provide feedback to you on your performance with a view to enhance
    your performance.

2.2 Now provide information on feedback.

Clarify that feedback is a communication technique in which the facilitator provides
information to participants about their progress in mastering a skill or activity. Feedback is
most effective when it is timely (provided immediately), positive and descriptive.

Guidelines for receiving feedback are:

        Ask for it. If you need information to answer a question or pursue a learning
         objective, ask for it.

        Direct it. Ask them to be specific and descriptive.

        Accept it. Do not defend or justify your behavior. Listen to what people have to
         say and thank them. Use what is helpful, quietly discard the rest.

Share that now we will conduct role-play to see a situation where follow-up is happening.

2.2 Now conduct the following role-play:

Situation one- (supervisor gives the feedback).

Raj is the supervisor of IPCs. On a routine field visit he accompanies, Ramesh the IPC. He
observes him during VAT. Ramesh shares the message during VAT. After the VAT, Raj
gives feedback to Ramesh using the relevant checklist.

Facilitator to ensure that after the role-play, feedback is given on how the follow -up was
done. Adequate focus should be given on the way feedback was given by the supervisor to
the IPC and how the IPC accepted feedback.

2.3 After the role-play is over share that in the field also similar situations will happen.
Participants hence need to be prepared for the same.




                                          IPC training manual, PSI Orissa, November 2004
Pre-training preparation:
-Prepare flipcharts for all the relevant points that needs to be shared during training.


Appendix 5.1

                                     FOLLOW-UP PLAN

Objective of the follow-up:
   1. To reinforce knowledge and skills that help IPCs transfer the same to the
       communities
   2. Identify problems faced by them during field visit and help solve these problems
   3. Gather information on the performance of IPCs and the
      conditions that influence performance

   How it          When would        Who would        What                 What tools would
   would be        it be done?       do it and        essential            be used to assess
   done.           (Time)            where            knowledge            knowledge and
   (Method)                                           and skills           skills during
                                                      would be             follow-up
                                                      assessed
   During VAT Weekly                 Project          IPC skills,          Knowledge and
                                     Supervisor       Message              skills assessment
                   Fortnightly                        delivery on          checklists as used
                                                      Safewat/ ORS         during the training
   By              During            Project          Knowledge            Knowledge and
   interviewing    fortnightly and   Supervisor       regarding            skills assessment
                   monthly                            Safewat/ORS          checklists as used
                   meetings etc.                                           during training
   Observing       During            Project          IPC skills           Knowledge and
   through         monthly           Supervisor                            skills assessment
   mocks/role-     meetings                                                checklists as used
   plays                                                                   during training




FOLLOW – UP TOOL TO ASSESS INTERPERSONAL COUNSELING (IPC)
SKILLS-
Knowledge and skill assessment checklists that have been used during pre and post tests will
be used continuously during follow-up too.



                                       IPC training manual, PSI Orissa, November 2004
                                               Day two

Session number:                           6

Topic:                                    Post-test

Duration:                                 1 hour

Objectives: At the end of the session, the participants will be able to:
            1 Assess their knowledge regarding hygiene and its importance to control water
            borne diseases and the role of water disinfectant to control the same.
            2. Assess their skills on sharing information with the community members
            regarding water disinfectant, oral rehydration salts and its use.


Content:
Knowledge and skills assessment

Training Materials:

                    Flip chart, pens, questionnaire, and checklist for OCP counselling.

Steps, duration and method:

                      Steps                                        Duration            Method
1. Knowledge assessment                                           20 minutes        Questionnaire
2. Skill assessment- How to conduct VAT on water                  40 minutes        Demonstration
disinfectant especially safewat?


                                        Learning Process

  Step-1                                      Post-test                                   20 minutes

1.1 Inform participants that they will be given a questionnaire, (refer to appendix of pre-test)
which needs to be filled according to whatever their present level of understanding is.




                                         IPC training manual, PSI Orissa, November 2004
1.2 Distribute the questionnaire and after the participants have completed filling it, collect
the same back and do the scoring. The facilitators need to share with the participants the
maximum and minimum scores obtained and the areas that still need to be improved.


  Step-2      Skill assessment- How to conduct VAT on water disinfectant                40 minutes
                                  especially safewat?

2.1 Facilitator to ask each participant to address the group of participants in the training
room on safewat, the water disinfectant. Using the relevant checklists (Refer to appendix in
pre-test session) assess each participant‟s present level of skills with regard to how to
conduct VAT on safewat.

2.3 Facilitator to ensure that the post test assessment form for all the participants is
    tabulated and kept for records. The details of what percentage had good skills and what
    percentage had poor skills should be shared with the participants by the end of the
    session.


Pre-training preparation:
-Read the scheme of the session thoroughly.
-Prepare enough photocopies of the post-test questionnaire for all the participants. Ensure
that the answer key part is not photocopied alongwith the pre/post test form. Use a
photocopy of the same form that was used for pre-test just ensure that post -test is ticked on
top of the sheet. Similarly the skills assessment will also happen the same way as happened
during the post-test.




                                       IPC training manual, PSI Orissa, November 2004
                                              Day two
Session number:                     7

Topic                           :   Evaluation

Duration                    :       15 minutes

Objectives      : At the end of the session, the participants will be able to:
1.Evaluate the training programme and synthesize the key learnings from the training.

Content:
                     Evaluation form

Training Materials:

                      Flip chart, pens, evaluation form

Steps, duration and method:

                        Steps                                       Duration              Method
1. Evaluation and synthesis                                         15 minutes       Question-answer
                                                                                     and interactive
                                                                                     discussion


                                         Learning Process

  Step-1                            Evaluation and synthesis                               15 minutes

1.1Inform participants that they will be given a copy of the evaluation form, (refer to appendix
6.1 for details) which they need to fill and return back to the facilitators in order to enable
them to evaluate the training programme. Facilitators can take the feedback from the
evaluation to improve the future training programmes.




                                          IPC training manual, PSI Orissa, November 2004
1.2Now the facilitators need to ask the participants to share the key learning points from the
training. Listen to the responses and add, clarify as required.


Pre-training preparation:
-Read the scheme of the session thoroughly.
-Prepare enough photocopies of the evaluation form for all the participants.



Appendix 7.1
                                      Evaluation form

                                                Strongly agree          Strongly disagree

The facilitator was well prepared               1            2           3          4       5

The facilitator spoke in a clear voice and      1            2           3          4       5
was easily understood
The facilitator was knowledgeable about         1            2           3          4       5
the topic and helped you to understand
your role clearly
The facilitator clearly expressed ideas and     1            2           3          4       5
information
The facilitator gave the group a chance to      1            2           3          4       5
ask questions
The facilitator understood the questions        1            2           3          4       5
asked, and answered them satisfactorily
The facilitator was interesting and engaging    1            2           3          4       5

The activities the facilitator used were        1            2           3          4       5
enjoyable
The facilitator provided information that       1            2           3          4       5
will be helpful to you when you go back to
work


What did you most like about this training session?




What did you like least about this training session?




                                       IPC training manual, PSI Orissa, November 2004
What suggestions do you have for improving this training session?




Thanks for taking your time to fill this form.




                                           Day two
Session number:         8

Topic:                   Synthesis and Closure

Duration:               15 minutes


Objectives: At the end of the session, the participants will be able to:
          1. List the key learning points for the day

Content:
Learning points for the day

Training Materials:

                  Flip chart, pens

Steps, duration and method:

                          Steps                                  Duration              Method
1. Key learning points for the day                               15 minutes       Interactive
                                                                                  discussion


                                      Learning Process

  Step-1                      Key learning points for the day                           15 minutes

1.1 Facilitator to ask the participants to come up with the key learning points from the
    training. Listen to the responses of the participants and add, clarify wherever required.
    Ask the participants regarding are they clear about what they are expected to do in the



                                       IPC training manual, PSI Orissa, November 2004
   field. Remind them that any problems they face in the field, they should share it with the
   team leader and project supervisor.

1.2 Thank the participants for their active participation and conclude the training.




References:

      Enhancing Interpersonal Communications Skills (IPC) curriculum for delivery of
       improved health services II project (DISH)- Republic of Uganda, MOH.

      Training Of Trainers, Pathfinder International, November 1997.




                                       IPC training manual, PSI Orissa, November 2004

				
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