TRAINING REPORT Amman_ Jordan by liamei12345

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									 TRAINING REPORT


SECOND REGIONAL TRAINING COURSE
      FOR MASTER TRAINERS
              ON
   COMMUNITY BASED INITIATIVES



        Amman, Jordan
     August 3 to 12, 2003
                                    CONTENTS
Serial No                               Subject                   Page No.
1              Introduction                                          2

2              Objectives, methodology and expected outcome          3

3              Proceeding                                            4

4              Field visit                                           18

5              Pre and post training assessment                      19

6              Concluding session                                    20

7              Recommendations                                       21

Annexes

    Annex-A Agenda                                                   23

    Annex-B List of participants and facilitators                    26

    Annex-C Pre training assessment form                             31

    Annex-D Post training assessment form                            33

    Annex-E Key for pre and post training assessment                 35

    Annex-F Results of pre and post training assessment              37

    Annex-G Evaluation of training form                              38

    Annex-H Results of evaluation of training                        39

    Annex-I Field visit to CBI area: Objectives and methodology      41

    Annex-J Report of field visit to Mudari village                  43




                                            1
1- INTRODUCTION
World Health Organization’s office Eastern Mediterranean Region is supporting the
member countries in development of community based initiatives (CBI) for health and
development. In order to enhance the capacities of the nationals and developing master
trainers for CBI, WHO-EMRO developed a CBI training manual and conducted first
regional training course during November 2002 in Islamabad (Pakistan) attended by 6
countries of the Region. The second regional training course for master trainers on
Community Based Initiatives was held in Amman (Jordan) from 5 to 12 August 2003 at
Raddison SAS Hotel (programme attached as Annex-A). The team of facilitators arrived
2 days prior to the commencement of the course for coordinating the arrangements,
finalizing the training programme and initiating the course. The facilitators assisted in
making organizational and logistic arrangements in addition to their primary
responsibility of preparing the training materials, making presentations and conducting
the sessions of group work. From 9 countries of the region, 33 participants (list attached
as Annex-B) attended the course. As most of the participants belonged to Arab speaking
countries (except those form Iran and Pakistan) the training was conducted in Arabic
combined with instant translation in English. Although the training materials were in
English, all the presentations were translated into Arabic, and Power Point presentations
on both Arabic and English were displayed simultaneously during the lectures. Mostly
the presentations were made in Arabic; however few were made in English. Summery of
each presentation was delivered in other language for the convenience of the participants.
Mostly the participants arrived the day before the commencement of training course,
except those form Iran arrived on 3rd day due to visa delay and those from Tunisia joined
on 4th day due to travel problems. The training was conducted according to the plan
adapted during the course work, assigning sufficient time for different training activities.
The presentations were followed by discussions and explanations; similarly the group
works were followed by plenary session for presenting outcomes of the groups.
Simultaneously, participants also provided feedback on the training materials to make
them more useful for future use.




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2 – Training objectives, methodology and
expected outcome
Training objectives:
The training course perused following objectives:
•     Developing master trainers in countries of the region for making them capable for
      orienting and training national authorities at various levels, technical teams,
      programme managers, communities and other stakeholders.
•     Updating the knowledge of the field management teams regarding the various
      operational aspects of the CBI.
•     Reinforcing leadership and management skills for effective and efficient
      implementation of the programme.

Methodology:
The training methodology included:
   - Presentations and discussions
   - Group works & case studies
   - Feedback
   - Field visit.

Expected outcome:
Participants were expected to learn the following:
    • The concept of health, its promotion and protection;
    • CBI approaches, process and its implementation procedures;
    • Developmental packages and indicators to measure the progress;
    • Leadership and management skills required for successful operation of the
        programme;
    • Technical expertise to implement CBI according to WHO/EMRO guidelines and
        tools;
    • Provide feedback on contents and methodology of training course.




                                          3
3 - PROCEEDING

Undermentioned is brief illustration of all sessions and group works held during this
training course:

3.A    Inauguration
The training course commenced on 5th August 2003 at 8 AM. The inaugural session was
chaired by Dr. Sa'ad Kharabsheh the under secretary MOH/Jordan, whereas other guests
included Dr. Mubashar Sheikh the regional advisor for CBI/EMRO, Dr. Ala’din Alwan
the WR/Jordan, Mr. Thomas McDermott the UNICEF RD and Mr. Abdul Muniem Abu-
Nuwar the UNFPA Representative for Jordan. The programme manager of Healthy
Village coordinated the session. Dr. Alwan WR/Jordan welcomed the participants on
behalf of WHO, wishing them pleasant stay in Jordan. Then the UNICEF RD and
UNFPA Representative addressed the floor explaining the mandate of their organizations
and areas of work, mentioning prospectus for future collaboration with CBI. Dr.
Mubashar Sheikh, the RA/CBI, WHO/EMRO made a comprehensive presentation on the
CBI concept, its status in the region, and objectives of the regional training course. The
undersecretary MOH/Jordan welcomed the participants on behalf of H/E Minister of
Health/Jordan and expressed commitment of his country for successful implementation of
the regional training course. He also elaborated the Jordan experience in implementing
CBI (Quality of Life Project implemented by Noor Elhussein Foundation and Healthy
Village Programme implemented by Ministry of Health). He hoped that participants will
obtain opportunity for sharing their experiences during this training course.

3.B    Presentations, group work and discussion
The training programme was based upon the following modules and units of CBI training
manual, in addition to the pre- and post-training evaluation, field visit, groups work,
plenary and discussion session (detailed plan attached):




Module 1    Basic concepts
            Unit 1.1 Health and quality of life
            Unit 1.2 Sustainable development and poverty reduction for health
            Unit 1.3 Community-based initiatives in the Eastern Mediterranean
                       Region
Module 2    Public Health
            Unit 2.1 Concept of health, health for all and primary health care
            Unit 2.2 Health promotion and protection
            Unit 2.3 Disease prevention and management


                                            4
Module 4    Social mobilization and development
            Unit 3.1 Community mobilization and social contract
            Unit 3.2 Health development
            Unit 3.3 Social development
            Unit 3.4 Economic development
            Unit 3.5 Health and development indicators
Module 4    Management of CBI
            Unit 4.1    Planning
            Unit 4.2    Organization
            Unit 4.3    Human resources development
            Unit 4.4    Community surveys and prioritization of needs
            Unit 4.5    Projects preparation and implementation
            Unit 4.6    Supervision and monitoring
            Unit 4.7    Financial management
            Unit 4.8    Documentation and reporting
            Unit 4.9    Promotion and advocacy
            Unit 4.10 Programme evaluation
Module 5    Leadership skills
            Unit 5.1 Management techniques
            Unit 5.2 Problem solving and decision making
            Unit 5.3 Effective communication
            Unit 5.4 Operational research and development

Module 1: Basic concepts
Module 1 comprises of 3 units and is related with the basic concepts of quality of life,
sustainable development, and poverty in relation to health as well as the community
based initiatives for health and development implemented in the EMR. The objective is to
orient the participants about the rationale, approaches and methodology of CBI.

Unit 1.1 Health and quality of life:
This unit provides an overview of quality of life paradigm and its relation to health
determination. Dr Muhammad Mahmood Afzal presented this unit, explaining its
objectives and expected outcome. He focused on the concept of quality of health, and the
linkages between health determinants and the quality of life. The QOL model indicates
the determinants which are not under the domain and direct responsibility of health
sector, therefore require multisectoral actions. QOL determinants are related to the level
of education of people, water supply, food and nutrition, income, housing and others
including the health. The commonly used indicators for measuring QOL as determined
by World Bank indicators (IMR, life expectancy, and literacy rates) were explained. The
strategic actions to achieve the better QOL, including decentralization of management



                                            5
systems, enhancing self reliance and promoting economic development and reduction of
unemployment and linking it with social development were also illustrated.

The participants commented that more indicators should be added for measuring QOL
like MMR, healthy lifestyles, political commitment and poverty reduction measures.

The presenter and Dr. Mubashar responded to these queries by explaining that there are
many indicators which can be used to measure quality of life; however few have been
selected with consensus for the sake of simplicity and ensuring standardization of
indicators used globally. It may be difficult to measure indicators like political support.
MMR is also difficult to measure in a short duration, as its denominator should be
sufficiently large.

Unit 1.2 Sustainable development and poverty reduction for health
This unit illustrates sustainable development and poverty reduction in relation to
achieving the health goals. Dr Mubashar RA/CBI, WHO/EMRO presented this unit and
explained the concepts of sustainable development, types of poverty, identifying the poor,
and the strategies for reducing poverty and attaining sustainable development focused on
health goals. During the presentation, he highlighted the following points:
   • Sustainable development is “an integrated socioeconomic gains ensuring
        improved quality of life, abolition of absolute poverty, and development of human
        services while sustaining health and total well-being”.
   • Non-economic factors which lead to poverty especially at local level are more
        related to human poverty and must be considered while adopting poverty
        reduction measures.
   • The mere economical income growth does not meet the wider concept of
        comprehensive development.
   • There should be due emphasis on human resource development, development of
        community-based mechanisms for self-financing such as Community
        Development Fund (CDF) as a means for sustainable development and public
        service institution.

Comments by participants were:
  • Poverty may have many definitions and indicators to measure it, including the
     Islamic definition of poverty.
  • Poorest of the poor should be targeted to change their socio-economic situation
     that is a real challenge for CBI managers, as the poor are the least educated and
     do not have chances to present their problems.
  • The effects of globalization on the quality of life of the poor and hence their
     health status have made the situations more critical.
  • Corruption is the main cause for rising levels of poverty; whereas the
     development centers don’t give due emphasis to the social and human
     development.
  • This unit may be merged with unit 1 so that quality of life, poverty and
     sustainable development can be considered together in relation to health.



                                            6
The presenter responded to the comments as follows:
   • Many definitions exist for explaining poverty; however it is very important for
       CBI managers first to understand the wide spectrum of causes leading to poverty,
       identifying the simplest and direct strategies and indicators enabling communities
       for reducing poverty. These definitions can be adapted at country level focusing
       on development of human resource ensuring the sustainability factor.
   • The role of the CBI is to help the poor to have their rights through accessing the
       simple and affordable measures, and demonstrate them the ways and means to
       come out of the poverty trap.

Unit 1.3 Community-based initiatives in the Eastern Mediterranean Region:
This unit describes the different community based initiatives have been launched in the
Eastern Mediterranean Region (EMR). Dr. Mubashar while presenting the unit elaborated
the rationale of CBI for health and development, the linkages between the community-
based approach, the inter-sectoral collaboration and developing partnerships to overcome
factors leading to poverty and ill health. CBI approaches such as BDN, HCP, HCP and
WHD were explained, elaborating their concepts, main objectives and the structures. He
also highlighted implementation status of CBI in the Region. He stated that WHO role is
to encourage and support to CBI methodology in principle in all countries regardless
names given or who ever partner is involved in the process. WHO acts as a catalyst for all
activities initiated by the communities as critical partner with other stakeholders.

Comments by participants were:
  • WHO should play a role in promoting Community Oriented Medical Education
     “COME”, to include CBI within the curricula of undergraduate students.
  • WHO should encourage exchange of experiences between the member countries.
  • WHO and MOH should train and orient other sectors, partners and NGOs to
     initiate similar initiatives and adopt strategies focusing on health and human
     development.

Module 2 Public Health
Module 2 contains 3 units ands is related to the concepts of health, HFA and PHC, and
the strategies for disease prevention and health promotion. This provides a basic
knowledge to the participants how health detriments work and how health can be
achieved as a holistic approach?

Unit 2.1 Concept of health, health for all and primary health care:
This unit describes the concepts of Health, HFA and PHC. Dr Salah El Badawi
presenting the unit, illustrated the definition of health, concept of health for all emerged
form WHO international conference and primary health care being the right approach for
achieving this target. He also mentioned the features of an equitable community health
system and role of the individuals, community, country and international levels
improving and maintaining health.




                                             7
Participants proposed that issues like decentralization and collaborations should be
addressed, and CBI should play catalytic role in promoting health concepts and
reminding all partners about their roles.

Unit 2.2 Health promotion and protection:
This unit relates to the concepts and strategies for promoting and protecting health. Dr.
Nazar presented the unit and mentioned the concepts, and ways and means for promoting
and protecting health. He focused on how CBI can contribute in health promotion with
emphasis on practicing healthy lifestyles and protecting major public health problems
through different community-based interventions.

Participants appreciated that health promotion should be provided due emphasis while
implementing CBI in the areas. All projects should be made more focused and oriented
towards promotion of health and healthy lifestyles.

Unit 2.3 Disease prevention and management:
This unit refers to the basic orientation about the common diseases and their
management. Dr. Nazar while presenting the unit introduced the common diseases which
are mostly affecting the health of the poor communities. He described their prevention
and management at community level.

The discussion remained focused mainly on community involvement and level of
involvement of the health and related sector in this process. Participants suggested that
common strategies should be adapted at local level to combat these health problems and
the communities in particular should be educated about their prevention and
management.

Module 3 Social Mobilization & Development
Module 3 has 5 units which are related to community mobilization and social contract,
developmental packages for health, social and economics, and the indicators to measure
the outcomes of CBI interventions. This module provides multisectoral practical
strategies and actions to achieve the targets of health and development.

Unit 3.1 Community mobilization and social contract:
The unit describes the concept and framework of social mobilization. In addition to this,
it presents the social contract that is supposed to be signed by all partners at the time of
initiating the CBI in an area. Dr. Mubashar presented the unit and described the concept
and objectives of social mobilization. This intended to enable the people for collective
actions through their organization and mobilization of all resources. The social contract is
a tool that illustrates the role of different partners. It emphasizes the steps which are to be
carried out by the community for getting orientation of the CBI approach, mobilizing all
components for proper organization and implementing appropriate strategies focusing on
socio-economic development. He mentioned the targets to be fixed in the social contract
should be based upon the area development profile derived from base line survey and in
accordance with the country national targets. This being the joint endeavour, role of all



                                              8
partners should be earmarked. The expected outcome of the social contract pertains to
improvement of health indicators and ultimately quality of life.

The participants raised the following points:
   • The indicators in the rural areas are usually not correct, and accurate data is not
       available.
   • Attention should be given to the priority needs according to the community
       requirements.
   • The roles of different stakeholders should be identified first while setting
       priorities and it should be emphasized that how to convince the community to
       assign priority to health sector against their actual requirements in the other social
       and income generating activities.
   • Development has social and economic dimensions and the focus may therefore be
       the on social interventions.
   • The active mobilization can take place where some structures are available and
       that needs financial and legal support.
   • Women and gender issue should be given sufficient priority in the social
       mobilization process.
   • It should be expounded that how community can be reached for social
       mobilization and organization, ensuring solidarity and harmony at local level?

Dr. Mubashar clarified the above issues and observations, and informed that solidarity is
important component of CBI, have brought the rival families together such as war in
Afghanistan was stopped for three days during the Polio campaign. He explained that
outcome indicators are designed for three years, which contribute the social development,
poverty reduction and improvement in quality of life. The roles of all stakeholders is
defined and documented in the social contract; whereas the indicators must be based
upon the actual needs of the community brought forward in the survey process. He added
that while setting targets, the communities should assign priority to health and there
should be no compromise on health development as this is central to all development
process and assists in poverty reduction.

Unit 3.2 Health development:
The unit described different health interventions must be carried out in each CBI area
irrespective of the issue that they are prioritized by the community or not. Dr. Nazar
presented the unit and highlighted its components, elements, specific objectives,
interventions and expected outcomes. The major elements of the package include
functional health facility, integrated management of child health, vaccination of children
and mothers, safe motherhood, food and nutrition, and control of communicable and
noncommunicable diseases.

The presentation was followed by discussion and clarification of the different
interventions carried out in the different countries. The participants raised the following
points for comments and clarification:




                                             9
   •   Environmental issues should be included in unit3.3 instead of unit3.2. They
       recognized its importance for programmes sustainability is particular in Healthy
       Cities Program.
   •   Definition and level of provision of the health packages is not clarified during
       presentation like role of community and role of health team.

The presenter appreciated these comments and assured they will be considered for the
final version of training manual.

Unit 3.3 Social development:
This unit is related to social interventions in response to the priority needs of the
community. Dr. Salah presented the development package of social sectors which
included education, literacy, housing, women empowerment, youth development, safe
drinking water and sanitation. The speaker highlighted the objectives and outcomes of the
interventions is different social sectors and explained different implementation
dimensions of these interventions. The intervention proposed in the unit will enable the
communities and partners to design innovative and feasible projects for social
development in the CBI areas.

The participants raised the following points for comments and clarification:
   • There is a need for change in behavior of the peoples towards women
       development, for increasing their literacy and empowering them in decision-
       making process.
   • The maximum and minimum needs package is required for uniform standard of
       life and improve the quality of life.

Dr. Mubashar winded up the discussion with the appreciation of the participants for their
keen interest in discussion and resolving the issues. He informed that EMRO has been
developing a standard format of packages for adaptation in all CBI areas in the countries.
He highlighted the issue of gender imbalance and need of appropriate actions and
strategies according to country and local requirements. It was discussed that males are
also discriminated in some areas as are females; therefore both should be given equal
consideration while designing projects to address the problem of gender inequities. It was
informed that recently a study has been conducted in Jordan on the gender issues, with
emphasis on women empowerment and this will be good entry point for introducing
strategies for balanced actions and equitable development.

Unit 3.4 Economic development:
The unit intends to provide a set of interventions which can be carried out for reducing
poverty. Dr. Fazli Hakim Khattak presented the unit and informed that major objective is
related to economic growth of the poor communities to achieve social gains, whereas the
expected outcome includes capacity building of the community for designing feasible and
innovative needs and interventions for poverty reduction and improvement in quality of
life. The major components of economic package include projects and activities related to
agriculture and irrigation, livestock and micro crediting. He explained that economic



                                           10
development package is a catalyst agent which supports improvement of social
indicators. The economic package may not be considered as assistance from a loan giving
agency or commercial banks. All economic development is meant for human
development, which after all assigns priority to the social sector.

The participants raised the following observations:
   • Local and appropriate technology may be adopted as a part of economic package
       for easy understanding and adaptation.
   • The women should be given more emphasis in development process through their
       training in the modern techniques for production and income generating that will
       improve their income and status of living.
   • Both gender groups should be given equal opportunities without empowering one
       group more and creating reverse imbalance.
   • The economic interventions should be need based, feasible and cost effective.
   • Each area should carry out income generation projects according to the
       availability of the resources.
   • As the unemployment rates are high, communities should be imparted technical
       training in various skills and provided facilities for small technologies for home
       based production like milk products, which should be according to local
       environment and demands.

Dr. Mubashar while concluding the session added that all interventions require proper
designing and feasibility. Some countries wrongly perceived to give more emphasis on
economic development that is merely a tool for social and health improvement. The
programme should play a catalytic role to invite and coordinate concerned sectors to
collaborate as multisectoral development is neither responsibility of the programme, nor
possible for CBI alone. We should negotiate with the partners and make it clear who will
do what. Again it needs lot of flexibility and dialogue. Regarding gender issue, every
community has boundaries and adjustments; we must comply with the cultural norms and
remain sensitive to local customs.

Unit 3.5 Health and development indicators:
This unit possesses the indicators to measure the outcomes of the interventions carried
out in CBI areas. Dr. Nazar presented the unit on and informed that these are tools for
assessing the programme achievements according to the predetermined goals and targets.
He presented the formulas of various indicators related to health, education, employment,
income and development.

The participants raised the following comments:
       • Difference between rate and ratio may be explained.
       • Literacy and education indicators may be elaborated.
       • More elaboration on types of indicators (e.g. inputs, process, out-put and
           impact indicators).
       • Classification of qualitative and quantitative indicators should be given.




                                           11
Responding to the queries, it was informed that indicators should be kept simpler, valid,
reliable, comprehensive, sensitive and specific. There are more indicators in the text
which might clarify the situation.

Module 4 Management of CBI
Module 4 is related to the management of CBI. It contains 10 units, which are identical to
the CBI guidelines and tools, as this module is prepared in accordance with this
document. This intends to make the participants capable to implement and manage the
programme in an effective manner.

Unit 4.1 Planning
This unit relates to the planning process in the CBI. Dr. Salah presented the unit and
explained planning process for introducing community based initiatives in a country and
at local level. Elaborating this process at model and expansion phases of the program, he
described and emphasized on the use of planning tools attached with the unit.

The participants divided into 4 groups, performed exercise to review and develop a plan
of action for CBI area. The groups presented their findings in the plenary session and
made relevant suggestion to improve the unit.

Responding to the queries, Dr. Mubashar emphasized that plan should be prepared
according to the available resources including those of financial, technical and human.
The plan should be comprehensive and clearly providing replies of questions like what,
how, and when to initiate the actions and complete the projects. It should be designed on
the basis of the community needs. He advised the participants to consult the CBI training
manual as well as CBI guidelines and tools for more understanding and designing of
feasible plans for the CBI areas in their respective countries.

Unit 4.2 Organization:
This unit describes the organizational set up in the CBI and illustrates the specific role of
each structure. Dr. Nazar presented the unit and elaborated the organizational levels and
the structures as well as their roles in the community based initiatives (BDN, HVP and
HCP). He also discussed the criteria for selecting community representatives and
developing intersectoral support system in a country.

Participants proposed to keep limited number of members in the CDC. They also asked
why the programme managers must be form the government sector. They suggested
strengthening the role of government departments and developing linkage among the
villages implementing CBI. Communities should be gradually empowered more by given
a bigger role. The women should be essential component of community organization, and
must have at least 40-50% of the total representation. At national level, technical
committee should also work in addition to national councils comprising of government
authorities.




                                             12
Responding to the queries ands suggestions, facilitators informed that the unit provides a
framework that is quite flexible and can be adapted according to the country and local
situation. It was also clarified that national council may not be required at initial stage;
however to ensure sufficient political commitment, it should be constituted after the
model area/s are developed.

The participants were divided into 4 groups and each group worked on one situation of a
village given in a case study and designed strategies for organizing the communities,
which were presented in the plenary session.

Unit 4.3 Human resources development:
The unit described the human resources development in CBI setting. Dr. Salah presented
the unit and emphasised the importance of capacity building in CBI, especially at
community and district levels. The contents of the training plan were discussed and
participants were asked to adapt them while implementing in their respective countries.

The participants were of the view that community cannot spare more time, therefore
community training should be only according to their convenience. The training plans
should be linked with the objectives and right kind of people should be invited in the
training sessions. The training materials should be translated into country languages and
even in local languages for better understanding of the people. The master trainers must
develop certain skills required for effective capacity building in the countries. They also
recommended addition of a column for levels in the training plan framework.

The participants in 4 groups prepared training plan for the assigned target groups and a
presented the outcomes in the plenary.

Unit 4.4 Community surveys and prioritization of needs:
This unit presents the tools and process of collecting baseline information, prioritization
of needs and preparing area development plan. Dr. Nazar highlighted the importance of
community based information system and described the survey for collecting household
and community information. He also elaborated how the community can identify their
problems and prioritise their needs as a prerequisite for preparation and implementation
of multisectoral developmental projects. The participants were asked to adapt the survey
tools according to country and local situations.

Groups read out the survey tools and made recommendations for their improvement.
They suggested that the questions must not give more than one meaning and while
translating into local language, the spirit and meaning of the question should not change.
It may be made in line with the health information system already practiced in some
countries. The information should be well documented and displayed in the CBI areas.
The indicators to be studied should be limited and the explanations of the terminologies
used should be available to the surveyors along with the survey tools. The format may be



                                            13
changed by putting indicators and then the relevant questions. The description of age
given by WHO and MOH should be same. The columns for youth should be recorded
according to the age group. They suggested that primary analysis of survey date should
be at local level, whereas advanced analysis should be at upper level like national level.

Unit 4.5 Projects preparation and implementation:
This unit is related to preparing the project proposals for social and income generation
activities. Dr. Nazar presented this unit, emphasising mainly on the difference between
social and income generation projects. He also explained the role of communities and
technical intersectoral teams in preparing project proposals. He described the methods to
prepare proposals and related feasibilities.

Participants in 4 groups prepared proposals for social and during group work which were
discussed in the plenary. It was emphasised that issue if sustainability should be
considered while preparing the proposals. The cost benefit and facilities should be the
basic criteria for the projects. The community must play key role in planning and
implementing the projects.

Unit 4.6 Supervision and monitoring:
The unit provides the mechanism to supervise e and monitor the CBI areas. Dr. Salah
presenting this unit and emphasized that supervision and monitoring should be an in built
mechanism of CBI. He detailed the main criteria and principles for effective supervision
and monitoring. The checklist for the supervision and monitoring of CBI areas was
described and the participants were asked to review this during the group work.

After group work, participants came up with the following comments:
           • Community should be involved in the supervision and monitoring of CBI.
           • Distinction should be made between supervision & monitoring.
           • Information on the community mobilization & social contract should be
              collected during the first supervisory visit.

Unit 4.7 Financial management:
The unit contains guidelines and tools to manage the community finances. Dr. Mahmood
presented the unit and mentioned that financial management is one of the fundamental
issues and key challenges in CBI. He narrated the whole process and steps to practice in
managing the accounts at community level. He also described difference between
principal account (PFA), revolving fund (RF) and community development fund (CDF).
The financial procedures and tools of CBI were also detailed with examples.

Groups reviewed the financial tools and presented their finding and comments according
to following:
    • Community should be fully empowered for management and use of finances with
        defined rules and regulations for maintaining transparency.


                                           14
   •   Government workers should not be provided from CDF.
   •   The revenues of some social projects (running & maintenance cost) should be
       deposited in CDF.
   •   The philosophy behind CDF should clarify that it is not Ribba. In this regards a
       Fatwa should be obtained and circulated to the CBI areas.
   •   Financial tools should be made simpler for use by the community.

Unit 4.8 Documentation and reporting:
The unit describes the information system to be practiced in the CBI areas. Dr. Nazar
presenting the unit emphasized its significance and introduced CBI documentation and
reporting tools which should be adapted by each country according to local needs. These
may be adapted for use in urban for healthy cities programme. He mentioned the levels of
reporting    in    model      phase,     whereas      middle    level     (districts and
governorates/provinces/states) will be included with the expansion of the programme.

The groups reviewed the tools and presented their recommendations as under:
   • Inclusion of information on Village Information Center (VIC).
   • Levels of reporting should be clear, informing whom will report to who.
   • Emphasis should be on community reporting by VDC and CRs.
   • Report should be on monthly basis consisting of individual report of the
       projects/activities and general report of the area.
   • Reporting tools should be simplified for community use and should be based upon
       the indicators.

Unit 4.9 Promotion and advocacy:
This unit illustrates basic information about how programme promotion and advocacy
can be carried out in CBI. Dr. Nazar while presenting the unit emphasized it importance
in bringing more partners on board in addition to getting political support and mobilizing
resource. It is an entry point for the decision makers and the programme success largely
depends upon successful advocacy. The tools used in CBI were presented briefly. The
participants were asked to adapt these at country level while carrying out advocacy
activities.

The groups made plans for carrying out advocacy in their area and presented in the
plenary. The results of the discussion and recommendations included:
    • Success stories and achievements of national programme should be used as a tool
       for advocacy.
    • Messages of signatories on specific occasions, functions and competitions and
       reports by government on development should also be made a tool for advocacy.
    • Exchange of experience and visits between CBI areas should be a regular feature.
    • At least one member of CBI national team should be responsible for advocacy &
       promotion.
    • Regular CBI newsletter should be published by regional office & circulated to
       member countries. In addition to this, CBI web site should be developed.
    • Advocacy should be carried out at regional and international level also.


                                           15
   •   The table in the text book to be reformatted from left to right as follows:
       ‘Target groups, channels of promotion and messages to be delivered’

Unit 3.10 Programme evaluation:
The unit contains the indicators and procedures required for the programme evaluation.
Dr. Nazar presented this unit and mentioned that evaluation is a crucial step in CBI
process. He presented indicators to be evaluated, its methodology and WHO experience
in the region.

The participants reviewed the evaluation indicators and presented the following
recommendations:
      • Concept and definition of effectiveness and efficiency should be introduced in
          this unit.
      • Distinction should be made between monitoring and evaluation to remove the
          confusion.
      • Indicators of evaluation should be based on inputs, processes & outputs in
          addition to thematic classification that should also be made clear.
      • Percentage should be taken instead of numbers.
      • Evaluation should be made for all level of the programme management.
      • Information of the programmes should be comprehensive and made available
          for evaluators.

Module 5
Module 5 is comprised of 4 units related to management techniques, problems solving
and decision making, effective communication and operational research. This is aimed to
build up capacities and develop certain skills among the CBI management teams so that
they may carry out programme activities more effective manner.

Unit 5.1 Management techniques:
The unit contains the skills required for efficient management, leadership role, team work
and effective coordination. Dr. Salah presenting this unit, stressed that community and
technical teams should acquire basic management skills and techniques to implement
CBI. He presented the basic concepts and applied techniques related to management,
leadership, team approach and coordination were presented.

Participants commented that CBI training should be practice oriented and these practical
skills and techniques must be learned by demonstration and applied in the field to
facilitate this development process.

Unit 5.2 Problem solving and decision-making:
The unit is based upon the methodology to solve the problems and make appropriate
decisions at local level. Dr. Nazar while presenting this unit described the problem
solving and decisions making cycle with examples and indicated its application in a
community setting.


                                            16
Participants commented on the need to have various alternative methods for decision
making according to the educational levels of communities. Participants in 4 groups were
assigned cases for this exercise and the outcomes were presented in the plenary.

Unit 5.3 Effective communication:
The unit comprise of the concepts and techniques of effective communication. Dr. Salah
presented this unit and mentioned various types of communication techniques and their
effective use in CBI in all levels.

Participants recommended that communication skills should be used as an essential
element and as a practical tool for mobilizing communities and partners.

Unit 5.4 Operational research and development:
This units contains the concept and methodology of making operational research,
developing a research proposal and writing the report. Dr. Nazar presented the unit and
emphasized on the role of operational research and the need for evidence based
documents in CBI. It was realized that there is greater need to carry out research on
related issues and documents them for making the approach more acceptable to the
partners. He went through the steps of research proposal, conducting research and writing
its report.

Participants showed their keen interest in this subject and they agreed that operational
researches should go hand in hand with all steps of CBI implementation. They
recommended that WHO should earmark some grants for research and it should be made
an essential component of CBI.




                                           17
4– Field visit
The field visit was carried out on the 11th August. The objectives of the field visits were:
   • Learning through demonstration
   • Capacity building for practical implementation of the programme

Dr Mahmood Afzal presented the objectives, guidelines and plans of the field visit
(copies attached as Annex-I). Later on participants were divided into two groups:
   1. One group went to Mudari village; 30 min drive south to Amman where the
       Healthy Village programme is implemented by MOH.
   2. Other group went to Ume Qais village, 2 hours drive by car from Amman in the
       far north of Jordan near the borders with Syria & Palestine, where the Quality of
       Life project is implemented by Noor Hussein Foundation.

During the field visit both groups obtained the opportunity to see the CBI in practical
form. They met with the communities and inspected the social and income generation
projects. They learned form the communities and the TSTs about the process of
implementing the projects, and interviewed the beneficiaries to see the outcome of these
interventions.

Each group presented their feedback on the field visit on the next day (report of one
group attached as Annex-H). Most of the comments were as follows:
   • MOH & NHF should collaborate and share their experience.
   • The selection criteria should be strictly followed while initiating the CBI.
   • Role of community should be strengthened in financial management.
   • VDCs & CRs should play major role in programme implementation.
   • ‘Village information center’ a documentation model of HVP may be adapted by
       the countries.

Both groups were satisfied for the field visits and they appreciated the efforts done by
both MOH & NHF. They were thankful to both of them for providing this opportunity to
see their experience.

One of the participants from Saudi Arabia commented that “this is the
first time for me be to be convinced that there is what is called bottom-up
planning and there is a role for community to decide on how to solve their
problems by themselves”.




                                             18
5- PRE & POST TRAINING ASSESSMENT
A tool was designed to assess the knowledge of participants before and after the training
course (attached as Annex-C and Annex-D). The assessment tool composed of 10
questions covering most of the topics and issues dealt during the training course. The
results of the pre and post assessment were analysis and compared with the standard key
(attached as Annex-E). Another tool was also designed for the participants to evaluate
and give their comments on the training course content and organization (Annex G).

According to the results (attached as Annex-F), there is remarkable gain of knowledge in
some of the topics, while for some the gain is minimal. This phenomenon can be
explained by the fact that tool was not well explained to the participants, and the Arabic
translation was not properly made with the resultant diminished understanding of the
questions. Another likely explanation is that the questions were open for one or more
options out of four and participants made more missing than mistakes. In this regards, the
pre-testing of the revised and translated tool will be useful for better understanding in
future courses.




                                           19
6- CONCLUDING SESSION
The concluding session was chaired by Dr. A. Alwan WR/Jordan. Dr. Mahmood Afzal
presented the details about the training course, informing about its structure, contents,
proceeding and outcomes. He appreciated the active participation of the participants
during the presentations, working sessions and discussions, which resulted in valuable
suggestions and feedback on the training materials. He also informed about the field visit
to HVP and QOL villages and sharing of experiences by each. He appreciated the
cooperation of WR office and the hard work done by the facilitators and the support staff.
He assured that comments made by the participants during training course will be taken
into account while reviewing the training materials.

Dr. Salah Al Badawi presented results of the pre and post training assessment, and
mentioned the outcome of the training course as remarkable. On behalf of the
participants, Dr Nour from Djibouti paid gratitude to the facilitators for their support and
guidance. He specially thanked CBI unit of WHO/EMRO for organizing such a
successful workshop which will help the participating countries in improvement of their
health and development programmes.

Dr A. Alwan WR Jordan thanked the participants for their patience to stay for 8 days in
this intensive course. He expected that participants will be able to better manage the CBI
activities and develop the capacities of the human resources when will go back to their
countries. He asked the participants to adapt the materials according to their situation. He
also highlighted on the importance of monitoring the progress of implementation and to
share information with each other.

He invited the participants to give their comments and feedback. Participants had
consensus that it was useful training course and they gained a lot from the training. They
thanked the Jordanian authorities for their hospitality and WHO regional office for
arranging the course. Their main comments were:
•     The hotel accommodation and its services were unsatisfactory and needs
      improvement.
•     The methods of conducting of the training course were good, facilitators did their
      hard work to present more holistic and valuable topics but there were some
      important points require need more explanations.
•     The exchange of ideas and experiences during working groups was a great chance;
      however more time was required to share the comments and suggestions with the
      participants of other groups.
•     Due to intensive training, there was not sufficient refreshing time.
•     The field visits were very good experiences useful to visualize the CBI ideas being
      practiced in reality. Such demonstration visits should be given more time.

At the end, Dr. Alwan on behalf of RD/EMRO distributed certificates to the participants
and wished them safe return back to their homes.


                                            20
7- Recommendations
Following is the summery of the recommendations made by the participants during the
training course:
•      The training manual should be revised and restructured, by performing following
       modifications in the final version:
             o The units of quality of life and sustainable development should be merged
             o The case study should be shifted from unit of organization to unit of social
                 mobilization
             o The components of environment and water supply should be shifted from
                 health package to social package
             o Classification of indicators should be elaborated for better understanding
             o The units of management techniques, communication and problem solving
                 & decision making should be merged together.
•      Poorest of the poor should be targeted, by defining poverty at country level,
       focusing on development of human resource and ensuring the sustainability factor.
•      WHO should support Community Oriented Medical Education “COME”) to
       include CBI in the curricula of undergraduate medical studies.
•      WHO and MOH should train and orient other sectors, partners and NGOs to initiate
       similar initiatives and adopt strategies focusing on health and human development
•      Promotion of health and healthy lifestyles should be focused in the CBI areas,
       implementing health interventions regardless it is priority of the community or not.
•      Economic development should be considered as a catalyst agent to support
       improvement of social indicators and the human development.
•      Both gender groups should be given equal opportunities without creating reverse
       imbalance.
•      Communities should be empowered to self manage the programme and monitor its
       activities.
•      CBI tools should be adapted and translated into local language,
•      The village information system implemented by HVP Jordan should be adopted by
       all countries with local adaptations
•      The reports from CBI areas should be disseminated on monthly basis based upon
       simple indicators.
•      WHO regional office should publish regular newsletter on CBI in addition to
       developing CBI web site.
•      Research should be made regular feature of CBI areas and WHO should earmark
       some grants for research.
•      The participants as master trainers should adapt training materials locally, translate
       into national languages and impart training to all teams and communities afresh.




                                             21
ANNEXES




   22
                                                                        Annex- A


                          SECOND REGIONAL TRAINING COURSE
   World Health
  Organization

                             FOR THE MASTER TRAINERS ON
                            COMMUNITY BASED INITIATIVES
                                5 to 12 August 2003, Amman, Jordan


   Regional office for
  Eastern Mediterranean
                             PROGRAMME
                             8 to 12 August 2003
    Time                    Activity                Unit            Facilitator
Tuesday, 05 August 2003
0800 to 0830 Registration                                     Dr Kreishan / Mrs Hijazi
0830 to 1000 Inaugural session
1000 to 1100 Pre-training assessment                               Dr El Badawi
              Module 1 (Basic concepts)
1100 to 1120 Health and quality of life            Unit 1.1          Dr Afzal
1120 to 1140 Sustainable development for health    Unit 1.2          Dr Sheikh
              and poverty reduction
1140 to 1200 Community based initiatives in        Unit 1.3          Dr Sheikh
              EMR
1200 to 1230 Discussion on Module1
              Module 2 (Public health)
1230 to 1300 Concept of health, HFA and PHC        Unit 2.1         Dr El Badawi
1300 to 1330 Discussion
1330 to 1400 Health promotion and protection       Unit 2.2       Dr Abdel Rahim
1400 to 1500 Lunch break
1500 to 1530 Discussion
1530 to 1615 Disease prevention and management     Unit 2.3       Dr Abdel Rahim
1615 to 1645 Discussion

Wednesday, 06 August 2003
              Module 4 (Social mobilization and development)
0830 to 0900 Community mobilization and social     Unit 4.1       Dr Sheikh
              contract
0900 to 0930 Discussion
0930 to 1000 Development package: Health           Unit 4.2  Dr Abdel Rahim /Dr
1000 to 1030 Discussion                                             Afzal
1030 to 1100 Development package: Social           Unit 4.3     Dr El Badawi
1100 to 1130 Coffee break
1130 to 1200 Development package: Economic         Unit 4.4   Dr Khattak / Dr El
1200 to 1230 Discussion                                            Badawi
1230 to 1300 Health and development indicators     Unit 4.5  Dr Abdel Rahim / Dr
1300 to 1330 Discussion                                            Khattak


                                     23
               Module 3 (Management of CBI)
1330 to 1400   Planning                               Unit 3.1       Dr El Badawi
1400 to 1500   Lunch break
1500 to 1645   Group work                             Unit 3.1
1645 to 1730   Presentation and discussion
1730 to 1800   Planning profile – a case study from                   Dr Khatak
               Pakistan

Thursday, 07 August 2003
0830 to 0930 Organization                              Unit 3.2   Dr Abdel Rahim / Dr
0930 to 1130 Group work                                                 Afzal
1130 to 1200 Coffee break
1200 to 1245 Presentation and discussion               Unit 3.2
1245 to 1315 Human resource development                Unit 3.3      Dr El Badawi
1315 to 1415   Group work
1415 to 1515   Lunch break
1515 to 1630   Group work(continue)                    Unit 3.3
1630 to 1700   Presentation and discussion

Friday, 08 August 03
O800 to 0845 Community survey and needs                Unit 3.4     Dr Abdel Rahim
               prioritisation
0845 to 1100 Group work
               Working coffee
1100 to 1130 Presentation and discussion               Unit 3.4
1130 to 1200 Projects preparation and                  Unit 3.5      Dr El Badawi
               implementation
1200 to 1430 Group work                                Unit 3.5
0800 to 0830 Presentation and discussion               Unit 3.5

Saturday, 09 August 03
0830 to 0900 Supervision and monitoring                Unit 3.6      Dr El Badawi
0900 to 1030 Group work
1030 to 1100 Coffee beak
1100 to 1145 Presentation and discussion               Unit 3.6
1145 to 1215 Financial management                      Unit 3.7        Dr Afzal
1215 to 1410 Group work
1410 to 1500 Lunch break
1500 to 1545 Presentation and discussion               Unit 3.7
1545 to 1630 Documentation and reporting               Unit 3.8     Dr Abdel Rahim
1630 to 1800 Group work                                             Dr Abdel Rahim

Sunday, 10 August 03
0800 to 0845 Presentation and discussion



                                      24
0845 to 0915    Promotion and advocacy                Unit 3.9       Dr El Badawi
0915 to 1100    Group work
                Working tea
1100 to 1130    Programme evaluation                  Unit 3.10     Dr Abdel Rahim
1130 to 1300    Group work
1300 to 1400    Presentation and discussion
1400 to 1500    Lunch break
                Module – 5 (Leadership skills)
1500 to 1520    Management techniques                 Unit 5.1       Dr El Badawi
1520 to 1540    Effective communication               Unit 5.3
1540 to 1615    Discussion
1615 to 1645    Problem solving and decision          Unit 5.2
                making
1645 to 1830    Group work

Monday, 11 August 03
0800 to 0820 Briefing on quality of life (QOL)                     Mr Hadid (QOL)
             programme, Jordan
0820 to 0940 Briefing on healthy village                          Dr Kreishan (HVP)
             programme (HVP) Jordan
0840 to 0850 Discussion and clarifications
0850 to 0900 Field visit objectives and                                Dr Afzal
             methodology
0900 to 1600 Field visit, demonstration of projects               Dr Kreishan (HVP)
             and interaction with the community                    Mr Hadid (QOL)

Tuesday, 12 August 03
0800 to 0830 Presentation and discussion              Unit 5.2
0830 to 0850 Post-training assessment                                Dr El Badawi
0850 to 0920 Feedback on field visit
0920 to 1000 Operational research and                 Unit 5.4    Dr Abdel Rahim / Dr
              development                                              Khattak
1000 to 1030 Discussion
1030 to 1100 Feedback on training course                            Dr Abdel Rahim
1100 to 1200 Certificates and concluding remarks                       Dr Alwan
1200          Lunch




                                      25
                                                                             Annex-B

  SECOND REGIONAL TRAINING COURSE FOR THE MASTER TRAINERS
                   COMMUNITY BASED INITIATIVE
              Amman, Jordan, from 5 to 12 August 2003

                   LIST & ADDRESSES OF PARTICIPANTS

Name               Designation       Address              Contact
DJIBOUTI
Mr Mohamed         National Focal    Address:             Tel: (253) 35 0647
Nour Saleh         Point for BDN     P.O.Box 298          Fax: (253) 34 1774
                   Programme         Djibouti
EGYPT
Mrs Hala Ali       BDN Focal         Address: 3 Magless   Tel: 010 150 7126 / (202)795
                   Point             Al-Shab.St.,         37 08
                                     P.O.Box 146          Fax:010 150 7126
                                     Cairo, Egypt         E.mail:alih@emro.who.int
ISLAMIC REPUBLIC OF IRAN
Eng. Seyed        Senior Expert      Ministry of Health- Tel: 98(21) 881160-3
Enayatollah Asaei of                 Department       of Fax: 98(21)8303016
                  Environmental      Environmental and E.mail: s_asaei@yahoo.com
                  Health/National    Occupational
                  Focal     Person   Health, Iran
                  for CBI
Mrs Zahra Salimi  Technical          Ministry of Health   Tel: 98(21) 88 11 360-63
                  Officer in BDN     Iran                 Fax: 98(21) 830 30 16
                  Group
                  Department of
                  Environmental
                  and
                  Occupational
                  Health
JORDAN
Dr Abdullah Odeh Ma’an Health        P.O.Box 4 , Ma’an    Tel: 077 759 829
Idwairej          Directorate,       Jordan               Fax: 032131347
                  Ministry of
                  Health
Dr Adel Daoud     Ministry of        Fuhias- Jordan       Tel: Office: 05 3516048
                  Health             P.O.Box 203          Res:4729533
                                     Al-Fuhais, Jordan
Dr Bilal – Al- Ministry of           North Agwar,         Tel: (02) 6587319/6587420
Humod-Bani Hani Health               Jordan               Res. 02 7314799
                                                          Fax: 6587101
Dr Nawal Kreishan BDN Focal          P.O.Box 922632       Tel:Office:5607144
                  Point              Amman 11192          Res:5530057


                                        26
                  Ministry of         Jordan               Mobile: 079-5830201
                  Health                                   Fax: 9626-568 6965
                                                           E.mail: kinawal@yahoo.com
Ms Nina Jada’     Noor Al-            Noor Al-Hussein      Tel: 9626- 5606992 Mob:962
                  Hussein             Foundation           79 5264554
                  Foundation          P.O.Box 926687,      Fax: 9626 5620864
                                      Amman 11110          E.mail:
                                      Jordan               nina_jadaa@hotmail.com
Mr Mahmoud Al-    Quality of life     Noor Al-Hussein      Tel: 5606993
Hadid             project director    Foundation           Fax: 5620864
                  Noor Al-            P.O.Box 926687,      E.mail: qol-nhf@nic.net.jo
                  Hussein             Amman 11110
                  Foundation          Jordan
MOROCCO
Dr Katra Ennada   Chef           de   220 rue Darl El      Tel: 037 20 73 84/061 3060
Darkaoui          Division      des   gueddar:             74
                  Soins               Ambassador Rabat     Fax: 037 20 7381
                  Ambulatoires        Morroco              E.mail:
                  Direction des                            nada_darkaoui@hotmail.com
                  Hopitaux et des
                  Soins
                  Ambulatoires
                  MOH, Rabat
Dr Naima          Enseignante-        residence El Yousr   Tel: (212)37.71.23.05/061 07
Chikhaoui         chercheur a         Im G2                64 02
                  l’INSAP             Secteur:17,HayRiad   Fax: (212) 37 75 08 84- (212)
                  Institut National   Rabat/Morocco        37.77.31.85
                  des Sciences                             E.mail: chikhaoui@menara.ma
                  d’Archeologie
                   et du
                  Patrimoine.
                  Department
                  d’Anthropologi
                  c sociale et
                  culturelle
                  Rabat
PAKISTAN
Dr Fazli Hakim    WHO                 Health Division,     Tel: 9251 9204187
Khattak           Economist           14.D,West Feroze     Fax: 92 51 921 5610
                                      Center, Blue Area    E.mail:
                                      Islamabad            khattakfh20@hotmail.com
                                      P.O.Box 1013
                                      Pakistan
Khawaja           Secretary for       14-D West Feroze     Tel: +92 51 920 4187
Mussaddiq Ali     IMCI                Center, Blue Area,   Mob: +92 300 850 7590
Khan                                  Islamabad            Fax: +92 51 921 5610


                                         27
                                     P.O.Box: 1013 (C/o E.mail:
                                     WHO Country        mussaddiq@hotmail.com
                                     Office),Pakistan   whoimci@comsats.net.pk
SAUDI ARABIA
Eng. Ahmed         HCP Focal         P.O.Box 43043         Tel:055268380
Abalkhail          Point             Ryadah 11561          Fax: 01 462 3341
                   Diriyah city      Riyadh,               E.mail:
                                     Saudi Arabia          mr-planer@hotmail.com
Mr Hamad Khalid    Health            P.O.Box 2903          Tel: 014 767519
Al Khowailid       Education         Riyadh 11461          Mob:055106976
                   Specialist/       Riyadh,               Fax: 01280-1469
                   Supervisor of     Saudi Arabia          E.mail: gosaiba@hotmail.com
                   Healthy Cities
                   Programme,
                   Riyadh
Dr Yahia Al        Assistant         Abha                  Tel: 2246330
Khaldi             Director for      P.O.Box: 2653         Fax: 9667 2246330
                   Primary           Saudi Arabia          E.mail:
                   Health, Aseer                           Yahiammh@hotmail.com
                   Region
SUDAN
Dr. Bahaa Eldin    Programme         Federal Ministry of   Tel: 012 139 314
Mohamed Dafaalla   Officer           Health,Khartoum       Fax: 00 249 11 436360 or
                                     P.O.Box : 303         438675
                                     Sudan                 E.mail: babanosa@Yahoo.com
Dr Ibrahim         Director Health   FMOH,Health           Tel: 00249 121 46 799
Suliman Mahjoub    Promotion         Promotion             Fax: 00 249 11 784819
Elsubai                              Sudan

Dr Samia           PHC Director      Khartoum- PHC         Tel: 432128/432095
Mohamed Hassan                       Building              E.mail:
                                     Sudan                 iman-tarig@hotmail.com
Dr Sumaia El Fadil Medical Officer   WRO                   Tel: 00 249 1177 6471
                   WRO, Sudan        P.O.Box:2234          Fax: 00 249 1177 6282
                                     Sudan                 E.mail:
                                                           sumfadil@yahoo.com
SYRIAN ARAB REPUBLIC
Dr. Haitham   Directorate of         P.O.Box 36597         Tel: 963 11 2217097
Jabbour       Healthy                Damascus-Al-          Res: 963 11 6615638
              Villages-MOH           Mazzeh                Mobile: 963 94 274094
                                     Syria                 Fax:963 11 2217097
                                                           E.mail:
                                                           jubbour@scs-net.org
                                                           haitham2003@shuf.com
Dr. Jazla Fida     Directorate of    Healthy Villages      Tel: 963 1122 17097
                   Healthy           Programme,            Mob: 963 94 249153


                                        28
                   Villages –          Ministry of Health,   Res: 963 1144 62094
                   MOH                 65 hotien st.         E.mail:
                                       Almazraa-             jazlaf@scs-net.org
                                       Demascus, Syria.
Mr. Mahmoud        Field               The Health Center,    Tel: ++94 556020 -++963
Da’as              Coordinator -       Palmyra-              94556020
                   Al badia area       Syria                 Fax: ++963 31 911300
TUNISIA
Dr Abdelbaki       Medecin de la       Hopital Regional      Tel: 00216 984 29006
Bouallegue         Sante Publique      Gafsa                 Fax: 00216 7622 9500
                   a Gafsa et          Tunisia
                   membre de la
                   Jeune
                    Chambre
                   Economique
Mr Mohamed         Inforamaticien a    Villa Ennajeh         Tel:216 9854 6806
Lotfi Alaya        la Compagnie        Doualy Gafsa          Fax: 216 762 24136
                   de                  Tunisia               E.mail:
                   Phosphate,Gafs                            lotfialaya@yahoo.fr
                   a Conseiller a la
                   Municipalite de
                   Gafsa
YEMEN
Dr Abdul Karim     Focal Point for     P.O.Box: 4342         Tel: 9671-616118
Mash-Hoor          BDN activities      Sana’a                Mob: 73761606
                   In Sana’a           Yemen                 Fax: 00 9671 251616
                   Governorate
Dr Gamil Al –      Focal Point for     Khor-Makssar-         Tel: 9671-252213 Sana’a/
Baidani            BDN activities      Aden,Yemen            9672 237776 Aden
                   In Aden             P.O.Box: 543          Res: 9672 234265 Aden
                   Governorate         Sana’a                Fax: 00 9671 251616
                                       Yemen
Eng. Abdul Malik   WHO-BDN-            Sana’a Al-Hasaba      Tel: 9671 332014 252213
Mufadal            Yemen               St.MOPH               Fax: 00 9671 252516
                                       P.O.Box: 543          E.mail:
                                       Yemen                 mufad@yemennet.net.ye
OBSERVERS FROM JORDAN
Dr. Raeq Abu- H.V Co-                  Zarka                 Tel: 02 6350421
Asbah         ordinator of             P.O.Box 6460          Mob:077 406 430
              Jerash                   Country:Jerash-
Ms Intisar    Noor Al-                 Nour Al-Hussein       Tel: 560 6992 077-210300
Nuseibah      Hussein                  Foundation            Fax: 5606994 - 5620864
              Foundation               P.O.Box 926687        E.mail:
                                       Amman-Jordan          qol-nhf@nic.net.jo
Mr Ahmad           Noor Al-            Noor Al-Hussein       Tel: 5606992- Res. 05 355
Hamdan             Hussein             Foundation-Quality    1301


                                          29
                    Foundation     of Life Project      Fax: 5620864,5606994
                                   P.O.Box1 (1110)      E.mail:
                                   926687               Ahamda47@hotmail
                                   Amman-Jordan
WHO SECRETARIAT
Dr. Ala’ Din WR, Jordan            WRO, Jordan          Tel:(++962-6) 5605027
Alwan,                                                  Fax: (++9626)5667533
                                                        E.mail:
                                                        whoamman@go.com.jo
Dr Mubashar         Regional       Eastern              Tel: 202-2765307
Sheikh              Adviser CBI    Mediteranian         E.mail:
                    WHO/EMRO,      Office,Wold Health   Mubashar@emro.who.int
                    Egypt          Organization,Nasr
                                   City, Cairo, Egypt
Dr Muhammad         Facilitator    513-C,               Tel:0092 42 5160924
Mahmood Afzal       WHO/Training   Faisal Town,         E.mail:
                    Course         Lahore,              mahmood_afzal_who@hotmai
                                   Pakistan             l.com
Dr Nazar Abdel      Facilitator   National CBI Focal    Tel:00249 12131402
Rahim               WHO/Training  Person MOH            Fax: 00249 438675
                    Course        P.O.Box 303           E.mail:
                                  Sudan                 nazarmohamed@hotmail.com
Dr Salah El         Facilitator   C/O WHO-              Tel:249 1213 1473
Badawi              WHO/Training Khartoum               Fax:249 11 776282
                    Course        P.O.Box :2234         E.mail:
                                  Sudan                 salah_badawi@hotmail.com
Eng. Randa Hijazi   CBI-BDN Focal P.O.Box : 811547      Tel: 5605027
                    Point         Amman 11181           Fax: 5667533
                    WRO/ Jordan   Jordan                E.mail:
                                                        whoamman@go.com.jo
Ms Khawla Al        Secretary      Address: WHO         Tel: 5605027
Soud                WRO/Jordan     Jordan               Fax: 5667533
                                                        E.mail: k.alsoud@yahoo.com




                                      30
                                                                                     Annex-C
                PRE TRAINING ASSESSMENT FORM
                       (Kindly select correct statement/s for each question)
                                                                                  Tick (√ ) the
                        QUESTIONS AND STATEMENTS                                  appropriate
                                                                                     boxes
                                                                                 A B C D
1. The community development means?
A). Poverty reduction is an essential component of health development
A) The health sector alone is responsible for improving alone can improve all
determinants of health
C) Development is achieved without community participation
D) Development projects are based upon needs assessment
2. The major objective of the CBI is:
A) Generating income
B) Promoting literacy
C) Improving health
D) Creating a parallel system for development
3. The critical partners for supporting community development are:
A) Public sector departments
B) NGOs and private sector
C) Community
D) International agencies including WHO
4. What kind of mechanism is needed for defining roles and setting the targets
at the time of initiation?
A) Formal contract between the community and supporting partners
B) Verbal understanding with the community
C) Arrangements with individual beneficiaries only
D) B+C
5. The role of a village development committee is:
A) Community mobilization
B) Programme management
C) Promotion and advocacy
D) All of the above
6. The role of the intersectoral technical support team is:
A) Decision making
B) Technical support
C) Providing loans
D) Implementation of the projects




                                                  31
                                                                           Tick (√ ) the
                      QUESTIONS AND STATEMENTS                             appropriate
                                                                              boxes
                                                                          A B C D
7. The major role of WHO is:
A) Advocacy and technical support
B) Providing funds
C) Managing programme
D) None of the above
8. The priority target groups for income-generating projects should be:
A) The poorest of the poor
B) Women and vulnerable groups
C) Members of the community organization
D) Technical support team
9. Who should guarantee the return of loans?
A) VDC
B) Government
C) Banks
D) No need for a guarantee
10. Supervision and monitoring for CBI should assess:
A) Technical capacity at all levels
B) Sustained improvement of socio-economic indicators
C) Documentation and dissemination of programme activities
D) Resource mobilization and partnerships




                                               32
                                                                                     Annex-D
               POST TRAINING ASSESSMENT FORM
                       (Kindly select correct statement/s for each question)
                                                                                  Tick (√ ) the
                        QUESTIONS AND STATEMENTS                                  appropriate
                                                                                     boxes
                                                                                 A B C D
1. The community development means?
A). Poverty reduction is an essential component of health development
A) The health sector alone is responsible for improving alone can improve all
determinants of health
C) Development is achieved without community participation
D) Development projects are based upon needs assessment
2. The major objective of the CBI is:
A) Generating income
B) Promoting literacy
C) Improving health
D) Creating a parallel system for development
3. The critical partners for supporting community development are:
A) Public sector departments
B) NGOs and private sector
C) Community
D) International agencies including WHO
4. What kind of mechanism is needed for defining roles and setting the targets
at the time of initiation?
A) Formal contract between the community and supporting partners
B) Verbal understanding with the community
C) Arrangements with individual beneficiaries only
D) B+C
5. The role of a village development committee is:
A) Community mobilization
B) Programme management
C) Promotion and advocacy
D) All of the above
6. The role of the intersectoral technical support team is:
A) Decision making
B) Technical support
C) Providing loans
D) Implementation of the projects




                                                  33
                                                                           Tick (√ ) the
                      QUESTIONS AND STATEMENTS                             appropriate
                                                                              boxes
                                                                          A B C D
7. The major role of WHO is:
A) Advocacy and technical support
B) Providing funds
C) Managing programme
D) None of the above
8. The priority target groups for income-generating projects should be:
A) The poorest of the poor
B) Women and vulnerable groups
C) Members of the community organization
D) Technical support team
9. Who should guarantee the return of loans?
A) VDC
B) Government
C) Banks
D) No need for a guarantee
10. Supervision and monitoring for CBI should assess:
A) Technical capacity at all levels
B) Sustained improvement of socio-economic indicators
C) Documentation and dissemination of programme activities
D) Resource mobilization and partnerships




                                               34
                                                                                     Annex-E

  KEY FOR PRE AND POST TRAINING ASSESSMENT
                       (Kindly select correct statement/s for each question)
                                                                                   Tick (√ ) the
                        QUESTIONS AND STATEMENTS                                   appropriate
                                                                                      boxes
                                                                                 A B C D
1. The community development means?                                              √
A). Poverty reduction is an essential component of health development                          √
B) The health sector alone is responsible for improving alone can improve all                  √
determinants of health
C) Development is achieved without community participation
D) Development projects are based upon needs assessment
2. The major objective of the CBI is:                                                    √
A) Generating income
B) Promoting literacy                                                                    √
C) Improving health
D) Creating a parallel system for development
3. The critical partners for supporting community development are:               √   √   √    √
A) Public sector departments                                                     √   √   √    √
B) NGOs and private sector
C) Community
D) International agencies including WHO
4. What kind of mechanism is needed for defining roles and setting the targets   √
at the time of initiation?                                                       √
A) Formal contract between the community and supporting partners
B) Verbal understanding with the community
C) Arrangements with individual beneficiaries only
D) B+C
5. The role of a village development committee is:                                            √
A) Community mobilization                                                                     √
B) Programme management
C) Promotion and advocacy
D) All of the above
6. The role of the intersectoral technical support team is:                          √
A) Decision making                                                                   √
B) Technical support
C) Providing loans
D) Implementation of the projects




                                                  35
                                                                            Tick (√ ) the
                      QUESTIONS AND STATEMENTS                              appropriate
                                                                               boxes
                                                                          A B C D
7. The major role of WHO is:                                              √
A) Advocacy and technical support                                         √
B) Providing funds
C) Managing programme
D) None of the above
8. The priority target groups for income-generating projects should be:   √
A) The poorest of the poor                                                √   √
B) Women and vulnerable groups                                                √
C) Members of the community organization
D) Technical support team
9. Who should guarantee the return of loans?                              √       √
A) VDC                                                                    √       √
B) Government
C) Banks
D) No need for a guarantee
10. Supervision and monitoring for CBI should assess:                     √   √   √    √
A) Technical capacity at all levels                                       √   √   √    √
B) Sustained improvement of socio-economic indicators
C) Documentation and dissemination of programme activities
D) Resource mobilization and partnerships




                                               36
                                                               Annex-F

RESULTS OF PRE AND POST TRAINING ASSESSMENT
Question Number     Pre Assessment/Correct     Post Assessment/Correct
                   Answer (23 Respondents)     Answer (28 Respondents)

     Q-1            14                61%          14            50%


     Q-2            6                 26%          8             29%


     Q-3            15                65%          20            71%


     Q-4            6                 26%          9             32%


     Q-5            13                57%          20            71%


     Q-6            9                 39%      17                 61%


     Q-7            3                 13%          5             18%


     Q-8            16                70%          19            68%


     Q-9            2                 0.1%         3             11%


     Q -10          10                43%          8             29%


   Average        4.09             41%       4.4               44%




                                 37
                                                                                  Annex-G

EVALUATION OF TRAINING
                                                 Grading
                                                                               Suggestions
     Components           1            2              3       4      5             for
                         Poor        Not        Satisfactory Good Excellent   improvement
                                 Satisfactory
Administrative
Arrival arrangements
at airport
Accommodation
Food
Secretarial support
Technical
Venue
Duration
Comprehension
Quality and relevance
of training modules
Facilitators support
Attitudes
Knowledge
Quality of
presentations
Quality of group
works
Quality of plenary
discussion
Field visit
Transport
Usefulness
Clarity of objectives
Quality of time spent
in the field
Feedback and
discussions
How this training would help you in your work?




Suggestions for improving the future training courses?


                                                38
                                                                                Annex-H
RESULTS OF EVALUATION OF TRAINING
                                                 Grading
                                                                             Suggestions
     Components          1           2              3       4      5             for
                        Poor       Not        Satisfactory Good Excellent   improvement
                               Satisfactory
Administrative
Arrival arrangements      3         2                       1      11
at airport
Accommodation             2          4              7       5       3
Food                      3         10              9       2       1
Secretarial support       1                         5       6      14
Technical
Venue                     1         5               9       8       4
Duration                  1          4              9      10       3
Comprehension                        4              5       8       8
Quality and relevance               1               2       4      18
of training modules
Facilitators support
Attitudes                 1                         5       7      14
Knowledge                                           5       9      13
Quality of                1                         5       8      13
presentations
Quality of group                    2               7      10       8
works
Quality of plenary                                  5      11      11
discussion
Field visit
Transport                            3              6      10       9
Usefulness                                          5      11      10
Clarity of objectives                               4      16       7
Quality of time spent               1               6      12       8
in the field
Feedback and                                        5      11       8
discussions
How this training would help you in your work?


    - Gain knowledge and share of ideas and experience.


    - Improve community information system.


                                              39
   - Proper implementation of new ideas and how to deal with communities.


   - Having proper training manual which will ease conduction of training courses at country
       level.


Suggestions for improving the future training courses?


   - Include more dynamic training methods and more case studies.


   - Extend the course for 2 more days. Include more practical exercises and fieldwork.


   -   Improve the accommodation and financial procedures for participants.




                                             40
                                                                                    Annex-I



                     FIELD VISIT TO CBI AREA
                   OBJECTIVES AND METHODOLOGY

   Objectives:
      Learning through demonstration visit
      Capacity building for practical implementation of the programme


   Guidelines
  I. The participants are expected to learn through in field visit:
        a. Status of the community organization and social mobilization.
        b. Intersectoral team and its role.
        c. Major sources of funding.
        d. Management of the program
        e. Partnerships (community, government, NGO and others).
 II. Programme implementation
        a. Planning process
        b. Community survey, priority listing and village profile
        c. Human resource development
        d. Projects proposals and feasibilities
        e. Supervision and monitoring
        f. Programme advocacy
III. Social and economic interventions
        a. Types of social projects:
                 i. Health and nutrition
                ii. Water and sanitation
               iii. Women development
               iv. Others
        b. Types of income generating projects:
                 i. Agriculture
                ii. Live stock (milking animals, poultry,)
               iii. Small business
               iv. Cottage industry
                v. Others
IV. Financial management (accounts, record keeping):
                 i. Involvement of the VDC in funds releases, utilization and execution of
                    the project.
                ii. Community partnership in supervision and monitoring
               iii. Availability of the loan cards and accounts keeping.
 V. Community information system
                 i. Documentation of meetings, activities and progress
                ii. Community information system


                                              41
              iii. Information sharing with the community and partners
VI. Achievements in:
                i. Education and literacy
               ii. Health and nutrition
              iii. Women development and employment
              iv. Drinking water and sanitation
               v. Increase in family income/ poverty reduction
              vi. Others
VII. Feedback




                                            42
                                                                                                  Annex-J

        REPORT OF FIELD VISIT TO MUDARI VILLAGE IN MADABA
          GOVERNORATE IN BALQA REGION 11 AUGUST 2003
                      (Jazla Fadda, Syria)

Demographic profile of Mudari village:
◊ The location of Mudari village is 40 km away from Amman, about 30 minutes a car.
◊ All the inhabitants are from Kharabshi tribe
◊ Population:           2086
◊ Number of families: 365
◊ Number of clusters: 3
(Each cluster consists of about 55 families)


                                                                        Arrival of the group to Mudari village

Group reached the village at 10:45 AM, and was given
worm welcome by the community. The head of VDC in
his speech explained the activities of HVP in Mudari
supported by WHO and MOH. These included the medical
camps days to give health services to people, awareness
lectures about environmental health, sending girls to
computer training course, sewing training course , livestock
raising projects , gave loans to 24 of families by WHO’
support. He added, there is a list of some needs of the
village like library containing children books, kindergarten,
garden for children, place for computers etc.
                                                                          Speech for Head of VDC


After that, Mrs Gehad Mahmoud kharabshi on of the CRs of the village in her speech
indicated he role of CR’s in proving latest information to the program such as births ,
deaths , abortions , drop-outs students etc. She also mentioned about the participation of
the CR’s in project’s activities to increase the awareness in the village. After that some
awards were distributed among the distinct women who participated in the training
course of computer & sewing.
                                         A distinct women in
                                         computer training course
                                         is receiving her certificate
                                         and award



                                                 CR’s have big role
                                                      in the village




                                             43
Visiting a tradition fair
It presents the handicrafts (carpets, flowers etc) made by the local women.


                                                            Some handicrafts in the village




Project of Agriculture :
Group had a talk with beneficiary Om Ayam. She told us
that she chose planting Zater alone and she got a loan of
700 JD. After submitting 5 % of the total amount for the
village development fund, she pays monthly 25 JD. She
said she obtained from the HVP both good income and
experience in planting.

                                         Om Ayham and planting Alzater

Project of raising livestock :
One of the village beneficiaries got a loan of 800 JD to buy sheep. She referred that the
products of the sheep are sold that enable the family to get
sufficient income for all their needs. Now she is able to
send her children in the school for learning.

                                                      Livestock project



Project of grocery shop:
Husien Hamad Allah established grocery shop after getting
a loan of 1000 JD and he’ll pay it back within 4 years, 33
JD a month, its 5 % has already been submitted for village
development fund. This grocery shop provided great
benefit to the beneficiary family and the whole village. His
income increased and he made some amendment and
improvement in the grocery shop from the profit. The most
important thing is that people don’t have to go to distant
shops to get their needs.                   Grocery shop project

Youth center of Al Hour valley:
This center is taking care of Alhour valley‘s youth,
especially those between 10-18 years old. The number of
youth who participate in this center are 60 active guys. The administrative and
consultative committee does the supervision to this center. This center is interactive with
HVP and is a forum to participate in all programme activities in any level.


                                               44
The center organizes youth camps which give awareness, rehabilitation, capacity building
and promoting the principle of team work. This center was established by the head
council of Jordanian youth as a donation of 150000 JD. The youth participate in the
vocational training course like computer, math etc. There is a documentation of all of the
meetings, activities as well as feed back.

The health center: (in health directorate of Balka)
This health center is the core of HVP‘s activities in
Mudari village, Dr.Adel is the head of this center , the
VDC is so cooperative and has big role in
imp[lamenting the program’s plan of action in the area.
Each field activity is lunched from the health center.
The decisions are made by VDC as a whole and the
specialized committees implement them. They had
some annual activities like Wafa day, Hygiene day and
Medical days etc.
                                                           This signboard shows the activities of HVP in the village

 The health center consists of several units: public health unit, the general physician unit,
dentistry unit, maternal care unit, in addition to laboratory & x rays unit. There is a
signboard on which all statistics related to health distributed by males and females
(disabilities, diseases, smoking ...) is displayed. The most important achievement is
information center, so the updating data and their processing are in it.

Remarks and comments
•     The community has information about the concepts, objectives and mechanism of
      the program; and they know their roles.
•     The supervision & monitoring process is completely done by program
      administration.
•     The partners help community to attain their needs
•     The community development fund is available and effective
•     Women have remarkable role in the development process
•     The projects of income generation contributed in increasing families’ income
•     The sectoral support team needs to be more activated
•     Financial sources are limited comparison with future expansion
•     Documentation of VDC meetings needs to be improved and the meeting should be
      convened periodically on fixed dates.
•     Revolving fund should be strengthened and reused for further projects.




                                             45

								
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