|
Training is an extremely critical component
of CHW programmes. It marks the trend for its performance, credibility
and eventual sustainability. Whether the programme is at scale or
at the level of small programmatic intervention, its quality, character
and impact is reflected through training - as the medium through
which ideology and objectives of the programme get instilled and
transferred to all cadres of personnel, and in determining the role
of the CHW by building her knowledge and skills in specific areas.
Training of CHWs have been identified as a significant factor contributing
to the success or failure of a CHW programme and its impact on the
health outcomes of a community. Access to basic training has been
found to be a fundamental need of CHWs, and improving access to
training is an important element of improving retention. Despite
the importance of CHWs and the need and relevance of training, the
challenges of providing them with high-quality training opportunities
remain.
 Given
this context, ICCHN is collaborating with the Foundation for Research
in Community Health (FRCH) to create a national research and resource
base on CHW training. The FRCH has been a pioneer in creating and
training community based health workers in rural Maharashtra, and
has been engaged in community based health provision innovations
for more than 30 years. This current initiative builds on FRCH’s
considerable experience in developing, implementing and researching
CHW programmes in its field areas, along with its innovative approach
to professional development, accreditation and certification for
community health workers. FRCH’s approach to training constitutes
a judicious mix of social and technical components of health, where
training of CHWs is understood as a process of building awareness,
professionalism and idealism, harnessed within an individual in
congruence with the needs of her community. Their training also
introduces cross cutting themes of integrity, equity, gender equality
and accountability to the health workers. The main aspects of the
FRCH training approach draw from theories such as ‘education
for change’ and are aimed to conscientise their workers to
analyse and assess the larger socio-economic and political determinants
of their communities’ health status. The primary aim of training
is understood as empowering rural women to learn – seek new
knowledge, and inculcating the confidence to translate this into
practice by applying the knowledge to their environment.
In this collaboration, efforts will be directed at -
A large amount of work has been undertaken in terms of content and
methodologies of training in CHW programmes by different groups,
and a need exists to consolidate the learnings from these. One of
the first initiatives within this has been consolidating FRCH's
experiences in CHW training over the past 30 years, and the evolution
of its approach from its innovations in its field areas in Mandwa,
Malshiras, Parinche and Ralegan Siddhi in rural Maharashtra. The
FRCH approach is not just concerned with imparting training for
current issues in health, but is also about the individual's self
development, charting out future directions for CHWs in constructing
career ladders through accreditation of training and promotion in
roles and functions. This publication aims to capture and disseminate
these innovations to the sector.
A significant innovation by FRCH has been the discourse on training
of trainers. The trainers are believed to be learners and facilitators
than merely teachers. Adopting a non-formal methodology of organising
training – completely decided by the problems and needs of
the community, and the comfort and competencies of the CHWs to absorb
new information – the trainers take an Amygdalian Approach,
which focuses on the “emotional” versus the “logical”.
The knowledge through training is therefore, not the 'What', but
the 'Why' and the 'How'. As the cadre of personnel whose role is
to continuously support and supervise the field level functionaries
or CHWs in the programme, the master trainers need to be capacitated
with technical knowledge, confidence, communication skills, integrity
and insight. The challenges are especially true in the case of large
scale programmes where large numbers need to be trained and supported,
capacities are not very strong and problems of transmission loss
emerge. These issues can be addressed only through well designed
and sensitive training of trainers.
Evaluation and monitoring of the training process helps to refine
planning and implementation of training, as well as to improve the
skill level of individual CHWs. CHW effectiveness and the impact
of training depends on various interrelated factors, including the
pedagogy of the training, its methodology and approach, the organisational
structure of the CHW programme with supportive human resources,
capacity of trainers and the availability and accessibility of healthcare
services. Due to this complexity of training evaluation, it is important
to analyse a programme in both quantitative and qualitative aspects
and to undertake it at different levels, in order to capture the
behavioural, social and political determinants that contribute to
differences in CHW training effectiveness. Accreditation of training
can ensure a desired level of standardised quality of services and
effectiveness in CHW performance. The pedagogic involvement in the
programme from professional educational institutes, through accreditation,
can raise the level of training-learning with technical inputs,
and regular evaluation to enhance the quality of both trainers and
learners. Moreover, accreditation can help in thinking about future
growth, continuing education and career progression of the CHWs.
With its experiences of the National Institute of Open Schooling
(NIOS) accredited CHW training modules that are widely used by different
accredited vocational institutes and civil society groups across
the country, FRCH is well positioned to inform other CHW programmes
on these issues.
The outcomes of this partnership will range
from publications, research on training, policy advocacy and capacity
building through engagements with state and national governments,
and workshops and consultations at the state and national levels.
A major effort towards this end has been the organisation of the
National Workshop on Community
Health Worker Training: Linking Pedagogy and Practice on
April 9-11, 2006 in Pune.
|
National Workshop on Community Health Worker Training: Linking Pedagogy and Practice Reflections and Recommendations