Volunteer community health workers (CHWs) are a major strategy for increasing access to and coverage of basic health interventions. Our village health worker training course reviews the process of training and continuing education of CHWs as an important component of involving communities in their own health service delivery. Participants will be guided through the steps of planning training and continuing education activities for village volunteers. The course draws on real-life examples from community-directed onchocerciasis control, village health worker programs, community case management efforts, peer educators programs and patent medicine vendor training programs, to name a few.
Lecture 1B: Principles of Learning, Part 2
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Do curso por Johns Hopkins University
Training and Learning Programs for Volunteer Community Health Workers
23 classificações
Johns Hopkins University
23 classificações
Curso 6 de 6 em Specialization Foundations of Global Health
Na lição
Getting Started
In this module, we will focus on the principles of learning, as well as approaching the health service and the community. There will almost be a quiz covering the first two lectures.
Conheça os instrutores
William Brieger, DrPHProfessor, Health Systems Program of the Department of International Health
Bloomberg School of Public Health
In Section B we are resuming our discussion of the principles of learning.
Principle 5, as we mentioned before, is that learning is an evolutionary process.
Behavior change requires time and patience.
It's not like turning on and off a light switch.
Before you were not able to fill out record forms and then you switch
the on switch and now all at once you're able to fill out the
record forms correctly for your antenatal clinic.
It takes awhile for people to practice, to learn.
So we need to make sure that in many ways with
our training, is not only that we organize a workshop for a
week, but that we also have follow ups and making sure that
people have a chance to try out the skills in real life.
And reinforce what they've learned through supervision,
which we'll be talking about in later lectures.
When there are quick changes in behavior, people
sometimes will adapt this in a structured way.
They will please the teacher, the trainer, but in the long term
when we try to impose learning on people it doesn't last very long.
It reminds me of the public health nurse that used
to go through the village where I worked in Nigeria.
And she had she was very adamant about children wearing diapers.
She didn't
want children walking around naked.
She didn't think it was right and so she would go through the
village and people would say the nurse is coming, the nurse is coming.
And everybody would rush and put panties or diapers on their
children and then the nurse would leave and they'd remove them.
So yes there were quick behavior changes but they weren't long lasting.
Again, when you force people to change behavior
quickly, it may not be meaning to them.
Their ability to internalize this may be doubtful.
So the idea of establishing learning programs and processes
at the pace of the learner is very important.
So this change in behavior can evolve, can be comfortable for the person.
Some of the situations that make it possible for this slowly evolving change
in behavior include free and open communication between the learner and
the facilitator or trainer.
And among the learners themselves in a training situation.
Sometimes confrontation, pointing out people's deficiencies, pointing
out the implications of health workers behaviors.
For example, we have set up role plays where people
play the health worker and some people play the client.
And all at once, people see what it's like
when, when the nurse yells at the mother for missing
an appointment with her child.
And then, this confrontation makes them realize, well, it doesn't feel very good.
I'd better, you know think about the implications of my behavior.
Acceptance is an important aspect.
The learner has to feel accepted and welcome allowed to make mistakes.
the learner is valued as a person.
Which leads into the notion of respect and, again,
people are accepted, are respected whether they make mistakes or not.
Training needs to set up a safe environment where people can
practice new skills and have an opportunity to learn from their mistakes.
Again self-revelation, people need to have opportunities where
they can feel safe to talk about their learning.
To talk about what's difficult, to
interact with other trainees and, and learn
from them to gain reassurance from them by sharing
their concerns, their fears about the new skills or not.
As we mentioned, collaboration is important.
One of the things that's important to recognize, also,
about learning and new situations is the concept of ambiguity.
As we mentioned, change is difficult.
Change may be frightening, adopting new skills.
We were trying to work with district health staff to,
implement the program for what they called community directed treatment.
With the drug Ivermectin to help control onchocerciasis.
And this was supposed to be
a community directed or community involvement approach.
And, this was a new role for health workers.
They had usually been used to going into the
community, into the village, telling people what to do.
So this
new role of working together as partners to
try to facilitate community meetings for everyone to contribute.
This was something they were not used to.
They didn't know what would happen.
And so, learning new skills often puts people in an ambiguous situation and it's
important for the, the trainer to let people know that they will be with them.
That, give them a sense of feeling of
safety so they can try these new skills and
overcome the ambiguouty.
Sharing evaluation is important, giving feedback both from the
trainer to the trainee, and among the trainees themselves.
Opportunities to practice giving feedback through return demonstrations.
Training needs to be an active process, where people are involved in the learning.
Where they share their ideas, where they
discuss, where they question, again as mentioned before,
training needs to be carried out in a safe environment.
People need to feel that they're free from any sort of threatening situation.
That their supervisors or bosses will not see them make a mistake.
And ultimately the trainee must learn to trust his
or her own judgement, trust his or her own skills.
So we need to establish this, and this takes
time, this is why training is an evolutionary process.
Even though we try to make the training situation feel safe for the
trainees since we can see in principle 6, sometimes learning is a painful process.
Learning those new skills, going to the
community, trying to organize meeting all at once.
Realizing that you're dictating to the people how they should
organize the program and people start disappearing from the meeting.
We do make mistakes and we have to recognize that for the, the learner these,
these mistakes can, can be painful.
Changing ways that things have been done in the clinic
for many, many years what are other people going to say.
The situation in the rural health centers in Kenya try
to encourage the staff to provide counseling for the patient.
The people who have not attended the training in the other room may
even knock on the wall," Well let's hurry up, let's get the patients moving.
Let's get
this queue rolling, because we want to go for our lunch break".
So giving up the old ways that have been the
norms in your work setting may be painful, may be threatening.
And so, it's important that the trainee feels
confident in the training situation, in the learning situation.
To try the new skills, then, you know,
having the support going back home and implementing them.
So it
is not easy to discard the old ways of doing things.
The health inspectors we had come for our diploma program in health education.
It was so easy for them to go out into the
community and start telling people this is what you should do.
You should wash your hands, you should make sure that you boil your water.
They were so used to telling people and it
was difficult to get them to become health educators.
Where instead of
telling people what to do, they would listen to people
and ask people to talk about the needs and problems.
And hold their tongue when they saw environmental situations that may
not be perfect, but try to build trust in the community.
So, learning these new skills can be a painful process.
Breaking away from old and comfortable ways of doing things.
Eventually hopefully will be followed by an appreciation and pleasure of discovery
that you can change, you can do new
things, that you can take on new job responsibilities.
Principle 7 emphasizes the importance of the learner in the learning process.
Learning is, we said before, an internal process.
People build on their experiences, and a good trainer will try to find out
what those experiences are, get people to
share about their background at the beginning of
the training.
Recognizing that a certain person may have a lot of experience in
immunization programs or another person may
have good experience in developing educational materials.
And so when those issues come up during the formal training
session, those people can be called on to share their experiences.
And also too that, that the learner, you know,
is building on what he or she already knows.
And figuring out
ways of helping the person do that because going from the
familiar to the unfamiliar is an important step in the learning process.
So if we recognize that the learners come with something, they're not the
toddlerese that you know of from teaching the tall, talk about teaching children.
But that they are actually experienced adults.
Then in this sense, be able to use
their experience and resources in an educational way.
So again the important recsource of the learner
in the training process should not be overlooked.
This principle has been used working with training youth peer educators.
They experience, even though they're young, they still experience problems
of sexual harassment, and pressure to use drugs, or have sex.
And so, when it comes time to organize training, role plays, and dramas
that they themselves develop, can explore these
different attitudes, feelings, experiences that they have.
Using their own experiences in developing these
dramas and role plays during a training program.
Again people will learn from themselves if they
can open up and become aware of themselves.
If training encourages them to draw on their
personal experiences, to think back about what they've done.
We'll talk about in our section on learning and training
methods, things such as brain storming, things such as group discussion.
Will give people an opportunity to share
what they've learned, to think what they have
experienced and, and bring that out into the open and examine it and build on it.
As we said in Principle 8, training is not
just an intellectual process, it's also an emotional process.
We need to learn new attitudes as well as new knowledge.
This is particularly true in terms of new
health programming that requires involvement of the community.
Now in the past many of the health workers in front line
health stations and health posts.
Even if they're just a health aide or a
health assistant, they've been looked up to as the doctor.
They have some sense of power and authority.
And yet, if they're trying to
organize new programs that require community participation.
Whether it's a community distribution of a new drug, whether it's training
village health workers, they have to work in terms of partnership with
the community.
And so they need to learn new attitudes, and see new roles for themselves.
Their attitude of respect of the community for example.
So that the training needs to introduce those kinds
of experiences, as well as the academic and intellectual ones.
Also, one recognizes, especially in training health workers,
that their work on the job is not just an intellectual activity.
It's not just applying knowledge and skills.
But they interact with other staff, they interact with with clients and patients.
And so, the way they interact, their
feelings, their thoughts, impact on how they behave.
How they apply the new skills and we need to
address that, providing realistic life experiences in the training setting.
So that they can develop these attitudes and values and see
the importance of the new skills, not just understand the steps involved.
This involves quite a lot of group interaction and learning.
People come together,
share, give feedback to each other, comment on each other's behaviors.
One thing that happens during the learning process, and we need to be aware
of, and we'll talk about this in
terms of our training implementation and monitoring.
Is that many things can get in the way of the learning process in terms
of the dynamics of the group of different types of personalities.
Some people may be dominating, some people may
be sitting back and not getting actively involved.
People may resent each other. Some people may refuse to participate.
Some people, they just read a news paper and not pay attention to the training.
Some situations where members of the group,
somebody brings out their computer and is
working on a report that they were
supposed to submit back home before they came.
And so, they use this as an opportunity to do their work instead
of getting involved and all of this interpersonal emotional
issues get in the way of people learning skills.
But, in a way, it's also part of the process.
It's part of the normal way that life goes on back in the work setting.
So, it's not that we want to divorce emotional and
attitudinal issues from the training but, recognize them, use them effectively.
Say okay, well here we are in a training setting, remember the last time
you had a staff meeting.
Maybe one or two people talked and everyone sat back.
Well this is what's happening right here in the training room.
Why is that happening?
How can communicate better? How can we interact better?
We can't get down to our official business if there are jealousies,
resentments, boredom among the members of the, the team.
Just like the same thing cannot happen if
there are these kinds of conflicts and problems
among the members of a training group.
So again we have to address these personal needs and issues.
Problems of attitudes towards the work, attitudes towards each other before
we can expect people to actually acquire new ideas and skills.
Back to principle 9 the last of the learning principles.
It's important
to recognize that learning is unique to each individual.
The problem-solving process is unique.
Ultimately, we do want to look at learning as problem solving.
Each person has their own style, some are able to acquire new knowledge and solve
problems effectively, and some may not. Some may be solely
interested in acquiring information, and getting
all the handouts, etcetera, that they don't
see the forest for all the trees that were destroyed to make the handouts.
So it's important to have individuals think about.
How they learn, how they acquire skills, and build this into training program,
so that people make the best use of the learning experiences that they have.
This will help learners know which approaches are good for them, which ones
are distracting for them, and then they can become more effective problem solvers.
Finally, we're concerned that as people become aware of how they learn, that we
also open, provide opportunities for them to experience new ways of learning.
Recognizing that you do learn from each other.
Recognizing that you can help yourself through readings.
That you can learn things through action,
that you can learn things through practice.
So it's important that a training program use a variety of methods and learning
models, so that people can find the one that is most effective for them.
The importance of learning
from each other cannot be overstressed.
I've noticed many times in the classroom, when students are
making presentations that other students are actually almost rude.
They'll be doing something else, talking in the back of
the room, getting their own presentation ready, not paying attention.
If the teacher talks, they all pay attention.
So, how do we again, set up these new situations
where people can recognize their own worth as learners and trainers of themselves.
And become aware that they can learn from each other.
So this is just an example of how we have to set
up new learning experiences and help people recognize the importance of these.
We'll go into more details in the next section
on this whole process of adult education and learning.
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