LHWs Refresher Training Curriculum - Sep 2014 (Recovered)

LHWs’ Refresher Training Curriculum: 2014

Lady Health Workers Program (National Program for Primary Health Care and Family Planning)

27 September 2014Department of Health, Government of Khyber Pakhtunkhwa

USAID FATA-KP Health Program, Save the Children


ContentsIntroduction....................................................................................................................................4

LHW Vision 2015...........................................................................................................................5

Objectives....................................................................................................................................................5

LHWs’ Refresher Training Curriculum.....................................................................................6

LHWs RTC Structure...................................................................................................................7

Day 1...............................................................................................................................................9

1.1. Introduction.........................................................................................................................................9Summary..............................................................................................................................................................9Time allocated......................................................................................................................................................9Method.................................................................................................................................................................9Materials...............................................................................................................................................................9Learning Objectives.............................................................................................................................................9Recommended session sequence..........................................................................................................................9

1.2. Health Promotion..............................................................................................................................10Summary............................................................................................................................................................10Time allocated....................................................................................................................................................11Method...............................................................................................................................................................11Materials.............................................................................................................................................................11Learning Objectives...........................................................................................................................................11Recommended session sequence........................................................................................................................11

Day 2.............................................................................................................................................13

2.1. Community Empowerment...............................................................................................................13Summary............................................................................................................................................................13Time allocated....................................................................................................................................................13Method...............................................................................................................................................................13Materials.............................................................................................................................................................14Learning Objectives...........................................................................................................................................14Recommended session sequence........................................................................................................................14

Day 3.............................................................................................................................................17

3.1. Women’s Health................................................................................................................................17Summary............................................................................................................................................................17Time allocated....................................................................................................................................................17Method...............................................................................................................................................................17Materials.............................................................................................................................................................17Learning Objectives...........................................................................................................................................17Recommended session sequence........................................................................................................................18

3.2. Newborn Care....................................................................................................................................19Summary............................................................................................................................................................19

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Time allocated....................................................................................................................................................19Method...............................................................................................................................................................19Materials.............................................................................................................................................................19Learning Objectives...........................................................................................................................................20Recommended session sequence........................................................................................................................20

Day 4.............................................................................................................................................21

4. Child Health.........................................................................................................................................21Summary............................................................................................................................................................21Time allocated....................................................................................................................................................21Method...............................................................................................................................................................21Materials.............................................................................................................................................................21Learning Objectives...........................................................................................................................................21Recommended session sequence........................................................................................................................22

Day 5.............................................................................................................................................24

5. 1. Nutrition...........................................................................................................................................24Summary............................................................................................................................................................24Time allocated....................................................................................................................................................24Method...............................................................................................................................................................24Materials.............................................................................................................................................................24Learning Objectives...........................................................................................................................................24Recommended session sequence........................................................................................................................25

5.2. Life Style and NCDs..........................................................................................................................26Summary............................................................................................................................................................26Time allocated....................................................................................................................................................26Method...............................................................................................................................................................26Materials.............................................................................................................................................................26Learning Objectives...........................................................................................................................................26Recommended session sequence........................................................................................................................27

Day 6.............................................................................................................................................28

6.1. Family Planning and HTSP.............................................................................................................28Summary............................................................................................................................................................28Time allocated....................................................................................................................................................28Method...............................................................................................................................................................28Materials.............................................................................................................................................................28Learning Objectives...........................................................................................................................................28Recommended session sequence........................................................................................................................29

6.2. Critical conditions and acute illnesses.............................................................................................29Summary............................................................................................................................................................30Time allocated....................................................................................................................................................30Method...............................................................................................................................................................30Materials.............................................................................................................................................................30Learning Objectives...........................................................................................................................................30Recommended session sequence........................................................................................................................30

6.3. Epidemic Control..............................................................................................................................31Summary............................................................................................................................................................31

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Time allocated....................................................................................................................................................31Method...............................................................................................................................................................32Materials.............................................................................................................................................................32Learning Objectives...........................................................................................................................................32Recommended session sequence........................................................................................................................32

Conclusion....................................................................................................................................33

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Introduction

Based on the forward looking and need-based step taken by the Khyber Pakhtunkwa Lady Health Workers’ (LHWs) Program, in September 2014 the Scope of Work (SOW) of the LHWs was revised and strengthened to become Health Promotion-oriented and focused on clearly defined service targets that contribute to the achievement of the ultimate objective of the LHWs (please refer to the LHWs HP-oriented SOW).

The SOW is aimed at streamlining the role and responsibilities of the LHWs so that they can produce the benefit that their cadre is supposed to produce. The SOW has laid the foundation on the basis of which the pre-service training curriculum of the LHWs will be developed so that the future LHWs will be aligned to the Vision and Service Targets laid down for LHWs in the SOW. This reform has the potential of addressing longstanding issues, confusions and role-conflicts that the LHWs have been facing in their work environment by providing the LHWs the requisite skills and knowledge that will enable them to become highly effective community based healthcare providers. It may be noted that the roles, responsibilities, knowledge and skill set of the supervisors and managers of the LHWs will also need to be reviewed to enable the LHWs play their aspired role effectively. However the big question of how to bring the large number of existing LHWs to the same professional orientation needs to be answered so that the LHWs Program maintains uniformity of approach and momentum.

In order to ensure that the existing LHWs also have the knowledge and skill as per SOW mentioned above set several steps will need to be taken. Whereas the approach of the LHWs Program will need to adapt to the revised set of roles, the on-the-job training materials and roles of various cadres within the LHWs Program will also need to be reviewed and strengthened/modified or developed afresh. And one of the most foundational steps is to develop a realignment strategy for the existing LHWs for which a Refresher Training Curriculum is needed.

This Refresher Training Curriculum addresses this basic issue of realigning the existing LHWs to the approved HP-oriented SOW so that the existing knowledge, skills and practices of the LHWs can be upgraded to enable them to work on the new paradigm. The course materials that will be developed on the basis of this Refresher Training Curriculum will need to refer to the SOW and the LHW Vision 2015. The course materials will not only provide the communications needed to upgrade and modify the skills and knowledge of LHWs but will also keep them focused at the revised SOW to avoid any future conflicts between the new batches of LHWs to be rolled out from 2015 and existing LHWs. The training of existing LHWs on this Refresher Training Curriculum developed in 2014 will therefore lead to attainment of the LHW Vision 2015.

For the sake of clarity this Refresher Training Curriculum should be read in the conjunction with the above mentioned LHWs’ SOW. The LHW Vision 2015 and Objectives captured in the said SOW is also presented hereunder to remind us of the ultimate objective of this Refresher Training Curriculum. This Refresher Training Curriculum is developed in line with the eight service targets provided in the LHWs’ SOW.

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LHW Vision 2015

The LHW is a female community-based healthcare worker whose primary role is to provide the right knowledge and instill the right behaviours among individuals, especially

women of reproductive age, so that the health of mothers, newborns and children improves.

The LHW also provides basic healthcare services for the management of common illnesses at community level and catalyzes the community to develop local responses to

address health issues including optimal utilization of health services.Ultimately the LHW plays a pivotal role in enabling communities to become healthier and

more self-reliant in improving the health of mothers, infants and children.

Objectives The LHW will work in the community assigned to her:

1. To promote Health by empowering communities through provision of health education messages, raising awareness, providing knowledge and developing skills needed for improving and maintaining a high standard of health among women, infants and children and communities in general.

2. To ensure that all expecting mothers are properly vaccinated against Tetanus and all children are fully immunized against the vaccine-preventable diseases as per Government of KP policy.

3. To provide basic healthcare services to communities for basic Management of Communicable Diseases including basic curative services for infectious diseases and by counseling and advocating for prevention and control of such diseases.

4. To provide basic healthcare services to communities for basic Management of Non- Communicable Diseases by counseling and advocating with the communities on appropriate and healthy lifestyles and nutrition.

5. To ensure that timely referral for acute/advanced/critical illnesses is made to a higher level healthcare facility instead of attempting to directly treatment illnesses.

6. To deliver critical messages for prevention and control of epidemics and to report suspected cases of epidemics to relevant health authorities for proper diagnosis, treatment and control.

7. To work with local health committees and/or groups by providing relevant information and impetus to take community action to address those issues that confound the health of mothers, infants and children.

8. To promote family planning and healthy timing and spacing of pregnancies, provide contraceptives and referral services for permanent and semi-permanent contraception for improved health of women and children.

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LHWs’ Refresher Training Curriculum

The LHWs’ Refresher Training Curriculum (RTC) has been designed on the basis that the existing LHWs are already well trained in various related aspects of the SOW. The existing LHWs, for example, have the knowledge and skills for community case management of childhood illnesses including diarrhea, pneumonia and malaria. They are also trained in community mobilization and communication. However based on various assessments, several gaps have been identified that exist in the knowledge and skills of the present contingent of LHWs. The RTC addresses these gaps in order to leverage the existing knowledge, skills and invaluable experience that the LHWs already have.

The RTC is designed in such a manner that a six-day refresher training program can be designed and implemented for the LHWs. The RTC responds to the Service Targets for the LHWs as per SOW and addresses the key new areas and gaps identified. The RTC is structured as follows:

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1.1. IntroductionBackground and Format of the Refresher Training

LHWs’ SOWLHW Vision 2015 and Service Targets

1.2. Health PromotionConcept

HP Roles: Advocacy, Enabling, MediationHealth Education and Counseling

Social Determinants of HealthLHW as a Health promoter

2.1. Community EmpowermentSocial Determinants of Health & Community

Community Groups and CommitteesMobilizing Community Support & Resources

Community Case Management Continuum of Care & ReferralTransportation for 2nd delay

3.1. Women’s HealthGeneral Concepts

Pregnancy and Ante-Natal CareTT VaccinationBreastfeeding

Post-Partum CareRole of LHW re Women’s Health & Referral

3.2. Newborn HealthGeneral Concepts

Promotion of ChlorhexidinePrevention of Hypothermia

Early initiation of Breastfeeding


LHWs RTC Structure

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5.2. Life Style and NCDsGeneral Concepts

NCDs; Common NCDsLife Style adjustments for prevention & control of NCDs

5. 1. NutritionGeneral Concepts incl. Stunting, Wasting & Anemia

Nutrition in Pregnancy and after DeliveryChildhood Nutrition: Disease- Malnutrition vicious cycle

6.2. Critical conditions and acute illnessesGeneral Concepts

Role of LHWsEmergency care: Breathing, Bleeding, Breaks

Referral

6.3. Epidemic ControlGeneral Concepts

Common EpidemicsRole of LHWs

6.1. Family Planning and HTSPGeneral Concepts

Contraception and commoditiesHTSP

Role of LHWs

4. Child HealthGeneral Concepts

GAPPDCCM for Pneumonia, Diarrhea and Malaria: Prevention, Treatment, Control

Vaccination


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Day 1

1.1. Introduction- Background and Format of the Refresher Training- LHWs’ SOW- LHW Vision 2015 and Service Targets

SummaryThis is the opening session for the 6-day Refresher Training Program and has to serve as the foundation for all of the sessions to follow. The participants will be introduced to the need of revision of LHWs scope of work and the process that was undertaken to develop the revised and HP-oriented SOW. Structure of the 6 days program will also be clarified to the participants.

The session will provide an opportunity for presenting the revised LHWs SOW to the participants and clarify if there are any issues in the minds of the participants. The LHWs Vision 2015 will be read and explained in detail and will be used as the basis for developing a shared vision among all participants. The session will also describe in details the eight objectives and service targets given in the SOW.

Time allocated 2 hours: 00 minutes

MethodDialogue/discussion between resource person and participants.

MaterialsUrdu translated versions of the following for all participants:

1. Schedule of the 6-day LHWs’ Refresher Training Program2. Approved LHWs’ SOW

Learning ObjectivesBy the end of the session the participants should be able:

1. to describe why the Refresher Training program is being held;2. to understand the overall structure of the 6-day Refresher Training Program;3. to relate to describe the LHWs Vision 2015;4. to know the LHWs’ Service Targets and their desired results.

Recommended session sequence00:00 hrs 00:05 hrs Start

Recitation from Holy Quran

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Schedule of 6-day (Urdu) Refresher Training Program and (Urdu) SOW to be distributed among participants

00:06 hrs 00:30 hrs Presentation – Introduction - Welcome and Introduction to the Refresher Training

Course;- Need and process of revision of LHWs SOW;- LHW Vision 2015;- Objectives of LHWs

00:30 hrs 01:00 hrs Discussion/ Q&A on LHWs Vision - Participants to describe their understanding/impressions; - Clarification provided by resource person;- Objectives of LHWs discussed how they contribute to - the LHWs Vision 2015.

01:00 hrs 02:00 hrs Plenary on Service Targets - Resource persons describes the Service Targets and answers - Questions; provides clarity on Service Targets, the skills and

knowledge required for the LHWs to meet the Service Targets;

- Discussion on how the Refresher Training Program will address existing gaps in the knowledge and skills of LHWs.

1.2. Health Promotion- Concept- HP Roles: Advocacy, Enabling, Mediation- Health Education and Counseling- Social Determinants of Health- LHW as a Health promoter

SummaryThis is a very critical segment of the Refresher Training as it captures many of the new additions to the scope and function of LHWs: it clarifies the meaning, concept and implications of Health Promotion. The session provides the opportunity for elaborating on the various roles of a Health Promoter and why an LHW has to become a Health Promoter. Exercises are provided for participants to learn about the skills of Advocacy, Enabling and Mediation so that they are able to apply these skills at appropriate junctures.

The segment describes Health Education and Counseling as integral parts of Health Promotion. It provides clear action points for the process of Health Education and Counseling and identifies where these strategies are applicable.

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The segment also then discusses the social determinants of health to provide a deeper understanding of the whole notion and dynamics of health and provides a perspective for other segments in the Refresher Training Program.


Method- Dialogue/discussion between resource person and participants on Health Promotion,

Health Education and Counseling and Social Determinants of Health- Case studies and video films (if possible) with questions for group work- Exercises for skill sessions for Advocacy, Enabling and Mediation- Role Play


1. Session notes2. Brief description of Health Promotion and Ottawa Charter3. Case studies/video film(s) for group work

Learning ObjectivesBy the end of the segment the participants should be able:

1. to demonstrate that they have a clear basic understanding of the concept and value of Health Promotion;

2. to understand the purpose, constituents and mechanics of Advocacy, Enabling and Mediation;

3. to practically differentiate between Health Promotion, Health Education and Counseling;4. to comprehend the holistic nature of Social Determinants of Health;5. to commit to be a Health Promoter.

Recommended session sequence(Urdu) Description of Health Promotion and Ottawa Charter to be distributed

00:00 hrs 00:45 hrs Presentation and Q&A – Introduction to Health Promotion - Health Promotion and Ottawa Charter;- Roles and Strategies of Health Promotion- Q&A

00:45 hrs 01:45 hrs Case Study – Analysis of HP Roles- Video film (in possible) OR PowerPoint presentation- Group Work on questions pertaining to Advocacy, Enabling

and Mediation

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- Group presentations - Plenary discussion to list out dimensions of HP roles and

their benefits01:45 hrs 02:30 hrs Skill Building for HP Roles

- Role play by three groups on three storylines on: Advocacy, Enabling and Mediation

- Preparation by three groups: 10 minutes - Role plays x 3 (5-7 minutes each with a max of 20 minutes

for all three plays)- Group discussion on what was learnt: DOs and DON’Ts of

Advocacy, Enabling and Mediation02:30 hrs 03:15 hrs Presentation: Health Education and Counseling

- Differences between HE, Counseling and HP- Discussion

applications of HE and Counseling technical knowledge requirements for HE and

Counseling03:15 hrs 03:40 hrs Social Determinants of Health – intensively participatory

analytical discussion- Assist the participants to build a typical picture and

signifiers of health of women and children in KP - Lead in analytical discussion on causes of causes of causes- Bring the discussion to the underlying factors that lead to

inequities and inequalities and ultimately to ill-health- Tease-out the Social Determinants of Health

03:40 hrs 04:30 hrs LHW as a Health Promoter – Plenary- Questions to be asked on:

what aspects of LHW’s role can benefit from HP? how can an LHW be a good Health Promoter? and what needs to be done so that the LHW becomes a

good Health Promoter?- Open discussion with conclusions drawn and reaffirmed by

the participants

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Day 2

2.1. Community Empowerment- Social Determinants of Health & Community - Community Groups and Committees- Mobilizing Community Support & Resources- Community Case Management Continuum of Care & Referral- Transportation for 2nd delay

SummaryThis whole-day segment is aimed at establishing the base on which the whole HP-orientation of LHWs’ role depends. The sessions in this segment will help develop a deep appreciation among the LHWs for the meaning and importance of community and the importance of their own role for community health. The segment will begin with linking up with the Social Determinants of Health and the concept causes of causes of causes and will link these with various community sub-groups and community as a whole. The discussion will lead to developing conceptual clarity of addressing vulnerability, inequities and inequalities as a means to improve the health status of women and children.

A discussion on working with communities through formal and informal groups will be undertaken to help the LHWs understand the mechanics of community groups and committees as a means to enhance community engagement. Another session will be held on the ways and means of mobilizing communities to garner support for issues that require community action and support and what does it mean to mobilize community resources. The LHW roles of Advocacy, Enabling and Mediation will be contextualized in the understanding of community empowerment and community mobilization.

Another session will be held on the process of community case management (CCM) that is an integral part of the LHWs’ role. The community side of the CCM will be explored and again the HP roles of LHW will be linked with the CCM process. Finally the participants will be led in a discussion on LHWs’ role in organizing community transport facility with pooled resources for addressing the 2nd delay in delivery to reduce the chances of maternal deaths due to lack of transport.


Method- Presentation and discussion between resource person and participants on Social

Determinants of Health and their direct and indirect relationship with vulnerability, inequities and inequalities;

- Case studies and video films (if possible) with questions for group work

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- Exercises for skill sessions for handling community group meetings and community transport for 2nd delay

- Presentation and discussion on CCM and concepts of continuum of care and referral- Role Play


1. Session notes2. Social Determinants of Health and diagrammatic representation of CCM hand-outs3. Case studies/video film(s) for group work


1. to demonstrate that they have a clear basic understanding of Social Determinants of Health and their relationship with vulnerability, inequity and inequality;

2. to describe the purpose and process of community group formation, supporting community groups and mobilizing community resources;

3. to clearly understand the process of CCM as part of continuum of care and limitation of LHWs’ role in CCM including timely referral.

Recommended session sequence

00:00 hrs 01:00 hrs Presentation and Discussion– Social Determinants and Community Sub-Groups

- Community and various Community Sub-Groups- Foundational Causes: Vulnerability, Inequity and Inequality;

Women and Children - the affected Community Sub-Groups - Most critical changes needed to reduce vulnerability,

inequity and inequality- Analysis: applicability of Advocacy, Enabling & Mediation

by LHWs to reduce vulnerability, inequity and inequality01:00 hrs 02:20 hrs Case Study – Community Mobilization

- Video film (in possible) OR PowerPoint presentation- Group Work on questions pertaining to need to bring people

together for joint action, community resources and pooling resources, Community Empowerment by education, information and capacities.

- Group presentations

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- Plenary discussion to recognize the issues that need community action and LHWs’ role; , DOs and DON’Ts of Community Mobilization

02:20 hrs 03:00 hrs Presentation - Interpersonal Communication & working with Groups

- Groups: formal and non-formal – advantages and disadvantages; the Agenda – importance of manifesto

- Group dynamics – roles in a Group- Communicating effectively with Groups- Supporting Groups: Advocacy and Mediation roles

03:00 hrs 03:45 hrs Empowered Communities – Role Play- Role play by three groups on three storylines on

Community: with commitment with commitment and information with commitment, information and capacity

Issue: 2nd delay - Preparation by three groups: 10 minutes - Role plays x 3 (5-7 minutes each with a max of 20 minutes

for all three plays)- Group discussion on what was learnt: how LHWs can

empower Communities?03:45 hrs 04:15 hrs Open Discussion – Anemia reduction in Women as a sign of

Community Empowerment- Plenary to obtain general consensus on the reasons that lead

to longstanding Anemia in women, its impact on health of women and their offspring and steps that need to be taken to reduce Anemia in women

What is Anemia? Why Anemia exists in women? What women need to address the issue? How can women get what they need to reduce

Anemia? What needs to change and at what level to enable

women to be Anemia-free?04:15 hrs 05:30 hrs Dialogue - Community Case Management Continuum of Care

& Referral- Open discussion on what is CCM, what is the scope of CCM

and what is the role of LHWs in CCM

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- Resource person to provide detailed presentation: concept of CCM Continuum of Care: personal, community and

institutional Issues in CCM

- Discussion and consensus building on: LHWs’ role in CCM Meaning and importance of referral Mechanism of referral

05:30 hrs 06:30 hrs Group Work – Strategy for Community Transport Arrangements for addressing the 2nd Delay

- Questions to be asked on: Define the characteristics of a community-managed

and community-financed transport mechanism? What are the biggest hurdles in establishing such a

mechanism? What roles can an LHW play to address these

hurdles in terms of Advocacy, Enabling and Mediation?

Plan of action for establishing such a mechanism- Presentations and Open discussion with conclusions drawn

and reaffirmed by the participants

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Day 3

3.1. Women’s Health- General Concepts- Pregnancy and Ante-Natal Care- TT Vaccination- Breastfeeding- Post-Partum Care- Role of LHW re Women’s Health & Referral

SummaryThis section deals with the technical aspects of health of women of reproductive age and highlights the scope of work that the LHW is responsible for. The sessions will address the critical issue of pregnancy and the role of LHWs in pregnancy care. The session also specifically includes vaccination of pregnant women with tetanus toxoid vaccine for prevention of Tetanus infection in mother and infant at the time of delivery. The session includes the issue of breastfeeding (benefits for the mother) and post-partum care of women.

Ultimately the role of LHW with respect to women’s health especially with reference to pregnancy and outcome of pregnancy is clarified along with the importance of referral at various stages of pregnancy to relevant healthcare provider.


Method- Presentation and discussion between resource person and participants on pregnancy and

ante-natal care;- Group work on ante-natal care, TT Vaccine, nutrition in pregnancy and post-partum care;- Presentation and discussion on LHW’s role in women’s health with respect to pregnancy

and delivery.


1. Session notes2. Ante-Natal Care steps and roles of various healthcare providers (like CMW, LHV etc.)


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1. to demonstrate that they clearly understand their role in pregnancy especially with respect to counseling and referral;

2. to have learnt the schedule for TT Vaccine for women and the process of becoming a healthcare provider for TT vaccination;


00:00 hrs 01:00 hrs Presentation and Discussion– The ante-natal, natal and post-partum periods

- Description of normal pregnancy: ante-natal period, natal period and post-partum period

- Major issues of each period that need care and attention- Routine measures for care during the three periods- LHW’s role clarification with respect to the three periods

01:00 hrs 01:40 hrs Group Work – Can DOs and Cannot DOs - Group Work:

What are the main aspects of care in antenatal, natal and post-partum periods?

what aspects of care is the LHW responsible for and why?

who is responsible for care which LHW cannot provide?

what to do in case help is needed? what skills are needed for LHWs to provide good

quality care?- Group presentations - Plenary discussion to clearly delineate LHWs’ role with

respect to ANC, natal care and post-partum care.01:40 hrs 03:00 hrs Technical Session (lecture & skill building) – ANC and PPC

- Advocacy: harmful and beneficial practices; nutrition; HTSP options; addressing Anemia; TT vaccination; preparation for delivery; Clean Delivery Kit; Skilled Birth Attendant (SBA); transport arrangements

- Enabling: skills and practices to help mothers protect themselves and their baby; improving nutrition; hygiene; TT vaccination administration

- Mediation: linking expecting mothers with SBA; family counseling for protecting mothers and babies health; transport arrangements for delivery

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03:00 hrs 03:40 hrs Technical Session (lecture & skill building) – Tetanus- What is Tetanus; mode of transmission; factors increasing

the risk of infection; prevention; treatment; outcome - TT Vaccine in pregnancy; schedule; availability and storage;

reporting- Practicum: TT Vaccine administration skills and reporting

03:40 hrs 04:20 hrs Technical Session (lecture & skill building) – Breastfeeding- Benefits of breastfeeding; early initiation of breastfeeding;

exclusive breastfeeding- Infant and Young Child Feeding – overview and application

04:20 hrs 04:30 hrs Plenary - Conclusion- Resource person to conclude the section on Women’s

Health and provide a summary of salient points for the participants

3.2. Newborn Care- General Concepts- Promotion of Chlorhexidine- Prevention of Hypothermia- Early initiation of Breastfeeding

SummaryThis section deals with the technical aspects of newborn health and the role of LHW with respect to newborn care. Prevention of neonatal sepsis due to umbilical cord infection with application of Chlorhexidine Digluconate 7.1% gel and saving newborns from hypothermia are the major technical aspects covered in addition to BCG vaccination. Early initiation of breastfeeding and its benefits for the newborn are also included although the same is included in the section on Women’s Health as well but this section will focus on benefits for the newborn.

Time allocated 1hour: 30 minutes

Method- Presentation and discussion between resource person and participants on infant care;- Group work on infant care, BCG vaccination, and post-natal care of the newborn;- Presentation and discussion on LHW’s role in infant health.

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1. Session notes2. Newborn Care steps and roles of various healthcare providers (like CMW, LHV etc.)


1. to demonstrate that they clearly understand their role in newborn care especially for promotion of Chlorhexidine Digluconate 7.1% gel and protection from hypothermia;

2. to have understood the role of LHW in infant care/post-natal care for the newborn.


00:00 hrs 00:50 hrs Technical session – Neonatal sepsis, Hypothermia, BCG and Breastfeeding

- The newborn’s health- Neonatal sepsis: causes including cord sepsis; - Heat loss: causes, prevention; - Newborn nutrition - Measures for cord care, preventing hypothermia , BCG

vaccination, early initiation of breastfeeding; Role of SBA- LHW’s role clarification with respect to newborn care


what are the main aspects of newborn care? what aspects of care the LHW is responsible for and

why? who is responsible for care which LHW cannot

provide? what to do in case help is needed? what skills are needed for LHWs to ensure good

quality care?- Group presentations - Plenary discussion to clearly delineate LHWs’ role:

especially promotion of Chlorhexidine, protection from hypothermia, BCG and breastfeeding

01:20 hrs 01:30 hrs Plenary - Conclusion- Resource person to clarify the limitations of role of LHWs

in newborn care and emphasize the health promotion aspect that LHWs have to cover; conclude the segment on

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Newborn Health and provide a summary of salient points for the participants.

Day 4

4. Child Health- General Concepts- GAPPD- CCM for Pneumonia, Diarrhea and Malaria: Prevention, Treatment, Control- Vaccination

SummaryThis segment pertains to the very important aspect of LHWs’ work related to Child Health. The segment will start with a review of the concept of Global Action Plan for Prevention of Pneumonia and Diarrhea (GAPPD) and its implications on LHWs’ role. A detailed section will be dedicated to the community case management (CCM) for childhood illnesses using the Integrated Management of Childhood Illnesses (IMNCI) protocol with technical aspects of prevention, identification, treatment and control of Pneumonia, Diarrhea and Malaria. The types and dosage of allowable medicines will also be explained in addition to the various steps needed for compliance by the care-givers. Special attention will be given to Nutrition and the ways and means to improve children’s nutrition status. A discussion on immunization of children will be included to emphasize on the importance of immunization and the role of LHWs in immunization.

The Health Promotion roles that LHW has to play in addressing the childhood illnesses and enhancing the health of children will be included in the segment.


Method- Presentations and discussion between resource person and participants on Child Health,

GAPPD, IMNCI and Immunization;- Group work on LHWs role in Child Health;


1. Session notes2. Child Health and role of LHW and Community 3. GAPPD handout, IMNCI handout, Immunization schedule handout

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1. to demonstrate that they clearly understand the details of GAPPD and its implication on childhood killer diseases;

2. to demonstrate that they can recognize the main signs and symptoms of Pneumonia, Diarrhea and Malaria in children;

3. to confirm that they have accurate knowledge of:a. medicines for Pneumonia, Diarrhea and Malariab. calculating dosage of medicines for Pneumonia, Diarrhea and Malaria

4. to demonstrate that they have accurate knowledge of immunization of children under 3 years of age;

5. to understand and commit to the role of LHWs re Child Health and referral as appropriate.


00:00 hrs 01:00 hrs Presentation and Discussion – Child Health- Description of children’s health issues and concerns - Major killers of under-five Children: Pneumonia and

Diarrhea; Malaria- Strategies to reduce under-five mortality due to Pneumonia

and Diarrhea: GAPPD; IMNCI- Strategies to prevent and control Malaria- Immunizable diseases and Immunization for children - Reminder of CCM


what are the main aspects of care in Pneumonia, Diarrhea and Malaria?

what aspects of care is the LHW responsible for and why?

who is responsible for care which LHW cannot provide?

what to do in case help is needed? what skills are needed for LHWs to provide good

quality care?- Group presentations - Plenary discussion to clearly delineate LHWs’ role with

respect to prevention, identification, treatment and control of Pneumonia, Diarrhea and Malaria.

01:45 hrs 03:45 hrs Technical Session (lecture & skill building) – IMNCI

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- Pneumonia: Prevention, Diagnosis, Treatment and Care – include recent classification of Pneumonia, treatment with Amoxicillin, calculating dose of Amoxicillin, care for the sick child including nutrition and control of fever with Paracetamol; Referral – need, process and follow-up

- Diarrhea: Prevention, Diagnosis, Treatment and Care – include recent inclusion of Zinc for treatment of Diarrhea, calculating dose of Zinc, care for the sick child especially maintaining hydration/rehydration with low osmiolality ORS, nutrition; Referral – need, process and follow-up

- Malaria: Prevention, Diagnosis, Treatment and Care – include treatment with XXXXXX, calculating dose of XXXXX, care for the sick child including nutrition and control of fever with Paracetamol??; Referral – need, process and follow-up

03:45 hrs 04:30 hrs Technical Session (lecture & skill building) – Immunization

- Immunizations available and immunization schedule- Role of LHW in routine immunization and national/sun-

national immunization days/polio campaigns04:30 hrs 06:00 hrs Technical Session (lecture & skill building) –

CCM for Pneumonia, Diarrhea and Malaria- Advocacy: harmful and beneficial practices; Nutrition;

Prevention; Hygiene; Nutrition; Care seeking for the sick child; Care during sickness; Compliance; Referral

- Enabling: skills and practices to help care givers/mothers protect their children from sickness; Improving nutrition; Hygiene; Oral Rehydration; Insecticide treated bednets; Referral

- Mediation: linking care givers/mothers of sick children with relevant healthcare provider; family counseling for protecting children against Pneumonia, Diarrhea and Malaria; community action for clean drinking water and reducing mosquito breeding

- Practicum: preparing ORS and administering ORS06:00 hrs 06:30 hrs Plenary - Conclusion

- Resource person to conclude the section on Child Health and provide a summary of salient points for the participants

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Day 5

5. 1. Nutrition- General Concepts incl. Stunting, Wasting & Anemia- Nutrition in Pregnancy and after Delivery- Childhood Nutrition: Disease- Malnutrition vicious cycle

SummaryThis section focuses at the value, dynamics and methods of human nutrition especially as it is applied to the health of women, newborns and children. The section will introduce the participants to the national and provincial status of nutrition as assessed by National Nutrition Survey 2011 and KP Provincial Analysis 2012 and will elaborate on the concepts of Stunting, Wasting and Anemia including assessment of malnutrition with Mid-Upper Arm Circumference (MUAC) Tape and weight measurements. Focus will also be made on the issues, concerns and solutions with respect to nutrition during pregnancy and delivery. Special attention will be paid to the disease-malnutrition-disease vicious cycle that leads to increase in the risk of childhood mortality.

The section will emphasize the health promotion roles of the LHW for improving the attention of community on nutrition of women, newborns and children and will enable the participants to learn the communication needed to motivate the mothers and care givers for adopting practices that help improve the nutritional status of women, newborns and children.


Method- Presentations and discussion between resource person and participants on Nutrition as a

general concern and as specifically applied to women, newborns and children;- Group work on LHWs role in Nutrition;- Skill building on use of MUAC tape and weighing children.


1. Session notes2. Nutrition and role of LHW and Community 3. MUAC Tape and weighing scales.

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1. to demonstrate that they clearly understand the value of Nutrition in women, newborn and child health;

2. to demonstrate that they can recognize malnutrition in children;3. to demonstrate that they have the skills and knowledge for Advocating, Mediating and

Enabling for Nutrition.


00:00 hrs 01:15 hrs Presentation and Discussion – Nutrition- Description of NNS 2011 and KP Provincial Analysis 2012 - Stunting, Wasting and Anemia; Acute and Chronic Severe

Malnutrition- Factors leading to malnutrition in Women in Pregnancy and

Post-Partum period, Newborns, Children- Description and discussion on:

Disease-Malnutrition-Disease vicious cycle Maintaining nutrition of children in sickness

especially Acute Respiratory Infections, Diarrhea and Measles

01:15 hrs 02:45 hrs Technical Session (lecture & skill building) – Improving Nutritional Status of Women, Newborns & Children

- Advocacy: harmful & beneficial practices; improving Nutrition: of girl child, pregnant mothers, lactating mothers, newborns & children; Breastfeeding; Weaning & weaning foods; prevention of Malnutrition; Hygiene; Referral

- Enabling: recognizing malnutrition; skills and practices to help care givers/mothers improve their own and their children’s nutrition; preventing disease-malnutrition-disease cycle in children; preventing and alleviating Anemia in women; maintaining Hygiene;

- Mediation: referral/linking care givers/mothers of children with severe malnutrition with relevant healthcare provider(s)/services; family counseling for preventing Anemia and malnutrition in children; community action for preventing Anemia and malnutrition in children

- Practicum: using MUAC tape, weighing scale, recognizing Anemia

02:45 hrs 03:15 hrs Plenary - Conclusion

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- Resource person to conclude the section on Nutrition and provide a summary of salient points for the participants

5.2. Life Style and NCDs- General Concepts- NCDs; Common NCDs- Life Style adjustments for prevention & control of NCDs

SummaryThis section is aimed at developing a basic understanding about the common non-communicable diseases that are generally affecting our communities these days i.e., Diabetes, Hypertension and Obesity (although reference will also be made in Nutrition section) and specifically issues that women face i.e., amenorrhea, dysmenorrhea, menorrhagia, hypermenorrhea.

The section will focus on adjustments and improvements in lifestyle including eating habits, dietary content, smoking, anxiety/stress, exercise, personal and household hygiene, water intake as well as improving behaviours, social interaction and tolerance to reduce anxiety/stress and manage anger. Community cohesiveness will be emphasized to promote community action for issues that need joint decision-making and improvements in health services and service utilization.


Method- Presentations and discussion between resource person and participants on lifestyle, non-

communicable diseases and issues faced by women;- Group work on LHWs role in improving behaviours to reduce stress and anger and

promote community cohesiveness;


1. Session notes2. Non-communicable diseases (NCDs) and issues faced by women.


1. to demonstrate that they clearly understand the contribution of personal habits and behaviours in the health of a person;

2. to demonstrate that they understand the basics of Diabetes, Hypertension, Obesity, Anxiety and Amenorrhea, Dysmenorrhea, Menorrhagia, Hypermenorrhea;

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3. to demonstrate that they have the skills and knowledge for Advocating, Mediating and Enabling for prevention and control of NCDs.


00:00 hrs 01:30 hrs Presentation and Discussion – Lifestyle & NCDs- Description of Lifestyle and its relationship with Social

Determinants of Health- Habits and behaviours that:

damage health protect and promote health

- basic factors about Diabetes, Hypertension, Obesity, issues related to menstraual cycle and relationship of Anxiety

- LHWs’ role in NCDs01:30 hrs 02:45 hrs Technical Session (lecture & skill building) –

Improving Lifestyle and coping with NCDs- Advocacy: harmful & beneficial practices; improving diet;

quitting smoking; managing stress; exercise; hygiene; referral

- Enabling: how to improve lifestyle and behaviours; skills to help people reduce harmful practices; preventing Hypertension; controlling Diabetes; skills to manage stress; maintaining Hygiene; women’s personal care (to address menstrual cycle related issues)

- Mediation: referral/linking community members with relevant healthcare provider(s)/services; family counseling for changing harmful practices and reducing stress; community action for improving mutual relationships and community hygiene.

02:45 hrs 03:15 hrs Plenary – Conclusion- Resource person to conclude the section on Nutrition and

provide a summary of salient points for the participants

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Day 6

6.1. Family Planning and HTSP- General Concepts- Contraception and commodities- HTSP- Role of LHWs

SummaryThis section on Healthy Timing and Spacing of Pregnancies (HTSP) and Family Planning (FP) aims to develop competence of LHWs on the rationale of both HTSP and FP and the choices available for couples to practice each. The focus would basically be laid not on contraception and family planning but on the health reasons of both babies and their mothers as the basis for making choices to use contraceptives to prolong space between pregnancies.

The participants will be provided a quick overview of the contraceptives that the LHW Program allows the LHWs to promote and provide to the community and information about linkages with other service providers who can assist couples in making informed decisions and adopting methods of their choice for HTSP.


Method- Presentations and discussion between resource person and participants on the reasons for

increasing space between pregnancies and the health benefits for mothers and children, choices for contraception available for couples and commodities available;

- Group work on LHWs role in HTSP/FP and referral;


1. Session notes2. HTSP/FP choices3. Sample contraceptive commodities for demonstration.


1. to demonstrate that they clearly understand the health reasons for mothers and children in addition to economic factors for using HTSP;

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2. to demonstrate that they can explain the uses, advantages and disadvantages of various contraceptive methods;

3. to demonstrate that they have the skills and knowledge for Advocating, Mediating and Enabling for HTSP.


00:00 hrs 01:00 hrs Presentation and Discussion – HTSP & FP- Rationale of creating space between pregnancies- Description of HTSP and FP – a comparison- Various permanent, semi-permanent and temporary methods

of contraception and their availability - Advantages and disadvantages of various methods of

contraception 01:00 hrs 01:45 hrs Technical Session (lecture & skill building) –

Promoting and enabling HTSP- Advocacy: why HTSP?; methods of contraception; choosing

suitable contraceptive method; post-partum IUCD; referral for method of choice

- Enabling: helping to chose the appropriate contraception method; provision of allowable contraceptive commodities; teaching skills to use selected method of contraception effectively; preventing side-effects and contraceptive failure

- Mediation: referral/linking community members with relevant FP service provider(s)/services; family counseling for HTSP and health of mothers and newborn; community action for supporting HTSP and involving males.

01:45 hrs 02:00 hrs Plenary – Conclusion- Resource person to conclude the section on HTSP/FP,

answer questions and provide a summary of salient points for the participants

6.2. Critical conditions and acute illnesses- General Concepts- Role of LHWs- Emergency care: Breathing, Bleeding, Breaks - Referral

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SummaryLHWs commonly are faced with community members seeking advice and assistance for emergencies and acute illnesses. This section addresses the aspects in daily life that may cause an LHW to be faced with an emergency or acute illness and prepares her for initial supportive action and ensuring that timely help is made available to the person in need.

The section will especially cover the classic emergency response of maintaining breathing, controlling bleeding and attending to breaks (fractures) and stabilizing the patient so that advanced care can be sought.


Method- Presentations and discussion between resource person and participants on the various

common emergency and acute illness scenarios and action needed;- Group work on LHWs role in emergencies/acute illnesses and referral;


1. Session notes2. Common household and community emergencies and acute illnesses3. Mannequin for practicing resuscitation4. Bandages for practicing control of bleeding 5. Wooden planks for immobilizing fractured limbs6. Household utensil/container for sponging to reduce fever.


1. to demonstrate that they clearly understand the action needed for rescuing severely injured person and/or acutely sick person;

2. to demonstrate that they have the skills for BBB and sponging for fever;3. to demonstrate that they have the skills and knowledge for Advocating, Mediating and

Enabling for responding to emergencies and acute illnesses.


00:00 hrs 00:45 hrs Presentation and Discussion – Emergencies and Acute Illenesses- Introduction to common emergencies and acute illnesses:

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Emergencies: road accidents, machinery operation accidents, electrocution, drowning, snake bite, shock – focus on breathing, bleeding and brakes

Acute illnesses: high grade fever, convulsions, acute asthma, hyper/hypo-glycemia, dehydration and shock – focus on high grade fever, breathing and circulation

00:45 hrs 01:30 hrs Technical Session (lecture & skill building) – Actions to address emergencies and acute illness

- Advocacy: avoiding accidents and emergencies; avoiding risk and early health seeking behavior

- Enabling: BBB response and resuscitation- Mediation: referral/linking community members with

relevant service provider(s)/services; community action for supporting emergency care.

01:30 hrs 02:00 hrs Skill Building Session- Practicing resuscitation (BBB) and water sponging for

reducing fever

6.3. Epidemic Control- General Concepts- Common Epidemics- Role of LHWs

SummaryVarious epidemics are seen on a daily basis ranging from Dengue Fever, Malaria, Cholera/Acute Gastroenteritis, Typhoid, Measles and Polio. What is the role on an LHW with respect to epidemics? Various expectations are associated with the LHWs with requirement of providing health education, spreading awareness, reporting and assisting in controlling epidemics.

This section presents the basics of how diseases can become epidemic. It will discuss the common control and preventive measures and the role LHWs are supposed to play with respect to epidemics and their reporting.


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Method- Presentations and discussion between resource person and participants on what is an

epidemic, progress of epidemic in community, epidemic control, epidemic reporting; Main features of Dengue Fever, Malaria, Cholera/Acute Gastroenteritis, Typhoid, Measles and Polio

- Group work on LHWs role in epidemics and referral.


1. Session notes2. Epidemics 3. Epidemic reporting proctocol(s).


1. to demonstrate that they clearly understand the process of epidemics in a community and the general epidemic control measures;

2. to demonstrate that they have the basic knowledge about Dengue Fever, Malaria, Cholera/Acute Gastroenteritis, Typhoid, Measles and Polio;

3. to demonstrate that they have the skills and knowledge for identifying and reporting epidemics.


00:00 hrs 01:00 hrs Presentation and Discussion – Epidemics Overview- what is an Epidemic and how epidemics spread- hallmarks of an Epidemic- Mosquito vector-borne: Dengue Fever, Malaria- Epidemics of GI Tract: Cholera/Acute Gastroenteritis,

Typhoid, - Immunizable diseases: Measles, Polio

01:00 hrs 01:45 hrs Technical Session (lecture & skill building) – LHWs’ role in Epidemics

- Advocacy: what is an epidemic, how to prevent epidemics, personal and community hygiene, safe food/drink, hand-washing, immunization

- Enabling: hallmarks of epidemics, health seeking in epidemics, preventing and controlling epidemics, treatment of the sick

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- Mediation: referral/linking community members with relevant health service provider(s)/services; Epidemic Reporting

01:45 hrs 02:00 hrs Plenary – Conclusion- Resource person to conclude the section on Epidemics,

answer questions and provide a summary of salient points for the participants

Conclusion

00:00 hrs 00:30 hrs Plenary – Conclusion- Summarize the topics of the 6-day RTC- Answer any questions- Agree follow-up actions with timeline and responsibilities.

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LHWs Refresher Training Curriculum - Sep 2014 (Recovered)

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