A Training Program in Community-Directed Intervention To Improve Access To Essential Health Services Training Guide

A Training Program in Community-
Directed Intervention to Improve

Access to Essential Health Services
Training Guide
June 2013
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Contents
ABBREVIATIONS AND ACRONYMS ......................................................................................................... 4
ABBREVIATIONS AND ACRONYMS ......................................................................................................... 4
ACKNOWLEDGMENTS ............................................................................................................................ 5
INTRODUCTION ...................................................................................................................................... 6
WORKSHOP OVERVIEW .......................................................................................................................... 6
Competency-Based Training Approach ........................................................................................... 6
WORKSHOP SYLLABUS............................................................................................................................ 7
Workshop Goals ............................................................................................................................... 7
Expected Outcomes ......................................................................................................................... 7
Learning Objectives.......................................................................................................................... 7
Training Contents ............................................................................................................................. 8
Sample Course Schedule .................................................................................................................. 9
Training/Learning Methods and Materials ...................................................................................... 9
Recommended Reading ................................................................................................................. 10
WORKSHOP LOGISTICS ......................................................................................................................... 10
Learner Selection ........................................................................................................................... 10
Workshop Duration........................................................................................................................ 11
Suggested CDI Team Workshop Composition ............................................................................... 11
ROLES OF COMMUNITY PARTNERS AND OTHER STAKEHOLDERS IN SUPPORTING CDDs ................... 11
Roles of Community Partners ..................................................................................................... 12
Roles of the Local Government (District) ....................................................................................... 12
Roles of the State/Regional Ministry ............................................................................................. 12
Role of the National Malaria Control Program .............................................................................. 13
HOW TO USE THIS GUIDE ..................................................................................................................... 13
MODULE 1: OVERVIEW OF iCCM STRATEGY THROUGH COMMUNITY-DIRECTED INTERVENTION ..... 14
MODULE 2: THE CDI PROCESS .............................................................................................................. 15
MODULE 3: THE VALUE OF COMMUNITY INVOLVEMENT ................................................................... 16
MODULE 4: MAPPING COMMUNITY STRUCTURE, NETWORKS, AND ORGANIZATION ....................... 17
MODULE 5: COMMUNITY-DIRECTED INTERVENTIONS TO DELIVER MALARIA PLUS PACKAGES ......... 18
MODULE 6: APPLYING CDI TO HOME MANAGEMENT OF MALARIA.................................................... 19
MODULE 7: CDI IN LLIN DISTRIBUTION AND USE ................................................................................. 20
MODULE 8: APPLYING CDI TO INTERMITTENT PREVENTIVE TREATMENT IN PREGNANCY ................. 21
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MODULE 9: ROLE OF THE CDI FOCAL PERSON ..................................................................................... 22
MODULE 10: A REVIEW OF EFFECTIVE TRAINING SKILLS ..................................................................... 23
MODULE 11: SAMPLE CDD MODULE ON COMMUNITY CASE MANAGEMENT .................................... 24
MODULE 12: INTRODUCTION TO HEALTH SERVICES SUPERVISION..................................................... 25
MODULE 13: BASIC M&E CONCEPTS FOR INTEGRATED COMMUNITY CASE MANAGEMENT OF
MALARIA ............................................................................................................................................... 27
MODULE 14: SUPPLY CHAIN MANAGEMENT FOR CDI ......................................................................... 29
MODULE 15: ROLES OF LOCAL GOVERNMENT AREA CDI TEAM MEMBERS ........................................ 30
MODULE 16: RAPID DIAGNOSTIC TEST TRAINING................................................................................ 31
MODULE 17: COMMUNITY MANAGEMENT OF PNEUMONIA.............................................................. 33
MODULE 18: COMMUNITY MANAGEMENT OF DIARRHEA .................................................................. 34
MODULE 19: BEHAVIOR CHANGE COMMUNICATION ......................................................................... 35
EVALUATION......................................................................................................................................... 36
Overview of Evaluation ........................................................................................................................ 36
Post-Training Follow-up and Action ..................................................................................................... 37
Post-Training Tasks for CDI Team Members .................................................................................. 37
Post-Training Jobs/Tasks for CDDs................................................................................................. 37
Pre- and Post-Tests ............................................................................................................................... 39
Workshop Evaluation ........................................................................................................................... 41
Appendix 1: Sample Performance Checklist......................................................................................... 43
Appendix 2: Sample Annual Action Plan .............................................................................................. 44
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ABBREVIATIONS AND ACRONYMS
ACT artemisinin-based combination therapy

BCC behavior change communication
CDD community-directed distributors
CDI community-directed intervention
CSO civil society organization
iCCM integrated community case management
IEC information, education, and communication
IPTp intermittent preventive treatment in pregnancy
ITN insecticide-treated net
LGA local government area
LLIN long-lasting insecticide-treated net
M&E monitoring and evaluation
ORS oral rehydration solution
PME participatory monitoring and evaluation
PMV patent medicine vendors
RDT rapid diagnostic test
SP sulfadoxine-pyrimethamine
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ACKNOWLEDGMENTS
This training program was developed in stages over a period of five years. In 2007 Jhpiego received a
grant from the ExxonMobil Foundation to provide community-directed malaria in pregnancy
interventions in several local government areas (districts) in the highly malaria-endemic area of
coastal Akwa Ibom, Nigeria. The original modules focused on the provision of intermittent
preventive treatment of pregnant women, acquisition and use of insecticide-treated bed nets, and
malaria case management. Later, with additional support from Ellicott Dredges, a Baltimore-based
company, the training curriculum was expanded to include integrated community case management
of common and febrile illnesses, including malaria, pneumonia, and diarrhea. Based on this
experience, Jhpiego was asked by the World Bank Malaria Booster Program to assist the National
Malaria Control Program in Nigeria to train teams in seven focal states on the principles and
processes of community-directed intervention as a means of delivering integrated community case
management. The basic technical modules were thereby expanded to include more information on
the process of establishing and sustaining community-directed interventions. Finally, the Target
States High Impact Project, USAID’s MCH/Reproductive Health bilateral project, asked Jhpiego to
provide technical assistance and training in rolling out community-directed interventions in the local
governments in its focal states.
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INTRODUCTION
Integrated community case management (iCCM) is the provision of basic prevention, diagnosis,
treatment, and counseling for common illnesses such as malaria, pneumonia, and diarrhea within
and by the community itself. iCCM is implemented by training community health volunteers to
provide these basic services within the community. Community-directed intervention (CDI) is an
approach that enables communities to organize and direct health service delivery, including the
distribution of health commodities, for the community, with the guidance of the government health
service. The CDI approach was first used by the African Program for Onchocerciasis Control. When
the approach was found to be successful, other programs adopted it for the delivery of other health
interventions, including guinea worm control, distribution of insecticide-treated nets (ITNs), vitamin
A distribution, immunization programs, and scale-up activities for the control of tuberculosis. The
CDI approach gives ownership for planning and decision making about the whole service delivery
process in order to achieve sustainability. This training program shows how to use a CDI approach
for iCCM interventions that strengthen essential health services.
WORKSHOP OVERVIEW
Competency-Based Training Approach
Competency-based training is learning by doing. It focuses on the specific knowledge, attitudes, and
skills needed to carry out a procedure or activity. The emphasis is on the learner’s acquisition of
knowledge, attitudes, and skills, rather than just on learning information. Competency in the new
skill or activity is assessed objectively through evaluation of the learner’s performance.
For competency-based training to be successful, the clinical skill or activity being taught must be
broken down into its essential steps. Each step is then analyzed to determine the most efficient and
safe way to perform and learn it. This process is called standardization. Once a procedure such as
conducting a focused antenatal care visit has been standardized, competency-based learning guides
and evaluation checklists can be developed to make learning the necessary steps or tasks easier and
evaluating the learner’s performance more objective.
An essential component of competency-based training is coaching. The classroom or clinical

facilitator first explains a skill or activity and then demonstrates it using an anatomic model or other
training aid. Once the procedure has been demonstrated and discussed, the facilitator observes and
interacts with learners to guide them in learning the skill or activity, monitoring their progress and
helping them acquire the necessary skills.
The coaching process ensures that the learner receives feedback at various points in the learning
process:
 Before practice—The facilitator and learners meet briefly before each practice session to review
the skill/activity, including the steps/tasks that will be emphasized during the session.
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 During practice—The facilitator observes, coaches, and provides feedback to the learner as s/he
performs the steps/tasks outlined in the learning guide.
 After practice—Immediately after practice, the facilitator uses the learning guide to discuss the
strengths of the learner’s performance and offer specific suggestions for improvement.
The CDI approach stresses building competency not only of individual community volunteers but of the
community itself in managing its health programs. Therefore, it is important to envision learning for CDI as
something that starts with the first contact health workers have with the community, through the
selection and training of volunteers on to follow-up supportive supervision and community problem
solving.
WORKSHOP SYLLABUS
This workshop and the related materials are intended to be used in a cascade fashion. Members of
national CDI training teams can use the workshop curriculum to train regional and state trainers and
facilitators, who in turn can use the materials when they conduct training for district and local
government teams. Once the local training teams have learned the CDI approach, they will use the
workshop curriculum to train and guide health facility staff and facility-level CDI focal persons, who
can then adapt the materials for community-level training activities.
Workshop Goals
The goal of the workshop is to give CDI training teams, CDI focal persons, and community-directed
distributors (CDDs) the knowledge, skills, and attitudes they need to effectively provide services at
the community level using the CDI approach and to train a critical mass of lower-level implementers.
Expected Outcomes
 Action plans illustrating how the learners will strengthen essential health services using the CDI
approach (see Appendix 2: Sample Annual Action Plan)
 A strategy development document
 A cadre of core lower-level CDI implementers with the most up-to-date knowledge, skills, and
attitudes for using CDI
Learning Objectives
The learners in this workshop are CDI training teams at the national, regional/state, district, and
health facility levels. Some of the modules will help the learners understand the process of setting
up CDI for integrated community case management (iCCM). Other modules are geared to the
technical content that they will pass on to CDDs.
By the end of the workshop, the learners will be able to:
1. Define community participation;

2. Explain the value and benefit of community involvement in health programs;
3. Identify and define community structures (e.g., kin groups, hamlets);
4. Identify the various volunteer community health agents and their roles;
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5. Describe the community social and economic factors that affect health;
6. List community resource persons who can be involved in control of malaria, pneumonia, and
diarrhea;
7. Describe community-level prevention methods;
8. Demonstrate accurate diagnosing skills, drug prescription, and illness treatment;
9. Demonstrate recording and reporting skills for community data; and
10. Describe storage methods for drugs and commodities at the community level.
General Objectives for Training CDDs
After learning to organize CDI, the CDI training teams will help communities recruit CDDs for
training. The trainers will then organize CDD training sessions in which they train CDDs to:
1. Mobilize their communities to use the interventions at their antenatal care clinic and other
related services at their health facilities;
2. Provide information about malaria, pneumonia, and diarrhea prevention and control activities
to women, men, and caregivers in their communities;
3. Conduct home visits and provide selected services during the visits;
4. Refer clients for treatment of malaria and other illnesses at the health facilities within their
communities;
5. Keep records on prevention and control activities in the communities; and
6. Manage commodities supplied for use in their communities.
Training Contents
Session/ Topic
Module
Registration and Pre-Test
1 Overview of iCCM Strategy through Community-Directed Intervention
2 The CDI Process
3 The Value of Community Involvement
4 Mapping Community Structure, Networks, and Organization
5 Community-Directed Interventions to Deliver Malaria Plus Packages
6 Applying CDI to Home Management of Malaria
7 CDI in LLIN Distribution and Use
8 Applying CDI to Intermittent Preventive Treatment in Pregnancy
9 Role of the CDI Focal Person
10 A Review of Effective Training Skills
11 Sample Module for CDDs on Community Case Management
12 Introduction to Health Services Supervision
13 Basic M&E Concepts for Integrated Community Case Management of
Malaria
14 Supply Chain Management for CDI
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15 Roles of Local Government Area CDI Team Members
16 Rapid Diagnosis Test Training
17 Community Management of Pneumonia
18 Community Management of Diarrhea
19 Behavior Change Communication
Review/Evaluation, Post-Test, Certificates
Sample Course Schedule
Day/Time Monday Tuesday Wednesday Thursday Friday

Morning 1 Introduction Review Review Review Review
~09:00– Modules 1 Module 6 Module 10 Module 14 Module 18
10:30 and 2
Break
Morning 2 Module 3 Module 7 Module 11 Module 15 Module 19
~11:00–
1:00
Lunch
Afternoon Module 4 Module 8 Module 12 Module 16 Team work &
1 ~2:00– planning
3:30 meetings
Break
Afternoon Module 5 Module 9 Module 13 Module 17 Closing
2 ~4:00–
5:00
Training/Learning Methods and Materials
Learning Methods
The following learning methods are used for this workshop:

 Illustrated lectures
 Large and small group discussions
 Case studies
 Role plays
 Group activities
Learning Materials
The following workshop learning materials are used along with this guide:
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 National guidelines for integrated community case management, if available
 Modules, in the form of PowerPoint presentations, which should be adapted to the country
setting (available on the Jhpiego website, at http://www.jhpiego.org/en/content/training-
program-community-directed-intervention-cdi-improve-access-essential-health-service)
 Handouts the facilitators can make from the PowerPoint slide modules after they have adapted
the slides
 Sample materials for demonstration and practice exercises
 Materials, including long-lasting insecticide-treated nets (LLINs) and insecticide-treated nets
(ITNs) and hanging kits; rapid diagnostic tests; bowls, bottles, spoons for oral rehydration
solution (ORS); soap for hand washing
 Samples of medicines such as artemisinin-based combination therapies (ACTs) in different
age packs, ORS packets, amoxicillin/cotrimoxazole
Recommended Reading
Please download the following from the Jhpiego Malaria Resources Website:
• Community-Directed Interventions for Priority Health Problems in Africa: Results of a
Multicountry Study
• Establishing Integrated Community Management of Malaria, Pneumonia and Diarrhea in Two
Selected Local Government Areas, Akwa Ibom State, Nigeria
• Improving Quality Performance among Community Health Workers Providing Integrated
Community Management of Febrile Illnesses in Nigeria
• Preventing Malaria in Pregnancy through Community-Directed Interventions: Evidence from
Akwa Ibom State, Nigeria
WORKSHOP LOGISTICS
Learner Selection
Training Teams and Focal Persons

State/regional training teams should be interdisciplinary, involving staff from maternal health, child
health, malaria control and other health agencies, pharmacy, monitoring and evaluation, and other
relevant sections of ministries of health. The teams can also include representatives of
nongovernmental organizations and donor agencies. Teams may consist of 10–15 people. Later they
will divide up the districts in their area and provide training on a rotational basis at that level.
District CDI teams also should reflect the multiple disciplines involved in running an iCCM
intervention. District teams are responsible for training staff from the health facilities in their areas.
The training team initially trains most or all of the staff on the technical updates needed to manage
health issues covered under iCCM. After this general training, the team may ask facilities to
nominate one or two staff members for additional training to serve as CDI focal persons and be
responsible for rolling out CDI in their surrounding communities.
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CDDs
CDDs are selected by their communities. Communities should be encouraged to develop selection
criteria that will ensure that they select people they can rely on and respect. Communities might
consider factors such as age, gender mix, duration of residence, ability to read and write in the local
language, quality of character (e.g., trustworthiness), and other issues.
Communities should select the number of CDDs that will meet their needs. For example, they may
decide that they need a female CDD to deliver malaria in pregnancy interventions or child illness
case management, while a male could distribute bed nets or other supplies. If training is held close
to the villages where CDDs live, the costs of training will be similar, regardless of the number of
CDDs trained.
The workshop curriculum is designed to ensure that CDI focal persons guide CDDs in the
implementation of their community tasks.
Workshop Duration
 Five to seven days of training will be needed for the training teams at various levels, including
the CDI focal persons. The training can be divided into a CDI organizational workshop and an
iCCM technical update workshop, if this makes the training more convenient for the learners.
 CDD training can be spread out over time for the convenience of both trainers and CDDs (e.g.,
by offering a series of CDD training sessions at weekly markets).
Suggested CDI Team Workshop Composition
 20–25 learners
 2–4 facilitators
 Depending on the number of districts in a region or facilities in a district, the training team may
need to hold more than one workshop to accommodate all learners. Larger workshops provide
less opportunity for trainee participation.
ROLES OF COMMUNITY PARTNERS AND OTHER STAKEHOLDERS IN SUPPORTING CDDs
The community partners and stakeholders for iCCM using a CDI approach include community-
based organizations, faith-based organizations, civil society organizations (CSOs), and other
nongovernmental organizations and agencies operating at the community level. These
organizations and agencies have important roles to play in community prevention and
management of malaria. Their activities may be coordinated by the national association of civil
society organizations, which may have membership on the country’s Country Coordinating
Mechanism (a body that helps prepare proposals for the Global Fund to Fight AIDS,
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Tuberculosis and Malaria). There may also be CSO coordinating bodies at the state/regional and
district levels that could be engaged to help roll out CDI for iCCM.
Roles of Community Partners
• Participating in establishing and facilitating community-based health development committees

in support of the CDDs
• Encouraging community ownership of iCCM
• Creating awareness by sensitizing communities to the rationale and implementation process of
the iCCM strategy
• Ensuring that CDDs carry out iCCM in accordance with national guidelines
• Ensuring that CDDs prepare good quality data with approved data capture tools and submit it to
the health facilities
• Designing behavior change communication (BCC) materials (or adapting existing materials) with
the input of the communities
• Training CDDs on follow-up and referral services
• Networking with other CSOs in the community or LGA to strengthen the iCCM strategy
• Identifying barriers to the implementation of iCCM and sharing them with the community to
proffer solutions
Roles of the Local Government (District)
• Distribute and disseminate to the village health committee and health facilities a strategy
document for implementation of iCCM
• Advocate for support and ownership of the program to traditional and religious leaders
• Using the supervisory checklist, conduct on-the-job supportive supervision of CDDs
• Coordinate all activities related to implementation of iCCM, including activities of CSOs in the
LGA
• Report to the ministry of health on the implementation of iCCM
• Ensure sustained availability of commodities for communities and health facilities
• Monitor training and supply of commodities for CDDs
• Ensure proper storage of commodities supplied
Roles of the State/Regional Ministry
• Distribute and disseminate to LGAs and health facilities a strategy document for implementation
of iCCM
• Adopt for implementation the national strategy document for iCCM
• Advocate for support and ownership of the program by policymakers
• Using the supervisory checklist, conduct on-the-job supportive supervision of CDDs
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• Coordinate all activities related to implementation of iCCM, including activities of CSOs in the
state
• Report to district, regional, and national health authorities, including specific programs (e.g.,
malaria, child health), as appropriate
• Ensure sustained availability of commodities for LGAs and health facilities
• Monitor training and supply of commodities for CDDs
• Ensure quality assurance of commodities supplied
• Write terms of reference for the facilitation team at the LGAs
Role of the National Malaria Control Program
• Advocate for support and ownership of the program by policymakers

• Develop and print strategy document for implementation
• Distribute and disseminate strategy document for implementation
• Coordinate all activities related to implementation of iCCM, including review of policies to
support implementation
• Using the supervisory checklist, conduct on-the-job supportive supervision
• Ensure sustained availability of commodities to states and LGAs
• Monitor training of CDDs and health workers

• Monitor supply and distribution of commodities to states and LGAs
• Ensure quality assurance of commodities supplied
HOW TO USE THIS GUIDE
This training guide should be used in conjunction with the 19 training modules that comprise the CDI
training curriculum. The modules may be downloaded from the Jhpiego website at:
http://www.jhpiego.org/en/content/training-program-community-directed-intervention-cdi-
improve-access-essential-health-service
The curriculum was created for use in a five- to six-day workshop. The 19 sections in this guide give
facilitators guidance and instructions for planning and conducting each of the workshop modules.
Before facilitating a CDI workshop, we recommend that facilitators read through the PowerPoint
presentation for each module. The modules may be adapted to the local/national context, as
needed.
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MODULE 1: OVERVIEW OF iCCM STRATEGY THROUGH COMMUNITY-
DIRECTED INTERVENTION
SESSION/Module TOPIC TIME

1 Overview of iCCM strategy through 45 minutes
community-directed intervention
SESSION OBJECTIVES
By the end of this module, learners will:
• Get to know each other
• List the workshop and learning objectives, course schedule, and materials
 List expected outcomes of the workshop
 Identify skills they wish to share with others
 Decide on the workshop norms
METHODS AND ACTIVITIES MATERIALS/RESOURCES
Illustrated presentation/discussions: Course overview • Multimedia equipment
Be sure to cover all of the following topics: • PowerPoint presentation
• Background and purpose of the workshop • Course introduction
• Introduction of learners • Flip chart board and papers
• Learners’ expectations • Markers
• Course structure and modules
• Session, workshop, and learning objectives
• Target audience for the course
• Workshop materials
• Workshop norms
• Learner certification
• Workshop outcomes (strategy development document
and action plan)
• Workshop outlines
• Reasons for using a CDI approach for iCCM
• High-impact malaria interventions
• Template for action plan (see Appendix 2)
Summarize key points
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MODULE 2: THE CDI PROCESS
Module/ SESSION TOPIC TIME
2 The CDI process 60 minutes
SESSION OBJECTIVES
 Define the CDI approach
 Describe program coverage benefits of using CDI
 Outline the steps to establish CDI
 List key approaches in gaining community commitment for a CDI program
 Describe the steps in selecting and training community distributors
 Explain how CDI can be adapted for use in controlling malaria
Illustrated presentation/discussions: Community-directed • Multimedia
interventions and key steps equipment
Role play: Divide the class into four or five groups. Each group will • PowerPoint
perform a role play about approaching a community to introduce a presentation
CDI program for malaria control: • Flip chart board and
papers
• The first and second groups will perform a role play about • Markers
the first meeting with the community gatekeepers. • Role play instructions
• The third and fourth groups will perform a role play about
holding the second community meeting.
Be sure to cover all of the following topics:
• What is community-directed intervention?
• CDI and onchocerciasis
• Benefits of CDI
• Expanding beyond ivermectin
• Lessons learned in a CDI approach
• Start-up components of a CDI approach
• Approaching the health service
• Roles for the health service
• Training health care providers for their roles
• Approaching the community
• Roles for the community
• Discussing and gaining commitment to community roles
• Training community distributors
• Major interventions for malaria in pregnancy
• Delivery of community health education on malaria
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MODULE 3: THE VALUE OF COMMUNITY INVOLVEMENT
SESSION/ Module TOPIC TIME

3 The value of community involvement and 45 minutes
its role in community and home
management of malaria
SESSION OBJECTIVES
 Identify and define community structures
 Define community participation
 Explain the value and benefit of community participation and involvement in health
programs
 Identify the various volunteer community health agents and their roles
 Describe the community social and economic factors that affect health
 List community resource people who can be involved in malaria control
Illustrated presentation/discussions: The value of community • Multimedia equipment
involvement: Roles in home management of malaria • PowerPoint presentation
Be sure to cover all of the following topics: • Flip chart board and
• Module objectives papers
• Definition of community • Markers
• Why community involvement is important (brainstorm)
• What constitutes a participatory approach
• Community role in participation
• Examples of community participation
• Community problem-solving
• Rationale and scientific basis for home management of
malaria
• Community involvement and access gaps
• Community management and agents
• Factors that affect malaria control
• What communities can do
• Local resources to support program implementation
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MODULE 4: MAPPING COMMUNITY STRUCTURE, NETWORKS, AND
ORGANIZATION

4 Community structure, networks, and 60 minutes
organization
SESSION OBJECTIVES

 State the definition of community used in “to roll out community-directed interventions”
 Describe the purpose of community mapping in building support and solving problems
 Explain the value of involving community members in mapping their own community
 List the steps and activities needed to map the organizations and resources in a community

Illustrated presentation/discussions: Community structure, • Multimedia equipment
networks, organization, mapping, and headcounts • PowerPoint presentation
papers
• Community mapping • Markers
• Components of mapping
• Resource and social mapping
• Why social mapping is important
• Using social mapping information
• Factors that influence what community looks like
• Rural and urban communities
• Charting the mapping results
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MODULE 5: COMMUNITY-DIRECTED INTERVENTIONS TO DELIVER
MALARIA PLUS PACKAGES

5 Using CDI to deliver Malaria Plus 90 minutes
Packages
SESSION OBJECTIVES
• Name the components of a Malaria Plus Package
• Describe key household and community practices that affect child growth promotion
and development
• List steps and activities for disease prevention at the home/community to reduce
illnesses and deaths
• Explain home management of malaria-related diseases such as diarrhea, chest infection,
malnutrition, and anemia
• List activities to promote care-seeking and compliance with healthy practices

Illustrated presentation/discussions: Using CDI to deliver • Multimedia equipment
Malaria Plus Packages • PowerPoint presentation
papers
• Session objective • Markers
• Background and purpose • CDD kits
• Why Malaria Plus Packages? • Community counseling
• Household and community practices card
• Growth promotion and development
• Disease prevention
• Prompt and appropriate home management of
illnesses
• Care seeking and compliance
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MODULE 6: APPLYING CDI TO HOME MANAGEMENT OF MALARIA

6 Applying CDI to home management of 80 minutes
malaria
SESSION OBJECTIVES
 Outline the three components of malaria case management
 Describe the processes of case management with children and with pregnant women
Illustrated presentation/discussions: Home management of • Multimedia equipment
malaria • PowerPoint presentation
Small group work: Use of case studies • Flip chart board and
papers
Practice session: Basic management of cases and referral • Markers
• Rapid diagnostic test kits
Be sure to cover all of the following topics: • ACTs
• Session objective • Community counseling
• Essential components of malaria case management card
• Diagnosis of malaria and benefits
o Rapid diagnostic test kits
o Microscopy
• Types of malaria
• Recognizing malaria in pregnant women
o Uncomplicated malaria
o Severe malaria
• Treatment of malaria
o Malaria in pregnancy
o Malaria in children
• What to do when convulsions occur
• Referral
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MODULE 7: CDI IN LLIN DISTRIBUTION AND USE
SESSION TOPIC TIME
7 Applying CDI to the distribution and use 60 minutes
of LLINs
SESSION OBJECTIVES
• Explain how to obtain and safely maintain stocks of LLINs
• Estimate LLIN needs based on community census
• Discuss the need to educate community members on the importance of sleeping under LLINs
every night (especially children and pregnant women)
• Discuss the need to encourage pregnant women to collect and use LLINs as soon as they realize
they are pregnant
• Outline the process of teaching community members how to use the nets
• Outline follow-up procedures for facility staff and CDDs to encourage continued LLIN use
• Discuss the importance of making sure that all women of reproductive age have and use an LLIN
so that they will be protected at the beginning of their next pregnancy
Illustrated presentation/discussion: Supplies, storage, and • Multimedia equipment
distribution of LLINs/ITNs at the community level • PowerPoint presentation
Demonstration: Demonstrate hanging a net over a sleeping • Flip chart board and
area, and allow learners to practice net hanging papers
• Markers
Be sure to cover all of the following topics: • A bed and mattress
• Obtaining and safely maintaining stocks of ITNs based • An ITN
on community census estimates
• Net hangers/ropes
• Educating community members on hanging nets and
• Nails and hammers
use of nets
• Nail removers
• Educating community members on the value of nets
• What information on causes of malaria to share
• Benefits of ITNs and net maintenance
• Comparison of treated and untreated nets
• Encouraging net use early in pregnancy
• Making home visits
• Ensuring net use
• Other ways to prevent malaria
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MODULE 8: APPLYING CDI TO INTERMITTENT PREVENTIVE TREATMENT
IN PREGNANCY
8 Applying CDI to IPTp 90 minutes
SESSION OBJECTIVES
 State their country’s specific malaria data
 Identify IPTp special target groups
 Describe the basis for IPTp and the use of SP for IPTp
 State the difference between chemoprophylaxis and IPTp
 Decide who should be given IPTp
 Decide who should not be given IPTp
 Describe how to give IPTp
 Describe the benefits of IPTp
Illustrated presentation/discussions: Malaria control during • Multimedia equipment
pregnancy • PowerPoint presentation
Role play: Demonstrate the steps in giving IPTp • Flip chart board and
papers
Practice session: Learners practice administering IPTp in a role play • Markers
• CDD kits
Be sure to cover all of the following topics: • Doses of SP
• Session objective • Clean water and cups
• Overview of malaria illness in Nigeria • Community counseling
• Why is malaria education important during pregnancy? card
• Special target groups for control of malaria in pregnancy
• World Health Organization’s IPTp recommendation
• The use of SP for IPTp
• The difference between chemoprophylaxis and IPTp
• Delivering IPTp through CDI
• Deciding who should receive IPTp
• Deciding who should not receive IPTp
• How to give IPTp
• Benefits of IPTp
• Health education on IPTp
21
MODULE 9: ROLE OF THE CDI FOCAL PERSON
9 Role of CDI focal person 90 minutes
SESSION OBJECTIVES

• Determine who is a CDI focal person
• Describe the role of the CDI focal person
• Explain how the health facility as a whole supports the CDI focal person and CDI activities
Illustrated presentation/discussions: Role of a CDI • Multimedia equipment

focal person • PowerPoint presentation/handouts
• Flip chart board and papers
Small group discussion: Why do we need a CDI • Markers
focal person?
Practice session: List the duties of a CDI focal

person
• Session objective
• Why do we need a CDI focal person?
• Who is a CDI focal person?
• Key duties of a CDI focal person
• Mobilizing the community
• Training the CDDs
• Supervising preparation
• Supervising CDDs
• Coordinating supplies
• Coordinating partners
• Monitoring and evaluation
• Role of health facility
22
MODULE 10: A REVIEW OF EFFECTIVE TRAINING SKILLS
10 Review of effective training skills 90 minutes
SESSION OBJECTIVES
 List principles and approaches of adult education for training health workers
 Describe a conducive learning environment that enables active skills practice and learning
 Identify locally appropriate learning aids
 Provide examples of training methods and experiences that are interactive
 Explain the need to monitor, evaluate, and revise training
Illustrated presentation/discussions: Effective training skills • Multimedia equipment

• PowerPoint
Brainstorming session: How can we make the environment conducive presentation/handouts
to learning and enable active skills practice? • Flip chart board and
papers
Questions and answers • Markers
Practice session: If time permits, allow learners to develop training

topics and present/facilitate individually for 5 minutes.
• Time to practice
• Components of effective training
• Foundations for educating health providers
• How to develop objectives for learning
• Planning for teaching
• Preparing the learning environment
• Preparing and using teaching aids
• Using locally available materials
• Delivering an interactive session
• How to facilitate group learning
• Monitoring and revising instructions
• How to facilitate the development of health care delivery skills
• Managing clinical practice
• How to prepare and use knowledge assessments
23
MODULE 11: SAMPLE CDD MODULE ON COMMUNITY CASE
MANAGEMENT
11 Sample CDD module on community case 2 hours
management
SESSION OBJECTIVES
 List the basic local resources needed to carry out CDD training
 Describe the basic malaria content that is appropriate for community-level volunteers
 Outline training methods that are appropriate for community volunteers
 Explain how community volunteer training can be evaluated
Illustrated presentation/discussions: Sample CDD module on • Multimedia equipment

community case management • PowerPoint
presentation/handouts
Role play: Counseling on drug adherence and adverse • Flip chart board and
reactions; compose songs to reinforce learning papers/chalk and chalkboard
• Markers
Practice session: Checking for actual body temperature, pallor • Samples of appropriate
of conjunctiva, finger nail beds, sunken fontanel, and other antimalarial medicines
signs of dehydration • Treatment recording forms
Be sure to cover all of the following topics: • Job aids
• Information, education, and
• Session objective communication materials (e.g.,
• Overview of session on community case management counseling card)
for CDDs • Quiet, well-ventilated room
• Objectives for training session on malaria case near the community
management for CDDs
• How to recognize malaria
• How to check for fever
• The need for rapid diagnostic test
• Malaria treatment and appropriate antimalarial
medicines, including dosage and regimen
• Treatment scenarios (use case studies)
• Counseling for treatment using drug pack and job aids
• Recordkeeping and reporting
• Follow-up activities to ensure drug adherence
• Referral and practical tips to ensure effective referral
• Evaluation of the session
24
MODULE 12: INTRODUCTION TO HEALTH SERVICES SUPERVISION
12 Introduction to health services supervision 90 minutes
SESSION OBJECTIVES
 Differentiate between traditional and supportive supervision
 Define supervision
 Describe who is a supervisor and the supervisor’s responsibilities
 Describe the skills and personal characteristics expected of a supervisor
 Define desired standard performance
 State the relationship between training and supervision
 Describe the use of checklists during supervision and assessment for quality improvement
(see Appendix 1: Sample Performance Checklist)
 Describe the process of root cause analysis and selection of problem-solving interventions
Illustrated presentation/discussions: Introduction to health services • Multimedia equipment
supervision • PowerPoint
presentation/handouts
Brainstorm: Discuss who is a traditional and supportive supervisor
• Flip chart board and
Question and answers: In your own words, what do you understand papers
by supervision? • Markers
Practice session: Use of supervision checklist (see Appendix 1: Sample • Supervision checklists
Performance Checklist)
• Traditional versus supportive supervision
• Supervision
• The two levels of CDI supervision
• Who is a supervisor?
• Internal versus external supervision
• Responsibilities of a supervisor
• Skills required for supportive supervision
• Supervisors’ personal characteristics
• Role of supervision for quality improvement of performance
standards
• Performance improvement framework
• Desired performance (using the framework to discuss)
• Relationship between training and supervision
• How to assess performance
• Supervisory tools (show example of checklist and how to use
it)
25
• How to conduct root cause analysis to identify performance
gaps
• How to select appropriate intervention(s) to address
identified performance gaps
• Monitoring and evaluation
26
MODULE 13: BASIC M&E CONCEPTS FOR INTEGRATED COMMUNITY CASE
MANAGEMENT OF MALARIA
13 Basic monitoring and evaluation concepts 2 hours
for integrated community case management
of malaria
SESSION OBJECTIVES
• Describe participatory monitoring and evaluation (PME)
• State the roles of beneficiaries in PME
• Define a community-based information system and state why it is important
• Explain the meaning of recordkeeping and state why it is important
• Describe reporting and state why it is important
• Define basic monitoring and evaluation (M&E) concepts and state the differences between
monitoring and evaluation
• State why M&E is important in programming
• Differentiate between data and information
• Describe data and identify qualities of good data
• Identify sources of data
• Demonstrate how to fill out the register for home management of malaria and the referral
form
Illustrative exercises: On feedback mechanism • Multimedia
Illustrated presentation/discussion equipment
• PowerPoint
Be sure to cover all of the following topics: presentation
• Differences between monitoring and evaluation using the when, • Flip chart board and
what, who, and how approach papers
• Why monitoring and evaluation are important in programming • Markers
• Things that can be monitored and things that can be evaluated • Home management
• The meaning of key M&E questions of
• Requirements for institutionalizing M&E malaria/community
• The PME approach daily case register
• Principles of PME and its role in CDI • Summary forms
• PME methods and tools • Referral forms
• Types and levels of indicators • Exercises and
• Community-based management information systems and assignment
different types of information that can be generated at materials
community level
27
• Different actors and their differing information needs at the
community level
• Recordkeeping and reporting: why they are important
• Requirements for setting up a user-friendly recordkeeping
system
• What is data?
• The difference between data and information
• Sources of data
Summarize Key Points
28
MODULE 14: SUPPLY CHAIN MANAGEMENT FOR CDI
SESSION TOPIC TIME
14 Supply chain management for CDI 50 minutes
SESSION OBJECTIVES
 Describe the process of antimalarial drug procurement and storage
 Explain how to estimate their community’s commodity needs
 Outline the stock recording method and reporting format
 Describe the distribution process for antimalarial medicines and other malaria commodities
(e.g., long-lasting insecticide-treated nets and rapid diagnostic tests)
 State how to monitor and report adverse drug reactions
 Discuss the role of patent medicine vendors in malaria commodity management

Illustrated presentation/discussions: Supply chain • Multimedia equipment
management for CDI • PowerPoint presentation
papers
• Session objective • Markers
• Forecasting and estimation of antimalarial commodities • CDD kits
• Procurement and supply • Community counseling
• LGA/district supply chain card
• Introduction of forms to account for antimalarial drugs
• The distribution process
• Maintaining stocks and storage facility
• Community preparation
• Monitoring of medicine safety
29
MODULE 15: ROLES OF LOCAL GOVERNMENT AREA CDI TEAM MEMBERS
15 Roles of local government area CDI team 90 minutes
members
SESSION OBJECTIVES
 Describe LGA/district core team members and their roles
 Explain division of labor among various core team members
 Define a program coordinator and a facilitator (who they are and what they do)
 Describe components of an action plan and the process for developing action plans (see
Appendix 2)
Illustrated presentation/discussions: Role of local • Multimedia equipment
government areas • PowerPoint presentation/handouts
Small group discussion: Divide into groups and • Markers
discuss the following:
• Tasks for program coordinator
• Tasks for BCC and mobilization
• Procurement, logistics, or supplies office
• Facilitator
• M&E

• Identification of people who could constitute
state/LGA/municipal core teams
• Training for state/LGA/municipal core teams
• How to involve all trained LGA/district
members
• Division of labor among team members
• The coordinator’s tasks
• Tasks for BCC and mobilization
• Tasks for procurement, logistics, and supplies
• The facilitator’s tasks
• Tasks for M&E and documentation
• How to develop action plan using the sample
template (see Appendix 2)
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MODULE 16: RAPID DIAGNOSTIC TEST TRAINING
16 Use of rapid diagnostic tests (RDTs) as a component of home 2.5 hours
management of malaria
SESSION OBJECTIVES
 Explain why the malaria control program has elected to use RDTs in the country/district
 Describe an RDT
 Name appropriate actions for positive, negative, and invalid RDT results
 Describe the steps in performing a malaria RDT
 Demonstrate the correct and appropriate skills for drawing blood safely and effectively with
a finger prick
 State the universal precautions
 Correctly interpret different RDT outcomes
 Demonstrate the skills for performing RDT safely and effectively, using the job aid as a
guide
 State appropriate treatment based on RDT results
Illustrated presentation/discussions • Multimedia equipment

• PowerPoint
Practice session: Divide the class into groups and ask each presentation/handouts
group to perform a rapid diagnostic test. Each member of the • Flip chart board and papers
group will conduct the test on a colleague. This continues until • Markers
each group member has practiced use of RDTs. • RDT job aids
• RDT test kit: one RDT kit for each
Demonstration and return demonstration: Trainer
learner (the RDT kit usually
demonstrates malaria diagnosis using RDTs; learners pair up
contains a new and unopened
and take turns conducting RDT tests on one another
alcohol swab, a new and
unopened blood lancet, and a
buffer)
• A wrist watch or clock
• Background and purpose
• A new pair of hand gloves
• The overall steps for CDDs
• A pencil
• RDT materials and the purpose for each item
• A sharps disposal container
• The role of desiccant, how to dispose of it, and why
• A non-sharps disposal bin
• The test cassette and functions of its parts
• Proper identification of clients
• Use of hand gloves, and universal precautions
• Blood collection devices and procedure:
 Capillary tube
 Straw
 Loop
31
 Pipette
 Other
• Method of disposal of used materials, including sharps
and non-sharps
• RDT results and interpretations:
 Positive
 Negative
 Invalid
• Basic issues in the use of RDTs
32
MODULE 17: COMMUNITY MANAGEMENT OF PNEUMONIA
17 Community management of pneumonia 90 minutes
SESSION OBJECTIVES
 Describe the global burden of pneumonia and reasons it cannot be neglected
 Describe the signs and symptoms of pneumonia and its relationship to other acute
respiratory infections
 Define pneumonia
 Describe methods for prevention and treatment of pneumonia
Illustrated presentation/discussions: Community • Multimedia equipment

management of pneumonia • PowerPoint presentation/handouts
Small group discussion: Why we cannot ignore • Markers
pneumonia in efforts to control malaria • Community counseling cards
• CDD kit
Practice session: Steps for examining chest in- • Antibiotics (Cotri tablets)
drawing, cough, fast breathing, and timing; and • Basin
referral • Methylated spirits
 Session objective
 Why we cannot ignore pneumonia in efforts
to control malaria
 The relationship between pneumonia and
other acute respiratory infections
 Global/annual pneumonia burden
 Classifications of pneumonia
 Recognition of pneumonia
 Signs and symptoms of pneumonia
 Causes and prevention of pneumonia
 Appropriate examination techniques for chest
in-drawing, cough, fast breathing, and timing
 Treatment of mild pneumonia (antibiotics)
 Preventing HIV in children
 Identification of danger signs and when to
refer
33
MODULE 18: COMMUNITY MANAGEMENT OF DIARRHEA
Session/Module TOPIC TIME
18 Community management of diarrhea 45 minutes
SESSION OBJECTIVES
 State the burden of diarrheal illnesses
 Define types of diarrheal diseases
 Describe steps in recognizing and classifying diarrhea
 List causes of diarrhea and ways to prevent diarrhea
 Describe management of diarrhea
Illustrated presentation/discussions: Applying CDI to • Multimedia equipment
management of diarrhea • PowerPoint presentation/handouts
Small group discussion: Why we cannot ignore diarrhea • Markers
in efforts to control malaria • Community counseling cards
• CDD kit
Practice session 1: Appropriate handwashing and air
• ORS sachets
drying; preparation of oral rehydration solution
• Soap for handwashing
Practice session 2: Steps in conducting examination for • Provision for running water (container
sunken eyes and fontanel, inelastic skin, and other signs with tap)
of dehydration • Basin
Be sure to cover all of the following topics: • Methylated spirits
• Why we cannot ignore diarrhea in efforts to
control malaria
• Global/annual diarrhea burden
• The classifications of diarrhea
• Recognition of diarrhea
• Signs and symptoms of diarrhea
• Causes and prevention of diarrhea
• Appropriate handwashing and drying process
• Breastfeeding and proper nutrition for infants
• Treatment of diarrhea (ORS preparation and
zinc requirement)
• Danger signs of dehydration and when to refer
34
MODULE 19: BEHAVIOR CHANGE COMMUNICATION
Session/Module TOPIC TIME
19 Behavior change communication 45 minutes
SESSION OBJECTIVES
At the end of this session, learners will be able to:

 Define behavior change communication
 Differentiate between BCC and information, communication, and education (IEC)
 Identify reasons why people change or do not change behavior easily
 Discuss basic issues and concepts in BCC
 State key BCC-centered messages to promote acceptance of iCCM by policymakers, frontline
health care providers, and community members
 Identify basic methods of communicating BCC-centered messages to target audience
Illustrated presentation/discussions: Behavior change • Multimedia equipment

communication • PowerPoint presentation/handouts
Small group discussion: How people can avoid getting • Markers
malaria and why they are not behaving in those ways • Community counseling cards
• CDD kits
Practice session 1: Songs to promote the use of malaria
commodities
Practice session 2: Telling stories to facilitate

understanding of dangers of malaria

• Basic BCC concepts, messages, and methods
• Reasons people do not change behaviors
• Definition of IEC
• Definition of BCC
• The difference between IEC and BCC
• The role of BCC in malaria prevention and control
• How to differentiate between common fever
causes
• The role of RDTs and acceptability among
providers and community members
• Why RDT is elected for malaria treatment
• The use of visual aids, community counseling
cards, songs, and storytelling in BCC
35
EVALUATION
Several evaluation mechanisms can be used with this training program. Here we review evaluation
activities and offer a sample pre-/post-test of simple knowledge items. We also identify some tools that
can be used to assess satisfaction and learning during the workshop.
Overview of Evaluation
Community-directed intervention includes a coaching process to ensure that learners receive feedback
regarding their performance. Coaching can be provided at the following times and in the following ways:
 Before training/practice: The facilitator administers questions to learners before the
training/practice session to review the knowledge and skill/activity, including the steps/tasks
that will be emphasized during the session.
 During training/practice: The facilitator observes, asks questions included in the slides or
developed ahead of the session, and provides feedback to the learner as s/he performs the
steps/tasks outlined in the learning guide.
 After training: Immediately after training/practice, the facilitator uses the learning guide/ set of
questions to discuss the strengths of the learner’s performance and offer specific suggestions
for improvement.
 Follow-up: Facilitators follow up learners with a checklist to measure their performance as they
move out to the field to practice. Follow-up visits can be made every two to three months or as
learners come to the facility to replenish stocks. A sample checklist is included in Appendix 1.
 Learners assess facilitators: At the end of the training, learners use questionnaires to provide
feedback to the facilitators on their performance.
EVALUATION METHODS AND ACTIVITIES EVALUATION MATERIALS/RESOURCES
To accomplish the set objectives, the following • Pre- and post-test questionnaires
methods of evaluation are suggested: • Checklists
• Use of pre- and post-test questions to assess • Questionnaire to assess
knowledge, skills, and competence before and facilitators/organization of the training
after training/practice • Sample questionnaires and checklists are
• Use of questions and answers during training and included in the module(s)
practice sessions to provide feedback
• Use of questionnaires to assess facilitators’
performance and organization and to provide
feedback
• Use of checklists to assess performance standard
such as retention of knowledge and skills. Each
level of assessment is used to provide feedback
to ensure that learners improve at the next level.
36
Post-Training Follow-up and Action
Post-Training Tasks for CDI Team Members
1. Establish an iCCM commodity stocking system in the district/facility.

2. Map the villages in the facility catchment areas.
3. Conduct outreach to villages to explain CDI and facilitate selection of CDDs.
4. Help villages/communities conduct a census for commodity estimation.
5. Organize CDD training that is accessible and convenient for all.
6. Set up a monitoring and evaluation system to guarantee smooth and accurate data flow and
reporting from village to facility to district.
7. Organize regular CDD meetings at the health facility for continuing education, reporting, and
restocking.
8. Conduct village supportive supervision meetings.
Post-Training Jobs/Tasks for CDDs
1. Conduct home visits and referrals
a. Identify and visit pregnant women and encourage them to register for and attend antenatal
care and to deliver at the facility.
b. Encourage women who have delivered outside of the health facility to go to the postnatal
clinic so that they and their babies can receive proper care (ask their reasons for delivering
outside the facility and report the reasons to the focal person).
c. Check to see if child immunization records are up-to-date and encourage families to receive
immunizations.
2. Provide home-based services
a. Distribute ITNs/LLINs, assist household members with hanging bed nets and/or ensure that
they have hung the nets correctly, and ensure that they know to sleep under the nets every
night.
b. Provide intermittent preventive treatment (IPTp) doses to pregnant women starting at 16
weeks.
c. Ask family members about current illnesses.
d. Administer rapid diagnostic tests (RDTs) for people who complain of fever.
e. Treat people with positive RDTs with artemisinin-based combination therapy (ACT).
37
f. Determine through signs and symptoms (e.g., fast breathing) whether a child has diarrhea or
pneumonia.
g. Treat diarrhea with ORS and zinc; treat pneumonia with amoxicillin or cotrimoxazole as per
national policy.
h. Demonstrate hand washing.
3. Recordkeeping
a. Keep records of all women and households visited and all services delivered.
b. Record all diagnostic tests performed and treatments provided to children and pregnant
women.
c. Keep and regularly update the community registers with new pregnancies, deliveries, and
entrants.
d. Submit monthly reports to the focal persons at their supervising health facilities.
e. Attend monthly meetings with the focal person to provide feedback from the community
and to share challenges and success stories.
4. Hold community meetings (or orient community leaders to hold meetings)
a. Provide community health education to promote antenatal and postnatal care, malaria
prevention during pregnancy, health facility deliveries, immunizations, and other health
services.
b. Encourage community members to ensure that pregnant women and their families sleep
under ITNs/LLINs every night.
c. Collect feedback from the community about the health facilities’ services (to give to the
facilities).
5. Collect and safely maintain health commodities and supplies
a. Collect all health commodities and supplies (ITNs/LLINs, sulfadoxine-pyrimethamine [SP],

ACT) from the supervising health facility.
b. Report availability of the collected commodities to the community elders.
c. Keep custody of commodities and supplies for use by community members.
d. Submit monthly accounts to the focal person at the supervising health facility for all the
health commodities and supplies collected and dispensed.
38
Pre- and Post-Tests
SAMPLE PRE- AND POST-TEST QUESTIONS FOR

APPLYING CDI TO MALARIA CONTROL
Part A: Multiple Choice

Instruction: Circle the appropriate answer to each question.
1. What is CDI?
a. Community drug initiative
b. Community-directed intervention
c. Community does it
d. All of the above
e. None of the above
2. CDI happens when:

a. Communities are given a health program
b. Communities take charge of distributing health commodities themselves, with guidance
from the health service
c. Communities are directed on how to distribute health commodities
d. All of the above
3. All of the following are recognized signs and symptoms of mild malaria, except one. Can you
identify the incorrect one?
a. Hotness of the body
b. Weakness of the joints
c. Bitterness of the tongue
d. Lack of consciousness
e. Body pains
4. What is the best treatment for diarrhea?

a. Drinking plenty of fluids
b. Drip
c. Continuous breastfeeding
d. Giving oral rehydration solution
5. What is the correct meaning of RDT?

a. Rapid direct treatment
b. Response=directed therapy
c. Rapid diagnostic test
d. Requiring direct treatment
39
Part B: True or False
Instructions: In the space provided, print a capital T if the statement is true and a capital F if the
statement is false.
6. Recording of services provided by the CDDs should be done

when you are less busy.
7. Pregnant women should be given the first dose of SP only when
the baby has started kicking in the womb.
8. If a baby vomits within 30 minutes of taking antimalarial drugs,
the dose should be repeated immediately.
9.
Insecticide-treated nets reduce the number of mosquitoes in the
house, both inside and outside the net.
10. Children who are taking malaria medicines should discontinue
treatment if they feel better within two days of starting
treatment.
When planning your workshop schedule, be sure to allot time for the pre- and post-tests. Pre-tests may
be taken as part of registration. Post-tests should be administered near the end of the workshop but
before learners depart. For example, facilitators might give the test just before lunch on the final day of
the workshop and score them during lunch, so that they can be handed back to the learners before the
end of the workshop.
40
Workshop Evaluation
CDI WORKSHOP EVALUATION

(To be completed by learners)
Please rate the course components using the following scale:

5- Strongly Agree 4- Agree 3-No Opinion 2-Disagree 1-Strongly Disagree
COURSE COMPONENT RATING

1. The pre-test questionnaire helped me to study more effectively.
2. The trainers used a variety of training methods (lectures, case studies, role
plays, group discussions, games, and so on).
3. The small group activities, case studies, role plays, and games contributed
significantly to my learning about applying CDI to malaria control.
4. The trainers clearly stated the learning objectives.
5. The trainers communicated clearly and effectively.
6. The trainers asked questions and involved me in the sessions.
7. The trainers used a variety of audiovisual materials (flipchart, LCD projector,
print handouts, and so on).
8. There was sufficient time scheduled for practicing, hands-on experience,
exercises, and skills.
9. The information presented in the course was mostly new to me.
10. The sessions were well organized.
11. The course has made me feel more competent or skillful at my work.
12. I feel confident that I have learned enough to train others to provide malaria
prevention and treatment in the community.
ADDITIONAL COMMENTS (use reverse side if needed)

1. What are the three major things you learned in this workshop?
2. What topics, if any, should be added (and why) to improve the course?
3. What topics, if any, should be omitted (and why) to improve the course?
4. The course length was (circle one):

(1) Too long (2) Too short (3) Just right
41
Typically, course evaluation involves administering questionnaires to learners at the end of the
workshop. However, one can also use ongoing evaluation measures such as the following:
• Wishes and Pluses: At the beginning of each day, conduct a brainstorming session in which
learners list what they wish had been done better and what they believe was a plus about the
previous day. The training committee can review these regularly and make improvements.
• Focus Group Discussion: Conduct one or two concurrent focus group discussions with about five
or six learners each to elicit their feedback on both the workshop content and methods. This
feedback will be especially important if the trainers will be repeating the training in additional
districts.
• Brief Questionnaire: At the end of each day distribute a one-page form that simply asks learners
to (1) list two to three main new ideas they learned that day, (2) say what they liked about the
workshop, and (3) mention what could be improved the next day.
42
Appendix 1: Sample Performance Checklist
This sample checklist from Nigeria can be modified and used during training and also in the field for
follow-up supervision. Adapt this to the actual tasks that the trainees will perform in your country.
43
Appendix 2: Sample Annual Action Plan
Team Member Names:

Name of State:
Date:
Based on what you learned during this workshop, please develop a plan that you can use to roll out CDI
training and implementation over the next year. Use the instructions and template below and the
example that follows to guide you in developing your own plan.
Instructions for completing an action plan

First, identify goals for the plan. Some sample goals are listed below. You may have others that are
relevant to your setting.
• Sample Goal No. 1: Mobilize support for CDI implementation among Roll Back Malaria partners
at state level within the SMOH and beyond
• Sample Goal No. 2: Design and implement CDI training and planning skills to LGAs
• Sample Goal No. 3: Design, develop, and facilitate training for LGAs to implement CDI within
their health facility catchment areas
• Sample Goal No. 4: Design, develop, and facilitate training for front-line health facilities to
implement CDI in the communities within their health facility catchment areas
Add the goals to your plan, leaving ample space for listing the activities and other information related to
each goal.
Activity Targets Inputs, Quarters of Year MOV* VI** Responsible Cost

Resources Q1 Q2 Q3 Q4 Person(s)
Goal 1:
Goal 2:
Goal 3:
*MOV = Means of verification

**VI = Verifiable indicator
44
After identifying and listing your goals, add the following information in the corresponding column
under each goal:
1. Activity: State the activity that will be undertaken to convert input to output. (Examples: train
facility-based CDI focal persons on case management of malaria; counseling on drug adherence
and adverse reactions; supportive supervision at facility level; mentoring (one on one) at health
facility)
2. Targets: State the target population or cadre of providers, or other activity beneficiary. (Using
the first example above, the target population will be facility-based CDI focal persons.)
3. Inputs/resources: State the space, time, materials, equipment, finances, etc., that will be put
into the project (e.g., stationery for printing training manuals, flip chart papers and board, etc.,
hall rental, participants’ daily subsistence allowance (DSA), hotel accommodations and
transportation, and so on).
4. Quarters of the year: State your expected target dates for completion of the task, indicate the
quarter in which each milestone will be completed, and be careful because completion of one
might affect the other.
5. Means of verifications (MOV): State the means that will be used to verify whether the project
activity has been completed. The source of this information should be identified before the
activity is implemented. (In the example above, the MOV would include an attendance list and a
report on training.)
6. Verifiable indicator (VI): State a parameter for measuring performance of the activity. (Using
the example above, verifiable indicators would include (1) the number of trainings conducted
and (2) the number of CDI focal persons trained on case management of malaria, counseling and
adverse reactions, and so on.)
7. Responsible person: Indicate who is responsible to drive or accomplish the task otherwise
and/or who is accountable for the completion of the task/activity (for example, the government
agency responsible for malaria control and the implementation partner).
8. Cost: State the estimated or actual cost of the activity after taking into account all sub-costs of
the activity.
An example of a completed plan for achieving a single program goal is included on the next page.
45
Sample Action Plan
Sample Program Goal 1: Provide training and skills at district/local government, health facility, and community levels
Inputs/ Quarters of Year Description/ Indicator Responsible
Activity Targets Cost
Resources Q1 Q2 Q3 Q4 MOV Person(s)
Train facility CDI Facility- DSA, per x x • Attendance • No. of Govt. agency N30,000,000
focal persons on based CDI diems/travel list trainings for malaria
case management focal funds, • Report of conducted control/
of malaria, persons logistics training • No. of CDI implementing
counseling on drug focal persons agency
adherence and trained on
adverse reactions, case
supportive management
supervision at of malaria,
facility level, counseling,
mentoring (one on and adverse
one) at health reaction
facility, on-the-job
training to address
challenges,
coordinate
community
meetings and
referrals
Train CDDs on CDDs DSA, per x x x • Attendance • No. of Govt. agency N35,000,000
identification of diems/travel list trainings for malaria
eligible target funds, • Report of conducted control/
groups, case logistics training • No. of CDDs implementing
management of trained on agency
malaria, drug case
adherence management
counseling, use of of malaria,
LLINs, supportive counseling,
supervision, and adverse
mentoring (one on reaction
46
Inputs/ Quarters of Year Description/ Indicator Responsible
Activity Targets Cost
Resources Q1 Q2 Q3 Q4 MOV Person(s)
one) at community
level, on-the-job
training, and
community
meetings
Train patent PMVs DSA, per • Attendance • No. of Govt. agency N25,000,000
medicine vendors diems/travel list trainings held for malaria
(PMVs) on case funds, • Report of • No. of PMVs control/
management of logistics training trained implementing
malaria, drug agency
adherence
counseling,
supportive
supervision,
mentoring, on-the-
job training,
community
meetings and
referrals *
Biannual training of Journalist DSA, per x x • Attendance • No. of Govt. agency N6,000,000
journalists on diems/travel list trainings held for malaria
malaria funds, • Report of • No. of control/
intervention logistics training journalists implementing
strategies (to trained agency
upgrade
knowledge, skills,
and practice of
journalists on
malaria message
*
Note that some iCCM programs include work with medicine vendors and shops.
47
production and
communicating)
Conduct training on Facility- DSA, per x x • Attendance • No of Govt. agency N8,000,000
M&E for CDI health based CDI diems/travel list trainings for malaria
facility focal focal funds, • Report of conducted control/
persons and CDDs persons, logistics training • No. of CDI implementing
and PMVs CDDs, and focal persons agency
PMVs trained
• No. of CDDs
trained
• No. of PMVs
trained
Biannual training of Advocacy DSA, per x x • Attendance • No. of Govt. agency N2,000,000
advocacy and and diems/travel lists trainings for malaria
mobilization mobilization funds • Reports conducted control/
committee committee and • No. of implementing
members members documenta mobilization agency
tion committee
members
trained
48

A Training Program in Community-Directed Intervention To Improve Access To Essential Health Services Training Guide

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A Training Program in Community-

Directed Intervention to Improve

ACT artemisinin-based combination therapy

Competency-Based Training Approach

An essential component of competency-based training is coaching. The classroom or clinical

By the end of the workshop, the learners will be able to:

1. Define community participation;

General Objectives for Training CDDs

Sample Course Schedule

Day/Time Monday Tuesday Wednesday Thursday Friday

Training/Learning Methods and Materials

The following learning methods are used for this workshop:

Training Teams and Focal Persons

Suggested CDI Team Workshop Composition

ROLES OF COMMUNITY PARTNERS AND OTHER STAKEHOLDERS IN SUPPORTING CDDs

Roles of Community Partners

• Participating in establishing and facilitating community-based health development committees

Roles of the Local Government (District)

Roles of the State/Regional Ministry

Role of the National Malaria Control Program

• Advocate for support and ownership of the program by policymakers

• Ensure sustained availability of commodities to states and LGAs

• Monitor training of CDDs and health workers

HOW TO USE THIS GUIDE

SESSION/Module TOPIC TIME

Summarize key points

SESSION/ Module TOPIC TIME

Summarize key points

SESSION/Module TOPIC TIME

By the end of this module, learners will:

METHODS AND ACTIVITIES MATERIALS/RESOURCES

Summarize key points

SESSION/Module TOPIC TIME

METHODS AND ACTIVITIES MATERIALS/RESOURCES

Summarize key points

SESSION/Module TOPIC TIME

Summarize key points

Summarize key points

By the end of this module, learners will:

METHODS AND ACTIVITIES MATERIALS/RESOURCES

Illustrated presentation/discussions: Role of a CDI • Multimedia equipment

Practice session: List the duties of a CDI focal

Be sure to cover all of the following topics:

Summarize key points

Illustrated presentation/discussions: Effective training skills • Multimedia equipment

Practice session: If time permits, allow learners to develop training

Be sure to cover all of the following topics:

Summarize key points

METHODS AND ACTIVITIES MATERIALS/RESOURCES

Illustrated presentation/discussions: Sample CDD module on • Multimedia equipment

Summarize Key Points

METHODS AND ACTIVITIES MATERIALS/RESOURCES

Summarize key points

Be sure to cover all of the following topics:

Summarize key points

Illustrated presentation/discussions • Multimedia equipment

Summarize key points

Illustrated presentation/discussions: Community • Multimedia equipment