Approach to training

The approach to training used in this manual is based on principles of nonformal education and adult learning. The sessions provide a balance between structured learning and independent discovery.

working assumption is that training is a creative process which requires that participants take an active role in identifying their own needs and in implementing session activities. Trainers are expected to identify and use the talents and resources within the group and community and to practice skills that help to motivate others toward self-reliance.

The goal of the training is for participants to develop a working knowledge of ORT/CDD, and skills for applying that knowledge in a meaningful way, particularly in health education activities and training of other community health workers. Both the goal and the approach follow from the Peace Corps philosophy of providing a role model and working with others rather than for them.

The ORT Manual can be considered a modified "competency-based" training design. It aims to help Trainees attain and demonstrate knowledge and skills (I.e. competencies) in ORT and CDD that they can apply in the community. Competencies are expressed in behavioral training objectives which appear at the beginning of each module. These objectives were developed based on review and analysis of the tasks performed by Volunteers working in ORT and CDD in the context of Primary Health Care. Within modules, each session includes one to four learning objectives. For the purposes of this manual, a learning objective describes what the Trainee does along the way toward accomplishing the terminal behavioral objective.

At the beginning of the training, participants should examine all of the behavioral objectives to be achieved by the end. Session 1 includes an activity in which trainers and Trainees examine, clarify and modify training objectives and design to meet group expectations.

Within sessions, activities follow the experiential learning cycle. This learning model provides an effective way for Trainees to gain competencies and focuses on learner-centered adult education, emphasizing in particular:

- the trainer as facilitator of learning (rather than provider of information).

- variety of educational methods to meet individual learning needs.

- learning goals, objectives, and activities which relate Trainees' previous knowledge and skills to those acquired during training, and application to the Job.

- Trainees' taking responsibility for their own learning.

- active participation of Trainees'

Experiential learning occurs when a person' (a) engages in an activity, (b) reviews the activity critically, (c) derives insight from the analysis, and (d) applies the result in a practical situation. When adapting the sessions from this manual to tit specific training situations, we recommend retaining all four of these steps. For example, if a session needs to be shortened, the trainer should modify the steps such that the Trainees' still experience, process, generalize and apply' cutting out the application step to shorten the session time is not a viable modification.

Some techniques used to actively involve learners are:

demonstration	role play
large group discussion	simulation
small group tasks	case studies
lecturettes	slide shows
community visits and interviews	readings
storytelling	skills practice

In facilitating learning, the trainer should create "learning environments" which are stimulating, relevant and effective. To the extent possible, the local community and resources should be utilized in conducting training.

For a fuller description of the experiential learning model and other valuable information on training design and delivery, please refer to A Trainers Resource Guide, Peace Corps and Session 19, Designing and Evaluating Health Education Sessions.

Basic Assumptions of the Manual

The ORT Manual reflects assumptions about the PCV as a development worker adapted from Peace Corps, The Role of the Volunteer in Development Manual:

Self Sufficiency:

Peace Corps Volunteers help others gain increasing self sufficiency.

Skill Transfer and Role Model:

PCVs are assigned a role in which the skills they possess are transferred to others, enabling local people to continue to solve problems.

Training as the Example:

We learn to train others the way we are trained. The sessions in this manual are designed to promote critical thinking, personal responsibility, active problem solving, and thorough analysis of information.

Problem Solving and Project Management

Volunteers are required to set goals, define tasks, and plan their day by day activities. Volunteers who are able to solve problems and manage themselves, possess a skill directly related to development work.

Gathering and Using Information

How information is gathered, sorted, filtered, verified, and put to use is critical to the process of understanding and defining development problems.

Role Definition:

Throughout the manual, focus is kept on the Volunteer's role in relation to ORT and CDD in the context of primary health care and development.

Organization of the ORT Training Manual

The ORT Manual is arranged in sections, called modules, which focus on interrelated health education and technical content areas. Each module begins with a set of behavioral objectives and contains a sequence of sessions which address the specific content area. The modular format allows the trainer to combine various modules and sessions as needed given training objectives, time limitations, and other program considerations.

It is important to note that these modules are not complete in themselves, They are based on modules in the Technical Health Training

Manual (THTM) and cross referenced to resources in the THTM. The cross-referencing feature is particularly useful in pre-service training and in providing elementary materials for Counterparts who may lack background in certain areas. (See "Using and Adapting the ORT Manual..)

The modules are:

1. Climate Setting and Assessment
2. Diarrhea, Dehydration and Rehydration
3. Diarrhea and Nutrition
4. Working with the Health System
5. Working with the Community
6. Community Health Education.

All sessions in the manual follow a consistent format which is briefly explained below. Sessions often have several purposes. For example, the activities may provide skill development on ORT and also provide participants with practice in nonformal education methods and materials development for teaching mothers, children and health workers about ORT. It is important for the trainer to study and understand the multipurpose design of a session before conducting it.

Session Format

Session Number

TITLE

TOTAL TIME

The total time scheduled for the session.

OVERVIEW

A brief statement on how the session relates to the overall training program, the activities in the session, and the expected learning outcomes.

OBJECTIVES

Statements of what is expected of participants in order to successfully complete the training course

RESOURCES

Printed materials needed for the session or useful for background information and available to Peace Corps stats and Volunteers through ICE

Handouts follow most sessions. Each handout is coded to the corresponding session and paginated Copies of handouts should be made in advance for distribution to trainees as specified in the session.

Trainer Attachments are also coded and follow some sessions. These are intended as resources for the trainer and are sometimes to be shared with participants who help with session preparation.

MATERIALS

Supplies and tools needed for the session.

PROCEDURE

A series of steps to follow in order to meet the objectives of the session.

Trainer Note

Notes to further explain the activities of the session. These include such things as alternatives, scheduling considerations, suggestions and further directions to the trainer.

Allowance is made for break time in each session. As the nodules and sessions ate modified, the trainer should always work in 5 minutes of break time for each hour of training and should decide when the actual breaks occur.

The nine-day, six-day, and four-day training schedules shown on the following pages indicate overall program design and suggested sequence of sessions for varying degrees of ORT/COD material mastery. All three schedules assume that participants will undertake ORT/ CDD activities in their host communities after the workshop so that they will further develop the knowledge and skills introduced in the training The schedules should therefore be used as references for developing workshops which meet the needs of particular training situations, but should not be perceived as completely sufficient without follow-up and the opportunity to use the skills taught.

Use and Adaptation of the Manual

The manual was prepared as a model for design of training sessions which promote a logical flow of learning. It is not intended to be used without first adapting sessions to focus on country-specific CDD-related health problems and the learning needs of Trainees in their particular assignments. Thus, for example, role plays, character settings, problem situations and other aspects of training activities must be modified to fit local conditions. Information on National CDD policies, programs, and national and regional incidence of diarrhea should be provided during the training as well as a glossary of works and vocabulary for discussing ORT and other aspects of CDO in the local language.

In preparation for adapting the manual to meet specific training needs, the training should:

1. Identify host country health problems, needs and target groups to be addressed during training.

2. Collect country-specific health data and other relevant information, particularly for diarrheal diseases,

3. Determine the primary and secondary health functions which the Volunteer is being trained to perform (preferably utilizing a task analysis).

4. Determine the average level of health knowledge and skills of the group to be trained.

5. Outline desired training goals, objectives, content, activities and evaluation plan.

6. Determine resource needs and availability of resources (e.g. personnel, materials, facilities, and time).

7. Review existing training manuals, designs and materials to determine their adequacy for meeting training objectives.

8. Select, sequence, end adapt specific sessions to be used in the program.

9. Add to the training design:

- opening and closing activities (e.g. Ice breakers, end-of-training dinner).
- climate-setting (e.g. sharing expectations, setting the agenda).
- group process (e.g. feedback sessions).

10. Hake arrangements for participants to practice assessment of nutritional status and stages of dehydration under the supervision of a qualified healthworker after the workshop.

Point 10 requires special emphasis. During the short period of the workshop it is impossible for participants to master skills such as assessment of dehydration and nutritional assessment. Supervised practice with real children is an important part of the mastery of the ORT course material.

These steps are fairly standard for the design of any training program and can serve as a general guide. For a more detailed description of training design and organization, please read "The Trainers' Resource Guide" Peace Corps (ICE).

The following subsections provide ideas for how the manual can be adapted to suit different training situations.

Adaptations Based on Trainee Needs and Experience

The more skill, knowledge, and practical experience participants bring, the more effective and enriching are the small group activities that allow them to pool knowledge and resources to teach each other. The experiential nature of the sessions allows inservice Volunteers and Counterparts to draw on their experiences in the field. They begin with what they already know and apply it to the new learning task. The trainer can use the pretraining quesitonnaires, (Trainer Attachments 1A and 1B in Session 1) to assess entry level knowledge and skills and to become familiar with the Trainees' specific needs and expectations.

To assure that training activities address the practical needs and working conditions of the participants ask them to bring to the workshop: local utensils, treatments for diarrhea and visual aids they use.

Once the training is underway, every effort should be made to adapt training activities to provide experiences and "hands-on" skill practice in the local community (For example: participants can pretest visual aids with members of the surrounding community instead of among themselves in the classroom.)

When generalists and specialists or Trainees' with different Jobs (e.g. Health, water and sanitation, science teacher) are trained together, the trainer should modify sessions so that participants have opportunities to share their different skills and experiences. Through well-organized peer-learning and small group discussions, specialists can contribute their expertise to the generalist skill acquisition, while generalists can help broaden the community development perspective of specialists. Throughout the ORT Manual, specific reference is made to activities which represent opportunities for peer teaching.

Adaptations For Preservice Training Workshops Prior to preservice workshops, trainers can use questionnaires and interviews to identify technical skill levels, perceived needs and current project descriptions of the Trainees scheduled to participate.

During the design stage, the trainer should adjust the sessions so that the "starting point" is the PCV's recent training and U.S. experience. When possible, first and second year Volunteers can be invited to sessions to share experiences with the Trainees.

This manual cross references The Technical Health Training Manual (THTM) to make it easier for the Trainer to incorporate ORT/CDD sessions in a preservice training program. The THTM provides more elementary background in Community Organization and Analysis, and Health Education, it is assumed that participants in training programs using this manual have already developed and practiced skills la community analysis, community organization and health education, and the language spoken in their community for presence training. Participants may require assistance in the local language(s) from the language instructors and first and second year Volunteers to carry out activities gathering information in the community. The Trainer Notes and Resource Sections provide ample materials and suggestions for providing more elementary material or more specialized training.

Joint Volunteer-Counterpart Training

Providing inservice training to both Volunteers and their host-country Counterparts is an ideal training scenario for many Peace Corps programs. Such workshops, however, may present problems having to do with differences in culture, language, teaching and learning styles, and familiarity with the technical subject matter. It is particularly important to learn as much about the Trainees as possible in this situation so that the training design can be adjusted adequately and arrangements made for translation of handouts and charts.

Workshops for Volunteers and Counterparts should include a number of joint sessions in the areas of information-gathering, project planning, and skill practice end separate concurrent sessions in areas of "hard" technical information and theory. The training design may need to be modified for the Counterparts' sessions.

In planning for joint Volunteer-Counterpart training the following is suggested:

1. If possible, select a trainer who can speak the local language. If this is not feasible, have a bilingual/bicultural resource person assist in workshop design.

2. Use the services of a professional translator if the training will be conducted in two languages. Do not expect the trainer to have the skills of a translator.

3. Allow extra time during the training sessions for translation.

4. Encourage both Counterparts and Volunteers to increase their understanding of the way the other groups learn by working together in the training program. This is also a good opportunity for Volunteers to increase their vocabulary and skill in the local language.

5. Prepare both groups to be patient and with some repetition and translation during the training.

6. Prepare a vocabulary list of local words needed to talk about ORT and CDD.

Adaptations Based on the Size of the Training Group

The session and activities in tints manual are designed to accommodate training groups of approximately 20 participants. If you anticipate a significantly larger number of participants, consider dividing them into two subgroups, each with its own technical trainer. If the larger group cannot be broken into smaller groups, time allotments for many of the activities will have to be exceeded. This is especially true in sessions which include small group tasks followed by reporting back to the large group.

Adaptations Based on Previous Use of the Manual

The technical and educational information contained in this manual is current at the time of this writing. However, advancing technology means modification will be needed to keep the manual up-to-date. Trainers are encouraged to write notes in the margins of the manual where new information applies or on activity was changed and improved. Also note changes in the time required to conduct the sessions as the session times listed are only estimates.

Adaptations Based On Available Materials and Equipment

It is best to use materials and equipment during the training that participants will have available in their host communities. They may have access to more or less variety of materials and equipment than suggested in the model and sessions should be modified accordingly. For example, you might want to use a film instead of a reading or discussion of a picture because particular health films are available in the country. Or you may want to substitute drawings or photographs where slides are suggested if slides are not available. Encourage participants to locate possible sources of materials and equipment from various agencies in the country.

Case studies, examples, stories and pictures will need to be modified to make them more appropriate for the local situation. If the trainer is not an artist, it is possible that someone in the community who has artistic skills would enjoy helping him or her adapt materials or design new ones.

Resources

In order to allow for broad applicability in a variety of countries, the ORT Manual has been written generically and has been drawn from a variety of references. The complete collection of materials used in the sessions is listed in the Bibliography at the end of the manual. The primary technical resources are the Supervisory Skills Modules: Programs for Controlling Diarrheal Diseases and Guidelines for Training Community Health Workers in Nutrition, both from WHO. Technical materials from CDC, AID, WHO, and UNICEF have also served as sources of accurate information and case examples.

Primary resources for Module 5, Community Analysis and Organization and Module 6, Health Education are Community Culture and Care, Helping Health Workers Learn, Bridging the Gap, Teaching and Learning with Visual Aids, and Community Health Education in Developing Countries.

The references, handouts and trainer attachments included with each session should be considered the mayor resources for the actual training. All of these materials are either available to Peace Corps trainers and Volunteers through Information Collection and Exchange (ICE) or are attached to the sessions to which they pertain. ICE also provides an annotated listing of available health publications and an ORT resource packet.

If possible, participants in ORT Training Courses should receive: the ORT Resource Packet, Bridging the Gap, Helping Health Workers Learn and Community Health Education in Developing Countries.

In addition to assembling written materials, the trainer should visit local agencies and groups and international organizations to obtain a variety of visual aids and support materials for use by both trainers and Trainees during the program. Training staff should pay attention to the various items identified in each session under "Materials" and locate these at the beginning of the program. Many people find it helpful to photocopy and compile all of the handouts ahead of time to avoid last minute "crises" in preparations.

A final, but important note on reference materials' in the course of develop tog this manual, extensive review of published data has revealed significant variations in some technical information and recommendations, For example, there are several variations in the "correct" amounts of sugars and salt required for one liter of homemade sugar salt solution. In some cases these variations represent differences in technical perspective and in others, outdated information. As of the final revision of the manual, all technical information is based on the most current and accurate data and guidelines available from WHO and CDC. Great care has be taken to ensure the quality of the technical material included in sessions, handouts, trainer attachments and suggested readings. As with any technical document, however, the content will have to be revised and up-dated in accordance with conclusions drawn from the most recent research.

Trainers and other users of the manual should always check with Peace Corps as well as host country health ministries to revalidate or modify material to ensure that it is consistent with country health policy and programming, particularly in the area of measurements for Oral Rehydration Solutions and the effectiveness of home available solutions.

Staff Preparation

The ORT Manual includes detailed session procedures and explanatory trainer notes for the benefit of seasoned as well as less-experienced trainers; merely following the steps in the sessions, however, does not guarantee a successful program. The training staff who design and conduct the program outlined here should represent a balance of skill and experience in adult training methodology, experiential learning, and technical expertise in the subject matter. The staff should be flexible and able to "let go" so that the participants are encouraged to take an active role in their education,

In addition to trainers' background skills and expertise, program success depends on adequate preparation time. A "training of trainers" workshop should be scheduled before the program, to provide the stuff an opportunity to review the most up-to-date technical content, practice training skills and build a cohesive and supportive team.

During the preparation time, trainers should review and adapt the session designs, prepare lecturettes in their own words, and have a complete sense of exactly what each session is trying to accomplish. If at all possible, trainers should simulate or rehearse sessions in order to anticipate questions and gain a sense of session flow. AT least one member of the training team should have a technical health background. Local health professions can also act as resource persons and present some of the more technical health aspects of the training.

Evaluation

Before dealing with the "how to do it" aspect of evaluation, it is useful to discuss "why do it".

Evaluation is an integral part of every training program and should be designed from the start of planning. It should include an assessment of the conduct of the program (logistic and administrative organization, and presentation of activities) as well as of the outcomes (If the participants have accomplished the objectives). Evaluation is a learning process which allows both trainers and trainers to:

- Test the knowledge and skills acquired during the course;
- Analyze the effectiveness of the activities used;
- Judge the appropriateness of the educational material used;
- Give participants and trainers a chance to express their criticisms and suggestions.

Constant evaluation during training is as important as final evaluation. Comments, criticisms and suggestions can be solicited during periodic meetings, informal conversations at the day's end, or by way of a suggestion box in the conference hall. These inputs aid trainers in modifying the course as the need arises.

Evaluation Tools Included in the Manual

Several methods for assessing Trainee performance and evaluating the training programs are incorporated into the manual. These include:
- Pre-assessment forms for Volunteers and Counterparts.
- Behavioral objectives for each nodule which state in measurable terms what the participants should be able to do by the end of the segment of training. The trainer can use this to assess participant performance and identify weaknesses in program contort or process.

- A pre-test/post-test system which assesses the participants" acquisition of knowledge and, to some extent, attitude change. The pre-test is part of Session 1, General Assessment.

- A final evaluation session including an evaluation tore (Session 2).

- Participant-led projects and presentations which assess learning and provide participants with the opportunity to immediately apply and practice what they have learned in a "safe" environment. These education events occur throughout the modules and enable Trainees to demonstrate both technical knowledge of primary health care and teaching skills.

It should be noted that all of these evaluation measures reveal either immediate reactions or changes in participants knowledge skills and attitudes. A more reliable judgement of program effectiveness can only be made in the field where participants perform their daily tasks. Questionnaires, supervisory visits and evaluation meetings, three to six months after the training, are means of gaining greater insight into the utility of the course and future training needs of Volunteers.

For more detailed information on evaluation, please refer to Demystifying Evaluation (Clark and McCaffery) and Helping Health Workers Learn.