WHO/IVB/13.06
Use of MenAfriVac™ (meningitis A vaccine) in a controlled temperature chain (CTC) during campaigns Adaptation guide and Facilitators guide
Immunization, Vaccines and Biologicals
WHO/IVB/13.06
Use of MenAfriVac™ (meningitis A vaccine) in a controlled temperature chain (CTC) during campaigns Adaptation guide and Facilitators guide
Immunization, Vaccines and Biologicals
The Department of Immunization, Vaccines and Biologicals thanks the donors whose unspecified financial support has made the production of this document possible. This document was produced by the Expanded Programme on Immunization (EPI) of the Department of Immunization, Vaccines and Biologicals This document forms part 3 of 3 parts of the training guide for the Use of MenAfriVac™ (meningitis A vaccine) in a controlled temperature chain (CTC) during campaigns Ordering code: WHO/IVB/13.06 Printed: July 2013 This publication is available on the Internet at: www.who.int/vaccines-documents/ Copies of this document as well as additional materials on immunization, vaccines and biologicals may be requested from: World Health Organization Department of Immunization, Vaccines and Biologicals CH-1211 Geneva 27, Switzerland • Fax: + 41 22 791 4227 • Email: vaccines@who.int •
© World Health Organization 2013 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 3264; fax: +41 22 791 4857; email: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; email: permissions@who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The named authors alone are responsible for the views expressed in this publication. Printed by the WHO Document Production Services, Geneva, Switzerland
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Contents
Preface..................................................................................................................................v
Section 1: Adaptation guide...........................................................................1 1. Using this guide..........................................................................................................3 Developing training material......................................................................................3 For whom is this guide intended?...............................................................................3 2. The generic training module. ....................................................................................4 3. Initiating the adaptation work.................................................................................5 3.1 The adaptation working group...........................................................................5 3.2 Policy decisions.....................................................................................................5 3.3 Training strategy decisions..................................................................................5 4. Steps to adapt the training package........................................................................7 5. Conclusion.................................................................................................................10
Section 2: Facilitators Guide........................................................................ 11 1. Introduction to this Facilitator Guide...................................................................12 For whom is this course intended?............................................................................12 What methods of instruction are used in this course?..............................................12 How is the course conducted?...................................................................................12 What is a facilitator?..................................................................................................13 What, then, does a facilitator do?.............................................................................13 How do you instruct, motivate and manage during the course?. ..........................14 What not to do............................................................................................................14 How can this Facilitator Guide help you?. .............................................................15 2. Checklist of instructional materials needed in each small group. .....................16 3. Checklist of supplies needed for work on the module........................................17 4. How to facilitate the module..................................................................................18 5. General guidelines for facilitating a module - Facilitator Techniques.............23 1. Techniques for motivation participants............................................................23 2. Techniques for relating modules to participants’ jobs. ....................................26 3. Techniques for co-facilitators to work together...............................................26 Annex 1: Monitoring sheet for the CTC- Answer key.............................................29 iii
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Preface
Meningococcal meningitis is an infection of the brain and spinal cord. It is caused by the bacterium Neisseria meningitidis (the meningococcus). The disease occurs in the whole world, but in sub-Saharan Africa meningitis epidemics occur every two to three years. Since the 1980s the intervals between major epidemics have become shorter and more irregular. The disease is most common in young children, but it also can be found in children and young adults living in crowded conditions, such as institutions or barracks. In 2000 it is estimated that there were 300 000 cases and 25 000– 30 000 deaths from meningococcal meningitis. In children, if meningitis is not treated, mortality is 50%; with early treatment mortality is reduced to between 5% to 10%. Even with treatment early in the disease, between 5% and 10% of children who are infected die. About 10%–15% of those surviving meningococcal meningitis will suffer from complications, including mental disorders, deafness, palsies and seizures. To protect as many persons as possible from the disease immunization campaigns are organized. New technologies are being developed to facilitate the organization of these immunization campaigns. One such new technology is the possibility to use Meningitis A vaccine outside of the regular cold chain using what is called the Controlled Temperature Chain (CTC). WHO and PATH, through the Optimize project, have developed a training module for training of nurses and other health workers organizing immunization sessions on how to use the CTC. This guide describes a process for countries to use to adapt the generic training module to the local situation.
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Use of MenAfriVac™ (meningitis A vaccine) in a controlled temperature chain (CTC) during campaigns Section 1: Adaptation guide
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Use of MenAfriVac® in a CTC during campaigns - Adaptation guide and Facilitators guide
1. Using this guide
Developing training material Developing training materials is a formidable task even in the best of situations. Sometimes this task can be made easier by using quality training material that has already been developed, either by another country or by a another national or international organization. However, if a country will use training material developed elsewhere it is essential to make sure that the training material is appropriate to the situation in each specific country. This process is called adaptation. Before conducting training, each country adapts the need to adapt the training module to the local situation to make the module consistent with national policies, guidelines and already existing training material for health workers involved in providing immunization services. The adaptation process is a key element in national preparations for implementing immunization campaigns.
For whom is this guide intended? This guide aims to help adapting the training module developed by the World Health Organization (WHO): How to use the controlled temperature chain (CTC) in a Meningitis A immunization campaign. It is intended to assist persons in making decisions about what adaptations are needed and in completing the tasks required to produce adapted materials for training health workers organizing immunization session: staff of the Ministry of Health immunization programmes and their advisers, including public health institutions, UNICEF, and other partners involved in the implementation of immunization services. Consultants from WHO and other organizations can also use the guide to assist countries in adapting the training materials.
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2. The generic training module The generic training module How to use the controlled temperature chain (CTC) in a Meningitis A immunization campaign is designed to teach health workers how to manage the CTC. By working through this module participants will learn how to integrate CTC in their regular immunization sessions during an immunization campaign with the Meningitis A vaccine. In particular, they will learn: • • • • • The process for using the controlled temperature chain How to plan for the immunization sessions during an immunization campaign with Meningitis A vaccine; How to prepare to transport vaccines using the controlled temperature chain; How to use the controlled temperature chain while transporting vaccines; How to use the controlled temperature chain during an immunization session.
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Use of MenAfriVac® in a CTC during campaigns - Adaptation guide and Facilitators guide
3. Initiating the adaptation work 3.1 The adaptation working group The work of adaptation should be done by an adaptation working group. The country may also request technical assistance from the World Health Organization to help with specific adaptation tasks or to train national experts in adaptation. The needs for technical assistance should be discussed during the initial planning meetings for the immunization campaign.
3.2 Policy decisions Before the adaptation work can start the Ministry of Health must have made decisions regarding the use of the CTC as recommended by WHO in immunization campaigns with Meningitis A vaccine: • That when using the MenAfriVac™ vaccine, the vaccine can be stored at up to +40 degrees Celsius for not more than four days immediately prior to administration, provided that the vaccine has not reached its expiry date and the vaccine vial monitor (VVM) is still valid. That unopened vaccine vials should be discarded at the end of four days at up to +40 degrees Celsius. That reconstituted vaccine should be used within six hours when stored at up to +40 degrees Celsius.
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3.3 Training strategy decisions Much of our traditional learning experience leads us to believe that we learn best by listening to experts. Fortunately there has been considerable research into adult learning and this provides much better understandings of the factors influencing adult learning. Training that actively engages an adult in the learning process achieves significantly greater results in learner self-awareness, changed behaviour, and the acquisition of new skills. This generic package has been developed based on active learning processes. The generic training package on the CTC consists of one training module accompanied by a facilitator guide. Before beginning the adaptation work the following decisions on the training strategy must be made. These decisions will help determine if all the content in the generic module is kept in the adapted version or if certain sections should be taken out or added:
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Will the training on how to use the CTC be conducted as a separate training course or will it be incorporated into an already existing training course on how to organize immunization services? Are health workers that are currently organizing immunization session well trained and competent in their daily tasks or will it be important to take advantage of the CTC training to provide an update on other tasks related to the organization of immunization sessions? Will it be necessary to translate the training package? Are the future facilitators competent in using a variety of teaching methodologies or are current training courses using traditional lectures only?
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Use of MenAfriVac® in a CTC during campaigns - Adaptation guide and Facilitators guide
4. Steps to adapt the training package Once the preparatory work described in section 3 above is completed the detailed work on adapting the training package can start. This work involves the steps listed in Figure 1 below. The steps are described in more detail below Figure 1. Figure 1: Steps to adapt the training package 1) Red-pencil all changes in the module based on the policy and training decisions 2) Check all the changes for accuracy, consistency and completeness. 3) Enter all changes in the module in the computer file. 4) Mark all adaptations in the modules in the Facilitator Guide for the Module and mark any other changes in facilitator guide. 5) Check all the changes for accuracy, consistency and completeness. 6) Enter all changes in the Facilitator Guide in the computer file. 7) Translate the training module and facilitator guide, if needed. 8) Print out the translated module and facilitator guide. Check them carefully against the adapted modules in English. 9) Field test the adapted modules with a small group of participants that are representative of the target group for the training. 10) Made adaptations following feedback from the field test. 11) Check all the changes for accuracy, consistency and completeness. 12) Prepare the final layout of the training module and the facilitator guide. 13) Print the material.
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Red-pencil all changes in the module based on the policy and training decisions When you start the actual physical adaptation of the modules and other materials, all the policy decisions should have been made. When pencilling the changes into the module, use a red pen or pencil that shows up well. Identify changes needed in the recording form shown in the annex of the module. Check all the changes for accuracy, consistency and completeness. Check all the changes that have been written in. This is essential. It is also essential that a second person checks everything and if possible a third. It is essential to check not only those changes that have been made but also to read through the modules to check for additional places where there should be changes. Enter all changes in the module in the computer file. Enter in the computer files all the changes that have been written on the module. Make sure you keep the original format to avoid additional work on pages where there are no changes. Mark all adaptations in the modules in the Facilitator Guide for the Module and mark any other changes in facilitator guide. As in step 1, red-pencil all changes in the facilitator guide that are needed based on the modifications you made to the module. Check all the changes for accuracy, consistency and completeness. Check all the changes that have been written in. This is essential. It is also essential that a second person checks everything and if possible a third. It is essential to check not only those changes that have been made but also to read through the Facilitator Guide to check for additional places where there should be changes. Enter all changes in the Facilitator Guide in the computer file. Enter in the computer files all the changes that have been written on the module. Make sure you keep the original format to avoid additional work on pages where there are no changes. Translate the training module and facilitator guide, if needed. It is important to use a limited number of technical words and to keep the translation as simple as possible. It is also important to be consistent in the translation — use the same words and sentences throughout the module. A list of key words will help with this process. First translate and check the translation of the list of key words. These are words that occur repeatedly in the module. Two or more people should check and agree on the translation of the key words.
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Use of MenAfriVac® in a CTC during campaigns - Adaptation guide and Facilitators guide
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Print out the translated module and facilitator guide. Check them carefully against the adapted modules in English. The person who enters the changes should check that all the changes written on the module and facilitator guide have been made, and none missed. Then a second person should check all the changes. Field test the adapted modules with a small group of participants that are representative of the target group for the training. Once the module and facilitator guide has been reviewed, adapted and translated, field testing should be conducted. This is an important part of the adaptation process in order to highlight any areas that have not been properly understood by the participants, and issues that may not be culturally relevant to your context. If new sessions have been developed, the field testing provides an opportunity for this material to be tested for the first time, to ensure that participants fully understand the new text.
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10) Made adaptations following feedback from the field test. The adaptation working group should discuss the feedback from the field test and decide which changes should be made. It is essential to make further modifications where the field test indicated that sections were not well understood. Other suggestions might be more of a personal preference of the person making the comments. Try to incorporate such comments as much as possible.
11) Check all the changes for accuracy, consistency and completeness. Check all additional changes that have been written in and that those changes have not changed the original meaning of a section. If new sections have been developed following the field test it is also essential that a second person checks everything and if possible a third. It is essential to check not only the changes that have been made to the module but also to read through the Facilitator Guide to check for consistency.
12) Prepare the final layout of the training module and the facilitator guide. When finished with the draft, take another look. Learners judge the complexity of content by the look of the page or screen. So it is important to create an eyeappealing layout to facilitate learning.
13) Print the material. Determine how many copies are needed for the first round of courses and calculate how many copies of module and other materials should be printed. Many countries make corrections after the first few courses. For this reason, limit the number of modules to be printed until materials can be finalized.
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5. Conclusion
The adaptation of the training module is the first step in the training process that will lead to health workers competent to integrate CTC in their regular immunization sessions during an immunization campaign with the Meningitis A vaccine. When the training package has been printed the training coordinator should develop training plans to ensure that all health workers are trained well in advance of the starting date of the immunization campaign. How to plan and organize training courses is described in other materials from WHO.
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Use of MenAfriVac® in a CTC during campaigns - Adaptation guide and Facilitators guide
Use of MenAfriVac™ (meningitis A vaccine) in a controlled temperature chain (CTC) during campaigns Section 2: Facilitators Guide
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1. Introduction to this Facilitator Guide For whom is this course intended? This training course is designed for health workers who organize immunization session and who will be using the controlled temperature chain (CTC) during a Meningitis A immunization campaign.
What methods of instruction are used in this course? This course uses a variety of methods of instruction, including reading, written exercises, discussions, and practical exercise. Practice, using individual written exercises, is considered a critical element of instruction.
How is the course conducted? • Small groups of participants are led and assisted by “facilitators” as they work through the course modules (booklets that contain units of instruction). Participants read the module text themselves and work through the exercises as they come to them. The facilitators are not lecturers, as in a traditional classroom. Their role is to answer questions, provide individual feedback on exercises, lead discussions etc. The modules provide the basic information to be learnt. Information is also provided in demonstrations and discussions. The modules are designed to help each participant develop specific skills necessary for using the CTC during a meningitis A immunization campaign. Participants develop these skills as they read the module and practice skills in written exercises and group discussions. To a great extent, participants work at their own pace through the module. In some activities, such as discussions, the small group will work together. Each participant discusses any problems or questions with a facilitator and receives prompt feedback on completed exercises. (Feedback includes reviewing and discussing the exercise with the participant.)
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Use of MenAfriVac® in a CTC during campaigns - Adaptation guide and Facilitators guide
What is a facilitator? A facilitator is a person who helps the participants to learn the skills presented in the course. The facilitator spends much time in discussions with participants, either individually or in small groups. For facilitators to give enough attention to each participant, a ratio of one facilitator to five or six participants is desired. In your assignment to teach this course, you are a facilitator. As a facilitator, you need to be very familiar with the material being taught. It is your job to give explanations, do demonstrations, answer questions, talk with participants about their answers to exercises, lead group discussions and generally give participants any help they need to successfully complete the course. You are not expected to teach the content of the course through formal lectures. (Nor is this a good idea, even if this is the teaching method to which you are most accustomed.)
What, then, does a facilitator do? As a facilitator, you do three basic things: 1) You instruct: –– –– –– –– –– –– –– –– 2) Make sure that each participant understands how to work through the materials and what is expected in the module and each exercise. Answer the participant’s questions as they occur. Explain any information that the participant finds confusing, and help the participant understand the main purpose of each exercise. Lead group activities, such as group discussions, to ensure that learning objectives are met. Promptly review each participant’s work. Discuss how the participant obtained the answers in order to identify any weaknesses in the participant’s skills or understanding. Provide additional explanations or practice to improve skills and understanding. Help participants to understand how to use skills taught in the course in their own work.
You motivate: –– –– Compliment the participant on correct answers, improvements or progress. Make sure that there are no major obstacles to learning (such as too much noise or not enough light).
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You manage: –– –– Plan ahead and obtain all supplies needed each day, so that they are in the classroom when needed. Monitor the progress of each participant.
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How do you instruct, motivate and manage during the course? • • Show enthusiasm for the topics covered in the course and for the work that the participants are doing. Be attentive to each participant’s questions and needs. Encourage the participants to come to you at any time with questions or comments. Be available during scheduled times. Watch the participants as they work, and offer individual help if you see a participant looking troubled, staring into space, not writing answers or not turning pages. These are clues that the participant may need help. Promote a friendly, cooperative relationship. Respond positively to questions (by saying, for example, “Yes, I see what you mean,” or “That is a good question”). Listen to the questions and try to address the participant’s concerns, rather than rapidly giving the “correct” answer. Always take enough time with each participant to answer questions completely (that is, so that both you and the participant are satisfied).
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What not to do..... • • • During times scheduled for course activities, do not work on other projects or discuss matters not related to the course. In discussions with participants, avoid using facial expressions or making comments that could cause participants to feel uncomfortable or embarrassed. Do not lecture about the information that participants are about to read. Give only the introductory explanations that are suggested in the Facilitator Guide. If you give too much information too early, it may confuse participants. Let them read it for themselves in the modules. Do not review text paragraph by paragraph. (This is boring and suggests that participants cannot read for themselves.) As necessary, review the highlights of the text during individual feedback or group discussions. Do not be condescending. In other words, do not treat participants as if they are children. They are adults. Do not talk too much. Encourage the participants to talk. Do not be shy, nervous or worried about what to say. This Facilitator Guide will help you remember what to say. Just use it!
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Use of MenAfriVac® in a CTC during campaigns - Adaptation guide and Facilitators guide
How can this Facilitator Guide help you? This Facilitator Guide will help you teach the course module. The Facilitator Guide includes a list of the procedures to complete the module, highlighting the type of feedback to be given after each exercise. At the back of this Facilitator Guide is a section titled “General Guidelines for facilitating a module”. This section describes training techniques to use when working with participants during the course. It provides suggestions on how to work with a co-facilitator. It also includes important techniques to use when: • • • participants are working individually, you are providing individual feedback, you are leading a group discussion,
To prepare yourself for each module, you should: • • • • • • • read the module and work the exercises, check your answers by referring to the answer sheets (provided as a separate packet), read in this Facilitator Guide all the information provided about the module, plan with your co-facilitator how work on the module will be done and what major points to make, think about sections that participants might find difficult and questions they may ask, plan ways to help with difficult sections and answer possible questions, ask participants questions that will encourage them to think about using the skills in their own health facilities.
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2. Checklist of instructional materials needed in each small group Item needed Facilitator Guide Module “Use of MenAfriVac™ (meningitis A vaccine) in a controlled temperature chain (CTC) during campaigns” Copy of course schedule 1 for each facilitator 1 for each facilitator and 1 for each participant 1 for each facilitator and participant Number needed
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Use of MenAfriVac® in a CTC during campaigns - Adaptation guide and Facilitators guide
3. Checklist of supplies needed for work on the module Supplies needed for each person include: • • • • • • name tag and holder 1 pens 1 pencil with erasers paper highlighter calculator (optional but helpful).
Supplies needed for each group include: • • • • • • large paper clips (helpful to mark place in the module while doing an exercise) pencil sharpener stapler and staples 1 roll of masking tape extra pencils and erasers flipchart pad and markers or blackboard and chalk
Supplies needed for each participant for Exercise B: • One (1) Peak Temperature Threshold Indicator
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4. How to facilitate the module
Procedures 1) Introduce yourself and ask participants to introduce themselves. 2) Do any necessary administrative tasks. 3) Explain your role as facilitator 4) Distribute and introduce module. Show and explain the icons and instructions that will guide participants through the module. 5) Ask participants to read through the first section of the module called “Introduction”. 6) Ask participants read Section 1. When they reach the stop sign at the end of the section, they turn to the last part of the module and read the instructions for Exercise A. Provide feedback to the participants on the individual exercise and lead the group discussion for Exercise A 7) Participants go back to Section 3 and read until the stop sign after section 3.3. When they reach the stop sign at the end of the section, they turn to the last part of the module and read the instructions for Exercise B. Provide feedback to the participants on the individual exercise and lead the group discussion for Exercise B 8) Participants go back to Section 4. They read until the stop sign after section 5.3. When they reach the stop sign at the end of the section, they turn to the last part of the module and read the instructions for Exercise C. Provide feedback to the participants on the individual exercise and lead the group discussion for Exercise C. 9) Participants go back to section 6. They read until the stop sign after section 7 and then complete Exercise D. Provide feedback to the participants on the individual exercise and lead the group discussion for Exercise D. 10) They read until the end of the module including the summary of important points. Participants should then do the self-assessment questions and check their own answers. 11) Conclude the module. --------------------------
Feedback
Individual feedback Group discussion
Individual feedback Group discussion
Individual feedback Group discussion
Individual feedback Group discussion
Self-checked
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Notes for each of these numbered procedures are given on the following pages.
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Introduce yourself and participants Introduce yourself as a facilitator of this course and write your name on the blackboard or flipchart. Ask the participants introduce themselves; ask them to write their names on the blackboard or flipchart. (If possible, also have them write their names on large name cards at their places.) Leave the list of names where everyone can see it. This will help you and the participants learn each other’s names. Administrative tasks There may be some administrative tasks or announcements that you should address. For example, you may need to explain the arrangements that have been made for lunch, transportation of participants, or payment of per diem. Explain your role as facilitator Explain to participants that, as facilitator (and along with your co-facilitator, if you have one), your role throughout this course will be to: • • • • • guide them through the course activities; answer questions as they arise or find the answer if you do not know; clarify information they find confusing; give individual feedback on exercises where indicated; lead the demonstration and group discussions.
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Distribute and introduce the module Distribute a copy of the module to each participant. Explain that the module will teach participants how to use the Controlled Temperature Chain (CTC) during a Meningitis A immunization campaign. Explain that the module is given as theirs to keep. As they read, they can highlight important points or write notes on the pages if they wish. They should also write the answers to the exercises in the indicated space in the module. Show and explain the icons and instructions that will guide participants through the module: • When participants reach a stop sign, stop and follow those instructions. Those instructions are usually to turn to a specified part of the module and do the exercise. The exercises are individual work followed by a group discussion. Explain: –– When an exercise is individual work, this means that you should work through the exercise by yourself and write the answers in your own module. However, if you have a question about what to do or about something that you read, you should ask a facilitator for help. When you have finished the exercise, you will see an instruction in a box that says “Please discuss your answers with a facilitator”. This semi-private discussion is called individual feedback. In this discussion, you and the facilitator will review your work. If you have made errors, the facilitator will help clarify any misunderstanding. The purpose is to help you learn. 19
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Then explain what participants should do when they have finished an exercise and are ready for individual feedback. (Depending on the room arrangement, they might raise their hand for a facilitator to come to them, or may come to the facilitator.) At the end of each exercise, there is a go back arrow with instructions to turn back (to a certain section) to begin reading again in the module where they left off). Follow those instructions and then continue reading until the next stop sign. When participants are reading Ask participants to read the first section of the module called “Introduction”. This might be challenging to some participants if they are not accustomed to extended reading. Watch to see if any participants are struggling. If a participant is visibly struggling, go to that individual and ask (quietly) if the participant has a question or needs help. Find out the problem and try to address it. Leaving a participant to struggle is likely to result in frustration and loss of motivation. When everyone has finished reading, ask if there are any questions about the module or the purpose of the course. Answer any questions ndividual reading and Exercise A: Individual exercise and group I discussion Ask participants read Section 1. When they reach the stop sign at the end of the section, they turn to the last part of the module and read the instructions for Exercise A. Observe as participants begin working on this first individual exercise. Ensure that they are not confused about what to do. Some participants may need a bit of encouragement to begin writing in the module. When you see that a participant has finished the exercise, go to him or her, or ask the participant to come to you. If individual feedback is a new method to the participants, most are likely to wait to see whether and how individual feedback happens. Some may decide they would rather not get individual feedback and will not come for feedback unless you prompt them. Be sure that every participant gets feedback on this exercise. Make sure that this first experience with getting individual feedback is a positive one. Look at each participant’s work carefully. Ask if the participant has questions and listen attentively to the questions. Answer carefully. Participants will assess whether you are really interested in giving them help and whether feedback is likely to be embarrassing or punitive. It is essential that you build each participant’s confidence so that interactions with a facilitator will be helpful or interesting, not punishing. When interactions are positive and participants feel that the facilitators are interested in their work, they are more motivated to do the work well. When a participant comes to you for feedback, sit down with the participant and review the answers. This exercise has no right or wrong answers as it is asking participants to reflect based on their own experience and what they have just read about. Make sure that the participant has not just answered “yes” or “no” but has written down a justification or an explanation for their answers. If the participant has questions, answer them. Try to find out the reason for any misunderstandings and clarify. The purpose of the interaction is to give feedback on what the participant did and to correct any misunderstandings. Use of MenAfriVac® in a CTC during campaigns - Adaptation guide and Facilitators guide
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After you have given individual feedback to all participants lead a group discussion to allow participants to share their opinions. ndividual reading and Exercise B: Demonstration, individual exercise and I group discussion Ask participants go back to Section 3 and read until the stop sign after section 3.3. When they reach the stop sign at the end of the section, they should again turn to the last part of the module and read the instructions for Exercise B. Distribute the Peak Temperature Threshold Indicator card to each participant. As the participants study the indicator card make sure participants are clear about how the indicator is working. As with Exercise A, this exercise has no right or wrong answers as it is asking participants to reflect based on their own experience and what they have just read about and reviewing a copy the Peak Temperature Threshold Indicator. Make sure that the participant has not just answered “yes” or “no” but has written down a justification or an explanation for their answers. If the participant has questions, answer them. Try to find out the reason for any misunderstandings and clarify. The purpose of the interaction is to give feedback on what the participant did and to correct any misunderstandings. After you have given individual feedback to all participants lead a group discussion to allow participants to share their opinions. Make sure during the discussion that participants are not confusing the VVM and the Peak Temperature Threshold Indicator. Individual reading and Exercise C: Individual exercise and group discussion Ask participants go back to Section 4 and read until the stop sign after section 5.3. When they reach the stop sign at the end of the section, they should again turn to the last part of the module and read the instructions for Exercise C. As with Exercise A and B, this exercise has no right or wrong answers as it is asking participants to use their own experience and what they have just read about to prepare the workplan for the immunization sessions during the campaign. Participants might have experience making plans for regular immunization sessions during the year. However, the immunization campaign is organized during a very limited period of time and the target population is much bigger. Carefully review participant’s workplans to make sure that they are realistic and feasible. You need to make sure that the CTC is respected and that unnecessary time is spent on travelling back and forth. Make sure that the participant has written down a justification or an explanation for their plan. If the participant has questions, answer them. Try to find out the reason for any misunderstandings and clarify. The purpose of the interaction is to give feedback on what the participant did and to correct any misunderstandings.
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ndividual reading and Exercise D: Individual exercise and group I discussion The exercise aims to ensure participants know how to complete the CTC monitoring sheet. The information provided in the example should be captured in the boxes for the first three days of a campaign, and then the answers should be reviewed together. A sample answer key is provided in Annex 1 of this module. Note that the number of vials to be taken out at the start of each day is left up to the vaccinator, depending on the amount recommended to take as a wastage buffer and so results may vary from those provided in the answer sheet. Variations across participant answers should be discussed in plenary—there are likely more than one correct answer.
10) Participants finish reading and do the self-assessment questions Ask participants go back to section 6 and read until the end of the module including the summary of important points. Participants should then do the self-assessment questions and check their own answers. Explain the purpose of the self-assessment questions and how to do them. The self-assessment questions address the important tasks taught in the module. Self-assessment questions are a review to help each of you assess for yourself what you have learnt and what you have missed or forgotten. They are not a test in the usual sense, because you do not turn them in to be graded or receive a grade. Instead, you check your own answers against the answers given in the module. After each answer, you will find (in parentheses) the section of the module where that information or step was taught. If you answer all the self-assessment questions correctly, you can feel satisfied and proud that you have learnt the important points that the module taught. If you miss a question, this tells you what you need to study again. Look back to the specified section of the module and reread it. When you answer the self-assessment questions, work carefully. Do not look ahead at the answers because this will reduce the effectiveness of the review. Also, if you look ahead at the answers, you will not know what you have learnt and what you need to study further.
11) Conclude the module Make any additional important points from this module that you want to reinforce with the participants. Thank the participants for participating in the individual reading and individual feedback, two methods which may not be very familiar to them. Congratulate them on completing this module.
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Use of MenAfriVac® in a CTC during campaigns - Adaptation guide and Facilitators guide
5. General guidelines for facilitating a module Facilitator Techniques 1. Techniques for motivation participants Encourage interaction 1) uring the first day, you will talk individually with each participant several times D (for example, during individual feedback). If you are friendly and helpful during these first interactions, it is likely that the participants: a) b) c) 2) will overcome their shyness, will realize that you want to talk with them, and will interact with you more openly and productively throughout the course
Look carefully at each participant’s work. Check to see whether participants are having any problems, even if they do not ask for help. If you show interest and give each participant undivided attention, the participants will feel more compelled to do the work. Also, if the participants know that someone is interested in what they are doing, they are more likely to ask for help when they need it. Be available to talk with participants as needed.
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Keep participants involved in discussions 1) requently ask questions of participants to check their understanding and to F keep them actively thinking and participating. Questions that begin with “what,” “why,” or “how” require more than just a few words to answer. Avoid questions that can be answered with a simple “yes” or “no.” a) After asking a question, pause. Give participants time to think and volunteer a response. A common mistake is to ask a question and then answer it yourself. If no one answers your question, rephrasing it can help to break the tension of silence. But do not do this repeatedly. Some silence is productive.
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cknowledge all participants’ responses with a comment, a “thank you” A or a definite nod. This will make the participants feel valued and encourage participation. If you think a participant has missed the point, ask for clarification, or ask whether another participant has a suggestion. If a comment is ridiculed or ignored, the participant may withdraw from the discussion entirely or not speak voluntarily again. Answer participants’ questions willingly, and encourage participants to ask questions when they have them rather than to hold the questions until a later time. 23
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WHO/IVB/13.06
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o not feel compelled to answer every question yourself. Depending on the D situation, you may turn the question back to the participant or invite other participants to respond. You may need to discuss the question with the course director or another facilitator before answering. Be prepared to say “I don't know but I'll try to find out.” se names when you call on participants to speak, and when you give them U credit or thanks. Use the speaker’s name when you refer back to a previous comment. aintain eye contact with the participants so everyone feels included. Be careful M not to always look at the same participants. Looking at a participant for a few seconds will often prompt a reply, even from a shy participant.
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Keep the session focused and lively 1) Keep your presentations lively: • • • 2) Present information conversationally rather than read it. Speak clearly. Vary the pitch and speed of your voice. Use examples from your own experience, and ask participants for examples from their experience.
rite key ideas on a flipchart as they are offered. (This is a good way to W acknowledge responses. The speaker will know that the idea has been heard and will appreciate having it recorded for the entire group to see.) When recording ideas on a flipchart, use the participant’s own words if possible. If you must be brief, paraphrase the idea and check it with the participant before writing it. You want to be sure the participant feels you understood and recorded the idea accurately. Do not turn your back to the group for long periods as you write. At the beginning of a discussion, write the main question on the flipchart. This will help participants stay on the subject. When needed, walk to the flipchart and point to the question. Paraphrase and summarize frequently to keep participants focused. Ask participants for clarification of statements as needed. Also, encourage other participants to ask speakers to repeat or clarify statements as needed. Restate the original question to the group to get them focused on the main issue again. If you feel someone will resist getting back on track, first pause to get the group’s attention, tell them they have gone astray and then restate the original question. Do not allow several participants to talk at once. When this occurs, stop the talkers and assign an order for speaking. (For example, say “Let’s hear Dr Samua’s comment first, then Dr Salvador’s, then Dr Lateau’s.”) People usually will not interrupt if they know they will have a turn to talk. Thank participants whose comments are brief and to the point. ry to encourage quieter participants to talk. Ask to hear from a participant in T the group who has not spoken before, or walk toward someone to encourage that person to talk. Use of MenAfriVac® in a CTC during campaigns - Adaptation guide and Facilitators guide
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Manage any problems 1) ome participants may talk too much. Here are some suggestions on how to S handle an overly talkative participant: • • Do not call on this person first after asking a question. After a participant has gone on for some time say, “You have had an opportunity to express your views. Let’s hear what some of the other participants have to say on this point.” Then rephrase the question and invite other participants to respond, or call on someone else immediately by saying, “Dr Samua, you had your hand up a few minutes ago.” When the participant pauses, break in quickly and ask to hear from another member of the group or ask a question of the group, such as, “What do the rest of you think about this point?” Record the participant’s main idea on the flipchart. As the participant continues to talk about the idea, point to it on the flipchart and say, “Thank you, we have noted your idea.” Then ask the group for another idea. Do not ask the talkative participant any more questions. If the same participant answers all the questions directed to the group, ask for an answer from another individual specifically or from a specific subgroup. (For example, ask, “Does anyone on this side of the table have an idea?”)
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ry to identify participants who have difficulty understanding or speaking T the course language. Speak slowly and distinctly so you can be more easily understood, and encourage the participant’s efforts to communicate. Discuss with the course director any language problems that seriously impair the ability of a participant to understand the written material or the discussions. It may be possible to arrange help for the participant. Discuss disruptive participants with your co-facilitator or with the course director. (The course director may be able to discuss matters privately with the disruptive individual.)
Reinforce participants’ efforts 1) s a facilitator, you will have your own style of interacting with participants. A However, a few techniques for reinforcing participants’ efforts include: • • • • • avoiding use of facial expressions or comments that could cause participants to feel uncomfortable or embarrassed, sitting or bending down to be on the same level as participants when talking to them, answering questions thoughtfully, rather than hurriedly, encouraging participants to speak to you by allowing them time, appearing interested, saying “That’s a good question/suggestion”.
WHO/IVB/13.06
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Reinforce participants who: • • • • • try hard, ask for an explanation of a confusing point, do a good job on an exercise, participate in group discussions, or help other participants (without distracting them by talking at length about irrelevant matters).
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Techniques for relating modules to participants’ jobs iscuss the use of procedures taught in the modules in participants’ own health D facilities. This will help participants begin to think about how to apply what they are learning. einforce participants who discuss or ask questions about using the procedures R in their own health facilities. Acknowledge and respond to their concerns.
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Techniques for co-facilitators to work together pend some time with the co-facilitator when assignments are first made. S Exchange information about prior teaching experiences and individual strengths, weaknesses and preferences. Agree on roles and responsibilities and how you can work together as a team. ssist one another in providing individual feedback and conducting group A discussions. For example, one facilitator may lead a group discussion while the other records the important ideas on the flipchart. The second facilitator could also check the Facilitator Guide and add any points that have been omitted. Work together on each module rather than taking turns having sole responsibility for a module.
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When participants are working: • • Look available, interested and ready to help. Watch the participants as they work, and offer individual help if you see a participant looking troubled, staring into space, not writing answers or not turning pages. These are clues that the participant may need help. Encourage participants to ask you questions whenever they need some help. If important issues or questions arise when you are talking with an individual, make note of them to discuss later with the entire group. If a question arises that you cannot answer adequately, obtain assistance as soon as possible from another facilitator or the course director. Review the points in this Facilitator Guide so you will be prepared to discuss the next exercise with the participants.
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Use of MenAfriVac® in a CTC during campaigns - Adaptation guide and Facilitators guide
When providing individual feedback: • • Before giving individual feedback, refer to the appropriate notes in this guide to remind yourself of the major points to make. If the participant’s answer to any exercise is incorrect or is unreasonable, ask questions to determine why the error was made. There may be many reasons for an incorrect answer. For example, a participant may not have understood the question, may have been unfamiliar with certain terms used in the exercise, may be accustomed to different procedures, may have overlooked some information about a case or may not understand a basic process being taught. Once you have identified the reason(s) for the incorrect answer to the exercise, help the participant correct the problem. For example, you may only need to clarify the instructions. On the other hand, if the participant has difficulty understanding the process itself, you might try using a specific case example to explain. After explaining, ask questions to be sure that the participant understands. Always reinforce the participant for good work by (for example): –– –– –– –– commenting on how well the participant understands, showing enthusiasm for the participant’s ideas for application of the skill in the health facility setting, mentioning that you enjoy discussing exercises with the participant, commenting that the participant’s hard work is appreciated.
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When leading a group discussion: • Plan to conduct the group discussion at a time when you are sure that all participants will have completed the preceding work. Wait to announce this time until most participants are ready, so that others will not hurry. Before beginning the discussion, refer to the appropriate notes in this guide to remind yourself of the purpose of the discussion. Begin the group discussion by telling the participants the purpose of the discussion. Often, there is no single correct answer that needs to be agreed on in a discussion. Just be sure the conclusions of the group are reasonable and that all participants understand how the conclusions were reached. Try to involve most of the group members in the discussion. Record key ideas on a flipchart as they are offered. Keep your participation to a minimum, but ask questions to keep the discussion active and on track. Always summarize, or ask a participant to summarize, what was discussed in the exercise. Give participants a copy of the answer sheet, if one is provided. Reinforce the participants for their good work by (for example): –– –– –– –– WHO/IVB/13.06
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praising them for the list they compiled, commenting on their understanding of the exercise, commenting on their creative or useful suggestions for using the skills on the job, praising them for their ability to work together as a group. 27
Monitoring sheet for the CTC- Answer key
Annex 1:
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Use of MenAfriVac® in a CTC during campaigns - Adaptation guide and Facilitators guide
Monitoring sheet for the Controlled Temperature Chain (CTC) for use during MenAfriVac™ immunization campaigns Team: .......................................................................................................... (To be kept during the whole immunization campaign) Date Sept 13 Sept 14 Sept 15 Date Date Date Date Date Date Date Date Date
Annex 1:
WHO/IVB/13.06
Name of Health Centre: . ..............................................................................................................................................................
BEFORE DEPARTURE 40 57 0
Number of new vials taken out of the cold chain PLUS Number of marked vials remaining from previous days 0 08h00 08h10 08h00 3 32
Time of verification of the VVM and the peak temperature threshold indicator (hh.mm)
Note that number of vials shown here includes wastage. Facilitators can adjust as per the wastage guidance in the country.
Peak temperature threshold indicator (Still good = 0 Threshold reached = 1)
BEFORE THE IMMUNIZATION SESSION 09h30 0 0 09h10 09h10 0
Time when immunization session started
Peak temperature threshold indicator (Still good = 0 Threshold reached = 1)
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Date Sept 13 Sept 14 Sept 15
Date
Date
Date
Date
Date
Date
Date
Date
Date
AT THE END OF THE DAY (before leaving the site of the immunization session) 14h00 0 0 0 15h00 14h00
Time of departure
Peak temperature threshold indicator (Still good = 0 Threshold reached = 1)
ON ARRIVAL AT THE HEALTH CENTRE 15h15 0 3 32 10 0 1 16h00 16h00
Time of arrival at health centre
Peak temperature threshold indicator (Still good = 0 Threshold reached = 1)
Number of marked vaccine vials remaining
ONLY FOR THE SUPERVISOR
Number of discarded vaccine vials (ONLY vaccine vials that have not been opened, but have to be discarded due to the fact that the temperature threshold has been reached, or if the four-day limit has passed. Please also complete the peak indicator expiration report). 0 0 10
Use of MenAfriVac® in a CTC during campaigns - Adaptation guide and Facilitators guide
NOTE: If your peak threshold indicator has expired, please call your supervisor immediately. Your supervisor will fill in an expiration report and complete the last row. You do not need to continue to complete the form, unless you receive a new batch of vaccines. In this case, please start a new column. Monitoring sheet for the Controlled Temperature Chain (CTC)
Department of Immunization, Vaccines and Biologicals Family, Women’s and Children’s Health (FWC) World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland E-mail: vaccines@who.int Web site: http://www.who.int/immunization/en/