web viewmanual for training of malaria prevention volunteers. this publication is made possible by...

Manual for Training of Malaria Prevention Volunteers

This publication is made possible by the generous support of the American people through the United States Agency for International Development (USAID) and President’s Malaria Initiative

(PMI).

PMI is an interagency initiative led by USAID and implemented together with the Centers for Disease Control (CDC). PMI’s goal is to reduce malaria deaths by 50% in 15 African countries, Mozambique, by reaching 85% of the most vulnerable groups, including pregnant women and

children less than five years of age, with prevention and life-saving services, supplies, and medicines.

1

Table of Contents

Table of Contents.............................................................................................................................2General Guidance for Training Facilitators.....................................................................................3

Planning: Things to Do Before the Training..............................................................................3Preparing to Conduct a Training on Malaria Communication for Volunteers................................4

Who is this Training for?.............................................................................................................4How to Use this Training Manual...............................................................................................4Sample Agenda ........................................................................................................................4

Session 1: Welcome and Introduction............................................................................................5Overview ........................................................................................................................7

Session Two: Malaria Causes and Symptoms................................................................................9Malaria ........................................................................................................................9Malaria in Mozambique.............................................................................................................11Symptoms of Malaria................................................................................................................12

Session Three: Malaria Prevention and Treatment.......................................................................13Malaria Prevention.....................................................................................................................14PIDOM ......................................................................................................................15LLINs ......................................................................................................................16Malaria in Pregnancy.................................................................................................................16Malaria Treatment.....................................................................................................................17

Session Four: Talking with Families about Malaria.....................................................................19Tips for Communicating Effectively with Families..................................................................20Six Essential Malaria Actions to Protect Families from Malaria..............................................20Talking with Families about the Actions they can take to Stay Healthy from Malaria.............23Talking with Families about Sleeping under a LLIN................................................................24Talking with Families about PIDOM........................................................................................26Talking with Families about the other Four Essential Malaria Actions....................................28

Session Five: Communication and Monitoring Guidelines for Volunteers..................................29Guidelines for Household Visits................................................................................................29

Annex A: Tips for Effective Facilitation......................................................................................32Annex B: Malaria Prevention Volunteer Training Pre/Post-Test.................................................33Annex C: Malaria Prevention Volunteer Program Guidance.......................................................35Annex D: Agreement/Disagreement Statements..........................................................................36Annex E: Family PIDOM Preparation Instructions......................................................................37Annex F: Instruction for LLIN Use..............................................................................................38Annex G: Barrier/Facilitator Worksheets.....................................................................................39Annex H: Volunteer Monitoring Log and Question Sheet...........................................................43

2

General Guidance for Training Facilitators

Planning: Things to Do Before the TrainingFacilitators will be responsible for overseeing the planning, coordination, and supervision of malaria prevention volunteers’ work in their communities. Logistics, training content, and materials will need to be prepared ahead of the training date. Some areas for consideration are below:

Logistical

1. Ensure enough copies of training hand outs ahead of the workshop.

2. Secure training materials (treated bed nets, flip charts, markers, etc.)

3. Arrange location, scheduling, and invitations for one-day volunteer training.

4. Inform local government of training as needed and extend appropriate invitations.

5. Distribute travel and transportation allowances at the end of training and ensure appropriate documentation.

Technical

1. Using this training module, prepare for and conduct trainings with malaria prevention volunteers and invite the local malaria focal person or other relevant government official.

2. Share guidance with volunteers for household activity roll out, M&E, and reporting.

3. Use this manual after the training as a resource on program guidance and malaria.

4. Serve as a resource for volunteers on communicating with families effectively about malaria.

Oversight, Monitoring, and Evaluation

1. Provide ongoing monitoring and oversight of program activities – provision of training and roll out of household level visits.

2. Provide reporting on communication activities conducted, ensure the quality of volunteer reporting, and provide any qualitative feedback that will help to shape the program in the future.

3

Preparing to Conduct a Training on Malaria Communication for Malaria Prevention Volunteers

Who is this Training for?This training is designed for volunteers who conduct household visits in their communities to talk with families about preventing and treating malaria.

How to Use this Training ManualThe course outline and materials are designed to be interactive and participatory. Training sessions are paired with group participatory sessions. Group discussions and role plays are designed to test and demonstrate the application of knowledge gained during this session. Facilitators are encouraged to make the training participatory and to draw from trainees’ experiences and resources. Annex A provides tips for effective facilitation.

Notes to facilitators are structured in the following way:

Ask and Discuss sections aimed at facilitating group dialog; Talking Points sections help to provide the content of the training; and Group Activities serve to reinforce the material presented.

This training is designed to last one day.

Sample Agenda

Session Title Time1 Welcome and Introduction 08:00 – 09:30

2 Malaria Causes and Symptoms 09:30 – 10:30

Break Break 10:30 – 10:45

3 Malaria Prevention and Treatment 10:45 – 12:15

Lunch Lunch 12:15 – 13:00

4 Talking with Families about Malaria 13:00 – 15:00

Break Break 15:00 – 15:15

4 Talking with Families about Malaria (Continued) 15:15 – 16:15

5 Communication and Monitoring Guidelines for volunteers and Closing

16:15 – 17:00

4

Session 1: Welcome and Introduction

Workshop Objectives:

Preparation:1. Review material prior to training

Procedure: 1. Welcome participants2. Administer the pre-test (Annex B)3. Lead the icebreaker4. Explain session objectives 5. Follow instructions in the left margin in

the sections below6. Engage participants around the content

in a participatory way

Materials: Annex B Pre-test Flip chart or board Markers Name tags Ball of string Annex C Malaria Prevention Volunteer

Guidance

Time: 1 hour 30 minutes

6

By the end of this session, participants will be able to:

1. Explain the role of a malaria prevention volunteer.2. Describe the causes of malaria.3. Describe the symptoms of malaria.4. Explain how malaria can be prevented.5. Explain when treatment for malaria should be sought.6. Name six essential malaria actions families can take to prevent and treat malaria.7. Feel confident talking with families about the six essential actions they can take to

protect their family from malaria.8. Demonstrate the correct way to document household visits using the monitoring

forms.

Welcome:

(10 minutes intro and pre-test)

Welcome the participants.

Administer the pre-test (Annex B). Explain the purpose of the pre-test to put participants at ease. Collect all pre-tests and put aside.

IcebreakerActivity – The Cobweb(15 Minutes):

Ask participants to form a circle

Give one person a ball of string and ask them to say their name and one sentence about their expectation of this workshop.

When finished, have that person toss the ball of string to another participant to share with the group.

Continue until all participants are woven into a cobweb.

At the end:

o Explain that everyone is gathered today to learn about how they can play an important role in helping their communities become malaria-free.

o That by learning and sharing experiences about being a malaria prevention volunteer together, they can make today’s training and their work in communities more effective. .

o Reconvene to plenary.

7

Overview

Present Workshop Objectives:

This workshop will help provide volunteers with information and skills they need to effectively talk with families about essential actions they can take to stay healthy from malaria.

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

o Explain the role of a malaria prevention volunteer.

o Describe the causes of malaria.

o Describe the symptoms of malaria.

o Explain how malaria can be prevented.

o Explain when treatment for malaria should be sought.

o Name six essential malaria actions families can take to prevent and treat malaria.

o Feel confident talking with families about six essential actions they can take to protect their family from malaria.

o Demonstrate the correct way to document household visits using monitoring forms.

Ask and Discuss (5 minutes):What does the following quote mean to you as a malaria prevention volunteer?

“The superior man is modest in his speech, but exceeds in his actions.” –Confucius

Talking Points:

Thank you for being a malaria prevention volunteer.

You play an important role in keeping families safe from malaria in your community.

As a malaria prevention volunteer, you are a role model in your local communities.

Action and sincerity around malaria begins with you and your family.

Volunteers have an important job: They talk with families about essential actions they can take to stay healthy from malaria.

Volunteers work to ensure healthy and malaria-free Mozambique.

8

Handout and Discuss (10 minutes): Handout Annex C: Volunteer Program Guidance.

Discuss the recommended number of visits for each volunteer – 10 new household visits per month and five repeat visits.

Explain that the objective of new household visits is to discuss with families actions they can take to protect themselves from malaria and that repeat household visits are to:

Check in on the family’s progress around taking steps to stay healthy and free from malaria,

Discuss any difficulties the family has had related to protecting themselves from malaria,

Discuss strategies that the family can try to make protecting themselves from malaria easier to do, and

Provide positive reinforcement around steps the family has taken to stay healthy from malaria since the volunteer’s last visit.

Activity (15 Minutes):

Ask participants to pair off with someone they do not know well.

Have each person interview their partner and share the following:

1. What they find personally rewarding about being a malaria prevention volunteer.

2. Their thoughts on how they can be a role model for others in local community on malaria.

Reconvene to plenary and have two or three volunteers share what they learned about their partner.

9

Session Two: Malaria Causes and Symptoms

Session Two Objectives:


Procedure: 1. Explain Session Two’s objectives2. Follow instructions in the left margin in

the section below3. Engage participants around the content


Materials: Flip chart or board Word cards (Agree, Disagree, Not

Sure) (Annex D) Tape

Time: 1 hour

Malaria

Ask and Discuss (5 minutes):

To what extent is malaria a problem in your community?

10


1. Describe the causes of malaria.2. Describe the symptoms of malaria.


Tape three word cards up in different parts of the room. The cards should read: ‘Agree’, ‘Disagree’, and ‘Not Sure’.

Tell participants you are going to read a statement and that they should physically move close to the answer that best represents their position on the statement.

After reading each statement, ask one or two people from each group to explain why they have chosen their position and how it affects their work as a volunteer.

1. Statement 1 : Families in my community believe they are at risk for malaria.

2. Statement 2 : Families in my community believe that getting malaria is serious and can be deadly.

3. Statement 3 : Families in my community believe that avoiding malaria is worthwhile and possible for them to do.

Reconvene to plenary.

Recap the findings for the three statements and continue the discussion of their meaning in the following future related sessions.

Talking Points:

Malaria is an illness which is transmitted by mosquito bites.

Mosquitoes are the only carriers of malaria.

Bewitching does not cause malaria.

Malaria is serious illness and can be fatal.

Pregnant women and young children are most vulnerable to malaria because they have less resistance to the illness, putting them at greater risk.

Malaria hurts families, our community, and society as a whole.

Malaria causes absences from school and work, which causes lost income and children to fall behind in their schoolwork.

By preventing and appropriately treating malaria, we can ensure our family’s health and prosperity.

There are six essential actions we can take to keep families and communities in Mozambique malaria-free.

11


What questions do families in your community have about the causes of malaria?

As volunteers, how can we best address these questions?

Record the questions and proposed solutions on a flip chart.

Malaria in Mozambique

Talking Points:

Mosquitoes that transmit malaria are found throughout Mozambique.

You can get malaria at any time of year, but the risk is greatest between November and February (the rainy season).

Malaria is a serious health concern. It is number one killer of young children in Mozambique.

Pregnant women and young children (under five) are most vulnerable to malaria because they have less resistance to the illness, which puts them at greater risk.

Over one in every three pregnant women in Mozambique has malaria during pregnancy. Malaria is a real risk for every pregnant woman and their babies.

Everyone can get malaria – even if they had it before. Just because someone had malaria in the past, does not mean that they are not at risk for it in the future or that it will be ok for them to have malaria again.

Last year, one out of every five people in Mozambique had malaria.

The Ministry of Health’s National Malaria Control Program helps to combat malaria. They distribute treated bed nets, carry out PIDOM, provide malaria treatment, and conduct other prevention and treatment activities. They also provide a free net to pregnant women who attend the antenatal care. During antenatal care, pregnant women receive the Intermittent Preventive/Presumptive Treatment (IPT) against Malaria, at least twice for free.

Malaria prevention organizations and volunteers work to ensure a healthy and malaria-free Mozambique through community mobilization, awareness-raising, and working with families to overcome barriers to malaria prevention and treatment.

There are simple actions families can take to prevent and treat malaria. As volunteers, we can talk with families about the risk of malaria, its potential impact on their health and prosperity, and to let them know the six essential actions they can take to safeguard their family’s health.

12

Symptoms of MalariaTalking Points:

It takes 10-15 days between when a person is infected with malaria and when they first experience symptoms.

Symptoms of malaria include:

1. Fever2. Severe headache3. Shivering or chills4. Lack of appetite5. Nausea or vomiting6. Diarrhea7. Convulsions8. Backache or joint pain

With young children, in particular, it is very important that at the first sign of fever and/or other symptoms of malaria, parents or caregivers take the child to the nearest health facility for malaria treatment or to the APE (Agente Polivalente Elementar de Saude) present in the village. – Even if the child does not seem to be getting worse or is able to play.


What questions do families in your community have about the symptoms of malaria?

What do families currently believe about the causes of fever?

How can we as volunteers, best address these questions and traditional beliefs?

Record the questions and proposed solutions on a flip chart.

13

Session Three: Malaria Prevention and Treatment

Session Three Objectives:


Procedure: 2. Explain Session Three’s objectives1. Follow instructions in the left margin in

the section below2. Engage participants around the content


Materials: Flip chart or board Pencils, paper, tape Treated bed nets Family PIDOM Preparation Sheet

(Annex E) Instructions on Net Use (Annex F)

Time: 1 hour 45 minutes


Hand out pencils and a sheet of paper to each participant.

Ask them to quickly sketch the inside and outside of a typical house in Mozambique and a typical family, demonstrating preventative measures against malaria.

Hang the pictures on the wall or share them with each other.

Have participants share their drawings with two or three other participants and discuss:

1. What they see in the picture as it relates to malaria?

2. What is missing in the picture related to preventing malaria?

3. For the family members depicted, who needs to be concerned about malaria and why?

14


1. Explain how malaria can be prevented.2. Explain when treatment for malaria should be sought.

Malaria Prevention

Ask and Discuss (5 Minutes):

Do families in your community believe it is important to take steps to protect themselves from malaria? Why or why not?

What are families currently doing (if anything) in your community to prevent malaria?

Talking Points:

There is no vaccine to protect against malaria.

There are, however, simple actions families can take to protect themselves.

Families can stay healthy from malaria by:

1. Always sleeping under a treated bed net, every night (even if outside).

This is especially important for pregnant women and young children (those under five) because they have less resistance to malaria.

Treated bed nets help protect from being bit by mosquitoes that transmit malaria, at night, when they are most likely to bite.

2. Allowing PIDOM teams to spray in their homes to kill the mosquitoes that carry malaria.

3. Cleaning up or covering water from around their homes because this is where mosquitoes that carry malaria lay eggs and breed.

Remember – as a malaria prevention volunteers, it is our job to be good role models for others in our community.

We can do this by:

1. Ensuring our own families always sleep under a treated bed net,

2. Cooperating with the PIDOM sprayers, and

3. Covering and cleaning water in our yards

By taking these measures ourselves, we can make it easier for our neighbors and other community members to follow in our footsteps.

Other things families can do in addition to sleeping under a treated bed net and allowing PIDOM spraying in their homes are:

15

1. Using chemical or natural repellents (e.g. ‘Baygon’ or other sprays, casca de coco, etc.).

2. Using window or door screens.

3. Minimize the time spent outside unprotected when mosquitoes are out the most (from dusk to dawn) in rural areas.

PIDOM

Handout, Ask, and Discuss (5 minutes):

Hand out Family PIDOM Preparation sheet (Annex E)

Ask: What have you heard about PIDOM before?

Talking Points:

PIDOM is a proven, effective way to prevent and control malaria.

The insecticides used in PIDOM are safe for people and animals and are approved by the Ministry of Health and international health authorities.

PIDOM teams visit homes before the rainy season and spray their inside walls.

Mosquitoes that land on the sprayed walls will die.

PIDOM is effective only against mosquitoes. It was not designed to kill all bugs like cockroaches, and it is safe for families and animals.

Rociadores have been trained to properly mix insecticides for use inside of homes.

Walls that have been sprayed are effective for 4-10 months.

For PIDOM to work, households need to:

Permit the PIDOM teams access to their homes

Remove or move furniture and other goods if needed so that the teams can spray the walls

Wait up two hours for the walls to dry before putting the furniture/goods back

16

Long Lasting Insecticide Treated Bed Nets (LLINs)

Talking Points:

LLINs are a proven and safe way to prevent malaria.

LLINs repel and kill mosquitoes.

When sleeping under a net, you are protected from bites from a malaria-carrying mosquito.

The insecticide on the net lasts around 20 washes or three years.

Families can get free LLINs during universal coverage distribution (in some districts) and at the antenatal care health facility for pregnant women. Families can also buy LLINs for 100 MZN in the public market.

Volunteers should encourage families through discussion to get a net and to sleep under it every night, because it will keep their families prosperous and healthy from malaria.

Every pregnant woman and young child should sleep under a net, every night as they are more vulnerable to the effects of malaria.

Activity(15-30 Minutes):

Ask: What questions do families in your community have about bed nets?

Demonstrate the proper way to use a LLIN and hand out instructions (Annex F).

Remember to let volunteers know that the LLIN has to air out after opening it for 2-4 hours before hanging it. The bag that stores the net must be burned outside the house to avoid storing food in it.

Enlist a volunteer to help you as needed.

Allow participants to practice hanging a net.

Malaria in Pregnancy

Talking Points:

Pregnant women and young children (under five) are very vulnerable to malaria. Malaria can severely impact their health and the health of their unborn baby.

There are several actions pregnant women and their families can take to ensure she and her baby are protected from malaria.

17

1. Pregnant women should always sleep under a net (LLIN), every night. This is a proven and safe way to prevent malaria.

2. If a pregnant woman has malaria symptoms, she should seek immediate treatment (within 24 hours) from the health facility or from an APE (Agente Polivalente Elementar). She should not delay or she might endanger her health and that of her baby.

3. Pregnant women should go to the antenatal care health facility during pregnancy. At antenatal care they will get pills (IPT), at least twice during pregnancy, to prevent or treat malaria for her and her baby.

4. At the antenatal care health facility, pregnant women may receive a treated bed net for free that they can sleep under.

5. If there are not nets available at antenatal care, volunteers should encourage pregnant women and their families to purchase a net to ensure her and her baby’s health.

Husbands/fathers can protect their wife and baby’s health by:

1. Making sure that they always sleep under a net (LLIN);

2. Ensuring they seek immediate treatment (within 24 hours) if they have malaria symptoms at the health facility or from an APE; and

3. Encouraging them to go for antenatal care.

Mothers, mothers’-in-law and other women in the house play an important role in keeping pregnant women and their babies healthy by also encouraging them to take these protective actions.

Volunteers should encourage women in the home to look out for pregnant women to help them stay safe from malaria.

Remember! As a malaria prevention volunteer, it is your job to be a good role model for others.

1. Ensure your wife, or the pregnant woman you are caring for, has access to antenatal care during pregnancy,

2. That she always sleeps under a treated bed net, and

3. That she seeks treatment immediately (within 24 hours) if she has symptoms of malaria.

Malaria TreatmentTalking It is important that people with malaria symptoms (e.g. fever) seek

diagnosis and treatment from a health facility immediately – within one

18

Points: day or 24 hours of symptoms so that they can get treatment (ACTs) before their illness becomes severe.

Young children (children under 5) should be brought to a health care worker as soon as possible -- within one-day (24-hours) of having symptoms (e.g.), for immediate treatment with ACTs.

Treatment of a fever at home is not advised, particularly for young children and pregnant women. A fever is a key sign of malaria and may be serious – even if it does not seem to be getting worse or a child is able to play. Families should go immediately to the health facility for treatment.

Treatment that is effective in curing malaria is available only through the health facility or the APE where there is not a health facility and not through traditional healers.

If you delay treating malaria at the health facility, it can become severe and possibly fatal. Young children are very vulnerable to malaria.

Anyone taking malaria medicine should take all of it as directed by the health facility so that they have a full recovery.

Families should follow the health worker’s instructions for malaria medicine and not share it with anyone else; otherwise they may not have a full recovery and the Malaria can become resistant.

Remember – as a malaria prevention volunteer, it is your job to be a good role model for others.

1. Always seek treatment for you or family members, especially young children, as soon as possible (within one day (24 hours)) of malaria symptoms (e.g. fever), and

2. Ensure all malaria medicine is taken as directed.

Activity(10 Minutes):

Ask participants to return to their earlier drawings of houses and families.

Have participants make any needed changes to their drawings based on what they learned about malaria and what is the ideal situation for malaria control for a Mozambican family.

19

Session Four: Talking with Families about Malaria

Session Four Objectives:

Preparation:1. Review material prior to training2. Prepare barrier sheet for the

participants’ exercise ahead of time

Procedure: 3. Explain Session Four’s objectives4. Follow instructions in the left margin in

the section below5. Give participants a break mid-session6. Engage participants around the content


Materials: Flip chart or board Markers Tape Pictures (Annex G) Barrier/facilitator worksheets (Annex

H)

Time: 3 hours

ASK AND DISCUSS (5 minutes):

What are strategies you can use to make sure that your visit with families on malaria are positive and effective?

20


1. Name six essential malaria actions families can take to prevent and treat malaria.2. Feel confident talking with families about six essential malaria actions they can take

to protect their family.

Tips for Communicating Effectively with Families

Talking Points:

Introduce yourself as a malaria prevention volunteer when you go to a house to conduct a visit.

Explain that you are talking with families in your community about malaria.

Observe and follow the traditional practices of the home and family.

Always be respectful.

Engage the family in a discussion. Do not lecture the family. Instead, talk openly with them about ways they can protect their family’s health and prosperity related to malaria and explain why this is important to do.

On repeat visits, engage family in a discussion around what actions have worked for them and what actions have been more difficult to do and why.

Listen to what the family has to say and always ask them for their questions.

If you do not have an answer to a question, write it down and refer them to someone who does, or follow up with them later when you have the right answer.

Remember to be a role model for families on keeping safe from malaria and share your own experiences with families.

Six Essential Malaria Actions to Protect Families from Malaria

Talking Points:

As malaria prevention volunteers, there are six essential actions that you should talk about with families. These actions, if taken, will help to keep the family malaria-free.

Every volunteer should know and understand these six essential malaria actions.

The six essential malaria actions are:

Action 1: Always sleep under a treated bed net every night – especially for pregnant women and young children (under five)

21

Ask and Discuss (5 minutes): Why do you think sleeping under a treated bed net is important for families to do?

Some possible reasons:

Prevention of bites from malaria-carrying mosquitoes.

Easy and cost-effective way to keep family safe from malaria.

Pregnant women and young children are more susceptible to malaria.

Action 2: Allow PIDOM teams into your home to spray to kill the mosquitoes that transmit malaria.


How does cooperating with PIDOM sprayers help to protect families from malaria?


PIDOM kills mosquitoes that transmit malaria in your home for several months after spraying.

PIDOM is safe for your family and animals and will help protect your family from malaria.

Action 3: Go to the antenatal care health facility during pregnancy where you will get pills (called IPT) to prevent or treat malaria for you and your baby.


Why do you think going to the antenatal care health facility for IPT is important for pregnant women and their babies?


By going to the antenatal care health facility, women can ensure a healthy pregnancy and baby.

Pills called IPT are given to pregnant women at the antenatal care health facility, which will help to both prevent and treat malaria – ensuring that both mom and baby stay healthy from malaria.

22

Action 4: Seek immediate (e.g. within 24-hours) treatment from the health facility as soon as you or your child experiences malaria symptoms (e.g. fever).


Why is immediate treatment at the health facility important upon experiencing malaria symptoms?


By going to the clinic immediately, you can get free treatment for malaria.

By getting immediate treatment, you can stop malaria before it becomes too dangerous.

Young children are very vulnerable to malaria and need to be taken immediately to the health facility for treatment.

Action 5: Take all malaria medicine (ACTs) as directed by the health facility.


Why do you think it is important to take all of your malaria medicine as directed?


It is important to finish all malaria drugs as prescribed to be completely cured from malaria.

If not taken appropriately, you could have a malaria relapse.

Action 6: Clean up or cover any water from around your house to reduce mosquitoes.


How does cleaning up or covering water around your house keep families safe from malaria?


Water around homes is where mosquitoes that carry malaria lay eggs and breed.

Cleaning or covering water will help reduce malaria-carrying mosquitoes around your home.

23


Ask participants to line up with their backs to you.

Tape a picture of an essential malaria action on the back of each participant (ensure even numbers of each action).

Ask participants to mix themselves up and to ask each other questions about the picture of their back until they guess the right action and find another participant with the same action.

Have each pair report back to the group their key malaria action and one reason why it is important for families to do.

Talking with Families about the Actions they can take to Stay Healthy from Malaria

Talking Points:

There are many reasons for why people choose to do something or not do something that is considered by others as good for them to do.

For families to choose whether or not to take steps to protect themselves from malaria, they need to:

1. Believe they are at risk for malaria;

2. Believe that getting malaria is serious and a bad thing for them and their family;

3. Believe that there are benefits in taking steps to protect themselves;

4. Believe the benefits outweigh the barriers they face in protecting themselves from malaria; and

5. Feel confident that they have the skills or ability they need to protect themselves.

As volunteers, we can help provide information about malaria so that people understand their risk of the illness and its negative effects on families’ health and prosperity.

We can listen to and answer people’s questions about malaria.

We can also talk with families about the barriers they are facing in and the benefits or ways to make particular actions easier to do.

24

Talking with Families about Sleeping under a LLIN

Ask and Discuss (and record barriers and facilitators on a flip chart) (15 minutes):

What makes sleeping under a treated bed net difficult for families in your community? What would make sleeping under a treated bed net easier for families to do?

Record responses on a flip chart using the example provided below:

Barrier Facilitator

1. 1.

2. 2.

3. 3.

Reference the following as needed to help prompt or support the discussion above:

Some barriers for people to sleep under a net and some ways we can address them (facilitators) with families are:

Barrier Facilitator

Family does not know how to use net properly

Tell or show family how to use the net

It is tiring to take down or put up net

Suggest they enlist help from someone or help them yourself

Net takes up too much space in the room

Suggest they roll up the net when not sleeping

The net is hot or uncomfortable to sleep under

Overtime, families say that they get used to sleeping under a net. They feel better about it because they know they are protecting their family’s health and prosperity.

The fabric of the net causes a rash

Airing a new net out for 2-4 hours before use will help prevent a rash

The white color of the net There are white and blue LLINs

25

symbolizes a shroud available

The family does not have access to a free net or cannot afford one

Encourage the family to buy a LLIN. If they cannot afford a net, encourage them to save their money. They cost 100 MZN. If they buy a net, they will be investing in their health and will save money from being sick.

Malaria has been around since the beginning of time. The person has had it before and can have it again

Everyone is susceptible to malaria. It is a serious illness that can be fatal for family members, especially for young children. The person can take action to prevent malaria.

Remember that there are also other ways you can encourage families to use a treated bed net:

Tell or show the family that you (the volunteer) and other community members also sleep under a net.

Explain to the family that by always using net, they can protect themselves and their children from malaria.

Explain that everyone is at risk for malaria, especially pregnant women and young children.

Explain that by using a net, the family will save money by not missing work and children will not miss school.


How can we use the barriers and facilitators we just identified to help strengthen our conversations with families around sleeping under nets?


Ask for five volunteers – one to play the role of a volunteer, the other four to play a typical family in their community.

Ask the volunteers to role play for the group a volunteer household visit where she/he talks with the family about malaria and the importance of sleeping under a treated bed net every night. Encourage the ‘family member’ volunteers to respond as a typical family might in their community.

26

After the role play, ask the viewers what worked well about the volunteer’s discussion with the family? What could have been improved in his/her communication and how?

Talking with Families about PIDOMTalking Points:

Another action that volunteers talk with families about is letting PIDOM sprayers into their homes to kill mosquitoes that cause malaria.

Ask and Discuss (and record barriers and facilitators on a flip chart):

What makes allowing PIDOM spraying in homes difficult for families to do? What would make this easier for families?

Record responses on a flip chart using the example provided below:

Barrier Facilitator

1. 1.

2. 2.

3. 3.

Reference the following as needed to help prompt or support the discussion above:

Some barriers for people to allow PIDOM and some ways we can address them (facilitators) with families are:

Barrier Facilitator

The Rociadores do not mix insecticides properly with the water, which is why flies survive

The Rociadores have been trained to properly mix insecticides. The insecticides are designed to kill mosquitoes that transmit malaria but not other insects

PIDOM brings bugs into the house

PIDOM is designed to kill mosquitoes that transmit malaria but not other insects. The bugs that you see were there before but came out of hiding when the

27

Barrier Facilitator

solution was sprayed

Is PIDOM safe? The insecticides used by Rociadores are safe for families, including babies, and animals. It is a proven and effective way to prevent mosquitoes that transmit malaria

Having to remove items from the house before spraying

Only some items need to be removed from the house, namely food and water. Other items may be pushed to the middle of the room if possible

The Rociadores steal goods while spraying the house

The Rociadores do not have the right to take any property from the house. If this happens, report it to the local government authorities

Rociadores try to charge for spraying the house

PIDOM is free. If someone asks for money or favors to spray your house, it is illegal. Families have a right to denounce such an act. If this happens, report it to the local government authorities

The Rociadores have the habit of talking about the economic and social status of the families whose homes they visit

This is unprofessional behavior. Families have the right to report this to the local government authorities. The Rociadores have a code of conduct to respect.

Some other ways you can encourage families to allow PIDOM sprayers in their homes is to:

1. Share an example of a positive experience you or someone you know had with PIDOM.

2. Remind the family of the importance of preventing malaria and that PIDOM is a safe and effective way to prevent mosquitoes that transmit malaria.

28

Remember, now that we are aware of barriers and facilitators for PIDOM, we need to use this information to help make PIDOM more acceptable to families.

Talking with Families about the other Four Essential Malaria Actions

Activity (45 minutes):

Explain that we will go through a similar barrier/facilitator exercise in small groups that we did in plenary for sleeping under a treated bed net and allowing PIDOM spraying.

Have participants count off by four to form four small groups.

Assign each group one of the remaining essential actions and hand out one barrier/facilitator worksheet (Annex H) per group.

Instruct each group to discuss barriers in their community for their assigned action and ways volunteers might help make these actions easier for families to do to protect themselves.

Groups should record the findings from their discussion on their worksheet.

Once completed, have the small groups share their action and the results from their discussion with another group. Does the other group have other barriers/facilitators to add to their list?

Have each group hand their completed worksheet to another group that they have not yet shared with.

Using the worksheet they have just received and their new essential malaria action, instruct the groups to develop a short role-play of a household visit. The visit can be a repeat visit or a new visit. The essential action on their sheet should be discussed. The group should pick their three top barriers and facilitators from the sheet to incorporate in their discussion.

In plenary, have the small groups present their role plays. After each role play, ask participants:

o What essential action was the volunteer talking with the family about today?

o What were three barriers that the family faced related to this action?

o What three things did the volunteer do or say to help overcome these barriers?

o Was this a successful household visit? If yes, why? If no, what could have been improved?

29

Ask and Discuss: Are there any questions on the six essential malaria actions or about talking with families

about malaria or these topics?

30

Session Five: Communication and Monitoring Guidelines for Malaria Prevention Volunteers

Session Five Objectives:

Preparation:1. Review material prior to training2. Copies of monitoring log3. Written scenario4. Post-test5. Evaluation

Procedure: 1. Explain Session Five’s objectives2. Follow instructions in the left margin in

the section below3. Post written scenario up on the wall4. Engage the participants around the

content in a participatory way

Materials: Flip chart or board Markers Stickers Annex I: monitoring log Annex J: post-test Annex K: evaluation form

Time: 45 minutes

Guidelines for Household Visits

Talking Points:

Malaria prevention volunteers should introduce themselves as volunteers working to eliminate malaria in their communities.

Every month, volunteers should try to visit a minimum of 10 new households and 5 repeat households (refer to the volunteer guidelines).

At repeat households, volunteers can ask families what difficulties they have faced in protecting themselves against malaria and what steps they

31


1. Demonstrate the correct way to document household visits using the monitoring forms.

have been successful with. Volunteers should continue to discuss with the family the malaria prevention and treatment actions they find difficult and should congratulate the family for those they have been successful with.

When visiting a house, ask if a malaria prevention volunteer has visited in the past. If yes, they are a repeat household. If not, they are a new household.

Volunteers will complete and regularly submit a simple monitoring log for their household visits. These should be completed IMMEDIATELY after each household visit.

Show and Explain:

Hand out copies of the monitoring log (Annex I).

Explain how to fill in the form.

ACTIVITY: 15 Minutes

Post a written version of the scenario at the front of the room.

Read the following to the participants. Ask them to pretend they are the volunteer. After hearing the scenario, instruct them to fill out their monitoring form as if they were the volunteer described in the scenario.

Provide the correct answers after everyone completed the forms, the reasons why, and answer any questions.

Carlos is a malaria prevention volunteer who lives in Mafarinha in the Dondo district. He just visited Alicia’s house on January 15, 2012. He had never been there before but he asked her if she had been visited by a malaria prevention volunteer in the past. She said she had. Alicia reported that since the last volunteer’s visit, she knew to visit the health facility as soon as her baby had symptoms of malaria and that last month she followed this advice. She reported that while she has a net, she has not yet hung it up because she does not know how to use it and thinks it will take up too much room in her home.

Carlos congratulated Alicia on keeping her baby safe from malaria by bringing him to the health center right away. He encouraged her to share her story with others so that they also know to go to the health center immediately upon experiencing symptoms of malaria. Carlos asked Alicia if she wanted help in hanging her LLIN. He explained that LLINs are an essential way she can prevent malaria for her baby who is more vulnerable to malaria and for her family. He also told her that she can roll up the net when it is not being used to make more

32

room in the house. Carlos then helped Alicia hang up the net and showed her how to roll it up.

Monitoring log answer key: Name: Carlos; Locality: Mafarinha; District: Dondo; Date: January 15, 2012; Name of Family: Alicia; Type of House: Repeat; Topics Discussed: Net, Go to Facility Immediately.

Ask and Discuss: Thank participants for their role in a successful workshop and in keeping their

communities prosperous and healthy from malaria. Ask:

o How do you feel about your experiences in this training?o What will you do with the knowledge and skills you have gained today?

Workshop Close:

Distribute post-test (Annex J) and collected completed forms.

Distribute evaluation (Annex K) and collect completed forms.

33

Annex A: Tips for Effective Facilitation

What Does It Mean To Be A Facilitator? (Taken from the Pakistan Safe Drinking Water and Hygiene Promotion Project’s Community Health Promotion Manual)

Attributes of an Effective Group Facilitator Facilitation is a skill, and skills can be learned. The following attributes can enhance your ability to facilitate and build a strong foundation. Personal attributes are difficult to change and to teach. It is up to you to work continuously on self-improvement.

Good sense of humor: Humor is one thing that can cut the ice, reduce tension and give you and your group energy in demanding situations. If in your training something less than ideal happens, you as the facilitator need to handle the resulting stress with confidence, style, and grace. If you can't laugh at yourself in difficult situations, you will find training facilitation very trying!

Assertiveness: As the facilitator you need to have the ability and courage to speak the hard truth when necessary. If you are afraid to say what needs to be said when it needs to be said, you will not be as effective or credible. The challenge of assertiveness is in knowing when to push and when to pull back. You need to know when to intervene to help keep the participants on track and when to let things work themselves out. Just a reminder: There is a big difference between assertiveness and aggressiveness.

Intuition: Facilitation is not a skill that rests on applying a simple formula to get the "right answer." Try to work on finding it on your own by identifying what is best for each situation. Intuition comes from experience, but also includes the ability to act on a hunch.

Creativity: Each time you facilitate you need to put together traditional, new, and creative ways to conduct the training. This is as important for the first training with a group or the hundredth.

Flexibility: As the facilitator, you must think on your feet, stay on your feet, and accept new and better ideas from others, to change or modify the course as needed. The facilitator who is attached to his or her first idea or to his or her ideas in general, will encounter difficulty.

Confidence and enthusiasm: A key to success is the ability to appear credible, articulate and knowledgeable in front of the participants from the start and to sustain a level of energy and enthusiasm that lasts until all the participants have left.

Team player: One way to incorporate teamwork and commitment among the participants is to use alternate facilitators. As the main facilitator you are the moderator, interpreter, and timekeeper, not the star. Your recognition comes from the work you allow others to accomplish and the successes you help to build.

High self-esteem: If a situation is not going well, the facilitator may be blamed, whether the facilitator was the cause of the problem or not. Even if an individual or group takes their frustration out on you, you cannot take it personally.

Sincerity: You, as the facilitator, must truly care about your group and its success and you need to practice what you preach.

Dedicated to learning: Good facilitators are dedicated to continuous improvement of their skills. The more tools you have available to use, the less likely you will panic when a certain technique doesn't work the way you planned.

References: Butler, A. S. Team Think . (1996). The McGraw-Hill Companies, Inc. Oakley, E. and D. Krug. Enlightened Leadership: Getting to the Heart of Change , (1991) Simon & Schuster

34

Annex B: Malaria Prevention Volunteer Training Pre/Post-Test

Date: ______________________________

Name: ______________________________

Location: ______________________________

1. How do people get Malaria? (Select one)?a. Witchcraftb. Bad airc. Mosquitoesd. Dirty watere. Poor sanitation in home

2. Please list three symptoms of malaria:

a. __________________________________________

b. __________________________________________

c. __________________________________________

3. What are six essential malaria actions can families take to protect themselves from malaria?

a. __________________________________________

b. __________________________________________

c. __________________________________________

d. __________________________________________

e. __________________________________________

f. __________________________________________

35

4. When should families seek treatment for malaria (circle one)?a. Before rainy seasonb. Within five days of having symptomsc. Only if a fever gets worsed. Within 24-hours or one day of having symptomse. If a neighbor gets sick

5. Why is it important to take all malaria medicine as directed by the health facility (circle one)?a. Because the medicine is expensiveb. Because malaria can relapse if not all the medicine is taken as directedc. It is not important to take all malaria medicine as directed by the health facilityd. Because the doctor said so

6. What is IPT?a. Spraying that is done in the home to prevent malariab. A type of bed netc. Pills given to pregnant women that prevents or treats malaria for her and her babyd. A type of mosquito repellente. A malaria medical test

7. True or False: PIDOM is safe for humans and animals?a. Trueb. False

8. True or False: malaria prevention volunteers should lecture families on malaria prevention?a. Trueb. False

9. True or False: malaria prevention volunteers are role models for families in their communities?

a. Trueb. False

10. True or False: malaria prevention volunteers should talk with families about barriers they are facing in preventing malaria?

a. Trueb. False

36

Annex C: Malaria Prevention Volunteer Program Guidance

Who can be a malaria prevention volunteer?

Anyone who wants to help protect families in their community from malaria.

What do malaria prevention volunteers do?

Malaria prevention volunteers play an important role in their communities. They conduct household visits and talk with families about ways they can prevent malaria and malaria treatment. Volunteers also provide regular updates on their activities. By becoming a malaria prevention volunteer, they play an important role in community.

Where do malaria prevention volunteers work?

Malaria prevention volunteers visit households to talk about malaria in communities around their place of worship and home.

How many visits should a malaria prevention volunteer make each Month?

It is suggested that each malaria prevention volunteer make at least 10 visits to new households to talk about malaria each month and 5 repeat household visits to follow up on key malaria prevention and treatment actions.

Why volunteer?

Malaria prevention volunteers are respected members of their community and their place of worship. Their work is important in helping to keep families in their community safe from malaria.

37

Annex D: Agreement/Disagreement StatementsInstructions: Cut and post these statements around the room for use in Session Two

AGREE

DISAGREE

NOT SURE38

Annex E: Family PIDOM Preparation Instructions

Inform families of the dates that the spraying will be carried out, so that they can have their houses prepared in advance

The preparation of houses should include: Transferring all furniture to the center of rooms and covering it, to allow sprayers easy

access to the walls Taking all food, water, and eating utensils outside Taking all clothing items outside Remove or put in cages all poultry and domestic pets

After the spraying residents should: Wait minimum two hours before reentering the house Sweep the floor before allowing children or pets to enter. All items collected during

sweeping should be burned or buried deeply

39

Annex F: Instruction for LLIN Use

The most common mosquito nets in Mozambique are made from polyester and are gernally Long Life Insecticide Treated Nets (LLIN), and they come already treated with insecticide.

The bed net repels or kills mosquitoes.

LLINs last for 3-5 years or 20 washes when well-maintained.

Studies have shown that when people regularly use LLINs, they become accustomed and no longer feel hotter using them. Opening windows can also help with ventilation.

Bed nets can be washed, though not as frequently as clothing items.

In order to properly protext people, the LLIN must be well-hung in a manner that doesn’t allow mosquitoes to enter. Regardless of whether the person sleeps in a bed or on a mat on the floor, it is possible to properly use a LLIN.

The plastic wrapping that the LLIN comes in should be properly disposed of and should not be used to hold food or other household items.

40

Annex G: Barrier/Facilitator Worksheets

Worksheet 1:Please complete this worksheet with your small group for the following essential malaria action: Go to the antenatal care health facility during pregnancy where you will get pills (called IPT) to prevent or treat malaria for you and your baby

Barrier Facilitator

1. 1.

2. 2.

3. 3.

4. 4.

5. 5.

6. 6.

7. 7.

8. 8.

9. 9.

10. 10.

41

Worksheet 2:Please complete this worksheet with your small group for the following essential malaria action: Seek immediate (e.g. within 24-hours) treatment from the health facility as soon as you or your child experiences malaria symptoms (e.g. fever)

Barrier Facilitator

1. 1.

2. 2.

3. 3.

4. 4.

5. 5.

6. 6.

7. 7.

8. 8.

9. 9.

10. 10.

42

Worksheet 3:Please complete this worksheet with your small group for the following essential malaria action: Take all malaria medicine (ACTs) as directed by the health facility

Barrier Facilitator

1. 1.

2. 2.

3. 3.

4. 4.

5. 5.

6. 6.

7. 7.

8. 8.

9. 9.

10. 10.

Worksheet 4:

43

Please complete this worksheet with your small group for the following essential malaria action: Clean up or cover any water from around your house to reduce mosquitoes

Barrier Facilitator

1. 1.

2. 2.

3. 3.

4. 4.

5. 5.

6. 6.

7. 7.

8. 8.

9. 9.

10. 10.

44

Annex H: Malaria Prevention Volunteer Monitoring Log and Question SheetFORM 3.1: HOME VISITS - Volunteer level

Volunteer:___________________________ Province:_____________________District:____________________Locality/Community:________________

Type of Visit Topics discussed

Date of visit Family visited New Repeat Net

Ante natal care/IPT

IRS Malaria medicine

Clean up Water around House

Go immediately to APE for symptoms

Signature

45

QUESTIONS ASKED BY FAMILIES DURING HOUSEHOLD VISITS (Please list):

46

web viewmanual for training of malaria prevention volunteers. this publication is made possible by...

Documents