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PREVENTION OF POSTPARTUM HAMMORRHAGE AT HOME

BIRTH

Facilitators Guide

His Majesty's Government Ministry of Health and Population

Department of Health Services National Health Training Center, Family Health Division, National Health Education

Information and Communication Center

June 2005

TABLE OF CONTENT

SECTION ONE: FACILITATORS GUIDE

COURSE SYLLABUS

Course Description 1-1

Course Goals 1-1

Participant Selection Criteria 1-1

Evaluation 1-1

Participant Learning Objectives 1-2

Training/Learning Methods

1-2

Training Materials

1-2

Course Duration

1-3

Suggested Course Composition 1-3

Course Schedule 1-4

Course Outline 1-5

INSTRUCTION FOR PRECOURSE QUESTIONNAIRE 1-18

Precourse Questionnaire 1-19

Precourse Questionnaire: Individual and group assessment Matrix 1-20

Instruction for Communication Game 1-21

ROLE PLAY SCENARIOS 1-22

Role Play 1 1-23

Role Play 2 1-23

Role Play 3 1-23

INSTRUCTION FOR MID-COURSE QUESTIONNAIRE 1-24

Mid-course questionnaire 1-25

Midcourse Questionnaire: Individual and group assessment Matrix 1-26

PRECOURSE QUESTIONNAIRE (ANSWER KEY) 1-27

MID-COURSE QUESTIONNAIRE (ANSWER KEY) 1-28

CHECKLIST FOR INTERPERSONAL COMMUNICATION SKILLS 1-29

INSTRUCTION FOR USING MODE CHART 1-30

Facilitators Guide 1 -

1

CB-MNC Prevention of Excessive Bleeding after Childbirth at Home Births: Training Guide for Female Community Health Volunteers (FCHVs)

COURSE SYLLABUS Course Description This 3-day* course is designed to prepare FCHVs to give information to pregnant women, their families, and their community members on the causes and prevention of excessive bleeding after childbirth. The course will focus on the use of Matri Suraksha Chakki to prevent excessive bleeding after childbirth at home birth and will provide FCHVs with the attitudes, knowledge, and skills needed to provide Matri Suraksha Chakki to pregnant women in their communities. Course Goals • To provide the participant with the knowledge and skills needed to talk to women, their

support persons, their families, and their community about how to recognize excessive bleeding after childbirth and actions to prevent excessive bleeding after childbirth and what to do if still bleeding after child birth.

Participant Selection Criteria Participants for this course should be Female Community Health Volunteers who have completed the basic FCHV training. One FCHV from each ward will be selected as the distributor FCHV. Additional criteria for selection to be a distributor FCHV are as follows: • Should be able to read and write. • Should be active. • Should be able to travel frequently in her respective ward. • Preferably working in maternal health (eg. distribution of iron, postpartum Vitamin A and

providing ANC information). Evaluation The trainer will assess participant knowledge through mid-course questionnaire at the end of the course. The trainer will also use a checklist to observe and assess participant skills in talking with women and giving information using the flipchart. Participants must score 80% in the knowledge assessment and perform all steps/tasks on the checklist correctly in order to successfully complete the course.

* This course will follow immediately after Birth Preparedness Package's training at Banke


2

Participant Learning Objectives By the end of this training course, the participant will be able to: 1. Explain the meaning and the main causes of excessive bleeding after childbirth and how it

can be prevented. 2. Provide information to pregnant women on how to recognize excessive bleeding after

childbirth, how to prevent excessive bleeding after childbirth, and how to store and use Matri Suraksha Chakki.

3. Explain what a skilled provider can do to prevent excessive bleeding after childbirth. 4. Describe the role and responsibilities of the FCHVs in helping prevent excessive bleeding

after childbirth through the use of Matri Suraksha Chakki. 5. Identify and register pregnant women in the community and record specific information

about them and their pregnancy. 6. Describe how Matri Suraksha Chakki is used to prevent excessive bleeding after

childbirth at home birth. 7. How to obtain Matri Suraksha Chakki and the re-supply process. 8. Talk to the pregnant women, her family and community by using interpersonal

communication skills. 9. Provide Matri Suraksha Chakki to women when they are in the 8th month of their

pregnancy. 10. Provide information to pregnant women, their families and their community to recognize

and manage the side effects of Matri Suraksha Chakki (Explain to the pregnant women, their families and community about the contraindications of Matri Suraksha Chakki).

11. Provide information to the pregnant women's families on when to take the woman to the hospital.

12. Conduct follow up visits to women’s homes after birth and record information on use of Matri Suraksha Chakki.

13. Report information about registered women and their use of Matri Suraksha Chakki to the ANM/MCHW at the health institution on monthly basis.

Training/Learning Methods • Illustrated lectures and group discussions • Role plays • Exercise • Demonstration • Brainstorming • Games Training Materials • Prevention of Excessive Bleeding at Home Births: Nepali Flipchart " 3/df ;'Ts]/L

u/fpFbf cTolws /Qm>fjsf] /f]syfd" (1 for each participant). • CB-MNC FCHV Distributor Register. • Excessive bleeding after childbirth Referral form. • Birth Registration form. • Death Registration form.


3

Course Duration 6 sessions in a 3-day sequence Suggested Course Composition • 25-30 FCHVs per batch, if TBA is present, will participate only on the first day. • 3 trainers who have received DTOT in CB-MNC - excessive bleeding after childbirth

prevention. • ANM/MCH as co-facilitator.

Facilitators Guide 1 - 4

COURSE SCHEDULE 3 days, 6 sessions

Day 1 Day 2 Day 3 10:00 a.m. – 2 p.m.

Opening Overview of course • Goals and objectives. • Setting norms/ground rules. • Participant's expectations. Precourse Questionnaire Brainstorming/Discussion: Experience sharing on maternal death and excessive bleeding after childbirth. Discussion/Brainstorming: Main causes of excessive bleeding after childbirth, how it can be prevented; why women should be attended by a skilled provider at birth; how a skilled provider can prevent excessive bleeding after childbirth.

10:00 a.m. – 2 p.m.

Review day’s scheduled activities

Illustrated lecture/game: Interpersonal and communication skills.

Demonstration/Role play/Discussion: Using effective interpersonal skills to talk to women and their families about excessive bleeding after childbirth. Discussion/Demonstrate: Identify and register pregnant women.

Exercise: Estimating month of childbirth.

Exercise: Using effective interpersonal skills to interview and register pregnant women.

Demonstration/Role play: Provide information to pregnant women on preventing excessive bleeding after childbirth using Matri Suraksha Chakki.

10:00 a.m. – 2:00 p.m.

Review day’s scheduled activities Demonstration/Role play: Provide information on excessive bleeding after childbirth and its prevention to anyone in the community. Discussion: Report information about registered women and their use of Matri Suraksha Chakki to midwife at health center. Role play/Assessment: Use effective interpersonal skills to register pregnant women, provide information on excessive bleeding after childbirth, how to prevent excessive bleeding after childbirth and how to use Matri Suraksha Chakki. Mid-course questionnaire

Lunch 2:00 p.m. – 2:45 p.m. Lunch 2:00 p.m. – 2:45 p.m. Lunch :00 p.m. – 2:45 p.m. 2:45 p.m. – 5:00 p.m.

Discussion: Information on Matri Suraksha Chakki. How Matri Suraksha Chakki is used to prevent excessive bleeding after childbirth at home birth.

Selection of Distributor FCHV

Discussion: Role of "Distributor FCHV" and "Non Distributor FCHV".

Discussion/Brainstorming: Role and responsibilities of FCHV in helping prevent excessive bleeding after childbirth at home birth through use of Matri Suraksha Chakki. Brainstorm/exercise

Review of day’s activities

2:45 p.m. – 5:00 p.m.

Demonstration/Role play: Provide information to pregnant women and her families on preventing excessive bleeding after childbirth using Matri Suraksha Chakki. Demonstration/Role play: Provide Matri Suraksha Chakki to women when they have completed 8th month of their pregnancy. Demonstration/Role play: Conduct follow up visits to women’s homes after birth and record information on their use of Matri Suraksha Chakki. Review of day’s activities

2:45 p.m. – 5:00 p.m.

Discussion: Course accomplishments relative to objectives. Review and Discuss: Mid Course Questionnaire. Discussion: How participants will begin their work as community volunteers. Closing


COURSE OUTLINE (3 days, 6 sessions)

Time Objective Teaching/Learning Methods Resources Needed

Day 1 (Total 330 minutes) AM 15 minutes

Opening/Introduction Objective: The participants will be able to: • Explain the course goals and objectives.

• Prepare newsprint listing course goal and participant learning objectives from the course syllabus (page no.1-2). Read aloud and explain.

• Describe how the course is organized, how the participants will be assessed at the end of the training.

Reference Manual, Flipchart, Newsprint, Markers and Masking tape.

15 minutes Objective: The participant will be able to: • Set the norms for how the participants and

trainers will work together during the course.

Brainstorming • Ask the participants what should be the ground rules. • List the responses in the newsprint and summarize. • Provide logistical information, such as tea and lunch

breaks, etc. • Allow time for participant questions and discussion.

Newsprint, Markers and Masking tape.

10 minutes Objective: The participants will be able to: Tell their expectations from the course.

Brainstorming with the participants. • Trainers should list the expectations of the participants in

the newsprint.

Newsprint, Markers and Masking tape.

20 minutes Pretest • Give pre-test to all the participants (See instruction on how to conduct the pre-test on page 1-18)

Small boxes, pink and white paper pieces, matrix

15 minutes - Tea Break


Time Objective Teaching/Learning Methods Resources Needed 30 minutes Objective: The participant will be able to:

• Discuss on their experiences and relate it to maternal death and excessive bleeding after childbirth in the communities.

Brainstorming: Ask the participants to share their experience starting with the following questions: • Where was your child born? • Did you face any difficulty during birth? • Have you heard/seen mothers dying due to heavy

bleeding after childbirth? Share the data of Nepal on excessive bleeding after childbirth and maternal mortality from Reference manual page no. 2-2.

Reference manual, Newsprint, Markers and Masking tape

45 minutes Objective: The participants will be able to explain: • Main causes of excessive bleeding after

childbirth. • Its prevention.

Brainstorming: • Ask participants how their communities recognize and

talk about excessive bleeding after childbirth. • Ask what are the words they use to describe or name

excessive bleeding after childbirth. • Explain the meaning and causes of excessive bleeding

after birth based on Reference manual (page no.2-2) • Explain how to recognize normal and excessive

bleeding using the flipchart - pages 1–3. • Explain the importance of using skilled birth attendant

for safe delivery and to prevent excessive bleeding after childbirth.

Reference manual, Flipchart, Newsprint, Markers and Masking tape


Time Objective Teaching/Learning methods Resources Needed 30 minutes Objective: The participants will be able to:

• Explain what a skilled provider can do to prevent excessive bleeding after childbirth.

Brainstorm Start the discussion putting the following questions: • How many women in your community give birth with a

skilled provider? • Why do women in your community use/not use a skilled

provider at birth? • What would you say to a woman and her family to

convince her to use a skilled provider? • Using the Flipchart page no. 4, explain the important role

of the skilled birth attendant while conducting delivery. Lecture Explain how the skilled birth attendant prevents excessive bleeding after childbirth using the notes developed from Reference manual page no. 2-4.

Reference manual, Flipchart and Models

30 minutes - Lunch


Time Objective Teaching/Learning methods Resources Needed

PM 90 minutes

Objective: The participant will be able to explain: • How Matri Suraksha Chakki is used to

prevent excessive bleeding after childbirth at home birth.

• Collect the current practice in the community how they manage excessive bleeding after childbirth when skilled birth attendant is not present.

• Explain when skilled birth attendant is not present

there is a medicine, which helps to prevent excessive bleeding after childbirth. Show and circulate the tablet/packet to the participants.

• Discuss the following issues using the Flipchart:

- Explain what is Matri Suraksha Chakki. - When to use? - How to use? - Common side effects and its management. - After taking Matri Suraksha Chhaki, if the

woman still bleeds, what should the family do? - While discussing about Matri Suraksha Chhaki

encourage the woman and family to use the key ring,.

Reference manual, Flipchart


Time Objective Teaching/Learning methods Resources Needed 30 minutes Objective: The participant will be able to:

• Select a Matri Suraksha Chakki "Distributor FCHV" from each ward.

• Explain that only one FCHV per ward can be selected to become "Distributor FCHV". Therefore FCHVs from each ward should form a group, discuss and select one FCHV who can become the distributor.

• Select one "Distributor FCHV through election process as per the following criteria: - She should have received basic training - She should be able to read and write. - She should be active. - She should be able to travel widely in their

respective ward. - Preferably working in maternal health (eg.

distribution of iron, postpartum Vitamin A and providing ANC information).

- Should not involve the FCHV who works as TTBA

• List out the names of the selected distributor FCHVs. • Explain the common roles and responsibilities of all

FCHVs. • Introduce the "Distributor FCHV" to the other

FCHVs of their respective wards. • Explain the specific roles and responsibilities of the

"Distributor FCHV" and "Non Distributor FCHV".

Reference manual, Newsprint, markers and Masking tape

30 minutes Objective: The participant will be able to: • Describe the roles and responsibilities of

the "Distributor FCHVs" in helping to prevent excessive bleeding after childbirth at home birth with the use of Matri Suraksha Chakki.

Brainstorming Ask the group to tell what are the roles and responsibilities of a "Distributor FCHVs". Question and answer • List down the answers given by the participants. • The trainer will reinforce the roles and

responsibilities of the "Distributor FCHVs".

Reference manual, Newsprint, Markers and Masking tape

15 minutes Review the day’s activities (Able to review days activities)

Trainer summarizes day’s activities, answers participants’ questions.

Newsprint, Markers and Masking tape



Day 2 (Total 235 minutes) AM 15 minutes

Objective: Review Previous day’s activities Warm up Exercise Trainer reviews the day’s activities

Newsprint, Markers and Masking tape

30 minutes Objective: Participant will be able to: • Tell about the interpersonal and

communication skills.

Brainstorming: Ask the group to say what are the different skills needed to communicate well with others. Illustrated Lecture on different communication skills: (Page no.1-21) Game: Ask participants to find a partner. Make the participants face each other. Each pair will be given a picture and an empty drawing paper and pencil. One participant will take the empty paper and the other will take the picture, which should not be shown to her partner. First round: the participant with the picture will describe the picture to her partner. The partner with the empty paper will have to draw what she understands. The person drawing will not be allowed to ask any questions. Once the participant finishes the drawing, the trainer will stick it on the wall. Second round: The participant with the picture will describe the picture to her partner. The partner with the empty paper will have to draw. This time they are allowed to ask question if she does not understand. Once the drawing is finish, the trainer will compare the two drawings. Using the drawings as an example, the trainer will explain to the participants the importance of communication and the skill needed for good communication.

Posters, Newsprint, Markers and Masking tape



• Identify pregnant women in the community.

• Record individual pregnant women in the FCHV form.

• Calculate the 8th month of the pregnancy. Note: • Provide information about CB-MNC

(Community Based Maternal and Neonatal Care) – Prevention of PPH at home birth.

• Assess the ANC visit during pregnancy • Encourage the woman to visit ANC.

Prepare newsprint to present how to identify pregnant women in the community. Lecture (20 minutes): Present how to identify and record pregnant women in the community based on the information of the Reference manual page no. 2-9 using prepared newsprint. Teach the participants to calculate the expected date of delivery based on the information in Reference manual page. No. 2-10. Teach the participants how to calculate 8th month of the pregnancy based on the information in Reference manual page no. 2-11. Exercise (10 minutes): Write different months on the white board or newsprint and ask participants to estimate the month of childbirth and the 8th month of pregnancy for each. Demonstrate (30 minutes): Trainer should clearly demonstrate the correct way to fill up the form. Then the trainer shows a correctly completed record form so that participants can compare their forms. The following should be well understood: • Teach the participants to calculate the expected date

of delivery • Teach the participants to calculate the 8th month of

pregnancy • Teach the participants to fill the register

Newsprint, Markers, Masking tape, FCHV registers and Reference Manual



130 minutes Objective: Participant will be able to: • Provide information on when and how to

use Matri Suraksha Chakki to prevent excessive bleeding at childbirth.

• Explain side effects of Matri Suraksha Chakki.

• Explain contraindication of Matri Suraksha Chakki use.

• Explain how to refer at the right time.

Demonstration (30 minutes): Trainer demonstrates how to provide information to a pregnant woman and her support persons using flipchart (Refer Chapter VI, page no. 2-15, for message) on the following points: • Excessive bleeding after childbirth. • How to identify excessive bleeding after childbirth. • How to use Matri Suraksha Chakki. Role-play using flipchart (100 minutes): Divide participants into groups of 3. Each group will perform a role play of a community volunteer interviewing and registering a pregnant woman and providing information on: • Excessive bleeding after childbirth. • How to identify excessive bleeding after childbirth. • How to use Matri Suraksha Chakki. • (One participant will be the woman, one will be her

support person, and one will be the community volunteer.

• Participants playing the role of the pregnant woman and support person will be given the roles they are to play by the trainer (see instructions in Role Play section 1, page no. 1-23).

• Participants will switch roles until each participant has played the role of the community volunteer.)

Trainer supervises and supports the groups to check content and answer any questions.

Reference manual, Flipchart, Newsprint, Markers and Masking tape

30 minutes - Lunch



PM) 60 minutes

Objective: The participant will be able to: • Calculate 8th month of pregnancy. • Provide Matri Suraksha Chakki to women

when they are in the 8th month of their pregnancy.

• Tell where to get the supply of Matri Suraksha Chakki.

• Tell how to store Matri Suraksha Chakki. • Tell how to save the used packet.

Demonstrate using flipchart (20 minutes): • How to provide Matri Suraksha Chakki to women

when they are in the 8th month of their pregnancy using the flipchart.

• How to store Matri Suraksha Chakki. • Ensure that all the information about Matri Suraksha

Chakki is understood by the woman and her family • Why to save the used packet. • Fill the form (Follow-up part in the form)

Role play (40 minutes): Divide participants into groups of 3. Each group will perform a role-play of a community volunteer visiting a woman in her 8th month of pregnancy. • (One participant will be the woman, one will be her

support person, and one will be the community volunteer.

• Participants playing the role of the pregnant woman and support person will be given the roles they are to play by the trainer (see instructions in Role Play section 2, page no. 1-23).

• Include the message of telling the woman to save the used package of Matri Suraksha Chakki


Trainers supervise and support the groups to check content and answer any questions.

Flipchart Matri Siraksha Chakki, FCHV form

15 minutes Summary of the day’s activities

Trainer summarizes day’s activities, answers participants’ questions.



DAY 3 (Total 330 minutes) AM (130 minutes) 15 minutes

Review day’s activities Warm up Exercise Review the day’s agenda

40 minutes Objective: The participant will be able to: • Conducts follow up visits to women after

birth. • Record information on their use of Matri

Suraksha Chakki. • Retrieve used/unused packages.

Demonstrate using Flipchart and CBMNC Form (10 minutes): • Follow up visit after birth. • Record information on use of Matri Suraksha

Chakki Role play: • Divide participants into groups of 3. Each group will

perform role play of conducting follow up visits after birth and recording information on use of Matri Suraksha Chakki, and retrieving used/unused Matri Suraksha Chakki packages.

• (One participant will be the woman, one will be the support person, and one will be the community volunteer.

• Participants playing the role of the pregnant woman and support person will be given the roles they are to play by the trainer (see instructions in Role Play section 3, Facilitators' Guide page no. 1-23).

• Trainers will supervise and support the groups to check content and answer any questions.

Reference manual, Flipchart, Form and Matri Siraksha Chakki



30 minutes Objective: Participants will be able to: • Reinforce information on excessive

bleeding after childbirth and its prevention by the use of Matri Suraksha Chakki, to anyone in the community.

Demonstration (10 minutes): • How to present content from the flipchart. Discussion: • Encourage participants to discuss their experience

giving presentations to community groups. Role play (20 minutes): Ask for 2 volunteers to present role-play on providing information to a community member. One participant will be the community member and one will be the community volunteer.

Flipchart

30 minutes Objective: The participant will be able to: • Report information about registered

women and their use of Matri Suraksha Chakki to the ANM/MCHW/supervisor at the health center.

Demonstrate: • How to record CB-MNC Register. • How to report effectively to the

ANM/MCHW/supervisor at the health center using the reporting form in the CB-MNC Register.

CB-MNC Register



• Demonstrate the whole process of providing information about excessive bleeding after childbirth, distribution of the Matri Suraksha Chakki and recording and reporting the use/unused of Matri Suraksha Chakki.

.

Role play: • Divide participants into groups of 3. Each group will

perform a role play of a community volunteer interviewing and registering a pregnant woman and providing information on excessive bleeding after childbirth, how to prevent it, and how to use Matri Suraksha Chakki and conducting follow up visits after birth.

• (One participant will be the woman, one will be her support person, and one will be the community volunteer.

• Participants playing the role of the pregnant woman and support person will be given the roles they are to play by the trainer (see instructions in Role Play section).


Trainers supervise and support groups to assess skills of each participant.

Flipchart, Matri Suraksha Chakki and CB-MNC Register


Time Objective Teaching/Learning methods Resources Needed 30 minutes Objective: Trainers will be able to:

• Assess participant’s knowledge. • Demonstrate and explain the method of marking the

answer sheet (ask them to tick mark the correct answer and cross mark the incorrect answer. For instruction see page no. 1-24).

• If any participant is unable to read and write Trainers should write the names of the participants before hand and read the questions and ask her to mark accordingly in the question paper.

• Distribute the mid course questionnaire to all the participants.

• Trainers will review and score questionnaires during lunch time and use results to guide discussion in the afternoon session.

• Trainers will ensure that all the participants have completed the answers.

Mid-course Questionnaire and Answer Sheet (one copy for each participant)

30 minutes - Lunch PM 60 minutes

Objective: Will review course content based on results of Mid Course Questionnaire.

Discussion: • Lead the discussion to elaborate on paying special

attention to those content areas in which the majority of participants did not do well.

• Ensure participants have understood all the information on excessive bleeding after childbirth.

• If the participants have scored less than 80%, plan for extra coaching and another session to assess the knowledge of the participants.

60 minutes Objective: Review how participants will begin their work as community volunteers to help prevent excessive bleeding after childbirth.

Discussion Participants will share what her role will be to prevent excessive bleeding after childbirth in the community.

Objective: To find out participants evaluation of the training.

Using the mode chart ask the participants to fill the mode chart. For detail information see page 1-30.

Mode chart, markers, masking tape

15 minutes - Closing


PRECOURSE QUESTIONNAIRE

Instruction Prepare 10 small boxes (each box stands for each question). Level the boxes according to the questionnaire (1 to 10). Give 10 white and 10 pink paper pieces to each participant. The trainer should read out the questions. After reading the question the trainer should explain to the participants that if the question is correct then they should choose the white paper and if incorrect then they should choose pink paper and put it in the box (which is leveled according to the question). Using the same technique for all the questions, ask the participants to use the colored pieces of paper as their answer. After finishing all the questions, collect all the boxes and mark the answer in the matrix to show the result of the precourse questionnaire to the participants.


PRECOURSE QUESTIONNAIRE

1. It is easy to know which woman will bleed too much after giving birth. ________

2. In Nepal one of the main cause of mothers death is excessive bleeding after childbirth. ________

3. Trained MCHW, ANM, Nurse or Doctor can prevent excessive bleeding after childbirth by giving oxytocin injection. ________

4. PPH can be prevented with the help of skilled birth attendant. ________

5. The community volunteer should give information about excessive bleeding after childbirth and how to prevent it only to the pregnant woman, and not allow her support persons or family to hear.

________

6. It is a dangerous sign if one cloth is deeply shocked with blood within half an hour after childbirth. ________

7. Heavy bleeding after childbirth is a normal process.

8. If the woman has heavy bleeding after childbirth, we need to wait and watch for sometime at home and then only take her to the hospital. ________

9. A sign of PPH is when the woman passes plenty of blood clots. ________

10. If placenta is not delivered completely, the remaining placenta will be expelled by itself. Therefore, it is not necessary to go the health facility for help.

________

Facilitators Guide 1 - 1 - 20

PRECOURSE QUESTIONNAIRE: INDIVIDUAL AND GROUP ASSESSMENT MATRIX

No. Of

Ques

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 Total

1

2

3

4

5

6

7

8

9

10


INSTRUCTION FOR COMMUNICATION GAME Before starting the game: Ask the participants to find a partner. Make the participants face each other. Each pair will be given a picture and 2 plain papers and pencil. One participant will take 2 plain papers and a pencil and the other will take the picture. Explain the participant not to show the picture to her partner.

First round: Ask the participant with the picture to describe the picture to her partner. The partner with the plain paper will have to draw what she understands. The person drawing will not be allowed to ask any questions. Once the participant finishes the drawing, the trainer will stick it on the wall. Second round: Ask the participant with the picture to describe the picture to her partner again. The partner with the plain paper will have to draw again. This time they are allowed to ask questions if she does not understand. Once the drawing is finish, the trainer will compare the two drawings. Using the drawings as an example the trainer will explain to the participants the importance of communication and the skill needed for good communication. Note: When comparing the two pictures the trainer should ask the participants what difference they found in the two pictures. Collect the responses given by the participants. Emphasis that when good Inter Personal communication skills (two way communications, interaction, asking questions, re-enforcing what others say etc) are used it is easier to make understand effectively.

Sample Picture


ROLE PLAY SCENARIOS Each role play exercise will be performed by groups of three participants. One participant will play the community volunteer, one participant will play the pregnant woman and one participant will play the support person. Participants will switch roles until each participant has played the community volunteer. Participants playing the pregnant woman and support person will be given the roles they are to play; the participant playing the community volunteer will not know the specific roles of the pregnant woman and support person in advance. This helps to ensure that the community volunteer applies new knowledge and skills learned during the course. As participants switch roles, they should be given their new roles. For each role play, trainer should write each role on a separate piece of paper. Trainer may either give participants the pieces of paper according to the roles they are playing or let participants draw roles from boxes labeled “pregnant woman” and “support person.” Before beginning role plays, give participants a few minutes to prepare for their roles. Encourage participants to draw on their past experiences as health volunteers when performing role plays.


Role Play 1: Registering Pregnant Women and Giving Information to Pregnant Woman and Support Persons Role for Pregnant Woman Role for Support Person Pregnant woman doesn’t want to hear about excessive bleeding after childbirth and Matri Suraksha Chakki

Support person wants to hear about Matri Suraksha Chakki.

Pregnant woman wants to hear about excessive bleeding after childbirth and Matri Suraksha Chakki.

Support person interrupts discussion, gives misinformation and rumors.

Woman wants to use Matri Suraksha Chakki.

Support person is TBA who is going to attend woman’s birth.

Role Play 2: Visiting the Pregnant Woman in the 8th Month of Pregnancy Role for Pregnant Woman Role for Support Person Woman is no longer pregnant.

None

Woman has moved.

None

Woman has changed her mind about using Matri Suraksha Chakki.

Support person has influenced woman to change her mind.

Woman still wants to use Matri Suraksha Chakki.

Support person still has misinformation and rumors.

Role Play 3 : Conducting Follow-up Visit After Birth Role for Pregnant Woman Role for Support Person Woman used Matri Suraksha Chakki correctly and had no problems.

Support person is TBA who attended woman’s birth.

Woman used Matri Suraksha Chakki correctly but continued to bleed.

Support person arranged for transportation to health facility.

Woman did not use Matri Suraksha Chakki.

Support person does not know why the woman did not use Matri Suraksha Chakki.

Woman has moved.

None


MID-COURSE QUESTIONNAIRE Instructions The trainer should give the mid-course questionnaire by reading the statements aloud to the participants. Give each participant a piece of paper. Each participant should write their name at the top of the paper and write the numbers 1 through 10 on the left side of the page. After the trainer reads each statement, participants will mark a '√' next to the number of the statement if they think it is “true” or a 'X' next to the number of the statement if they think it is false. Participants must answer correctly 8 statements. Trainers should discuss incorrect answers individually with each participant. Trainer should ask the participant general questions to determine whether she is weak in a specific topic or in the overall content of the course. Participants who do not answer correctly 8 statements will be given additional True/False statements (written by the trainer) until they have correctly answered 8 questions.


MID-COURSE QUESTIONNAIRE

1. It is easy to know which woman will bleed too much after giving birth. ________

2. In Nepal one of the main cause of mothers death is excessive bleeding after childbirth. ________

3. Trained MCHW, ANM, Nurse or Doctor can prevent excessive bleeding after childbirth by giving oxytocin injection. ________


________

5. It is a dangerous sign if one cloth is deeply shocked with blood within half an hour after childbirth. ________

6. FCHV can give Matri Suraksha Chhakki to the pregnant woman any time. ________

7.

Matri Suraksha Chhakki should be given immediately after delivery before delivery of placenta. Even if the placenta gets delivered quickly after the delivery of the baby even without taking the medicine, you should still give the medicine.

________

8. Shivering is one of the side effect of Matri Suraksha Chhakki. ________

9. Even after taking Matri Suraksha Chhakki, if there is heavy bleeding, the woman should be taken to the hospital. ________

10. If the woman could not take Matri Suraksha Chhakki after the delivery she can keep the medicine for next delivery or give it to her friend. ________

Facilitators Guide 1 - 1 - 26

MIDCOURSE QUESTIONNAIRE: INDIVIDUAL AND GROUP ASSESSMENT MATRIX

No. Of Ques

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Total

1

2

3

4

5

6

7

8

9

10


PRECOURSE QUESTIONNAIRE (ANSWER KEY)

1. It is easy to know which woman will bleed too much after giving birth. False

2. In Nepal one of the main cause of mothers death is excessive bleeding after childbirth. True

3. Trained MCHW, ANM, Nurse or Doctor can prevent excessive bleeding after childbirth by giving oxytocin injection. True


True

5. It is a dangerous sign if one cloth is deeply shocked with blood within half an hour after childbirth. False

6. FCHV can give Matri Suraksha Chhakki to the pregnant woman any time. True

7.


False

8. Shivering is one of the side effects of Matri Suraksha Chhakki. False

9. Even after taking Matri Suraksha Chhakki, if there is heavy bleeding, the woman should be taken to the hospital. True

10. If the woman could not take Matri Suraksha Chhakki after the delivery she can keep the medicine for next delivery or give it to her friend. False


MID-COURSE QUESTIONNAIRE (ANSWER KEY)

1. It is easy to know which woman will bleed too much after giving birth. False

2. In Nepal one of the main cause of mothers death is excessive bleeding after childbirth. True

3. Trained MCHW, ANM, Nurse or Doctor can prevent excessive bleeding after childbirth by giving oxytocin injection. True


False

5. It is a dangerous sign if one cloth is deeply shocked with blood within half an hour after childbirth. False

6. FCHV can give Matri Suraksha Chhakki to the pregnant woman any time. True

7.


True

8. Shivering is one of the side effects of Matri Suraksha Chhakki. True

9. Even after taking Matri Suraksha Chhakki, if there is heavy bleeding, the woman should be taken to the hospital. True

10. If the woman could not take Matri Suraksha Chhakki after the delivery she can keep the medicine for next delivery or give it to her friend. False


CHECKLIST FOR INTERPERSONAL COMMUNICATION SKILLS

FCHV being observed: ………………………………. Date: ……………………………….

BEHAVIOR BEING OBSERVED YES NO COMMENTS

1. Greet the woman 2. Introduce herself 3. Explain the purpose of the visit 4. Sit facing the woman (and support person) 5. Good eye-contact 6. Show an attentive expression 7. Relaxed and friendly 8. Voice of adequate volume 9. Talk in adequate speed 10. Responsive toward verbal and non verbal

behavior

11. Convey all necessary information 12. Answer all of the woman’s (and support

person) questions well

13. Interrupt / cut in mid sentence 14. Woman easily understand the explanation Description: Yes : if it is carried out No : if it is not carried out Note : if there is anything that the observer

needs to emphasize.

Conclusion/Recommendation: ………………………………………. ………………………………………. ……………………………………… Observer, ( ………………………)


INSTRUCTION FOR USING OF MODE CHART

Before leaving the classroom ask all the participants to mark in one of the pictures, which they find appropriate. If the participant found the training interesting, informative then mark and straight line under the picture 1. If the participant found the training satisfactory only, then mark straight line under the picture 2 and if the participant found the training not interesting, then mark straight line under the picture 3.

Sample picture

Picture 1: Good

Picture 2: Satisfactory

Picture 3: Not Good

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