facilitation skills for conducting international health ... · vitamin angels – facilitation...

Facilitation Skills for Conducting

International Health Courses

This manual has been developed by Vitamin Angels for use in developing facilitators andtrainers and is considered to be in the public domain. Any use of this manual should include anacknowledgment of Vitamin Angels.

Published in May of 2017.

Vitamin Angels

www.vitaminangels.org

Preface

Vitamin Angels is a leading partner for the alleviation of essential micronutrient deficiencyamong underserved and at-risk infants and young children. We mobilize and deploy privatesector resources to help at-risk populations—specifically pregnant women, new mothers, andchildren under five—gain access to lifesaving and life changing vitamins and minerals,especially vitamin A.

Vitamin Angels works to support “universal distribution” and “targeted distribution” of vitamin Ain countries defined by the World Health Organization (WHO) as experiencing moderate tosevere vitamin A deficiency. Vitamin Angels also supports preventive “mass drugadministration (MDA)” or “targeted distribution” of albendazole for deworming in countriesdefined by the WHO as being endemic for soil-transmitted helminths (STH).

This manual is designed for education and training personnel responsible for planning andconducting courses to prepare international healthcare workers to deliver vitamin Asupplementation and albendazole (for deworming) and other services. This manual providesinformation that is essential when preparing service providers to become course facilitators andskill development trainers, who are then able to train new service providers.

Vitamin Angels would like to acknowledge our use and adaptation of materials from Jhpiego, anaffiliate of Johns Hopkins University, for inclusion in this manual.

TABLE OF CONTENTS

Chapter Contents Page

1 Approach to Developing Service Providers 1-1

• Goal of service provider courses 1-3

• Mastery learning approach 1-3

• Features of effective service provider courses 1-4

• Responsibilities of facilitators, trainers and learners 1-7

• Selecting and developing facilitators and trainers 1-7

2 Vitamin Angels’ Service Provider Courses 2-1

• Features of the VAS+D eLearning course 2-2

• Features of the VAS+D skill development course 2-2

• Features of the VAS+D instructor-led course 2-3

• Features of cascade training 2-4

3 Delivering Course Presentations 3-1

• Using effective presentation skills 3-2

• Introducing a presentation 3-3

• Using questioning techniques 3-6

• Summarizing a presentation 3-8

• Presentation Skills: Self-Assessment Guide 3-10

4 Using Audiovisual Aids 4-1

• Reasons for using audiovisuals 4-2

• Using flipcharts 4-2

• Using a job aid 4-3

• Using a whiteboard 4-3

• Using video 4-4

5 Assessing Knowledge and Skills 5-1

• Administering a knowledge assessment 5-1

• Defining skill development and evaluation 5-2

• Using a checklist to facilitate skill development 5-3

• Using a checklist to evaluate skill performance 5-4


6 Developing Service Delivery Skills 6-1

• Skill development process 6-2

• Characteristics of an effective facilitator and coach 6-3

• Conducting an effective skill demonstration 6-4

• Coaching skill development 6-5

• Evaluating skill competency 6-8

• Demonstration and Coaching Skills: Self-Assessment Guide 6-11

7 Planning and Conducting a Service Provider Course 7-1

• General planning issues 7-2

• Selecting Learners 7-4

• Course materials 7-5

• The facilitator’s guide 7-5

• Classroom selection and arrangements 7-6

• Facilitator planning 7-7

• Dealing with attendance problems 7-8

• Presenting a course overview 7-9

• Presenting course sessions 7-10

• Evaluating the learners and the course 7-11

• Help and follow-up after the course 7-11

• Facilitator development and evaluation 7-14

• Facilitator’s Checklist for Course Preparation 7-15

• Action Plan 7-17

8 Planning and Conducting the VAS+D Skill Development Course 8-1

• Design of the skill development course 8-2

• Learner selection 8-3

• Required course materials 8-3

• Training site arrangements 8-4

• Trainer planning 8-5

• Conducting the skill development course 8-6

• Process for developing trainers 8-7


Appendix 1 How People Learn and Groups Develop 3

• How people learn 4

• Understanding group dynamics 8

Appendix 2 Facilitate Learning Activities 3

• Facilitating small group activities 4

• Facilitating the use of case studies 6

• Facilitating the use of role plays 8

• Facilitating brainstorming sessions 9

• Facilitating group discussions 10

• Sample 1 (Case Study) 13

• Sample 2 (Role Play) 14

Vitamin Angels – Facilitation Skills – Chapter 1 - 1

CHAPTER ONE

APPROACH TO DEVELOPING SERVICE PROVIDERS

Introduction

Healthcare service providers must be trained to international standards and best practices in orderto provide quality services. In this manual, we will use vitamin A supplementation with deworming(VAS+D) as the primary example for service provider training. The approach to planning andconducting VAS+D training can be applied to most other healthcare services.

Vitamin Angels conducts several types of education and training events and courses to strengthenprograms and develop service providers. Table 1.1 lists the types of events and courses, thoseparticipating, those responsible, and the result of each.

Table 1.1. Education and Training Events and Courses

Event orCourse

Those Participating Conducted By Result

Orientation Stakeholders, PotentialField Partners, HealthcareSupervisors, etc.

Vitamin Angels’Program Staff

Participants oriented to VitaminAngels’ approach toprogramming and training

VAS+DInstructor-LedCourse

Service providers who willprovide VAS+D to eligiblechildren

Vitamin Angel’sCourse Facilitators

Competent VAS+D serviceproviders

VAS+DeLearningCourse

Service providers who willprovide VAS+D to eligiblechildren

Self-study Completion of the knowledgecomponent of the VAS+Dcourse (and with practice canlead to competent serviceproviders)

VAS+D

SkillDevelopmentCourse

Service providers who willprovide VAS+D to eligiblechildren and are unable tocomplete the eLearningcourse

Vitamin AngelsCourse Facilitators orSkill DevelopmentTrainers

Competent VAS+D serviceproviders

FacilitationSkills Course

Competent serviceproviders

Vitamin Angels’Technical ServicesStaff

Qualified Course Facilitator

Training SkillsCourse

Competent serviceproviders

Vitamin Angels’Technical ServicesStaff

Qualified Skill DevelopmentTrainer

As shown in Table 1.1, the VAS+D instructor-led course requires about 8 hours to complete.This course includes a PowerPoint presentation (PPT), interactive content presentations, and aknowledge assessment. There are also skill demonstrations, skill practice, and competencyevaluations. This course is conducted by qualified course facilitators. The VAS+D instructor-ledcourse has been replaced by the eLearning course and the skill development course.


• The eLearning course, an electronic course that can be taken on a computer or tablet,covers the same content as the VAS+D instructor-led course and includes a knowledgeassessment. When followed by practice, this course can result in competent serviceproviders.

• The one-day skill development course is designed for those service providers unable tocomplete the eLearning course due to language, computer or other issues. The skilldevelopment course is conducted by qualified skill development trainers (refer toChapter 2 for more detailed information).

The focus of this chapter is the training approach used to develop service providers. We willalso describe the roles and responsibilities of course facilitators and skill development trainers.

Chapter Objective

After completing this chapter, you will be able to describe a mastery learning approach thatincorporates adult learning principles and features competency-based learning, coaching andhumanistic learning techniques.

Enabling Objectives: To achieve the chapter objective, you will:

• State the goal of service provider courses• Describe the mastery learning approach• Identify the key features of effective service provider courses• Identify the responsibilities of those attending and conducting courses• Describe how to select and develop facilitators and trainers

Each of these objectives will be covered in the pages that follow.


Goal of VAS+D Service Provider Courses

The goal of service provider courses is to assist health workers in learning to provide safe, highquality services to children and their caregivers through improved work performance. Learningdeals primarily with obtaining the knowledge, skills and attitudes needed to provide services andassumes an immediate application of the information and skills being learned. Effective coursesemphasize the application of knowledge and attitudes in the performance of skills.

Learning is defined as knowledge, skills or attitudes acquired by instruction or study. Learningoccurs during self-study, education courses, training courses, eLearning courses, workshops,seminars and in many other environments.

To be effective, course facilitators and skill development trainers must use appropriate learningmethods and strategies. The participatory, “hands-on” techniques emphasized in this manualare best reflected in this ancient proverb.

What I hear, I forget; What I see, I remember; What I do, I understand.

Mastery Learning Approach

The mastery learning approach used in service provider courses assumes that all learners canmaster (learn) the required knowledge, attitudes and skills if sufficient time is allowed andappropriate learning methods are used. The goal of mastery learning is that 100 percent of thosecompleting the course will “master” the required knowledge, skills and attitudes.

While some learners are able to acquire new knowledge or a new skill immediately, others mayrequire additional time or alternative learning methods before they are able to demonstratemastery. Not only do people vary in their abilities to absorb new information, individuals alsolearn best in different ways – through written, spoken or visual means. Mastery learning takesthese differences into account and uses a variety of learning methods.

The philosophy underlying the mastery learning approach is one of continual assessment oflearning. With this approach, it is essential that learners be informed of their progress in learningnew information and skills.

With the mastery learning approach, knowledge assessments (tests) are often administered aspart of the service provider course. In the VAS+D instructor-led course the knowledgeassessment is administered near the end of the course to assess each learner’s knowledge ofkey course content. The eLearning course also includes several mid-course learningassessments as well as a knowledge assessment at the completion of the course.


With the mastery learning approach, assessment of learning is:

• Competency-based, which means assessment is keyed to the course objectives andemphasizes acquiring the essential knowledge, attitudes and skills needed to perform ajob, not simply acquiring new knowledge.

• Dynamic, because it enables facilitators and trainers to provide learners with continualfeedback on how successful they are in meeting the course objectives and, whenappropriate, to adapt the course to meet learning needs.

• Less stressful, because from the outset, learners, both individually and as a group, knowwhat they are expected to learn and where to find the information; they also have ampleopportunity for discussion with the facilitator or trainer.

Features of Effective Service Provider Courses

Effective service provider courses are designed and conducted according to adult learningprinciples – learning is participatory, relevant and practical – and:

• Uses behavior modeling

• Is competency-based

• Incorporates humanistic learning techniques

Each of these features is described briefly in this section.

Adult Learning Principles – The learning techniques and approaches discussed throughout thismanual are based on the following eight principles:

1. Learning is most productive when learners are ready to learn. Although motivation isinternal, it is up to the facilitator or trainer to create a climate that will nurture motivationin learners.

2. Learning is more effective when it builds on what the learners already know or haveexperienced.

3. Learning is more effective when learners are aware of what they need to learn.

4. Learning is made easier by using a variety of learning methods and techniques.

5. Opportunities for practicing skills by starting in controlled or simulated situations (e.g.,through small-group activities) are essential for skill acquisition and for development ofskill competency.

6. Repetition is necessary for learners to become competent or proficient in a skill.

7. The more realistic the learning situation, the more effective the learning.

8. To be effective, feedback should be immediate, positive and nonjudgmental.


Behavior Modeling – Social learning theory states that when conditions are ideal, a personlearns most rapidly and effectively from watching someone else perform (model) a skill or activity.For modeling to be successful, the facilitator or trainer must clearly demonstrate service deliveryso that learners have a clear picture of the performance expected of them.

Learning to perform any skill takes place in three stages (Table 1-2). In the first stage, skillacquisition, the learner sees others perform the skill (actual demonstration or video) andacquires a mental picture of the required steps. Once the mental image is acquired, the learnerattempts to perform the skill, usually with supervision. Next, the learner practices until skillcompetency is achieved and she or he feels confident performing the skill. The final stage, skillproficiency, only occurs with repeated practice over time.

Table 1-2. Levels of Performance

Skill Acquisition Knows the steps and their sequence to perform the required skill butneeds assistance

Skill Competency Knows the steps and their sequence and can perform the required skill

Skill Proficiency Knows the steps and their sequence and efficiently performs therequired skill

Competency-based learning (CBL) is distinctly different from traditional educational processes.Competency-based learning is learning by doing. It focuses on the specific knowledge, attitudesand skills needed to carry out a procedure or activity. How the learner performs (i.e., acombination of knowledge, attitudes and, most important, skills) is emphasized rather than justwhat information the learner has acquired.

Moreover, CBL requires that the facilitator or trainer encourage learning rather than serve in themore traditional role of lecturer. Competency in the new skill or activity is assessed objectivelyby evaluating overall performance.

While CBL traditionally has been used for courses, elements of this approach are also applicableto education settings (e.g., nursing school, midwifery school) as well. Finally, CBL has a soundscientific basis. As shown in Table 1-3, a person’s ability to recall essential information isincreased when the material is learned through participatory methods, rather than through morepassive methods such as listening to a lecture or obtaining new information through reading.

Table 1-3. Learning Recall Related to Type of Presentation

Type of Presentation Percentage of Material Recalled

After 3 Hours After 3 days

Verbal (one-way) lecture 25% 10-20%

Written (reading) 72% 10%

Visual and verbal (illustrated lecture) 80% 65%

Participatory (role plays, case studies,practice)

90% 70%

Adapted from: Dale 1969.


For CBL to occur, the skill or activity to be taught must first be broken down into its essentialsteps. Each step is then analyzed to determine the most efficient and safe way to perform andlearn it. This process is called standardization. Once a procedure such as VAS+D servicedelivery has been standardized, then skill development and assessment instruments(performance checklists) can be designed. These checklists make learning the necessary stepsor tasks easier and evaluating the learner’s performance more objective.

Vitamin Angels approach to service delivery is based on a performance checklist thatcontains the 39 essential steps to provide vitamin A supplementation and deworming. Thereis also a visual checklist that contains images of the 39 steps and is used as a job aid duringservice delivery. These checklists are discussed in more detail in other chapters.

An essential component of CBL is coaching, which uses positive feedback, active listening,questioning and problem-solving skills to encourage a positive learning climate. Unfortunately,the teaching model with which most health professionals are familiar is the classroom instructorlecturing to a group of students who anxiously take notes so that they can pass a writtenexamination. This lecture-based approach to teaching, used by a skilled facilitator or trainer, canbe effective in providing basic knowledge. It is, however, a very poor way of developing servicedelivery skills.

What is needed is a learning approach that is different from traditional classroom teaching.Coaching has been used successfully for technical training in business and industry for manyyears. To use coaching in VAS+D courses, the facilitator or trainer should first demonstrate theservice delivery steps during a role play. Once VAS+D service delivery has been demonstratedand discussed, the facilitator or trainer then observes and interacts with the learners to provideguidance in learning the skill, monitor progress and help the learners overcome problems.

The coaching process ensures that the learner receives immediate feedback regardingperformance:

• Before practice – The facilitator or trainer demonstrates VAS+D service delivery usingthe visual checklist.

• During practice – The facilitator or trainer observes and provides feedback to the learneras he or she provides VAS+D as outlined in the visual and performance checklists.

• After practice – This feedback session should take place immediately after practice.Using the performance checklist, the facilitator or trainer discusses the strengths of thelearner’s performance and also offers specific suggestions for improvement.

When CBL is integrated with adult learning principles and is based on behavior modeling, theresult is a powerful and extremely effective method for developing learner skills.

Humanistic Learning Techniques – The use of more humane (humanistic) techniques alsocontributes to better service delivery courses. A major component of humanistic learning is theuse of role plays or small-group practice, which allow the learners to practice service deliveryand develop skill competency in a safe environment.


The learner should demonstrate the required skills using a simulated child as well as appropriatecaregiver or client interactions several times during small-group practice and demonstratecompetence before providing VAS+D to a real child. The number of times a learner needs topractice VAS+D delivery to reach competency will vary depending on the individual’sbackground and experience.

Only after a learner has demonstrated skill competency during training should the learner havetheir first contacts with children and caregivers.

Responsibilities of the Facilitators, Trainers and Learners

In competency-based learning, the responsibility for meeting learning objectives is shared bythose conducting the course and the learners. The goal is to help each learner demonstratecompetency in performing service delivery, not just earn a high grade on a test of knowledge. Ifa learner does not demonstrate competency, the facilitator or trainer should not attribute failuresimply to the learner’s lack of ability, but should look for ways to improve learning methods orprovide additional practice for the learner.

The role of the facilitator and trainer is to manage the learning process. Their function is to guidelearners toward the discovery of new knowledge and the acquisition of new or improved skills.They also seek to influence learner attitudes by serving as a role model. For example, thefacilitator and trainer should always demonstrate the skill completely and accurately – poorperformance is never acceptable.

Learners are actively involved in the learning process, and are encouraged to contribute whatthey know about the topic being discussed. The knowledge that learners bring to the course isessential to the total learning process. The success of this approach is based on the willingnessof learners to take an active part in the course and to share their experiences and knowledgewith other group members.

Selecting and Developing Facilitators and Trainers

Perhaps the most crucial decision in designing a service delivery course is the selection of thefacilitators and trainers. It has often been assumed that anyone with strong academic credentialsand good healthcare skills can be a competent course facilitator or trainer, but experience inmany parts of the world has shown that performing and teaching healthcare skills are two verydifferent things.

In selecting potential facilitators and skill development trainers for the VAS+D course, thefollowing criteria should be considered:

• Demonstrated proficiency. The individual must first be proficient performing VAS+Dservice delivery skills.

• Interest in conducting VAS+D courses. A health professional who is genuinelyinterested in conducting courses will be more likely to take the time necessary to learnand practice the required facilitation and coaching skills.

• Humility. A good facilitator or trainer is able to admit when she or he makes mistakes.


The process for becoming a course facilitator or skill development trainer includes the followingsteps:

• First, the individual must acquire the required service delivery skills (i.e., be competent).Over a period of time the potential facilitator or trainer must become proficientdemonstrating VAS+D service delivery skills.

• After becoming proficient at performing the required technical skills, the individual whowants to become a facilitator will attend a facilitation skills course. The individual wantingto become a skill development trainer will attend a training skills course. Both coursesare based on the content in this manual.

• Following completion of the facilitation or training skills course, the new facilitator ortrainer will conduct one or more courses for service providers with an experiencedfacilitator or trainer until she or he is able to competently (and ideally proficiently) conductservice provider courses independently.

The specific steps to become a qualified course facilitator or skill development trainer includethe following:

• Complete the VAS+D eLearning or skill development course and demonstrate skillcompetency. Continue to practice to become proficient demonstrating VAS+D servicedelivery skills.

• Complete the facilitation or training skills course.

• Lead at least one and up to three (or more if needed) VAS+D instructor-led (for facilitators)or skill development courses (for trainers) and be observed and found competent atleading courses by a Technical Services Consultant.

• Submit a video recording of at least five minutes of a course presentation (coursefacilitators only).

• Submit a video recording showing a proficient demonstration of VAS+D service deliveryusing the visual checklist.

• Submit a video showing a competency evaluation of a learner including the use ofsandwich feedback and determination of competency.

• Complete a final interview with Vitamin Angels’ Technical Services staff.

Summary

Developing facilitation and training skills will assist new facilitators and trainers when conductingservice provider courses. When mastery learning that is based on adult learning principles andbehavior modeling is integrated with competency-based learning, the result is a powerful andextremely effective method for conducting courses. And when humanistic learning techniquesand other learning methods are incorporated, course time and costs can be reduced.


The goal of a service provider course is to help healthcare workers and volunteers, who throughthe process of learning to provide safe, high quality services, become competent serviceproviders. The responsibility for achieving the learning objectives is shared by the facilitator,trainer and each learner. If a learner does not meet the course objectives, the facilitator or trainershould look for additional ways to assist the learner and improve learning methods.

Finally, not every proficient service provider can become a course facilitator or trainer. Therefore,the criteria for selecting potential candidates should include humility and a sincere interest inconducting courses, in addition to proficiency in delivery of services.


CHAPTER TWO

VITAMIN ANGELS’ SERVICE PROVIDER COURSES

Introduction

Vitamin Angels (VA) is committed to working with field partners (FP) to prepare them to givevitamin A supplementation and deworming together (VAS+D) to children 6-59 months (e.g.,preschool-age or young children). Our vision is that 100% of those who deliver VAS+D will betrained according to international best practices. In 2016 we developed a computer-basedeLearning course that service providers can take online or offline using a flash drive (USB). Thiscourse may be taken online or using the same USB on any computer at a service provider’splace of work, at home, or at a computer lab. It typically takes 2-4 hours to complete and isaccessible to any service provider who can read the languages in which the course is available.The VAS+D eLearning course provides learners with step-by-step instructions of standardizedVAS and deworming entrance counseling, eligibility criteria, service delivery using infectionprevention practices, and exit counseling. It includes digital access to VA training materials andshows how to use the VAS+D visual checklist. The course also includes a session that explainshow to coach others and encourages the learner to practice in order to reach skill competency.

While the eLearning course alone may be sufficient for some field partners, VA recognizes thatthere are challenges to distributing the eLearning course. One challenge is that some serviceproviders may not have access to a computer or be able to read any of the languages availablefor the course. In this case, VA would consider conducting a Skill Development Course for thisfield partner. Another challenge is if a field partner has a large number of service providers andeLearning alone cannot reach them all. In this situation, Vitamin Angels can provide training to atop level of service providers and then assist a large field partner with the design of a cascadetraining system, including eLearning and instructor-led courses, in order to reach all of theirproviders.

In this chapter, you will learn about the eLearning course as well as the types of instructor-ledcourses and the implications for cascade training.

Chapter Objective

After completing this chapter, you will be able to identify the key features of Vitamin Angels’VAS+D instructor-led course, eLearning course, skill development course, and how these coursesare used as part of cascade training.


• Identify key features of the VAS+D eLearning course• Identify key features of the VAS+D skill development course• Identify key features of the VAS+D instructor-led course• Identify key features of cascade training



VAS+D eLearning Course

The VAS+D eLearning course is available through the Vitamin Angels’ website and on a USBflash drive (or pen drive) so that users can register and complete the entire course either onlineor offline. For those who are taking the course offline, after completing the course they mustconnect to the Internet to upload their information to the learning management system (LMS)and then print their completion receipt.

This eLearning course focuses on the delivery of VAS+D services to children 6-59 months of ageand includes three main components:

1. Knowledge acquisition: Those taking the eLearning course will use a computer to firstlearn the basics of giving VAS+D to young children, and then complete a knowledgeassessment at the end of the course. Upon successful completion of the knowledgeacquisition part of the course, they will be able to print a “completion” certificate.

2. Skill practice and competency evaluation: Learners will watch a video of VAS+D beingdelivered, learn the steps to provide VAS+D as shown in the visual checklist, and areinstructed to practice these steps so that they can become competent in providingVAS+D to young children. After practicing the skill, learners can then be evaluated forcompetency in delivering VAS+D and receive a competency certificate. In order to receivea “competency” certificate, learners must demonstrate that they are able to perform thesteps required to administer VAS+D. This demonstration of skill competency may bedone either by uploading a video online or through an in-person demonstration for aqualified Vitamin Angels facilitator or skill development trainer.

3. Coaching skills: Learners are taught how to coach others in their organization to deliverVAS+D.

VAS+D Skill Development Course

The VAS+D skill development course requires about 4-6 hours and focuses on skill practice andcompetency evaluation. This course is conducted for service providers who are unable to useeLearning. There may be situations where the skill development course is used as part of acascade training system when eLearning is not applicable (see cascade training section later inthis chapter).

This course is conducted by qualified course facilitators or skill development trainers. Thenumber of facilitators or trainers must be sufficient to allow all of the learners to practice and(when time permits) be evaluated for competency.

A standardized course schedule and outline is available to support the facilitators and trainersas they plan and conduct a successful course. Chapter 8 will focus on how to plan and conductthe VAS+D skill development course.


VAS+D Instructor-led Course

The VAS+D instructor-led course (ILC) is an in-person course lasting about 8 hours over oneday. As with the VAS+D eLearning course, those completing the instructor-led course will alsocover three main areas:

1. Knowledge acquisition: Course participants learn the basics of giving VAS+D to youngchildren, and complete a brief knowledge assessment.

2. Skill practice and competency evaluation: Learners watch a demonstration of VAS+Dbeing delivered, learn the steps to provide VAS+D as shown in the visual checklist, andpractice these steps so that they can become competent in providing VAS+D to youngchildren. After skill practice, learners are evaluated and can receive a competencycertificate.

3. Coaching skills: Learners are taught how to coach others in their organization to deliverVAS+D, and are provided feedback as they learn to coach others.

There are a number of advantages of the ILC:

• Qualified course facilitators conduct the course ensuring that all learners are able tocompetently provide VAS+D services.

• Learners are able to interact with the course facilitators to develop their skills, addressquestions, and to discuss implementation of services.

• Learners are able to interact with other service providers to discuss challenges and sharesuccess stories.

There are several limitations of the ILC:

• Requires learners to travel and attend a day-long course. This means being away fromtheir jobs and service delivery sites.

• Requires a venue (typically a hotel) in addition to the costs of a meeting room, hotel roomsfor learners and facilitators, travel costs, meals, breaks, etc.

• Requires the use of presentation technology (e.g., computer, projector, screen, flipchart,etc.).

The ILC typically includes 12-16 learners. Training this number in each course makes itchallenging to train large numbers of service providers.

The VAS+D instructor-led course (ILC) is very effective in developing competent VAS+D serviceproviders. Vitamin Angels may periodically need to conduct the ILC for those field partners withlimited access to the eLearning course, to support the development of course facilitators andskill development trainers, and to train the top-level facilitators or trainers in a cascade trainingsystem.


Because the VAS+D instructor-led course includes a knowledge component and a skilldevelopment component, it can be “split” to create two separate, complementary courses:

1. The knowledge component becomes the VAS+D eLearning course. The eLearningcourse also includes information about coaching.

2. The skill development component becomes the VAS+D skill development course.Coaching is demonstrated during the skill development course.

Cascade Training

Vitamin Angels conducts VAS+D courses to help field partners ensure that their service providersare providing services to young children according to international standards and best practices.

When a large field partner has many service providers (e.g., 50-100 or more) and/or too manyservice delivery distribution sites for the VAS+D skill development course to be feasible, acascade training approach is used. Cascade is defined as a process whereby something,typically information or knowledge, is successively passed on.

Cascade training involves training a small group of people who then pass on what they havelearned and train others in their organization. For example, the 2 people that are trained in theVAS+D skill development course could easily train 10-20 other service providers in theirorganization. However, these 2 people might find it challenging to coach and train 100, 500 or1,000 other service providers by themselves. By training others, who then train others, who thentrain others etc., all of the service providers in an organization can be trained. Cascade trainingmay also be used when a field partner has several “layers” of service delivery (e.g., state, county,city or hospital, clinic, community center, etc.).

Vitamin Angels recommends that eLearning combined with the skill development course be usedto develop service provider skills at successive cascade levels. Depending on the number ofservice providers to be trained, the skill development course may last 4-6 hours and can beconducted with or without presentation technology.

Figure 1 at the end of this chapter shows the basic steps in the design and implementation of acascade training system. There are many questions in addition to the ones presented in thediagram. Keep in mind that the implementation of cascade training is the responsibility of thefield partner and the extent of Vitamin Angels’ involvement is the decision of the field partner,and dependent on VA’s time and resource availability.

Ideally, Vitamin Angels will help facilitate the design and development of the field partner’scascade training system in addition to conducting the Level 1 training (see Figure 1). Trainingconducted at all subsequent levels is the responsibility of the field partner. One of the primarychallenges of cascade training is determining who will conduct the skill development course ateach level. Also, there is the logistical challenge of developing skill development trainers at eachlevel.


If a field partner is large enough to warrant using cascade training, more information can becollected to determine how the cascade system should be designed and implemented. Thisinformation will show the number of service delivery sites, the number of service providers,whether or not field partners have staff who have training responsibilities, etc.

Using the information and discussions during meetings (e.g., face-to-face design meetings,conference calls, video conferences), Vitamin Angels will work with the field partner to developa cascade training implementation plan. This plan will describe the roles and responsibilities ofthe field partner and Vitamin Angels in order to ensure that all VAS+D service providers have thetraining they need to be competent.

For field partners who have staff who are dedicated trainers, Vitamin Angels might conduct oneor more VAS+D instructor-led courses for these trainers. An alternative would be to use theeLearning course (including the skill development course) for these trainers. The decision as towhich approach would be used will depend on the field partner as well as time and resourcesrequired. Details on meeting the training needs of each field partner would be described in thecascade training implementation plan.

For field partners who do not have dedicated trainers, Vitamin Angels will work with them toidentify those who may be able to function as skill development trainers (e.g., supervisors, qualitycontrol or monitoring personnel). Vitamin Angels might conduct either an ILC or the eLearningand skill development courses for these trainers. The decision as to which approach would beused will depend on the number of children reached and the number of service providers, aswell as time and resources required. Details on meeting the training needs of each field partnerwould be described in the cascade training implementation plan.

Cascade: With eLearning

There are two options for supporting a field partner’s cascade training using eLearning:

• Option 1: Field Partner plans and implements their own cascade (small or mid-sizeorganizations): Vitamin Angels provides the eLearning course on USB drives and the fieldpartner designs and implements their own cascade training. For organizations with onlya few service providers, it should be fairly easy to cascade training within theirorganization to ensure that all service providers are competent in delivering VAS+D. Fororganizations with many service providers, the field partner is likely to encounter manychallenges with the design and implementation of cascade training.

• Option 2: Vitamin Angels assists field partner to plan cascade (large organizations):Especially for large organizations, Vitamin Angels provides the eLearning course on USBdrives and works with the field partner to design a cascade training system for theirorganization. Vitamin Angels would assist with training the Level 1 trainers and wouldthen observe them conducting their first skill development course for Level 2 people.While this approach requires initial work by the field partner to assist in designing thecascade process for their organization, it is much more likely to result in ensuring that allservice providers in their organization are trained to provide quality services.


Cascade: Without eLearning

There may be some field partners who will need to implement cascade training without eLearning(e.g. health workers or volunteers without computers or the required computer literacy skills; noeLearning available in their language).

In these situations, a one-day skill development course can be conducted with an additionalfocus on the information in the VAS+D fact sheets. Covering the information in the fact sheetswill be the knowledge part of the course.

There are two basic options for supporting a field partner’s implementation of cascade trainingwithout eLearning:

• Option 1: Small or mid-size organizations: Vitamin Angels can train the Level 1 trainersfor the field partner. After receiving training from Vitamin Angels, it should be fairly easyfor organizations with only a few service providers to cascade training within theirorganization to ensure that all service providers are competent in delivering VAS+D. Fororganizations with many service providers, the field partner is likely to encounter manychallenges with the design and implementation of cascade training.

• Option 2: Large organizations: Vitamin Angels can assist with the design anddevelopment of the field partner’s cascade training approach. Vitamin Angels can thentrain the Level 1 trainers and would then observe them conducting their first skilldevelopment course for Level 2 people. While this approach requires initial work by thefield partner to assist in designing the cascade process for their organization, it is muchmore likely to result in ensuring that all service providers in their organization are trainedto provide quality services.

Summary

The availability of eLearning will help Vitamin Angels’ field partners to ensure all of their serviceproviders are trained to competently provide vitamin A supplementation and deworming toyoung children. The use of eLearning will also allow large field partners to design, develop, andimplement cascade training to ensure all of their service providers are competent.

Vitamin Angels is confident that through the eLearning, skill development, and instructor-ledcourses along with cascade training, we can help at-risk populations of children under five gainaccess to lifesaving and life changing vitamin A and deworming, that is delivered according tointernational standards and best practices.


Figure 1: Sample Cascade Training Implementation Process

ExampleCascade Training Design Meetings• How many children are served?• How many service delivery sites?• Where are the service delivery

sites located?• How many service providers?• Training capability?• Etc.Results in a cascade trainingimplementation plan

Level 1 Training (Field Partner Level)• Who is available to conduct

training?• Who will they be training?• eLearning with skill development

course?• Be observed as they conduct their

first VAS+D skill developmentcourse

Level 3 Training (and subsequentlevels if needed)• Conducted by Level 1 or 2

trainers?• Who will they be training? Are

these service providers or arethere multiple levels?

• Where will they be conductingskill development courses?

Level 2 Training• Conducted by Level 1 trainers• Who will they be training? Are

these service providers or arethere multiple levels?

• Where will they be conductingskill development courses?

Level 1 Training

10 Regional Staff Attend VAS+D Course(10 people are trained at Level 1)

Level 2 Training

10 Regional Staff train the supervisor/medicalofficer in each of the 10 clinics in their region

(100 people are trained at Level 2)

Level 3 Training

100 Clinic Staff each train 10 serviceproviders in their clinics

(1,000 people are trained at Level 3)

Design meeting with VA and Field Partner


CHAPTER THREE

DELIVERING COURSE PRESENTATIONS

Introduction

The learning environment has a tremendous impact on the quality of the learning experience. Apositive learning setting maximizes the effectiveness of various learning methods, and helpslearners to achieve the course objectives. Delivering interactive course presentations helps tocreate a positive learning setting.

Good planning, before the course begins, is necessary to create a positive learning environment.Because the facilitator sets the tone for the course, how the facilitator delivers information isthe key to establishing and maintaining a positive learning environment during the course. In anycourse, how something is said may be just as important as what is said.

Chapter Objective

After completing this chapter, you will be able to plan and deliver interactive course presentations.


• Use effective presentation skills• Introduce a presentation• Use questioning techniques• Summarize a presentation


Note: Read the content in Appendix 1 and Appendix 2 to provide important backgroundinformation that will assist you when planning and delivering interactive presentations.


Using Effective Presentation Skills

There are a number of general presentation skills you can use to make a course session moreeffective. These techniques can be used with several different types of presentations (e.g.,content presentation, discussion, skill demonstration). The skilled facilitator uses a variety oftechniques to involve learners, maintain interest, and avoid a repetitive presentation style. Somecommon techniques are listed below.

• Follow a plan and use notes. Your notes include the learning objectives, presentationintroduction, questions, activities, audiovisual reminders, and the presentation summary.Your presentation slides serve as your notes for the content you are covering. You canalso add notes to pages of the reference manual or to copies of the presentation slides.

• Communicate in a way that is easy to understand. Many learners will be unfamiliarwith the terminology of a new subject. The facilitator should use familiar words andexpressions, explain new language, and attempt to connect with the learners during thepresentation.

• Maintain eye contact with learners. Use eye contact to “read” faces. This is an excellenttechnique for establishing rapport and getting feedback on the learners’ understanding ofthe content.

• Project your voice so that those in the back of the room can hear clearly. Vary volume,voice pitch, tone, and inflection to maintain learners’ attention. Avoid using a monotonevoice, which is guaranteed to put learners to sleep!

• Avoid the use of repetitive words, phrases, or gestures that may become distractingwith extended use.

Examples:“OK, now....”“Is that clear?”“Do you see what I’m saying?”Hands in pockets, pacing, or rocking on heels

• Display enthusiasm about the topic and its importance. Smile, move with energy, andinteract with learners. The facilitator’s enthusiasm and excitement are contagious anddirectly affect the enthusiasm of the learners.

• Move around the room. Moving around the room helps ensure that the facilitator is closeto each learner at some time during the session. Learners are encouraged to interact whenthe facilitator moves toward them and maintains eye contact.

• Use appropriate audiovisual aids (e.g., slides, flipcharts, and real objects) during thepresentation.

• Be sure to ask both simple and more challenging questions.


• Provide positive feedback to learners during the presentation.

Examples:“Very good point, Dorothy!”“Thanks for sharing that story.”“Lunah has made an excellent comparison!”

• Use learners’ names as often as possible. This will help to create a positive learningsetting and keep the learners focused on the presenter. You can use names duringquestioning, when providing positive feedback, and when referring to commentspreviously made by learners.

• Display a positive use of humor related to the topic (e.g., cartoons on slide or flipchart,humorous stories).

• Provide smooth transitions between topics. Within a given presentation, a number ofseparate yet related topics may be discussed. When shifts between topics are abrupt,learners may become confused and lose sight of how the different topics fit together intoa bigger picture. The facilitator must ensure that the transition from one topic to the nexttopic is smooth. This can be accomplished by:

o A brief summaryo A series of questionso Relating content to practice or using an application exercise (case study, role play,

etc.) before moving on to the next topic

• Be an effective role model. The facilitator should be a positive role model in dress,appearance, enthusiasm for the course, being on time, and finishing at the scheduledtime.

Introducing a Presentation

The first few minutes of any presentation are critical. Learners may have their minds on othermatters, be unclear as to what the session is about, or have little interest in the topic. Theintroduction should:

• Capture the interest of the entire group and prepare learners for the information to follow

• Make learners aware of the facilitator’s expectations

• Help foster a positive learning environment

Using a Variety of Introductory Techniques – The facilitator can select from a number oftechniques to provide variety and ensure that learners do not become bored. Many introductorytechniques are available, including:

• Reviewing the objectives. Introducing the topic by a simple restatement of the objectiveskeeps the learners aware of what is expected of them.


Example:“We will now learn how to cut open a vitamin A capsule. Our objective is to cut thecapsule following the recommended procedure. Any questions before we begin?”

• Asking a series of questions about the topic. The effective facilitator will recognizewhen learners have prior knowledge concerning the course content and encourage theircontributions. The facilitator can ask a few key questions, allow learners to respond,discuss answers and comments, and then move into the body of the presentation.

Examples:“Can someone give us an example of an important infection prevention practice?”

“Jose, this is a slide showing the set up for vitamin A and deworming distributionin a local community. Can you identify any potential problems with client flow?”

• Relating the topic to previously covered content. When a number of presentations arerequired to cover one subject, relate each presentation to previously covered content. Thishelps the learners understand the continuity of the presentations and how each relates tothe overall topic. Where possible, link topics so that the summary of one presentation canintroduce the next.

Example:“In our last presentation we were discussing when to give vitamin A supplements.Mary had asked about distributing vitamin A during child health days. In this nextpresentation, we will discuss distribution opportunities and answer Mary’squestion.”

• Sharing a personal experience. There are times when the facilitator can share apersonal experience in order to create interest, emphasize a point or make the topic morejob-related. Learners enjoy hearing these stories so long as they relate to the topic andare used only when appropriate.

Example:“We will now practice the steps in the performance and visual checklists. Beforewe begin, I would like to share with you my first experience meeting with a motherand her new baby. The mother was....”

• Relating the topic to real life experiences. Many course topics can be related tosituations most learners have experienced. This technique not only catches the learner’sattention but also facilitates learning because people learn best by anchoring newinformation to known material.

Example:“Our next step is to greet the client. Have you ever had a client who was verynervous and anxious? What did she say or do? How did it affect you? Yasmina,tell us how you would feel if you were the client.”

• Using a small-group activity. Case studies, problem solving activities, and small-grouppractice focus attention on specific situations related to the topic. Working in small groupsgenerally increases interest in the topic.


Example:“Our next topic is the side effects associated vitamin A. Please read the situationon the flipchart and answer the two questions. We will discuss your responseswhen everyone has finished.”

• Using a video or other audiovisual aid. Use of appropriate audiovisuals can bestimulating and generate interest in a topic.

Example:“Now that we have reviewed the steps in the VAS+D performance and visualchecklists, I would like to show you a video of VAS+D delivery. Please make notesof things you think the service provider does well and areas where she couldimprove her performance.”

• Giving a demonstration. Beginning a presentation with a brief demonstration (e.g., howto greet a caregiver with a baby) will generally increase learner interest.

• Using a content expert. Speakers with a specific area of expertise often add credibilityto a presentation. The facilitator must be sure that the guest speaker is capable of makingan effective presentation. When this is the case and time is available, the content expertcan motivate the learners’ interest in the topic.

Example:“To begin this VAS+D course I have asked Sister Mary from the local clinic to sharewith you her experiences with administering albendazole for deworming. Pleasejoin me in welcoming Sister Mary.”

• Using a game, role play or simulation. Games, role plays, and simulations generatetremendous interest through direct learner involvement, and therefore are useful forintroducing topics.

Example:“Jane, you asked how to handle a situation when a child’s father comes to theVAS+D event with his daughter, but seems unsure about whether he wants her tohave the vitamin A or not. That is a great question. Let’s do a quick role play. I willplay the service provider and Jane is the father. Let’s get started.”

• Relating the topic to future work experiences. Learners’ interest in a topic will increasewhen they see a relationship between the course and their work. The facilitator cancapitalize on this by relating objectives, content and activities of the course to real worksituations.

Example:“I will now demonstrate proper infection prevention practices that you will use everytime you administer vitamin A and albendazole. In fact, it is one of the mostimportant things you will do for the safety of the child, caregiver, and for you andyour family.”


Using Questioning Techniques

What is a key characteristic of an effective facilitator? Which interactive method will the bestfacilitators employ? Which techniques will make the session more interesting? The answer to allof these questions is effective questioning and reinforcement techniques.

The primary purpose of questioning is to encourage the learners to think about the topic. Mostfacilitators agree that learners often say that they understand the content, but a knowledge orskills assessment may prove otherwise. Effective questioning gives the learners opportunities tothink through content and gain a fuller understanding of the concepts being presented.

There are a number of questioning techniques you can use to keep learners interested in thesession.

• Ask a question of the entire group. The advantage of this technique is that those whowish to volunteer may do so; however, some learners may dominate while others may notparticipate.

Example:“Would someone please tell me why we...?”

• Target the question to a specific learner by using that individual’s name beforeasking the question. The learner is aware that a question is coming, can concentrate onthe question and respond accordingly. The disadvantage is that once a specific learneris targeted, other learners may not concentrate on the question.

Example:“Jose, can you tell me what would happen if we...?”

• State the question, pause and then direct the question to a specific learner. Alllearners must listen to the question in the event that they are asked to respond. Theprimary disadvantage is that the learner receiving the question may be caught off guardand ask the facilitator to repeat the question.

Example:“What is the vitamin A dosage for a three-year old? Rosminah, can you tell us?”

The key in asking questions is to avoid a pattern. The skilled facilitator uses all three of thetechniques mentioned above to provide variety and maintain the learners’ attention. Additionalquestioning techniques the facilitator can use to make the session more interesting include:

• Use learners’ names during questioning. This is a powerful motivator and also helps tokeep all learners involved.


• Repeat a learner’s correct response. This provides positive reinforcement to the learnerand allows the rest of the group to hear the response.

Example:“Mulamba is correct. The body cannot make vitamin A.”

• Provide positive reinforcement for responses to keep the learners interested in thepresentation. Positive reinforcement may take the form of praise, displaying a learner’swork, using a learner as an assistant or using positive facial expressions, nods or othernonverbal actions.

Examples:“I couldn’t have said it better!”“Very good answer, Sony!”“I like the way you stated that, Joygrace.”“Excellent thinking, Ola.”

• When a learner’s response is partially correct, the facilitator should reward the correctportion and then improve the incorrect portion or redirect a related question to that learneror to another learner.

Examples:“I agree with the first part of your answer; however, can you explain...?”

“You almost have it! Enrique, can you give Otte some help?”

“Doyin is correct. Vitamin A comes in capsules; however, she said it was apowdered capsule. Lunah, do you agree with Doyin?

• When a learner’s response is incorrect, the facilitator should make a noncriticalresponse and restate the question to lead the learner to the correct response.

Examples:“Sorry, Shilpa, that is not correct. Let’s look at the situation in a different way.Suppose we....”

“Nikhil, that’s not quite what I was looking for. Let’s go back to our previous sessionwhen we discussed universal distribution. Stuti, what is the . . .?

When learners ask questions, the facilitator has two options:

• Answer the question, or

• Respond with another question.

The facilitator must draw on personal experience to determine which option is appropriate foreach situation. When the question deals with a complex subject or relates to a topic not previouslydiscussed, the facilitator may wish to answer the question.


Two final cautions about questions from learners:

• When unable to answer a question, the facilitator should acknowledge it and admit to notknowing the answer. After the session, the facilitator should research the answer andshare it during the next session. Another option is to ask another facilitator for their inputor ask this person to locate the answer as you continue with your presentation.

• When learners ask questions that will guide the discussion away from the topic, thefacilitator must decide whether answering the question and allowing the ensuingdiscussion will be valuable. When learners will benefit, and time permits, the facilitatormay wish to follow the new line of discussion. If not, the facilitator must move thediscussion back to the topic.

Summarizing a Presentation

A summary is used to reinforce the content of a presentation and provide a review of its mainpoints. Generally, a summary is used at the end of a presentation. When course topics arecomplex, however, periodic summaries may be used to ensure that learners understand thecontent as it is being presented. In addition, summaries can be used effectively beforedemonstrations or breaks that interrupt the presentation.

The summary should:

• Be brief.

• Draw together the main points.

• Involve the learners.

Many summary techniques are available to the facilitator, including:

• Asking the learners for questions, thereby giving learners an opportunity to clarify theirunderstanding of the content. This may result in a lively discussion focusing on thosepoints that seem to be the most troublesome.

• Asking the learners questions that focus on major points of the presentation.

• Administering a practice test (when time permits) which gives learners an opportunityto demonstrate their understanding of the material. After the test, use the questions as thebasis for discussion by asking for correct answers and explaining why each answer iscorrect.

• Using a game to review main points provides some variety, when time permits. Onepopular game is to divide learners into two teams, give each team time to develop reviewquestions and then allow each team to ask questions of the other. The facilitator servesas moderator by judging the acceptability of questions, clarifying answers and keeping arecord of team scores. This game can be highly motivational and can serve as an excellentsummary at the same time.


Summary

The learning environment has a critical impact on the quality of a person’s learning experience. Itis the facilitator’s responsibility to create a positive learning setting so that learning occurs andcourse objectives are met. Creating this setting requires thought and careful planning.

The facilitator can sustain a positive environment by using presentation skills that involve learnersand engage their interest. Interesting and informative introductions, effective questioning andreinforcement, and concise and interactive summaries are presentation techniques that can makecourse sessions more interesting, and ultimately more effective, learning experiences. ThePresentation Skills: Self-Assessment Guide (Sample 3-1) can be used to help determine theeffectiveness of presentation skills.


SAMPLE 3-1

PRESENTATION SKILLS: SELF-ASSESSMENT GUIDE

To what degree are the following statements true of your actions or behavior when making coursepresentations?

PRESENTATION SKILL YES SOMETIMES NO

1. I present an effective introduction.

2. I state the objective(s) of the presentation as partof the introduction.

3. I ask questions of the entire group.

4. I target questions to individuals.

5. I ask easy as well as more difficult questions.

6. I use learner names.

7. I provide positive feedback.

8. I respond to learner questions.

9. I use notes as well as a personalized referencemanual or slides.

10. I maintain eye contact with learners.

11. I project my voice so that all learners can hear.

12. I move about the room.

13. I use audiovisuals effectively.

14. I display a positive use of humor.

15. I present an effective summary.

16. I provide opportunities for application or practiceof presentation content.

Those presentation skills I feel competent in using include:

Those presentation skills I would like to improve include:


CHAPTER FOUR

USING AUDIOVISUAL AIDS

Introduction

Have you ever attended a course during which the person presenting the information just talkedthe entire time? It is usually very boring plus some topics are more difficult to understand if youonly hear the presenter describe the content. Research tells us that using audiovisuals duringcourse presentations not only makes the content easier to understand, but they also provide achange in the learning methods which helps to keep learners interested and focused.

Chapter Objective

After completing this chapter, you will be able to use audiovisuals during a course.


• Identify reasons for using audiovisuals• Present information using flipcharts• Demonstrate techniques for using a job aid• Demonstrate techniques for using the whiteboard• Demonstrate techniques for using video



Reasons for Using Audiovisuals

Audiovisuals include equipment and/or materials used to supplement course presentations (e.g.,flipcharts, videos, photos, real objects). There are a number of reasons for using audiovisuals:

• Supplement classroom presentations and skill demonstrations

• Provide for variety in instruction (someone talking or lecturing gets very boring after a fewminutes)

• Provide other methods of learning the information (e.g., seeing a photo of a servicedelivery site may be more clear than only hearing a description)

• Reduce planning time as the audiovisuals may do an excellent job of presenting specificinformation (e.g., photos, videos of service delivery)

Using Flipcharts

A flipchart (also spelled flip chart) is a chart or pad with sheets of paper attached at the top andmounted on a stand. The sheets can be flipped over to present information sequentially. Note thefollowing important points when using flip charts:

• Use pens or markers designed for use with flipcharts.

• Print in block letters large enough that they can easily be read from anywhere in the room.

• Use different colored markers to provide contrast.

• Make borders around the edge of the page. These borders “frame” the page focusing theviewer on the content. The border also makes the flipchart look more professional.

• Use a header box with 1-2 words to give the flipchart a title.

• Use bullets to identify individual points to help the readability of the items presented.

• For some types of thinner paper, you may need to use every other page when the pagesare prepared in advance. This is to prevent seeing the next page through the page beingviewed at the time.

• Avoid crowding too much information on one page.

• You can fold up and tape the lower portion of a page to be able to reveal the informationwhen appropriate (e.g., to reveal the answer to a question).

• Post flipchart pages around the room when applicable. You will need tape to hang pages.

Flipchart pages can be prepared in advance for items such as presentation topics, objectives,questions, activities, agenda for the day, etc. You can also use the flipchart spontaneously to writea question, brainstorm ideas, put items in a “parking lot”, etc.


Using a Job Aid

A job aid is a learning and performance support tool that provides guidance for an activity that alearner undertakes during a course or on the job. Job aids support performance allowing a userto get something done.

Job aids are everywhere. Most fire extinguishers have instructions for use on the side of thecanister. The instruction label is a job aid so that when needed the step-by-step instructions arethere to help the user correctly use the extinguisher.

In some cases, the job aid is used when someone is first learning a skill. For example, a recipe isa job aid. The first few times you make the food dish you will follow the steps in the recipe. As youbecome competent at making the dish you may no longer need the recipe.

Examples of job aids for VAS+D service delivery include:

• Performance checklist for skill development and assessment during a course and tosupport performance on the job after the course.

• Visual checklist which is a picture version of the performance checklist.

• Laminated instruction sheet with photos.

• A client health card showing how to correctly complete the card. This could be used duringa course to train service providers and could also be used at a service delivery site to helpstaff and caregivers.

• Model to simulate a child receiving vitamin A and albendazole. This can be as simple asa balloon and a cup to simulate the baby’s mouth so that vitamin A and albendazole canbe administered during small group practice activities.

Job aids are useful whenever course learners are experiencing difficulties learning a skill or healthworkers need support on the job during service delivery.

Using a Whiteboard

Some classrooms will have a whiteboard. In some cases, there will be chalkboards. Whiteboardscan also serve as a screen and are much easier to clean than chalkboards.

The whiteboard has many uses:

• Post the agenda for the course.

• List course announcements.

• Making a sketch or drawing (e.g., how to lay out an area for VAS+D service delivery).


The major advantage of the whiteboard is that it is easy to use. You just need to make sure thatyou have the correct markers (or chalk for a blackboard). There are some limitations of thewhiteboard:

• Limited amounts of materials can be presented at one time.

• Difficult to write and observe learners.

• No permanent record of the material presented.

Techniques for using the whiteboard include:

• Always use the correct markers (i.e., dry erase markers and not permanent markers) andkeep the board clean. Keep a bottle of alcohol or board cleaner available to remove theink when the wrong markers are used.

• Make text and drawings large enough for the learners to see.

• Avoid talking to the board with your back to the learners, as learners may not be able tohear and you lose eye contact.

• Prepare complex drawings in advance if the whiteboard must be used.

• Use the board for spontaneous discussions, brainstorming, and problem solving.

Using Video

Videos can be very useful in helping learners understand learning topics (e.g., seeing a video ofa competent service provider giving VAS+D services).

Videos can be shown on computers and can be made available on memory sticks (also knownas flash drives, thumb drives and USB sticks), CD-ROMs and DVDs as opposed to the older stylevideotapes. If you are planning on using a video during a course, it is essential to know in advancehow the video will be played, seen (i.e., projected on screen or shown on a monitor) and heard(i.e., external speakers for the computer) by the learners so you can make sure the requiredequipment is available.

Prior to showing a video, ensure that the learners know what the video is about, the objective,and specific points to watch for. Follow the video with a discussion of the content – relate thevideo content to the objectives. During the follow-up discussion ask questions about what wasshown in the video. You can also ask the learners to come up with questions to ask the others inthe course.

Summary

Using flipcharts, job aids, whiteboards, and videos make the course more effective. The use ofaudiovisuals during the course also makes the learning more enjoyable for both the learners andfacilitators.

Vitamin Angels – Facilitation Skills – Chapter 5-1

CHAPTER FIVE

ASSESSING KNOWLEDGE AND SKILLS

Introduction

Assisting learners to develop the knowledge, skills, and attitudes required to provide qualityservices is the central purpose of the service provider course. Being able to measure learningprogress satisfactorily and evaluate performance objectively are extremely importantelements in the process of developing quality service providers. It is the responsibility of thefacilitator to determine whether each learner has acquired the knowledge, attitudes, and skillsdefined in the course objectives.

Chapter Objective

After completing this chapter, you will be able to use evaluation instruments to measure learnerknowledge and to evaluate skill performance.


• Administer a knowledge assessment• Define skill development and evaluation• Use a checklist to assist in skill development• Use a checklist to evaluate skill performance



Administering a Knowledge Assessment

Assessment or evaluation of knowledge (testing) is an important factor in determining the successof learners in achieving the course objectives. In the VAS+D instructor-led course the knowledgeassessment is conducted near the end of the course to determine the level of informationpossessed by each learner. The knowledge assessment and answer key are located in theVAS+D facilitator’s guide and will need to be copied prior to the course.

Note: Because the VAS+D skill development course focuses on skill development and skillcompetency evaluation, there is no formal knowledge assessment in the VAS+D skilldevelopment course. There is a knowledge assessment in the VAS+D eLearning course.

To administer the knowledge assessment at the time shown in the VAS+D instructor-led courseschedule:

1. Prepare copies of the knowledge assessment (one for each learner).

2. Distribute the knowledge assessment to the learners and ask each learner to write theirname on the assessment.

3. Explain to the learners that the purpose of the knowledge assessment is to determinewhat they know about the course content.

4. Slowly, read aloud the knowledge assessment questions (if needed).

5. Give the learners time to complete the knowledge assessment.

6. Ask that once they answer all of the questions that they turn their knowledge assessmentface down.

7. Collect the knowledge assessments and review the results as described in the VAS+Dfacilitator’s guide.

Skill Development and Evaluation

In the past, deciding whether a learner was competent (qualified) to perform a skill both duringand, most importantly, after a course was often difficult. Importantly, skill competency can only bedetermined if learner performance is objectively measured relative to a standard.

Competency-based skill development and assessment instruments (performance checklists),which measure the ability to perform skills or other observable behaviors relative to a standard,have made learner assessment much easier. Performance checklists are used both to facilitatelearning the steps in performing VAS+D delivery as well as to evaluate performance.

Progress in the development of a skill is measured with reference to various levels or stages ofperformance. The three levels of performance in acquiring a new skill, which are briefly describedin Chapter 1 are defined more fully as follows:


• Skill acquisition represents the initial phase in learning a new skill. One or more practicesessions are needed for learning how to perform the required steps and the sequence inwhich they should be performed. Assistance and coaching are necessary for the learnerto achieve correct performance of the skill.

• Skill competency represents an intermediate phase in learning a new skill. The learnercan perform the required steps in the proper sequence but may not progress from step tostep efficiently.

• Skill proficiency represents the final phase in learning a new skill. The learner efficientlyand precisely performs all of the steps in the proper sequence.

Note: As described previously in this manual, there are two types of checklists:

• Performance Checklist – This checklist includes a detailed description of each of thesteps needed to perform a skill (e.g., administer VAS+D). This checklist also includesa rating scale which can be used to measure a learner’s ability to perform each step.

• Visual Checklist – This checklist includes the same steps as the performancechecklist, additionally there is an image showing each step. This checklist is used whenlearning to perform the skill and is also used as a job aid when providing services.

Using a Checklist for Skill Development

A performance checklist contains the individual steps in sequence that are required to perform askill in a standardized way. Performance checklists are designed to help learn the correct stepsand the sequence in which they should be performed (skill acquisition), and also to measureprogressive learning in small steps as the learner gains confidence and skill (skill competency).The performance checklist may need to be copied prior to the course.

Using performance checklists in competency-based learning:

• Ensures that learning is based on a standardized procedure• Standardizes learning materials and audiovisual aids• Forms the basis of facilitator demonstrations as well as learner practice sessions

In addition, performance checklists can be used as a self- or peer-assessment tool.

Examples of how performance and visual checklists can be used at different stages of the courseare given below.

• Initially, learners can use the performance and visual checklists to follow the steps as thefacilitator demonstrates service delivery or as they watch a video of service delivery.

• Then, during the classroom practice sessions in which learners are paired, one learneracting as a “service provider” demonstrates service delivery while the other learner usesthe performance or visual checklist to prompt the “service provider” on each step. During


these sessions, the facilitators or trainers circulate from group to group to monitor howlearning is progressing and check to see that the learners are following the steps outlinedin the performance checklist. It is during these practice sessions that the learners beginintegrating the more detailed information from the the performance checklist into their useof the visual checklist.

• After learners become competent in performing service delivery, they can use theperformance checklist to rate each other’s performance. This exercise can serve as a pointof discussion before learners are assessed by the facilitator using the performancechecklist.

Using a Checklist to Evaluate Skill Performance

Well-constructed checklists should contain only sufficient detail to permit the facilitator or trainerto evaluate and record the overall performance of the skill. If a checklist is too detailed, it candistract from the primary purpose, which is to observe the overall performance of the learnerobjectively.

Using checklists in a skill competency-based course:

• Ensures that learners have mastered the skills, first during small group practice sessions• Ensures that all learners will have their skills measured according to the same standard• Forms the basis for follow-up observations and evaluations during service delivery

The performance checklist is first used to assess learners’ performance during small groupactivities or role plays. After learners demonstrate competency, they can work with children andtheir caregivers, and the performance checklist is once again used to monitor and evaluate theirperformance.

When completed, the performance checklist, together with the facilitator’s or trainer’s commentsand recommendations, provides objective documentation of the learner’s level of performance.Also, it serves as one part of the process of confirming that the learner is qualified to provideservices.

Summary

All learners attending a service delivery course must be able to demonstrate mastery of theessential knowledge and skills. The use of well-designed, competency-based instruments thatassess knowledge and skill development can make mastering these skills easier.

The knowledge assessment administered at the end of the instructor-led VAS+D course is usedas a measure of learner knowledge about course content. The performance checklist enableslearners to chart their progress in learning new skills and, by breaking the skill down into itsessential elements, to pinpoint areas for improvement.

Finally, evaluating whether learners have acquired new skills can be accomplished usingcompetency-based performance checklists. These checklists can be used to measure a widevariety of learner skills and behaviors in realistic job-related situations.

Vitamin Angels – Facilitation Skills – Chapter 6–1

CHAPTER SIX

DEVELOPING SERVICE DELIVERY SKILLS

Introduction

Service provider courses (e.g., VAS+D instructor-led course, VAS+D skill development course)place the learner with an experienced facilitator or trainer in a setting where the learner canobserve and practice the skills required to reach an established standard of performance. Thistype of learning requires one-on-one interaction with the learner. This interaction is needed tohelp the learner acquire and apply specific knowledge and positive attitudes, and developeffective service delivery skills.

Service delivery skills are developed through the following process:

• Demonstration of service delivery skills by the facilitator or trainer (or by watching avideo)

• Practice of service delivery skills by the learner under the supervision of the facilitator ortrainer (or individually by those using eLearning)

• Assessment of the learner’s service delivery competency by the facilitator or trainer

This process helps ensure that learners will be competent in the skills required to provide qualityservices. This chapter will explore the process of transferring the ability to perform skills fromfacilitators and trainers to those attending the course.

Chapter Objective

After completing the chapter, you will be able to demonstrate service delivery skills and assessservice delivery competency.


• Identify the three phases in the skill development process• Identify the characteristics of an effective coach• Conduct an effective skill demonstration• Coach development of a skill• Evaluates skill competency



Skill Development Process

The process of learning service delivery skills includes the following:

1. First, understanding service delivery during interactive classroom presentations in theinstructor-led course, through eLearning, or through review of the VAS+D fact sheetsduring the skill development course. This includes observing a demonstration ofservice delivery skills following the steps in the performance and visual checklists.

2. Then, practicing service delivery in a simulated environment as the facilitator or trainerobserves and provides feedback (this is known as coaching).

3. After adequate practice, assessment of each learner’s performance of service deliveryand overall competency in a simulated situation, using the performance checklist.

Table 6-1 shows the three stages of the general skill development process. Note how the rolesshift during the process. During initial skill acquisition, the facilitator or trainer demonstrates theskill as the learner observes.

As the learner practices service delivery, the facilitator or trainer functions as a coach andobserves and assesses or evaluates performance. Feedback from the facilitator or trainer andthe other learners will help the learner progress from skill acquisition to skill competency.

When demonstrating skill competency, the learner is now the person performing service deliveryas the facilitator or trainer evaluates performance.

Table 6-1. Skill Development Process

ROLES LEVEL OF PERFORMANCE

Skill AcquisitionSkill Acquisition toCompetency (simulation) Skill Competency

Facilitator orTrainer

Demonstrates skills Coaches the learner andassesses learnerperformance

Evaluates learnerperformance

Learner Observes thedemonstration

Practices and performs theskills

Performs the skills

The learner progresses from skill acquisition to skill competency through practice. After the learnerreaches skill competency during simulations, the process begins again as the skill is performed withchildren and their caregivers.

Changing Roles: During a service provider course the facilitator or trainer takes on severaldifferent roles. The facilitator conducting an instructor-led VAS+D course is an interactivepresenter or instructor during classroom sessions. During small-group practice sessions thefacilitator or trainer becomes a coach. When assessing skill competency, the facilitator ortrainer takes on the role of the evaluator.


Characteristics of an Effective Facilitator, Trainer and Coach

People learn best by observing the correct modeling of a procedure by a proficient serviceprovider. Approved, agreed upon standards of performance are essential to the learningprocess, particularly when assessing progress in learning a new skill. The facilitator or trainermust accurately demonstrate the service delivery steps so that the learner has a clear picture ofthe expected performance.

When delivering services, each provider may perform and interact with children and theircaregivers differently. However, when it comes to developing new providers, it is essential thatthe course facilitators and trainers demonstrate the agreed upon standard service delivery asoutlined in the performance checklist.

Learners acquire new skills most easily when they are highly motivated to learn and are notoverwhelmed by feelings of anxiety and fear. Adults often experience fear when learning newskills, especially if they feel their self-esteem or image with colleagues will be damaged, or ifprevious learning experiences have been embarrassing or threatening.

Learners will associate new skills or techniques they are learning with the environment in whichthey are learning them. If the learning environment is pleasant, supportive and enhancesself-esteem, the learner is more likely to learn and use the skills. If the learningenvironment or the behavior of the facilitator or trainer produces feelings of discomfort or stress,however, learners may try to relieve the discomfort by discounting the quality of the learning andthe relevance of the skill.

An effective facilitator or trainer:

• Is proficient in the skills to be taught

• Encourages learners in developing new skills

• Promotes open (two-way) communication

• Provides immediate feedback:

o Informs learners whether they are meeting the objectives

o Does not allow a skill to be performed incorrectly

o Gives positive feedback as often as possible

o Avoids negative feedback and instead offers suggestions for improvement

• Recognizes learning skills can be stressful and knows how to regulate learner stress:

o Observes learners and watches for signs of stress

o Allows breaks during learning sessions

o Provides for changes in the learning routine

o Focuses on learner success instead of failure

o Uses appropriate humor


The characteristics of an effective coach include:

• Being patient and supportive

• Providing praise and positive reinforcement

• Correcting errors while maintaining learner self-esteem

• Listening and observing

To understand fully the role of the coach, it is helpful to compare the effective and ineffectivecoach. The effective coach involves all learners in the learning process and provides them withpositive feedback. The ineffective coach is controlling, avoids involving the learners, andtypically fails to provide positive feedback. A comparison of the effective and ineffective coachis presented below.

The Effective Coach . . . The Ineffective Coach . . .

Focuses on the practical

Encourages working together (collegialrelationship)

Works to reduce stress

Fosters two-way communication

Is a facilitator of learning

Focuses on the theoretical

Maintains a distance (status is above thelearners)

Often creates stress

Uses one-way communication

Acts as the authority or the only source ofknowledge

Conducting an Effective Skill Demonstration

The facilitator or trainer can use two methods to demonstrate VAS+D service delivery:

• Perform a role play that includes a service provider and a caregiver with a child.

• Show a video of service delivery.

When planning, and giving a VAS+D skill demonstration the facilitator or trainer should followthese guidelines:

• Before beginning, state the objectives of the demonstration and point out what thelearners should do (e.g., observe carefully, follow along using their performance andvisual checklists, save questions for the end of the demonstration, etc.).

• Make sure that everyone can see the steps involved.

• Never demonstrate the skill incorrectly.

• Demonstrate VAS+D service delivery in as realistic a manner as possible.


• Use the visual checklist to demonstrate all steps of VAS+D service delivery in theproper sequence.

• Take enough time so that each step can be observed and understood. Remember thatthe objective of the demonstration is for the learner to develop the skills, not for thefacilitator or trainer to show speed.

• Narrate those steps that are not accompanied by a description (e.g., I am washing myhands; I am holding the capsule with the narrow tip pointing up and using clean, oil freescissors to cut off the tip, etc.).

• Use capsules, scissors and objects used to crush albendazole tablets properlyand make sure learners see clearly how they are handled.

• At the conclusion of the demonstration, ask if learners have any questions.

Coaching Skill Development

In order for learners to develop service delivery skills they must practice the steps in thechecklists. After the demonstration of service delivery, the learners practice in small groupswhile the facilitator or trainer (acting as a coach) observes and provides feedback.

The following suggestions are provided for conducting the VAS+D small group practice session:

• Divide the learners into pairs. Try to match those who may have more experience withthose with less experience.

• One of the learners will assume the role of the service provider. The other learner willassume the role of the observer (also acting as the child’s caregiver). The observer willuse the performance checklist to informally rate and provide feedback on the provider’sperformance. If there are three learners in the group, the third person can prompt theprovider with the correct steps or sequence when requested.

• The facilitator or trainer moves among the groups to observe, provide feedback, askquestions, and step in to demonstrate if needed.

• Once the provider in a group completes VAS+D service delivery and has receivedfeedback from the other learner(s), then they change places and another learner takeson the role of the service provider.

Communicating During Coaching

Active listening is an important skill for the facilitator or trainer to develop. The following areexamples of active listening techniques:

• Stop talking and listen to the speaker.• Restate the speaker’s exact words.• Paraphrase in your own words what the speaker said.• Understand and reflect the underlying feelings of the speaker.


When actively listening, it is appropriate to ask open-ended questions such as, “Can you tell memore about that?” or “Help me understand what you said.” It is also appropriate to ask for helpas a part of active listening; for example, “I’m not sure I fully understand what you are saying,”or “I’m confused as to whether you mean the provider or the caregiver. Can you explain more?”

Active listening does not include probing questions of a cross-examination type such as “Whydid you do that?” or “What are you going to do about that?” Active listeners are not accusatory,nor do they ask questions that lead to only one answer. Active listening reflects what has beensaid and draws the learner out to expand further on the meaning or feelings. It also is acommunication tool which can be used to shape learning and reinforce effective behavior in apositive way.

Everyone likes being heard and appreciated. Supportive comments from the facilitatorstrengthen and reinforce desired behavior.

Questioning is used during courses to assess the learner’s knowledge and to teach problemsolving. Providers, when interviewing clients, normally use two types of questions: closedquestions that have a small range of answers (often yes or no); and open questions that allowa wide range of responses. Both types of questions are useful in assessing the learner’s level ofknowledge.

Questioning does not mean interrogating. The facilitator or trainer should let learners know thatthe purpose of questioning is to help target instruction, not to embarrass them. Asking themwhat they know and what they want to learn will help assess their needs and focus learningmore precisely.

Feedback is essential throughout the coaching process, including during and after practicesessions and skill evaluations. Many facilitators and trainers find it difficult to acquire the skill ofgiving feedback. Although the following guidelines for giving and receiving feedback may behelpful, facilitators and trainer usually need practice to become more confident with thisessential skill.

Guidelines to follow in giving feedback are:

• Be timely. Give your feedback immediately after observing skill performance.

Example:“Jane, you did an excellent job of responding to the caregiver’s questions.”

• Be specific. Describe the behaviors and reactions, particularly those that the learnershould keep and those that should be changed. Refer to the notes recorded on theperformance checklist to help focus the feedback on key points.

Example:“Maria, you did a very good job of making sure that the child had swallowed thefull dose. However, you then placed the capsule on the table. Where should youhave placed the used capsule?”


• Be descriptive, not judgmental. Describe the consequences of the behavior; do notjudge the person.

Example:“After you welcomed the caregiver you immediately begin to describe thecaregiver’s infection prevention role. You did not explain VAS+D delivery or showher the capsules. This caused the caregiver to become confused.”

An effective approach is to use “sandwich” feedback. This means starting and ending thefeedback (top and bottom of the sandwich) with positive feedback. Here are the steps to providesandwich feedback:

• Ask the performer what he or she thinks they did well (focus on the positive).

Example:“Ola, tell me what you feel you did well when providing albendazole.”

• Ask the performer what they would do differently if they were repeating the skillperformance.

Example:“Joygrace, are there any steps in the visual checklist that you feel you need to dodifferently the next time you deliver vitamin A and deworming?”

• Share your observations of the steps performed well.

Example:“Ada, I agree with your comments regarding the steps you did well. In addition, Ithink the way you communicated with the caregiver was well done.”

• Offer any additional suggestions for improvement (build on what the performer indicatedthat she or he would do differently).

Example:“Maria, you indicated that you forgot to wash your hands before giving thevitamin A. In addition to making sure that you wash your hands before giving thevitamin A to the child, be sure to include all possible side effects during theentrance counseling. You forgot to mention headache.”

• Close with several positive observations.

Example:

“Emmanuel, I thought that you did a very good job with administering thealbendazole. I specifically liked the way you communicated with the caregiverand child and how you competently performed the steps in the checklist.


Evaluate Skill Competency

The final step in the skill development process is for the facilitator or trainer to assess orevaluate each learner using the performance checklist to ensure that the learner cancompetently perform. In order for the individual evaluations to benefit all of the learners, thefollowing skill evaluation process is recommended for the VAS+D service provider courses:

• One of the pairs of learners who practiced together set up to demonstrate VAS+Dservice delivery. Depending on the number of learners and facilitators or trainers, thisdemonstration may be given in front of all of the other learners or may be only for asingle facilitator or trainer.

• Using the visual checklist, the learner who is the service provider treats the other learneras a caregiver. The remaining learners observe and use the performance checklist totake note of steps the service provider is doing well, as well as steps whereimprovement could be made.

• The facilitator or trainer is observing and recording performance ratings on aperformance checklist.

• At the conclusion of the demonstration, the facilitator or trainer will lead a discussionasking first the service provider and then the observers what the service provider didwell and also asking how the service provider could do even better next time. Avoidasking what the service provider did wrong as this creates tension and a negativelearning environment.

• Following feedback from the service provider and observers the facilitator or trainer willoffer any final comments on strengths and areas to improve.

• At this point the facilitator or trainer must make a decision based on the checklist ratingsystem. Is the learner who demonstrated VAS+D service delivery competent (meaningthis person is qualified to provide services)? Or is the learner not competent and needsadditional practice (i.e., did they receive 0 or – performance ratings for any of the steps)?

• If the learner is competent, then the facilitator will make this note on the performancechecklist.

• If the learner is not competent, then the facilitator has several options:

o In some situations, the learner may recognize a mistake and immediately repeatsthe part within the visual checklist where they experienced problems.

o Ask the learner to join the large group and then repeat the evaluation later.

o If there are two facilitators or trainers, take the learner aside for additionalpractice and coaching. The learner will be evaluated again (only repeating thepart(s) within the visual checklist where they experienced problems.)

• Learners have several opportunities to correctly (competently) perform the steps in theVAS+D performance and visual checklists.


Important: When there are two facilitators or trainers and space is available, it isrecommended that you divide the learners into two groups and conduct the skill evaluations atthe same time. This will cut the time required for the evaluations in half.

At the conclusion of the skill evaluation process, in most cases all of the learners will havedemonstrated competency providing VAS+D. If for some reason there is a learner who is unableto competently perform the steps to provide VAS+D, this learner would be required to completethe course again before being qualified.

The essential elements of the skill development process are summarized in the self-assessmentguide presented in Sample 6-1 at the end of the chapter.

Summary

Development of service delivery skills as presented in this chapter is based on a three-partprocess

• Demonstration of service delivery skills by the facilitator or trainer (or by watching avideo)

• Practice of service delivery skills by the learner under the supervision of the facilitator ortrainer (or individually by those using eLearning)

• Assessment of the learner’s service delivery competency by the facilitator or trainer

An effective coach must have good communication skills, including the use of active listening,questioning techniques and feedback, in order to develop learners’ skills fully. The facilitator ortrainer also must be able to conduct an effective demonstration as well as assess learningduring the coaching process. Through one-on-one interaction the learner is guided in order toacquire and apply new knowledge and skills.

Once the learner is ready, the facilitator or trainer will use the performance checklist to observethe learner performing service delivery and make a determination if the learner is competent toprovide services.


SAMPLE 6-1

DEMONSTRATION AND COACHING SKILLS: SELF-ASSESSMENT GUIDE

To what degree are each these statements true of your actions when demonstrating VAS+Dskills to learners, coaching skill development, and evaluating skill performance?

Demonstration Skills Yes Sometimes No

1. I follow the steps in the performance checklist.

2. I use the visual checklist during the demonstration

3. I state the objective(s) as part of the introduction.

4. I present an effective introduction.

5. I arrange the demonstration area so that learners areable to see each step in VAS+D service deliveryclearly.

6. I never demonstrate an incorrect step.

7. I communicate with the caregiver and child during thedemonstration of VAS+D service delivery.

8. I ask questions and encourage learners to askquestions.

9. I demonstrate appropriate infection preventionpractices.

10. I maintain eye contact with learners as much aspossible.

11. I project my voice so that all learners can hear.

12. I provide opportunities for the learners to practiceVAS+D service delivery in small groups.

Coaching Skills Yes Sometimes No

13. I observe and provide sandwich feedback whenlearners are practicing in small groups.

14. I encourage the learners to initially use theperformance checklist and then transition to the visualchecklist.

15. I move from group to group to ensure that all learnersare being observed and provided with feedback.

16. I encourage the other learner(s) in the small group toprovide feedback on the service provider’sperformance.

17. I demonstrate how to perform steps if necessary.


Evaluating Skills Yes Sometimes No

18. I use the performance checklist to evaluate eachlearner for skill competency.

19. I involve the learner being evaluated as well as theother learners in providing sandwich feedback.

20. I determine if the learner is competent, needsadditional practice in order to try again, or if the learneris not competent in providing VAS+D.

Those skills I feel competent in using include:

Those skills I would like to improve include:


CHAPTER SEVEN

PLANNING & CONDUCTING A SERVICE PROVIDER COURSE

Introduction

A successful service provider course does not come about by accident, but rather throughcareful planning. This planning takes thought, time and preparation. In this chapter, we will usethe instructor-led vitamin A supplementation and deworming (VAS+D) service provider courseas an example of how to plan and conduct a course.

The instructor-led VAS+D course is conducted by qualified course facilitators. Each facilitatormay have a different level of involvement in planning and organizing a course. All facilitatorsneed to be thoroughly familiar with the issues surrounding course planning.

The facilitator is responsible for ensuring that the course is carried out essentially as it wasdesigned. The facilitator must make sure that the skill practice sessions, which are an integralpart of the course, as well as the classroom sessions, are conducted appropriately. In additionto taking responsibility for the organization of the course in general, the facilitator must also beable to give presentations and demonstrations and lead other course activities, all of whichrequire prior planning. Well-planned and executed course sessions will help to create a positivelearning experience.

Chapter Objective

After completing this chapter, you will be able to plan and conduct the VAS+D instructor-ledservice provider course.


• Consider general planning issues• Ensure appropriate learner selection• Review the required course materials• Study the Facilitator’s Guide• Select and make arrangements for the classroom• Complete facilitator planning• Deal with attendance problems• Present a course overview• Present the course sessions• Evaluate the learners and the course• Provide help and follow-up after the course• Describe how to use the Facilitator Skill Development and Evaluation tool



General Planning Issues

Planning an instructor-led VAS+D service provider course (11 hours typically conducted over 2days) requires time and attention to detail and ideally should begin several months before thecourse. A typical timeline for planning activities is presented in Table 7-1. A detailed checklist oftasks for the facilitator can be found in Sample 7-1 at the end of the chapter.

In order to plan effectively the facilitator must know well in advance how many learners will beattending the course. After determining the number of learners, the facilitator should check onthe following course requirements:

• Adequate space for classroom and skill practice activities

• Adequate housing for the learners attending the course (if required)

• Course materials (e.g., reference manuals, learner’s guide, performance checklist, visualchecklist, etc.)

• Any supplemental materials for the learning activities (e.g., knowledge assessments)

• Supplies and equipment (e.g., vitamin A capsules, scissors, albendazole tablets, tools oritems to crush the tablets, flipcharts, paper and pencils, balloon babies, etc.)

One of the most important considerations in selecting a site for a course is finding a goodclassroom facility. The organizers of the course must weigh the advantages and disadvantagesof selecting a learning site close to where the majority of the learner’s work. Conducting acourse in, or even near, the workplace can cause interruptions and distractions. Conversely, thegreater the distance the course site is from the learners’ work sites, the greater the costs oftransportation and housing.

There are a number of administrative arrangements for which the facilitator may have no directresponsibility, such as arranging for housing accommodations, meals, breaks and transportationpayments. In the interest of minimizing problems at the beginning of the course, however, thefacilitator should work closely with the person who is handling these arrangements to makecertain that all administrative details are taken care of promptly. These details include:

• Scheduling the venue for the course

• Confirming financial support, including how travel costs and housing allowances will bepaid to or on behalf of the learners

• Making arrangements for learners, including housing or hotel accommodations andtransportation to and from the course

• Providing pertinent information to learners (e.g., course syllabus, financial and housingarrangements, contact information, location of training site, etc.)

• Obtaining learning materials, equipment and supplies needed for course activities


Table 7-1. Suggested Timeline for Preparing for a VAS+D Service Provider Course

TIME PRIORTO COURSE

ACTIVITY

3 months

2 months

1 month

1 week

1 to 2 days

• Confirm learning site (classroom and skill practice facilities)• Select housing accommodations (if necessary)• Select and confirm course facilitators• Select and notify learners• Begin learning material translations (if required)

• Initiate administrative arrangements (contracts for training site, hotels, etc.)• Confirm housing accommodations• Order materials and supplies• Finalize learning material translations (if required)

• Review course syllabus, schedule and outline and adapt if necessary• Review content and prepare for each course session• Prepare or plan audiovisuals (slide presentations, flipcharts, video, etc.)• Arrange for all audiovisual equipment (computer, projector, flipchart, etc.)• Visit classroom site and confirm arrangements• Confirm receipt of learning materials, supplies and equipment• Finalize administrative arrangements• Reconfirm housing arrangements• Send E-copies of learning materials to learners• Prepare electronic copies of materials and media to distribute during the course

• Review final list of learners for background experience using the questionnaire• Review the course syllabus and outline• Assemble learning materials• Prepare course certificates• Meet with co-facilitator(s) to review the course schedule and assignments

• Prepare classroom facility• Prepare and check audiovisual equipment and other learning aids• Arrange all needed materials and supplies• Check with co-facilitators to be sure there are no other arrangements that need

to be made


Selecting Learners

Selection of appropriate learners is critical to the success of any course. The facilitator mayhave an excellent course design, materials, classroom facilities and supporting audiovisuals, butthese mean very little if the wrong learners attend the course. Having clear, agreed-upon criteriafor course learners is crucial.

There is a syllabus for the VAS+D course (refer to facilitator’s guide) which containsinformation about a course. A key element of the course syllabus is the target audience orlearner selection criteria. Once the individuals responsible for selecting and nominating courseparticipants have a clear understanding of these criteria, they can help to make certain that theindividuals selected to attend are those for whom the course was designed.

The following criteria should be considered when selecting learners for a VAS+D skills course:

• Learners should be responsible for either or both:o Vitamin A and deworming planning, implementation and oversight, oro Training of field level staff.

• Learners should have an interest in providing VAS+D services.

• The learner or the learner’s organization (e.g., NGO, CBO, clinic, mobile clinic, hospital)should be capable of offering VAS+D services.

• Learners should have the support of their supervisor or manager. In order to achieveimproved job performance, the facilitator should communicate with supervisors andmanagers whenever possible and ask that they endorse the VAS+D course, encourageattendance and participation, take part in planning the transfer of new knowledge andskills to the job and provide support when the service provider who completed thecourse begins to apply newly acquired skills on the job.

• Two individuals from each organization, or in some cases the project site, should attendthe course, when appropriate. Learning pairs makes it more likely that the new skillswill be used when learners return to their sites, because they will be able to assist andcoach each other at their workplace.

Learners should be selected and notified in advance of the course, whenever possible. As partof their invitation, learners (and their supervisors, if appropriate) should be sent informationabout the course. In addition to the dates, location and logistical information, learners shouldreceive a copy of the course syllabus when possible. The syllabus describes the course and itsgoals, learning materials, learner selection criteria and how the learners will be evaluated.


Course Materials

Use of standardized learning materials helps ensure consistency in the transfer of knowledgeand skills and in the objective evaluation of learner performance. Facilitators are provided with alearning package which contains all the materials the facilitator will need to conduct the course.The VAS+D learning package consists of:

• Reference Manual for Administration of Vitamin A Supplements in Universal DistributionProjects (i.e., the VAS Reference Manual)

• Reference Manual for Administration of Deworming Tablets to Preschool Children 12-59Months of Age in Vitamin A Distribution Projects (i.e., the Deworming Reference Manual)

• Learner’s Guide

• Facilitator’s Guide

• Supplemental handouts (e.g., VAS+D fact sheets, visual checklist, skill performancevideos, USB thumb drive with resource materials, etc.)

The reference manuals provide all of the essential information needed to conduct the course.Because the reference manual serves as the “text” for the learners and the “reference source”for the facilitator, special handouts usually are not needed. Country-specific supplementalmaterial, however, may be prepared and distributed as appropriate. The manual also provides areadily available reference for problem solving and review of newly learned information after thecourse.

The Learner’s Guide serves as the road map to guide the learner through the course. Itcontains a model course syllabus and schedule as well as all supplemental printed materialssuch as the performance checklist.

The Facilitator’s Guide contains the learner’s guide materials as well as facilitator-specificinformation such as the knowledge assessment and answer key.

The Facilitator’s Guide

The facilitator’s guide is essential in planning and conducting the VAS+D service deliverycourse. The course facilitator must study the facilitator’s guide and know the contentscompletely. Doing so will help ensure that the VAS+D service delivery course is successful andthat all participants completing the course are competent.

The contents of the facilitator’s guide include:

• Overview of the learning approach used in the VAS+D service delivery course

• Description of the mastery learning approach

• Description of the components of the VAS+D resource package

• Course syllabus (discussed later in this chapter)


• Description of the presentation slides (discussed later in this chapter)

• Description of how to conduct the knowledge assessment

• Performance checklist

• Course evaluation for the learners to complete at the end of the course

The VAS+D facilitator’s guide also includes three annexes:

1. Flipcharts for the VAS+D classroom

2. Developing VAS+D service delivery plans

3. Frequently asked questions

Classroom Selection and Arrangements

The classroom for a course is usually located in a hotel or training center where the learners arestaying. In choosing a site, the facilitator should make sure that:

• This course is the only event scheduled in the room.

• The space is large enough for the number of learners attending the course and willaccommodate:

o Tables arranged in a U-shape or other formation that will allow as many of thelearners as possible to see one another and the facilitator

o A table in the front of the room where the facilitators can place their coursematerials

o Space for audiovisual equipment (e.g., flipchart, screen, computer, projector); thefacilitator should make sure that learners will be able to see the projection screenand flipcharts

o Space for learners to work in small groups

o Space to set up a simulated VAS+D service delivery site

• The room is properly heated or cooled and ventilated.

• There will be adequate electric power throughout the course, and contingency planshave been made in case the power fails.

• There are toilet facilities which are adequately maintained.

• Furniture such as tables, chairs and desks is available.


• There is a whiteboard with markers.

• The lighting is adequate, and the room can be darkened enough to show slides andvideos and still permit learners to take notes or follow along in their learning materials.

• There is audiovisual equipment in working order. There are sufficient electricalconnections, and extension cords, electrical adaptors and power strips (multi-plugs) areavailable, if necessary.

There are also other arrangements related to the learning site which the facilitator needs toconsider:

• Refreshments for morning and afternoon breaks should be planned. Decide if thesebreaks will be set up in the classroom, outside of the classroom or in another room (e.g.,cafeteria).

• The facilitator may need to plan for meals. Decide if these meals will be set up in theclassroom, outside of the classroom or in another room (e.g., cafeteria).

• The room should be set up the day before the course begins.

Facilitator Planning

Facilitator preparation is essential to conducting a successful VAS+D service provider course.The facilitator will find that the thorough preparation was well worth the effort when the courseruns smoothly and the learners leave with the ability to competently perform the skills acquiredduring the course. The facilitator’s guide contains three planning documents the facilitator willuse in preparing for course – the course syllabus, schedule and outline.

Preparation for the VAS+D service provider course falls into two categories: getting ready forthe course in general (e.g., obtaining necessary supplies and equipment) and planningindividual course sessions. The following steps are recommended.

• Review the course syllabus, including the course description, goals, learning methods,materials, methods of evaluation, etc.

• Review the course schedule.

• Study the course outline. The course outline provides detailed suggestions regardingthe teaching of each objective and the facilitation of each activity. Based on suggestionsin the course outline and the facilitator’s own ideas, the facilitator will gather thenecessary equipment, supplies and materials.

• Read and study the reference manual to ensure complete familiarity with the contentto be presented during the course.

• Review and make copies of the knowledge assessment, performance checklistand course evaluation.


• Review the presentation slides. The PowerPoint presentation provided as part of thelearning package contains all of the course slides.

• Check all audiovisual equipment (e.g., computer, projector, flipchart stand with paper).

• Practice VAS+D service delivery using the visual checklist.

• Prepare VAS+D supply kits. These kits include the supplies learners will need whenpracticing VAS+D service delivery.

• Obtain information about the learners who will be attending the course using thelearner contact form (provided by Vitamin Angels). It is important for the facilitator toknow basic information about the learners such as:

o Why the learners enrolled in the course. Sometimes this can be determined inadvance, although often the facilitator has to ask learners when the course begins. Itis important for the facilitator to know why they are attending and how they feel aboutcoming to the course in order to create a positive learning environment and achievecourse objectives.

o The experience and educational background of the learners. The facilitator shouldattempt to gather as much information about learners as possible before the course.If this is not possible, the facilitator should inquire about their backgrounds andexpectations during the first day of the course.

• There should be a clear expectation that each course learner will be providingVAS+D services following the course. This allows the facilitator to use specificexamples related to how to set up and properly distribute vitamin A and albendazole.

Dealing with Attendance Problems

The VAS+D course is designed for 12-14 learners. It is therefore essential that the correctindividuals be selected to attend the course and that all learners are there for the entire course.Prior to attending the VAS+D course the learners are sent information that includes:

• Location of the course.

• Arrival date and time as well as the departure date and time.

• Contact information for the hotel and the course facilitators.

• Expectations in terms of attendance and being on time for all course sessions andactivities.


The day the participants are scheduled to be at the training site the course facilitator must verifythat each learner has arrived. When the course is being held at a hotel, verify that eachparticipant has checked in before the course begins. If someone fails to check in, contact themor the person within their organization to determine if there have been any travel delays. Do notwait until everyone is in the classroom to start trying to figure out why someone is not there.

Once the course begins it is essential that all learners be in all of the sessions. Being late to theclassroom or missing a session is not acceptable. Here are some suggestions for ensuring thatall learners attend all sessions:

• Discuss expectations at the beginning of the course. These include attending allsessions on time, turning off cell phones, and actively participating in all courseactivities.

• When a learner arrives at a session late, remind them (in front of the group) thateveryone needs to be in the room ready to go at the agreed upon time.

• When a learner arrives late for a second time, talk to this person alone (or with the otherfacilitator) reminding them of the expectations and letting them know that if they are lateagain that this could have an impact on their ability to complete the course and receive acertificate. Also, let this person know that if they are late again that you will need tocontact their organization.

Note: In those rare cases when attendance becomes an issue, the facilitator may determinethat the learner will receive a Certificate of Participation instead of a Certificate ofCompetency.

Presenting a Course Overview

The day has finally arrived! The classroom has been arranged and the learners are entering theroom and taking their seats. Although you feel a little nervous, you know that you have plans forbeginning the course on a positive note. These plans include an interesting and exciting courseoverview. An introductory course overview may be used to:

• Welcome the learners and review course goals and learning objectives

Example:“Welcome to the vitamin A supplementation and deworming course. My name isShilpa and I will be one of your facilitators. The goal of this course is to prepareyou to deliver vitamin A supplementation and to provide albendazole. Let’s take alook at the course objectives.”

• Allow learners to become acquainted with one another

Example:“Let’s take a few minutes and introduce ourselves. I would like you to findanother learner to interview. In addition to your partner’s name, ask her or him toshare one characteristic of an effective service provider. Please take about fiveminutes and then we will meet everyone.”


• Describe the course schedule and activities that will occur during the course

Example:“Each of you has a copy of the course schedule. Note that this is a two-daycourse during which you will learn about vitamin A supplementation anddeworming and will learn how to provide VAS+D services. Are there anyquestions about the schedule?”

• Examine the course materials

Example:“One of the manuals we will be using in this course is the Reference Manual forAdministration of Vitamin A Supplements in Universal Distribution Projects. Themanual contains the essential, need-to-know information we will be learningduring the course. In addition, you have a copy of the learner’s guide whichcontains the course syllabus, schedule and other information we will use duringthe course.”

Presenting Course Sessions

Applying the interactive presentation skills presented in this manual, the facilitator will conductthe sessions as described in the course outline. During the classroom presentations, thefacilitator will:

• Interact with the learners.

• Ask and answer learner questions.

• Move around the room.

• Maintain eye contact.

• Project her or his voice so everyone can hear.

• Provide positive feedback.

• Explain information in the reference manual or on the presentation slides.

During the demonstration of VAS+D service delivery the facilitator will:

• Ensure the simulated setting is as real as possible.

• Ensure that each learner has a copy of the performance checklist and the visualchecklist.

• Demonstrate each step using the visual checklist.

• Ask and answer questions following the demonstration.


• After answering learners’ questions the facilitator will divide the learners into smallgroups and provide instructions for the practice session.

During the practice session, the facilitator will:

• Move from group to group observing the learners as they practice.

• Provide positive feedback and offer suggestions for improvement.

• Ensure that each of the learners is observed performing VAS+D delivery.

Evaluate the Learners and the Course

Evaluation is an integral part of the learning process. Evaluation can determine whether thelearning has met its goals (i.e., whether learners’ knowledge, attitudes and skills improved) andidentify aspects of the course that should be strengthened. Evaluations occur during and at theend of the course and include:

• Evaluation of learner knowledge using the knowledge assessment

• Evaluation of peer skills using the performance checklist

• Evaluation of each learner’s skills by the facilitator using the performance checklist

• Evaluation of the course by the learners (this may be done with an evaluation formand/or by having an open discussion with the learners at the end of the course)

The majority of the learners will be able to competently demonstrate VAS+D service deliveryand will receive a competency certificate at the end of the course. If there are learners whoare unable to perform the required skills, they should receive a statement of participation.

Help and Follow-Up After the Course

Service delivery courses often fail to produce long-term results when attention is not given totransferring learning to the workplace. Application of newly acquired skills to the job is not theresponsibility only of the learners. The facilitator and the learner’s sponsoring organizationshould make every effort to ensure that each learner has the opportunity, resources andmotivation to apply new knowledge and skills on the job following the course.

New knowledge and skills need to be practiced soon after learning them or they will be lostand never applied.


Facilitators can help ensure that learning is effective, stays with each learner and gets appliedon the job by:

• Using learning activities that promote transfer of the new skill to the workplace• Developing and implementing action plans• Follow-up activities

Effective Transfer of Skills

Before a course starts, there should be a clear idea of how the learners will use newly acquiredskills. The facilitator should know that all parties including the learners, supervisors, and otherfacilitators understand and agree to what the learners will be expected to do after returning tothe job. Any resources, including time, staff support, equipment and supplies needed to carryout the new skills should be planned for before the learners enter the course, not after resumingtheir work.

In addition to the planning needed to ensure transfer of new skills to the workplace, there are anumber of other learning activities which will increase the probability that learners will use theirnew skills. For example, any learning activity that is seen by the learner as realistic andwork-related will increase the likelihood that what has been learned will be applied.Finally, simulated skill practice with caregivers and their children, problem-solving discussionsand role plays give the learner confidence to apply new skills effectively and avoid theembarrassment of failure while on the job.

The following learning materials and activities also can increase transfer of learning to the job:

• Reference manuals and handouts that learners can use to refresh their memoriesonce they return to their jobs

• Performance and visual checklists that summarize the key steps in delivering VAS+D

• Analysis of work-related barriers to applying skills (i.e., may be discussed withlearners during the course)

• Role plays focusing on ways to deal with difficult situations on the job (if time permitsduring the course)

• Action planning to map out how and when new skills will be applied (may be as simpleas discussions with the learners about their plans or this may involve an action planningform)

• Learners attending the course in “teams” from the same organization

Action Plans

Another way that facilitators can increase learning transfer is through the use of action plans.An action plan is a sequence of steps that must be taken after completion of the course to planand deliver VAS+D.


An action plan has three major elements:

1. Specific tasks: what will be done and by whom?

2. Time horizon: when will it be done?

3. Resource allocation: what specific support is required and available?

To be effective, action plans should include the following elements:

• Early commitment. Secure commitment for action plans before the course, if possible.

• Realistic goal setting. Make sure that goals are specific, measurable, achievable andrealistic.

• Public discussion. Provide opportunities for discussion of action plans with other learners.Feedback helps create realistic planning, discussion can create a support network ofcolleagues who can help carry out the plans and public commitment increases the likelihoodthat the plans will be implemented.

• Monitoring VAS+D service delivery. When possible, build in opportunities for facilitators orlocal expert service providers to visit a learner’s work site to monitor progress in carrying outthe action plan. When personal visits are not possible, write or phone to check onimplementation of the plan.

Action plans may be formal documents or discussions completed either prior to or during acourse (see Sample 7-2 for a general action plan template). Whether an informal discussion ora formal document, action plans are essential in helping to ensure that the knowledge and skillsacquired during a course are implemented after the course.

In the VAS+D course facilitator’s guide there are supplemental activities that ask the learners todevelop site level action plans. The purpose of these exercises is to encourage learners to thinkcritically about their distribution activities, stimulate conversation among learners aboutdistribution planning and site-level activities, and serve as a starting point for generaldiscussions on collaboration, coordination, resource sharing, and other project managementconcerns. When time permits, these activities can be valuable action planning tools.

Follow-up Activities

Most facilitators know that follow-up after a course is essential, but few actually do it. Theexcuses are many and include:

• “I have no time.”

• “I have no budget.”

• “I have other courses to conduct.”


Perhaps facilitators would take follow-up more seriously if they realized that relapse rates(learners who go back to their pre-course ways of doing things) can be high without follow-up.

Follow-up can be almost any contact between the facilitator and learners that helps the learnersapply what they learned more effectively. The more intensive and frequent the follow-up, themore likely it will support transfer of learning. For effective follow-up, the facilitator can:

• Send relevant articles to learners after the course• Send links to websites with course related content• Send text messages or emails to support service providers• Exchange correspondence about successes and problems• Encourage learners to “network” and support each other• Make personal visits to monitor and consult on problems or meet with supervisors• Organize refresher courses and/or send videos to renew and extend skills• Arrange follow-up meetings with groups of learners to share experiences and discuss

mutual problems

Facilitator Development and Evaluation

After completing the facilitation skills course, new facilitators will be working with a proficientfacilitator when they conduct VAS+D service delivery courses. During these courses the newfacilitator will be observed and coached to help them become competent and, eventually,qualified course facilitators.

Vitamin Angels uses the Facilitator Skill Development and Evaluation Tool that can be usedby the new facilitator to help plan and conduct courses. This tool can also be used by theproficient facilitator to evaluate the new facilitator’s performance.

When available, a video camera can be used to make recordings of some or all of the coursepresentations, facilitator demonstrations, and facilitator evaluation sessions. This tool (as well asthe self-assessment guides in the Facilitation Skills for Conducting International Health Coursesmanual) can then be used to analyze and assess the facilitator’s ability to effectively plan andconduct the course.

Summary

Many of the problems encountered during a course can be avoided through careful planning(see Sample 7-1). Giving thought to learner selection, and communicating with both thoseattending and their supervisors, will help to ensure that the appropriate learners are present.Making arrangements concerning classroom facilities is the next critical step in planning thecourse. Reviewing the course materials and adapting them as necessary are also keycomponents of the planning process. When the course begins, the facilitator will find that thiscareful planning was well worth the effort, and has helped to create an environment where thesuccessful transfer of knowledge, attitudes and skills can occur.


SAMPLE 7-1

FACILITATOR’S CHECKLIST FOR COURSE PREPARATION

KEY PREPARATION STEPS WHENCOMPLETE

COMMENTS

Learner Selection and Management

Review learner selection criteria in the course syllabus

Visit the potential learners in advance (if possible)

Clarify responsibility for learner transportation to and from thecourse

Arrange learner transportation to and from the course (ifapplicable)

Clarify housing arrangements

Clarify housing costs

Clarify transportation reimbursement rates (if applicable)

Provide the learners with the phone numbers of the learningsite and/or person making arrangements, if appropriate

Classroom Logistics

Consider cost and proximity to work when selecting a site

Ensure classroom is large and has good light and ventilation

Ensure that the required audiovisual equipment is available

Arrange for breakout rooms (if applicable)

Arrange for breaks and meals

Arrange to set up the room the day before the course begins

Make sure the furniture is arranged appropriately

Classroom Preparation

Review the course syllabus

Review the course outline

Review the course schedule

Review the performance and visual checklists

Review the knowledge assessment

Study the reference manual

Study the presentation slides and facilitator notes

Prepare presentation notes

Prepare supporting audiovisuals

Check all audiovisual equipment

Prepare for skill practice sessions (arrange for supplies)


SAMPLE 7-2

ACTION PLAN

Goal: ___________________________________________________________________________________________

Action Steps

What will be done?

Responsibilities

Who will do it?

Timeline

By when(day/month)?

Resources

Resources Available

Resources Needed

Potential Barriers

Who might resist?

How?

CommunicationsPlan

Who is involved?

What methods?

Step 1:

Step 2:

Step 3:

Step 4:

Step 5:

Evidence of Success (How will you know that you are making progress? What are your benchmarks?)

Evaluation Process (How will you determine that your goal has been reached? What are your measures?)


CHAPTER EIGHT

PLANNING AND CONDUCTING THE VAS+D SKILLDEVELOPMENT COURSE

Introduction

Vitamin Angels’ vision is that all vitamin A supplementation and deworming (VAS+D) serviceproviders are able to competently provide services to eligible children. In the VAS+D instructorled course, service providers learn the essential knowledge through PowerPoint and interactivecourse presentations. They develop the required skills by observing the course facilitator and thenpracticing as the facilitator observes, coaches, and evaluates their skill competency.

As we learned in a previous chapter, eLearning allows service providers to learn the essentialknowledge and then practice on their own, or with others in their organization. One way to learnand demonstrate skill competency is for service providers to attend the VAS+D skill developmentcourse. Another way is to be coached and evaluated by another service provider in theirorganization who is already competent at VAS+D delivery, a common approach used in cascadetraining.

The VAS+D skill development course is conducted by qualified skill development trainer or coursefacilitator. In this chapter, we will assume the course is being conducted by a pair of trainers. Thetrainer is responsible for ensuring that the course is conducted according to the course scheduleand outline.

Chapter Objective

After completing this chapter, you will be able to plan and conduct a VAS+D skill developmentcourse.


• Describe the design of the skill development course• Ensure appropriate learner selection• Review the required course materials• Select and make arrangements for the training site• Complete trainer planning• Conduct the skill development course• Describe the process for developing trainers



The VAS+D Skill Development Course

The VAS+D skill development course requires less than 8 hours (4-6 hours depending on thenumber of learners and trainers) and focuses on skill practice and competency evaluation. Thiscourse may be used to train service providers who are unable to use eLearning.

Note – The one-day skill development course may also be used as part of a cascade trainingsystem. See Chapter 2 for more information on cascade training.

This course is conducted by qualified skill development trainers. The number of trainers must besufficient to allow all of the learners to practice and be evaluated for competency during thecourse. Table 1.1 shows the schedule for the VAS+D skill development course.

Table 1.1: VAS+D Skill Development Course Schedule

Vitamin A Supplementation and Deworming (VAS+D) Skill DevelopmentCourse Schedule

TimeAllotted

8:00 am Registration and Tea 30 min

8:30 am Introductions 15 min

8:45 am Course Overview, Objectives and Review of Materials 10 min

8:55 am Demonstration of VAS+D Service Delivery (video, if available) 15 min

9:10 am Review of the Performance Checklist and Visual Checklist 40 min

9:50 am Introduction to Skill Practice and Competency Evaluation andCoaching

15 min

10:05 am Demonstration of VAS+D Service Delivery (including feedback) 20 min

10:25 am Skill Practice and Competency Evaluations 95 min

12:00 pm Lunch 45 min

12:45 pm Skill Practice and Competency Evaluations 90 min

2:15 pm Vitamin A and Deworming Fact Sheet/eLearning modules ifavailable

30 min

2:45 pm Question and Answer Session 20 min

3:05 pm Course Closing 10 min

3:15 pm Departure


In reviewing the course schedule, it should be clear that the primary focus is on skill development.If time allows, there is a 30-minute session at the end of the course to review the VAS+D factsheets which provide additional information about vitamin A supplementation and deworming.

Learner Selection

Learners attending a VAS+D skills development course should meet these criteria:

• Learners should be responsible for either or both:o Vitamin A and deworming planning, service delivery and oversight, oro Training of service providers.

• Learners should have an interest in providing VAS+D services.

• The learner or the learner’s organization should be capable of offering VAS+D services.

• Learners should have the support of their supervisor or manager.

Learners should be notified in advance of the course. As part of their invitation, learners (and theirsupervisors, if appropriate) should be sent information about the course. In addition to the dates,location and logistical information, learners should receive a copy of the course syllabus whenpossible. The syllabus describes the course and its goals, learning materials, learner selectioncriteria, and how the learners will be evaluated.

Course Materials

The VAS+D skill development course is designed so that it can be conducted with or withoutpresentation technology (i.e., computer and projector). There are no PowerPoint presentationsduring the skill development course. If a computer and projector are available, the trainer canshow the VAS+D video as well as portions of the eLearning course, if time allows.

The course materials include:

• VAS+D Visual Checklist• VAS+D Fact Sheet• VAS+D Performance Checklist• Vitamin A and Deworming FAQs


Course supplies include:

• Vitamin A capsules (both red and blue)• Deworming tablets• Hand sanitizer• Clean scissors• Napkins or tissues• Small squares of clean white paper for crushing tablets• Glass bottle for crushing tablets• Plastic bag for trash• Pens• Tally Sheets, Distribution Registers, and Child Health Cards• Balloons (to use as babies)

The quantities of course materials and supplies will depend on the number of service providersattending the course.

The trainer will also need a copy of the VAS+D skill development course trainer’s guide thatincludes the course schedule and course outline.

Training Site Arrangements

The skill development course may be held at a field partner’s facility or may be in a hotel or trainingcenter. In choosing a site, the trainer should make sure that:

• This course is the only event scheduled in the room that day.

• The space is large enough for the number of learners attending the course and willaccommodate:

o Tables arranged in a U-shape or other formation that will allow as many of thelearners as possible to see one another and the trainer

o A table in the front of the room where the trainers can place their course materials

o Space and tables for learners to work in small groups for skill practice andcompetency evaluation

• The room is properly heated or cooled and ventilated.

• There are toilet facilities which are adequately maintained.

• Furniture such as tables, chairs, and desks is available.

• The lighting is adequate.


There are also other arrangements related to the learning site which the trainer needs to consider:

• Refreshments for morning and afternoon breaks should be planned. Decide if thesebreaks will be set up in the classroom, outside of the classroom or in another room (e.g.,cafeteria).

• The trainer may need to plan for lunch. Decide if lunch will be set up in the classroom,outside of the classroom or in another room (e.g., cafeteria).

• The room should be set up before the course begins.

Trainer Planning

Trainer preparation is essential to conducting a successful VAS+D skill development course. Thetrainer will find that thorough preparation was well worth the effort when the course runs smoothlyand the learners leave with the ability to competently perform the required skills.

Preparation for the course falls into two categories: getting ready for the course in general (e.g.,obtaining necessary supplies and equipment) and planning course delivery. The following stepsare recommended:

• Complete the VAS+D eLearning course, practice and be evaluated as competent.

• Review the course syllabus, including the course description, goals, learning methods,materials, methods of evaluation, etc.

• Review the course schedule. If there are several trainers, determine who is responsiblefor each of the course sessions.

• Study the course outline. The course outline provides detailed suggestions regarding howto conduct the course.

• Read and study the reference manuals to ensure complete familiarity with vitamin Asupplementation and deworming.

• Review and make copies of the performance checklist, fact sheets, and FAQs.

• Ensure that there is a sufficient number of visual checklists.

• Practice VAS+D service delivery using the visual checklist.

• Prepare VAS+D supply kits. These kits include the supplies learners will need whenpracticing VAS+D service delivery.

• There should be a clear expectation that each learner will be providing VAS+D servicesfollowing the course. This allows the trainer to use specific examples related to how to setup and properly distribute vitamin A and deworming.


Conduct the Skill Development Course

The day of the skill development course is finally here. The two trainers arrived yesterdayafternoon to set up the room. There are going to be 14 learners, so the room is set for 7 pairs oflearners to work together during skill practice.

The trainers will be following the schedule shown in Table 1. The following is brief description ofhow the day will go (for more detail see the course outline).

• Learners begin to arrive. They sign in and have some tea.

• At the time indicated in the schedule, the trainer asks everyone to introduce themselves.

• The trainer then goes over the schedule, objectives and the course materials.

• The trainers will demonstrate VAS+D. One of the trainers will be the service provider andwill be using the visual checklist. The other trainer will act as a caregiver with a child. Thetrainers can also show the VAS+D service delivery video (if possible).

• The trainers will then review the performance and visual checklists. The learners shouldbe very familiar with the checklists after completing the eLearning course. If this is a skilldevelopment course for service providers who do not have access to eLearning, then thetrainers will need to ensure that all learners clearly understand the purpose of eachchecklist.

• The trainers will then explain skill practice, competency evaluation, and coaching.

• The learners will now see a second demonstration of VAS+D. This time one of the trainerswill be the service provider and one of the learners will play the role of the caregiver witha child. The other trainer will be the coach. Following service delivery, the trainer will sitwith the service provider and provide sandwich feedback. The trainer will also indicate ifthe service provider is competent or not.

• The learners will then work in pairs to practice VAS+D while making sure to providefeedback to each other. The trainers will move from pair to pair observing and providingfeedback, and will begin to assess competency as learners are ready.

• Following the competency evaluations, one of the trainers will review the information inthe fact sheets. If all of the learners have completed the eLearning course, then thissession may not be required. However, if time permits, this will be a very good review. Ifthis is a course for learners who have not taken the eLearning course, then this sessionis required.

• The end of the course includes a question and answer session and closing.

The Drop-In Option – In some cases, the trainers may use a “drop-in” model for conducting theskill development course. For example, a large hospital has 18 service providers who havecompleted the eLearning course. The trainers can set up a room at the hospital and the providerscan drop-in to watch the VAS+D video (as a refresher), practice service delivery and then beevaluated for competency. It may be helpful to ask providers to sign up for time slots in advanceto avoid having too many people in the room at one time.


Developing Trainers

The process to develop a qualified skill development trainer includes the following steps:

1. An individual completes the VAS+D instructor led course or eLearning course togetherwith the skill development course. The individual must demonstrate the ability tocompetently provide services.

2. The individual then attends the one-day training skills course.

3. The newly developed skill development trainer then assists with conducting severalVAS+D skill development courses while being observed and coached by a qualifiedcourse facilitator or skill development trainer. As part of these courses the qualifiedfacilitator or trainer completes the appropriate sections of the Facilitator SkillDevelopment and Evaluation Tool (discussed in Chapter 7) capturing information aboutthe new trainer’s performance. In addition, videos of skill development activities arerecorded. These are reviewed by Vitamin Angels personnel and, if approved, the newtrainer is qualified and issued a certificate.

4. The newly qualified trainer is then able to work with other qualified facilitators and trainersto conduct the VAS+D skill development course.

Summary

Caregivers of children receiving vitamin A supplementation and deworming must be confidentthat the service provider is competent. Services must be provided according to internationalstandards and best practices. This means that service providers must be trained. Through acombination of eLearning and the skill development courses conducted by qualified trainers,Vitamin Angels is confident that eligible children will receive quality services from competentservice providers.

Vitamin Angels – Facilitation Skills – Appendix 1 - 1

APPENDIX 1


HOW PEOPLE LEARN AND GROUPS DEVELOP

Note: This appendix contains supplemental information that may be useful to coursefacilitators, and provides important information for those learning to plan and conductcourses for health workers.

Introduction

The environment within which learning occurs has a tremendous impact on the quality of thelearning experience. A positive learning climate maximizes the effectiveness of various learningmethods, and thereby helps learners to achieve the course objectives.

Good planning, before the course begins, is necessary to creating a positive learning climate.Because the facilitator sets the tone for the course, how the facilitator delivers information isthe key to establishing and maintaining a positive learning climate during the course. In anycourse, how something is said may be just as important as what is said. To help create andmaintain an atmosphere that is conducive to learning, the facilitator must understand howpeople learn and how groups develop.

Objective

After completing this section, you will be able to describe how people learn and groups develop.

Enabling Objectives: To attain the objective, you will:

• Identify characteristics of how people learn• Explain how groups form and develop


How People Learn

Establishing a positive learning climate depends on understanding how adults learn. Thefacilitator must have a clear understanding of what the learners need and expect, and thelearners must have a clear understanding of why they are there. Adults who attend courses toacquire new knowledge, attitudes and skills:

• Require learning to be relevant

• Are highly motivated if they believe learning is relevant

• Need participation and active involvement in the learning process

• Desire a variety of learning experiences

• Desire positive feedback

• Have personal concerns and need an atmosphere of safety

• Need to be recognized as individuals with unique backgrounds, experiences andlearning needs

• Must maintain their self-esteem

• Have high expectations for themselves and their facilitator

• Have personal needs that must be taken into consideration

These ten characteristics are described in more detail below.

Relevance

The facilitator should provide learning experiences that relate directly to the current or futurejob responsibilities of the learners. At the beginning of the course, the objectives should bestated clearly and linked to job performance. The facilitator should take time to explain howeach learning experience relates to the successful accomplishment of the course objectives.

Motivation

People bring high levels of motivation and interest to a course. Health workers, for example,may wish to acquire new knowledge and skills to improve VAS+D service delivery. Motivationcan be increased and channeled by the facilitator who provides clear learning goals andobjectives. To make the best use of a high level of learner interest, the facilitator should exploreways to incorporate the needs of each learner into the learning sessions. This means that thefacilitator needs to know quite a bit about the learners, either from studying backgroundinformation about them or by allowing learners to talk early in the course about their experienceand learning needs.


Involvement

Few individuals prefer just to sit back and listen. The effective facilitator will design learningexperiences that actively involve the learners in the learning process. Examples of how thefacilitator may involve learners include:

• Allowing learners to provide input regarding schedules, activities and other events

• Questioning and feedback

• Brainstorming and discussions

• Hands-on work

• Group and individual exercises

• Classroom activities

Variety

Learners attending courses desire variety. The facilitator should use a variety of learningmethods including:

• Audiovisual aids (e.g., job aids, flipcharts, writing boards, videos, etc.)

• Interactive presentations

• Demonstrations

• Brainstorming

• Small group activities

• Group discussions

• Role plays and case studies

• Guest speakers

Positive Feedback

Learners need to know how they are doing, particularly in light of the objectives andexpectations of the course. Is their progress in learning meeting the facilitator’s expectations? Istheir level of performance meeting the standards established for the delivery of VAS+Dservices? Positive feedback helps to provide this information.

Learning experiences should be designed to move from the known to the unknown or fromsimple activities to more complex ones. This progression provides positive experiences andfeedback for the learner. To provide positive feedback, the facilitator can:


• Give verbal praise either in front of other learners or in private

• Use positive responses during questioning:

o “That’s correct!”

o “Good answer!”

o “That was an excellent response!”

• Recognize appropriate skills while coaching during skill practice sessions:

o “Very good work! Lunah is holding the capsule in the correct position toadminister the vitamin A to the child.”

o “I would like everyone to notice the way James greeted the child’s caregiver. Hedid an excellent job, and the way you greet your clients should be similar.”

• Let the learners know how they are progressing toward achieving learning objectives

Personal Concerns

The facilitator must recognize that many learners fear failure and embarrassment in front of theircolleagues. Learners often have concerns about their ability to:

• Fit in with the other learners

• Get along with the facilitator

• Understand the content of the course

• Perform the skills being taught

The facilitator must be aware of these concerns and open the course with an introductoryactivity (e.g., fun methods of having learners introduce themselves; establish group norms thatwill place learners at ease). It should communicate an atmosphere of safety so that learnersdo not judge one another or themselves. For example, a good introductory activity is one whichacquaints learners with one another and helps them to associate the names of the otherlearners with their faces. This opening activity can be followed by learning experiences thatsupport and encourage the learners.

Being Treated as an Individual

People want to be treated as individuals, each of whom has a unique background, experienceand learning needs. A person’s past experiences are good foundations upon which thefacilitator can base new learning.

Each person is the best judge of what ideas and skills are relevant to her or his particularwork situation.


To help ensure that learners feel like individuals, the facilitator should:

• Use learner names as often as possible (the facilitator can use name tents to help learnand use learner names)

• Involve all learners as often as possible

• Treat learners with respect

• Allow learners to share information with others during classroom instruction and skilldevelopment

Self-Esteem

Learners need to maintain high self-esteem to deal with the demands of a skill developmentcourse. Often the learning methods used in a skill development course are different from othercourses learners may have experienced. It is essential that the facilitator show respect for thelearners, no matter what practices and beliefs they hold to be correct, and continually supportand challenge them. This requires the facilitator to:

• Reinforce those practices and beliefs embodied in the course content.

• Provide corrective feedback when needed, in a way that the learners can accept anduse it with confidence and satisfaction.

• Provide learning experiences that adds to, rather than subtracts from, their sense ofcompetence and self-esteem.

• Recognize learners’ own career accomplishments.

High Expectations

People attending courses tend to set high expectations both for the facilitators and forthemselves. Getting to know their facilitators is a real and important need. Facilitators shouldbe prepared to talk modestly, and within limits, about themselves, their abilities and theirbackgrounds.

Personal Needs

All learners have personal needs during a course. Taking timely breaks and providing the bestpossible ventilation, proper lighting and an environment as free from distraction as possible canhelp to reduce tension and contribute to a positive learning atmosphere.

The challenge for the facilitator is to acknowledge all of the learners’ desires, needs andconcerns and at the same time help the individuals come together as a group. By sharing withthe learners’ expectations of how they will behave during the course, and asking them to tell thegroup their own expectations, the facilitator begins the process of establishing patterns ofbehavior acceptable to the group, or group norms. This step is critical in creating a positivelearning climate.


Understanding Group Dynamics

From the previous section on adult learning, it is clear that establishing a positive learningclimate depends on the individual learners coming together to form a healthy, mutuallysupportive group. A collection of individuals becomes such a group when:

• They share a common purpose.

• The members think of themselves as a group and they share a common experience inattending the course.

• Each member’s contributions and questions are valued and respected.

• An open and trusting climate develops.

• The members pay attention to how they work together.

These are the forces, known as group dynamics, that are present among individuals whocome together to form a group. To understand and learn to manage group dynamics, thefacilitator, without making any judgments, must become aware of what is happening in theroom. Gradually, as shown in Figure 1, the facilitator progresses through several steps –observation, increased awareness, discussion with other facilitators – before developing optionsto support the group and help it achieve its goals.

Figure 1. Steps in Understanding Group Dynamics

2. Developincreasedawareness

3. Discussobservationswith otherfacilitators

1. Observe

4. Develop options tosupport the group:• Increased energy• Focus on the

individual• Focus on the group


While monitoring the development of the group and making choices to guide it, the facilitatormust also realize that the group functions at several levels – as individuals, as small groups(especially when several learners are from the same organization) and as the larger group. Thedynamics become more complex as the members move from contributing individually, tointeracting in small groups, and then working within the larger group; they are individuals and apart of the small group and members of the large group.

At the same time, the small group unit is bringing its own dynamic to the larger group. Eachfacilitator will find that she or he is most comfortable observing and understanding the behaviorsat one of these levels – individual, small group or larger group.

The new facilitator must be aware of this, and strive to become adept in working at each level inorder to manage group dynamics effectively. One way of developing skills in observing andworking at these various levels is to use a journal (see sample on the next page).


Using a Journal

A new facilitator conducting courses often finds it difficult to be aware of everythinghappening in the classroom. One way to improve observation skills is to keep a journal. Thefacilitator should take 30-45 minutes after each day of the course to make notes as describedbelow.

• Identify a specific incident that stands out for you.

Examples:• One learner was particularly helpful in encouraging her group to complete its task.• A learner challenged your technical knowledge about vitamin A.• At a particular time during the morning, the group fell totally silent and tension started

to build in the room. You have noticed that learners are deferring to a senior courselearner who does not like “all this interactive nonsense.”

• Record this incident in as much detail as possible, identifying what each person in theexchange said or did.

• Write what you were doing (if anything) during the incident.

• Write what you were thinking.

• Record what you were feeling. This step is extremely important because often our feelingswill give us information about a situation that our analytical minds cannot give.

• After all the thoughts and feelings are recorded, ask yourself this question: “What can Ilearn from this incident?” There are times when an answer will immediately present itself.At other times, you may have to wait a while for an idea. If nothing comes to you, leave itand come back to it later, or leave it completely.

• Note on what level you make your observations: individual, small group or total group.

• Over time, if you look back at what you have written, you can begin to identify patterns inyour learning. Sharing these patterns with other facilitators will help strengthen yourobservation skills and support other facilitators in further developing their skills.


What the Group Does (Content) and How It Does It (Process)

In monitoring group development, the facilitator attends to the content as well as the processin the group. When the group is discussing how adults learn or how to give an effectivepresentation, their focus is on content.

In a course, the content is determined before the course begins. It is described in the courseobjectives and further refined during each session. The content includes:

• Readings from the reference manual

• Information from PowerPoint slides (and other audiovisuals)

• Group discussions on the learning objectives

• Small group activities and follow-up discussions

The challenge for the facilitator is to make sure that all required course content is covered andthat the course objectives are met.

When the individuals in the course are working together as a group, their interaction is known asgroup process. Group process includes:

• Communications

• Participation

• Group cohesion

• Atmosphere

• Group norms

• Leadership

Managing the group process is as important for the facilitator as managing the content ofthe course.


Why is it important for the facilitator to understand group process? For learners to move towardtheir learning goals, a course needs three important elements:

• Structure

• Direction

• Leadership

Without these elements, the group may begin to disintegrate, and undesirable group behaviorthat will hinder learning may emerge. But with these elements in place, the healthy groupdescribed above can develop. Understanding what to look for will help the facilitator know whento intervene if the group begins to develop any unhealthy patterns (e.g., arriving late, ridiculingother learners, talking during a presentation).

The facilitator can also intervene in the group in order to reinforce positive, healthy groupbehavior. Table 1 shows aspects of group process that the facilitator and learners shouldobserve, gives examples of both positive and negative behaviors that the facilitator shouldwatch for and suggests steps the facilitator can take when undesirable behavior occurs.

As a result of the interactive methods used and the facilitator’s management of the groupprocess, a group identity gradually emerges. The members of the group see that this course isdifferent and their experience tells them that this way of learning is far superior to the old ways.As they get to know one another in the interactive sessions, learners begin to view the otherswith respect and value their contributions and questions. This results in an open and trustingclimate in which learners can learn.

With practice, the effective facilitator becomes confident – about both the course material beingpresented and the status of the group interaction. Knowing when to intervene in the group lifeand when to stand back is a skill that is developed over time. Knowing how to gauge the energyof the group and how to keep the group moving forward also are skills that are acquired withexperience. Each learning event provides additional information about which techniques areeffective and which are not.

When the facilitator uses this experience as a learning tool for new facilitators, the classroomindeed becomes a living laboratory where everybody learns and benefits. A critical factor inkeeping the group energy alive and moving forward is the facilitator’s ability to present thecourse material in a number of different ways that will keep the learners engaged.


Table 1. Group Process: Behaviors and Interventions

ASPECT OFGROUP

PROCESS

DESIRED BEHAVIOR EXAMPLES OF UNDESIRABLEBEHAVIORS

POSSIBLE INTERVENTIONS

Communication When learners speak, othergroup members listen andrespond appropriately.Learners are aware of howcommunication ishappening in the group.

Learners interrupt one another or thefacilitator.Group members do not listen to oneanother.Learners look at the floor when theytalk.Learners carry on side conversations.

The facilitator asks group members what they notice about how they arecommunicating: “Do you see any patterns or themes in the way people arecommunicating?”When there are side conversations, the facilitator moves toward the peoplewho are involved in it, or asks the learner who is trying to speak to thegroup: “What does it feel like when you are speaking and others are talkingat the same time?”

Participation Discussion is structured sothat everyone canparticipate.

Some learners dominate discussion.A few learners are uncomfortabletalking in a group.The facilitator talks too much.

When dominant members want to contribute, the facilitator says, “Let’s hearfrom some other people.”The facilitator is sensitive in drawing out the learners.The facilitator monitors the amount of time he or she is speaking; self-awareness is the key.

Group Cohesion Members accept groupgoals and are willing towork toward them.

There is competition betweenindividuals or subgroups working on atask.

The facilitator calls the group’s attention to the effects of competition, andexplains to them that some degree of competitiveness can be helpful to thegroup interaction. The facilitator tells the group, “There are enough rewardsfor everyone and enough time for all to complete the tasks.”

Atmosphere Group members arefriendly with one anotherand feel free to expressthemselves and sharepersonal feelings.

Group members are formal in theirinteractions.Atmosphere is tense.

The facilitator asks the group, “What is the atmosphere in the group rightnow?” If the group is silent, the facilitator describes the group atmosphereand asks for comments from learners.If the atmosphere is tense, the facilitator starts a discussion about the effectof tension on the group. If tension is the result of unresolved conflict, discussthe issue and resolve it, or agree to disagree.

Group Norms The group has developed aconsensus about how towork together.

Learners arrive late.Learners talk at the same time.Sessions do not end on time.Feedback is insincere.

Discuss norms on the first morning. When norms are not honored, thefacilitator must discuss this issue with the group. The facilitator can bring tothe front of the room the flipchart page about norms that was created on thefirst day, and ask the group members whether they are still committed tofollowing the norms or if they want to change them.

Leadership The facilitator respects thelearners and speaks tothem as colleagues, andthe learners respect thefacilitator.

The facilitator speaks to the learners ina condescending way.The facilitator is not comfortable in aleadership role.The facilitator discourages discussionthat disagrees with her or his opinion.

The facilitator has to take responsibility for her or his own behavior. Whenthere are two or more facilitators, they need to give one another feedback. Ifconducting the course alone, the facilitator arranges to be observed by amore experienced facilitator who will provide feedback. In either case, thefacilitator being observed will have to make clear to the observer in whatareas she or he believes she needs feedback.

Vitamin Angels – Facilitation Skills – Appendix 1 -14

Vitamin Angels – Facilitation Skills – Appendix 2-1

APPENDIX 2


Facilitating Learning Activities

Note: This appendix contains supplemental information that may be useful to coursefacilitators, and provides important information for those learning to plan and conduct coursesfor health workers.

Introduction

An effective presentation or small-group activity can be one of the most rewarding aspects of afacilitator’s responsibilities. The facilitator who is able to maintain learner interest with anexciting, dynamic delivery using a variety of learning techniques is more likely to be successfulin helping learners reach course objectives. The facilitator will find that the time and effortinvested in planning prior to the course were well spent as the facilitator and learners interact,discuss, question and work together.

As seen in this manual, there are a number of presentation skills that the facilitator can use tomake a learning session more effective. This appendix focuses on facilitating learning activitiessuch as small group activities, case studies, role plays, brainstorming and discussions.

Objective

After completing this section, you will be able to facilitate small group activities, case studies,role plays, brainstorming and discussions.

Enabling Objectives: To attain the objective, you will:

• Facilitate a small-group activity• Facilitate the use of a case study• Facilitate the use of a role play• Conduct a brainstorming session• Facilitate a discussion


Facilitating Small-Group Activities

There are times during courses when the learners may be divided into several small groups.Examples of small group activities are:

• Solving a problem that has been presented by the facilitator or another learner

• Reacting to a case study that can be presented in writing or orally by the facilitator

• Conducting a role play within the small group and presenting it to the group as a whole(e.g., VAS+D delivery small-group practice)

Small group activities offer many advantages including:

• Providing learners an opportunity to learn from one another

• Involving all learners

• Creating a sense of teamwork among members as they get to know one another

• Providing for a variety of viewpoints

When small group activities are being conducted, it is important that learners not be in the samegroup every time. The facilitator can create small groups by:

• Assigning learners to groups

• Asking learners to count off “1, 2, 3,” etc. and having all the “1s” meet together, all the“2s” meet together, etc.

• Asking learners to form their own groups

• Asking learners to draw a group number (or group name, or color) from a basket

The classroom(s) used for small group activities should be large enough to allow severalarrangements of tables and chairs so that individual groups can work without disturbing oneanother. The facilitator should be able to move easily about the room to visit each group. Ifavailable, consider using smaller rooms (known as breakout rooms) near the primary classroomwhere small groups can go to work on their problem-solving activities, case studies or roleplays.

Activities assigned to small groups should be challenging, interesting and relevant; shouldrequire only a short time to complete; and should be appropriate for the background of thelearners. Each small group may be working on the same activity or each group may be takingon a different problem, case study or role play. Regardless of the type of activity, there is usuallya time limit. When that is the case, inform groups when there are 5 minutes left and again whentheir time is up.


Instructions to the groups may be presented:

• In a handout• On a flipchart• On a slide• Orally by the facilitator

Instructions for small group activities typically include:

• Directions• Time limit• A situation or problem to discuss, resolve or role play• Learner roles (if a role play)• Questions for a group discussion

After the groups have completed their activity, the facilitator will bring them together as a largegroup for a discussion of the activity. This discussion may involve:

• Reports from each group• Responses to activity questions• Role plays developed and presented by learners in the small groups• Recommendations from each group

It is important that the facilitator provide an effective summary discussion following small groupactivities. This provides closure and ensures that learners understand the point of the activity.


Facilitating the Use of Case Studies

A case study is a learning method using realistic scenarios that focus on a specific issue, topicor problem. It is used principally to reinforce or expand the learners’ knowledge. Learnerstypically read, study and react to the case study orally during a group discussion or in writing.The primary advantage of the case study is that it focuses the attention of the learner on a realsituation. Learners may work separately or in small groups to solve or complete a case study.

Advantages of using a case study include:

• It is a participatory method of learning which actively involves all of the learners andencourages them to interact with one another.

• Learners react to realistic and relevant cases which relate directly to the course andoften to their work environment.

• Reactions often provide different perspectives and different solutions to problemspresented in the case study.

• Reacting to a case study helps learners develop problem-solving skills.

Case studies can be developed by the facilitator or the learners. Situations for the casestudies can be found in one or more of the following sources:

• Experiences the facilitator has had

• Records from healthcare delivery sites

• Experiences from clinic staff, learners or clients

After learners have read the case study, either individually or in small groups, they should begiven the opportunity to react to it. Typical reaction exercises include:

• Analysis of the problem. The learners are asked to analyze the situation presented inthe case study and determine the source of the problem.

• Focused questions. These inquiries ask learners to respond to specific questions.

Example:

“What are three observations suggesting that the VAS+D provider competentlyperformed the steps in the checklist?”

• Open-ended questions. These questions provide the learners with more flexibility inresponding.

Example:

“What are some of the consequences of failing to wash your hands beforeproviding vitamin A?”


• Problem solutions. The learners are asked to offer suggestions regarding the situationbeing presented.

Example:

“How could this problem have been avoided?”

Once learners have reacted to the case study they should be given the opportunity to sharetheir reactions. This sharing might take the form of one or more of the following:

• Reports from individuals or small groups

• Responses to case study questions

• Role plays presented by individuals or small groups

• Recommendations from individuals or small groups

The facilitator should summarize the results of the case study activity before moving on to thenext topic.

An example of a case study is presented at the end of this appendix.


Facilitating the Use of Role Plays

A role play is a learning method in which learners act out roles in a situation related to thelearning objectives. Although knowledge is usually required to conduct an effective role play, itspurpose is to influence the behavior of learners. Role play has several advantages:

• Role play can create a motivational climate because learners are actively involved in arealistic situation.

• Learners can experience a real-life situation without having to take real-life risks.

• Role plays give the learners an understanding of the client’s situation.

Examples:

o Make learners aware of the communication skills needed for providingVAS+D.

o Practice VAS+D service delivery in small groups.

To conduct the role play, the facilitator should:

• Decide what the learners should learn from the role play (the objectives)

• Devise a simple situation

• Explain what the learners should do and what the other learners should observe

• Discuss important features of the role play by asking questions of both the players andobservers

• Summarize what happened in the session, what was learned and how it applies to theskill or activity being learned

An example of a role play can be found at the end of this appendix.


Facilitating Brainstorming Sessions

The primary purpose of brainstorming is to generate a list of ideas, thoughts or alternativesolutions that focus on a specific topic or problem. This list may be used as the introduction to apresentation or form the basis of a group discussion. Brainstorming requires that learners havesome background information related to the topic.

The following guidelines will help you to facilitate the use of brainstorming:

• Establish ground rules (e.g., all ideas are accepted, no discussion of ideas duringbrainstorming)

Example:

“During this brainstorming session, we will be following two basic rules. All ideaswill be accepted; Alain will write them on the flipchart. At no time will we discussor criticize any idea. Later, after we have our list of suggestions, we will go backand discuss each one. Are there any questions? If not....”

• Announce the topic or problem.

Example:

“During the next few minutes we will be brainstorming and will follow our usualrules. Our topic is ‘Opportunities for distribution of vitamin A supplements.’ Iwould like each of you to think of at least one opportunity. Maria will write theseon the board so that we can discuss them later. Who would like to be first? Yes,Ilka....”

• Maintain a written record on a flipchart or writing board of the ideas and suggestions.This will prevent repetition and keep learners focused on the topic, and will be usefulwhen it is time to discuss each item.

• Involve the learners and provide positive feedback in order to encourage more input.

• Review written ideas and suggestions periodically to stimulate additional ideas.

• Conclude brainstorming by reviewing all the suggestions.


Facilitating Group Discussions

The group discussion is a learning technique in which most of the ideas, thoughts, questionsand answers are developed by the learners. The facilitator typically serves as the facilitator andguides learners as the discussion develops.

Group discussion is useful:

• At the conclusion of a learning session• After viewing a video• Following a skill demonstration• After reviewing a case study• After a role play• Following a brainstorming session• At any other time when learners have prior knowledge or experience related to the topic

Attempting to conduct a group discussion when learners have limited knowledge of orexperience with the topic often will result in little or no interaction and thus an ineffectivediscussion. When learners are familiar with the topic, the ensuing discussion is likely to arouselearner interest, stimulate thinking and encourage active participation. This interactionaffords the facilitator an opportunity to:

• Provide positive feedback• Emphasize key points• Create a positive learning climate

Follow these key points to ensure successful group discussions:

• Arrange seating to encourage learner interaction (e.g., tables and chairs set up in aU-shape, square or circle so that learners face one another).

• State the topic as part of the introduction.

Example:

“To conclude this presentation on how to set up the workspace during vitamin Adistribution, let’s take a few minutes to discuss the importance of creating aworkspace. Youssef, what do you think about creating a workspace?”

• Shift the conversation from the facilitator to the learners.

Examples:

“Rajesh, would you share your thoughts on...?”“Rosa, what is your opinion?”“Enrique, do you agree with my statement that...?”


• Act as a referee and intercede only when necessary.

Example:

“It is obvious that James and Dorothy are taking opposite sides in this discussion.Dorothy, let me see if I can clarify your position. You seem to feel that....”

• Summarize the key points of the discussion periodically.

Example:

“Let’s stop here for a minute and summarize the main points of our discussion.”

• Ensure that the discussion stays on the topic.

Examples:

“Sandra, can you explain a little more clearly how that situation relates to ourtopic?”

“Monica, would you clarify for us how your point relates to the topic?”

“Let’s stop for a moment and review the purpose of our discussion.”

• Use the contributions of each learner and provide positive reinforcement.

Examples:

“That is an excellent point, Mulamba. Thank you for sharing that with the group.”

“Ola has a good argument against the policy. Otte, would you like to take theopposite position?”

• Minimize arguments among learners.

• Encourage all learners to get involved.

Example:

“Joygrace, I can see that you have been thinking about these comments. Canyou give us your thoughts?”

• Ensure that no one learner dominates the discussion.

Example:

“Luz, you have contributed a great deal to our discussion. Let’s see if someoneelse would like to offer....”


• Conclude the discussion with a summary of the main ideas. The facilitator mustrelate the summary to the objective presented during the introduction.

Summary

The learning techniques described in this appendix are somewhat non-traditional as manycourses depend on traditional lecturing by instructors. However, the use of small groupactivities, case studies, role plays, brainstorming and group discussions can make your coursemuch more interactive, effective and enjoyable for you and your learners.

The facilitator who can use these learning methods effectively to give an exciting, dynamicpresentation that holds the learners’ interest is more likely to be successful in helping learnersreach the course objectives.


Sample 1: Case Study

Directions for Learners

Divide into small groups. Read this case study individually. As a group, agree on the answers tothe questions. When all of the groups have finished their discussion, the case study andanswers from all of the groups will be reviewed in a group discussion.

Case Study

A mother brings her 11-month old baby to the vitamin A distribution event at the local clinic.You see that the child is having difficulties breathing.

Questions:

1. What information do you try and determine from the child’s health card and from themother?

2. Is the child eligible to receive vitamin A?


Sample 2: Role Play

Directions for Learners

Two learners in your group will volunteer for (or will be assigned) roles. One will be a VAS+Dprovider, the other a caregiver. Each learner who has a part in the role play should take a fewminutes to read the background information and prepare. The observer(s) in the group alsoshould read the background information so they can participate in the small group discussionfollowing the role play.

Learner Roles:

Provider: The health provider is very experienced with VAS+D delivery. The provider is alocal community during a health day and has set up to provide vitamin A.

Client: The client is a 23-year-old woman with three children. She has never broughtany of her children in for vitamin A and is very nervous about coming to see you.The ages of her children are 4 months, 2 years and 6 years. When the motherand her children come in it becomes evident that she is very nervous.

Focus oftheRole Play:

The focus of the role play is on the interaction between the provider and client.The provider must reassure the client. The client should continue to be nervousuntil the provider chooses the appropriate words and expressions that will informand calm the client.

Discussion Questions

1. Did the provider approach the client in a positive, reassuring manner?

2. Did the provider’s approach have the planned effect on the client? What otherapproaches would have been effective?

3. Were the client’s fears realistic?

4. How could this problem have been avoided?

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