Adapting HBLSS to Fit Your Program_DuBois_5.11.11


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  • Beneficiaries 43,700 WRA, 43,700 U5s
  • Master training was 3 weeks and used the Kiswahili version of the HBLSS Basic Manual Community Meetings 1-4 and Take Action Card Booklet developed by White Ribbon Alliance Tanzania, the MOH and other partners. We also used the English version since there were some discrepancies in the Kiswahili translations. We made some changes to the Kiswahili version with white tape, but were unable to reprint them due to cost. Materials distributed to Master Trainers: HBLSS Basic Manual (English, Kiswahili) Take Action Card Booklet (English, Kiswahili) Laminated teaching picture cards Teaching models (doll, placenta and cord, uterus)
  • INTEGRATED TRAINING ACTIVITIES: Due to cost and the required MOH MNC curriculum for training TBAs, WellShare adapted the HBLSS training and integrated it into the regular MNC training. This included an additional 2 days of training focused on HBLSS. Some MOH skills were slightly different than HBLSS skills, but this was discussed as part of the training. TBAs were very pleased with the HBLSS materials and training. The training was done by the district Reproductive and Child Health Coordinator with WellShare staff. Recommendations from the mid-term evaluation indicated a need for additional training of TBAs. So, we used a TOT model to provide refresher training and provide training across more HBLSS community meetings. PHOTO: TBAs at graduation
  • STGs – led by TBAs for young single pregnant women and mothers; HBLSS used by TBAs to educate the young women; TBAs also presented the picture cards and materials at community meetings including more participation by men and village leaders. Photos: STG mom with her baby. TBA at home.
  • Due to cost, only 2 sets of teaching picture cards and teaching models were provided to each village. Because TBAs frequently work in tandem, this worked. The M & E was too expensive to implement, so we integrated aspects of it into a Village Pregnancy Register which also captured other information needed by the project.
  • The HBLSS training in the Hadzabe and Datoga, which used a modified version to train 15 health advocates, resulted in a request for additional training on MNC because the initial training was so successful. The majority trained were men. Prohibitive costs include the M & E activities which would be great to do as specified, but we did not have sufficient funds.
  • Adapting HBLSS to Fit Your Program_DuBois_5.11.11

    1. 1. WellShare International Diana DuBois, MPH, MIA CORE Group Spring Meeting 11 May 2011
    2. 2. HBLSS – Karatu District, Tanzania
    3. 3. Tanzania Child Survival Project <ul><li>Karatu District, Arusha Region </li></ul><ul><ul><li>Population ~250,000 </li></ul></ul><ul><ul><li>45+ villages </li></ul></ul><ul><li>USAID-funded </li></ul><ul><li>5-year program (2006-2011) </li></ul><ul><li>Intervention areas: Maternal Newborn Care, Malaria, CDD, ARI, FP </li></ul>
    4. 4. HBLSS Integration <ul><li>Initial/specified training cascade </li></ul><ul><ul><li>Master training of trainers – 3 weeks </li></ul></ul><ul><ul><ul><li>(6 WellShare + 8 partner staff; ACNM consultants) </li></ul></ul></ul><ul><ul><li>HBLSS trainers </li></ul></ul><ul><ul><ul><li>(14 local TBAs; ACNM consultants and master trainers) </li></ul></ul></ul><ul><ul><li>HBLSS guides </li></ul></ul><ul><ul><ul><li>(32 local health facility staff and TBAs) </li></ul></ul></ul>
    5. 5. HBLSS Integration <ul><li>Integrated training activities (subsequent) </li></ul><ul><ul><li>Maternal newborn care training for TBAs </li></ul></ul><ul><ul><ul><li>Integrated with MOH MNC curriculum for TBAs </li></ul></ul></ul><ul><ul><ul><li>Additional 2 days HBLSS training for 36 TBAs </li></ul></ul></ul><ul><ul><li>HBLSS TOT training for TBAs </li></ul></ul><ul><ul><ul><li>Equivalent to “HBLSS trainers” training </li></ul></ul></ul><ul><ul><ul><li>84 TBAs trained over 5 days </li></ul></ul></ul><ul><ul><ul><li>Subsequent training of additional TBAs in local villages by TOT TBAs </li></ul></ul></ul><ul><ul><li>Health advocate training for Hadzabe/Datoga </li></ul></ul><ul><ul><ul><li>15 trained using modified HBLSS materials </li></ul></ul></ul><ul><ul><li>MNC training for MAISHA taxi drivers </li></ul></ul><ul><ul><ul><li>45 trained using modified HBLSS materials </li></ul></ul></ul>
    6. 6. HBLSS Integration <ul><li>Community level education to Survive & Thrive Groups </li></ul><ul><ul><li>Home visits by TBAs </li></ul></ul><ul><ul><li>Village community meetings (TBAs showed materials to men and village leaders </li></ul></ul>
    7. 7. Costs <ul><li>Initial master training </li></ul><ul><ul><li>Approx. $30,000 </li></ul></ul><ul><ul><ul><li>Consultants - $21,000 </li></ul></ul></ul><ul><li>TBA TOT training </li></ul><ul><ul><li>Approx. $140 per person </li></ul></ul>
    8. 8. Adaptations <ul><li>Other Adaptations </li></ul><ul><li>2 sets of laminated teaching picture cards/teaching models per village </li></ul><ul><li>Pictorial information on the “safe delivery kit” was adapted to meet local standards and availability; also translated to Kiswahili and Kiiraqw </li></ul><ul><li>Adapted materials for Hadzabe and Datoga health advocates and MAISHA drivers </li></ul><ul><li>Adapted M & E materials into expanded Village Pregnancy Register (a WellShare tool) as M&E was too costly to implement </li></ul>
    9. 9. Lessons Learned / Challenges <ul><li>Lessons Learned </li></ul><ul><ul><li>HBLSS materials very well received by beneficiary populations </li></ul></ul><ul><ul><li>HBLSS can effectively be used to provide MNC training to male educators </li></ul></ul><ul><ul><li>Village leaders became proponents of HBLSS and promoted it in their villages </li></ul></ul><ul><ul><li>HBLSS has been integrated into the body of knowledge passed down from older to younger TBAs </li></ul></ul><ul><li>Challenges </li></ul><ul><ul><li>Cost for total program is prohibitive (esp. M&E act.s) </li></ul></ul><ul><ul><li>Distance between households has affected training and follow-up supervision </li></ul></ul>
    10. 10. Recommendations <ul><li>HBLSS should be more broadly implemented </li></ul><ul><ul><li>Story format well-received by communities </li></ul></ul><ul><ul><li>Effective even when modified </li></ul></ul>
    11. 11. Contact <ul><li>WellShare International </li></ul><ul><li>122 West Franklin Avenue </li></ul><ul><li>Suite 510 </li></ul><ul><li>Minneapolis, MN 55404 </li></ul><ul><li> </li></ul>