LHWs Refresher Training Curriculum - Sep 2014 (Recovered)

LHWs’ Refresher Training Curriculum: 2014
Lady Health Workers Program
(National Program for Primary Health Care and Family Planning)
27 September 2014
Department of Health, Government of Khyber Pakhtunkhwa
USAID FATA-KP Health Program, Save the Children

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Contents
Introduction................................................................................................................................... 4
LHW Vision 2015.......................................................................................................................... 5
Objectives.......................................................................................................................................5
LHWs’ Refresher Training Curriculum .................................................................................... 6
LHWs RTC Structure .................................................................................................................. 7
Day 1............................................................................................................................................... 9
1.1. Introduction.............................................................................................................................9
Summary...................................................................................................................................................................................9
Time allocated .........................................................................................................................................................................9
Method......................................................................................................................................................................................9
Materials ...................................................................................................................................................................................9
Learning Objectives................................................................................................................................................................9
Recommended session sequence..........................................................................................................................................9
1.2. Health Promotion...................................................................................................................10
Summary.................................................................................................................................................................................10
Time allocated .......................................................................................................................................................................11
Method....................................................................................................................................................................................11
Materials .................................................................................................................................................................................11
Learning Objectives..............................................................................................................................................................11
Recommended session sequence........................................................................................................................................11
Day 2............................................................................................................................................. 13
2.1. Community Empowerment......................................................................................................13
Summary.................................................................................................................................................................................13
Time allocated .......................................................................................................................................................................13
Method....................................................................................................................................................................................13
Materials .................................................................................................................................................................................14
Day 3............................................................................................................................................. 17
3.1. Women’s Health.....................................................................................................................17
Summary.................................................................................................................................................................................17
Time allocated .......................................................................................................................................................................17
Method....................................................................................................................................................................................17
Materials .................................................................................................................................................................................17
3.2. Newborn Care........................................................................................................................19
Summary.................................................................................................................................................................................19

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Time allocated .......................................................................................................................................................................19
Method....................................................................................................................................................................................19
Materials .................................................................................................................................................................................19
Day 4............................................................................................................................................. 21
4. Child Health.............................................................................................................................21
Summary.................................................................................................................................................................................21
Time allocated .......................................................................................................................................................................21
Method....................................................................................................................................................................................21
Materials .................................................................................................................................................................................21
Day 5............................................................................................................................................. 24
5. 1. Nutrition...............................................................................................................................24
Summary.................................................................................................................................................................................24
Time allocated .......................................................................................................................................................................24
Method....................................................................................................................................................................................24
Materials .................................................................................................................................................................................24
5.2. Life Style and NCDs...............................................................................................................26
Summary.................................................................................................................................................................................26
Time allocated .......................................................................................................................................................................26
Method....................................................................................................................................................................................26
Materials .................................................................................................................................................................................26
Day 6............................................................................................................................................. 28
6.1. Family Planning and HTSP....................................................................................................28
Summary.................................................................................................................................................................................28
Time allocated .......................................................................................................................................................................28
Method....................................................................................................................................................................................28
Materials .................................................................................................................................................................................28
6.2. Critical conditions and acute illnesses.....................................................................................29
Summary.................................................................................................................................................................................30
Time allocated .......................................................................................................................................................................30
Method....................................................................................................................................................................................30
Materials .................................................................................................................................................................................30
6.3. Epidemic Control ...................................................................................................................31
Summary.................................................................................................................................................................................31

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Time allocated .......................................................................................................................................................................31
Method....................................................................................................................................................................................32
Materials .................................................................................................................................................................................32
Conclusion ................................................................................................................................... 33

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Introduction
Based on the forward looking and need-based step taken by the Khyber Pakhtunkwa Lady Health
Workers’ (LHWs) Program, in September 2014 the Scope of Work (SOW) of the LHWs was
revised and strengthened to become Health Promotion-oriented and focused on clearly defined
service targets that contribute to the achievement of the ultimate objective of the LHWs (please
refer to the LHWs HP-oriented SOW).
The SOW is aimed at streamlining the role and responsibilities of the LHWs so that they can
produce the benefit that their cadre is supposed to produce. The SOW has laid the foundation on
the basis of which the pre-service training curriculum of the LHWs will be developed so that the
future LHWs will be aligned to the Vision and Service Targets laid down for LHWs in the SOW.
This reform has the potential of addressing longstanding issues, confusions and role-conflicts that
the LHWs have been facing in their work environment by providing the LHWs the requisite skills
and knowledge that will enable them to become highly effective community based healthcare
providers. It may be noted that the roles, responsibilities, knowledge and skill set of the
supervisors and managers of the LHWs will also need to be reviewed to enable the LHWs play
their aspired role effectively. However the big question of how to bring the large number of
existing LHWs to the same professional orientation needs to be answered so that the LHWs
Program maintains uniformity of approach and momentum.
In order to ensure that the existing LHWs also have the knowledge and skill as per SOW
mentioned above set several steps will need to be taken. Whereas the approach of the LHWs
Program will need to adapt to the revised set of roles, the on-the-job training materials and roles
of various cadres within the LHWs Program will also need to be reviewed and
strengthened/modified or developed afresh. And one of the most foundational steps is to develop
a realignment strategy for the existing LHWs for which a Refresher Training Curriculum is
needed.
This Refresher Training Curriculum addresses this basic issue of realigning the existing LHWs to
the approved HP-oriented SOW so that the existing knowledge, skills and practices of the LHWs
can be upgraded to enable them to work on the new paradigm. The course materials that will be
developed on the basis of this Refresher Training Curriculum will need to refer to the SOW and
the LHW Vision 2015. The course materials will not only provide the communications needed to
upgrade and modify the skills and knowledge of LHWs but will also keep them focused at the
revised SOW to avoid any future conflicts between the new batches of LHWs to be rolled out
from 2015 and existing LHWs. The training of existing LHWs on this Refresher Training
Curriculum developed in 2014 will therefore lead to attainment of the LHW Vision 2015.
For the sake of clarity this Refresher Training Curriculum should be read in the conjunction with
the above mentioned LHWs’ SOW. The LHW Vision 2015 and Objectives captured in the said
SOW is also presented hereunder to remind us of the ultimate objective of this Refresher Training
Curriculum. This Refresher Training Curriculum is developed in line with the eight service
targets provided in the LHWs’ SOW.

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LHW Vision 2015
The LHW is a female community-based healthcare worker whose primary role is to
provide the right knowledge and instill the right behaviours among individuals, especially
women of reproductive age, so that the health of mothers, newborns and children
improves.
The LHW also provides basic healthcare services for the management of common
illnesses at community level and catalyzes the community to develop local responses to
address health issues including optimal utilization of health services.
Ultimately the LHW plays a pivotal role in enabling communities to become healthier and
more self-reliant in improving the health of mothers, infants and children.
Objectives
The LHW will work in the community assigned to her:
1. To promote Health by empowering communities through provision of health education
messages, raising awareness, providing knowledge and developing skills needed for
improving and maintaining a high standard of health among women, infants and children and
communities in general.
2. To ensure that all expecting mothers are properly vaccinated against Tetanus and all children
are fully immunized against the vaccine-preventable diseases as per Government of KP policy.
3. To provide basic healthcare services to communities for basic Management of Communicable
Diseases including basic curative services for infectious diseases and by counseling and
advocating for prevention and control of such diseases.
4. To provide basic healthcare services to communities for basic Management of Non-
Communicable Diseases by counseling and advocating with the communities on appropriate
and healthy lifestyles and nutrition.
5. To ensure that timely referral for acute/advanced/critical illnesses is made to a higher level
healthcare facility instead of attempting to directly treatment illnesses.
6. To deliver critical messages for prevention and control of epidemics and to report suspected
cases of epidemics to relevant health authorities for proper diagnosis, treatment and control.
7. To work with local health committees and/or groups by providing relevant information and
impetus to take community action to address those issues that confound the health of mothers,
infants and children.
8. To promote family planning and healthy timing and spacing of pregnancies, provide
contraceptives and referral services for permanent and semi-permanent contraception for
improved health of women and children.

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LHWs’ Refresher Training Curriculum
The LHWs’ Refresher Training Curriculum (RTC) has been designed on the basis that the
existing LHWs are already well trained in various related aspects of the SOW. The existing
LHWs, for example, have the knowledge and skills for community case management of
childhood illnesses including diarrhea, pneumonia and malaria. They are also trained in
community mobilization and communication. However based on various assessments, several
gaps have been identified that exist in the knowledge and skills of the present contingent of
LHWs. The RTC addresses these gaps in order to leverage the existing knowledge, skills and
invaluable experience that the LHWs already have.
The RTC is designed in such a manner that a six-day refresher training program can be designed
and implemented for the LHWs. The RTC responds to the Service Targets for the LHWs as per
SOW and addresses the key new areas and gaps identified. The RTC is structured as follows:

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LHWs RTC Structure
1.1. Introduction
- Background and Format of the Refresher Training
- LHWs’ SOW
- LHW Vision 2015 and Service Targets
1.2. Health Promotion
- Concept
- HP Roles: Advocacy, Enabling, Mediation
- Health Education and Counseling
- Social Determinants of Health
- LHW as a Health promoter
2.1. Community Empowerment
- Social Determinants of Health & Community
- Community Groups and Committees
- Mobilizing Community Support & Resources
- Community Case Management Continuum of Care &
Referral
- Transportation for 2nd delay
3.1. Women’s Health
- General Concepts
- Pregnancy and Ante-Natal Care
- TT Vaccination
- Breastfeeding
- Post-Partum Care
- Role of LHW re Women’s Health & Referral
3.2. Newborn Health
- General Concepts
- Promotion of Chlorhexidine
- Prevention of Hypothermia
- Early initiation of Breastfeeding

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5.2. Life Style and NCDs
- General Concepts
- NCDs; Common NCDs
- Life Style adjustments for prevention & control of NCDs
5. 1. Nutrition
- General Concepts incl. Stunting, Wasting & Anemia
- Nutrition in Pregnancy and after Delivery
- Childhood Nutrition: Disease- Malnutrition vicious cycle
6.2. Critical conditions and acute illnesses
- General Concepts
- Role of LHWs
- Emergency care: Breathing, Bleeding, Breaks
- Referral
6.3. Epidemic Control
- General Concepts
- Common Epidemics
- Role of LHWs
6.1. Family Planning and HTSP
- General Concepts
- Contraception and commodities
- HTSP
- Role of LHWs
4. Child Health
- General Concepts
- GAPPD
- CCMfor Pneumonia, Diarrhea and Malaria: Prevention,
Treatment, Control
- Vaccination

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Day 1
1.1. Introduction
- Background and Format of the Refresher Training
- LHWs’ SOW
- LHW Vision 2015 and Service Targets
Summary
This is the opening session for the 6-day Refresher Training Program and has to serve as the
foundation for all of the sessions to follow. The participants will be introduced to the need of
revision of LHWs scope of work and the process that was undertaken to develop the revised and
HP-oriented SOW. Structure of the 6 days program will also be clarified to the participants.
The session will provide an opportunity for presenting the revised LHWs SOW to the participants
and clarify if there are any issues in the minds of the participants. The LHWs Vision 2015 will be
read and explained in detail and will be used as the basis for developing a shared vision among all
participants. The session will also describe in details the eight objectives and service targets given
in the SOW.
Time allocated
2 hours: 00 minutes
Method
Dialogue/discussion between resource person and participants.
Materials
Urdu translated versions of the following for all participants:
1. Schedule of the 6-day LHWs’ Refresher Training Program
2. Approved LHWs’ SOW
Learning Objectives
By the end of the session the participants should be able:
1. to describe why the Refresher Training program is being held;
2. to understand the overall structure of the 6-day Refresher Training Program;
3. to relate to describe the LHWs Vision 2015;
4. to know the LHWs’ Service Targets and their desired results.
Recommended sessionsequence
00:00 hrs  00:05 hrs Start
Recitation from Holy Quran

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Schedule of 6-day (Urdu) Refresher Training Program and (Urdu)
SOW to be distributed among participants
00:06 hrs  00:30 hrs Presentation – Introduction
- Welcome and Introduction to the Refresher Training
Course;
- Need and process of revision of LHWs SOW;
- LHW Vision 2015;
- Objectives of LHWs
00:30 hrs  01:00 hrs Discussion/ Q&A on LHWs Vision
- Participants to describe their understanding/impressions;
- Clarification provided by resource person;
- Objectives of LHWs discussed how they contribute to
- the LHWs Vision 2015.
01:00 hrs  02:00 hrs Plenary on Service Targets
- Resource persons describes the Service Targets and answers
- Questions; provides clarity on Service Targets, the skills and
knowledge required for the LHWs to meet the Service
Targets;
- Discussion on how the Refresher Training Program will
address existing gaps in the knowledge and skills of LHWs.
1.2. HealthPromotion
- Concept
- HP Roles: Advocacy, Enabling, Mediation
- Health Education and Counseling
- Social Determinants of Health
- LHW as a Health promoter
Summary
This is a very critical segment of the Refresher Training as it captures many of the new additions
to the scope and function of LHWs: it clarifies the meaning, concept and implications of Health
Promotion. The session provides the opportunity for elaborating on the various roles of a Health
Promoter and why an LHW has to become a Health Promoter. Exercises are provided for
participants to learn about the skills of Advocacy, Enabling and Mediation so that they are able to
apply these skills at appropriate junctures.
The segment describes Health Education and Counseling as integral parts of Health Promotion. It
provides clear action points for the process of Health Education and Counseling and identifies
where these strategies are applicable.

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The segment also then discusses the social determinants of health to provide a deeper
understanding of the whole notion and dynamics of health and provides a perspective for other
segments in the Refresher Training Program.
Time allocated
4 hours: 30 minutes
Method
- Dialogue/discussion between resource person and participants on Health Promotion,
Health Education and Counseling and Social Determinants of Health
- Case studies and video films (if possible) with questions for group work
- Exercises for skill sessions for Advocacy, Enabling and Mediation
- Role Play
Materials
1. Session notes
2. Brief description of Health Promotion and Ottawa Charter
3. Case studies/video film(s) for group work
Learning Objectives
By the end of the segment the participants should be able:
1. to demonstrate that they have a clear basic understanding of the concept and value of
Health Promotion;
2. to understand the purpose, constituents and mechanics of Advocacy, Enabling and
Mediation;
3. to practically differentiate between Health Promotion, Health Education and Counseling;
4. to comprehend the holistic nature of Social Determinants of Health;
5. to commit to be a Health Promoter.
(Urdu) Description of Health Promotion and Ottawa Charter to be
distributed
00:00 hrs  00:45 hrs Presentation and Q&A – Introduction to Health Promotion
- Health Promotion and Ottawa Charter;
- Roles and Strategies of Health Promotion
- Q&A
00:45 hrs  01:45 hrs Case Study – Analysis of HP Roles
- Video film (in possible) OR PowerPoint presentation
- Group Work on questions pertaining to Advocacy, Enabling
and Mediation
- Group presentations

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- Plenary discussion to list out dimensions of HP roles and
their benefits
01:45 hrs  02:30 hrs Skill Building for HP Roles
- Role play by three groups on three storylines on: Advocacy,
Enabling and Mediation
- Preparation by three groups: 10 minutes
- Role plays x 3 (5-7 minutes each with a max of 20 minutes
for all three plays)
- Group discussion on what was learnt: DOs and DON’Ts of
Advocacy, Enabling and Mediation
02:30 hrs  03:15 hrs Presentation: Health Education and Counseling
- Differences between HE, Counseling and HP
- Discussion
 applications of HE and Counseling
 technical knowledge requirements for HE and
Counseling
03:15 hrs  03:40 hrs Social Determinants of Health – intensively participatory
analytical discussion
- Assist the participants to build a typical picture and
signifiers of health of women and children in KP
- Lead in analytical discussion on causes of causes of causes
- Bring the discussion to the underlying factors that lead to
inequities and inequalities and ultimately to ill-health
- Tease-out the Social Determinants of Health
03:40 hrs  04:30 hrs LHW as a Health Promoter – Plenary
- Questions to be asked on:
 what aspects of LHW’s role can benefit from HP?
 how can an LHW be a good Health Promoter? and
 what needs to be done so that the LHW becomes a
good Health Promoter?
- Open discussion with conclusions drawn and reaffirmed by
the participants

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Day 2
2.1. CommunityEmpowerment
- Social Determinants of Health & Community
- Community Groups and Committees
- Mobilizing Community Support & Resources
- Community Case Management Continuum of Care & Referral
- Transportation for 2nd delay
Summary
This whole-day segment is aimed at establishing the base on which the whole HP-orientation of
LHWs’ role depends. The sessions in this segment will help develop a deep appreciation among
the LHWs for the meaning and importance of community and the importance of their own role for
community health. The segment will begin with linking up with the Social Determinants of
Health and the concept causes of causes of causes and will link these with various community
sub-groups and community as a whole. The discussion will lead to developing conceptual clarity
of addressing vulnerability, inequities and inequalities as a means to improve the health status of
women and children.
A discussion on working with communities through formal and informal groups will be
undertaken to help the LHWs understand the mechanics of community groups and committees as
a means to enhance community engagement. Another session will be held on the ways and means
of mobilizing communities to garner support for issues that require community action and support
and what does it mean to mobilize community resources. The LHW roles of Advocacy, Enabling
and Mediation will be contextualized in the understanding of community empowerment and
community mobilization.
Another session will be held on the process of community case management (CCM) that is an
integral part of the LHWs’ role. The community side of the CCM will be explored and again the
HP roles of LHW will be linked with the CCM process. Finally the participants will be led in a
discussion on LHWs’ role in organizing community transport facility with pooled resources for
addressing the 2nd delay in delivery to reduce the chances of maternal deaths due to lack of
transport.
Time allocated
6 hours: 30 minutes
Method
- Presentation and discussion between resource person and participants on Social
Determinants of Health and their direct and indirect relationship with vulnerability,
inequities and inequalities;
- Case studies and video films (if possible) with questions for group work

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- Exercises for skill sessions for handling community group meetings and community
transport for 2nd delay
- Presentation and discussion on CCM and concepts of continuum of care and referral
- Role Play
Materials
1. Session notes
2. Social Determinants of Health and diagrammatic representation of CCM hand-outs
3. Case studies/video film(s) for group work
Learning Objectives
1. to demonstrate that they have a clear basic understanding of Social Determinants of Health
and their relationship with vulnerability, inequity and inequality;
2. to describe the purpose and process of community group formation, supporting
community groups and mobilizing community resources;
3. to clearly understand the process of CCM as part of continuum of care and limitation of
LHWs’ role in CCM including timely referral.
00:00 hrs  01:00 hrs Presentation and Discussion
– Social Determinants and Community Sub-Groups
- Community and various Community Sub-Groups
- Foundational Causes: Vulnerability, Inequity and Inequality;
Women and Children - the affected Community Sub-Groups
- Most critical changes needed to reduce vulnerability,
inequity and inequality
- Analysis: applicability of Advocacy, Enabling & Mediation
by LHWs to reduce vulnerability, inequity and inequality
01:00 hrs  02:20 hrs Case Study – Community Mobilization
- Video film (in possible) OR PowerPoint presentation
- Group Work on questions pertaining to need to bring people
together for joint action, community resources and pooling
resources, Community Empowerment by education,
information and capacities.
- Plenary discussion to recognize the issues that need
community action and LHWs’ role; , DOs and DON’Ts of
Community Mobilization

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02:20 hrs  03:00 hrs Presentation - Interpersonal Communication &
working with Groups
- Groups: formal and non-formal – advantages and
disadvantages; the Agenda – importance of manifesto
- Group dynamics – roles in a Group
- Communicating effectively with Groups
- Supporting Groups: Advocacy and Mediation roles
03:00 hrs  03:45 hrs Empowered Communities – Role Play
- Role play by three groups on three storylines on
Community:
 with commitment
 with commitment and information
 with commitment, information and capacity
Issue: 2nd delay
- Preparation by three groups: 10 minutes
- Role plays x 3 (5-7 minutes each with a max of 20 minutes
for all three plays)
- Group discussion on what was learnt: how LHWs can
empower Communities?
03:45 hrs  04:15 hrs Open Discussion – Anemia reduction in Women as a sign of
Community Empowerment
- Plenary to obtain general consensus on the reasons that lead
to longstanding Anemia in women, its impact on health of
women and their offspring and steps that need to be taken to
reduce Anemia in women
 What is Anemia?
 Why Anemia exists in women?
 What women need to address the issue?
 How can women get what they need to reduce
Anemia?
 What needs to change and at what level to enable
women to be Anemia-free?
04:15 hrs  05:30 hrs Dialogue - Community Case Management Continuum of Care
& Referral
- Open discussion on what is CCM, what is the scope of CCM
and what is the role of LHWs in CCM
- Resource person to provide detailed presentation:
 concept of CCM
 Continuum of Care: personal, community and
institutional

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 Issues in CCM
- Discussion and consensus building on:
 LHWs’ role in CCM
 Meaning and importance of referral
 Mechanism of referral
05:30 hrs  06:30 hrs Group Work – Strategy for Community Transport
Arrangements for addressing the 2nd Delay
- Questions to be asked on:
 Define the characteristics of a community-managed
and community-financed transport mechanism?
 What are the biggest hurdles in establishing such a
mechanism?
 What roles can an LHW play to address these
hurdles in terms of Advocacy, Enabling and
Mediation?
 Plan of action for establishing such a mechanism
- Presentations and Open discussion with conclusions drawn
and reaffirmed by the participants

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Day 3
3.1. Women’sHealth
- General Concepts
- Pregnancy and Ante-Natal Care
- TT Vaccination
- Breastfeeding
- Post-Partum Care
- Role of LHW re Women’s Health & Referral
Summary
This section deals with the technical aspects of health of women of reproductive age and
highlights the scope of work that the LHW is responsible for. The sessions will address the
critical issue of pregnancy and the role of LHWs in pregnancy care. The session also specifically
includes vaccination of pregnant women with tetanus toxoid vaccine for prevention of Tetanus
infection in mother and infant at the time of delivery. The session includes the issue of
breastfeeding (benefits for the mother) and post-partum care of women.
Ultimately the role of LHW with respect to women’s health especially with reference to
pregnancy and outcome of pregnancy is clarified along with the importance of referral at various
stages of pregnancy to relevant healthcare provider.
Time allocated
4 hours: 30 minutes
Method
- Presentation and discussion between resource person and participants on pregnancy and
ante-natal care;
- Group work on ante-natal care, TT Vaccine, nutrition in pregnancy and post-partum care;
- Presentation and discussion on LHW’s role in women’s health with respect to pregnancy
and delivery.
Materials
1. Session notes
2. Ante-Natal Care steps and roles of various healthcare providers (like CMW, LHV etc.)
Learning Objectives
1. to demonstrate that they clearly understand their role in pregnancy especially with respect
to counseling and referral;

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2. to have learnt the schedule for TT Vaccine for women and the process of becoming a
healthcare provider for TT vaccination;
00:00 hrs  01:00 hrs Presentation and Discussion
– The ante-natal, natal and post-partum periods
- Description of normal pregnancy: ante-natal period, natal
period and post-partum period
- Major issues of each period that need care and attention
- Routine measures for care during the three periods
- LHW’s role clarification with respect to the three periods
01:00 hrs  01:40 hrs Group Work – Can DOs and Cannot DOs
- Group Work:
 What are the main aspects of care in antenatal, natal
and post-partum periods?
 what aspects of care is the LHW responsible for and
why?
 who is responsible for care which LHW cannot
provide?
 what to do in case help is needed?
 what skills are needed for LHWs to provide good
quality care?
- Plenary discussion to clearly delineate LHWs’ role with
respect to ANC, natal care and post-partum care.
01:40 hrs  03:00 hrs Technical Session(lecture & skill building) – ANC and PPC
- Advocacy: harmful and beneficial practices; nutrition;
HTSP options; addressing Anemia; TT vaccination;
preparation for delivery; Clean Delivery Kit; Skilled Birth
Attendant (SBA); transport arrangements
- Enabling: skills and practices to help mothers protect
themselves and their baby; improving nutrition; hygiene; TT
vaccination administration
- Mediation: linking expecting mothers with SBA; family
counseling for protecting mothers and babies health;
transport arrangements for delivery
03:00 hrs  03:40 hrs Technical Session(lecture & skill building) – Tetanus
- What is Tetanus; mode of transmission; factors increasing
the risk of infection; prevention; treatment; outcome

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- TT Vaccine in pregnancy; schedule; availability and storage;
reporting
- Practicum: TT Vaccine administration skills and reporting
03:40 hrs  04:20 hrs Technical Session(lecture & skill building) – Breastfeeding
- Benefits of breastfeeding; early initiation of breastfeeding;
exclusive breastfeeding
- Infant and Young Child Feeding – overview and application
04:20 hrs  04:30 hrs Plenary - Conclusion
- Resource person to conclude the section on Women’s
Health and provide a summary of salient points for the
participants
3.2. Newborn Care
- General Concepts
- Promotion of Chlorhexidine
- Prevention of Hypothermia
- Early initiation of Breastfeeding
Summary
This section deals with the technical aspects of newborn health and the role of LHW with respect
to newborn care. Prevention of neonatal sepsis due to umbilical cord infection with application of
Chlorhexidine Digluconate 7.1% gel and saving newborns from hypothermia are the major
technical aspects covered in addition to BCG vaccination. Early initiation of breastfeeding and its
benefits for the newborn are also included although the same is included in the section on
Women’s Health as well but this section will focus on benefits for the newborn.
Time allocated
1hour: 30 minutes
Method
- Presentation and discussion between resource person and participants on infant care;
- Group work on infant care, BCG vaccination, and post-natal care of the newborn;
- Presentation and discussion on LHW’s role in infant health.
Materials
1. Session notes
2. Newborn Care steps and roles of various healthcare providers (like CMW, LHV etc.)

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Learning Objectives
1. to demonstrate that they clearly understand their role in newborn care especially for
promotion of Chlorhexidine Digluconate 7.1% gel and protection from hypothermia;
2. to have understood the role of LHW in infant care/post-natal care for the newborn.
00:00 hrs  00:50 hrs Technical session– Neonatal sepsis, Hypothermia, BCG
and Breastfeeding
- The newborn’s health
- Neonatal sepsis: causes including cord sepsis;
- Heat loss: causes, prevention;
- Newborn nutrition
- Measures for cord care, preventing hypothermia , BCG
vaccination, early initiation of breastfeeding; Role of SBA
- LHW’s role clarification with respect to newborn care
- Group Work:
 what are the main aspects of newborn care?
 what aspects of care the LHW is responsible for and
why?
provide?
 what skills are needed for LHWs to ensure good
quality care?
- Plenary discussion to clearly delineate LHWs’ role:
especially promotion of Chlorhexidine, protection from
hypothermia, BCG and breastfeeding
- Resource person to clarify the limitations of role of LHWs
in newborn care and emphasize the health promotion aspect
that LHWs have to cover; conclude the segment on
Newborn Health and provide a summary of salient points for
the participants.

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Day 4
4. Child Health
- General Concepts
- GAPPD
- CCM for Pneumonia, Diarrhea and Malaria: Prevention, Treatment, Control
- Vaccination
Summary
This segment pertains to the very important aspect of LHWs’ work related to Child Health. The
segment will start with a review of the concept of Global Action Plan for Prevention of
Pneumonia and Diarrhea (GAPPD) and its implications on LHWs’ role. A detailed section will be
dedicated to the community case management (CCM) for childhood illnesses using the Integrated
Management of Childhood Illnesses (IMNCI) protocol with technical aspects of prevention,
identification, treatment and control of Pneumonia, Diarrhea and Malaria. The types and dosage
of allowable medicines will also be explained in addition to the various steps needed for
compliance by the care-givers. Special attention will be given to Nutrition and the ways and
means to improve children’s nutrition status. A discussion on immunization of children will be
included to emphasize on the importance of immunization and the role of LHWs in immunization.
The Health Promotion roles that LHW has to play in addressing the childhood illnesses and
enhancing the health of children will be included in the segment.
Time allocated
6 hours: 30 minutes
Method
- Presentations and discussion between resource person and participants on Child Health,
GAPPD, IMNCI and Immunization;
- Group work on LHWs role in Child Health;
Materials
1. Session notes
2. Child Health and role of LHW and Community
3. GAPPD handout, IMNCI handout, Immunization schedule handout
Learning Objectives
1. to demonstrate that they clearly understand the details of GAPPD and its implication on
childhood killer diseases;

22
2. to demonstrate that they can recognize the main signs and symptoms of Pneumonia,
Diarrhea and Malaria in children;
3. to confirm that they have accurate knowledge of:
a. medicines for Pneumonia, Diarrhea and Malaria
b. calculating dosage of medicines for Pneumonia, Diarrhea and Malaria
4. to demonstrate that they have accurate knowledge of immunization of children under 3
years of age;
5. to understand and commit to the role of LHWs re Child Health and referral as appropriate.
00:00 hrs  01:00 hrs Presentation and Discussion – Child Health
- Description of children’s health issues and concerns
- Major killers of under-five Children: Pneumonia and
Diarrhea; Malaria
- Strategies to reduce under-five mortality due to Pneumonia
and Diarrhea: GAPPD; IMNCI
- Strategies to prevent and control Malaria
- Immunizable diseases and Immunization for children
- Reminder of CCM
- Group Work:
 what are the main aspects of care in Pneumonia,
Diarrhea and Malaria?
 what aspects of care is the LHW responsible for and
why?
provide?
 what skills are needed for LHWs to provide good
quality care?
- Plenary discussion to clearly delineate LHWs’ role with
respect to prevention, identification, treatment and control of
Pneumonia, Diarrhea and Malaria.
01:45 hrs  03:45 hrs Technical Session(lecture & skill building) – IMNCI
- Pneumonia: Prevention, Diagnosis, Treatment and Care –
include recent classification of Pneumonia, treatment with
Amoxicillin, calculating dose of Amoxicillin, care for the

23
sick child including nutrition and control of fever with
Paracetamol; Referral – need, process and follow-up
- Diarrhea: Prevention, Diagnosis, Treatment and Care –
include recent inclusion of Zinc for treatment of Diarrhea,
calculating dose of Zinc, care for the sick child especially
maintaining hydration/rehydration with low osmiolality
ORS, nutrition; Referral – need, process and follow-up
- Malaria: Prevention, Diagnosis, Treatment and Care –
include treatment with XXXXXX, calculating dose of
XXXXX, care for the sick child including nutrition and
control of fever with Paracetamol??; Referral – need,
process and follow-up
03:45 hrs  04:30 hrs Technical Session(lecture & skill building) – Immunization
- Immunizations available and immunization schedule
- Role of LHW in routine immunization and national/sun-
national immunization days/polio campaigns
04:30 hrs  06:00 hrs Technical Session(lecture & skill building) –
CCM for Pneumonia, Diarrhea and Malaria
- Advocacy: harmful and beneficial practices; Nutrition;
Prevention; Hygiene; Nutrition; Care seeking for the sick
child; Care during sickness; Compliance; Referral
- Enabling: skills and practices to help care givers/mothers
protect their children from sickness; Improving nutrition;
Hygiene; Oral Rehydration; Insecticide treated bednets;
Referral
- Mediation: linking care givers/mothers of sick children with
relevant healthcare provider; family counseling for
protecting children against Pneumonia, Diarrhea and
Malaria; community action for clean drinking water and
reducing mosquito breeding
- Practicum: preparing ORS and administering ORS
- Resource person to conclude the section on Child Health
and provide a summary of salient points for the participants

24
Day 5
5. 1. Nutrition
- General Concepts incl. Stunting, Wasting & Anemia
- Nutrition in Pregnancy and after Delivery
- Childhood Nutrition: Disease- Malnutrition vicious cycle
Summary
This section focuses at the value, dynamics and methods of human nutrition especially as it is
applied to the health of women, newborns and children. The section will introduce the
participants to the national and provincial status of nutrition as assessed by National Nutrition
Survey 2011 and KP Provincial Analysis 2012 and will elaborate on the concepts of Stunting,
Wasting and Anemia including assessment of malnutrition with Mid-Upper Arm Circumference
(MUAC) Tape and weight measurements. Focus will also be made on the issues, concerns and
solutions with respect to nutrition during pregnancy and delivery. Special attention will be paid to
the disease-malnutrition-disease vicious cycle that leads to increase in the risk of childhood
mortality.
The section will emphasize the health promotion roles of the LHW for improving the attention of
community on nutrition of women, newborns and children and will enable the participants to
learn the communication needed to motivate the mothers and care givers for adopting practices
that help improve the nutritional status of women, newborns and children.
Time allocated
3 hours: 15 minutes
Method
- Presentations and discussion between resource person and participants on Nutrition as a
general concern and as specifically applied to women, newborns and children;
- Group work on LHWs role in Nutrition;
- Skill building on use of MUAC tape and weighing children.
Materials
1. Session notes
2. Nutrition and role of LHW and Community
3. MUAC Tape and weighing scales.
Learning Objectives

25
1. to demonstrate that they clearly understand the value of Nutrition in women, newborn and
child health;
2. to demonstrate that they can recognize malnutrition in children;
3. to demonstrate that they have the skills and knowledge for Advocating, Mediating and
Enabling for Nutrition.
00:00 hrs  01:15 hrs Presentation and Discussion – Nutrition
- Description of NNS 2011 and KP Provincial Analysis 2012
- Stunting, Wasting and Anemia; Acute and Chronic Severe
Malnutrition
- Factors leading to malnutrition in Women in Pregnancy and
Post-Partum period, Newborns, Children
- Description and discussion on:
 Disease-Malnutrition-Disease vicious cycle
 Maintaining nutrition of children in sickness
especially Acute Respiratory Infections, Diarrhea
and Measles
Improving Nutritional Status of Women, Newborns & Children
- Advocacy: harmful & beneficial practices; improving
Nutrition: of girl child, pregnant mothers, lactating mothers,
newborns & children; Breastfeeding; Weaning & weaning
foods; prevention of Malnutrition; Hygiene; Referral
- Enabling: recognizing malnutrition; skills and practices to
help care givers/mothers improve their own and their
children’s nutrition; preventing disease-malnutrition-disease
cycle in children; preventing and alleviating Anemia in
women; maintaining Hygiene;
- Mediation: referral/linking care givers/mothers of children
with severe malnutrition with relevant healthcare
provider(s)/services; family counseling for preventing
Anemia and malnutrition in children; community action for
preventing Anemia and malnutrition in children
- Practicum: using MUAC tape, weighing scale, recognizing
Anemia
- Resource person to conclude the section on Nutrition and
provide a summary of salient points for the participants

26
5.2. LifeStyle and NCDs
- General Concepts
- NCDs; Common NCDs
- Life Style adjustments for prevention & control of NCDs
Summary
This section is aimed at developing a basic understanding about the common non-communicable
diseases that are generally affecting our communities these days i.e., Diabetes, Hypertension and
Obesity (although reference will also be made in Nutrition section) and specifically issues that
women face i.e., amenorrhea, dysmenorrhea, menorrhagia, hypermenorrhea.
The section will focus on adjustments and improvements in lifestyle including eating habits,
dietary content, smoking, anxiety/stress, exercise, personal and household hygiene, water intake
as well as improving behaviours, social interaction and tolerance to reduce anxiety/stress and
manage anger. Community cohesiveness will be emphasized to promote community action for
issues that need joint decision-making and improvements in health services and service
utilization.
Time allocated
3 hours: 15 minutes
Method
- Presentations and discussion between resource person and participants on lifestyle, non-
communicable diseases and issues faced by women;
- Group work on LHWs role in improving behaviours to reduce stress and anger and
promote community cohesiveness;
Materials
1. Session notes
2. Non-communicable diseases (NCDs) and issues faced by women.
Learning Objectives
1. to demonstrate that they clearly understand the contribution of personal habits and
behaviours in the health of a person;
2. to demonstrate that they understand the basics of Diabetes, Hypertension, Obesity,
Anxiety and Amenorrhea, Dysmenorrhea, Menorrhagia, Hypermenorrhea;
Enabling for prevention and control of NCDs.

27
00:00 hrs  01:30 hrs Presentation and Discussion – Lifestyle & NCDs
- Description of Lifestyle and its relationship with Social
Determinants of Health
- Habits and behaviours that:
 damage health
 protect and promote health
- basic factors about Diabetes, Hypertension, Obesity, issues
related to menstraual cycle and relationship of Anxiety
- LHWs’ role in NCDs
Improving Lifestyle and coping with NCDs
- Advocacy: harmful & beneficial practices; improving diet;
quitting smoking; managing stress; exercise; hygiene;
referral
- Enabling: how to improve lifestyle and behaviours; skills to
help people reduce harmful practices; preventing
Hypertension; controlling Diabetes; skills to manage stress;
maintaining Hygiene; women’s personal care (to address
menstrual cycle related issues)
- Mediation: referral/linking community members with
relevant healthcare provider(s)/services; family counseling
for changing harmful practices and reducing stress;
community action for improving mutual relationships and
community hygiene.
02:45 hrs  03:15 hrs Plenary – Conclusion
- Resource person to conclude the section on Nutrition and
provide a summary of salient points for the participants

28
Day 6
6.1. FamilyPlanningand HTSP
- General Concepts
- Contraception and commodities
- HTSP
- Role of LHWs
Summary
This section on Healthy Timing and Spacing of Pregnancies (HTSP) and Family Planning (FP)
aims to develop competence of LHWs on the rationale of both HTSP and FP and the choices
available for couples to practice each. The focus would basically be laid not on contraception and
family planning but on the health reasons of both babies and their mothers as the basis for making
choices to use contraceptives to prolong space between pregnancies.
The participants will be provided a quick overview of the contraceptives that the LHW Program
allows the LHWs to promote and provide to the community and information about linkages with
other service providers who can assist couples in making informed decisions and adopting
methods of their choice for HTSP.
Time allocated
2 hours: 00 minutes
Method
- Presentations and discussion between resource person and participants on the reasons for
increasing space between pregnancies and the health benefits for mothers and children,
choices for contraception available for couples and commodities available;
- Group work on LHWs role in HTSP/FP and referral;
Materials
1. Session notes
2. HTSP/FP choices
3. Sample contraceptive commodities for demonstration.
Learning Objectives
1. to demonstrate that they clearly understand the health reasons for mothers and children in
addition to economic factors for using HTSP;

29
2. to demonstrate that they can explain the uses, advantages and disadvantages of various
contraceptive methods;
Enabling for HTSP.
00:00 hrs  01:00 hrs Presentation and Discussion – HTSP & FP
- Rationale of creating space between pregnancies
- Description of HTSP and FP – a comparison
- Various permanent, semi-permanent and temporary methods
of contraception and their availability
- Advantages and disadvantages of various methods of
contraception
Promoting and enabling HTSP
- Advocacy: why HTSP?; methods of contraception; choosing
suitable contraceptive method; post-partum IUCD; referral
for method of choice
- Enabling: helping to chose the appropriate contraception
method; provision of allowable contraceptive commodities;
teaching skills to use selected method of contraception
effectively; preventing side-effects and contraceptive failure
relevant FP service provider(s)/services; family counseling
for HTSP and health of mothers and newborn; community
action for supporting HTSP and involving males.
- Resource person to conclude the section on HTSP/FP,
answer questions and provide a summary of salient points
for the participants
6.2. Critical conditionsand acuteillnesses
- General Concepts
- Role of LHWs
- Emergency care: Breathing, Bleeding, Breaks
- Referral

30
Summary
LHWs commonly are faced with community members seeking advice and assistance for
emergencies and acute illnesses. This section addresses the aspects in daily life that may cause an
LHW to be faced with an emergency or acute illness and prepares her for initial supportive action
and ensuring that timely help is made available to the person in need.
The section will especially cover the classic emergency response of maintaining breathing,
controlling bleeding and attending to breaks (fractures) and stabilizing the patient so that
advanced care can be sought.
Time allocated
2 hours: 00 minutes
Method
- Presentations and discussion between resource person and participants on the various
common emergency and acute illness scenarios and action needed;
- Group work on LHWs role in emergencies/acute illnesses and referral;
Materials
1. Session notes
2. Common household and community emergencies and acute illnesses
3. Mannequin for practicing resuscitation
4. Bandages for practicing control of bleeding
5. Wooden planks for immobilizing fractured limbs
6. Household utensil/container for sponging to reduce fever.
Learning Objectives
1. to demonstrate that they clearly understand the action needed for rescuing severely injured
person and/or acutely sick person;
2. to demonstrate that they have the skills for BBB and sponging for fever;
Enabling for responding to emergencies and acute illnesses.
00:00 hrs  00:45 hrs Presentation and Discussion – Emergencies and Acute Illenesses
- Introduction to common emergencies and acute illnesses:

31
 Emergencies: road accidents, machinery operation
accidents, electrocution, drowning, snake bite, shock
– focus on breathing, bleeding and brakes
 Acute illnesses: high grade fever, convulsions, acute
asthma, hyper/hypo-glycemia, dehydration and
shock – focus on high grade fever, breathing and
circulation
Actions to address emergencies and acute illness
- Advocacy: avoiding accidents and emergencies; avoiding
risk and early health seeking behavior
- Enabling: BBB response and resuscitation
relevant service provider(s)/services; community action for
supporting emergency care.
01:30 hrs  02:00 hrs Skill Building Session
- Practicing resuscitation (BBB) and water sponging for
reducing fever
6.3. EpidemicControl
- General Concepts
- Common Epidemics
- Role of LHWs
Summary
Various epidemics are seen on a daily basis ranging from Dengue Fever, Malaria, Cholera/Acute
Gastroenteritis, Typhoid, Measles and Polio. What is the role on an LHW with respect to
epidemics? Various expectations are associated with the LHWs with requirement of providing
health education, spreading awareness, reporting and assisting in controlling epidemics.
This section presents the basics of how diseases can become epidemic. It will discuss the common
control and preventive measures and the role LHWs are supposed to play with respect to
epidemics and their reporting.
Time allocated
2 hours: 00 minutes

32
Method
- Presentations and discussion between resource person and participants on what is an
epidemic, progress of epidemic in community, epidemic control, epidemic reporting; Main
features of Dengue Fever, Malaria, Cholera/Acute Gastroenteritis, Typhoid, Measles and
Polio
- Group work on LHWs role in epidemics and referral.
Materials
1. Session notes
2. Epidemics
3. Epidemic reporting proctocol(s).
Learning Objectives
1. to demonstrate that they clearly understand the process of epidemics in a community and
the general epidemic control measures;
2. to demonstrate that they have the basic knowledge about Dengue Fever, Malaria,
Cholera/Acute Gastroenteritis, Typhoid, Measles and Polio;
3. to demonstrate that they have the skills and knowledge for identifying and reporting
epidemics.
00:00 hrs  01:00 hrs Presentation and Discussion – Epidemics Overview
- what is an Epidemic and how epidemics spread
- hallmarks of an Epidemic
- Mosquito vector-borne: Dengue Fever, Malaria
- Epidemics of GI Tract: Cholera/Acute Gastroenteritis,
Typhoid,
- Immunizable diseases: Measles, Polio
LHWs’ role in Epidemics
- Advocacy: what is an epidemic, how to prevent epidemics,
personal and community hygiene, safe food/drink, hand-
washing, immunization
- Enabling: hallmarks of epidemics, health seeking in
epidemics, preventing and controlling epidemics, treatment
of the sick

33
relevant health service provider(s)/services; Epidemic
Reporting
- Resource person to conclude the section on Epidemics,
answer questions and provide a summary of salient points
for the participants
Conclusion
- Summarize the topics of the 6-day RTC
- Answer any questions
- Agree follow-up actions with timeline and responsibilities.

LHWs Refresher Training Curriculum - Sep 2014 (Recovered)

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