Tài liệu A Client-Centered Approach to Reproductive Health: A Trainer’s Manual docx

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SECTION II
TRAINER'S GUIDE 19

MODULE 1: GETTING STARTED 21
Getting started: Schedule/overview/materials/objectives/key learning
points 22
Activity 1: Objectives of training 24
Activity 2: Introductions 26
Activity 3: Hopes, fears and contributions 28
Activity 4: Training norms 30
Activity 5: Setting the training climate 32
MODULE 2: SELF-AWARENESS 35
Self-awareness: Schedule/overview/materials/objectives/key learning
points 36
Activity 1: Ideal health worker 38
Activity 2: Self-awareness 40
Activity 3: Jo-Hari window 42
Activity 4: Who am I? 44
MODULE 3: REFLECTIONS AND GO-AROUND 47
Reflections and go-around: Schedule/overview/objectives 48
Activity 1: Reflections 50
Activity 2: Sharing experiences 51
MODULE 4: VISION OF IDEAL SOCIETY 53
Ideal society: Schedule/overview/materials/objectives/learning points 53
Activity 1: Vision 55
Activity 2: Role of an individual 57
MODULE 5: GENDER 59
Gender: Schedule/overview/materials/objectives/learning points 61
Activity 1: Sex and gender 63
Activity 2: Roles and attributes of men and women 64
Activity 3: Gender discrimination 66

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Activity 4: Attitudes and values 69
MODULE 6: COMMUNICATION 73
Communication: Schedule/overview/materials/objectives/learning
points 75
Activity 1: Definition and elements of communication 77
Activity 2: Barriers to communication 80
Activity 3: Types of communication 82
MODULE 7: TOOLS OF COMMUNICATION 87
Tools of communication:
Schedule/overview/materials/objectives/learning points 84
Activity 1: Communication tools 91
Activity 2: Types of questions 94
Activity 3: Listening 97
Activity 4: Client-provider interaction 99
GAMES/ENERGIZERS/EXERCISES 95
MODULE 8: BEHAVIOR 103
Behavior: Schedule/overview/materials/objectives/learning points 105
Activity 1: Definitions 100
Activity 2: Types of behavior 110
Activity 3: Demonstration of types of behavior 112
MODULE 9: POWER 115
Power: Schedule/overview/materials/objectives/learning points 117
Activity 1: Meaning and sources of power 119
Activity 2: Types of power 122
GAMES/ENERGIZERS/EXERCISES 117
MODULE 10: SAHR 127
SAHR: Schedule/overview/materials/objectives/learning points 129
Activity 1: SAHR background: motivation, counseling,and negotiation 132
Activity 2: SAHR components 134
Activity 3: Application of SAHR 137
Activity 4: SAHR in action 141

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MODULE 11: REFERRAL SYSTEM 143
Referral system: Schedule/overview/materials/objectives/learning
points 145
Activity 1: Referrals 136
Activity 2: Referral system and protocol 173
MODULE 12: PERCEPTION OF CHANGE 151
Perception of change: Schedule/overview/materials/objectives/
learning points 153
Activity 1: Change 142
MODULE 13: TEAM BUILDING 157
Team building: Schedule/overview/materials/objectives/learning points 159
Activity 1: Importance of team work 161
Activity 2: Factors involved in team-building 164
MODULE 14: EVALUATION AND CONCLUSION OF TRAINING 165
Evaluation and conclusion:
Schedule/overview/materials/objectives/learning points 167
Activity 1: Evaluation 168
Activity 2: Conclusion 169


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SECTION III
TRAINING MATERIAL
1
171

Training material 1.1: Objectives of the training 173
Training material 1.2: What is a client-centered approach? 174
Training material 1.3: Reproductive health 175
Training material 1.4: Young-old lady picture 176
Training material 2.1: Self-awareness 178
Training material 2.2: Jo-Hari window 179
Training material 5.1: Gender 181
Training material 5.2: Statements to put on Zopp cards 171
Training material 6.1: Communication and components of
communication 172
Training material 6.2: Role-play on communication/feedback 174
Training material 6.3: Barriers to commuication: clarification 175
Training material 6.4: Exercise on overcoming communication
barriers 179
Training material 6.5: Role-plays for mixed messages 181
Training material 7.1: Tools of communication 197
Training material 7.2: Statements for Zopp cards 199
Training material 7.3: Types and examples of questions 189
Training material 7.4: Alternate listening exercise 191
Training material 7.5: Listening 192
Training material 7.6: Alternative presentation 194
Training material 8.1: Behavior 196
Training material 8.2: Role-plays 201

1
Note: Training materials are numbered by module and the order in which they appear
within the module; they are not numbered sequentially. They are indicated in the modules
by the letters TM.

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Training material 9.1: Power 203
Training material 9.2: Change and power dynamics 207
Training material 10.1: Definitions of communication components 208
Training material 10.2: Introduction to the concept of SAHR 221
Training material 10.3: Posters showing SAHR approach 212
Training material 10.4a: SAHR guidelines at work for static center
workers 215
Training material 10.4b: SAHR guidelines at work for community
workers 219
Training material 10.5a: Salutation & assess: Case studies for static
center workers 223
Training material 10.5b: Salutation & assess: Case studies for
community workers 236
Training material 10.5c: Help & reassure: Case studies for static
center workers 237
Training material 10.5d: Help & reassure: Case studies for community
workers 239
Training material 10.6a: Salutation & assess: Role-plays for static
center workers 229
Training material 10.6b: Salutation & assess: Role-plays for
community workers 243
Training material 10.6c: Help & reassure: Role-plays for static center
workers 245
Training material 10.6d: Help and reassure: Role-plays for community
workers 247
Training material 10.7: Assessment sheet 249
Training material 10.8: Alternative presentation 238
Training material 11: New dimension of referral system 252
Training material 12: Perception of change 241
Training material 13.1a: Broken squares game: preparation 243
Training material 13.1b: Broken squares game: instructions for game
and players 257

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Training material 13.1c: Broken squares game: instructions for
rapporteur 246
Training material 13.2: Factors involved in team building 259
Training material 14.1: Training evaluation form 260
Training material 14.2a: Poem (in Urdu) 262
Training material 14.2b: Poem (in English) 254
Training material: Games/Energizers/Exercises 256




ACKNOWLEDGEMENTS

The concept of SAHR evolved out of profound and often deep arguments
about what exactly was required to change the attitude and behaviour of
health care providers. The essence of the client centered approach is
designed to make health care providers more receptive to the need of
clients and responsive to clients’ situations beyond just their immediate
health problems. The Population Council, Islamabad is extremely proud to
be associated with the SAHR training, which has been recognized, by
Government and NGOs in Pakistan. We hope that it will have utility
internationally, in settings similar to Pakistan, where it can help bring about
significant improvements in quality of care and enhance utilization of
services in the public and private sectors.

The groundwork that lead up to the formulation of the training benefited
from inputs from many professionals. Deep gratitude is due to Dr. Anrudh
Jain who brought the concept of quality of care and the importance of
improving conditions of reproductive health services in countries like
Pakistan. Several others contributed to the early debate and in particular
Dr.Safia Ameen, Dr.Albert Henn, Mr. Peter Miller, Ms. Yasmin Zaidi are
acknowledged for their intellectual contribution. Dr. Ambreen Ahmed was
the person who first introduced the concept of the psychological principles
of self awareness which in turn contribute towards behavior change within
individuals. ROZAN, an NGO that does such training in the public and private
sector, carried out the master training for our trainers.

A core team from the Population Council was involved from the beginning to
the end: Drs Gul Rashida and Zakir Hussain have been the heart of this
training and development of the manual. Dr.Ali Mir has been a core member
at various stages of the course development. Mr.Fayyaz Khan contributed
towards the communication part of the training. This team expanded the
ROZAN training much further, combined it with examples in reproductive
health rooted in the Pakistani context and evolved the six day training
course, which is described in this manual. They have been assisted through
out by Bushra Bano, Saima Pervez who continue to help them with training


programs. Lubna Shireen, Zeba Tasneem and Tayyaba Gul were also an
essential part of the core team during earlier trainings in Sargodha

The manual was edited earlier by Mary D’Souza. It was later transformed
into the shape of a training manual by the very detailed rewriting of Pam
Ledbetter. Formatting of the manual was initially done by Khurram Shehzad;
and it was finalized in its current form including cover design and lay out by
Mehmood Asghar.

This project has been funded initially by Rockefeller Foundation and
Population Council central funds. Later the UNFPA sponsored the training of
master trainers on the basis of a draft manual. The finalization and printing
of this manual has been funded by the European Union.

Finally, we acknowledge the encouragement derived from the faces of
several hundred trainees especially community based workers and
paramedics, that inspired us to put this manual together. We hope that it
will go a long way in improving the quality of care of reproductive health
services in Pakistan and elsewhere.


Dr. Zeba A. Sathar
Country Director
Population Council, Islamabad



FOREWORD

This training manual grew out of a project on improving the quality of care
rendered by public-sector providers of reproductive health services. This
important project was designed and implemented by the Population Council
in collaboration with the Ministries of Population Welfare, and Health. I am
honored to have been associated with this initiative in Pakistan at a time
when the government was thinking about integrating the service delivery
components of these two Ministries. For this reason, the scope of this
project extended beyond improving the quality of care provided by family
planning workers and incorporated health workers providing maternal and
child health services.

In our work, we have defined quality of care as: the way the system
providing services treats its clients. Hence, the training program placed the
client at its center. The success of all efforts made by the service delivery
system, in attracting and keeping clients, depends upon the content and
quality of interaction when the client comes in contact with the provider—
whether the client is visiting a fixed clinic or being visited by a community-
based worker at home.

In order to offer good quality of care, the provider, in addition to being
technically competent, should also treat the client with dignity and respect,
assess her reproductive health needs by asking questions rather than making
assumptions based on her profile, and help her negotiate a solution that is
appropriate to her circumstances. Most training programs focus on improving
the technical skills of providers; this training manual departs from this usual
focus and is oriented to improving providers’ inter-personal skills. Emphasis
is placed on the client and helping her to meet her own needs rather than on
meeting some artificial goals or targets (for example, service goals such as
immunization of 50 children or 20 IUD insertions). A client-centered
approach pays attention to a client’s background, her life, and
circumstances and, therefore, this manual emphasizes such topics as
equality, gender, and sources of power within the household. Since many
providers (especially the community-based workers) have the same
background and face similar familial constraints as their clients, this training
program is oriented to empower providers so that they in their turn can
empower their clients.

I hope the use of this manual in training programs will change providers’
orientation such that they are able to treat a client as an individual person
rather than as a patient, a case, or a number. However, a sustained change
in providers’ orientation also requires that their supervisors change their


orientation from being inspectors and find faults to become supportive
supervisors and help workers to overcome obstacles.

This manual is a product of pain-staking efforts of many colleagues. I would
particularly like to acknowledge Drs. Zeba Sathar, Gul Rashida, Ali Mir, and
Zakir Hussain for their commitment to make it a success.


Anrudh K. Jain
Acting Vice President and Director
International Programs Division
Population Council, New York
2 February 2005

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