Community-based deworming: Developing effective trainings and materials

Claire Gwayi-Chore is Senior Associate for Project Implementation and Communications for the Deworm the World Initiative at Evidence Action. She writes about creating training materials for community health volunteers in our Tumikia Project, which is assessing different treatment strategies for control and elimination of soil-transmitted helminths.

29 May 2015

Deworm the World at Evidence Action is implementing partner in the Tumikia Project. Evidence Action’s Deworm the Word Initiative has supported the Kenya Ministries of Health and Education to implement its National School-Based Deworming Programme (NSBDP) since 2012. The programme successfully dewormed 6.4M school-age children last year and has steadily reduced the prevalence of parasitic worms as a public health threat in Kenya. Even though a very high number of children are reached annually, reinfection occurs via untreated community members. This is why we are excited to partner with TUMIKIA. TUMIKIA’s goal is to break the re-transmission and reinfection of parasitic worms with a community-based strategy. So what are we learning from implementing the school-based deworming program that is useful for the community-based approach of TUMIKIA?

Adjusting the Training Cascade

The school-based deworming programme’s training cascade – a highly efficient way to reach frontline workers that uses the existing government infrastructure - had to be adjusted to work for TUMIKIA’s community-based approach. As such, it’s important to keep in mind that instead of teachers, community health volunteers are deworming households in the community. NSBDP uses a tiered training cascade where master trainers based within each county train sub-county and division trainers who, in turn, teach frontline teachers how to implement deworming in their classrooms.  

In TUMIKIA, community health volunteers are trained by community health assistants, their supervisors within the national community health structure. The community health assistants, in turn, are trained by their supervisors at the sub-county level. The figure below depicts the training cascade for TUMIKIA:

Adjusting the Training Materials 

Implementing such a cascade required some adjustments for TUMIKIA: With school-based deworming, the key implementers, the teachers, are educated personnel, so their training and monitoring tools, used during Teacher Training and on Deworming Day, were developed with their education level in mind. However, TUMIKIA community health volunteers conducting the household deworming campaign have varying levels of education. Some may not have finished high school, for example. Therefore, we needed to develop training materials that community health volunteers could understand and use correctly and effectively.

We developed two levels of training materials:

  • a training guide for trainers of community health volunteers
  • a handbook for the health volunteers themselves, which they receive during their training.

          

We wanted to run highly interactive training sessions, so there are lots of activities and role-playing in the training guide. The handbook is modelled after the school-based deworming programme, where we found that teachers often use their training booklet as a reference document long after their training. The content is written in simple language and contains lots of images so community health workers can easily reference it as they deworm their communities.  

Redesigning the Community Sensitization & Mobilization Materials

Community health volunteers are trusted members in the community who provide health education and implement various health interventions. For TUMIKIA, they are also charged with sensitizing community members and mobilizing them to be dewormed. The volunteers also teach healthy behaviours to prevent worm re-infection.

Based on our experience, we designed two posters:

  • Encouraging health behaviour change. It includes information about how people become infected with worms and depicts ways to prevent worm infections. 
  • Announcing dates of deworming. It contains pictorials that explain how deworming works, with space for the community health volunteers to write the dates of the deworming campaign on the poster before they mount them in strategic places within their villages.

   

The posters were developed and designed by our team to ensure that they are informative and provide relevant information. They are in Swahili to ensure that community members understand the information. These posters are mounted in highly visible places in the villages, and serve as a visual aid when the volunteers conduct village level meetings and health education sessions.

Working with our Project Partners

We worked with the Community Health, Neglected Tropical Disease, and School Health Units in the Kenyan Ministry of Health, the Kenya Medical Research Institute (KEMRI), and the Kwale County Ministry of Health team in developing the materials. All have extensive knowledge and skills in developing training and community sensitization materials for the community level. They also helped us localize information and images to maximize buy-in. For instance, for Kwale, which is on the Coast, we added information about local worm prevalence – complete with images of coconut trees -- and depictions of both Christian and Muslim populations. This collaborative process was invaluable. We are now testing the materials and gathering feedback, and are assessing the quality of deworming in case we need to refine the materials for the next round.

Learn more about the Tumikia Project.  

Learn more about the Kenya National School-Based Deworming Programme. If you would like to request a soft copy of the materials, please send an email to DtWKenya [at] evidenceaction [dot] org