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Guidelines for Training Traditional Health Practitioners in Primary Health Care
(1995; 86 pages) View the PDF document
Table of Contents
View the documentINTRODUCTION AND PURPOSE
Open this folder and view contentsSTEP I: PLANNING FOR THE TRAINING
Open this folder and view contentsSTEP II: DETERMINING THE CONTENT FOR TRAINING
Open this folder and view contentsSTEP III: DETERMINING THE TRAINING METHODS
Open this folder and view contentsSTEP IV: SELECTING TRAINING MATERIALS
Open this folder and view contentsSTEP V: TRAINING THE TRAINERS
Open this folder and view contentsSTEP VI: EVALUATING THE TRAINING
View the documentCONCLUSION
View the documentAPPENDICES
View the documentREFERENCES
 

APPENDICES

Appendix 1

HANDWASHING

Lesson plan for TBAs, from:
WHO. Training of Traditional Birth Attendants (TBAs). A guide for TBA trainers. WHO. Geneva 1992

   

Appendix 2

A. DIFFERENT POSITIONS OF THE BABY IN THE WOMB

B. EATING MORE DURING PREGNANCY

C. EDUCATING THE COMMUNITY

Flip chart for TBAs and mothers, from:
WHO. Training of Traditional Birth Attendants (TBAs). An Illustrated Guide for TBAs. WHO. Geneva 1992

   

Appendix 3

BIRTH CHECKLIST

Flip chart for TBAs, from:
Voluntary Health Services Society/ODA, Dhaka, Bangladesh

   

Appendix 4

A. HOW TO MAKE A MEDICINAL HERBARIUM
B. HOW TO GROW AN HERB GARDEN

Visual aids for herbalists, from:

UNICEF, et. al. Manual Para Medicos Indigenas (Manual for Indigenous Doctors), UNICEF, Instituto Nacional Indigenista, Gobierno del Estado de Oaxaca, Mexico, D.F. 1990

   

Appendix 5

HOW TO PREVENT DIARRHOEA

Visual aids for various THPs, from:
UNICEF, op. cit.

   

Appendix 6

PREGNANCY PROGRESS CHART

A graphic record card for TBAs, from:
Bangladesh Primary Health Care, "Pictorial Health Record Card", Dhaka, Bangladesh

   

Appendix 7

CERTIFICATE OF PARTICIPATION

A certificate for completion of training for THPs, from:
Dormaa Healers Project, Ministry of Health, Dormaa District, Ghana, 1988

   

Appendix 8

REFERRAL NOTES

THP referral cards for routine and urgent patients, from: Dormaa Healers Project, Ministry of Health, Dormaa District, Ghana, 1988

APPENDIX 1

HANDWASHING

Lesson plan for TBAs


HANDWASHING

OBJECTIVES

The TBA will be able to:

1. Describe the difference between clean and dirty hands.

2. Explain how dirty hands can cause infection in the mother and tetanus in the newborn.

3. Demonstrate thorough cleaning of nails and hands.

4. Explain the ways in which hands can become contaminated again after thorough washing.

PREPARATION

• Illustrated Guide for TBAs.

• Soap, nailsticks, nailbrush (if available);

• Clean water in a jug or mug or any other container;

• A basin, pail or bucket to collect and dispose of dirty water;

• Two glasses and a small bowl;

• An antiseptic such as Savlon, Dettol (if available, and routinely supplied to TBAs).

1. Describe the difference between clean and dirty hands.

Hands are often dirty even when they look clean.

• Ask the TBAs if their hands are clean. Almost all will say 'yes'.

• Pour clean water into a glass and put it aside. Now put clean water in a small bowl and ask a TBA to rub her hands together in it for one or two minutes. Pour the water from this bowl into a second clean glass. Show the two glasses of water - one with water from the bowl and the other with clean water - to the TBAs. They will be able to see for themselves that the water from the bowl is dirty. Even though the TBA's hands looked clean, they were in fact dirty.

2. Explain how dirty hands can cause infection in the mother and tetanus in the newborn.

There is dirt in the air and on things we touch.

Dirt has germs in it.

We cannot see germs. That is why we have to be very careful.

Germs cause disease.

Germs on dirty hands can enter a mother's body during delivery and cause disease.

• Ask the TBAs about the jobs they do in the house or in the fields and about things their hands come in contact with. Tell them that all the time everybody's hands will have germs on them unless specially cleaned.

 

• Stress that delivery is like an operation (there is bleeding and a raw wound). Therefore there is a great risk of infection from germs getting inside the body.

 

• Give the example of open wounds getting infected.

 

• Relate germs on the hands being transferred to the mother's inside or through the cord to the baby's inside during delivery.

 

• Emphasize that ordinary washing does not remove germs from hands. The TBA has to wash her hands in a special way. Her hands must be scrubbed thoroughly before delivery.

 

• Tell the TBAs where dirt can get stuck and that it is difficult to remove from underneath and around the nails.

 

• Ask the TBAs to remember mothers they have seen who had fever and bad smelling vaginal discharge after delivery.

When the umbilical cord is cut with a dirty instrument or touched by dirty hands, germs can enter the baby's body through the cord and make the baby sick. The baby can get fits (spasms). If not treated immediately, the baby dies. This disease is called tetanus (use a local name for this, if available).

• Ask the TBAs if they have seen a baby with fits (spasms).

 

• Explain the relationship between germs and fits (spasms).

 

• Show the illustration of a baby with spasms and a stiff body in the Illustrated Guide (Page 29).

3. Demonstrate thorough cleaning of nails and hands.

Cut nails short. Remove dirt from underneath and around the nails with a nailstick.

Remove bangles and rings.

Pour water on the hands and arms upto the elbows.

Use soap to scrub the hands and arms thoroughly especially between the fingers and around the nails. Use a nailbrush if available.

Wash the soap off with plenty of water.

Rinse the hands thoroughly in a bowl of water with an antiseptic like Dettol or Savlon (if available).

Hold the forearms and hands upwards with fingers spread out.

Keep the forearms raised so that they dry with the extra water trickling down from the elbows.

Air dry the hands.

• Show the illustrations of nail cleaning and handwashing in the Illustrated Guide (Pages 12 - 14).

 

• Demonstrate the correct method of handwashing. Describe each step as it is being demonstrated.

 

• Ask one TBA to give a return demonstration.

 

• The rest of the TBAs should participate by commenting on the correctness of the method.

 

• Demonstrate that washed hands are clean by dipping dry hands in a bowl of clean water, rubbing them together and then pouring the water from the bowl into a clean glass. Show the TBAs that the water from the bowl has remained clean.

4. Demonstrate the ways in which hands can become contaminated again after thorough washing.

A void touching objects other than those to be used during the delivery.

Do not start conducting the delivery while the hands are still wet. Wet hands attract dirt and germs.

Do not wipe washed hands with a towel or even a clean looking cloth. Germs that are present on the cloth or towel will make the hands dirty again.

• Explain that touching washed hands with a towel, the mother's clothes or any other unclean objects will make the hands dirty again. If this happens the TBA must wash them AGAIN or rinse them in Dettol or Savlon solution.

 

• Emphasize that if the delivery does not take place within ten minutes of hand washing, the TBA should dip her hands in antiseptic solution or wash them again.

REVISE AND SUMMARIZE

TBAs must always remember:

• Hands are often dirty even when they look clean.

 

• Germs on dirty hands can enter the mother's body during delivery and cause infection (fever and bad smelling vaginal discharge).

 

• When the cord is cut with dirty instruments or touched by dirty hands, germs can enter the baby through the cord and make him/her sick with a serious illness called tetanus.

How to clean hands, arms and nails correctly:

• Cut nails short and clean them with a nailstick.

 

• Remove bangles and rings.

 

• Scrub hands and forearms thoroughly using soap, especially between the fingers and around the nails.

 

• Rinse hands thoroughly in an antiseptic solution such as Dettol or Savlon solution (if available).

 

• Dry the hands in the air with fingers spread out and kept higher than the elbows.

 

• Do not wipe hands with a towel or cloth after washing them.

 

EVALUATION

Every day during the training period, one or two TBAs should demonstrate handwashing. The others in the group should be encouraged to comment on the correctness of the technique.

Each TBA should be able to:

1. Describe the way germs enter the body of the mother and the baby and cause infection.

2. Recognize the seriousness of infection in the mother and of tetanus in the newborn.

3. Say why it is important to wash hands thoroughly before delivery.

4. Demonstrate handwashing more than once during the course.

5. Explain how hands can get contaminated after washing by touching things that look clean but are dirty.

APPENDIX 2

A - DIFFERENT POSITIONS OF THE BABY IN THE WOMB

Flip chart for TBAs and mothers

THIS ILLUSTRATION SHOWS

• A baby in the womb with head downwards.

• A baby in the womb with buttocks downwards.

• A baby in the womb placed sideways.

POINTS FOR DISCUSSION

• How can the position of the baby in the womb be recognized?

• At which stage should this be checked?

• What are the different positions a baby may take in the womb?

• When should a TBA refer the pregnant woman for management of abnormal position of the baby?

POINTS TO REMEMBER

By feeling the abdomen for the position of foetal parts and locating the place of foetal heart sound, the TBA can have a rough Idea of the position of the baby In the womb. This can also be done by checking where the head of the baby Is located.

• Checking for the position of the baby should be done only during the last two weeks of pregnancy since the baby can change positions before this.

• A baby may be born head first (which Is normal) or buttocks first or maybe placed In the womb sideways.

• Always refer a woman who has her baby sideways In the womb since this baby cannot be delivered at home. It will require an operation. If the TBA suspects that the baby will be born with buttocks first she must consult a midwife or doctor to confirm and to decide about the place of delivery.

APPENDIX 2

B - EATING MORE DURING PREGNANCY

Flip chart for TBAs and mothers

THIS ILLUSTRATION SHOWS

• A pregnant woman eating more of what she normally eats.

POINTS FOR DISCUSSION

• Why should women eat more food during pregnancy?

• What are the foods that pregnant women should eat?

• Should any restrictions in food intake be observed?

POINTS TO REMEMBER

A pregnant woman must eat extra food every day to meet the needs of the rapidly growing baby In the womb.

A pregnant woman should eat more of the foods that she normally eats at home. If she cannot eat large amounts of food at one time, she should eat several times during the day.

• No special foods are required.

• A pregnant woman should not restrict foods since any restrictions may reduce her total food Intake. This will affect the growth of the baby adversely.

APPENDIX 2

C - EDUCATING THE COMMUNITY

Flip chart for TBAs and mothers

THIS ILLUSTRATION SHOWS

• A TBA discussing the importance of women's nutrition in her community.

POINTS FOR DISCUSSION

• What role can a TBA play to increase community involvement in improving MCH and family planning services?

• Whose assistance should the TBA seek for the success of her work?

POINTS TO REMEMBER

In addition to providing nutrition education during pregnancy, TBAs must help families to obtain appropriate services. This will help In pregnancy spacing, Immunizations, treatment of Illnesses and promote safe motherhood and child survival.

• TBAs should utilise all resources available In the community such as community leaders, women's groups and other agencies concerned with community development. This can be done by Interacting with people and groups frequently.

• TBAs should Interact with people and educate them about the essentials of health care.

APPENDIX 3

BIRTH CHECKLIST

A visual aid for TBAs


1. Prepare a clean bed.


2. Wash your hands well with soap.


3. Use the delivery kit.


4. Tie the umbilical cord.


5. Immediately after birth, encourage the mother to nurse the baby.

APPENDIX 4

A - HOW TO MAKE A MEDICINAL HERBARIUM

Visual aids for herbalists

Parte de este material fue tomado de promoción del desarrollo popular, A.C.

{An herbarium is a collection of dried plants and also a museum that functions like a library in which specimens are identified and classified in some order. The descriptions that accompany them should contain important information that will be a basis for study and to teach how to use the medicinal plants.}

UN HERBARIO ES UNA COLECCIÓN DE PLANTAS SECAS Y TAMBIÉN UN MUSEO QUE FUNCIONA COMO BIBLIOTECA, EN LA QUE LOS EJEMPLARES APARECEN IDENTIFICADOS Y ORDENADOS DE ALGUNA MANERA.

LAS ETIQUETAS QUE LOS ACOMPAÑAN DEBEN POSEER UNA SERIE DE DATOS IMPORTANTES QUE PUEDEN SERVIR DE BASE PARA ESTUDIO DIVERSOS Y PARA LA ENSEÑANZA MÁS FÁCIL DEL USO DE LAS PLANTAS MEDICINALES.

GOOD-HERB

(DESCRIPTION: A shrub from approximately 50 to 60 centimeters high that grows in the countryside and is also cultivated for commercial use.

USE: For washing the vagina, cough, and cleansing.

PREPARATION: Boil from 3 to 4 minutes in a litre of water for cleansing the vagina; for cough, drink as a tea.

ORIGIN: Throughout the state

DESCRIPCION: ES UN ARBUSTO DE 50 A 60 CMS. DE ALTURA APROXIMADAMENTE, CRECE EN EL CAMPO Y TAMBIÉN SE CULTIVA PARA SU COMERCIALIZACIÓN EN CAMPOS DE LABRANZA.

USO: LAVADOS VAGINALES, TOS, LIMPIAS.

PREPARACIÓN: SE HIERVEN DE 3 A 4 RAMITAS EN UN LITRO DE AGUA PARA LOS LAVADOS VAGINALES, PARA LA TOS SE TOMA ENTE.

PROCEDENCIA: TODO EL ESTADO.

HIERBA - BUENA

APPENDIX 4

B - HOW TO GROW AN HERB GARDEN

Visual aids for herbalists

A COMMUNITY PHARMACY OF MEDICINAL PLANTS

(Knowing and practicing that which you have learned, look around for a place that will serve to protect our plants and arrange them in order for when you need them.)

FARMACIA COMUNITARIA DE PLANTAS MEDICINALES

CONOCIENDO Y PRACTICANDO LO QUE SE HA DICHO, PODEMOS BUSCAR ENTRE TODOS UN LUGAR QUE SIRVA PARA GUARDAR NUESTRAS PLANTAS Y TENERLAS ORDENA DAS Y A MANO PARA CUANDO SE NECESITEN.

APPENDIX 5

HOW TO PREVENT DIARRHEA

Visual aids for various THPs

PARA INSTALAR ALGUNOS SISTEMAS DE AGUA O DE ELIMINACIÓN DE LAS DEPOSICIONES SE PUEDE NECESITAR UN TÉCNICO, PERO LA PARTICIPACIÓN DE LA GENTE ES LO MÁS IMPORTANTE. SI LA COMUNIDAD NO ESTA CONVENCIDA DE LOS BENEFICIOS DE UN SERVICIO Y NO PARTICIPA EN SU INSTALACIÓN, MANTENIMIENTO Y UTILIZACIÓN, LOS RESULTADOS NO SERÁN MUY BUENOS (VEA LA SECCIÓN SOBRE AGUA Y SANEAMIENTO)

¿QUE OTRAS COSAS PODEMOS ACONSEJAR PARA PREVENIR LA DIARREA?

1.- LA LECHE MATERNA ES MUY IMPORTANTE PARA MANTENER SALUDABLES A LOS NIÑOS Y EVITAR LAS DIARREAS. LOS NIÑOS ALIMENTADOS CON BIBERÓN SE ENFERMAN MÁS.

{One requires a technical expert to install systems for good water and to eliminate human wastes, but enlisting the participation of the people is the most important. If the community is not convinced of the benefits of a service and they do not participate in its installation, maintenance, and utilization, the results will not be very successful (see the section about water & sanitation).

What other things can we advise to prevent diarrhea?

1. Mothers milk is very important to maintain childrens health and to avoid diarrhea. Children fed with a bottle will get sick.}

(2. After 4 months the child should eat other foods, prepared in a clean way, then followed by breastfeeding.

3. Wash hands with water and soap,

- after working

- before preparing the meal}

2. DESPUÉS DE LOS 4 MESES EL NIÑO DEBE COMER OTROS ALIMENTOS, PREPARADOS CON MUCHA HIGIENE, ADEMÁS DE SEGUIR MAMANDO.

3. LAVARSE LAS MANOS CON AGUA Y JABON

DESPUÉS DE OBRAR

ANTES DE PREPARAR LA COMIDA.

{ - after changing the child's diapers

- before breastfeeding

4. Boil water for drinking and for preparing children's food.

5. Wash well the child's eating utensils.

6. Wash well fruits and vegetables before giving them to the child.}

DESPUÉS DE CAMBIAR PAÑALES AL NIÑO.

ANTES DE DARLE DE MAMAR.

4.- HERVIR EL AGUA QUE SE USA PARA BEBER Y PREPARAR LOS ALIMENTOS DE LOS NIÑOS.

5.- LAVAR BIEN LOS TRASTES QUE EL NIÑO USA PARA COMER.

6.- LAVAR BIEN LAS FRUTAS Y VERDURAS ANTES DE DÁRSELAS AL NIÑO.

{7. Give food to small children soon after preparing it. If they don't eat it all, don't keep it; and don't give it to another younger brother/sister.

8. Keep food well covered to keep out flies and other animals that would dirty it.

9. Keep children's nails cut as short as the adults.

10. Don't let animals enter the house because they carry dirt on their feet and snouts.}

7.- A LOS NIÑOS PEQUEÑITOS DARLES EL ALIMENTO EN SEGUIDA DE PREPARARLO. SI NO LO COMEN TODO, NO SE DEBE GUARDAR; SI NO, DÁRSELO A OTRO HERMANITO.

8.- MANTENER LOS ALIMENTOS BIEN TAPADOS PARA EVITAR QUE LAS MOSCAS Y OTROS ANIMALES LOS ENSUCIEU.

9.- MANTENER LAS UÑAS CORTAS, TANTO DE LOS NIÑOS COMO DE LOS ADULTOS.

10.- NO DEJAR QUE LOS ANIMALES ENTREN EN LA CASA, PORQUE LLEVAN SUCIEDAD EN SUS PATAS Y HOCICO.

{11. Use and maintain a well-covered latrine or toilet to keep flies and other animals out.

12. If you defecate in the open space bury the feces in a hole.

13. Teach the small children to use the pot and immediately afterwards dump the contents into the latrine or bury it.)

11.- USAR Y MANTENER BIEN TAPADA LA LETRINA O EXCUSADO, PARA EVITAR QUE LAS MOSCAS Y OTROS ANIMALES ENTREN.

SI OBRAS AL AIRE LIBRE, ENTERRAR LA DEPOSICIÓN BIEN HONDO.

ENSEÑAR A LOS NIÑOS CHIQUITOS A USAR LA BACINICA E INMEDIATAMENTE DESPUÉS ECHAR LA DEPOSICIÓN EN LA LETRINA O ENTERRARLA.

APPENDIX 6

PREGNANCY PROGRESS CHART

A graphic record card for TBAs

APPENDIX 7

CERTIFICATE OF PARTICIPATION

A certificate for completion of training for THPs

APPENDIX 8

REFERRAL NOTES

THP referral cards for routine and urgent patients

NATIONAL TRADITIONAL BIRTH ATTENDANT PROGRAMME

(MINISTRY OF HEALTH)

REFERRAL NOTE

......................................................a traditional birth attendant in

....................................village, is referring the bearer of this card for

ROUTINE medical attention. Please afford this patient every courtesy.

Thank You

NATIONAL TRADITIONAL BIRTH ATTENDANT PROGRAMME

(MINISTRY OF HEALTH)

REFERRAL NOTE

......................................................a traditional birth attendant in

....................................village, is referring the bearer of this card for

URGENT medical attention. Please afford this patient every courtesy.

Thank You

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