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Home Care - 5.3 Training and Resources
5.3 Training and Resources
The teams were divided into 2 mixed groups of 20 for formal training, which was conducted in 3 one-week modules with the second week comprising a placement with an existing community health project.
The training course was facilitated by a nurse-trainer from the MoH Master Trainer Programme. The trainers, who were drawn from a wide range of institutions, were encouraged to use participatory techniques including case studies and roles plays as much as possible. The course contained modules on counselling, models of AIDS care, HIV/AIDS education for families, voluntary counselling & testing (VCT), home care, hygiene, nutrition, use of drugs, managing symptoms, psychological problems, pain management, TB, traditional medicine, HIV/AIDS & children, working with volunteers, working with the community, and palliative care.
The lesson plans, handouts and summaries were compiled into a draft training pack in Khmer which is available at the AIDS Care Unit of NCHADS.
A participatory evaluation of the training course conducted immediately afterwards indicated a high degree of satisfaction by course participants in preparing them for their roles in the HCTs.
The consensus of HCT members interviewed during this evaluation, was that the initial training provided during start-up was essential preparation for their work in the home care programme.
Lesson learned: comprehensive training for the HCTs, using participatory approaches where appropriate, is essential preparation for initiating a home care programme
It is recommended that the draft training pack used in initial training is updated and developed into a training resource pack for use when the home care programme is expanded.
A heavily adapted Khmer version of WHO’s “Handbook on AIDS Home Care” was one of the resources used during the training. This continues to be the main resource for the home care programme, with a copy being provided to each home care team member. Originally developed by NGOs in Africa, the handbook shows primary health workers how to manage symptoms in the home and how to use stories to teach about the realities of HIV/AIDS. The handbook has been extensively field tested and 5,000 copies have been printed by WHO for distribution by NCHADS. Because of the usefulness of this resource, it is recommended that the Handbook is re-translated into English and 1000 copies are printed for distribution to IOs and NGOs working in the field of AIDS Care. It is also recommended that the pictures from the “Home Care Stories” are incorporated into a flipchart for teaching purposes.
It is recommended that the AIDS Care Handbook is translated into English and 1000 copies are printed for distribution to NGOs/IOs
It is recommended that pictures from Home Care Stories are incorporated into a flipchart for teaching purposes by organisations working in the field of AIDS care.
In response to training needs identified during participatory reviews, KHANA and World Vision have supported and/or facilitated a series of further orientations and refresher training.
During September 1998 all HCT members underwent a 1-week placement in local hospitals and/or hospices to upgrade their diagnostic and treatment skills. The HCTs also hosted social workers from Social Services Cambodia to help improve their knowledge of HIV/AIDS.
In October and November 1999, with support from KHANA, all local NGO and government team members attended a 1-week basic counselling course. In addition, one NGO member and one government member of each team attended a 2-week post basic counselling course run by Quaker Services Australia (QSA) on contract from KHANA. KHANA has also contracted QSA to facilitate monthly counselling follow-up sessions with team members, where case studies are presented and discussed.
In the last quarter of 1999, KHANA ran a short course for HCTs in Appropriate Prescribing and contracted Douleurs sans Frontières to conduct a course for HCTs in Physiotherapy for Pain Relief.
The evaluation noted that these on-going training updates and orientations are helping the HCTs to provide a more professional service. However, a number of HCT staff still express a desire for further training. The team members perceived that their main skills/knowledge gaps were in clinical diagnosis and management of symptoms, in the appropriate use of pharmaceutical products, and in counselling.
In the light of recent and ongoing training, the evaluation team are of the opinion that further counselling training is not a high priority. Indeed, in the 17 observations of home care teams at work, the evaluation team were particularly impressed with the counselling skills of the home care staff, and noted that these were among some of the best they had observed in Cambodia.
It is believed however, that there is a case for upgrading skills in clinical diagnosis of common conditions related to HIV/AIDS. It is to the credit of the home care team staff that they recognise the need for better diagnostic skills, especially in a country where the prevailing medical ethos does not encourage sharing diagnosis with patients, and where self-prescription and treatment without diagnosis is common.
It is also felt that HCT staff should continue to receive ongoing refresher training in treatment regimes to enable them to deal with issues and answer questions from patients about medication, side effects, etc. A case study approach could be used to address individual issues as they arise.
It is evident that, with the increase in the AIDS epidemic and the widening profiles of PLHA, the HCTs will continue to face new issues and challenges. One issue which emerged during this evaluation is the increasing number of pregnant women who are HIV+ and who do not wish to continue the pregnancy. A second challenge, which is becoming increasingly prevalent, is the number of children, many of whom are themselves HIV+, who have become, or who will soon become orphaned because of AIDS-related deaths.
It is recommended that the Home Care Network assumes responsibility for establishing and implementing a system of ongoing refresher training and orientations to deal with these emerging issues. Some training can be conducted on-the-job, while other issues can be dealt with during short workshops. It is believed that the Home Care Network can draw on existing skills and resources available in Cambodia, and it is suggested that KHANA, MoH, NGOs, and other ministries could play a major role in resourcing this.
It is recommended that the Home Care Network implements a schedule of ongoing refresher training and orientations to deal with emerging issues facing HCTs. KHANA, MoH, NGOs and other ministries could act as resources with funding and support through the Home Care Network.
The teams were divided into 2 mixed groups of 20 for formal training, which was conducted in 3 one-week modules with the second week comprising a placement with an existing community health project.
The training course was facilitated by a nurse-trainer from the MoH Master Trainer Programme. The trainers, who were drawn from a wide range of institutions, were encouraged to use participatory techniques including case studies and roles plays as much as possible. The course contained modules on counselling, models of AIDS care, HIV/AIDS education for families, voluntary counselling & testing (VCT), home care, hygiene, nutrition, use of drugs, managing symptoms, psychological problems, pain management, TB, traditional medicine, HIV/AIDS & children, working with volunteers, working with the community, and palliative care.
The lesson plans, handouts and summaries were compiled into a draft training pack in Khmer which is available at the AIDS Care Unit of NCHADS.
A participatory evaluation of the training course conducted immediately afterwards indicated a high degree of satisfaction by course participants in preparing them for their roles in the HCTs.
The consensus of HCT members interviewed during this evaluation, was that the initial training provided during start-up was essential preparation for their work in the home care programme.
Lesson learned: comprehensive training for the HCTs, using participatory approaches where appropriate, is essential preparation for initiating a home care programme
It is recommended that the draft training pack used in initial training is updated and developed into a training resource pack for use when the home care programme is expanded.
A heavily adapted Khmer version of WHO’s “Handbook on AIDS Home Care” was one of the resources used during the training. This continues to be the main resource for the home care programme, with a copy being provided to each home care team member. Originally developed by NGOs in Africa, the handbook shows primary health workers how to manage symptoms in the home and how to use stories to teach about the realities of HIV/AIDS. The handbook has been extensively field tested and 5,000 copies have been printed by WHO for distribution by NCHADS. Because of the usefulness of this resource, it is recommended that the Handbook is re-translated into English and 1000 copies are printed for distribution to IOs and NGOs working in the field of AIDS Care. It is also recommended that the pictures from the “Home Care Stories” are incorporated into a flipchart for teaching purposes.
It is recommended that the AIDS Care Handbook is translated into English and 1000 copies are printed for distribution to NGOs/IOs
It is recommended that pictures from Home Care Stories are incorporated into a flipchart for teaching purposes by organisations working in the field of AIDS care.
In response to training needs identified during participatory reviews, KHANA and World Vision have supported and/or facilitated a series of further orientations and refresher training.
During September 1998 all HCT members underwent a 1-week placement in local hospitals and/or hospices to upgrade their diagnostic and treatment skills. The HCTs also hosted social workers from Social Services Cambodia to help improve their knowledge of HIV/AIDS.
In October and November 1999, with support from KHANA, all local NGO and government team members attended a 1-week basic counselling course. In addition, one NGO member and one government member of each team attended a 2-week post basic counselling course run by Quaker Services Australia (QSA) on contract from KHANA. KHANA has also contracted QSA to facilitate monthly counselling follow-up sessions with team members, where case studies are presented and discussed.
In the last quarter of 1999, KHANA ran a short course for HCTs in Appropriate Prescribing and contracted Douleurs sans Frontières to conduct a course for HCTs in Physiotherapy for Pain Relief.
The evaluation noted that these on-going training updates and orientations are helping the HCTs to provide a more professional service. However, a number of HCT staff still express a desire for further training. The team members perceived that their main skills/knowledge gaps were in clinical diagnosis and management of symptoms, in the appropriate use of pharmaceutical products, and in counselling.
In the light of recent and ongoing training, the evaluation team are of the opinion that further counselling training is not a high priority. Indeed, in the 17 observations of home care teams at work, the evaluation team were particularly impressed with the counselling skills of the home care staff, and noted that these were among some of the best they had observed in Cambodia.
It is believed however, that there is a case for upgrading skills in clinical diagnosis of common conditions related to HIV/AIDS. It is to the credit of the home care team staff that they recognise the need for better diagnostic skills, especially in a country where the prevailing medical ethos does not encourage sharing diagnosis with patients, and where self-prescription and treatment without diagnosis is common.
It is also felt that HCT staff should continue to receive ongoing refresher training in treatment regimes to enable them to deal with issues and answer questions from patients about medication, side effects, etc. A case study approach could be used to address individual issues as they arise.
It is evident that, with the increase in the AIDS epidemic and the widening profiles of PLHA, the HCTs will continue to face new issues and challenges. One issue which emerged during this evaluation is the increasing number of pregnant women who are HIV+ and who do not wish to continue the pregnancy. A second challenge, which is becoming increasingly prevalent, is the number of children, many of whom are themselves HIV+, who have become, or who will soon become orphaned because of AIDS-related deaths.
It is recommended that the Home Care Network assumes responsibility for establishing and implementing a system of ongoing refresher training and orientations to deal with these emerging issues. Some training can be conducted on-the-job, while other issues can be dealt with during short workshops. It is believed that the Home Care Network can draw on existing skills and resources available in Cambodia, and it is suggested that KHANA, MoH, NGOs, and other ministries could play a major role in resourcing this.
It is recommended that the Home Care Network implements a schedule of ongoing refresher training and orientations to deal with emerging issues facing HCTs. KHANA, MoH, NGOs and other ministries could act as resources with funding and support through the Home Care Network.