1. Lesson Learnt - Training Nigeria’s Experience

2. Outline Introduction planning Selection of personnel Criteria for CHWs selection Training Description Training Training Analysis Challenges Recommendations

3. Introduction 9 states are eligible for SMC in Nigeria, ACCESS-SMC supported some 181 LGAS in 2 of the states- Sokoto and Zamfara states Several cadre of personnel were trained to deliver the intervention after a careful selection process The intervention was welcomed by all stakeholders and the benefiting communities

4. Planning Microplaning was conducted in the two states with the objective of obtaining critical information that will guide the implementation process The micro-plan identified and quantified the following: Eligible children to be reached Settlements to be covered Personnel requirements Training materials Logistics Budget

5. Selection of Personnel The selection of all personnel was based on the criteria set in the guidelines and manual. The cadre of personnel selected included Master trainers State supervisors LGA Team Health Facility staff Ward Supervisors Team Supervisors CHW Town announcers Community mobilizers

6. Selection Criteria for CHW Female or male; 18 years or older Literacy preferred; able to read and write in English Reside in the community where SMC was to be delivered Respected member of the community Committed to reducing malaria in the community Previous experience with MDA, vaccination campaigns, or health promotion preferred Volunteers (transportation cost covered) Able to keep records and be accountable for medicines Available to distribute SMC for 5 days each month for four consecutive months each year

7. Training Description

8. Description of Training SokotoZamfaraTotalNumber of Training Days Number of trainers/ Class Number of trainees /Class Ratio of trainees to trainer Venues/Loca tion Duration of training 1 Master TrainersN/A 254 days22513Abuja8 hours 2 National Trainers70 1403 days33512state Capital8 hours 3 Training of CHWs3,4453,1566,6013 days23518Decentralise d within the communities 6 hours 4 Training of Supervisors 2141914052 days23518same6 hours 5 Training of Health Facility Staffs 6726821,3542 days23518same6 hours 6 Training of Ward Supervisors 107751822 days2105same6 hours 7 Orientation of Town Announcers 3212225431 day23317same3 hours 8 Orientation of Traditional & Religious Leaders 3212225431 day23317same3 hours

9. Pre and Post Test Evaluation- NToT 20 questions worth 5 points each. 22 participants completed the Pre- and Post-Test. Average Pre-Test Scores of Master Trainers: 74%; the lowest score was 35% and the highest score was 90% Average Post-Test Score of Master Trainers: 95%; 6 participants scored 100% and 12 scored 95%. The lowest score was 75%. Average percent improvement between test Pre- and Post-Test scores: 21%. The biggest % improvement was 65%.

10. Pre and Post Test Evaluation- SToT 20 questions worth 5 points each. 22 participants completed the Pre- and Post-Test. Average Pre-Test Scores : 44%; the lowest score was 10% and the highest score was 85% Average Post-Test Score : 82%; 2 participants scored 100%.The lowest score was 45%. Average percent improvement between test Pre- and Post-Test scores: 38%. The biggest % improvement was 70%.

11. Content of Training Introduction to SMC Preparing for cycle Administration SP and AQ safety Referral & Pharmacovigilance first line treatment of uncomplicated malaria SMC supervision Trainer competency Assessment

12. Training Analysis The criteria for selection of trainers stipulated in the manual was used for the selection of trainers both at National and at state. 10 CHWs team to one supervisor All were expected to be supervised, the supervision was not adequate. All the supervisors were trained on how to supervise using role plays and scenarios as outlined in the supervisor training manual. The competency checklist were used while supervising, but one cannot say to what extend this checklist were used. Also as the cycles progresses, some felt they don’t need the checklist and that it can be done off-heart without the checklist We encouraged 50% of the CHW should be literate and 50% illiterate. No HR job description for the CHWs

13. Challenges Difficulty in recruiting personnel meeting the selection criteria especially in hard to reach areas. Challenges in feeding the participants during the Ramadan fast, we had to monetize the Lunch. Time allocated was insufficient for the training contents. Insufficient transportation stipends, for people coming from difficult terrains. Delayed commencement of trainings due to delay in finalization of training materials.

14. Recommendations The training materials should be revised to simpler English for easy understanding. Increase the training days to cover the manual completely. Increase in scenarios and role plays in the training manual to make it more practical oriented. Trainings should be further decentralized, bringing it closer to the people, will reduce the cost of transportation of participants. Selection of trainers should be source locally and within the LGA and decentralised. Need to increase the transportation stipends especially to those living in hard to reach areas.

15. THANK YOU