1. Ministry of Health
The Opportunity to Advance A Behavior Change Communication Campaign to Promote Latrine Adoption in rural Laos PDR Training of Frontline Workers
June 2015
Prepared and sponsored by:

2. Training objectives
After the training, the trainees/frontline workers will…
Understand a new concept of the overarching campaign titled “The Opportunity to Advance”;
Gain basic communication skills;
Know how to use IPC/BCC Toolkit to conduct household visits and group meetings in their local community to promote latrine adoption amongst rural households in Lao PDR

3. Agenda
Time
Content
Day 1
Day 2
(Find agenda in a Document Word file)

4. Self-introductions Please share with others:
Your name, where you work and your position
Think about a time when you had to open defecate
What did you like about it?
What did you dislike about it?

5. Training session rules
Penalties for rule breaker
...
Ask class to come up with some ground rules for classroom. They could include “turn off phone, come on time, etc.
Ask class to come up with FUN or FUNNY fines for breaking the rules such as “sing a song”, “lead ice-break” etc.
Write rules and punishments on A4 paper for entire training course.

6. What’s an open defecation?
Facilitator asks for volunteer(s)

7. What’s an open defecation?
No latrine
Defecating in the open, often in fields, forests, bushes, open bodies of water, or other open spaces.

8. IMPROVED SANITATION?
Facilitator asks for volunteer(s)

9. IMPROVED SANITATION?
Improved sanitation: Having a sanitation facility that ensures hygienic separation of human excreta from human contact.
No latrine - Open defecation in fields, bushes, streams
Unimproved latrines do not separate feces/urine from human contact. They include pit latrines without slabs, bucket latrines, hanging latrines and shared latrines.
Improved latrines that hygienically separate human excreta from human contact. Improved latrine types include: water flush to sewer/septic and simple pit with slab and cover, among others

10. Session 1
Open Defecation

11. Current Situation in Lao PDR
4 out of 10 people
defecate in the open every day
4 out of 10 people defecate in the open every day, or approximately 2 million people
practice OD
2.3 million people
lack access to improved sanitation

12. Current Situation in Lao PDR
Open defecation by province (%)

13. Impact of Open Defecation
In Lao PDR, each year poor sanitation contributes to:
3 million cases of illness
6,000 premature deaths
Nearly 40% of deaths in children under five are due to diarrheal diseases
The most recent study by the World Bank has found that for children under two, sanitation had the greatest impact on reducing stunting, more so than clean water supply.
Almost half of children under five in Lao PDR are too short for their age, a result of chronic malnutrition
Recent research in Lao PDR shows that poor sanitation poses an even greater risk than unsafe water or poor hygiene to children under 2 years of age.

14. results in diarrhea in children
Poor sanitation/hygiene and under-nutrition
results in diarrhea in children
Loss of nutrition
Under-nutrition increases a child’s risk for illnesses (diarrhea, colds, etc.) because their bodies are too weak to fight off germs

15. The importance of latrines✗
The importance of latrines
When people defecate in the open, the germs within the feces are released into the environment and contaminates:
Water sources such as streams and ponds, which are often sources of drinking water
Crop fields, sources of food(morning glory, herbs)
Flies land on the feces and spread germs to food
Fingers that are not washed after touching feces cause illness by contaminating food and facial contact
A latrine is a key way to stop the spread of germs

16. ✔

17. Wash your hands after usign the toilet
(15 ນາທີ)

18. Brainstorm ?
Energizer
Why do you think 2 million people in Lao PDR still defecate in the open?

19. Why is sanitation important?
Messages

20. Why is sanitation important?
Constructing or buying a latrine is important for protecting a family’s health, and in turn important to the health, prosperity and wellbeing of entire communities.
Improved health and wellbeing as a result of providing you and your family with a cleaner living environment and reducing the spread of disease. No disease, chidren and family will be healthier and have more time for other activities...
A latrine may be even less expensive than you think if compared to the opportunities that are more expensive.
The messages in this toolkit are based around the feeling of progressing and improving a family’s quality of life (ohkawt suu kwam sivilai) as a result of having and using an improved latrine.

21. The Opportunity to Advance
Session 2
The Opportunity to Advance

22. What do we want them to do?
Households without a latrine cease open defecation and take actions to build/obtain latrine
Households using unhygienic latrine take actions to upgrade to an improved latrine
All members of community support each other towards becoming open defecation free

23. Small investment in latrine = increasingly greater benefits
The Opportunity to Advance
Quality of life
This is how I see the relationship between our a small investment (as little as 250,000 kip) at the bottom of the pyramid that leads to benefits, which leads to improving your daily quality of life, which increases your chance for progress.
Convenience, Safety, dignity, health, status – wellbeing
Latrine!

24. Questions?

25. Lunchtime
Please return at …..

26. Roles and Responsibilities
Session 3
Roles and Responsibilities

27. Training Cascades Central-level TOT Provincial & District-level TOT
Training for community volunteers and authorities

28. Roles and Responsibilities
Frontline Workers
Village Health Workers, Lao Women’s Union and/or Lao Front for National Reconstruction members, together with CLTS Committees, will directly facilitate group meetings and conduct household visits in their communities.
Frontline Workers will work the Village Chief to determine which households are appropriate to target with messages and activities.
The success of the campaign will rest heavily on ensuring a clear strategy for engaging the most rural and remote families and communities. The role of community leaders, health staff, and volunteers from mass organizations, such as the Lao Women’s Union and Lao Front for National Reconstruction are critical to the campaign’s objectives.
Reaching these people requires a clear chain of responsibility as outlined below.
1. Master Trainers
Ministry of Health officials at central level (Nam Saat, CIEH, Nutrition Centre, Department of Health and Hygiene Promotion). Master trainers are responsible for training District Authorities to further train Frontline Workers on the application of the tools and related skills. Master trainers could also be from other agencies that are involved in rual sanitaiton work such as mass organization, DPs, local associations and etc.
2. Provincial Authorities
Provincial health officials will attend trainings in order to conduct advocacy on behalf of the campaign, District Trainers and Frontline Workers and to assist with monitoring efforts. Provincial officials will also be tasked with providing recognition to households, villages and districts that build latrines and achieve Open Defecation Free status.
3. District Trainers
Staff from district Nam Saat, district CIEH, and/or district-level nutrition focal points are responsible for training Frontline Workers to gain the skills and understanding of tools to conduct activities in their own/neighboring communities. District Trainers will also monitor progress and provide mobilization support to Frontline Workers to conduct community and household-level activities.
Criteria for choosing homes for household visits:
1st priority households: Households without a latrine
2nd priority households: Households using unhygienic latrines

29. Community-level activities
Session 4
Community-level activities

30. Community-level activities
Best scenarious IPC activity is conducted after CLTS triggering. Frontline Workers are tasked with carrying out interpersonal communication activities in their own communities, including:
1. Group/Village Meetings
2. Household visits

31. Community-level activities
Best scenarious IPC activity is conducted after CLTS triggering. Frontline Workers are tasked with carrying out interpersonal communication activities in their own communities, including:
1. Group/Village Meetings
Conduct this activity after CLTS triggering. Conducted with multiple households for approximately 60 minutes per session.
The size of the group meetings can vary from a small group of 4-5 families or a larger village-wide meeting.

32. Community-level activities
Best scenarious IPC activity is conducted after CLTS triggering. Frontline Workers are tasked with carrying out interpersonal communication activities in their own communities, including:
2. Household visits
Conduct this activity after CLTS triggering. Trained frontline workers will visit with the individual families that have not yet made a latrine buying contract for 30 minutes per visit.

33. Session 5
BCC TOOLKIT

34. 1. POSTERS
Ask participants to read the poster messages.
Description: These posters contain the campaign’s key visuals and messages
Use: Hang them during larger group meetings, at health centers, village notice boards, and other public areas where people gather.

35. Poster#1 “Building a latrine provides peace of mind”.
“Convenience, safety, privacy”.
“Together We Can Make An Open-Defecation-Free Lao PDR”.
Key points/messages are?:

36. Poster#2

37. Poster#3 “Having a latrine provides peace of mind”.
“Convenience, safety, privacy”.
“Together We Can Make An Open-Defecation-Free Lao PDR”.

38. 2. STORY CARDS
Description: Three stories that entertain and generate discussion while highlighting the different benefits of owning a latrine.
Use: The suggested storylines and guiding questions are meant to be displayed, used to entertain and engage household members to discuss what they understand from the pictures and related stories.

39. Story#1

40. Story#2

41. Story#3

42. 3. Pricing discussion and overcoming objections
The pricing discussion is designed to help people to understand the actual price of a low-cost latrine as compared to other common household items.
Review the tool and discuss.
The section titled “Overcoming Objections” is designed as a series of responses that the Frontline Worker should be prepared to communicate to common objections presented by households/family members that think they are not ready to commit to buying/constructing a latrine
For families still contemplating...
For families ready to act...
For families already taking action...

43. 4. Take action card
Description: Get families to commit to making several actions towards a latrine after the meeting.
Use:

44. Campaign Toolkit PRICING DISCUSSION POSTERS TAKE ACTION STORIES
Take out package and show
The tools described below have been carefully designed so at the end of the visit or meeting, the target audience is motivated to buy a latrine, know how much a latrine would cost, have thought about how they could finance a latrine and have been given a reminder to take action towards getting a latrine.
The tools empower Frontline Workers by giving them easy tools to help others think differently and act.
Posters
Create awareness and reminder
Stories
Create desire for latrines
Pricing and objections discussion Increase knowledge of latrine prices and overcome common objections
Take-Action Card
Discuss practical actions towards getting a latrine

45. BCC TOOLKIT Demonstration and guidelines for group feedback
Session 6
BCC TOOLKIT Demonstration and guidelines for group feedback

46. Communication skills
When we train frontline workers to carry out interpersonal communication, what things should they keep in mind?
Tools: Bring all materials and extra handouts of latrine sales cards
Skills: Practice the stories, know the pricing game, think about possible objections, know who are you are talking to, persuade through conversation/discussion (versus telling)
Attitude: be friendly, be open to new information, be prepared to repeat messages, don’t tell - discuss
Skills – know who you talking to.

47. Steps for conducting visits and group meetings
Prepare
Introduce yourself and team
Use Story Cards/Flipcharts
Discuss price of the latrine and help villagers find solutions
Use “Take Action Card”
Extra info:
Prepare: Look over and read all contents of each story until fully understood. Preferably you should do this until you remember and are able to tell each story in your own words.
Introduce and explain basic purpose of visit
Ask questions: Use the storyboards and guiding questions to engage household members to tell you what they understand from the pictures
Listen: Pay attention to what has been said and give participants enough time to tell you their responses.
Explain: Tell them the message for the picture. Encourage them if they are right. Do not embarrass them if they misunderstand the pictures, retell the story in your own words.
Entertain: Play the pricing game and help households to know that a latrine can be much cheaper than they thought.
Resolve: help households overcome objections through objections card.

48. 1. Instructions and Storytelling steps
Remember: Consider which story best fits the household(s) you are visiting
If father is at home, choose the story of “Gan Long Tuun Tee Kuum Ka” (Mother Keo selling tam mak huung) – about improving livelihoods, convenience, protecting community health.
If mother is at home, choose story of “Gan Pajon Phai Kong Nang La” (La forced to venture alone into the night) – about safety, convenience, responsibility for family.
If both father/mother are at home, choose the story of “Sao Noy Key Ai” (Young Noy and her embarrassing predicament) – about pride, status, responsibility for family.
Skills – know who you talking to.

49. 1. Instructions and Storytelling steps
Engage your audience
Build the scene
Build tension and release tension
Emphasize what’s important
Discuss by asking questions and listening
Skills – know who you talking to.

50. 2. Pricing Discussion Steps for leading the discussion:
Conduct this activity after the storytelling session is finished.
Show your audience the pictures of the two types of latrine (dry pit and pour flush) on the first page.
Explain there are two common kinds of the latrine and their structures (superstructure, slab and pit).
Ask them to think of anything that costs around 500,000 Kip.
Then, ask again if they can think of things they know of or have previously purchased that cost 500, ,000 Kip. If yes, what is it? How did they pay? (Savings? Borrow? Selling something?). Ask how much they think a simple latrine costs? Pay attention to what they say.
Next show them pictures of the items in page 2-3 and ask what they see and how much each item costs. Point one by one and ask the price of each item. (Note: When visiting a household try to notice items in the house, and what jobs the family members have. Do they have any additional jobs to earn extra income for their family? Ask them to compare the price of the items to the latrine).
Compare the cost of simple pour flush latrine with a mobile phone, a TV satellite dish/receiver, animals… (the idea is to make them know how the cost of buying latrine parts compares with these items).
Ask if they can build a simple latrine house. If yes, what kind of materials will they use?
Ask if they could save 500,000 Kip in the next 2-3 months from saving, selling rice and/or selling animals? If yes, how? If no, why?
Skills – know who you talking to.

51. 2. Take Action Card Steps:
Do this session before finishing up the household visits or the group meeting.
Write down the contact person’s name and the phone number of the latrine supplier on the card. (Do it prior the household visits)
Make enough copies and distribute them to households before closing the meeting or the visit.
Explain the purpose of the card and help them fill or make their plan, numbered: 1, 2, 3, 4… You can give them some examples that they can follow.
Assist the households, especially, the ones who are still hesitating, or are waiting and have not yet decided or made a buying contract. Tell them that you will visit them and support them to succeed with their plan.
Skills – know who you talking to.

52. Role Plays Conduct a group meeting and a household visit

53. Role plays Split into 3 groups
Group 3: Group meeting (7 people) – 2 Frontline Workers, 4 villagers, 1 observer
Group 1: Household visit (3 people) – 1 Frontline Worker, 1 man or woman, 1 observer
Group 2: Household visit (4 people) – 1 Frontline Worker, 1 man & woman, 1 observer
During next 30 minutes, read over content and prepare for public demonstration of your visit
The 1st group will present to the entire class followed by 2nd and 3rd groups

54. Demonstration & guidelines for group feedback
Please observe!
How well prepared was the Frontline Worker?
How well did Frontline Worker:
ASK the questions,
LISTEN to participants,
EXPLAIN the answers,
ENTERTAIN with the game and
RESOLVE questions or challenges
How friendly was he/she?
What could be improved?
Inform the class that you will carry-out a household visit for trainees to observe. Ask for volunteers to be a father and a mother. Ask other participants to observe and note how well you carried out the demonstration based on the criteria.

55. Summary of the training day 1 and homework

56. DAY 2

57. Prepare for role play Group work

58. Role plays Split into 3 groups
Group 3: Group meeting (7 people) – 2 Frontline Workers, 4 villagers, 1 observer
Group 1: Household visit (3 people) – 1 Frontline Worker, 1 man or woman, 1 observer
Group 2: Household visit (4 people) – 1 Frontline Worker, 1 man & woman, 1 observer
During next 30 minutes, read over content and prepare for public demonstration of your visit
The 1st group will present to the entire class followed by 2nd and 3rd groups

59. Introduction to household visit and group meeting plan

60. Role plays Afternoon Time: 1PM Time: 4PM Locations:.............
Group 1: Goes to Ban ....
Group 2: Goes to Ban ....
Group 3: Goes to Ban ....
Each group to conduct a group meeting. Take roughly 60 mn (10-15 people) and a household visit (30 mn).
Time: 4PM
Locations:
Feedback and summary of the community-level activities
Close the training

61. Any questions?
Ask trainees if they have any questions

62. Nutrition Break
Please return at …..

63. Course evaluation Training Frontline Worker
We would like to ask for your input to improve this course:
Content – too much, to little, what topics would you like to know more about?
Flow – does the order of the contents presented make sense? What could be improved?
Class practice – were the instructions clear? What could be improved?
Training Frontline Worker
In looking at the Training Guidelines for Frontline Worker, what could be improved?
What are some of the common challenges that you have faced in conducting training of Frontline Workers?
Judy for topic 2, you may have to tell them the key sessions of the first day again