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Health workers trained in IMCI face many challenges when applying the new integrated case management approach at first-level health facilities. Training settings tend to differ from actual work environments, so the skills learned in training and the transfer of those skills require systematic support. For this reason, follow-up after training is considered to be an essential component of the IMCI training process (and a possible bridge to supervision) supporting the application and reinforcement of skills acquired during training.
This document provides a brief description of the methods and materials for this follow-up being developed by the WHO Division of Child Health and Development (CHD).
Objectives of follow-up after training
To help newly trained health workers to sustain and improve their skills, the objectives of follow-up are:
Follow-up is planned as a part of IMCI training. The goal is to conduct a minimum of one follow-up visit to each health worker at his or her health facility within a month of the training. The visit should be conducted shortly after training for two reasons:
The preparation of follow-up supervisors generally involves training in an IMCI course, training as an IMCI course facilitator, and training to conduct follow-up visits. Those selected to conduct follow-up should possess some clinical skills and be available to conduct visits to peripheral-level health facilities where health workers have been trained. Whenever possible, they should be district-level supervisors. It is therefore most efficient if IMCI planners select persons who are able both to facilitate district-level courses and to conduct follow-up visits after training.
Follow-up consists of a set of well-defined tasks which are designed to reinforce the skills of the health worker and to solve problems. The primary activities undertaken during a follow-up visit include:
1) Reinforce skills of the health worker
2) Review facility supports and solve problems
3) Complete a summary report of the follow-up visit.
1. Reinforce skills of the health worker
The supervisor observes and assists health workers to assess, classify, and treat ill children. The supervisor also observes and supports the communication and counselling skills of health workers. To reinforce a health worker's skills the supervisor:
2. Review facility supports and solve problems
Facility supports are the conditions within the health facility that affect the implementation of integrated case management. The supervisor reviews these supports, checking for the:
3. Complete a summary report of the follow-up visit
Before leaving the health facility, the supervisor completes a brief summary report of the visit. The report outlines the results of the visit, describes action taken to reinforce good practices and to solve problems, and identifies additional action needed. The follow-up supervisor leaves a copy of the summary report at the health facility. In some countries a copy is also given to the district office.
Depending on the geographical location of health facilities, a supervisor or team of supervisors may visit more than one facility in a day in order to maximize use of time and resources. Countries may also choose to add activities to the basic follow-up package in order to gather monitoring or evaluation data. Possible additions to the process could include a review of health facility records and interviews with caretakers after the child has been treated.
One follow-up visit is an integral part of IMCI training, but CHD hopes
that IMCI follow-up procedures will be incorporated into routine supervisory
systems and thereby improve the quality of care.