CHAPTER 2: HANDLING ADMINISTRATIVE ARRANGEMENTS
Careful administrative planning is essential for the training to be
successful. The planning steps are listed below. One or two
instructors may do all of these steps, but it is advisable that the team of
instructors and staff participate. Suggestions for each of these steps are
provided in greater detail in this chapter.
Notice that some of the steps, such as steps 5-8, will be time-consuming only
the first time this training is planned. When future courses are
conducted, the same procedures and materials can be used with only minor
adjustments as necessary.
A checklist for handling administrative arrangements can be found on page
30. You may wish to use it to keep track of the steps as you complete
Step 1. Determine the number of participants that can be trained
Step 2. Design course agenda
Step 3. Make sure adequate funds and supplies are available
Step 4. Obtain copies of training materials and references in the appropriate
Step 5. Make any needed improvements in the facility prior to training
Step 6. Plan how participants' progress will be monitored
Step 7. Prepare and distribute a course announcement
Step 8. Select and prepare other instructors and staff
Step 1 - Determine The Number Of Participants That Can Be Trained
To effectively acquire clinical skills in diarrhoea case management, each
participant should have the opportunity to observe and treat cases of different
degrees of severity. At a minimum, each participant should treat one
dehydrated patient during the training and observe treatment of several
more. The more cases observed and treated by each participant, the more
skilled that participant will become in assessing and treating the full range of
To assure a sufficient number of cases for each participant, determine the
average number of dehydrated patients expected during the time that the course
will be offered (that is, during the three or four day training period).
This number represents the maximum number of participants that can be
effectively trained. For example, if 10 dehydrated cases are expected, ten
participants can be trained. The number of participants that can be
trained will be greater during the seasons when diarrhoea is more
frequent. Do not schedule training when you anticipate a low number of
Step 2 - Design Course Agenda
A sample agenda is presented below. Review this agenda and decide if it
suits your needs and fits within the time available to conduct the
training. Detailed information on how to conduct each of the agenda
sessions can be found in Chapter 3; you may wish to refer to this information as
you design your agenda.
|Sample Agenda Day 1
8:30 - 9:00 Registration
9:00 - 9:30
Welcome: Objectives of training, planned activities, introduction of
participants, administrative announcements
9:30 - 9:45 Break
9:45 - 10:45 Presentation on Principles of Clinical Management
10:45 - 12:00 Individual work on "Management of the Patient with
12:00 - 13:00 Lunch
13:00 - 16:00
Individual work on "Management of the Patient with Diarrhoea" Module (continued)
16:00 - 16:30 Presentation on Management of Acute Diarrhoea
8:30 - 9:30 Instructor demonstrates proper case
9:00 - 12:00 Practical work (with break between
10:00 and 10:30)
12:00 - 13:00 Lunch
13:00 - 14:00 Practical
14:00 - 15:00 Individual work on "Management of the Patient with
15:00 - 15:15 Break
15:15 - 16:15 Drills
of case management techniques
16:15 - 17:00 Presentation on
Epidemiology and Etiology of Diarrhoea
- 9:00 Presentation on Prevention of Diarrhoea
9:00 - 12:00
Demonstration / Practical work
12:00 - 13:00 Lunch
14:00 Practical work
14:00 - 15:00 Drills of case management
techniques, or additional exercises
15:00 - 15:15 Break
15:15 - 16:00 Course Progress Check
8:30 - 9:00 Discussion of results of Course Progress Check
- 12:00 Practical work
12:00 - 13:00 Lunch
13:00 - 15:00
Individual and group work on improving case management
15:00 - 15:15
15:15 - 16:00 Improving case management (continued)
16:00 - 17:00 Course evaluation
You may wish to change this
agenda by omitting some of the presentations, or scheduling the presentations
during the evening. Or you may wish to shorten the course to three days by
scheduling longer days (e.g., until 17:30).
If everyone in your course will need training in IV therapy, you may want to
schedule a session on that topic - perhaps a demonstration and a
discussion. Or if only a few cases of diarrhoea come to the facility
during practical work, you will need to shorten that session and add more time
to conduct additional drills or additional exercises.
Do not hand out the Course Progress Check until participants have completed
their work on the module "Management of the Patient with Diarrhoea" (Chapter 1
in the Participant Manual) and have heard presentations on the principles of
clinical management and the management of acute diarrhoea. The Course
Progress Check can be found on page 156 of this document.
The most important scheduling consideration is for practical work to begin
when most patients present at the facility. The sample agenda assumes that
patients would be available by 8:30. If patients are waiting earlier or if
cases come who will be good for demonstration, the practical work should start
as early as possible. In fact, if a very sick child comes to the facility
on the first day of the course, you may want to consider asking participants to
observe staff treating this child. You should then discuss what the staff
person did and what happened as a result of treatment. At times when
participants are not actively involved in case management, they should remain
near the treatment area, in case new patients arrive or an instructor wants to
discuss a patient with the group. During this time participants can read
reference materials, and work on "Management of the Patient with Diarrhoea",
additional exercises, or their plans for establishing proper case management in
their own facilities.
Use your best judgement in adapting this agenda, taking care to allow
sufficient time for each task (as listed on the Training Design Forms for each
activity in Chapter 3).
Step 3 - Make Sure Adequate Funds And Supplies Are Available
Funds may be needed to support participants' travel and per diem,
extra supplies, training and reference materials, special compensation for
instructors, coffee and tea breaks, and other miscellaneous items.
Review the lists of supplies on page 20 and take inventory of the supplies
on hand. Will these be sufficient considering the normal case load, plus
the expected number of participants? Review the Training Design Forms for each activity in Chapter 3 to see if any
materials need to be copied, or if any supplies need to be ordered or
prepared. These materials and supplies are listed in the "Resources"
column of the Training Design Forms. Supplies for Diarrhoea Treatment
in the Assessment and Treatment Area
- Forms for record keeping
- Wall chart: Management of the Patient with Diarrhoea
- ORS packets of the standard size in the area (for demonstrating to mothers)
- ORS packets for 5, 10 or 20 litre and 5, 10 or 20 litre drum with cover and
side tap (if number of patients is sufficient)
- Jars and flasks (commonly available sizes and one marked with volume
- Antibiotics for cholera, dysentery, and parasitic diarrhoea
- Beds or tables with wires above for hanging bottles of IV fluid
- Lactated Ringer with giving sets
- Scalp vein (butterfly) needles
- Mother's Cards, other health education pamphlets, and other materials for
families on management and prevention of diarrhoea, including feeding
- Posters on preparation of ORS solution and home therapy fluid, feeding during
diarrhoea, diarrhoea prevention, etc.
- Baby scales (accurate to 20 grams) Thermometers
- Glasses, cups and spoons Forms for record keeping
- Cotton and gauze Soap
- Milk powder [optional] Diapers
- Towels and other linens Waste basket or bucket
- Storage cabinet or shelves Wash basin and towel rack
- Fan(s) Chairs or benches
- Droppers and syringes
Step 4 - Obtain Copies of Training Materials and References in the
Obtain enough copies of the "Diarrhoea
Management Training Course: Participant Manual" for every participant to have a
copy to use during the training and to take back to his own facility when the
course is over.
The manual and the other materials can be an
important source of information for participants when they return to their
facilities. The materials will help participants answer questions about
treatment procedures and the rationale for them. They will give
credibility to the new ideas and will help to convince other physicians and
staff. Participants can also use the materials when training others.
Step 5 - Make Any Needed Improvements in the Facility Prior to
One instructor for the Diarrhoea Management Training Course should have
attended a training session at a diarrhoea training unit. During this
training, a plan for improving the current diarrhoea treatment practices in your
facility was prepared. This plan may have identified changes needed in
operating policies, treatment procedures, training, equipment, staff and
arrangement of space.
It is important to make as many of these changes as possible before hosting
the training so that participants are able to observe improved case management
techniques and procedures.
Step 6 - Plan How Participants' Progress Will Be Monitored
Monitoring each participant's progress during the course will allow the
instructor to identify what the participant has accomplished at any point in
time, and what remains to be taught. Individual attention can then be
given to each participant to assure successful completion of the training.
The basic tool for monitoring is a list, or checklist, of what the
participants should do. Several checklists, and ways to use them, are
Each participant has a list of the activities that he or she should
accomplish during the training. An example of a checklist for a
participant to use in monitoring his or her own progress is on page 24.
Each day the participant checks off the activities accomplished that day.
Periodically, the participant discusses his or her progress with the instructor
and may bring any particular needs to the instructor's attention. (For
example, the participant may not have had a chance to treat a severely
Each instructor is assigned certain
participants to monitor. The instructor learns about each participant's
work by observing and talking to the participant. When a participant
accomplishes an activity, the instructor makes sure the participant marks it off
on his or her checklist. (See an example of an additional instructor's
checklist in Annex B.)
Though this may be done informally, it is
very important. The instructor is responsible for making sure that each
participant has the opportunity to participate and achieve all of the training
objectives. Instructors must know what skills each participant has learned
in order to know what remains to be taught. If a participant is having
difficulties, the instructor can give additional guidance to help the
participant master the skill. If the instructor does not feel that
participants will learn certain skills during regular course time, he could
schedule an evening session for review or drills.
Another method for monitoring skills and knowledge is to have participants
answer a set of questions before the end of the training. The students or
the instructor may check the answers. Time is scheduled to teach the
skills or knowledge that the questions revealed participants have not yet
learned. (A set of questions on management of acute diarrhoea suggested
for a progress check begins on page 156.)
SUMMARY OF CLINICAL SKILLS
Participant Name _______________________________
CLINICAL SKILLS CASE NAME AND DATE
Assess other problems
Teach mother to
treat diarrhoea at home
Determine amount of oral fluid for first 4 hours
Administer ORS solution
Teach mother to administer ORS solution
with difficulties in administering ORS
Show the mother how much ORS solution
to give at home
Determine amount of IV fluid for first 3 (or 6) hours
(severe dehydration) [Optional]
Give IV therapy [Optional]
Plan for improving diarrhoea case management at my facility was written and
discussed with an instructor:
_____ Yes _____ No
Step 7 - Prepare And Distribute A Course Announcement
Participants who are committed to learning and using the improved diarrhoea
case management procedures will make the training a success.
can take certain actions to help assure that appropriate and motivated participants will come to the training. Create the proper expectations by clearly describing what the training will accomplish and who will benefit
from it. Contact nearby health centres and small hospitals that might send
participants to the training and send them a course announcement. They
should give a copy of the course announcement to the potential participants so
that each participant will realize what will be expected.
also wish to send the course announcement to regional health officials.
The course announcement should cover the following points:
- Benefit to the participant -- skills the participant will learn
- What type of participant should come and why -- responsibilities and
characteristics of people who can apply the skills in their work
- Purpose -- why the training is being offered
- Involvement -- that participants will work in the facility with patients and
- Schedule -- dates and times that
participants are expected to be at the facility and the location
- Administrative information -- any additional information about
accommodations, transportation and per diem
- Response --
how to register and the deadline for registering
An example of a
course announcement can be found on page 26.
Diarrhoea Management Training Course
3-6 August, 1992
Who Should Attend?
Physicians, nurses, nurses' assistants, and other health staff from health
centres and small hospitals where diarrhoea cases are managed who want to learn
about advances in treatment of diarrhoea, including use of Oral Rehydration
What Are the Purposes of the Training?
- To train physicians and other health workers to treat cases of diarrhoea
using the most up-to-date and effective procedures, and
- To prepare participants to practice good case management in their own
What Skills Will Be Taught?
This training course develops the skill and confidence of physicians and
other health workers in case management of diarrhoea, particularly the use of
ORT for acute diarrhoea. Participants develop skills in the most effective
techniques for assessing diarrhoea cases, treating non-dehydrated and dehydrated
cases, and treating dysentery. They will also learn how to educate mothers
on the management of diarrhoea at home, including advice on fluids and foods to
give the child. Participants will apply these techniques with actual
patients and their families who come to the facility for care.
When Will the Training Be Held?
The training will be held from 3 through 6 August, 1992. Participants
should plan to begin promptly at 8:30 on 3 August, and can expect to be finished
with the training by 15:00 on 6 August. All training sessions will be held
at the District Hospital.
How Do Participants Register?
To register for the training, call (Name of Training Director) at (phone
number), or write to the following address:
All participants must be registered by 13 July, 1992.
Step 8 - Select and Prepare Other Instructors and Staff
Courses in many facilities will have relatively few participants and only one
instructor to organize and conduct the training. Some facilities, however,
will conduct courses with many participants. These larger courses will
require additional instructors, as well as other staff (e.g., nurses or nurses'
assistants), to help out in the treatment area.
The physicians and nurses who will be additional instructors should be:*
- trained in improved diarrhoea case management and have experience treating
at least 25 dehydrated cases using ORT,
- familiar with the course materials as a result of successfully completing
the course themselves either at their own facility or in a nearby facility,
- given adequate time to do the training,
- interested in being instructors,
- committed to use of ORT and proud that they use it,
- skilled in key training activities such as:
- getting the participants' attention and keeping them alert,
- making sure that each participant has the right materials and
understands how he is to use them,
- checking often for understanding and skill development, and providing
appropriate information or feedback to increase learning,
- encouraging participation and questions,
- providing correct and concise answers to questions, or guiding
participants to reach answers themselves,
- guiding group activities, such as group discussions and role-plays,
- using words that participants understand, a clear and audible voice,
and training aids that help, not distract.
Other staff at the training facility who will help during practical work
sessions should be:
- trained in improved diarrhoea case management and have experience
treating dehydrated cases using ORT,
- given adequate time to do the training,
- committed to the use of ORT and proud that they use it.
Be sure that there will be enough instructors and experienced staff
members to give each participant individual attention.
To prepare instructors for the training:
Give all instructors
a copy of the "Participant Manual," Training Design Forms and any guidelines for
sessions they will be teaching, and the agenda. Review the training
objectives and agenda, and assign each individual to certain sessions as
necessary. Discuss the training design for each activity planned.
Select the individual(s) who will deliver each short presentation and provide
the text for the presentation. Review the important points about being an
effective instructor, including how to:
- by making sure that each participant understands how he is to work
through the materials and what he is expected to do,
- by answering the participant's questions as they occur,
- by making clear any information that the participant finds confusing
as he works through the course, and by helping the participant to understand the
main purpose of each exercise,
- by guiding group activities, such as group discussions and
- by promptly evaluating each participant's work and giving correct
- by identifying weaknesses in the participant's skills or
understanding and providing explanation or practice to correct them,
- by helping the participant to understand how to apply concepts taught
in the course to practical problems, for example, to actual situations in his
- by complimenting the participant on his correct answers,
improvements, or progress,
- by making sure that there are no major obstacles to learning (such as
too much noise or not enough light).
- by making sure that each participant has access to the right supplies
and materials when he needs them,
- by monitoring the progress of each participant.
To prepare other staff for the training:
Be sure that the
staff members who will be working closely with the participants:
- are present during each shift, each day of the course, in adequate
- are trained to give ORT and teach mothers,
- perform case management tasks correctly,
- keep adequate
records to document a patient's progress (that is, adequate for participants to
learn a patient's response to therapy during time participants are not there),
- are friendly and supportive of participants, so that
they will help the participants as needed, correct mistakes diplomatically, and
discuss their experiences treating difficult or unusual cases.
Conduct a meeting to prepare the staff for the training. They must be
informed of what the participants will be doing in the facility so that they can
help and guide them. Give them an opportunity to ask questions about how
the training will work and what they should do. Answer these questions
carefully. The staff will have a critical teaching role.
CHECKLIST FOR HANDLING ADMINISTRATIVE ARRANGEMENTS
- Maximum number of participants determined (usually same number as
average number of dehydrated patients expected during course).
- Course agenda designed.
- Arrangements made for obtaining adequate numbers of copies of the
course materials and necessary supplies. (Necessary supplies and materials
are listed on pages 20-22).
- Arrangements made for securing needed funds to support participants'
travel and per diem, extra supplies, training and reference materials, special
compensation for instructors, coffee and tea breaks, and other miscellaneous
- Arrangements made for making any needed improvements in the facility
prior to training (that is, improvements identified by staff during a previous
training session at a diarrhoea training unit).
- Plans made for monitoring participants' progress throughout course.
- Dates of course selected, allowing at least 4 days.
- Letter sent out containing course announcement to nearby health
centres and small hospitals.
a. explains that a course will be held, and the
purpose of the course.
b. clearly states the number of participants to attend
the course, and that these should be individuals who
are responsible for managing diarrhoea cases.
c. mentions the length of the course (4 days) and that individuals
should plan to attend the entire course.
d. describes the location and dates of the course.
e. clearly states the date by which course
participants should register and to whom to send the
names of nominated participants.
- Room for training identified (e.g., large enough to seat all
participants, with tables and adequate lighting).
instructors selected (only if number of participants is expected to be more than
- Other instructors prepared for training. They:
a. have copies of all necessary materials.
b. know who will be giving each presentation.
c. have discussed the training design and agenda, and
are assigned to certain sections as necessary.
d. have discussed the important points about being an
- Other staff participating in the training briefed. They:
a. know what participants will be doing in the
facility so that they can help and guide them.
b. have an opportunity to ask questions about how the
training will work and what they should do.
- Local authorities asked to participate in the opening ceremony and/or
invited to the course, if desired.
AT THE FACILITY, BEFORE THE COURSE BEGINS
- Arrangements made for welcoming participants.
- Arrangements made for adequate room for conducting the course (large room
available during the course for seating all instructors, participants and
- Arrangements made for meals and coffee/tea service.
- Arrangements made for typing and copying of materials during the course
(for example, answer sheets and list of participants).
- Plans for opening ceremony (if necessary) finalized with local
- Course materials and supplies organized and placed in appropriate areas
(for example, slide projector and, if possible, videotape player and
DURING THE COURSE
- Course Directory (including names and addresses of all participants and
instructors) provided to everyone.
- Course photograph, if desired, made in time to be developed before course
- Course completion certificate prepared for each participant