Improving basic child healthcare skills

Mon, 7 February 2011

I learnt more than I was expecting. As a manager of the house now I know that you need well developed staff to work with so that they know the importance of record keeping, CPR and when to worry about the children’s health.” – Project beneficiary

FINAL REPORT: Bigshoes Foundation Basic Chid Healthcare Training

The Bigshoes Foundation Basic Child Health Training Programme ran a 12-month programme from April 2009 to March 2010. The programme aimed to train 250 caregivers, who work in children’s home and within Johannesburg communities in basic child health skills. As a result of this training, caregivers would be better equipped to meet the health care needs of children while also providing relief to the public health care system.

Training sessions were structured into 5 day workshops. Children’s home caregivers were the focus of five workshops while 6 workshops were conducted for community members. The training received by caregivers will allow them to monitor child development, provide better nutrition, emotional support, palliative care and to manage minor injuries and illnesses.

Outputs and Impact

232 participants were trained between April 2009 and March 2010 through the homes and community workshops. This amount was slightly less than the 250 target set by the Bigshoes as a result of financial constraints experienced by participants and their places of employment.

• Six children’s home caregiver workshops were conducted. Each of these workshops took place over five days. Citing demand from the homes, Bigshoes scheduled an additional workshop. These workshops reached a total of 95 caregivers.
• There were five community member workshops held throughout the funding period, with each workshop being conducted over 5 days. All in all, 137 community members received training; participation was driven by a keen interest in skills development within the communities.
• Despite the high number of participants receiving training, a lack of response from community organizations in the Johannesburg region resulted in one of the community workshops being changed to a homes workshop.
• A highly qualified trainer joined the Bigshoes team; the organization initiated a new programme for the specifically designed for police officers. As a result, 34 police officers were trained in the emergency care of abandoned newborns.
• As more community members were trained than originally anticipated, this is likely to increase the number of indirect child beneficiaries.
• Bigshoes intends to accredit their course through the South African Qualifications Authority to ensure alliance with national unit standards. External factors have delayed these efforts with Bigshoes subsequently seeking to gain accreditation through Foundation for Professional Development.

Expenditure

The total budget cost for the project was R258,460 and has been paid out in full.

Description	Budget	Expenditure
Purchase Of Resuscitation Dolls	19 500	21 313
CPR Booklets with Resuscitation Kits	11 970	11 212
Purchase Of Stationery for the year	5 000	5 139
Monthly Portion half Post trainer	23 040	38 260
Monthly Position locums	41 180	41 180
Monthly Portion of HR/ Fundraiser	34 000	34 000
Monthly Portion of Project/Finance Manger	18 000	18 000
Sessional Trainer	57 600	35 850
Training Manuals	19 500	17 042
Nashua Rentals	1 040	1 516
Telkom	5 000	5 000
Venue Hire	2 000	2 200
Travel	2 400	6 827
Continued Medical education	13 230	7 000
Cleaning	5 000	4 000
TOTAL	258 460	249 539

Challenges

• Ensuring that training information remains current has proved to be challenging. The field of HIV is a particular concern as new research is continuously being conducted. To address this Bigshoes has established relationships with medical specialists, nurses and HIV organizations.
• Financial constraints were again a negative impact, resulting in training groups being smaller than initially expected
• Punctuality in regards to the training workshops was also an issue. On most occasions, the first day was delayed because of latecomers. Bigshoes ensures that the importance of punctual arrival is highlighted on the first day of training, along with the consequences that could arise should too many training hours be missed.
• Communication with project participants proved to be rather challenging. Information regarding the programme had to pass through a number of levels before reaching participants. To address this issue Bigshoes provides continuous feedback to the organizing body to deal with such glitches in future training.
• The community member workshop and the abandoned baby training proved challenging because of large groups arriving for CPR training. Bigshoes consequently hired a second registered nurse to assist with training facilitation.

Monitoring and evaluation

• Pre- and post-intervention tests covering the contents of the course were given to participants at the beginning and end of the course. On average, scores increase by 16% throughout the course of the year
• Information on participants and their activities is maintained on an electronic database, with statistics being reported to management on a monthly basis. Caregivers were asked to provide information regarding how many children they worked with directly. Through this monitoring process the organisation realised that they were having an indirect impact on more children than the 1500 they had originally estimated.
• The training co-coordinator kept in contact with the managers whose staff participated in the homes training programme. Feedback was received on any noticeable change in terms of participant’s skills, knowledge and work since the course. The programme has been widely supported by mangers who continue to send their new staff for training. Although feedback is currently received on an informal basis through manager calls and visits, Bigshoes aims to formalise this process in the future.
• After each course, a report detailing where participants are employed, their positions and their test results is completed and circulated to the relevant role players within Bigshoes as well as to the managers of participants who have completed their training.

Conclusion

The Bigshoes training programme has come to the end of its year long course. A marked increase in participant’s basic health care knowledge and skills was seen. The managers who sent their staff to the training unanimously support the course and continue to send staff for training. Participants also spoke well of the training remarking on their increased knowledge and skills and how they would be used to better care for children. Although the financial constraints of participants and their organizations, hindered Bigshoes’s ability to train 250 caregivers, the target was almost reached with 232 successful participants.

Workshops to keep kids safe and healthy

Mon, 22 February 2010

I learnt more than I was expecting. As a manager of the house now I know that you need well developed staff to work with so that they know the importance of record keeping, CPR and when to worry about the children’s health.” – Project beneficiary

Progress Report 2: Bigshoes Foundation Basic Child Health Training Programme

The Bigshoes Foundation Basic Child Health Training Programme is a 12-month programme running from April 2009 to March 2010. It will target 250 caregivers working in children’s homes and in communities in the Johannesburg area. These caregivers will be trained in basic child health skills so that they can meet the health care needs of the children in their care. Training will be delivered through 10 five-day workshops with approximately 25 caregivers at each workshop. Five of the workshops will focus on Children’s Home care giving, while the other five will focus on Community Member care giving.

Caregivers will be able to monitor the development of each child and look out for signs of danger. This will help relieve some the burden on the public health care system and Bigshoes’ medical clinics and outreach, which will allow for them to concentrate on more complex medical problems, accurate HIV diagnosis and adoption medicals.

Outputs and Impact

• CPR Resuscitation dolls and booklets were purchased in February 2009
• Thus far, 158 caregivers have received training through nine workshops of five days each. Five Children’s Home Caregiver workshops and four Community Member workshops were held from February to October 2009. While the aim was to train 25 caregivers per workshop, average attendance was 18 caregivers at each workshop.
• During the five-day training workshops, the caregivers received training on basic health care, HIV management and palliative care. The training enabled the caregivers to efficiently manage day-to-day illnesses and injuries. They learned how to apply first aid when required, administer ARV medication appropriately, manage common childhood illnesses at home and monitor the children’s development. Caregivers were trained to recognize early warning signs of serious conditions and seek medical attention. The training has made children less dependent on overburdened clinics and hospitals for problems that can be safely managed at home.
• Results from comparisons of pre- and post-workshop tests for the nine workshops indicate that caregivers have improved their knowledge by approximately 25%.
• Training caregivers has a far-reaching impact. Assuming the 158 trained caregivers each have approximately seven children in their care, approximately 1100 children will benefiting from this project.
• Bigshoes doctors attended the fourth International AIDS Conference, while doctors and training staff also attended the Paediatric Palliative Care Conference. The workshop trainer attended training as part of her continued medical education. This included attending a debriefing course on grief and loss and an international conference run by Children’s Hospice International.

Expenditure

The cost of the project is R258,460, of which R196,816 has been paid. One remaining tranche payment of R61,644 is yet to be paid.

Description	Budget	Expenditure
Purchase Of Resuscitation Dolls	19 500	21 313
CPR Booklets with Resuscitation Kits	11 970	11 212
Purchase Of Stationery for the year	5 000	5 139
Monthly Portion half Post trainer	23 040	15 360
Monthly Position locums	41 180	27 453
Monthly Portion of HR/ Fundraiser	34 000	22 667
Monthly Portion of Project/Finance Manger	18 000	12 000
Sessional Trainer	57 600	26 250
Training Manuals	19 500	13 270
Nashua Rentals	1 040	832
Telkom	5 000	3 334
Venue Hire	2 000	1 800
Travel	2 400	3 428
Continued Medical education	13 230	7 000
Cleaning	5 000	4 000
TOTAL	258 460	175 058

With a few minor exceptions the project is on track as far as expenses are concerned. There was marginal over spend on the resuscitation dolls as they needed to be imported from Canada and import prices have increased since the original budget was put forward. The organisation managed to save on the purchase of CPR Booklets and Resuscitation Kits, but needs to reallocate this funding towards the unforeseen expense of replacing the plastic bags that form the lungs of the CPR manikins. There was also a saving on the printing of training manuals.

Challenges

• As in the first reporting period, there was a problem with late arrivals. This happened despite putting up adequate direction signage in the building, as well as sending directions to the participating organisations beforehand.
• Bigshoes tries to be as flexible as possible with workshop attendance, by allowing caregivers to complete four out of five days and return for the remainder (CPR training – one full day) when it is more convenient for them. They also have set up “catch-up” training which will include those who did not successfully complete the whole course. However, attendance rates remain low. Bigshoes have found an unfortunate correlation between non-attending trainees and organisations who have not contributed anything financially towards the training.
• Bigshoes tried improving training availability by offering training at the organisation premises. However, it was evident that training on site can be too distracting as trainees kept leaving the training area to feed children or were called out by other members of staff. In terms of setting up, it was also quite complicated to take all the equipment to the organisation, pack up and unpack on a daily basis.

Monitoring and evaluation

• Pre-tests were conducted on the first day of the workshop to determine the baseline for the level of information held by participating caregivers.
• Post tests were conducted on the last day of the workshop to indicate the change in content knowledge of participating caregivers.
• Pre and post test results for workshops from February through to October 2009:

Description	Comm Org	Home Care	Comm Org	Home Care	Comm Org	Home Care	Comm Org	Home Care	Home Care	Avge
	Feb	Mar	Apr	May	Jun	Jul	Aug	Sep	Oct
Attendance (Aim:25)	26	6	20	21	25	16	25	10	9	18
Pre Test	67%	55%	67%	61%	69%	57%	58%	77%	59%	63%
Post Test	81%	87%	80%	77%	78%	71%	72%	79%	79%	78%
% Increase	21%	58%	19%	26%	13%	25%	24%	3%	34%	25%

Conclusion and Evaluator Analysis

The project is nearing completion and has seen good results in terms of increasing caregiver knowledge. There have also been positive reports from the caregivers who attended the training.

The project has experienced some minor challenges, mainly with regards to attendance. However, Bigshoes have made a concerted effort to overcome these challenges, even going as far moving training to participating organisation’s premises.

The improved capacity of caregivers in this area will improve the basic health of the children in their care. It will also relieve the unnecessary burden on immediate clinics as caregivers are able to see to problems that would have previously been referred.

Bigshoes Foundation Basic Child Health Training Programme

Mon, 28 September 2009

“I’ve got experience now about what I am doing. I’ve learned more about First Aid, HIV/AIDS and how to measure some of the medication with a syringe.” – Project beneficiary

Progress Report 1:Big Shoes - Child care workshops underway

The Bigshoes Foundation Basic Child Health Training Programme is a 12-month programme running from April 2009 to March 2010. It seeks to empower 250 caregivers working in children’s homes and in communities in the Johannesburg area. These caregivers are trained in basic child health skills to adequately meet the health care needs of children in their care as part of their strategy to improve the overall medical care of orphans and vulnerable children. These skills will be delivered through ten 5-day workshops with approximately 25 caregivers at each workshop. Five of the workshops will focus on Children’s Home care giving, while the other five will focus on Community Member care giving.

As a result of the intensive training programme, the children will receive better nutrition, emotional support, palliative care and management of minor injuries and illnesses. Caregivers will be able to monitor the development of each child and look out for signs of discord correctly. This will in turn relieve the burden on the public health care system and Bigshoes’ medical clinics and outreach as better management of basic child health means that more time can be spent on complex medical problems, accurate HIV diagnosis and adoption medicals. The ultimate beneficiaries of this project are disadvantaged children who have either been placed in childcare institutions or are in need of care and are living in disadvantaged communities.

Outputs and Impact

• CPR Resuscitation dolls and booklets were purchased in February 2009
• Thus far, 98 caregivers have received training through five workshops. Two Children’s Home Caregiver workshops of 5 days each were held in March and May 2009. Six caregivers attended workshop one and 21 caregivers attended workshop two. Three Community Member workshops of 5 days each were held in February, April and June 2009. 26 caregivers attended workshop one, 20 caregivers attended workshop two and 25 caregivers attended workshop three.
• During the five-day training workshops, the child caregivers received training on basic health care, HIV management and palliative care. The training enabled the child caregivers to efficiently manage day to day illnesses and injuries in children. They learned how to apply first aid when required, administer ARV medication appropriately, manage common childhood illnesses at home and monitor the normal development of a child. Caregivers were trained to recognize early warning signs of serious conditions and seek medical attention, which will avoid unnecessary morbidity and mortality. The training has made children less dependent on overburdened clinics and hospitals for problems that can be safely managed at home.
• Results from comparisons of pre- and post-workshop tests for the five workshops indicate that caregivers have improved their knowledge by approximately 26%.
• Training possibly remains one of the most powerful tools in breaking the cycle of poverty, and the training provided here could stimulate interest in the health care sector and possibly open a new career path for some caregivers. With up-skilling child and youth caregivers who look after an average of seven children each, the project’s reach into the community is extended dramatically. If the 98 trained caregivers have approximately seven children in their care, this results in approximately 686 children benefiting from this project.
• The workshop trainer attended training as part of her continued medical education. This included attending a debriefing course on grief and loss and an international conference run by Children’s Hospice International. The aim of this was to ensure that the trainers are kept up to date with the latest developments in the field and are capacitated in order to deliver a quality high level of training.

Activities to be completed

• Three Children’s Home Caregiver workshops of 5 days each, including pre- and post-intervention tests
• Two Community Member workshops of 5 days each, including pre- and post-intervention tests
• Continued medical education, with sessions held every Wednesday
• Printing of remaining training manuals. This is being delayed as material may change slightly once the accreditation process has been completed. The process is currently being delayed by unforeseen procedural requirements.

Expenditure

The cost of the project is R258,460, with R142,317 outstanding

Description	Total Budget	Total Expenses to date
Purchase Of Resuscitation Dolls	19 500	21 313
CPR Booklets with Resuscitation Kits	11 970	11 212
Purchase Of Stationery for the year	5 000	5 139
Monthly Portion half Post trainer	23 040	7 680
Monthly Position locums	41 180	13 727
Monthly Portion of HR/ Fundraiser	34 000	11 333
Monthly Portion of Project/Finance Manger	18 000	6 000
Sessional Trainer	57 600	13 050
Training Manuals	19 500	3 738
Nashua Rentals	1 040	416
Telkom	5 000	1 667
Venue Hire	2 000	1 000
Travel	2 400	-
Continued Medical education	13 230	7 000
Cleaning	5 000	2 000
TOTAL	258 460	105 275

The project has not reached completion so expenditure thus far is obviously not at budgeted levels. As can be seen above, with a few minor exceptions the project is on track as far as expenses are concerned. There was marginal over spend on the Resuscitation Dolls as they needed to be imported from Canada and import prices has increased since the original budget was put forward. The organisation had managed to save on the purchase of CPR Booklets and Resuscitation Kits, but needs to reallocate this funding towards the unforeseen expense of replacing the plastic bags that form the lungs of the CPR manikins. Although this is not a big expense, a quote has not been received as yet. This is also a consumable item which would need to go through future organisational budgets. There was also a saving on the printing of training manuals.

Challenges

• There was a minor problem with late arrivals as candidates sometimes travel long distances or struggle with transport, which delays the start of training significantly. Bigshoes have decided to inform future candidates that the start time is 8am instead of 9am. Often participants had difficulty finding the relevant building. Once they were in the building some could also not find Bigshoes. The organisation has consequently decided to put signs up for the next course and send directions through to the relevant participating organisations beforehand.

• The February training for Children’s Home Caregiver workshop saw significant under-attendance, with only six of the fourteen booked participants arriving. Some care givers actually forgot about the workshop, while others found taking a whole five days away from their organisations would just be too difficult to manage. Very often, they were simply too busy and had nobody to assume their duties while they were away attending training. Bigshoes tries to be as flexible as possible by allowing caregivers to complete four out of five days and return for the remainder (CPR training – one full day) when it is more convenient for them. They have set up “catch-up” training which will include those who did not successfully complete the whole course. They are also considering making the training more easily available to organisations by training at their facilities, which will improve the consistency of attendance.

• In most groups there were at least one or two candidates who would have benefitted much more significantly if the training was presented in their first language. To ensure that they are not disadvantaged because of this, Bigshoes asked that one of their colleagues interpret when necessary. This slowed down the training somewhat but was still manageable.

• Many of the group asked if they could come back for further training in other areas – especially in dealing with children on an emotional level. Some mentioned a variety of psychosocial issues which they face on a daily basis and feel ill-equipped to handle. They also mentioned that they struggle with the emotional impact of the work. Bigshoes, while expressing sympathy, does not have the capacity to consider expanding the training to include psychosocial aspects at this stage. For now, they are compiling a list of resources to assist trainees in this regard.

• There has been a delay with the accreditation of the training as proof of the organisation’s registration as a Public Benefit Organisation, which is still pending, has been requested by the accreditor. The trainer also needs to be trained as a moderator and facilitator, which can only be done after the organisation has been registered as a Public Benefit Organisation.

Monitoring and evaluation

• Pre-tests were conducted on the first day of the workshop to determine the baseline for the level of information held by participating caregivers.
• Post tests were conducted on the last day of the workshop to indicate the change in content knowledge of participating caregivers.
• Pre and post test results for workshops from February through to June:

	Community Org	Home Care	Community Org	Home Care	Community Org
	February	March	April	May	June	Average
Pre Test	67%	55%	67%	61%	69%	64%
Post Test	81%	87%	80%	77%	78%	81%
% Increase	21%	58%	19%	26%	13%	26%

Conclusions and Evaluator Analysis

The project is about mid-way to completion and has seen good results in terms of increasing caregiver knowledge. There have also been positive reports from the caregivers who attended the training.

The project has experienced some minor challenges, mainly with regards to attendance and material not being presented in participants’ mother tongue. Wherever possible, these issues are being addressed. The participants also enquired about increasing the scope of the workshops to cover areas where their knowledge is lacking. While Bigshoes is not able to expand to fulfil this role as yet, they are compiling a list of resources to give to the trainees.

The improved capacity of caregivers in this area will improve the basic health of the children in their care. It will also relieve the unnecessary burden on immediate clinics as caregivers are able to see to problems that would have previously been referred.