swaziland psychosocial curriculum adaptation report
DESCRIPTION
Swaziland Psychosocial Curriculum adaptation reportTRANSCRIPT
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Table of contents Table of contents ................................................................................................................... 2
Acknowledgements ............................................................................................................... 3
Executive summary ............................................................................................................... 4
1.0 INTRODUCTION ........................................................................................................................ 6 1.1OVERVIEW ........................................................................................................................ 6
1.2 PREVIOUS RCQHC/ANECCA TECHNICAL ASSISTANCE TO EGPAF-SWAZILAND ........... 7
2.0 RATIONALE / OBJECTIVE FOR RCQHC/ANECCA TECHNICAL ASSISTANCE ............................ 8 3.0 CONSULTANCY PROCESS: ....................................................................................................... 8
3.1 DESK REVIEW OF THE AVAILABLE DOCUMENTS ............................................................ 8
3.2 MEETING WITH EGPAF & SNAP-HTC OFFICIALS ............................................................. 9
3.3 CURRICULUM ADAPTATION WORKSHOP .................................................................... 10
3.4 DRAFTING OF THE TRAINING CURRICULUM ................................................................ 16
3.5 STAKEHOLDERS MEETING ............................................................................................. 17
3.6 TRAINING OF TRAINERS ............................................................................................... 23
4.0 ACHIEVEMENTS: ...................................................................................................................... 37 4.1 LESSONS LEARNT .......................................................................................................... 37
5.0 RECOMMENDATIONS/NEXT STEPS ........................................................................................ 38 Appendix 1:Curriculum adaptation schedule 11th- 13th July 2011 .................................... 40
Appendix 2: Stakeholders meeting schedule ....................................................................... 41
Appendix 3:TOT Schedule ................................................................................................... 42
Appendix 4: Peer review form ............................................................................................ 43
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Acknowledgements This report is the summary of the consultancy process to adapt the training curriculum on HIV
counseling and psychosocial support for children and adolescents in Swaziland. The adaptation
process involved different officials both from MOH- SNAP and Partners in Swaziland whose
dedication, hard work and commitment made this exercise possible.
ANECCA/RCQHC would like to extend sincere appreciation to the organizers MOH- SNAP
EGPAF – Swaziland for continued support and commitment towards responding to children’s
needs. In special way I would like to thank the leadership and all staff of EGPAF-Swaziland for
providing valuable support towards curriculum adaptation exercise. Your coordinated
communication, timely organization and participation kept the process moving.
Sincere thanks goes to HTC – SNAP officials for being able to empathetically engage in the
process with high level commitment and dedication from the beginning to the end. I’m indebted to
this team for going out of their way to put aside their office work they had planned and
dedicated one full month to the curriculum adaptation exercise.
Many thanks goes to HTC-ETWG that participated in first workshop to discuss gaps and needs at
National and facility level as far HIV counseling and psychosocial support for children and
adolescent is concerned, developed draft curriculum chapters, units and objectives .
I wish to thank the stakeholders from different institutions of higher learning in Swaziland, MoH
and partners who opened their hearts to give credible information to input the training curriculum.
I thank them for the valuable inputs and open sharing that helped improve the curriculum content
and lay out.
Finally I would like to acknowledge the valuable contribution from the trainers who attended the
training of trainer’s course for thier inputs to the curriculum. The group went an extra mile on top
of the busy course that included preparing for micro teaching to give their honest feedback to the
curriculum and shared feedback on the general usability of the curriculum.
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Executive summary This report presents information on the process of the consultancy for curriculum adaptation
exercise for Swaziland. The curriculum adaptation process was very participatory and inclusive of
different partners in Swaziland that include MOH-SNAP, EGPAF, ICAP, URC, BAYLOR different
universities in Swaziland, Clinton Foundation and others; while ANECCA gave the technical
guidance.
The developed training curriculum will be used to train Health Care Providers in Swaziland in HIV
counseling and psychosocial support for children and adolescents.
HIV counseling and psychosocial support for children is a key gap area in the care process by
most health care providers due to limited knowledge and skills and more importantly limited
resource materials including specific curriculums to cover counseling and psychosocial support for
children and adolescents.
The overall objective of the consultancy was to offer technical assistance to develop a National
HIV counseling and psychosocial support for children and adolescent adapted from the ANECCA
psychosocial care and counseling curriculum. RCQHC/ANECCA was also requested to Train
Trainers using the developed psychosocial National HIV counseling and psychosocial support
curriculum to build capacity at national level and in turn facilitate the roll out of the program
throughout the country.
The curriculum adaptation process started by desk review of available curriculums followed by
workshop attended by HTC-ETWG (HIV Testing and Counseling –Extended Technical Working
Group in Swaziland) to determine curriculum content, objectives and general lay out. A smaller
editorial team composed of HTC- SNAP officials worked hand in hand with the consultant to put
together the draft curriculum that was presented to the stakeholders. The stakeholders helped to
input the curriculum and thereafter a training of trainers’ course was facilitated using the adapted
curriculum.
Deliverables
• Swaziland National training curriculum in HIV counseling and psychosocial support for
children and assessment
• Training slides for all the chapters in the curriculum
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• A training schedule
• Course assessment tool.
• Twenty two health care providers trained as trainers in HIV counseling and psychosocial
support in children
• Work plans based on the four regions in Swaziland were developed following the TOT
and will be instrumental in facilitating the roll out HIV counseling and psychosocial support
in children and adolescents.
Next steps
• Supervision of trainings .ANECCA to offer post training mentorship support to the trained
health care providers while carrying out in Country trainings.
• ANECCA to offer mentorship to health care providers on disclosure at facility level for
knowledge and skills development since it was still mentioned as a challenge even after
the trainings.
• ANECCA to offer technical support to develop tools/ job aides on disclosure, adherence,
Pre and post test counseling, psychosocial assessment to EGPAF- Swaziland and SNAP –
HTC for easy use in counseling rooms and ensure offering of standardized and quality
psychosocial support to children and adolescents
• Impact assessment of the pediatric and adolescents psychosocial program in Swaziland
by ANECCA, document success and best practices and plan the next steps
• ANECCA will need to plan and offer technical support through adolescents trainings to
EGPAF- Swaziland and SNAP- HTC in establishing adolescent HIV care program since
most children are growing to adolescent stage. The adolescent program will cover training
on Transitioning, depression, mental health, reproductive health, adherence and disclosure
among adolescents. This so because adolescents are different and unique
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1.0 INTRODUCTION
Elizebeth Pediatric AIDs Foundation (EGPAF) invited RCQHC/ANECCA to provide Technical
Assistance in the adaptation of the curriculum on HIV counseling and Psychosocial support for
children and adolescents in Swaziland between July 10th and August 11th 2011.
This report therefore provides overview information, rational/objective for RCQHC/ANECCA
technical assistance and previous engagements between EGPAF – Swaziland and
RCQHC/ANECCA, the curriculum development processes and activities including training of
trainers’ course as well as recommendations/next steps.
1.1OVERVIEW
HIV and AIDS inevitably cause psychological and social suffering for children who get infected.
During the past few years, low and middle income countries have made good progress in building
the capacity to provide prevention, care, support and treatment for children. As many children
infected with HIV at birth continue to grow to adolescent stage; the health care providers
capacity to provide psychosocial is weak and limited. While most trainings have concentrated on
skills building of different cadres of healthcare workers for pediatric HIV prevention and
treatment; most counselors are trained to counsel adults, there have been fewer capacity building
efforts for pediatric HIV counseling and psychosocial support yet psychosocial care aspects are
closely linked to treatment care outcomes.
General psychosocial support is an integral part for comprehensive care for HIV infected children
and adolescents and their families. Psychosocial care does not only facilitate positive coping
among children and adolescents infected with HIV and AIDS but also improves adherence to long
term medication, enhances disclosure, reduces self stigma and further helps in provision of the
much needed Pre-and post test counseling. However one key gap area has been limited number
of Health care providers with knowledge and skills to offer psychosocial care and HIV counseling
in children and adolescents. As earlier mentioned; most counselors are trained to handle adults.
There are also limited and standardized materials to guide Health Care providers on HIV
counseling and psychosocial support to children and adolescents.
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There have also been limited efforts to develop curriculums that are specific for pediatric and
adolescent psychosocial support and HIV counseling. This situation has left major gaps in
psychosocial care for HIV infected children and adolescents to compliment the medical care
offered.
There is therefore need to develop training curriculums for capacity building of Health Care
Providers to ensure comprehensive and quality pediatric HIV care.
In an effort to further eliminate this gap EGPAF- Swaziland requested RCQHC/ANECCA to
provide Technical Assistance to develop the Swaziland National Psychosocial curriculum adopted
from the RCQHC/ANECCA Psychosocial curriculum. The National Psychosocial curriculum is
expected to be instrumental in building the National capacity to offer the much needed
psychosocial care and counseling. RCQHC/ANECCA would also orient Health Care providers in
TOT skills in an effort to build their capacity to roll out the HIV counseling and psychosocial
support for children and adolescent trainings throughout the country.
1.2 PREVIOUS RCQHC/ANECCA TECHNICAL ASSISTANCE TO EGPAF-SWAZILAND In February 2007, RCQHC/ANECCA provided technical assistance to EGPAF- Swaziland in form
of 4-day training during which 20 healthcare providers from EGPAF supported sites were
oriented in pediatric and adolescent HIV counseling skills. The course was an ‘excerpt’ from the
ANECCA Pediatric and Adolescent HIV Psychosocial Care and Counseling Training Curriculum/
Course initially designed to be conducted over a minimum of 12 days. At the end of this course,
consensus was reached between the two organizations that there was need for more capacity
building of a similar nature for staff of EGPAF-Swaziland supported sites. It was on this premise
that EGPAF- Swaziland engaged RCQHC/ANECCA, in 2009, to provide 12-day training for 20
facility-based service providers in pediatric and adolescent HIV psychosocial care and counseling,
in preparation for a new EGPAF programmatic initiative to expand pediatric testing and
diagnosis in the country’s health facilities. Trainees were equipped with the necessary knowledge
and skills and facilitated in developing results-oriented action plans aimed at guiding them in
implementing their newly acquired skills. The plans were also to serve as a benchmark for support
supervision exercises to strengthen and consolidate the trainees’ knowledge and skills.
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2.0 RATIONALE / OBJECTIVE FOR RCQHC/ANECCA TECHNICAL ASSISTANCE
EGPAF and the Swaziland Ministry of Health are collaborating in the next phase of the project
aimed at building national capacity in pediatric HIV counseling and requested technical assistance
from RCQHC/ANECCA with an objective to offer technical assistance to develop a National HIV
counseling and psychosocial support for children and adolescent adapted from the ANECCA
psychosocial care and counseling curriculum. RCQHC/ANECCA was also requested to Train
Trainers using the developed psychosocial National HIV counseling and psychosocial support
curriculum to build capacity at national level and in turn facilitate the roll out of the program
throughout the country.
3.0 CONSULTANCY PROCESS: This section discusses the consultancy process and details of how the work was executed
3.1 DESK REVIEW OF THE AVAILABLE DOCUMENTS Five days were dedicated to reviewing the available materials to form the basis for curriculum
development while still in Uganda from 4th – 8th July 2011. Below is the list of different related
materials that were reviewed. Some of the materials were sent from Swaziland EGPAF office and
SNAP HTC office to help do ground work before proceeding to Swaziland.
• Swaziland HTC Guidelines 2010
• Provider Initiated HIV counseling and Testing trainers manual MOH Swaziland
• ANECCA Psychosocial care and counseling curriculum for children and adolescents living
with HIV and AIDS
• Swaziland Pediatric HIV management guidelines October 2010
• Standard operating procedures and best practices Baylor College of Medicine
Foundation- Uganda/Pediatric Infectious Disease clinic (PIDC)
10th July 2011
Consultant travelled to Swaziland
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3.2 MEETING WITH EGPAF & SNAP-HTC OFFICIALS A working meeting was held at EGPAF offices on 11th July 2011 to discuss the curriculum
development process, the work schedule and requirements to make the work a success, in
attendance was:
Meeting with EGPAF- Swaziland officials
• Dr. Caspian …….. Director of Clinical services
• Zandile Nhleko- Community linkages officer
• Rose Nasaba – Pediatric and Adolescent Psychosocial Advisor ANECCA
From this meeting EGPAF further pledged their support and full participation for smooth running
of the whole process. The need to fully involve HTC leadership and team from SNAP was
discussed and emphasized to ensure addressing actual needs and gaps as far as psychosocial
support and general counseling of children living with HIV and AIDS is concerned. It was also
noted that there was no much materials in Swaziland to review as far as children counseling is
concerned. In addition, the team noted that much has been done in adult counseling, however very
minimal has been done as far as in children and adolescent counseling materials is concerned. The
team agreed to meet with HTC focal person Ms Phumzile Mndzebele to get her on board and
charter out the way forward.
Meeting at SNAP- HTC office
In attendance of the meeting at SNAP-HTC offices were:
• Phumzile Mndzebele-HTC Focal Person- SNAP
• Lenhle Nzibanze- HTC Technical Advisor
• Rose Nasaba- ANECCA
• Zandile Nhleko- Community linkages officer- EGPAF
• Dr. Caspian Chouraya- Director Clinical services- EGPAF
The meeting with HTC focal person at SNAP further discussed and agreed on the process and
time lines to execute the work. The HTC focal person assured the team of her availability and full
participation to ensure good outcomes. She also informed the meeting that she invited the HTC
ETWG to participate by attending a 2day working meeting on curriculum adaptation at EGPAF
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12th-13th. It was also agreed from this meeting that 28th July 2011 the draft curriculum would be
presented to the stakeholders for their input and 1st- 5th August 2011 a TOT would be facilitated
using the developed curriculum materials for further pretesting and orienting the trainers on the
content and assessing the usability of the materials.
3.3 CURRICULUM ADAPTATION WORKSHOP The workshop comprising of HTC team from SNAP including other technical partners and EGPAF
officials (HTC-ETWG) took place at EGPAF offices- board room from 12th -13th July 2011. The
workshop aimed at defining actual gaps and needs as a basis for determining curriculum content,
discuss and determine curriculum content including name of the curriculum, lay out and objectives.
See the three day time table in appendix 1:
Below is the list of Participants who attended the three day curriculum adaptation workshop.
HTC –ETWG ( HTC- Extended Technical Working Group)
Name Organizatio
n
Position Phone
number
1. Zandile Nhleko EGPAF Community
Linkages
76060923 znhleko@p
edaids.org
2.Phumzile
Mndzebele
SNAP HTC focal person 76122036 Phumtswa2
gmail.com
3. Lenhle Nsibandze SNAP HTC Tech officer 76051103 lenhlep@y
ahoo.com
4.Gciniwe Dlamini PSI Counsellor 76643771 gciniwed@
yahoo.com
5.Scelile Zwane NERCHA Ass -Cordinator 76449886 scelilez@n
ercha.org.s
z
6.Maphangisa
Dlamini
EGPAF Community
Linkage
76137132 maphangis
om
7.Rose Nasaba RCQHC/AN 2567726035 rnasaba@r
11
ECCA 09 cqhc.org
8. Dr.Hailu Aliala Bailor E.D Baylor 76023942
9.Sifundo Mkandhla URC HTC Cordinator 76032837 sifundom@
urc-sa.com
10. Nosipho Storer ICAP
Advisor
APSCL 76148279 ns267@col
umbia.edu
11. Makhosazane
Dlamini
PSI HTC Coodinator 76065728 [email protected]
z
12. Dr. Caspian
Chouraya
EGPAF Director Clinical
Services
13.Gugulthu…. SNAP
12th –July 2011-First day of the Workshop
This was the first day of meeting the HTC –ETWG after introductions and overview remarks by
the HTC – coordinator SNAP – Ms Phumzile Mndzebele, participants were divided into two
groups to identify actual gaps at National and Facility level in Swaziland as far as counseling
and psychosocial support for children and adolescents is concerned. While group one discussed
and presented gaps and Needs at National Level, group two discussed and presented on needs
at facility level. This was aimed at coming up with the curriculum that addresses the actual needs
and gaps. Further still the discussion outcomes formed a basis for determining actual curriculum
content.
Pictorial representation of HTC-ETWG during discussions and presentation during curriculum adaptation meeting
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Below is the table showing the discussions outcomes of the gaps and trends at the national and
facility level in Swaziland.
National level- GROUP 1 Facility Level- GROUP 2
Weak co-ordination of counseling services
for children and adolescents
No child friendly facilities
Weak collaboration- Each partner has a
different style
Health care providers lack the proper skills
to counsel children
Poor follow ups – Health care providers
who were trained have not been followed
up
Lack of documentation in the facilities
Lack of support structures for the children
and adolescents
Lack of educational toys
Standardization of the curriculum Lack of policies
Poor dissemination of the rights and child
guidelines
In adequate personnel
No proper tolls and referral hospital for
children and adolescents
Lack of team work
No enough trained counselors to offer
counseling support to children and
adolescents
Disclosure to children is still a challenge
Poor proper screening for those who will be
doing the pediatric counseling
Few trained Health care providers to
handle children and adolescents
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After presentation of the above gaps; participants highlighted the issues below for further
discussion
• The issue of consent which is said to be too high
• There are neither standardized materials nor curriculum on HIV counseling for children and
adolescents in Swaziland.
• There was a general consensus that health care providers still lack required knowledge
and skills to offer HIV counseling and psychosocial support to children infected and
affected with HIV and AIDS
• Integration of services and building capacity of all health facilities to offer HIV counseling
and psychosocial support to children and adolescents infected and affected with HIV and
AIDS
• There are poor linkages and referral systems for HIV infected children and adolescents to
access services in the country.
• The issue of the trained people to be followed up, mentored and supervised was brought
out and workshop recommended for a clear strategy to be put in place on how it is going
to be done.
Discussion conclusion:
The group agreed that the training curriculum will address the knowledge and skills gaps
including specific issues like referrals and linkages.
After this the facilitator refocused the discussion on determining curriculum content. Participants
further worked in two groups to define the chapters that they want to comprise the curriculum.
Both worked on similar assignment. Their discussions were further processed to agree as one
group and come up with chapters the whole team deemed very important and relevant.
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Pictorial representation of HTC-ETWG-during group discussions
Below is the list of chapters that the combined working group came up with by close of the day.
1. Over view of HIV infection in children and adolescents
2. Understanding children and adolescents
3. Counseling children and adolescents in HIV
4. Disclosure
5. Referral and Linkages to HIV Prevention care and Treatment in children and
6. Adherence
7. Palliative care
8. x. Grief and bereavement in children and adolescents
9. Ongoing care and support
10. Care for the Carer
11. Legal and Ethical issues in pediatrics
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Presentation of the draft curriculum chapters by the two working groups
Processing of the presented draft chapters for consensus by the whole group
Main Highlights
• The group agreed not to put a separate chapter on adolescents. They felt it should cut
across.
• The group also agreed on chapters instead of modules.
13th August 2011
The day started with reviewing the chapters that were developed the previous day. The group
embarked on discussion of the units under each chapter that was agreed upon the previous day.
For full participation the work was done in two groups in which one group discussed and
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presented units for chapters with even numbers and second group discussed and presented units
under chapters with odd numbers. The presentations for each group were eventually presented in
plenary to come up with the agreeable units upon which to develop content. The group further
discussed and developed draft training curriculum goal and objectives as well as curriculum name.
The developed chapters were distributed among the participants based on individual choice and
expertise to participate in developing the draft content to be sent back to the editorial team by
Monday 17th July 2011.
Pictorial representation of the HTC-ETWG-that developed the first draft of the HIV counseling and PSS
support curriculum for children and adolescents Swaziland at EGPAF offices
3.4 DRAFTING OF THE TRAINING CURRICULUM Drafting of the training curriculum and putting it together involved receiving draft content from the
HTC-ETWG and putting it together to make it ready for presentation to the stakeholders for their
review and inputs. This activity was carried out at SNAP – HTC offices and EGPAF offices
The team that worked tirelessly to accomplish this was composed of Phumzile, Lenhle and Rose.
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Pictorial representation of the editorial team
.
3.5 STAKEHOLDERS MEETING The Stakeholders meeting took place on 28th July 2011 at Bethel Courts. The meeting started with
the word of Prayer by a volunteer followed by introductions –names and place of work. This was
followed by official welcome remarks by Phumzile Mndzebele HTC –Cordinator SNAP. She
welcomed everybody and appreciated their commitment and taking off time from their busy
schedule to come and attend the stake holders meeting ( See schedule- appendix 2)
In her remarks she noted that they have been overlooking HIV counseling and psychosocial
support for children and adolescents and emphasized that as a Country they have embarked on
scaling up HTC for children and adolescents for better ART treatment out comes.
She further explained that as a country they need to go beyond comprehensive care for the
Mother but more importantly respond to holistic needs of children and adolescents for better out
comes.
She highlighted to the group that most Health Care Providers are ill equipped to handle children
and adolescent. HIV counseling before testing and after is often given to parents or guardians on
behalf of children though children are of age and seem to be understanding. She further noted
that as a country there are no materials and specific curriculum on HIV counseling and
psychosocial support for children and this has translated into limited capacity among health care
providers to offer quality and comprehensive HIV counseling and psychosocial support for
children and adolescents.
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Only one session was put in the provider Initiated counseling training manual and experience has
shown that this is very little and not enough to develop health care provider capacity and skills to
offer HIV counseling and psychosocial support to children and adolescents. She therefore called
upon Stakeholders for their full participation and in put to the draft curriculum.
She concluded by thanking EGPAF for the financial support to the whole process and appreciated
ANECCA for the Technical leadership in the process.
The HTC- SNAP coordinator giving opening remarks at the stakeholders meeting
Presenting the draft curriculum to the stakeholders: By Phumzile Mndzebele,Rose Nasaba,
Lenhle Nsibhanze
Overview
• No standardized children and adolescent HIV/AIDS counseling curriculum in the Country
• Many trainings but no harmonized training materials and no standard guidelines
• Just a chapter in Provider Initiated HIV Testing and Counseling which takes up only one in
the training – Not sufficient for skills development
• Health Care Providers fear to talk to children and adolescents
• Earlier Trainings done using ANECCA curriculum
After giving this important overview she presented an outline of the draft curriculum: Below is an
outline of what she presented in power point format.
• Title
• Purpose
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• Objectives
• Target group
• Course Duration
• Training and Learning Methods
• Selection criteria for Trainee participants
• Training duration- Schedule
• Chapter outline
o Overview of HIV infection in children
o Understanding children and adolescents on HIV and AIDS
o Counseling children on HIV
o Referrals and Linkages to HIV prevention care and support.
o Disclosure of HIV infection in children
o Adherence
o Palliative care in children and adolescents
o Grief loss and bereavement
o Facilitating Resilience and coping among children living with HIV and AIDS
o Legal issues
o Care for carers
After this presentation Stakeholders were requested and encouraged to give their views and
comments in preparation for next discussions and presentation. Hard copies with detailed
information of the draft curriculum were distributed to stakeholders from which to give their
detailed inputs and comments.
Remarks by EGPAF Country Director
After presentation of the draft curriculum outline, Dr. Madhi- Executive Director EGPAF was
invited to give short remarks
In his remarks Dr.Madhi, welcomed everyone to the adaptation exercise aimed at developing a
curriculum to offer HIV counseling and psychosocial support to children and adolescents in
Swaziland. He stressed that this exercise is important because it addresses the needs of children.
He further noted that offering pre and post test counseling services to children has been a
challenge especially when it comes to issues like consent, disclosure and adherence.
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He noted that the curriculum will sharpen Health Care Providers skills in the country. He further
highlighted the collaboration between EGPAF and ANECCA since 2008 that has materialized into
adaptation of the curriculum to facilitate roll out of trainings throughout the Country. He thus
requested the stakeholders for their input and active participation and asserted that “If we
succeed we succeed together and if we fail we fail together” .He explained to the group that this
exercise will be followed by a TOT using the adapted curriculum and there after move on with
trainings
He concluded by thanking the Core team for their great commitment and dedication exhibited so
far and encouraged them to continue. He concluded by thanking MOH under the leadership of
Phumzile –HTC coordinator for their commitment and good collaboration, he further appreciated
ANECCA for sending Rose their top consultant to guide the process and thanked everyone for
making time to come and wished every one fruitful deliberation.
EXECUTIVE DIRECTOR giving opening remarks at the stakeholders meeting
Stakeholders were consequently divided into 4 groups, given hard copies of the draft curriculum
and each group allocated two chapters based on their expertise to discuss and present to the
whole group.
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Pictorial representation of stakeholders group discussions
This activity was very beneficial as each group came up with their inputs and presented to the
bigger group for consensus building.
Main highlights from the discussions
-Need for consistency
-Course duration was discussed and consensus reached
-Discussion on the purpose and objectives of the curriculum corrections made
-Discussion and agreeing on category of trainee participants
-Training methods and activities
-Need to include a separate chapter on psychosocial support since it appeared in the title.
-Need for a stand lone chapter on communication with children and adolescents
22
Pictorial representation of the stakeholders meeting
29-30 July 2011- Integrating inputs and comments from the stakeholders- Rose, Phumzile,
Lenhle
This core group developed a chapter on psychosocial support and incorporated it in the whole
curriculum. This was a result of the stakeholders meeting highlighting the need to talk about
psychosocial support since it is an integral part of counseling and more so the curriculum “tittle”
contains the word psychosocial thus need to give it a chapter.
A separate chapter on communication with children and adolescents was also developed and
incorporated instead of living it as a unit under understanding children and adolescent chapter. In
addition, the core working group discussed and agreed to merge resilience and coping chapters
as units under psychosocial support chapter and merge referral and linkages for prevention, care
and treatment chapter for children and adolescents as a unit under HIV counseling for children
and adolescents.
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3.6 TRAINING OF TRAINERS
1st- 5th August
Venue: Bethel Court Vineyard Hotel, Ezulwini Valley. Swaziland Training dates: 01-05 August 2011 Training methods used: Lectures using power point presentations
Group work Buzz groups Brainstorming Role plays Experience sharing Demonstrations Teach backs/microteaching Reflection exercise.
Pictorial representation of the different teaching methods used during the TOT
Group discussions
24
Group discussions and presentation by TOT participants
25
TOT facilitators
The training of trainers course was facilitated by Rose Nasaba from ANECCA- Uganda and co-
facilitated by Fortunate Shabalala - Swaziland
DAY ONE: 01-08-2011
The day started with a word of prayer followed by introductions in which participants were
asked to state who they were, where they work and their expectations of the training from the
training. This was followed by welcome remarks by the National HTC Coordinator who welcomed
everyone and stated that the training was organized in response to a need identified by HCW
themselves where they felt that they lacked the skills and competencies needed to implement what
was expected of them in the pediatric guidelines.
The Coordinator mentioned that the HTC office has been able to put together a draft training
curriculum to train HCW on HIV counseling and psychosocial support for children and adolescents
with financial and technical support from partners especially EGPAF and ANNECA respectively.
She continued to note that the training curriculum has gone through stakeholders for their input
and the TOT is to provide forum to pretest the curriculum while also developing trainers who will
roll out the training to their respective regions. She concluded by saying that participants need to
feel free to make inputs to the curriculum and encouraged active participation throughout the
training.
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Pictorial representation of the HTC- Coordinator giving opening remarks at beginning of the TOT
Participant’s expectations
1. Gain more knowledge and understanding on caring for children who are not adherent to ART
and do not have primary guardians or carers
2. Gain knowledge and confidence to train fellow health care providers
3. Acquire knowledge and skills to organize a training for children
4. Gain more knowledge on disclosure of HIV status to children (who should disclose, how should
disclosure be done and when should disclosure be done).
5. Learn how to motivate HCW to help children living with HIV
6. Gain more knowledge and skills that I can pass on to HCW working with children
7. Know how to motivate caregivers to disclose their status to their children
8. Learn more about counseling and psychosocial support in the context of children and
adolescents
9. Learn more about effective counseling skills on ART for PMTCT
10. Gain knowledge on how to help guardians or families to bringing children to health facilities
access services, especially for children living with HIV
11. Get expertise on psychosocial issues affecting children and how disseminate the information to
carers
12. Gain skills on how to train HCW on PSS and pediatric counseling
13. Understand how to empower HCW on when, how, and what to disclose
14. Gain more skills to assist in disclosure for children already on ART
15. Be enlightened on how to work collaboratively with social workers in assisting children living
with HIV and AIDS
27
16. Gain more knowledge on how to ensure continuity of support for children living with HIV and
AIDS
17. Gain consensus on strengthening ongoing supportive counseling, referral and linkages for
children
The lead facilitator processed the expectations and clarified and by presenting the training
overview and course objectives and distribution of the course schedule ( See TOT cource schedule
appendix 3) Course aim
The primary aim of this course is to equip participants with knowledge and skills about teaching
and planning training programmes on HIV counselling and psychosocial support for children and
adolescents. This Teaching Skills Course aimed at addressing issues concerned with teaching and
adult facilitation skills.
Course objectives
At the end of the course, it is expected that participants will be able to:
1. Apply the main principles of adult education to a training course while facilitating on
psychosocial support and counselling for children and adolescents infected and affected
by HIV and AIDS;
2. Describe and utilise different methods of teaching and demonstrate competence in
different teaching methods
3. Outline the key steps involved in conducting a training needs assessment, developing
curriculum and training materials and evaluating training programmes;
4. Identify their own key skills and abilities in facilitating adult training courses, identify
areas where development is needed, and suggest strategies to achieve these goals.
5. Organise and facilitate teach backs in HIV counselling and psychosocial support for HIV
infected children and adolescent for skills development.
TASKS
To ensure smooth and enjoyable workshop, participants volunteered to take on the below listed
tasks:
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• Team Leader (the overall seer and maintain respect for each other and discipline within
the group): Clara Mujaya
• Time Keeper: Lucia Maseko
• Matron (to take care of lodging and food issues): Lungile Simelane
• Spiritual Leader: Nokuthula Maseko
GROUND RULES
These were set by the participants:
• Respect for each other
• Keep mobile phones on vibration, silent or offline mode. Respond only to very important
calls
• Keep time all the time
• Raise hand if you want to say something while sessions are in progress
After presentation of the goal and objectives of the workshop and setting of ground rules,
participants were given a pre-test to do.
Pre –Course assessment
Participants were given course assessment exercise comprised of questions derived from TOT
topics that comprised the course content. The pre- course assessment was given to the participants
on the first day of the training to help in assessing how much they knew before the training so as
to form a basis of measuring change in the knowledge levels and acquisition at the end of the
training through post course assessment (See –course assessment results)
Presentations of the day included introduction to adult learning which focused on the explaining
how adults learn, the principles and variety methods useful in teaching adults and the levels of
learning. The day ended with a presentation on training needs assessment and an evaluation of
the day. DAY TWO: 02.08.2011
The day commenced with a word of prayer led by the Spiritual leader of the group. A
presentation on Planning a training session and training materials development followed through
to break, after which another presentation on training in the community and session planning was
done.
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Pictorial representation on teaching in the community session by participants
Teaching in the community session was also one of the interesting sessions in which participants
were divided in three groups and tasked to use creative methods of teaching illiterate mothers at
community level aimed at equipping them with knowledge and skills to generate innovative ideas
of teaching at community level in preparation to teach backs the next morning.
The afternoon was dedicated to assisting participants prepare for their microteaching to be
conducted the following day. Participants were paired and each pair tasked with a chapter from
the draft training curriculum on HIV counseling and psychosocial Support for children and
adolescents. Each trainee developed a teaching plan including deciding on appropriate teaching
methods and materials to be used suitable for particular given topic. In addition to carrying micro
teaching participants were requested to note down gaps and give comments on each chapter
given to input the curriculum.
DAY THREE AND FOUR: 03-04.08.2011
These two days were dedicated to microteaching in the morning and evaluation feedback in the
afternoon. Participants presented their training plans to facilitators prior to the teaching. This
assisted in evaluating if they were:
• On time as planned
• Used the methods planned
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• Materials planned for the training
Besides the use of evaluation forms for self and peer evaluation, participants were video-
recorded and this formed part of the evaluation of the micro-teaching where participants got
feedback from peers, facilitators as well as the video plays.
Both days ended with an assignment where participants were asked to develop regional training
plans. Participants were to meet as regions and develop the plan. The plan was to be presented
the following day. An evaluation of the progress was done, where all participants stated that
they enjoyed the sessions, that the micro teaching was very useful and had sharpen their
facilitating skills .In addition participants shared having gained confidence and that the feedback
they got both from peers and in watching the video was helpful though hectic.
Pictorial representation of some participants carrying out micro teaching exercise
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Each participants exhibited innovative methods of teaching that enable adults to learn best. This
was a very interesting exercise that encouraged creativity among participants while facilitating.
DAY FIVE: 05.08.2011
The day was opened with a word of prayer followed by a post test and evaluation in the form of
written forms.
Participants asked each one to share what he/she has learnt from the course on top of the
evaluation forms they had filled and below is list of what they shared:
Lessons learnt.
• Presentation skills
• Have gained confidence in facilitating trainings.
• Skills in carrying out a TNA
• Making a lesson plan
• Characteristics of adult learners
• Difference between a teacher, tutor and facilitator
• Skills on how to train at community level
• Use of humor to make the session interesting and enjoyable
• Timing of a session using a lesson plan
• Importance of relating content to objectives
• Importance of being knowledgeable about subject matter
• Presentation ( dress code)
• Role of a co facilitator
• Practice is important
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• How to manage difficult participants
• Importance of using different training methods
• Ways of evaluating a training
• Role plays as a teaching method
• Teaching methods to relate to a topic
• Different roles of a facilitator
• How to make a simple lesson plan
• Group dynamics and how to deal with difficult characters
• Importance of a check list while preparing for trainings.
The lead facilitator sought for inputs on the curriculum and this was done through brainstorming.
Participants then refined their follow up training plans for their respective regions.
OFFICIAL CLOSURE
Directed by the National HTC Coordinator, the workshop was officially closed by the Deputy
Programmes Manager from SNAP on behalf of the Programme Manager. Prior to delivering his
speech, the participants’ representative thanked the MoH for allowing them to attend such an
informative and transforming workshop and the first of its kind in Swaziland. She mentioned that
they are going back to their workplaces as change agents and will implement what they have
learned through the training plans they have developed, resources permitting. She pleaded for
continued mentorship support from the MoH and EGPAF and ANECCA.
The Country Director of EGPAF stated that the Foundation is committed to advancing the plight of
children affected and infected with HIV. The Director mentioned that while there has been
considerable advance in HIV, this has mostly been directed towards adults with pediatric issues
still lagging behind. He said that as the mandate of the Foundation is to curb pediatric HIV,
EGAPF will continue to fund initiatives such as this that are directed in increasing children and
adolescents’ access to preventive, curative and supportive HIV services. He thanked the MoH for
allowing trainees to participate in the workshop and ANNECCA for providing technical expertise
during the training. He concluded by asking participants to share the information they have
gathered widely as the training was responding to an identified skills gap among Health Care
Providers on child counseling and PSS.
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In his closing remarks the Deputy Programmes Manager, thanked EGPAF for funding the
workshop and ANNECCA for allowing the facilitator to come and share their technical expertise
in the area of PSS for children and adolescents. He said as MoH and SNAP particularly, they
uphold on the value of prevention in the absence of a cure for HIV disease. He appealed to
participants to consider positive prevention as well as they go about imparting knowledge and
information to colleagues and service consumers. He particularly made emphasis on making sure
that all means possible be made to reach the hard to reach areas, saying that there are still
pockets of society that hardly access services because they are geographically inaccessible.
The Deputy Programmes Manager shared initiatives with participants that MoH through SNAP is
engaged in one of which is a tripartite between SNAP, UNISWA and Morehouse Medical School
in the US where they are working with prison populations to bring preventive services there.
Secondly he shared that the MoH prevention thematic group is at the verge of establishing a
“think tank” which will assist in carrying out activities such as research, evaluations to inform and
advise planners and implementers on progress being made from time to time in the prevention of
HIV.
He concluded by appealing to those willing to be part of the think tank to submit their CV’s for
consideration, stressing that this would be completely voluntary as there will be no monetary
benefit. He closed the workshop by handing certificates of attendance to all participants.
The workshop was closed at 13:45 with a word of prayer that was preceded with the singing of
a chorus.
Pictorial representation of officials from MOH- SNAP, EGPAF-Swaziland at the official closing of the
TOT course
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COURSE ASSESSMENT METHODS
Various methods were planned and used to assess whether learning had taken place and these
included: Pre and post course, End of day evaluation and case studies, question and answer
during the training, final course evaluation, Micro teaching/teach backs for every participant,
lesson planning and preparation, videotaping and playing back for plenary feedbacks, peer
review and self review and feedback sharing after teach backs
a) Daily evaluation: Each participant was given a form to fill at the end of each day, indicating
personal lessons learnt from the day’s topics, what was easy to learn, what was hard to learn and
make recommendations for improvements. This exercise was instrumental in identifying challenges
faced by participants during class and how best they could be helped to catch up.
Facilitators used comments from end of each daily response to identify the learning gaps and
therefore plan what to emphasize during class the following day to make sure that learning takes
place
b) Morning recap& quiz. Participants worked in groups and were tasked to develop questions
addressing the major themes from the previous day’s topic and important lessons learnt. The
developed questions were given to the whole group for answering the following morning. This was
done every morning before beginning the day’s sessions to assess the level of knowledge
retention and further still encourage participants to revise their notes and put in more effort in
what was being taught in class.
35
Pictorial representation of morning recap/quiz as an evaluation method
c) Micro teaching/teach backs
Micro teaching/teach backs were planned and incorporated in the course for participants to
practice presentation skills, explanation of the content, use of different methods of teaching that
aid adult learning, developing lesson objective etc . Participants were given topics from the
adapted HIV counseling and Psychosocial curriculum and tasked to prepare a twenty minute
presentation that covers the most important message from the topic given and can fit in 20
minutes. Fellow participants were given Peer review forms (See Appendix 4) to note the strength
and offer feedback after.
From the participants feedback to the facilitators, teach backs were a very unique exercise that
enhances their capacity to prepare excellent presentations, give quality content to adult learners ,
widen their scope to use different methods of facilitation that is appreciated by learners
Pre and Post course assessment exercise
This was given at the beginning of the training to assess the knowledge levels and the end of the
training to assess change in knowledge levels:
Pre and pNo. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Scores
post course aPr35504525354040452545504050402050354035
0
10
20
30
40
50
60
70
80
90
100
s in %ages
Pre
assessment Tre 5 0 5 5 5 0 0 5 5 5 0 0 0 0 0 0 5 0 5
0
0
0
0
0
0
0
0
0
0
0
1 2 3 4
and Pos
TOT Swazilan
4 5 6 7 8
st course
nd Post 70 95 85 95 95 90 95 90 80 85 80 85 90 95 80 85 75 70 85 80 70 80
9 10 11 12 1
Participants
e assessm
13 14 15 16 17
Nos
ment res
7 18 19 20 21 2
sults‐TO
22
OT
Pre
Post
36
%
t %
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Post course assessment results showed great improvement compared to scores participants got at
the beginning of the course. Other than improvement in the scores participants boasted of having
acquired unique skills to be good trainers and facilitators not only in HIV counseling and
psychosocial support for Health Care providers but also as general trainers since the skills and
knowledge acquired can be replicated to other trainings/courses.
4.0 ACHIEVEMENTS: • Successful adaptation of the training curriculum for Health Care Providers in HIV
counseling and psychosocial support for children and adolescents in Swaziland
• A training schedule accompanying the training schedule was developed. PowerPoint slides
for all the curriculum topics were developed.
• The draft curriculum was presented to the stakeholders who in turn provided their
constructive input to the curriculum during a one day stakeholders meeting.
• The adapted curriculum was pretested during a TOT and its usability ascertained and
gave their input that was incorporated in the curriculum.
• Twenty two Health Care Providers were trained and passed as Trainers of Trainers in HIV
counseling and Psychosocial Support for children and adolescents. This group is expected
to be instrumental in rolling out the training throughout the Country.
• The TOT participants developed work plans based on the four regions to facilitate step
down trainings.
4.1 LESSONS LEARNT • Disclosure of HIV positive test results to children is still a challenge to health care providers
including those who were trained in psychosocial care and counseling for HIV infected
children and adolescents. The TOT participants decried own fear and uneasiness in
facilitating disclosure of HIV positive test results to children despite appreciating the
importance of disclosure including adherence to medication. During their sharing the HCP
noted that parents/ guardians cited stigma and discrimination at family and community
level as another barrier to disclosure in children. Failure to involve school teachers and
weak community structures that aggravate stigma and discrimination were some of the
bottle necks towards disclosing to children their HIV positive test results.
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• The participants further noted that most children learn of their positive sero status
accidentally and unprepared a situation that is likely to affect their coping mechanisms.
• The TOT participants in addition pointed out that offering Pre – test counseling in children
is still a challenge and a big gap. Counseling is often given parents/ guardians on behalf
of the children irrespective of developmental and understanding level a situation that
limits children’s participation into their care.
• Weak follow up support structures were pointed as bottle neck to knowledge and skills
development at facility level
5.0 RECOMMENDATIONS/NEXT STEPS • Follow up technical mentorship support to the trained Health Care Providers at facility
level by ANECCA within 3 months after the training to ensure knowledge and skills
development and there after handover to EGPAF and SNAP to continue with mentorships.
• Need for onsite mentorship support for Health Care Providers on Disclosure of HIV test
results to children and adolescents by ANECCA and HTC-SNAP.
• Develop an appropriate Swaziland grown disclosure strategy, implement and assess its
impact.
• ANECCA to offer technical support to SNAP and EGPAF – SWAZILAND to develop tools
on disclosure, adherence, Pre and post test counseling, development and understanding of
children, psychosocial assessment, to guide health care providers at health facility level
while handling children. The tools will work as job aides and guide health care providers
while offering HIV counseling and psychosocial support to children and adolescents.
• Carry out impact assessment after the trainings using the adapted curriculum to measure
impact, assess what worked and did not for future focused planning and replication in
other programs
• ANECCA to offer Technical support EGPAF-Swaziland to develop and establish an
adolescent focused HIV program and services at health facilities Swaziland. This will
involve training Health Care Providers on Transitioning, Reproductive Health, Mental
Health, Life skills, HIV care in adolescents, Depression, disclosure and adherence, stigma
and discrimination. This is so because most children living with HIV are growing into thus to
prepare them for transitioning, SRH etc.
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• ANECCA and EGPAF Swaziland need to plan for operational research in psychosocial
support and counseling in Swaziland following the trainings already carried out for
quality improvements and replication in other Countries.
LIST OF TOT PARTICIPANTS Ref. Name Sex Organization Address
1. Hlengiwe Ntshalintshali F MoH Sithobela Health Centre
2. Sihle Tsabedze F MoH SNAP
3. Phumzile Mndzebele F MoH SNAP
4. Lenhle Nsibandze F MoH SNAP
5. Eunice Maziya F MoH Mkhuzweni Health Centre
6. Phumzile Mhlanga F MoH Vuvulane Clinic
7. Zandile Nhleko F EGPAF Mbabane
8. Julia Ziyane F
9. Clara Mujaya F EGPAF Lubombo Region
10. Sinqobile Matsenjwa F MoH KSII PHU
11. Nokulunga Dlamini F MoH Mbabane PHU
12. Nokuthula Maseko F EGPAF Mbabane
13. Nobuhle Mthethwa F RFMH RFMH
14. Nomsa Dlamini F MoH Hlathikhulu Gov. Hospital
15. Lucia Maseko F MoH Mankayane PHU
16. Lungile Simelane F EGPAF Mbabane
17. Nikiwe Shabangu F MoH Mbabane VCT
18. Thabsile Fakudze F MoH Health Promotion Unit
19. Phumlile Mkhabela F MoH Mbabane VCT
20. Lomalungelo Dlamini F MoH Wellness Centre
21.
22.
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Appendix 1:Curriculum adaptation schedule 11th- 13th July 2011 TIME Day One ‐11th July
2011 Day Two ‐12th July 2011 Day Three‐13th July
2011 8:30am‐9:00am Introductions & expectations9:00am‐10:30am
Planning meeting with EGPAF
Why are we here, actual gaps and trends at National & facility level Group work and presentation
Presentation on curriculum development process
10:30am‐11:00am Break Break
11:00am‐1:00pm Meeting with HCT coordinator‐ SNAP & EGPAF, agree on the process, strategy and schedules
Review of available curriculums Group discussions and presentations on summaries from the review
Developing curriculum goals and objectives (Group work discussions
1:00pm‐2:00pm Lunch break Lunch break Lunch break2:00pm‐4:00pm Continued Determine content and modules(
Group discussions) .Plenary presentations and agreeing on modules and content
Presentation and agreeing on objectives and goals. Next steps and the process.
4:00pm‐5:00pm Cont’d
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Appendix 2: Stakeholders meeting schedule
SNAP Children and adolescents curriculum Meeting 28th February 2011- Bethel Court
(Agenda) Program me Director: Lenhle Nsibandze 08:30 Registration Lenhle Nsibandze 09:00 Introductions Lenhle Nsibandze 09:10 Welcome remarks Phumzile Mndzebele 09:20 Remarks from EGPAF Country Director 09:40 Overview of the children And adolescents HIV psychosocial Phumzile Mndzebele Curriculum 10:00 Tea/Coffee break 10:40 Group work Rose Nasaba
11:40 Presentations and Discussion Group Participants 12:40 Wrap –up and way forward Phumzile Mndzebele 13:00 LUNCH
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Appendix 3:TOT Schedule August 2011 1st -5th Mbabane Swaziland: Time Day One Day Two Day Three Day Four Day Five Recap Recap Recap Recap 8:30- 10-30 am
Welcome remarks Introductions Expectations, aims and objectives & course assessment exercise
Developing training materials Session planning continued
Micro teaching Microteaching Post course assessment Presentation of work plans
10: 30 am B R E A K 11:00 -1:00pm
Introduction to adult learning. Approaches to adult education, including experiential learning.
Teaching in the community & Presentation skills, managing group behaviors
Micro teaching
Micro teaching: Presentation of work plans and training plans.
1:00-2:00pm
L U N C H
2:00-3:30 pm
Method of teaching Training needs assessment.
Assessment. Preparation for micro teaching
Micro teaching.
Micro teaching:
Final review of the program/ evaluation
3:30-3:45pm
B R. E A K
3:45-4:45:00pm
Developing training program/course
Preparation for micro teaching continued
Micro teaching Micro teaching Official closure and awarding of certificates
4:45-5:00pm
Questions and answers plus days evaluation.
Continued Microteaching: Preparation time (work plans)
Close close close close
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Appendix 4: Peer review form TEACHING EXERCISE
Peer Review Form Presenter’s Name__________________________________________ Topic/Content_____________________________________________ Use the scale below to provide a score for each of the items below.
1 = Very poor 2 = Poor 3 = Average 4 = Good 5 = Excellent
Item 1 2 3 4 5 Comments
Room preparation
Equipment/resource preparation
Introduction was interesting and caught my attention
Clear aims and objectives were
Appeared to be well-prepared
Demonstrated that she/he was knowledgeable about topic
Attempted to involve all participants
Used visual aids skillfully
Developed good rapport with class
Use of voice
Minimum distracting gestures
Stayed to time
Checked if learning had taken place
Session was easy to understand
Overall Evaluation 1 2 3 4 5
Was the lesson interesting and taught well?
Was the content relevant and useful to you?
Did learning take place?
The main thing I learnt from this session was:
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Assessor’s Name ________________________________ Date________________