Care Group Orientation€¦ · Care Group Orientation Promoter Lesson Plan Module 1 of 5 . 3 Care Group Orientation Table of Contents: Lesson 1: Introduction to Care Groups.....9

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Care Group Orientation

Promoter Lesson Plan

Module 1 of 5

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Care Group Orientation

Table of Contents:

Lesson 1: Introduction to Care Groups .................................................... 9

Lesson 2: Teaching Techniques ............................................................. 17

Lesson 3: Mother Leader Responsibilities ............................................. 28

Lesson 4: Watching for Change and Monitoring Groups ........................ 39

Lesson 5: All Children Have Value ......................................................... 51

Lesson 6: I Can Change! ........................................................................ 59

Lessons 1-6 Pre and Posttest ................................................................ 68

Lessons 1-6 Pre and Posttest ANSWERS ............................................... 70

Lessons, stories, and activities in the Care Group Orientation Lesson Plan are meant to complement the information provided in Care Group Orientation Mother Leader

Flipchart.

Understanding the Lesson Plan

Each lesson begins with objectives. These are the behavior, knowledge and belief objectives that are

covered in the lesson. Make sure that each of these objectives is reinforced during the lesson. There are four types of objectives. Each is described below.

Behavior Objectives: Most objectives are behavioral objectives written as action

statements. These are the practices that we expect the caregivers to follow based on the key messages in the flipchart.

Knowledge objectives: For example, we want mothers to be able to name the danger signs as well as the five ways that diarrhea-causing germs are transmitted. These are facts that the caregivers must memorize during the lesson, using the

pictures as a reminder. Belief objectives: We know that beliefs and attitudes affect our practices. Many

times it is a person‟s inaccurate belief or worldview that hinders them from making a healthy behavior change. In this module we are reinforcing the belief that change is

possible. We also have a lesson devoted to discussing child value. Behavioral determinant objectives: Behavioral determinants are reasons why

people practice (or don‟t practice) a particular behavior. There are eight possible behavioral determinants as identified in the Barrier Analysis1 surveys done in each region. The surveys identify the most important determinants for each behavior. By

reinforcing the determinants that have helped the doers (caregivers in the

1 See http://barrieranalysis.fhi.net for more information.

http://barrieranalysis.fhi.net/

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community already practicing the new behavior) we are able to encourage the non-doers (caregivers who have not yet tried or been able to maintain the new

practices). We also help non-doers (caregivers who are not practicing new behaviors) to overcome obstacles that have prevented them from trying or maintaining the practice in the past. Behavioral determinants will be more

prominent in future modules.

Under the objectives, all of the materials needed for the lesson are listed. The

facilitator should make sure to bring all of these materials to the lesson. In Lesson 5, we introduce the idea of an Activity Leader who will focus on the

needed materials for Module 2. See below for more information. Each exercise (section of the lesson plan) is identified by a small picture.

Pictures are used to remind non-literate Mother Leaders of the order of the activities. For example when it‟s time to lead the game the lesson plan shows a

picture of people laughing as if they are enjoying a game (see below). The pictures in the lesson plan help to cue Mother Leaders of the next activity.

Review the descriptions below for more information.

The first activity in each lesson is a game. Games help

the participants to laugh, relax and prepare for the lesson. Some games review key messages that the

participants have already learned. Some games promote the belief objectives. Make sure that everyone participates in the games.

Following the game is the attendance and

troubleshooting section. All facilitators will take attendance. The troubleshooting questions only apply to facilitators (promoters) training others.2 The promoter

follows up with any difficulties that the Mother Leaders had teaching the previous lessons. Refer to the role play

in Lesson 4 for more information. Next the facilitator opens the flipchart to the first picture of the lesson. He or

she reads the story printed on the back of the flipchart, adding more details and descriptions as desired.

The story in each lesson is followed by discussion questions. These questions help the facilitator to find out

the caregivers current practices (related to the lesson). This section is marked by the A (ask) in the ASPIRE

method.3 This section is meant for discussion, not for teaching. Be sure to let everyone voice their opinions

2 In the Tubaramure program, paid staff are called promoters. The role of the promoters is to

train Mother Leaders to facilitate lessons with their neighbors. A few exercises, noted above, are only for promoters and do not need to be used by the Mother Leaders when sharing with their

neighbors. 3 For more information about the ASPIRE method review Lesson 2.

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The second, third and fourth picture in each lesson

are for teaching the key objectives of the lesson. After turning to the second flipchart page [the S (Show) - in

ASPIRE], ask “What do you see in this picture?” Let the participants respond and describe what they think the flipchart pictures are telling them.

Next, explain the key messages written on the back of the flipchart. The key messages also appear as captions on the flipchart pages. Be sure to explain each picture using the additional bullets printed on the back of the flipchart (or

in the lesson plan). The lesson plan also contains additional information for the trainer. The additional information does not need to be discussed during the

lesson unless it directly relates to questions by the participants.

After the fourth picture of the lesson, is an activity.

Activities are “hands-on” exercises to help the participants understand and apply what they have learned. Most of these activities require specific

materials and preparations.

Beginning in Module 2, an activity leader is responsible to organize materials for

the Lesson Activity. The Activity Leader for Module 2 is elected in Lesson 5. The Activity Leader meets with the facilitator ten minutes before each lesson to

discuss the needed materials for the next lesson‟s activity. The Activity Leader is responsible to talk with the others (Mother Leaders or neighbors) during the “Attendance and Troubleshooting” to organize the materials needed for the next

meeting, asking them to volunteer to bring the items. The facilitator will lead the activity, but the Activity Leader will support her by organizing the volunteers

and aiding the facilitator as needed during the activity. After the activity, the facilitator completes the P-I of the ASPIRE method.

The ASPIRE method is used to reinforce participatory methods of teaching. It is explained in detail in Lesson 2.

In the probe section the facilitator asks if there are any

obstacles that may prevent the caregivers from trying the new practices. They discuss these obstacles and then move to the next section.

The facilitator informs the caregivers of ways to

overcome the concerns that are mentioned. The facilitator gives more information or a different perspective to help the caregivers understand how to

move forward.

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Next is Practice and Coaching. This section is required for the training of Mother Leaders. We want to make

sure that they understand the material and can present it to others. In this small group activity, the promoter

can observe and coach those who are having difficulty.

Finally the facilitator completes the R-E of the ASPIRE method.

The facilitator requests a commitment from the Mother

Leader (or caregivers) to begin practicing the new practices they have discussed. If they agree, the

caregivers should make a verbal commitment. It is up to the caregivers to make a choice. They should not be forced to make a commitment if they are not ready.

The last section is where the facilitator examines the Mother Leader (or caregivers‟) practices based on the teaching from the last lesson. The facilitator encourages

them to try the new practices they have not yet done.

All lessons follow the pattern described above. Lessons can be adapted as needed to fit the needs of your care group. Lessons should not exceed two hours in length although some lessons may take longer than others. The

suggested time for each section is listed below.

Section name Time needed for this section

Game Attendance and Troubleshooting

Story and Ask (picture 1) Show and Explain (picture 2) Show and Explain (picture 3)

Show and Explain (picture 4) Activity

Probe Inform Practice and Coaching

Request Examine

10 minutes 5- 15 minutes

10 minutes 5 minutes 5 minutes

5 minutes 15 minutes

10 minutes 5 minutes 20 minutes

2 minutes 15 minutes

2 hours

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Acknowledgements

Hanold, Mitzi J. (2009) Care Group Orientation Mother Leader Lesson Plan. Washington DC. Food for the Hungry (FH), made possible through support

provided by the Office of Food for Peace, Bureau of Democracy, Conflict, and Humanitarian Assistances, and the U.S. Agency for International Development under the terms AID-FFP-09-00004-00. The opinions expressed herein are

those of the author and do not necessarily reflect the view of the U.S. Agency for International Development.

Many thanks to our illustrators [insert the local illustrator‟s name], Ocatvio

Gonzales and Petra Röhr-Rouendaal. Editors include Carolyn Wetzel (FH), and Mary Hennigan (CRS), Deanna Olney (IFPRI). For questions or comments,

please contact the author at [email protected].

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Lesson 1: Introduction to Care Groups

Caregivers will be able to describe the program goal: all parents will take actions to help their children grow tall, strong and healthy. That is, infants

and children will not die of malnutrition and preventable diseases before age two, but be healthy and strong.

o Mothers will have good nutrition and health while pregnant and give

birth to healthy infants.

o Caregivers4 will be able to prepare healthy foods for their children to grow tall and strong.

o Caregivers will prevent, identify and manage childhood diseases.

o Caregivers will keep water, food, and bodies clean to prevent illness

and disease.

Caregivers will be able to name the Tubaramure partner organizations: Food for the Hungry, International Medical Corps, CRS (Caritas) and USAID.

Caregivers will be able to describe those who will be reached with the health

messages: pregnant women and infants less than 24 months.

Caregivers will be able to explain why the Tubaramure program is targeting pregnant women and children less than 24 months.

o The largest increase in malnutrition (poor nutrition) occurs in the first 24 months of life.

o By targeting this age group, we will see the greatest reduction in child sickness and death.

o If children survive the first two years of life and grow well, they are more likely to be healthy for many years in the future.

Caregivers will believe that change is possible.

Materials: 1. Attendance Registers for Mother Leaders

2. Care Group Orientation Mother Leader Flipchart for the promoter and each

Mother Leader

Lesson 1 Summary: Game: Getting to Know You

Attendance

Share the story and ask about the women about their beliefs about change:

Healthy Children.

Show pictures and share key messages on flipchart pages 6-11: The Tubaramure Goals, Reaching Mothers and Children, and Tubaramure

Partners.

4 The term caregivers refers to all beneficiaries who care and support children in the Tubaramure program

(Promoters, Mother Leaders, beneficiaries and their families).

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Activity: Tubaramure Song

Probe about possible barriers

Inform them of possible solutions to the barriers

Practice and Coaching in pairs

Request a commitment

1. Game: Getting to know you ─ 10 minutes

1. Ask Mother Leaders to talk to the woman sitting next to them to find out

about their family (how many children, how old are they, what are their names, etc). Finally, ask what they hope to learn from being a Mother Leader.

2. In a large group, ask each Mother Leader to introduce her neighbor until

everyone has been introduced.

2. Attendance ─ 5 minutes

1. Take attendance, marking the attendance sheet for those who are present

and those who are absent.

Healthy Children (Picture 1.1) ─ 10 minutes

3. Story

Read the story on page 4 of the flipchart.

The story explains how the Tubaramure program changed the old woman‟s community.

The story is set in the future. It describes the changes seen by the old woman. It describes how women will talk about the Tubaramure program many years from now.

The old woman says, “Of all my children, your father was the strongest child. My other children were often sick and lacked energy. I was pregnant with your father when the Tubaramure program began. Because

of the Tubaramure program, the community made changes that helped children to grow. Children were born healthy and were sick less often.

Children grew taller and stronger than those born before the program. Today, children do not struggle, but are healthy and strong in the first years of life.”

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4. Ask

Read the questions on page 4 of the flipchart.

Ask the first questions to review the changes that occurred in the story.

Ask the last two questions to encourage the women to discuss how the

program goal might change life in the community? Encourage the women to think about how healthy children might make life easier for the parents.

Would it affect their productivity, their finances, and their happiness?

Encourage discussion. Don’t correct “wrong answers.” Let everyone give an opinion. This page is for discussion, not for teaching.

After the participants answer the last question, move to the next flipchart page by saying, “Let compare your ideas with the messages on the following

pages.”

? What problems existed when the old woman

was having children? How did it change?

? Are children in your community healthy? Why or why not?

? How would life be different if all children were healthier and stronger?

Tubaramure Goals (Picture 1.2) - 5 minutes

5. Show:

Ask the caregivers to describe what they see in the pictures on page 7.

? What do you see in these pictures?

6. Explain:

Share the key messages using flipcharts pages 6 and 7.

Use the captions on the flipchart to remind you which images represent each

point.

Children will grow tall.

o Caregivers will be able to prepare healthy foods for their children to grow tall.

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o Healthy foods allow bones to grow and lengthen.

Children will be strong.

o Caregivers will be able to prepare healthy foods to

strengthen their bones and muscles.

o Children will have more energy and strength.

Children will be healthy.

o Mothers will have good nutrition and health while pregnant and give birth to healthy infants.

o Caregivers will be able to diagnose illness and get help

quickly.

o Caregivers will be able to help their children when they are sick to overcome the illness.

o Caregivers will keep water, food and bodies clean to

prevent illness.

? Are these goals important to you? Why or why not?

Additional Information for the Trainer

Infant Mortality The infant mortality rate (death rate) in Burundi is 101 deaths out of every

1,000 live births5 (for infants less than one year of age). In more developed

countries infant mortality rates are between 5-10 infant deaths out of every 1,000 live births.

The Tubaramure program will not only increase health, but also help to

reduce the numbers of deaths in infants and children.

Reaching Mothers and Children (Picture 1.3) - 5 minutes

7. Show:



8. Explain:


5 http://www.unicef.org/infobycountry/burundi_2774.html

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Use the captions on the flipchart to remind you which images represent each point.

To help children grow, we will share messages with pregnant women

and mothers with children less than 24 months.

o Like a bird that protects her eggs in a nest, infants and children need protection and special care in the first two

years of life.

o During the first two years children are most vulnerable to sickness and death.

o Healthy two year olds are more likely to grow up into

healthy adults.

For five years Tubaramure staff will train Mother Leaders with skills to help children grow tall, strong and healthy.

o After five years, you will be well known in the community

for the work you have done.

o You will be able to see a change in children‟s height, strength and health.

By continuing to train others, even after the program is over, you will be able to share these life-changing skills with others in your

community and region.

Additional Information for the Trainer Malnutrition

The greatest increase in malnutrition occurs between 6 and 24 months of age. Six months marks the age when most mothers add foods to the infant‟s

diet. It is during this time that infants begin to experience diarrhea more frequently. Frequent diarrhea often results in malnutrition.

Tubaramure Partners (Picture 1.4) - 5 minutes

9. Show: Ask the caregivers to describe what they see in the pictures on page 11.


10. Explain: Share the key messages using flipcharts pages 10 and 11.


point.

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This program is your program. You are the ones who will help children to grow tall, strong and healthy.

o With your experience, talents, and time we will be able to see changes.

o The Community Development Committee will support you

with their wisdom and advice when problems arise.

There are several other organizations helping you to reach your goal: USAID, Food for the Hungry, Caritas, and International Medical

Corps.

o All of these organizations are working with you to help children to grow tall, strong and healthy.

o Together they will provide training and advice for five

years so that you will have the skills and knowledge to improve child growth.

11. Activity: Tubaramure Song - 15 minutes

Below is a song which describes the goals of the Tubaramure program.

We will take action so that our children will grow

Tall strong and healthy.

With good food and care, and good hygiene our children will grow

We can do it, we can change our community

I can change and I can help my neighbors to change

Tubaramure is our future, a strong and healthy future

We will take action so that our children will grow

Tall strong and healthy.

1. Practice the Tubaramure Song with the Mother Leaders.

2. Sing it several times so that they learn the words.

3. Challenge the women to learn the song and share it with those who ask

about the program.

12. Probe ─ 10 minutes

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? Do you agree to work with the Tubaramure staff to reach this goal? Is there anything that might prevent you from helping the community to reach this goal?

Ask mothers to talk to a woman sitting next to them for the next five minutes.

They should share any personal concerns that they have about the program goals. Together they should try to find solutions to these worries and problems.

After five minutes, ask the Mother Leaders to share what they have discussed.

13. Inform ─ 5 minutes

Help find solutions to their concerns. If a woman offers a good solution to

another woman‟s concern, praise her and encourage others to consider this solution.

Possible concerns:

14. Practice and Coaching ─ 20 minutes

1. Give each Mother Leader a Care Group Orientation Mother Leader flipchart. Ask them to share the teachings they have learned with the person sitting

next to them using the first two flipchart pages.

2. They should try to teach the person next to them in the same way that they promoter used the flipchart to teach them.

3. After ten minutes, ask the women to switch roles. The other Leader Mother

will share the teachings from the third and fourth pages of the flipchart.

4. The Promoter should watch, correct, and help the Mother Leaders who are having trouble.

5. When everyone is finished, answer any questions that the mothers have

about the materials, or today‟s lesson.

15. Request ─ 2 minutes

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? Are you willing to commit to working with the Tubaramure program to help

children grow tall, strong and healthy?

Ask each mother to say aloud the commitment that she is making. For example,

I commit to working with the Tubaramure partners so that children grow tall, strong and healthy, or I commit to reaching pregnant mothers and mothers of

children 23 months or younger.

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Lesson 2: Teaching Techniques

Mother Leaders will be able to share the flipchart messages using ASPIRE with someone else in the Care Group.

o Mother Leaders will be able to explain the meaning of each step in ASPIRE, the method for effective facilitation.

o Mother Leaders will be able to ASK about current practices without judging or criticizing participant answers.

o Mother Leaders will be able to SHOW the lesson‟s three flipchart pages and explain the key messages for each image.

o Mother Leaders will be able to PROBE to find out obstacles or

problems that might prevent a mother from trying a new practice.

o Mother Leaders will be able to INFORM a mother, giving alternative ideas or suggestions to help them overcome the obstacles that are

mentioned.

o Mother Leaders will be to REQUEST a commitment from another mother after each lesson.

o Mother Leaders will be able to EXAMINE the commitments of a

mother from the last meeting to find out if she has fulfilled her commitments.

Caregivers will be able to identify the different parts of the lesson with the

appropriate pictures.

Mother Leaders will believe that they can be part of the change in other‟s lives (change agent).

Materials:

1. Attendance Registers

2. Two copies of the role play at the end of this lesson

3. Care Group Orientation Mother Leader Flipchart

Lesson 2 Summary: Game: Making Eyeglasses

Attendance

Share the story and ask about the methods used for teaching others:

Teaching for Change

Show pictures and share key messages on flipchart pages 14-19: Ask and Show, Probe and Inform, and Request and Examine.

Activity: Role Play with ASPIRE





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Examine beliefs related to the goals of the program

1. Game: Making Eyeglasses ─ 10 minutes

We will begin with a game.6 I will show you how you can make eyeglasses. You have to follow my directions. If you follow them, just as I say, you will make a

pair of eye glasses with your hands. Let‟s work together to see if you can make them.

I will tell you what to do, but you must do it on your own. I won‟t answer

questions, or tell you if you are doing it right. You must listen. Explain the following steps.

1. Press and hold the tips of your thumb and first finger together on each hand. Your fingers should form two small circles on each hand.

2. Keep your fingers pressed together. Now touch the two circles together from each hand so that they are joined in front of you.

3. Next touch your remaining six fingers under your chin, so that the palms of

your hands are facing away from you. 4. Keeping your fingers under your chin, move the palms of your hands towards

your eyebrows, until you can lay your thumbs across your eyebrows.

? How did you do? Let‟s try it again. This time I will SHOW you.

Read the same instructions again. Answer questions. Help those who are having trouble. Show them with your hands what they should do for each step.

? What can we learn from this exercise? Encourage discussion.

o People learn best when they can see and hear how to do a new

thing.

o People learn best when they practice the new thing with someone who has done it before.

o In our program we will be sharing new skills and new practices. We

have to show them and help them to practice the new skills.

6 The game is used to demonstrate that people need to SHOW us how to make changes, not just educate

about change. This game can be substituted with another game as needed. However, make sure that the new game includes the same learning lesson.

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o The best way to be a new teacher, is to commit to doing the practice yourself first. Then you will know how to instruct others.


1. Take attendance, marking the attendance sheet for the Mother Leaders who are present and those who are absent.

2. Then mark the Mother Beneficiary attendance sheet, reading off each Mother

Beneficiaries name and marking their attendance based on the Mother Leader report.

Story: Teaching for Change (Picture 2.1) ─ 10 minutes

3. Story:


The story describes teaching techniques used in the Tubaramure program.

The great granddaughter says, “How did the community change?” “The community selected Mother Leaders. I was chosen as a Mother Leader. I met with a promoter and learned new things. Then I began to share

messages with my neighbors. I told stories and asked questions about my neighbor‟s lives. I encouraged my neighbors to try new things. I also

made changes at home.”

4. Ask


Ask the first question to review the story.

Ask the second question to find out their beliefs about the effectiveness of these methods.

Ask the last question to find out their willingness to teach this way.



pages.”

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? How did the Mother Leader help the women change?

? How do these things help others to change?

? Do you think you can teach this way?

Ask and Show (Picture 2.2) - 5 minutes

5. Show:



6. Explain:



The word ASPIRE will remind you what to do.

o Each letter in ASPIRE represents one step that will help you to be a good teacher.

A in ASPIRE stands for ASK.

o We should remember to ASK mothers about the practices that

they are doing related to the lesson.

o This will help us to know what to teach.

o If we are teaching about hand washing, we can ask each woman, “how often do you wash your hands?”

S stands for Show.

o Each lesson will have about four flipchart pages.

o We show them the flipchart page and ask them to describe what they see.

o Then we explain the meaning of the pictures.

o Each picture is explained on the back of the flipchart.

o The main points are also written on the picture page.

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Additional Information for the Trainer The Ask

If the facilitator discovers during the ASK phase that all of the learners are already practicing the new behavior, the facilitator does not need to spend

much time explaining the behavior and giving reasons for change. Based on the learner responses during the ASK phase, the facilitator will adapt the

teachings so that it is relevant to the learner‟s current behaviors and experiences.

If some of the message points are shared by a learner during the story and discussion, the facilitator can refer back to this discussion. For example the

facilitator might review the message and then say, “This message was already explained by Jeanine during the discussion,” instead of re-teaching

the same message again. This reaffirms the learners and acknowledges information that is already known by the learners.

Probe and Inform (Picture 2.3) - 5 minutes

7. Show:



8. Explain:



P and I are the next steps in ASPIRE.

P in ASPIRE stands for PROBE.

o After you have shown all four pages of the lesson, ask about obstacles that may prevent the families from trying the new

practice.

o For example, “Is there anything that might make it difficult for you to cover your food to keep out the flies?”

o Listen to the concerns that the women mention.

I in INSPIRE stands for INFORM.

o Suggest ways that the caregivers can overcome the problems

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that they mention.

o For example, “You said that you need to purchase fabric to

cover your pots. Could you use reeds to weave a lid instead?

Request and Examine (Picture 2.4) ─ 5 minutes

9. Show:

Ask the caregivers to describe what they see in the picture on page 19.


10. Explain:



R and E are the last two steps in ASPIRE.

R in INSPIRE stands for REQUEST.

o Ask the caregivers if they would like to commit to trying the new practice.

o For example, “We learned about covering foods. What will you commit to do now?

o Ask the mother to say out loud what she has decided to do.

o It is her choice; we will not force mothers to change.

E in INSPIRE stands for EXAMINE.

o Ask the women about the commitments that they made at the last meeting.

o Have they done the things that they committed to?

o For example, “At our last meeting, you said you would go to

the clinic. Did you go?”

? How do you think these steps will help you to be a good teacher?

Additional Information to the Trainer

Commitments Many studies have shown that if learners make a verbal commitment in front

of others, they are more likely to remember the commitment and actually

follow-through on the commitment.

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By allowing the learners to make their own commitments, we allow them to take responsibility and set goals that are relevant to their own experience.

The facilitator‟s role is to make it easy for others to proceed through the

process of change. Reminding and helping them follow-up on their commitments is one way of achieving this goal.

11. Activity: Role Play – 15 minutes

1. Ask each Mother Leader to look at Lesson 3 in her Care Group Orientation Mother Leader Flipchart. Ask her to look for each of the small ASPIRE

pictures in the flipchart? (Where is the ASK image? Where is the SHOW image? Where is the PROBE image?)

2. Explain to the Mother Leaders that the small images are clues to help them

remember what to do next when they are teaching.

3. When they begin teaching, they will use these small images to help them follow the ASPIRE method.

Now let‟s watch a role play to see what happens when a Mother Leader visits a mother in her home. This role play takes place after several lessons have been taught. We will focus on the last four steps – the P-I-R-E steps.

4. Ask for two volunteers to act out the role play at the end of this lesson with

you.

5. Give one copy of the role play to each volunteer. For a low-literate audience, you might also consider asking one literate volunteer to read the role play. Each volunteer should listen and then act out each sentence after it is read.

Adapt as needed.

6. After the role play is over, read the discussion questions below.

? What did you see in this role play?

7. Encourage discussion. Add any of the following points that are not mentioned.

a. The Mother Leader often repeated what the mother said in a different

way (paraphrasing). This helps to clarify and confirm what the mother has said.

b. The Mother Leader did not force the mother to make a commitment.

She mentioned the benefits of adopting the practices.

c. The Mother Leader integrated ASPIRE into the discussion.

o Probe: “What do you think about this lesson? Is there anything that might make it difficult for you to only give breastmilk for the

first six months?”

o Inform: “The nurse at the health post can read the growth chart and show you that the child is growing well.”

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o Request: “Would you be willing to commit to exclusively breastfeed your infant until six months, and then begin slowing adding foods?”

o Examine: You said that you would commit to putting the newborn

child to the breast immediately after she was born. Did you do that?


? What do you think about these ideas? Is there anything that might prevent

you from using the ASPIRE method and sharing with others?

Ask mothers to talk to a woman sitting next to them. They should share any

personal concerns that they have about the lesson. Together they should try to find solutions to these worries and problems. After five minutes, ask the Mother

Leaders to share what they have discussed.


Help find solutions to their concerns. If a woman offers a good solution to

another woman‟s concern, praise her and encourage others to consider this solution.

Possible concerns:


1. Ask Mother Leaders to share the teachings they have learned today using the first two flipchart pages. They should share with another woman in the care

group using the ASPIRE method.

2. Tell each Mother Leader to ask, “What do you see here. What do you think it means?” before they explain each picture.

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3. Then after the woman has responded, clarify any misunderstandings and explain what this picture means for the health program in our community.

4. After ten minutes, ask the women to switch roles. The person they are

sharing with should practice using the next two pages of the flipchart.


6. When everyone is finished answer questions that the mothers have about

today‟s lesson.

Additional Information for the Trainer: Lessons 2, 3, and 4 are for the training of Mother Leaders. You may choose

not to share lessons 2, 3 and 4 with the neighbor groups. However, sharing all lessons may encourage greater support from the community.


? Are you willing to commit to using the APSIRE method with your neighbors?

Ask mothers to give a verbal declaration that they will use the ASPIRE method

every time they share with others.

16. Examine ─ 15 minutes

Ask each Mother Leader one-on-one about their commitments from the last meeting:

At the last meeting what was your commitment?

How are you feeling about this commitment? Have you shared it with others? How did they respond?

Have you shared the messages you learned with others?

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Role Play: Using A-S-P-I-R-E with a Neighbor Additional Information for the Trainer: This role play will only be used with Mother Leaders and does not need to be shared with neighbor groups.

Setup: The promoter will act as the Mother Leader and sit together with the two

volunteers (Mother and Mother-in-Law) during the role play.

Explain: The Mother Leader is sitting with a mother in her home. She has just shared messages about breastfeeding with the mother and her mother-in-law.

(That is, she has already ASKED about current practices and SHOWN all three flipchart pages.) Listen to how the Mother Leader uses the last four steps of the ASPIRE method. The woman that is mentioned in the discussion is the Model

Mother, or mother who follows the recommended teachings.

Mother Leader: What do you think about this lesson? Is there anything that might make it difficult for you to exclusively breastfeed for the first six months of

your child‟s life?

Mother-in-Law: I have heard from your story that the Model Mother gave her child only breastmilk until he was six months old. Then at six months she added

foods. I have never heard such teaching before.

Mother to Mother-in-Law: You are right; we have never heard such teaching. It‟s true that infants don‟t need other foods or drink before they are six months

old. Even some women in our villages wait to give food until the child is six months old.

Mother-in-Law: Yes. Some women say that giving food earlier gives the child diarrhea.

Mother Leader: So it sounds like although many mothers give foods early, some wait to give foods to prevent the child from getting illnesses.

Mother-in-Law and Mother: Yes Mother Leader: What do you think? Do you think it is possible that waiting to

give foods or drink might prevent illness?

Mother: It may be true. I have heard your teaching and the story of the Model Mother. She is very wise and her children are much stronger than the other

mothers. How can we be sure that our children are growing well with just breastmilk?

Mother Leader: The nurse at the health post can read the growth chart and

show you that the child is growing well. Would you be willing to commit to trying to exclusively breastfeed your infant until six months, and then begin adding foods?

Mother: Yes, it is possible. We will talk to our family and make a decision with

them before your next visit.

Mother Leader: Okay. I will ask you at my next visit. Now let‟s examine what you have done since my last visit. You said that you would commit to putting

the newborn child to the breast immediately after she was born. Did you do that?

Mother: Yes, I made the commitment and I followed through. Look. She is

very strong and healthy now.

27

Mother Leader: That is wonderful. You are trying new things. I can even see that you child is happy and healthy too.

Mother-in-Law and Mother: Thank the Mother Leader for coming. Mother Leader: Schedule a time for her next visit, thanks the woman and

leaves.

28

Lesson 3: Mother Leader Responsibilities

Mother Leaders will meet with the promoter (in the care group) once every

two weeks to learn a new lesson.

Mother Leaders will commit to being a role model; making healthy changes in their home and modeling healthy practices to others.

Mother Leaders will share a new lesson with their neighbor groups7 once

every two weeks.

o Neighbor groups consist of at least four and not more than 12 pregnant mothers or mothers with children less than 24 months.

o Once each month the Mother Leaders will teach her neighbors all

together in one large group (neighbor group). At the second monthly meeting, she will teach in each neighbor‟s home (household visit).

During each household visit, Mother Leaders will share two messages from the Picture Cards.

o The Picture Cards have messages that are specific to pregnancy and the monthly development of the child. These messages will help mothers to adopt healthy practices relevant to the child‟s growth.

Before each lesson, Mother Leaders will ask each neighbor about the family‟s

health.

Mother Leaders will report new pregnancies, maternal deaths and deaths of children less than 24 months back to the promoter at each meeting.

Materials:

1. Attendance Registers

2. Picture Cards for each Mother Leader

3. One extra copy of the role play


Lesson 3 Summary

Game: Hello Hello

Attendance

Share the story and ask the women‟s feelings about being a Mother Leader: A Family that Brought Change

Show pictures and share key messages on flipchart pages 22-27: Teaching

Mother Leaders and Neighbor Groups, Asking about the Family‟s Health, and Sharing Message from the Picture Cards.

Activity: Role Play with the Picture Cards




7 Neighbor groups represent the beneficiaries who are reached every two weeks by the Mother Leaders.

29


Examine commitments from the previous lesson

1. Game: Hello Hello ─ 10 minutes

1. Ask the Mother Leaders to stand in a circle.

2. Select one Mother Leader. Ask her to walk around the outside of the circle

and tap someone on the shoulder.

3. The “tapped person” walks the opposite way around the circle, until the two women meet. They greet each other three times by name.

4. The two Mother Leaders then walk quickly back to the open spot, walking in opposite directions around the circle. The person who fills the spot first is the

winner.

5. The other Mother Leader then walks around the outside of the circle and chooses someone to tap.

6. Repeat the game until everyone has had a turn.

Now that we are energized, let‟s begin today‟s lesson.


1. Take attendance, marking the attendance sheet for those who are present

and those who are absent.

2. Then mark the Mother Beneficiary attendance sheet, reading off each Mother Beneficiaries name and marking their attendance based on the Mother Leader report.

Story: A Family that Brought Change (Picture 3.1) ─ 10 minutes

3. Story:


This story gives some reasons why the old lady‟s husband was proud of her

new responsibilities.

30

The old lady says, “I remember when I was chosen to be a Mother Leader.

My husband was so proud. He said, „In our community, the sound of crying is often heard. Children are always sick and struggle to survive.

Soon our community will be filled with laughter. Children will be healthy and strong. I am so proud that you were chosen to bring change.‟”

4. Ask


Ask the first question to review the reason why the Mother Leader‟s husband

was proud of her role as a Mother Leader.

Ask the second question to discuss the beliefs and thoughts of the Mother Leaders and their families about the new responsibilities.


After the participants answer the last question, move to the next flipchart page by saying, “Let compare your ideas with the messages on the following pages.”

? Why was the old lady‟s husband proud of his wife?

? What does your family think of you working as a Mother Leader?

Teaching Mother Leaders and Neighbor Groups (Picture 3.2) - 5

minutes

5. Show:



31

6. Explain:



point.

Mother Leaders will learn a new lesson every two weeks and share it with their neighbors.

o Mother Leaders will meet in the care group with the

Promoter every two weeks.

o Every two weeks Mother Leaders will learn a new lesson.

o Mother Leaders will share the messages with their neighbor groups (4-12 women).

Each month, the Mother Leader will share one lesson in a group and one lesson in each home.

o Once a month the Mother Leader will share the new lesson in the neighbor group.

o Once a month she will share the new lesson at each home.

o During each household visit, Mother Leaders will share two messages from the Picture Cards.

o This allows her to share with other family members in the household.

Asking about the Family’s Health (Picture 3.3) - 5 minutes

7. Show:



8. Explain:



32

Ask about the health of the family.

o At the start of each lesson, the Mother Leader will ask

about the family‟s health.

o She will refer families to the health center to treat illnesses mentioned.

o She will take questions to the Mother Leader Care Group.

o Mother Leaders will listen for births, deaths and new

pregnancies for women in the group and their children under 24 months.

Report mother or child death and new pregnancies to the promoter.

o The promoter will share this information with the local

clinics and Ministry of Health.

o This will help the clinics to understand the health needs of the families in the community.

o This information will also help the Mother Leader Care

Group to understand the needs of the families in the community.

Sharing Messages from the Picture Cards (Picture 3.4) ─ 5 minutes

9. Show:



10. Explain:



point.

The Picture Cards have five pages.

o Each page gives specific messages based on the age of the child or month of pregnancy.

The first page is for pregnant women in the first seven months of

pregnancy.

The second page is for pregnant women in the last two months of

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pregnancy and for infants up to five months of age.

The third page is for children six to eight months.

The fourth page is for children nine to eleven months.

The last page is for children 12 to 23 months.

Find the age of pregnancy or the age of the child on the cards.

o Share two or three messages from the appropriate Picture

Card at each household visit.

11. Activity: Role Play ─ 15 minutes

1. Ask for three volunteers to act out the role play at the end of this lesson with you. Give one copy of the role play to each volunteer.

2. For low literate audience, you might also consider asking a literate volunteer to read the role play. Each volunteer should listen and then act out each

sentence after it is read. Adapt as needed.

3. After the role play is finished, ask the discussion question below.

? What did you see in this presentation?

4. Encourage discussion. Add any of the following points that are not mentioned:

a. The Mother Leaders explains that she is a volunteer that will be

visiting every two weeks.

b. She reminds the neighbor of the program goals.

c. She begins by asking about the family‟s health.

d. She refers families to the health center to treat illnesses mentioned.

e. At the end of the lesson she gives two messages with the Picture

Card.

? What do you think will help the Mother Leader to be a successful Mother Leader?

5. Encourage discussion. Add any of the following points that are not

mentioned.

a. She is willing to learn new things and come to all of the trainings.

b. She communicates easily with others. She listens and respects others.

c. She helps others to try new practices.

d. She is committed to continue helping mothers even after all the

training is complete.

e. She believes that change is possible and encourages other mothers to believe too.

34


? What do you think about these ideas? Is there anything that might prevent

you from completing all of your responsibilities?

Ask mothers to talk to a woman sitting next to them for the next five minutes. They should share any personal concerns that they have with these messages.

Together they should try to find solutions to these worries and problems. After five minutes, ask the Mother Leaders to share what they have discussed.


Help find solutions to their concerns. If a woman offers a good solution to another woman‟s concern, praise her and encourage other mothers to consider

this solution.

Possible concerns:


1. Ask Mother Leaders to share the teachings they have learned today using the

first two flipchart pages. They should share with another woman in the care group using the ASPIRE method.

2. Tell each Mother Leader to ask, “What do you see here. What do you think it

means?” before they explain each picture.

3. Then after the woman has responded, clarify any misunderstandings and explain what this picture means for the health program in our community.

4. After ten minutes, ask the women to switch roles. The person they are

sharing with should practice using the next two pages of the flipchart.

35


6. When everyone is finished answer questions that the mothers have about

today‟s lesson.


? Are you willing to make a commitment to the teachings you have heard

today? What is your commitment?

Ask each mother to say out loud a new commitment that she will make today.

Each mother can choose the commitment that is most important to her.

For example: I commit to meeting my neighbors every two weeks and being a role model to others. I commit to coming to the care group meeting twice a

month and making changes in my life. I commit to asking about the families health at each meeting.


Ask each Mother Leader one-on-one about their commitments from the last meeting:


How are you feeling about this commitment?

Have you practiced the ASPIRE method since the last meeting?

36

Role Play: Visiting the Neighbor Groups (Asking about Family

Health and the Picture Cards) Additional Information for the Trainer: This role play will only be used with Mother Leaders and does not need to be shared with neighbor groups.

Setup: The promoter will act as the Mother Leader. She is standing outside the door of one of her neighbors. Inside the house the Mother and Mother-in-Law

are sitting.

Explain: The Mother Leader is coming to visit one of her neighbors.

Mother Leader: Greetings to you and your family. Is this a good time to talk?

Would your husband or others in your family like to join us?

Mother: My husband is not here. But my mother-in-law is here with me. She will listen too.

Mother Leader: As you know I am an elected community volunteer, a Mother

Leader, and I have been receiving training to help families raise healthy children.

Mother: Yes. We are very glad that you have come.

Mother Leader: I am a volunteer. I don‟t receive any money from the program. I volunteered to visit the neighbor groups every two weeks so that we can learn together. I believe that we can help bring change to the community so

that our children will be tall, strong and healthy.

Mother: Yes I have heard of this program.

Mother Leader: Yes. (pause) How is your family; are you and your children well?

Mother: My youngest child has a fever.

Mother Leader: Have you taken him to the clinic?

Mother: Yes, and I received some medicine this morning. He seems to be getting better.

Mother Leader: Good. Make sure to give all the medicine that the clinic

described. If the child doesn‟t improve, you should return tomorrow. How is the rest of your family?

Mother: The rest of us are healthy.

Then, at the end of the lesson…

Mother Leader: Now that we have finished the lesson, I want to remind you of some health messages for your children. How old are your children?

Mother: The youngest is 6 months and the next is 3 years old. Mother Leader: Our program focuses on children under age 2, so I can share

health messages only for your youngest children. Mother Leader: For a child 6 months of age, you should begin giving one or two spoonfuls of thick, soft porridge once or twice a day after breastfeeding.

After the infant begins to accept the porridge, begin giving four large spoonfuls of porridge three times a day after breastfeeding.

Mother: How do I prepare the porridge?

37

Mother Leader: The picture shows that the first porridge includes a mashed staple like manioc mixed with oil until it thick and easy for an infant to swallow.

This will help the child to grow.

Mother: I will try it this week and see if he likes it.

Mother Leader: Yes try to give him four spoonfuls three times a day after breastfeeding. At our next meeting, I will share more messages to help you add

new foods.

Mother: Yes your teaching is good. I will try the porridge to see if he will take it.

Mother Leader: Our next meeting is with all the neighbors under the tree in

the village center on Wednesday morning. Are you coming?

Mother: Yes I will come.

Mother Leader and Mother exchange greetings and end the meeting.

39

Lesson 4: Watching for Change and Monitoring Groups

Mother Leaders will watch for changes in the health of their neighbor groups

and the health of their own children.

o Mother Leaders will look for positive changes in child illness.

o Mother Leaders will look for positive changes in child growth.

o Mother Leaders will look for changes in height and strength.

Mother Leaders will share changes that they see with the promoter including information from vital events at each meeting.

Care Groups will celebrate the small changes that they see every few

months.

Mother Leaders will watch the pregnancies and the age of the children in the neighbor groups to make sure they are reaching the most vulnerable to

malnutrition (pregnant mothers or women which children 23 months or younger).

Mother Leaders will watch the size of their group making sure that they do

not go over 12 neighbors in each group.

Care Group Leaders will believe that change is possible.

Materials: 1. Attendance Register

2. Three copies of the role play at the end of the lesson.


Lesson 4 Summary:

Game: Fruit Salad

Attendance

Share the story and ask about the group‟s ideas for monitoring change: Watching Child Growth

Show pictures and share key messages on flipchart pages 30-35: Waiting for

Changes in Family Health, Watching Neighbor Groups, and Sharing Progress with Others.

Activity: Role Play – Reporting





Examine commitments from the last meeting

40

1. Game: Fruit Salad ─ 10 minutes

1. The Promoter divides the Mother Leaders into three to four groups. Each group is given a fruit name such as oranges, papaya and bananas.

2. Mother Leaders then sit in chairs (or on mats) in a circle. The Promoter

stands in the center of the circle and shouts out the name of one of the fruits.

3. All of the women in this fruit group must change places with one another. The Promoter tries to take one of their places as they move, leaving another

Mother Leader in the middle without a seat.

4. The new Mother Leader in the middle shouts another fruit name and the Mother Leaders in this fruit group must all change places with each other.

5. If someone says, „fruit salad‟ all Mother Leaders have to change seats.

Now that we are energized and ready for our lesson, let‟s begin!


1. Take attendance, marking the attendance sheet for those who are present and those who are absent.

2. Then mark the Mother Beneficiary attendance sheet, reading off each Mother

Beneficiaries name and marking their attendance based on the Mother Leader report.

Story: Watching Child Growth (Picture 4.1) ─ 10 minutes

3. Story:


The story describes how one care group decided to monitor the progress of the Tubaramure program in their community.

Our care group began to watch (monitor) our children‟s growth. We wanted to see if the changes we made were helping our children. We

began taking our children to the health clinic every three months to have them measured and weighed. Pregnant women went every three months to the clinic to have their belly measured. We were encouraged. Even

small changes helped our children to grow. It encouraged us to keep working.

41

4. Ask


Ask the first two questions to review the messages from the story.

Ask the last question to encourage the women to brainstorm other ways they

can watch for change in the community. Leader Mothers are not required to monitor change. However, if they understand the goal and begin looking for improvements, it will encourage them to continue the work.



pages.”

? Why did the women decide to watch their children‟s growth?

? How did watching growth encourage them to continue?

? What are some other ways you can watch for change?

Watching for Changes in Family Health (Picture 4.2) - 5 minutes

5. Show:



6. Explain:



We can watch for changes in the health of the families in our neighbor groups.

o Changes in the number of child illnesses.

42

o Changes in the height of children.

o Changes in the strength of children.

o We can encourage our neighbor groups to look for change

too.

We can combine the information from all Mother Leaders and look for changes. In these pictures the number of children with diarrhea

has decreased.

o Tubaramure staff will also measure changes and share this information with us.

? How will we know if the change is good?

o If sickness decreases, it will encourage us. We have made

improvements.

o If height and strength do not change or go down, we need to keep working and make changes in our homes.

Watching Neighbor Groups (Picture 4.3) - 5 minutes

7. Show:



8. Explain:



Mother Leaders will work with one group of 12 mothers.

o If groups have fewer than 12 mothers, the Mother Leader can include more mothers in the group.

o Groups should have no more than 12 mothers.

Women who are not pregnant and do not have children less than two

43

years will graduate from the program.

o In order to reach our goal we must focus on pregnant

mothers and mothers with children less than 24 months of age.

o Women with older children will graduate so that new

mothers can join the neighbor groups. o Mother Leaders can continue to volunteer, sharing with

their neighbors even if they are not pregnant or do not have children less than 24 months.

? Why are these things important?

o The child‟s future health is affected by his nutrition and strength in the womb and in the first two years of life.

Neighbor group members must graduate so new mothers can also receive training.

o Small groups make it easier for the mothers to see the flipcharts and learn.

Additional information for the trainer: Graduation

When children turn 24 months old, the mothers must graduate from the program, unless they are a Mother Leader. Mother Leaders are encouraged to continue volunteering.

Neighbor mothers will graduate but may continue attending care group

meetings once a month, if they would like. Graduated neighbor mothers will not receive home visits and their attendance will not be tracked on the Care

Group Registers.

Sharing Progress with Others (Picture 4.4) ─ 5 minutes

9. Show:



10. Explain:


44


When we see change, share it with others.

o Share stories of change with our partners.

o Share stories of change with the Ministry of Health.

o Share stories of change with the Community Development Committee.

o Share stories of change with other mother groups in the

community.

o Sharing will encourage us to continue.

We need to celebrate the small changes that we see every few months.

o It may take many years to reach our goal of all children growing tall, strong and healthy.

o We need to celebrate the small changes to encourage us to

keep going.

11. Activity: Role Play

Additional Information for the Trainer: This role play will only be used with Mother Leaders and does not need to be shared with neighbor groups.

1. Ask for three volunteers to act out the role play at the end of this lesson with

you.

2. Give one copy of the role play to each volunteer.

3. For low literate audience, you might also consider asking another literate volunteer to read the role play. Each volunteer should listen and then act out

each sentence after it is read.

4. After the role play if finished as the following questions.

? What did you see in this presentation?

5. Encourage discussion. Add any of the following points that are not mentioned by the mothers:

a. Mother Leaders are responsible to report the attendance of the

women in their groups at each care group meeting.

b. The Promoter asks about problems with the meetings, and helps the mothers to find solutions.

c. If there are problems encouraging a new practice a few suggestions

are given:

45

Ask other Mother Leaders what they have done to help mothers change.

Speak with other members in the household about the new

practices.

Have caregivers who are practicing the healthy practice come and share their experiences with the mother.

Seek support from community leaders regarding the new

behaviors.

d. The Mother Leaders should report changes in the numbers of women in their group as well as any new births, deaths or

pregnancies that occurred among their group members.


? What do you think about these ideas? Is there anything that might stop you

from watching for change in the community?




Help find solutions to their concerns. If a woman offers a good solution to another woman‟s concern, praise her and encourage other mothers to consider using this solution when they talk with others.

Possible concerns:

46




2. Tell the Mother Leaders listening to the message that they should give one objection to the lesson; one reason that they think this message would be

difficult for them.

3. The Mother Leaders sharing the message should try to help the women overcome this obstacle.

4. After ten minutes, ask the women to switch roles. The other Leader Mother

will share the teachings from the next two flipchart pages.


6. When everyone is finished, answer any questions that the mothers have

about the materials, or today‟s lesson.




Ask each mother to say out loud a new commitment that she will make today.

Each mother can choose the commitment that is most important to her.

For example: I commit to watching for change in the growth of my children. I commit to making sure that only pregnant mothers or women with children less

than 24 months join the neighbor group meetings. I commit to watching the number of women in my group so that my group is always full.


47

Ask each Mother Leader one-on-one about the commitment that she made at the last meeting:


How are you feeling about this commitment?

Have you practiced using the Picture Cards with others? How did they respond?

Have you asked your neighbor‟s about their family health at each visit?

48

Role Play: Reporting to the Care Group Additional Information for the Trainer: This role play will only be used with Mother Leaders and does not need to be repeated with neighbor groups. The

underline, slanted text explains the actions of the actors. The words in normal font should be said aloud.

Setup: You need three volunteers each with a copy of the role play. The volunteer Mother Leaders should sit in a small circle in front of the Promoter

(just as they would sit in a care group meeting). The Promoter should be sitting with an attendance register and pen on her lap. A flipchart is sitting nearby.

Explain: This role play is a care group meeting between the promoter and a

group of Mother Leaders. After the attendance each week, I will ask about the family health any troubles you have had in your groups. We will begin following

this example at our next meeting.

The promoter greets all of the Mother Leaders.

Promoter: Let‟s begin with attendance.

Promoter looks at his register and calls the name of the first Mother Leader (Mother Leader 1).

Mother Leader 1: Yes I am here.

The promoter makes a mark in the register. He then calls the name of Mother

Leader 2.

Mother Leader 2: Yes The promoter makes a mark in the register. He then calls the name of Mother Leader 3.

Mother Leader 3: Yes The promoter makes a mark in the register. He then calls the name of Mother Leader 4.

Mother Leader 3: She could not make it to today‟s meeting.

The promoter makes a mark in the register. The promoter then turns to the

Mother Beneficiary List in his register for Mother Leader 1.

Promoter: Let‟s review the attendance and health of women and children in your neighbor groups.

The promoter calls the name of Mother Leader 1.

Mother Leader 1: We had a group meeting on Wednesday and (… she lists 10 Mother Leaders names) attended. I met with everyone except Anne-Marie. She

was away visiting relatives. So I did not see her. She returned this week. I will teach both lessons to her during the next two weeks.

Promoter: You visited all mothers, except Anne-Marie. You plan to teach her

both lessons at your next meeting.

The promoter makes 11 marks on the register. Mother Leader 1: Yes. There are no new births, deaths or pregnancies for the women in my group.

Promoter: You said that none of the women in your group had any new health events to report.

Mother Leader 1: Yes

49

The promoter looks at her register and calls the name of Mother Leader 2. Promoter: Please tell me the names of the women who came to your meeting.

Mother Leader 2: I met with all of my neighbors (she lists eight names).

The promoter makes eight marks on the register. Promoter: You taught lessons to all of your mothers. What about Agathe? You did not mention her name.

Mother Leader 2: Agathe has moved away. She no longer comes to my

meetings. The promoter makes a mark on the register next to Agathe‟s name.

Promoter: You only have eight neighbors in your group now since Agathe has left.

Mother Leader 2: Yes.

Promoter: Do you have any new births, pregnancies, or deaths to report?

Mother Leader 2: Yes, Chantal is pregnant.

Promoter: Chantal is pregnant. Ok I will mark that on the register. Is there anything else to report?

Mother Leader 2: No, that is all.

Promoter makes a mark on the register.

The promoter calls the name of Mother Leader 3. Mother Leader 3: I asked all of the women to come to one meeting together. Only half of them came.

Mother Leader 3: You know that it is your responsibility to visit each mother. If it is difficult for all of them to come to one meeting, then you need to meet with them one-on one. You must make sure that you teach all of the mothers

that you are given.

Mother Leader 3: Yes. I know.

Promoter: Please tell me which neighbor‟s attended.

Mother Leader 3 lists four names of women from her neighbor group. The promoter repeats the names of the four women and makes three marks in

the register.

Promoter: Do you have any new births, pregnancies or deaths to report?

Mother Leader 3: No there are no changes in the health of my neighbor group. Promoter: Ok. No changes.

The promoter makes a mark in the register.

Promoter: Let‟s talk after the lesson about meeting with the rest of your neighbors. I can help you with some ideas for meeting with the mothers. It is

important that you visit all mothers.

Mother Leader 3: Yes. Let us talk after the lesson. I do not want to be replaced.

Promoter: Ok, we will talk at the end of the lesson. Now that we have taken

attendance, tell me about your meetings. How did your visits go? Did the women understand the teachings on exclusive breastfeeding?

Mother Leader 1: Many people here believe that water and other foods must be given to the infant when they are born.8 Some mothers did not want to

commit to changing their ways. They found the teaching very difficult.

8 Adapt or insert other common “harmful beliefs” or obstacle to breastfeeding from your barrier analysis

findings.

50

Promoter: You were teaching about breastfeeding and some mothers had trouble accepting the message. What did you do?

Mother Leader 1: I told them that it was okay if they did not feel ready to

make a commitment to exclusive breastfeeding. I told them that I would continue meeting with them, and that they could talk to other mothers and

make a decision later.

Promoter: (Speaking to Mother Leader 2 and 3) Did any of you have these troubles?

Mother Leader 2: Yes, one mother in my group is giving water and other foods

to her infant before it is time. So I asked about the health of her infant. Her infant had been very sick. I asked her to try breastfeeding only to see if her infant‟s health and weight improves. She said she would try it.

Promoter: So, you asked the mother to try out the new practice, and see if the baby‟s health improved. That is a very good idea. [Turning to Mother Leader 1] You may consider giving this same advice to the woman you mentioned the next

time that you meet.

Mother Leader 1: Yes I will try that. I will also see if I can get other mothers who exclusively breastfeed to talk with her. When she hears from these

mothers and sees the health of their infants, she may be ready to listen.

Promoter: You may also speak to the others in her household, the mother-in-laws and the husband if they will listen. Once the whole family understands it

may be easier for the mother to try something new.

Mother Leader 3: Yes. That is good. Several other family members joined the meeting that I had with the mothers. It was very helpful.

Promoter: [To Mother Leader 3] Yes, it is very good that you are encouraging others to join. [To the group] Any other problems?

Mother Leader 2: The mothers that I met with were very happy with this information. They said that it was so good and they wished that they had known sooner.

Promoter: Good. Yes, as we continue to share with women in our community,

we hope that they too will share with their neighbors and that many children will be healthy and strong. Ok. Let‟s begin the lesson.

51

Lesson 5: All Children Have Value

Caregivers will believe that all children are unique and valuable; none are

born with more value than the others.

o Girls and boys both have value and should be equally cared for and loved.

o The first born and the last born both have value and should be equally

cared for and loved.

o A child from the poorest family and a child from the wealthiest family both have value; both should receive equal care and love.

Caregivers will believe that it is important to promote value and equality for

all children including male and female, first born and last born, rich and poor, healthy and the weak.

Caregivers will be able to recognize inequality in the community.

Mother Leaders will identify an Activity Leader to help solicit help for the

lessons in Module 2.

Materials: 1. Attendance Registers


Lesson 5 Summary:

Game: Memory

Attendance and Troubleshooting

Share the story and ask about the current beliefs about child value: First and Second Born Children

Show pictures and share key messages on flipchart pages 38-43: Each Child

is Unique and Valuable, Special Care for Those We Value, Showing Equal Value to All Children.

Activity: Showing Value






1. Game: Memory─ 10 minutes

52

1. Ask the women to stand in a circle.

2. Starting with one woman, she must make a statement and indicate part of her body.

3. The statement should not match the action that she doing. For example she says, “This is my nose,” when pulling on her ear.

4. The woman standing next to her must repeat the phrase and action and then add another phrase and action of their own.

5. Continue going around the circle with each woman saying and doing the actions from everyone before them and adding a new one.

6. If someone forgets or does the wrong thing, they should sit down.

7. The last woman standing is the winner.

Now that we are energized, let‟s begin reviewing your work over the last two

weeks.

2. Attendance and Troubleshooting ─ 15 minutes

1. The Promoter should fill out the attendance sheets for each Mother Leader following the role play model from Lesson Four.

2. Promoter asks if any of the Mother Leaders had problems during their

meetings with their mothers. Promoter problem solves with the mothers, helping to solve troubles they are having, and asking other Mother Leaders

for advice.

3. Promoter asks about maternal deaths, child deaths or new pregnancies in the neighbor groups. Promoter records new events on the attendance sheet.

4. Promoter thanks all of the mothers for their hard work and encourages them to continue.

5. Explain that you would like a volunteer to help organize the “Activities” in the next six lessons. The volunteer will be called the Activity Leader. She will be responsible to coordinate the supplies and preparations for the activities in

the next module. She will make sure that each volunteer brings one or more of the needed items for the lesson‟s activities. She will come to each of the

meetings ten minutes early so the promoter can give her the list of needed items and explain the activity for the next lesson. The Activity Leader will then ask for volunteers who are willing to bring the needed items during the

“Attendance and Troubleshooting” section. She will also assist the promoter during the day‟s activity. A new Activity Leader will be elected after she has

completed the flipchart.

6. Ask the new activity leader to come ten minutes early to the next meeting and you will explain her to prepare for Lesson 1 of Module 2.

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Story: First and Second Born Children (Picture 5.1) ─ 10 minutes

3. Story:


The story describes a family that values some children over others in the family.

There was a family with four children. The caregivers gave special care to the first and second born. The third child was a girl who was very small at

birth and often sick. The fourth child was born with a deformity. The parents favored the first and second born. They gave them special care.

The last two children were neglected. The third child died before her fifth birthday. The last child lived, but had health troubles throughout his life.

4. Ask


Ask the first question to review the practices of the caregivers in the story.

Ask the second question to find out if the mothers believe this is a good or bad practice.

Ask the last question to find out how common this practice is in the community.



pages.”

? Why didn‟t the family value the last two children?

? Did they have good reasons to value some children more than others?

? Do people here value some children over others?

Each Child is Unique and Valuable (Picture 5.2) - 5 minutes

5. Show:


54


6. Explain:



point.

Each child is unique.

o Each child‟s looks different from all others.

o Each child‟s personality is different than all others.

o Each child‟s abilities are different than all others.

Each child has value.

o Each child has a future in which they can do great things.

o Since each child is unique, they are able to bring new

ideas, experiences and opportunities to the community.

o Like a seed in the earth, each child is born with the desire to live and grow.

? Why do people in this community value children?

? How have you seen people show value to children?

Additional Information for the Trainer Value of Children

Caregivers may value children for many different reasons. Reinforce the

positive beliefs mentioned by the participants. If you see a discrepancy between the beliefs of the caregivers (children

are valuable) and the actions of the caregivers (few caregivers show or demonstrate value), then ask the caregivers why this happens. Is there a

reason why people have certain beliefs but do not act on them? If the value of children is low in the community, consider ways to

encourage a greater appreciation for them. If caregivers do not value

children, it will be less likely they will commit to making changes to help them.

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Special Care for Those We Value (Picture 5.3) - 5 minutes

7. Show:



8. Explain:



We give them foods to grow strong.

o We give special portions of food to our children to ensure they get sufficient food and nutrients.

We bathe and keep them clean.

o We set aside time to bathe our children because we take special care of the things we value.

We encourage them.

o We praise them when they are doing well.

o We encourage them when they have troubles.

o We gently discipline our children when they do wrong because we love them and want them to learn.

We use money to care for them.

o We save money to meet our children‟s food, clothing, and

health needs.

o When we value children, we care for them the same as (or even better) than we care for ourselves.

? Do people in this community give children special care? Why or why not?

Showing Equal Value to All Children (Picture 5.4) ─ 5 minutes

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9. Show:



10. Explain:



point.

When we value all children, we give them equal care.

o We do not favor some children and neglect others.

Provide equally for all children.

o If we feed some children better because they are favored and neglect others, we are not showing equal value.

o If we let some children suffer because we do not favor them, we are not showing equal value.

o If we only send one child to school and not the other, we are not showing equal value.

? How does unequal care affect child health?

11. Activity: Showing Value ─ 15 minutes

1. Ask the mothers to identify which children in the community do not get equal

care. Responses may include the disabled, the youngest children, female children, etc.

2. Ask the mothers to identify practices that can help to show equal value. For

example, how can they change the way they care for these children to show they are equally valued. How could they care for them in a new way that

shows value?

3. Encourage the women to try some of these new practices this week to help show equal value to all children.

57



from believing that all children are created with value and deserve equal care?





using this solution when they talk with others.

Possible concerns: Mothers may mention that other family members may disagree with these

principles. Encourage them to share the teachings and flipchart pictures with

their family members and discuss these new ideas.




2. Tell the Mother Leaders listening to the message that they should give one objection to the lesson; one reason that they think this message would be

difficult for them.

3. The Mother Leaders sharing the message should try to help the women overcome this obstacle.

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4. After ten minutes, ask the women to switch roles. The other Leader Mother will share the teachings from the next two flipchart pages.

5. The Promoter should watch, correct, and help the Mother Leaders who are

having trouble.

6. When everyone is finished, answer any questions that the mothers have about the materials, or today‟s lesson.




Ask each mother to say out loud a new commitment that she will make today. Each mother can choose the commitment that is most important to her.

For example: I believe that all children were created with value and commit to

caring for all of my children equally. I commit to discussing these ideas with my spouse. I commit to giving my child special portions of food. I commit to

changing my beliefs about the value of children.


Ask each Mother Leader one-on-one about the commitment that she made at

the last meeting. At the last meeting what was your commitment? Have you followed through with your commitment during the last two weeks? How?

For example:

Did you ask each of your neighbors about the family‟s health at your last

visit?

Were you able to report on the attendance of each woman in your neighbor group at your last meeting?

Are all of the women in your group either pregnant or have children less than

24 months of age?

What will you do if one of the mothers stops attending the neighbor meetings?

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Lesson 6: I Can Change!

Caregivers will be able to explain one way in which they have started a new

practice (or changed) during their life.

Caregivers will be able to explain at least three things that help people to make changes in their lives.

Caregivers will be able to name three reasons that they have confidence in

their ability to change.

Caregivers will be able to reflect on their lives and identify which of their own behaviors or attitudes they would like to change.

Caregivers will believe they are able to make changes with their current

skills, knowledge and abilities.

Caregivers will believe that change is possible.

Materials: 1. Attendance Register

2. Several strips of fabric to use as blindfolds

3. Care Groups Orientation Mother Leader Flipchart

Lesson 6 Summary: Game: Blindfold Walk

Attendance and Troubleshooting

Share the story and ask about the women‟s confidence in their ability to

change.

Show pictures and share key messages on flipchart pages 46-51: Thinking about Change, Things That Help Us to Change and Believe That You Can Change.

Activity: The Confidence Ruler






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1. Game: Blindfold Walk ─ 10 minutes

1. An obstacle course is set for everyone to see (place chairs, or mats, or other people in the path to the other side). An ending line or “target” is identified

on the opposite side of the room.

2. Participants split into pairs. One of the pair ties fabric around their head covering their eyes (or closes their eyes tightly) so they cannot see.

3. The other member of the pair now gives advice and direction to their partner

to help them to get safely to the other side of the room.

? What helped you to get to the other side? If you tried to cross the room without any help, would it be difficult for you? Encourage discussion.

? What can we learn from this game?

o As we teach, we need to guide those who are “following unhealthy

practices” or “blindfolded.”

o We need to encourage others and support them, (not force them) to make changes in their lives.

Now that we are finished with our game, let‟s begin.

2. Attendance and Troubleshooting ─ 15 minutes

1. The Promoter should fill out the attendance sheets for each Mother Leader following the role play model from Lesson Four.

2. Promoter asks if any of the Mother Leaders had problems during their

meetings with their mothers. Promoter problem solves with the mothers, helping to solve troubles they are having, and asking other Mother Leaders

for advice.

3. Promoter asks about maternal deaths, child deaths or new pregnancies in the neighbor groups. Promoter records new events on the attendance sheet.

4. Promoter thanks all of the mothers for their hard work and encourages them

to continue.

Story: Story of Change (Picture 6.1) ─ 10 minutes

3. Story: Martha’s Hard Work


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At the end of the civil war, Martha went into hardships, due to poverty caused by

the death of her husband and the fact that everything she possessed had been

stolen. Her neighbors wondered how she managed to survive when there was no

one who cared to whom she could go to.

Despite all this, she was not disheartened and she was continually expecting a

miracle from God. Martha was not discouraged and she decided to start weaving

baskets and try to sell them so as to earn a living for her family. But even then,

it was not at all easy because it was difficult for her to find buyers. And when

she was lucky to come across a potential buyer, they offered too little money

that could hardly suffice for her to even buy salt. One day, she met some people

from Bujumbura who were in the area to attend a family ceremony. They were

pleased by her courage and they decided that they will be buying all the baskets

that she will be able to weave. After that, Martha organized an association so as

to be able to weave many baskets. As a result, today she has overcome poverty.

4. Ask


Ask the first two questions to review the points in the story.

Ask the last question to find out how confident the women are in their own ability to change and bring change.

Encourage discussion. Don’t correct “wrong answers.” Let everyone

give an opinion. This page is for discussion, not for teaching.


pages.”

? Do you have confidence in your ability to bring change to this community?

Thinking About Change (Picture 6.2) - 5 minutes

5. Show:


62


6. Explain:



Change is normal part of life. We all make changes.

o When we marry, we change the way we live.

o When we have children, we change the way we prepare food and spend our time.

o As the weather changes, we have to change the foods that we eat because not all foods are available throughout the

year.

Some changes happen very quickly, such as buying soap for washing.

Other changes take a long time to learn, such as learning to sew.

? What are some changes that you have already made in your life?


Examples of Change The women in the group may have trouble thinking of something they have

changed. The promoter should give an example form their own life; something that you have changed about yourself rather than how you changed someone else.

For example, “I changed the way that I fed my children after learning about the importance of porridge,” or “I changed where I go when my child has

fever because I changed my beliefs about the causes of malaria.”

Things That Help Us To Change (Picture 6.3) - 5 minutes

7. Show:


63


8. Explain:



point.

Encourage one another.

o Help each other to try new practices.

o Give people hope that they can change.

o Ask advice from others who have already tried the new

practices.

Practice the new skill.

o Practice making the new type of porridge. Practice showing equal care to your children.

o The more you practice the new skill, the easier it will be to

make a long-term change.

Make changes in small steps.

o Make easy changes first.

o Once you have success with the small things, it will help

you to make bigger changes.

Believe That You Can Change (Picture 6.4) ─ 5 minutes

9. Show:



10. Explain:


64


Remember your past success.

o Remind yourself of positive changes that you have already seen in your life.

The community chose you.

o Your community is confident of your skills and experience.

o They selected YOU to help them to reach the goal.

o They believe in you.

Remember that you have others to help you.

o The neighbor groups (and care group) will help you as you

make changes together.

o We will equip you with skills and knowledge so that your children grow tall, strong and healthy.

? How many of you have been able to keep the commitments that you‟ve made so far?

? How can that success help you make other commitments?


Creativity The Tubaramure program will give families new skills and ideas to help

children grow. However, women in the groups can also bring their own ideas for bringing change.

For example, they might discover a new way to build a hand washing station

with local materials, or a new way to remember the childhood danger signs.

Encourage everyone to participate in bringing change with creative solutions to local problems.

11. Activity: The Confidence Ruler

1. Put a piece of rope on the ground with five knots in it (or five rocks spread apart in a line. Explain that

we are going to talk about how people feel about their ability to

change.

2. Ask the women to think of something they would like to

change in their life. For example,

65

they want to stop smoking, or stop fighting with their spouse, or show equal value to their children.

3. Wait for everyone to think of something to change.

4. Then ask, “How confident are you that you will be successful changing this thing?

5. Explain that one end of the rope (where the 1 is above) represents that you think it is completely impossible for you to change this things with your

current skills and knowledge. Explain that the other end (5) represents something that you think you will definitely be able to change with your

current skills and knowledge.

6. The promoter should demonstrate with an example from his/her own life, standing on the line at the place that represents his/her confidence level.

7. Then ask the rest of the group to stand on the line at the point that represent

their belief in their ability to change. If more than one person wants to stand on the same number, have them stand shoulder to shoulder.

8. Discussion:

9. Ask one person standing near the lower end of the line (1 or 2):

a. “So you don‟t feel too confident in your ability to change. What are the

things that you would need to happen to help you feel more confident in your ability to change? Are there certain skills that you would need to learn? What skills?”

b. “If you didn‟t make the change that you are thinking about, what are the negative things that could happen?”

c. “What would be the good things about making the change that you want to make?”

d. Even though you don‟t feel very confident about change right now, are

there some people who would be willing to help you make the change if you asked them? Who are those people?

10.Ask one person standing near the middle of the line (3):

a. “Why would you rate your ability to change here in the middle rather

than at 0 or 1?”

b. “If you didn‟t make the change that you are thinking about, what are

the negative things that could happen?”

c. “What would be the good things about making the change that you want to make?”

d. “Who are the people that you think will support you in making the

change you want to make?

11.Ask one person standing near the high end of the line (numbers 4 and 5):

a. “What are the things that make you confident in your ability to change?”

b. “Who are the people that you think will support you in making the

change you want to make?

12.Ask everyone to sit down. Ask. “What can we learn from this exercise?”

a. Review the reasons mentioned for the women‟s confidence. Encourage the women that change is possible and they should know there the

care group will support them as they try new practices in their lives.

66



from believing that you are able to make changes in your life?





using this solution when they talk with others.

Possible concerns:




2. Tell the Mother Leaders listening to the message that they should give one

objection to the lesson; one reason that they think this message would be difficult for them.

3. The Mother Leaders sharing the message should try to help the women

overcome this obstacle.

67

4. After ten minutes, ask the women to switch roles. The other Leader Mother will share the teachings from the next two flipchart pages.

5. The Promoter should watch, correct, and help the Mother Leaders who are

having trouble.

6. When everyone is finished, answer any questions that the mothers have about the materials, or today‟s lesson.




Ask each mother to say out loud a new commitment that she will make today. Each mother can choose the commitment that is most important to her.

For example: I believe that I am able to make healthy changes in my life. I

believe that the women in my care group (or neighbor group) will support me as I make changes. I commit to making healthy changes in my life. I commit to

trying new practices to improve child health.


Ask each Mother Leader one-on-one about the commitment that she made at

the last meeting. At the last meeting what was your commitment? Have you followed through with your commitment during the last two weeks? How?

For example:

How have you shown each of your children that you value them in the last

two weeks?

How have you given special care to your children in the last two weeks?

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Lessons 1-6 Pre and Posttest

Two questions from each lesson are listed below. Before and after teaching the materials to staff and trainers, give the posttest to evaluate their comprehension. For those who score 75% or less (must have at least 9 correct

answers), give them more training to help them understand the information. Trainers should not teach others until they are able to score 75% or better.

1. Fill in the three words which describe the goals of the program below.

The goal of the Tubaramure program is the following: parents will take actions

to help their children grow ____________, ____________, and ____________. 2. Who are the people that the Tubaramure program is targeting with

health messages? Circle only ONE answer.

A) Parents and children under five years of age. B) Parents and children from age 2 to five years.

C) Pregnant women and children who are malnourished. D) Pregnant women and children less than 24 months of age.

3. Which one of the steps below helps the facilitator to know the current practices of the women in the group? Circle only ONE answer.

A) ASK B) SHOW

C) PROBE D) REQUEST

4. The last step of ASPIRE is examine. What does the Leader Mother examine during this step?

_________________________________

5. How often does the Leader Mother meet with her neighbor group?

6. At each household visit, the Leader Mother should share how many

messages from the Picture Cards?

________________________________________

7. What should a Leader Mother do if one of the women in her neighbor groups is not pregnant and does not have a child 23 months or younger?

_______________________________________________

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8. True or False. Circle your answer. It is important for Leader Mothers to

watch for change so they can see the benefits of the work they are doing.

9. True or False. Circle your answer. All children are unique and valuable. 10. True or False. Circle your answer. All children no matter their age,

gender, or birth order should be given equal care.

Name two things that help people to make changes in their lives. 11. ________________

12. ________________

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Lessons 1-6 Pre and Posttest ANSWERS 1. The goal of the Tubaramure program is the following: parents will take

actions to help their children grow __TALL, STRONG, and HEALTHY. 2. Who are the people that the Tubaramure program is targeting with

health messages? Circle only ONE answer. D) Pregnant women and children less than 24 months of age.

3. Which one of the steps below helps the facilitator to know the current practices of the women in the group? Circle only ONE answer.

A) ASK

4. The last step of ASPIRE is examine. What does the Leader Mother examine during this step? The commitments made by the neighbors at the last meeting.

5. How often does the Leader Mother meet with her neighbor group?

Once every two weeks or twice a month.

6. At each household visit, the Leader Mother should share how many messages from the Picture Cards?

Two or three messages from the appropriate card.

7. What should a Leader Mother do if one of the women in her neighbor groups is not pregnant and does not have a child 23 months or younger?

Tell the neighbor that she must graduate from the program. Explain that the group is only for pregnant women or women which children 23 months or

younger. 8. True. It is important for Leader Mothers to watch for change so they can see

the benefits of the work they are doing.

9. True. All children are unique and valuable. 10. True. All children no matter their age, gender, or birth order should be

given equal care.

Name two things that help people to make changes in their lives. 11. and 12. Any two of the following answers are correct: - Encourage one another

- Practice the new skill or change - Make changes in small steps

- Remember your past success. - Remember that the community chose you. - Remember that you have others to help you.

Documents

Care Group Orientation€¦ · Care Group Orientation Promoter Lesson Plan Module 1 of 5 . 3 Care Group Orientation Table of Contents: Lesson 1: Introduction to Care Groups.....9