Maximizing participation in community health worker curriculum and program design: Strategies from "Las Promotoras de Salud" program in San Ramon, Nicaragua

Teach For Health (TFH) is developing a sustainable health promoter training program among 21 coffee-farming cooperatives in Nicaragua, with a total population of approximately 12,000. 17 female health promoters and 5 Master Trainers representing 16 communities completed a 2-week workshop in December 2009. TFH and a Nicaraguan partner NGO are overcoming obstacles to community health worker retention by maximizing participation in program development. TFH incorporated participatory methods throughout the workshop, including Problem-Based Learning, small group exercises, role-playing, goal-generating sessions, and focus groups to compose mutually acceptable Memorandums of Agreement. Health promoters were instrumental in designing the curriculum. Day one was dedicated to sharing expectations of the workshop between health promoters and facilitators. These sessions were used to finalize the schedule. One TFH staff was assigned to observe interactions daily, refining the program as necessary. Evaluation methods included pre/post knowledge tests on health topics, focus group feedback, participant interviews and anonymous evaluation forms. Much of the workshop was focused on problem solving, presentation skills, teamwork and managing expectations. Topics included community health advocacy and equity, principles of health promotion, and barriers to changing health behaviors. After the workshop, 15 of 17 promoters have attended monthly continuing education. This presentation will demonstrate the methods of community diagnosis utilized in the workshop to identify and overcome obstacles faced by health promoter programs in rural “developing” country settings. Presenters will discuss long-term program plans, focusing on maximizing participation in curricular design, developing sustainable horizontal infrastructure, and building feedback mechanisms to respond to emerging problems.