Training illiterate frontline health workers: Strategies used and lessons learned in rural South Sudan

Purpose: In rural South Sudan, where only 26% of those over age 15 have ever attended school, older women serving as frontline volunteer health workers –Home Health Promoters (HHPs) –often have minimal access to formal education. In preparation for an operations research embedded in a centrally-funded USAID Child Survival and Health Grants Program project in Warrap State (2010-2014), World Vision staff trained 15 illiterate HHPs from a rural community, ranging in age from 32-50, in March 2013 to deliver integrated community case management plus essential newborn care, including newborn resuscitation. Data used: Quantitative (pre/post tests and skill evaluation) and qualitative (observation and lead trainer’s notes) information was used to evaluate the training. Methods: Working through translation and using a variety of approaches including sharing of experiences, hands-on activities, songs, videos, pictorial recording forms, and cue cards, trainers observed skill transfer during final testing. Results: The training achieved 100% attendance. A 12 question verbal pre-test/ post-test showed increases in knowledge; particularly of identification of danger signs and use of breath counting to determine fast breathing. At week’s end, 12 of 15 passed competency testing for newborn resuscitation. Nine of 15 training attendees were found to be sufficiently competent in all skill areas, including use of recording forms, to receive project accreditation at the conclusion of training, with 13 of 15 accredited within six weeks of supervision. Recommendations: Illiterate volunteers can demonstrate community case management and essential newborn care skills learned through intensive hands-on training utilizing a variety of approaches, followed by supportive supervision.