THE RCQHC/ HCP/ACP PAEDIATRIC HIV/AIDS TRAINING
PROJECT
MONITORING AND EVALUATION SYSTEM
FOR
PAEDIATRIC HIV/AIDS TRAINING COMPONENT
DATE: JUNE 2011
LIST OF ABREVIATIONS
ACP
AIDS Control Program
AIDS
Acquired Immunodeficiency Syndrome
F
Female
GOV
Government
HC
Health Centre
HCP
Health Communication Partnership
HCW
Healthcare Worker
HIV
Human Immunodeficiency Virus
M
Male
M&E
Monitoring and Evaluation
MO
Medical Officer
MOH
Ministry of Health
NGO
Non-governmental Organization
RCQHC
Regional Centre for Quality of Health Care
TBD
To Be Discussed
TOT
Trainer of Trainers
ii
TABLE OF CONTENTS
LIST OF ABREVIATIONS ........................................................................................................ ii
TABLE OF CONTENTS ........................................................... Error! Bookmark not defined.
ACKNOWLEDGEMENT ...........................................................................................................v
1. INTRODUCTION ................................................................................................................. 1
1.2 Objectives ...................................................................................................................... 2
1.3 Approach to M&E ........................................................................................................... 2
1.3.1 Monitoring ................................................................................................................ 2
1.3.2 Evaluation ................................................................................................................ 3
2. M&E SYSTEM FRAMEWORK ............................................................................................ 4
2.1 Data Collection System .................................................................................................. 5
2.2 Data Processing, Analysis and Reporting ...................................................................... 5
2.3 Data Storage .................................................................................................................. 5
2.4 Evaluation and Feedback ............................................................................................... 5
2.5 Stakeholders .................................................................................................................. 6
3. DATA COLLECTION INSTRUMENTS ................................................................................ 7
3.1 Standard Attendance Form ............................................................................................ 7
3.2 Paediatric HIV/AIDS Training Report ............................................................................. 7
3.3 TOT Observation Tool and Observation Report ............................................................. 8
3.4 End Evaluation Participant Tool ..................................................................................... 8
BIBLIOGRAPHY ...................................................................................................................... 9
ANNEXES ............................................................................................................................. 10
1.0 SUMMARY PERFORMANCE INDICATORS ............................................................... 10
1.1 TRAINER OF TRAINERS ......................................................................................... 10
iii
1.2 FRONTLINE HEALTHCARE WORKERS ................................................................. 11
1.0 PERFORMANCE INDICATOR REFERENCE SHEET ................................................. 13
1.1 TRAINER OF TRAINERS ......................................................................................... 13
1.2 FRONTLINE HEALTHCARE WORKERS ................................................................. 19
2.0 TOOLS ......................................................................................................................... 25
2.1 STANDARDIZED PAEDIATRIC HIV/AIDS TRAINING ATTENDANCE FORM ......... 25
2.2 TOT OBSERVATION TOOL ..................................................................................... 26
2.3 PARTICIPANT DAILY EVALUATION FORM ............................................................ 27
2.4 PARTICIPANT END EVALUATION FORM ............................................................... 28
2.5 POST TRAINING SUPPORT SUPERVISION TOOL.......…..……………………..…..30
3.0 SUMMARY REPORTS ................................................................................................. 46
TRAINING REPORT ....................................................................................................... 47
TOT OBSERVATION REPORT ...................................................................................... 52
iv
ACKNOWLEDGEMENT
This document is a product of efforts by two consultant Medical Epidemiologists with training
in paediatrics; Ezekiel Mupere MBChB, M.Med (Paediatrics), PhD (Epidemiologist) and Eric
Wobudeya MBChB, M.Med (Paediatrics), MSc. (Epidemiology). The consultants were
facilitated by staff from three stakeholders: Regional Centre for Quality of Care (RCQHC),
AIDS Control Program (ACP), and Health Communication Partnership (HCP). We are
grateful to the consultants, all staff (Eva Magambo, Ruth Musekura, Kimberly Burns Case,
and Robert Nangai from HCP; Dr. Peter Elyanu from ACP; and Dr. Daniel Tumwine, Dr.
Henry Barigye, Dr. Micheal Mawanda, and Mr. Taasi Geoffrey from RCQHC), and
stakeholders who participated in a series of consultative meetings to conceptualize and
operationalize the framework, tools, indicators, and database.
This document was made possible by the support of the American people through the United
States Agency for International Development (USAID) and RCQHC. The views expressed by
the authors do not necessarily reflect those of these organizations.
v
1. INTRODUCTION
In Uganda it is estimated that 130,000 children under 14 years are living with HIV with 42,000
children in immediate need of life saving antiretroviral drug treatment. However, only 17,000
of these (41%) are receiving this essential intervention. Tackling the paediatric HIV/AIDS
pandemic is possible where resources are available, services are accessible, and efforts
coordinated.
The Regional Centre for Quality of Health Care (RCQHC) is affiliated to Makerere University
School of Public Health. RCQHC’s mission is to provide leadership in building regional
capacity to improve the quality of health care in Africa by promoting evidence-based better
practices.
The Regional Centre for Quality of Health Care (RCQHC) in partnership with the Health
Communication Partnership (HCP) is currently implementing a 2-year initiative to support the
MOH/AIDS Control Program (ACP) to scale up paediatric HIV services in Uganda. The
program aims to strengthen the capacity of healthcare providers in Uganda to offer quality
paediatric HIV/AIDS services (care, treatment and support). This RCQHC/HCP/ACP project
will train national and regional trainers for paediatric HIV/AIDS services and also offer them
support supervision as they train frontline healthcare providers.
The purpose of this Monitoring and Evaluation (M&E) system is to establish a unified and
coherent tracking of the trainings and supervision provided to the trainer of trainers (TOT),
and the trainings provided to the frontline health care workers (HCW). The data collected
through this framework will be used for tracking and reporting training outputs to the ACP at
the MOH and other stakeholders in a timely manner, monitoring and evaluating the
implementation of the project’s trainings, and feedback review to all stakeholders.
1
1.2 Objectives

Develop tools for collecting data on paediatric HIV/AIDS training and support
supervision done by this project.

Develop a system for collection of data on training and support supervision.

Develop a database for health care workers trained in paediatric HIV/AIDS care and
treatment and counselling.

Train project staff to maintain database and M&E system.

To improve reporting at all levels by making it simpler, better and faster.
1.3 Approach to M&E
In this M&E framework system, an approach based on results was adopted, which is derived
from four pillars:

Defined strategic goals which provide a focus for action

Specifications of expected outcomes which contribute to the achievement of the
desired goals

Alignment of processes, and resources in support of the expected outcomes

Ongoing monitoring and assessment of performance, integrating lessons learnt into
future planning; and improved accountability for results (whether this project made a
difference in the HCWs’ capacity to provide quality paediatric HIV/AIDS services in
Uganda).
The result-based monitoring system is based on the model of the linked hierarchy from inputs
to activities to outputs to outcome and ultimately impacts1.
1.3.1 Monitoring
Monitoring is a continuous function that uses the systematic collection of data on specified
indicators to provide management and the main stakeholders of an ongoing project with
indicators of the extent of progress and achievement of objectives and progress in the use of
allocated funds. It involves collecting, analyzing and reporting data on inputs, activities,
outcomes, impacts and external factors, in a way that supports effective management.
2
Monitoring usually reports on actual performance against what was planed or expected.
Monitoring in this training project will be conducted at two levels: activity and output.
Activity monitoring
Activities are the processes or actions that use a range of inputs to produce the desired
outputs and ultimately, outcomes. In essence, activities describe ‘what we do’. Activities will
be managed and monitored by the program staff at the MOH AIDS Control Program (ACP).
The program will maintain an activity database for tracking progress in terms of physical
implementation of the specified targets according to work plan. For monitoring purposes,
each activity plan specifies the output, activity description, activity schedule, inputs, progress
indicators and targets.
Output monitoring
Outputs are final products, goods and services produced for delivery. Outputs may be
defined as ‘what we produce or deliver’. They are the deliverables that the program budgets
for and produce following implementation of the planned activities. Tracking outputs data will
be obtained by aggregating results of from the activity database. Monitoring activities and
outputs data will be captured by using structured data collection instruments (Annex II).
1.3.2 Evaluation
Evaluation is the systematic and objective assessment of an ongoing or completed project
including its design, implementation, and results. It is a time-bound and periodic exercise that
seeks to provide credible and useful information to answer specific questions (lessons
learned) to guide decision making by project staff, managers, and policy makers. The aim is
to determine the relevance and fulfillment of objectives, development efficiency,
effectiveness, impact, and sustainability. Impact evaluations examine whether underlying
theories and assumptions were valid, what worked, what did not and why. Evaluation can
also be used to extract cross-cutting lessons from operating unit experiences and
determining the need for modifications to strategic results framework.
3
We carry out evaluations when it is deemed that the interventions so far implemented are
sufficient to have achieved a significant part of an objective. An objective is formulated as an
outcome (strategic objective) and a good proposed design for achieving an objective requires
specification of quantifiable results, a time frame, and a baseline for assessing change. In this
training project for trainers and frontline HCWs, an evaluation will use evidence from
quantitative results (knowledge) attained by participants during trainings; monitoring
supervision data for TOTs and quantitative pre-test results as baseline to determine whether
the targeted HCWs will have improved in knowledge to provide quality paediatric HIV/AIDS
services in Uganda.
2. M&E SYSTEM FRAMEWORK
An M&E System is the set of organizational structures, management processes, standards,
strategies, plans, indicators, information systems, reporting lines and accountability
relationships which enables departments, stakeholders, and other institutions to discharge
their M&E functions effectively. In this conceptual framework, we define the components of
the system, how the system functions, the key players, relationships between players and
assignment of responsibilities. The operational components in this M&E system (Figure 1) will
include:

Data collection system

Data processing, analysis, storage, and reporting

Evaluation for lesson learning

Partner organizations as key stakeholders
The necessary activities that will drive the implementation and attainment of the required data
will include: data collection system, processing, storage, analysis, reporting, and lesson
learning. The data will influence the project implementation, planning, and ensuring
sustainability of the training program to improve quality of paediatric HIV/AIDS services in
Uganda.
4
2.1 Data Collection System
Field lead trainers and supervisors at national, regional, and district levels will ensure that
training and supervision reports, and the supporting tools (Annex II and III) are completed
during field implementation. Designated lead trainers by the implementing organizations will
ensure that all training reports and supporting tools are delivered to the administrator at the
MOH ACP offices in both electronic and paper form in a timely manner. The ACP program
officer at the MOH will institute an administrative mechanism to ensure that implementing
organizations deliver timely the training reports and supporting tools to the ACP offices.
2.2 Data Processing, Analysis and Reporting
This designed M&E system will capture, integrate and store information from 1) all paediatric
HIV/AIDS trainings countrywide including national trainers, TOTs, and cascade training of
frontline HCWs and 2) support supervision sessions for TOTs. Data collected in this training
project through lead trainers of the training workshops and supervisions at national, regional
and district level will be submitted to the program officer and head of the database at the
MOH ACP offices. The program officer and his support staff will process the data. The team
at the ACP will conduct the in-house data quality assessment with a prepared report. The
ACP administrative team will enter the data into a prepared database, clean and conduct the
required analysis to prepare reports for stakeholders’ meetings and feedback.
2.3 Data Storage
The M&E data will be stored in hard and electronic formats. Designated M&E file for this
training project will be assigned and an electronic M&E database in excel spreadsheets has
been developed. The M&E data will be developed to capture data on all indicators at activity
and output levels (Annex I). The database will be maintained by the ACP team at the MOH
ACP offices.
2.4 Evaluation and Feedback
The ACP Program officer and the support staff will prepare evaluation and feedback reports
to stakeholders, affiliated support organizations and facilitators of the trainings. The feedback
will be conducted through regular quarterly and annual reports, reflection and learning
5
workshops, research dissemination workshops, publication of study findings, and direct
interaction with stakeholders and facilitators during implementation.
2.5 Stakeholders
The partner organizations in this training project include RCQHC, HCP, and ACP at the
MOH. The stakeholder organizations have provided support in development of training
reports and supporting tools for data collection. The stakeholders will receive formal
information and reports for the trainings from the program officer and the M&E team based at
the MOH ACP offices. The stakeholders will provide feedback and external quality assurance
regarding data collection, processing, and reporting to the program officer MOH ACP.
Figure 1: Operational M&E System Conceptual Framework
Data Collection system
Implementing
Organization
Lesson
and
Learning
Field Lead
Trainers
Sources of
Information
Electronic & Hard Copies:
 Training reports
 Supervision reports
MOH-ACP
Data:
Processing
Storage
Analysis
Reporting
Stakeholders:

HCP, ACP and
RCQHC
Role:
 External quality
assurance
 Feedback
 Reports to funders
6
3. DATA COLLECTION INSTRUMENTS
A set of tools has been developed for use in data collection by the RCQHC in consultation
with HCP and ACP – MOH as partners (Appendix II). The tools will be used to collect data on
paediatric HIV/AIDS trainings and support supervision for TOTs. The lead trainers for the
training workshops and supervision activities will send completed tools and the associated
supportive reports to the administrative staff at the ACP – MOH. The administrative staff and
ACP Program officer will process the data. The completed tools and supporting documents
will be filed in designed files as reference for audit at the ACP offices.
3.1 Standard Attendance Form
This form captures the number of participants for each training activity by their gender,
cadre of professional training, affiliated health facility, level of facility such as health
center III, facility district, e-mail and telephone contact. This form should be completed
for all training activities conducted by the MOH ACP. Each participant should complete
the form and sign. The lead trainer should sign and indicate the date when the activity
was implemented. The completed form should be used by the lead trainer to complete
the training report.
3.2 Paediatric HIV/AIDS Training Report
The training report should be completed immediately after the training by the lead
trainer using the Attendance Form. This report bears the unique identifier for the
training, date, details the background information concerning the training, the venue
and district location for the training, total number of participants by gender, course
name, course objectives, list of facilitators, course content, mode of delivery, course
assessment evaluation of participants for their pre- and post-test, summary of
participants’ course evaluation, challenges, recommendations, and list of participants
as detailed on the Attendance Form plus facility type, pre- and post-test for
participants.
This report should completed by the lead trainer immediately after the training. The
lead trainer is responsible and must e-mail the electronic and hard copies of this report
7
to the MOH ACP administration within a week after the training using the following email address: paedhivtrainings@gmail.com.
3.3 TOT Observation Tool and Observation Report
This form is used by the supervisor to observe and evaluate the TOT participant when
he/she facilitates a session. The supervisor will observe and rate the trainee TOT
through aspects of preparing, introducing, conducting, and transitioning between
topics. The trainee will also be observed and rated in feedback and conclusion of the
session to the participants. The trainee will be rated on four-likert scale from excellent,
to poor. The trainee will be expected to conduct several sessions and an aggregated
score will be obtained. Scores for at least three sessions will be aggregated onto the
Observation Report to judge the participant as one who can train independently, train
with minimal support, train after mentorship, or one who cannot train at all. The
Observation Report will also indicate the number of sessions the participant will have
conducted. The Observation Tool and the Observation Report should be completed,
signed, and dated when the training took place by the lead trainer. The completed tool
and report should be sent to the ACP Program Officer electronically and in hard copies
by the lead trainer.
3.4 End Evaluation Participant Tool
The End Evaluation Participant Tool should be completed by the participants on the
last day of the training after completion of the training the schedule. This tool captures
participants’ evaluation of the training content, input regarding facilitation and logistics,
process or schedule, procedures, and any further comments from participants
regarding sessions that were favorite, lacking in clarity or in information. The tool also
encourages participants to suggest ideas for improving the quality of the training. The
tool prompts the participant to rate various aspects of the training. The lead facilitator
should use the participants’ ratings to aggregate the participants’ course evaluation
score. The participants’ course evaluation score is captured in the training report.
8
3.5 Post Training Supervision Tool
The purpose of this tool is to determine the extent to which trained health workers
have translated the acquired knowledge, skills and attitudes into practice as frontline
pediatric HIV care service providers. This form is used by the support supervisor to
observe and evaluate the trained frontline health work when he/she is at work at
facility. The supervisor also uses this tool to evaluate how the trained health workers
have translated the acquired knowledge, skills and attitudes into practice at the facility.
The supervisor will use this to 1) make the follow-up on the implementation of the
three specific pledge actions that health workers made at the end of the training, 2)
assess the effectiveness of the referral system (intra-facility, Inter facility and
community-facility referrals), 3) determine the extent to which the facilities have
defined and provided a comprehensive care package (10 point management plan,
functional care team etc), 4) ensure proper use of the Health management information
systems; proper recording, utilization of data tools, completeness of data and
reporting; and 5) identify and address challenges related to paediatric HIV care and
treatment service provision at the facility. The supervision tool will be completed,
signed, and dated by the lead supervisor. The completed tool and report should be
sent to the ACP Program Officer electronically and in hard copies by the lead trainer.
BIBLIOGRAPHY
1. Based on “Results-Based Monitoring: Guidelines for Technical Cooperation Projects
and Programs”, GTZ, May 2004, p.9.
9
ANNEXES
1.0 SUMMARY PERFORMANCE INDICATORS
1.1 TRAINER OF TRAINERS
Performance Indicator
1.1 Number of TOT trained in
paediatric HIV Care and
Treatment
1.2 Proportion of TOT
supervised as they conducted
sessions in paediatric
HIV/AIDS Care & Trainings
1.3 Proportion of supervised
TOT in HIV Care and
Treatment who can train
independently or with minimal
support
1.4 Number of TOT trained in
HIV Counseling
1.5 Proportion of TOT
supervised as they conducted
sessions in paediatric HIV
Counseling
Definition and Unit of Measurement
Number of healthcare workers trained as
TOT in paediatric HIV Care and Treatment.
Unit: Number
Number of healthcare workers trained as
TOT in HIV Care and Treatment who were
supervised divided by the number that was
trained
Data source
Database
summary
report
Disaggregation
Cadre,
Region
Database
summary
report
Cadre
Unit: Percent
Number of supervised TOT in HIV Care and Database
Treatment who demonstrated the ability to summary
train independently or to train with minimal
report
support divided by the number that was
supervised
Unit: Percent
Number of personnel trained as TOT in HIV
Counseling.
Unit: Number
Number of personnel trained as TOTs in
HIV Counseling who were supervised
divided by the number that was trained.
National,
Regions,
gender
Target
Actual
Leader
ACP
ACP
TBD
ACP
Database
Summary
Report
Cadre
ACP
Database
Summary
Report
Cadre
ACP
Unit: Percent
10
Performance Indicator
1.6 Proportion of supervised
TOT in HIV Counseling who
can train independently or
with minimal support
Definition and Unit of Measurement
Number of supervised TOT in HIV
Counseling who demonstrated the ability to
train independently or to train with minimal
support divided by the number that was
supervised
Data source
Database
Summary
Report
Disaggregation
National,
Regions,
Gender
Target
TBD
Actual
Leader
ACP
Data source
Database
Summary
Report
Disaggregation
Cadre
Target
TBD
Actual
Leader
ACP
Database
Summary
Report
Cadre
TBD
ACP
Database
Summary
Report
Cadre
TBD
ACP
Unit: Percent
1.2 FRONTLINE HEALTHCARE WORKERS
Performance Indicator
2.1 Number of healthcare
workers trained in Paediatric
HIV/AIDS Care and
Treatment
2.2 Proportion of frontline
healthcare workers who
demonstrated improvement in
knowledge during the
Paediatric HIV/AIDS Care
and Treatment trainings
2.3 Proportion of frontline
healthcare workers
supervised as they conduct
Paediatric HIV/AIDS Care
and Treatment at facility
Definition and Unit of Measurement
Number of frontline healthcare workers
trained in Paediatric HIV/AIDS Care and
Treatment.
Unit: Number
Number of frontline healthcare workers who
attained a post-test score of 50% during the
Paediatric HIV/AIDS Care and Treatment
divided by the total number that was
trained.
Unit: Percent
Number of frontline healthcare workers who
were supervised as they conduct Paediatric
HIV/AIDS Care Treatment divided by the
total number that was trained.
Unit: Percent
11
2.4 Number of healthcare
workers trained in Paediatric
HIV/AIDS Counseling
2.5 Proportion of frontline
healthcare workers who
demonstrated improvement in
knowledge during the training
in HIV Counseling
2.6 Proportion of frontline
healthcare workers
supervised as they conduct
Paediatric HIV/AIDS
Counseling at facility
Number of frontline healthcare workers
trained in Paediatric HIV/AIDS Counseling.
Database
Summary
Report
Cadre
TBD
ACP
Unit: Number
Number of frontline healthcare workers who
attained a post-test score of 50% during the
training in HIV Counseling divided by the
total number that was trained.
Database
Summary
Report
Cadre
TBD
ACP
Unit: Percent
Number of frontline healthcare workers who
were supervised as they conduct Paediatric
HIV/AIDS Counseling at facility divided by
the total number that was trained.
Database
Summary
Report
Cadre
TBD
ACP
Unit: Percent
12
1.0 PERFORMANCE INDICATOR REFERENCE SHEET
1.1 TRAINER OF TRAINERS
Performance Indicator Reference Sheet
Level:
Trainer of Trainers
Indicator: 1.1 Number of TOT trained in paediatric HIV Care and Treatment.
Description
Definition: Number of healthcare workers trained as TOT in paediatric HIV Care and Treatment.
Unit of Measure: Number
Disaggregation by: Cadre, Region
Justification: The indicator measures the capacity to train healthcare workers in lowest health units in HIV Care and Treatment.
Overtime it indicates the number of newly trained TOT in HIV Care and Treatment; and over space it shows the coverage of TOT in HIV
Care and Treatment by region.
Plan for Data Acquisition
Data Collection Method: Data for this indicator will be captured by the TOT training report. TOT trainees will document their sex and
cadre on the attendance sheet. This information will later be transcribed onto the training report by the lead trainer.
Responsible Person: Field lead trainers and implementing organization at national and regional levels will ensure that training reports
are completed during field implementation and later delivered to the paediatric ACP Program Officer both electronically and hard copy.
Data Quality Issues
Actions: Completeness and timeliness in delivery of training reports
Responsible Person: The paediatric ACP Program Officer will ensure that received reports are complete and are received in a timely
manner.
Plan for Data Analysis, Review, and Reporting
Data Entry: Data will be entered and cleaned in the MS Excel spreadsheet by the administrative assistant at the ACP Program Office.
Data Analysis: Counts using the MS Excel Spreadsheet Report
Presentation: Frequency tables and Bar graphs
Review of Data: Annual
Reporting: The results will be reported in the HIV/AIDS MOH ACP annual program report.
13
Performance Indicator Reference Sheet
Level:
Trainer of Trainers
Indicator: 1.2 Proportion of TOT supervised as they conducted sessions in paediatric HIV/AIDS Care & Trainings.
Description
Definition: Percent of TOT healthcare workers supervised as they conducted paediatric HIV Care and Treatment.
Unit of Measure: Percent
Numerator: Number of TOT healthcare workers supervised as they conducted paediatric HIV Care and Treatment
Denominator: The number of TOT healthcare workers that was trained.
Disaggregation by: Cadre
Justification: This indicator is an assessment for quality of TOT in HIV Care and Treatment. Overtime it indicates the number of quality
assessments made among TOT in HIV Care and Treatment.
Plan for Data Acquisition
Data Collection Method: Data for this indicator will be captured by the observation tool report. The national trainers will supervise the
TOT. The lead observer will complete the observation report.
Responsible Person: Field lead observer and implementing organization will ensure that observation reports are completed during field
supervision of TOT. Electronic and hard copies of the observation report will be delivered to the ACP Program office by the lead observer.
Data Quality Issues
Actions: Completeness and timeliness in delivery of training reports
Responsible Person: The paediatric ACP Program Officer will ensure that received observation reports are complete and are received in
a timely manner.
Plan for Data Analysis, Review, and Reporting
Data Entry: Data will be entered and cleaned in the MS Excel spreadsheet by the administrative assistant at the ACP Program Office.
Data Analysis: Counts using the MS Excel Spreadsheet Report
Presentation: Frequency tables and Bar graphs
Review of Data: Annual
Reporting: The results will be reported in the HIV/AIDS MOH ACP annual program report.
14
Performance Indicator Reference Sheet
Level:
Trainer of Trainers
Indicator: 1.3 Proportion of supervised TOT in HIV Care and Treatment who demonstrated the ability to train independently or with
minimal support.
Description
Definition: Percent of supervised TOT healthcare workers in HIV Care and Treatment who demonstrated the ability to train independently
or to train with minimal support.
Numerator: Number of supervised TOT healthcare workers in HIV Care and Treatment who demonstrated the ability to train
independently or to train with minimal support
Denominator: The number of TOT healthcare workers in HIV Care and Treatment who were supervised
Unit of Measure: Percent
Disaggregation by: Cadre, Region
Justification: The indicator measures both the available capacity and ability or quality of TOT to train healthcare workers in lowest health
units in HIV Care and Treatment. Prospectively it indicates the number of newly trained TOTs who have the ability to train in HIV Care and
Treatment. The coverage in the country can be shown according to regions.
Plan for Data Acquisition
Data Collection Method: Data for this indicator will be captured by the observation tool report. The national trainers will supervise the
TOT. The lead observer will complete the observation report.
Responsible Person: Field lead observer and implementing organization will ensure that observation reports are completed during field
supervision of TOT. Electronic and hard copies of the observation report will be delivered to the ACP Program office by the lead observer.
Data Quality Issues
Actions: Completeness and timeliness in delivery of training reports
Responsible Person: The paediatric ACP Program Officer will ensure that received observation reports are complete and are received in
a timely manner.
Plan for Data Analysis, Review, and Reporting
Data Entry: Data will be entered and cleaned in the MS Excel spreadsheet by the administrative assistant at the ACP Program Office.
Data Analysis: Counts using the MS Excel Spreadsheet Report
Presentation: Frequency tables and Bar graphs
Review of Data: Annual
Reporting: The results will be reported in the HIV/AIDS MOH ACP annual program report.
15
Performance Indicator Reference Sheet
Level:
Trainer of Trainers
Indicator: 1.4 Number of TOT trained in HIV Counseling.
Description
Definition: Number of personnel trained as TOT in HIV Counseling.
Unit of Measure: Number
Disaggregation by: Cadre, Region
Justification: The indicator measures the capacity to train healthcare workers in lowest health units in HIV Counseling.
Overtime it
indicates the number of newly trained TOT in HIV Counseling; and over space it shows the coverage of TOT in HIV Counseling by region.
Plan for Data Acquisition
Data Collection Method: Data for this indicator will be captured by the TOT training report. TOT trainees will document their sex and
cadre on the attendance sheet. This information will later be transcribed onto the training report by the lead trainer.
Responsible Person: Field lead trainers and implementing organization at national and regional levels will ensure that training reports
are completed during field implementation and later delivered to the paediatric ACP Program Officer both electronically and hard copy.
Data Quality Issues
Actions: Completeness and timeliness in delivery of training reports
Responsible Person: The paediatric ACP Program Officer will ensure that received reports are complete and are received in a timely
manner.
Plan for Data Analysis, Review, and Reporting
Data Entry: Data will be entered and cleaned in the MS Excel spreadsheet by the administrative assistant at the ACP Program Office.
Data Analysis: Counts using the MS Excel Spreadsheet Report
Presentation: Frequency tables and Bar graphs
Review of Data: Annual
Reporting: The results will be reported in the HIV/AIDS MOH ACP annual program report.
16
Performance Indicator Reference Sheet
Level:
Trainer of Trainers
Indicator: 1.5 Proportion of TOT supervised as they conducted sessions in paediatric HIV Counseling.
Description
Definition: Percent of TOT personnel in HIV Counseling who were supervised as they conducted sessions in HIV counseling.
Unit of Measure: Percent
Numerator: Number of TOT personnel in HIV Counseling who were supervised
Denominator: The number of TOT personnel who were trained in HIV Counseling
Disaggregation by: Cadre
Justification: This indicator is an assessment for quality of TOT in HIV Counseling. Overtime it indicates the number of quality
assessments made among TOT in HIV Counseling.
Plan for Data Acquisition
Data Collection Method: Data for this indicator will be captured by the observation tool report. The national trainers will supervise the
TOT. The lead observer will complete the observation report.
Responsible Person: Field lead observer and implementing organization will ensure that observation reports are completed during field
supervision of TOT. Electronic and hard copies of the observation report will be delivered to the ACP Program office by the lead observer.
Data Quality Issues
Actions: Completeness and timeliness in delivery of training reports
Responsible Person: The paediatric ACP Program Officer will ensure that received observation reports are complete and are received in
a timely manner.
Plan for Data Analysis, Review, and Reporting
Data Entry: Data will be entered and cleaned in the MS Excel spreadsheet by the administrative assistant at the ACP Program Office.
Data Analysis: Counts using the MS Excel Spreadsheet Report
Presentation: Frequency tables and Bar graphs
Review of Data: Annual
Reporting: The results will be reported in the HIV/AIDS MOH ACP annual program report.
17
Performance Indicator Reference Sheet
Level:
Trainer of Trainers
Indicator: 1.6 Proportion of supervised TOT in HIV Counseling who demonstrated the ability to train independently or with minimal
support.
Description
Definition: Percent of supervised TOT in HIV Counseling who demonstrated the ability to train independently or to train with minimal
support.
Numerator: Number of supervised TOT in HIV Counseling who demonstrated the ability to train independently or to train with minimal
support
Denominator: The number of TOT personnel in HIV Counseling who were supervised
Unit of Measure: Percent
Disaggregation by: Cadre, Region
Justification: The indicator measures both the available capacity and ability or quality of TOT to train healthcare workers in lowest health
units in HIV Counseling. Prospectively it indicates the number of newly trained TOTs who have the ability to train in HIV Counseling. The
coverage in the country can be shown according to regions.
Plan for Data Acquisition
Data Collection Method: Data for this indicator will be captured by the observation tool report. The national trainers will supervise the
TOT. The lead observer will complete the observation report.
Responsible Person: Field lead observer and implementing organization will ensure that observation reports are completed during field
supervision of TOT. Electronic and hard copies of the observation report will be delivered to the ACP Program office by the lead observer.
Data Quality Issues
Actions: Completeness and timeliness in delivery of training reports
Responsible Person: The paediatric ACP Program Officer will ensure that received observation reports are complete and are received in
a timely manner.
Plan for Data Analysis, Review, and Reporting
Data Entry: Data will be entered and cleaned in the MS Excel spreadsheet by the administrative assistant at the ACP Program Office.
Data Analysis: Counts using the MS Excel Spreadsheet Report
Presentation: Frequency tables and Bar graphs
Review of Data: Annual
Reporting: The results will be reported in the HIV/AIDS MOH ACP annual program report.
18
1.2 FRONTLINE HEALTHCARE WORKERS
Performance Indicator Reference Sheet
Level:
Frontline Healthcare Workers
Indicator: 2.1 Number of healthcare workers trained in Paediatric HIV/AIDS Care and Treatment.
Description
Definition: Number of frontline healthcare workers trained in Paediatric HIV/AIDS Care and Treatment.
Unit of Measure: Number
Disaggregation by: Cadre
Justification: The indicator measures the capacity of healthcare workers to promote and provide Paediatric HIV/AIDS Care and
Treatment. This indicator overtime shows the number of newly trained healthcare workers in Paediatric HIV/AIDS Care and Treatment
and thus an increase in capacity to promote and provide Paediatric HIV/AIDS Care and Treatment. The distribution can be shown by
cadre.
Plan for Data Acquisition
Data Collection Method: Data for this indicator will be captured by the training report for frontline healthcare workers. Participants during
the cascade training will document their sex and cadre on the attendance sheet. This information will later be transcribed onto the training
report by the lead facilitator.
Responsible Person: Field lead facilitator and the implementing organization will ensure that training reports are completed during field
implementation and later delivered to the paediatric ACP Program Officer both electronically and in hard copy.
Data Quality Issues
Actions: Completeness and timeliness in delivery of training reports
Responsible Person: The paediatric ACP Program Officer will ensure that received reports are complete and are received in a timely
manner.
Plan for Data Analysis, Review, and Reporting
Data Entry: Data will be entered and cleaned in the MS Excel spreadsheet by the administrative assistant at the ACP Program Office.
Data Analysis: Counts using the MS Excel Spreadsheet Report
Presentation: Frequency tables and Bar graphs
Review of Data: Annual
Reporting: The results will be reported in the HIV/AIDS MOH ACP annual program report.
19
Performance Indicator Reference Sheet
Level:
Frontline Healthcare Workers
Indicator: 2.2 Proportion of frontline healthcare workers who demonstrated improvement in knowledge during the Paediatric HIV/AIDS
Care and Treatment trainings.
Description
Definition: Proportion of frontline healthcare workers who attained a score of 50% in post-test during the Paediatric HIV/AIDS Care and
Treatment.
Unit of Measure: Percent
Numerator: Number of frontline healthcare workers who attained a score of 50% in post-test during the Paediatric HIV/AIDS Care and
Treatment
Denominator: The total number of frontline healthcare workers that was trained
Disaggregation by: Cadre
Justification: The indicator measures the capacity of healthcare workers to promote and provide Paediatric HIV/AIDS Care and
Treatment. This indicator overtime shows the number of newly trained healthcare workers in Paediatric HIV/AIDS Care and Treatment
and thus an increase in capacity to promote and provide Paediatric HIV/AIDS Care and Treatment. The distribution can be shown by
cadre.
Plan for Data Acquisition
Data Collection Method: Data for this indicator will be captured by the training report for frontline healthcare workers. Participants during
the cascade training will document their sex and cadre on the attendance sheet. This information will later be transcribed onto the training
report by the lead facilitator.
Responsible Person: Field lead facilitator and the implementing organization will ensure that training reports are completed during field
implementation and later delivered to the paediatric ACP Program Officer both electronically and in hard copy.
Data Quality Issues
Actions: Completeness and timeliness in delivery of training reports
Responsible Person: The paediatric ACP Program Officer will ensure that received reports are complete and are received in a timely
manner.
Plan for Data Analysis, Review, and Reporting
Data Entry: Data will be entered and cleaned in the MS Excel spreadsheet by the administrative assistant at the ACP Program Office.
Data Analysis: Counts using the MS Excel Spreadsheet Report
Presentation: Frequency tables and Bar graphs
Review of Data: Annual
Reporting: The results will be reported in the HIV/AIDS MOH ACP annual program report.
20
Performance Indicator Reference Sheet
Level:
Frontline Healthcare Workers
Indicator: 2.3 Proportion of frontline healthcare workers who were supervised as they conduct the Paediatric HIV/AIDS Care and
Treatment at facility.
Description
Definition: Proportion of frontline healthcare workers who were supervised as they conduct the Paediatric HIV/AIDS Care and Treatment
at facility.
Unit of Measure: Percent
Numerator: Number of frontline healthcare workers who were supervised at the facility as they conduct Paediatric HIV/AIDS Counseling
Denominator: The total number of frontline healthcare workers who were trained
Disaggregation by: Cadre
Justification: The indicator measures the extent to which trained healthcare workers have acquired knowledge, skills and attitudes into
practice as service providers. This indicator overtime shows the numbers of trained healthcare workers supervised at facility level and are
in practice. The distribution can be shown by cadre.
Plan for Data Acquisition
Data Collection Method: Data for this indicator will be captured by the post-training supervision tool for frontline healthcare workers. The
post-training supervision leader will complete the tool with names of healthcare workers supervised and their respective district and
facility. This information will later be entered into the database for frontline healthcare workers by the ACP administrator.
Responsible Person: Field lead post-training supervisor and the implementing organization will ensure that post-training supervision
tools are completed during field implementation and later delivered to the paediatric ACP Program Officer both electronically and in hard
copy.
Data Quality Issues
Actions: Completeness and timeliness in delivery of the post-training supervision tools
Responsible Person: The paediatric ACP Program Officer will ensure that received tool are complete and are received in a timely
manner.
Plan for Data Analysis, Review, and Reporting
Data Entry: Data will be entered and cleaned in the MS Excel spreadsheet by the administrative assistant at the ACP Program Office.
Data Analysis: Counts using the MS Excel Spreadsheet Report
Presentation: Frequency tables and Bar graphs
Review of Data: Annual
Reporting: The results will be reported in the HIV/AIDS MOH ACP annual program report.
21
Performance Indicator Reference Sheet
Level:
Frontline Healthcare Workers
Indicator: 2.4 Number of healthcare workers trained in Paediatric HIV/AIDS Counseling.
Description
Definition: Number of frontline healthcare workers trained in Paediatric HIV/AIDS Counseling.
Unit of Measure: Number
Disaggregation by: Cadre
Justification: The indicator measures the capacity of healthcare workers to promote and provide Paediatric HIV/AIDS Counseling. This
indicator overtime shows the number of newly trained healthcare workers in Paediatric HIV/AIDS Counseling and thus an increase in
capacity to promote and provide Paediatric HIV/AIDS Counseling. The distribution can be shown by cadre.
Plan for Data Acquisition
Data Collection Method: Data for this indicator will be captured by the training report for frontline healthcare workers. Participants during
the cascade training will document their sex and cadre on the attendance sheet. This information will later be transcribed onto the training
report by the lead facilitator.
Responsible Person: Field lead facilitator and the implementing organization will ensure that training reports are completed during field
implementation and later delivered to the paediatric ACP Program Officer both electronically and in hard copy.
Data Quality Issues
Actions: Completeness and timeliness in delivery of training reports
Responsible Person: The paediatric ACP Program Officer will ensure that received reports are complete and are received in a timely
manner.
Plan for Data Analysis, Review, and Reporting
Data Entry: Data will be entered and cleaned in the MS Excel spreadsheet by the administrative assistant at the ACP Program Office.
Data Analysis: Counts using the MS Excel Spreadsheet Report
Presentation: Frequency tables and Bar graphs
Review of Data: Annual
Reporting: The results will be reported in the HIV/AIDS MOH ACP annual program report.
22
Performance Indicator Reference Sheet
Level:
Frontline Healthcare Workers
Indicator: 2.5 Proportion of frontline healthcare workers who demonstrated improvement in knowledge during the training in HIV
Counseling.
Description
Definition: Proportion of frontline healthcare workers who attained a score of 50% in post-test during the Paediatric HIV Counseling
training.
Unit of Measure: Percent
Numerator: Number of frontline healthcare workers who attained a score of 50% during the Paediatric HIV Counseling training
Denominator: The total number of frontline healthcare workers who were trained
Disaggregation by: Cadre
Justification: The indicator measures the capacity of healthcare workers to promote and provide Paediatric HIV Counseling. This
indicator overtime shows the number of newly trained healthcare workers in Paediatric HIV Counseling and thus an increase in capacity to
promote and provide Paediatric HIV Counseling. The distribution can be shown by cadre.
Plan for Data Acquisition
Data Collection Method: Data for this indicator will be captured by the training report for frontline healthcare workers. Participants during
the cascade training will document their sex and cadre on the attendance sheet. This information will later be transcribed onto the training
report by the lead facilitator.
Responsible Person: Field lead facilitator and the implementing organization will ensure that training reports are completed during field
implementatin and later delivered to the paediatric ACP Program Officer both electronically and in hard copy.
Data Quality Issues
Actions: Completeness and timeliness in delivery of training reports
Responsible Person: The paediatric ACP Program Officer will ensure that received reports are complete and are received in a timely
manner.
Plan for Data Analysis, Review, and Reporting
Data Entry: Data will be entered and cleaned in the MS Excel spreadsheet by the administrative assistant at the ACP Program Office.
Data Analysis: Counts using the MS Excel Spreadsheet Report
Presentation: Frequency tables and Bar graphs
Review of Data: Annual
Reporting: The results will be reported in the HIV/AIDS MOH ACP annual program report.
23
Performance Indicator Reference Sheet
Level:
Frontline Healthcare Workers
Indicator: 2.6 Proportion of frontline healthcare workers who were supervised as they conduct the Paediatric HIV/AIDS Counseling at
facility.
Description
Definition: Proportion of frontline healthcare workers who were supervised as they conduct the Paediatric HIV/AIDS Counseling at
facility.
Unit of Measure: Percent
Numerator: Number of frontline healthcare workers who were supervised at the facility as they conduct Paediatric HIV/AIDS Counseling
Denominator: The total number of frontline healthcare workers who were trained
Disaggregation by: Cadre
Justification: The indicator measures the extent to which trained healthcare workers have acquired knowledge, skills and attitudes into
practice as service providers. This indicator overtime shows the numbers of trained healthcare workers supervised at facility level and are
in practice. The distribution can be shown by cadre.
Plan for Data Acquisition
Data Collection Method: Data for this indicator will be captured by the post-training supervision tool for frontline healthcare workers. The
post-training supervision leader will complete the tool with names of healthcare workers supervised and their respective district and
facility. This information will later be entered into the database for frontline healthcare workers by the ACP administrator.
Responsible Person: Field lead post-training supervisor and the implementing organization will ensure that post-training supervision
tools are completed during field implementation and later delivered to the paediatric ACP Program Officer both electronically and in hard
copy.
Data Quality Issues
Actions: Completeness and timeliness in delivery of the post-training supervision tools
Responsible Person: The paediatric ACP Program Officer will ensure that received tool are complete and are received in a timely
manner.
Plan for Data Analysis, Review, and Reporting
Data Entry: Data will be entered and cleaned in the MS Excel spreadsheet by the administrative assistant at the ACP Program Office.
Data Analysis: Counts using the MS Excel Spreadsheet Report
Presentation: Frequency tables and Bar graphs
Review of Data: Annual
Reporting: The results will be reported in the HIV/AIDS MOH ACP annual program report.
24
2.0 TOOLS
2.1 STANDARDIZED PAEDIATRIC HIV/AIDS TRAINING ATTENDANCE FORM
Name of Training:________________________________________________________________________________________________
Date of Training: _____/______/___________
Training Venue:________________________________________________________
Serial
No.
Names
(Surname first, given name)
Sex:
(M/F)
Cadre
(e.g
MO)
Health Facility
Name
Facility
Level e.g
HC III
Facility
District
E-mail
Telephone
Signature
25
2.2 TOT OBSERVATION TOOL
Date:___/____/_____ Course
Name:__________________________________________________
(Day/Mon/Year)
Supervisee
Name:______________________________________________________________________
Module:_______________________________ Session:______________________________
Training Venue:_________________________ District :___________________________
Rating Scale: 3=Excellent 2=Good 1=Needs Improvement 0=Poor
Item
Rating
Comments
Preparation:
Trainer prepared for the session ahead of time
3 2 1 0
Introduction:
Trainer explained purpose and objectives of the activity
(why it is important to the learners, what they will
3 2 1 0
practice, etc.)
Conducting Practical Exercises/ Group activities:
Explained tasks clearly and involved learners
Organized and supported learners to complete their
3 2 1 0
tasks
Activity was reviewed well
Conducting Games:
Explained tasks clearly
3 2 1 0
Organized learners and Facilitated games
Conducting Interactive Activities:
Used a variety of activities and approaches in order to
keep participants’ engaged
3 2 1 0
Used (or followed) the training materials (e.g. used
slides, key messages from Facilitator’s Guide and
referred participants to their guides as needed, etc.)
Adapted activities to participants’ needs
Asked open-ended questions
Time keeping
Transitioning: Trainer provided smooth transitions
between topics, explicitly indicating a shift in topic and
3 2 1 0
linking topics together.
Feedback: Listened to participants and open to
3 2 1 0
feedback
Concluding: Trainer summarized activity, emphasized
key points & related topic to learners’ experiences &/or
3 2 1 0
rest of training course.
Objectives: How well were the objectives of this
session met?
3 2 1 0
Overall evaluation of the session, add all ratings out of
27
26
2.3 PARTICIPANT DAILY EVALUATION FORM
Date:____/____/_______ Course
Name:______________________________________________
(Day/Mon/Year)
Venue:_______________________________
District _________________________
Please take a momentary to complete this form to give us a quick feedback on the positive and
negative aspects of this training that happened today. Do not put your name.
List the strengths and weakness of today’s training
Strengths
Weaknesses
1.
1.
2.
2.
3.
3.
List the key issues that you learnt from today’s sessions
Name the Concepts that were difficult to understand from today’s sessions
Suggestions for improvement
27
2.4 PARTICIPANT END EVALUATION FORM
Date:____/____/_______ Course
Name:______________________________________________
(Day/Mon/Year)
Venue:_______________________________
District _________________________
Evaluation Information
Please take a moment to rate (from zero as worst to 10 as best) this Training in terms of
Content, Facilitation, Time Management, and Responsiveness to your educational needs. Also
provide Comments accordingly. (Your comments are an important contribution to our designing
training/learning experiences that meet your professional needs).
Please circle one choice for each statement
Training Content:
I feel that the content provided valuable information, skills and experiences relevant to the topic.
0_____1_____2_____3_____4_____5_____6_____7_____8_____9_____10
Strongly disagree
Strongly agree
I can easily apply the training’s subject matter to my job/work.
0_____1_____2_____3_____4_____5_____6_____7_____8_____9_____10
Strongly disagree
Strongly agree
I understood the training content:
0_____1_____2_____3_____4_____5_____6_____7_____8_____9_____10
Strongly disagree
Strongly agree
Training Input: Facilitation and Logistics
I feel can easily use the training materials that I received as part of the training.
0_____1_____2_____3_____4_____5_____6_____7_____8_____9_____10
Strongly disagree
Strongly agree
The training materials were enough.
0_____1_____2_____3_____4_____5_____6_____7_____8_____9_____10
Strongly disagree
Strongly agree
The training venue was appropriate:
0_____1_____2_____3_____4_____5_____6_____7_____8_____9_____10
Strongly disagree
Strongly agree
The meals at the training venue were excellent:
0_____1_____2_____3_____4_____5_____6_____7_____8_____9_____10
Strongly disagree
Strongly agree
28
Training Process: Schedule
The opportunity for interacting, participating and asking questions was excellent:
0_____1_____2_____3_____4_____5_____6_____7_____8_____9_____10
Strongly disagree
Strongly agree
The instructor’s knowledge and facilitation style was excellent:
0_____1_____2_____3_____4_____5_____6_____7_____8_____9_____10
Strongly disagree
Strongly agree
The number of days allocated to this training was adequate.
0_____1_____2_____3_____4_____5_____6_____7_____8_____9_____10
Strongly disagree
Strongly agree
The home work given was helpful.
0_____1_____2_____3_____4_____5_____6_____7_____8_____9_____10
Strongly disagree
Strongly agree
Training Product
Overall the value of the training program was excellent:
0_____1_____2_____3_____4_____5_____6_____7_____8_____9_____10
Strongly disagree
Strongly agree
I would recommend this training to colleagues in my area of work/practise.
0_____1_____2_____3_____4_____5_____6_____7_____8_____9_____10
Strongly disagree
Strongly agree
Further Comments:
What was your favourite session in this training?
What aspects of training do you want more information on?
What session do you feel should be modified?
What should we do to improve the quality of this training?
Please provide any additional comments which you feel would be useful to enhance this
training, to develop new training programs, or to provide to individual speakers.
For Official Use Only: Total Evaluation Score Out of 130 ________________ (Add all the
ratings)
29
2.5 POST TRAINING SUPPORT SUPERVISION TOOL
MINISTRY OF HEALTH – UGANDA
District:__________________________________________
Facility:__________________________________________
Facility Level:_____________________________________
IP:______________________________________________
Date visited:_______________________________________
30
Background
In Uganda it is estimated that roughly 146,000 children under 14 years are living with HIV/AIDS.
Roughly 76,750 of these are in immediate need of ARV treatment and yet only 24% (18,500)
have access to ART. However, without ART, 50% of HIV-positive children will die before
reaching the age of three years and an additional 25% will die by age five. Most of these deaths
can be prevented if children born to HIV-infected mothers are diagnosed early, receive proper
health care and nutrition and are initiated on HIV treatment as soon as they are eligible.
In Uganda paediatric ART services remain low with 68% and 58% of General Hospitals and HC
IVs respectively providing any form of Paediatric ART provision, compared with 100% and 82%
respectively providing adult ART services. This presents a major barrier to testing at-risk
children and enrolling HIV-positive children in ART programmes. In addition, most health care
workers lack the skills to identify, treat and care for children at risk of HIV and to counsel and
provide psycho-social support for HIV-positive children and their caregivers. A number of
partners are involved in training paediatric ART service providers and providing paediatric
HIV/AIDS services, but guidelines and curricula to support these activities have not been
harmonised.
The Regional Centre for Quality of Health Care (RCQHC) in partnership with the Health
Communications Partnership (HCP) are currently implementing a 2-year initiative to support the
MOH/AIDS Control Programme (ACP) to scale up paediatric HIV services in Uganda by
strengthening the capacity of health care providers at hospitals and health centres in Uganda to
refer children at risk of HIV for testing and HIV/AIDs services; to counsel caregivers and children
affected by HIV/AIDS; and to offer quality HIV/AIDS counseling, care, support and treatment
services for children with HIV/AIDS. This will be achieved through training of health care
providers, training of trainers from districts and partner organizations, and mentoring /support
supervision of health care providers.
31
Training of health professionals
A standardised Paediatric HIV Care and Treatment training curriculum was developed and mid
level health workers have been trained with the aim of greatly improving their capacity to
manage paediatric HIV/AIDS patients The five day practical in-service training is a part of the
package of trainings for health care professionals requires mentor team follow up-visits to offer
individualized support and follow up.
Goal of the support supervision:
The goal of the support supervision is to determine the extent to which trained health workers
have translated the acquired knowledge, skills and attitudes into practice as frontline pediatric
HIV care service providers.
Specific objectives
The support supervision exercise will specifically achieve the following objectives
1. Follow up on the implementation of the three specific pledge actions that health workers
made at the end of the training
2. Assess the effectiveness of the referral system (intra-facility, Inter facility and
community-facility referrals)
3. Determine the extent to which the facilities have defined and provided a comprehensive
care package (10 point management plan, functional care team etc)
4. Ensure proper use of the Health management information systems; proper recording,
utilization of data tools, completeness of data and reporting.
5. Identify and address challenges related to paediatric HIV care and treatment service
provision at the facility
32
TIME TABLE FOR POST TRAINING SUPPORT SUPERVISION VISIT
Day 1
8:30-9:00 am
9:00-9:30 am
9:30-10:00 am
10:00-10:30 am
10:30-1:00pm
1:00-2:00pm
2:00-3:30 pm
Day 2
Team
Team member 1
member 2
Meeting with DHO
Meeting with facility In charge
Meeting with Trainees
Break Tea
Observe case
Chart Review
management and
improve skills
Lunch
Checking Availability of
Paed Formulations and
test kits
Client
satisfaction
review
3:30-4:00 pm
Team meets to prepare feed back
4:00-5:00 pm
Debrief meeting
8:30-9:00 am
9:00-9:30 am
9:30-10:00 am
10:00-10:30 am
10:30-12:00
Team member 1
Team member 2
Work with Site to implement some of the
action point discussed in the debrief
12:00-1:00pm
Development of key follow up actions
with Team
Debrief to Health facility in charge
1:00-2:00pm
2:00-3:00 pm
Lunch
Debrief to DHO
3:00-5:00 pm
Travel to the Next district
33
1. PREPARATION FOR POST TRAINING FOLLOW UP VISIT (to be filled before leaving for the field)
Check list for preparation:
Item
Yes
No
Comment
Has district been communicated to about Visit?
Has health facility been communicated to about Visit?
Is the list of trainees available?
Are pledge of action cards available for each site?
Have sufficient forms for the Visit been printed?
Names of Trainees being followed
Names
1
Cadre
Tel contact
Was trainee available to be follow up on site
Yes
No
2
3
4
5
34
2. INTRODUCE THE FOLLOW-UP ACTIVITY

Make a brief stopover at DHO’s office: Introduce yourself and explain purpose of Visit

Introduce your self to the Health facility in charge, explain the purpose of the visit, and identify the health worker(s) you would like
to observe.
3. MEET BRIEFLY WITH RELEVANT STAFF. (Review the pledge of action cards)

Explain what you will do.

Ask staff what they are doing differently or have seen since the training.

Become oriented to the facility: See the examination and treatment areas and areas where patient records and drug supplies are
kept.

Identify a place to observe case management practices and give feedback.
Pledge of action
Action taken
Comments
( yes or No)
1
2
35
Indicate any other actions or changes the team has instituted since after training
Availability of Job Aides.
Job Aide
Is it available?
Are
they Are the Job aides Placed in the
being Used?
right Place? If in a wrong place,
help the worker place it in the
right place. If nonexistent, leave
behind the new guidelines.
Yes
No
Yes
No
Yes
No
HIV testing algorithm
National Paediatric ART guidelines 2011
Paediatric ART dosing by formulation and wt range Feb. 2011
Paediatric ART dosing Pamphlet Feb 2011
WHO Paediatric ART clinical staging
Atlas of common opportunistic infections in children
36
4. OBSERVE CASE MANAGEMENT AND REINFORCE SKILLS (should be done with patients with a range of
problems)

Select some children in the waiting area, introduce yourself, explain what you intend to do and ask permission. Choose different
types of patients. For chronic HIV care patients, include Pre-ART and ART, quick and regular circuit patients by quickly asking
them the reason why they are there.

Follow the patient through the entire sequence of care. Follow through and record steps the patient goes through and observe
the process. Privately, help the health worker identify problems in case management and solve them. Note problems with patient
flow/team work/task shifting and save them for the clinical team meeting.
Area
Aspects to be observed
Response
Yes
Triage
Is
there
Triage
Comment
No
Area?
( if no establish one with staff)
Is Triage being done? (reception, wt taken,
BP, Temp, retrieval of charts)
Are Patients are triaged into regular and
quick circuits
[Help train team member in triage.]
Immunization
Is immunization status of children under 5
being reviewed
Growth
monitoring
Are Weights taken for all children’s
Are weight’s being interpreted.
37
Area
Aspects to be observed
Response
Yes
Development
monitoring
Does the clinician review the developmental
Clinical
assessment,
Clinical
Staging, CD
monitoring and
OI prophylaxis.
Are clinical assessments done for possible
Comment
No
milestones of the children?
opportunistic infections?
Are patients assessed for TB?
Is TB status recorded on the Charts?
Do clinicians do WHO clinical staging
correctly?
( Support clinician to use WHO Paediatric
HIV clinical staging charts)
Do clinicians stage children at every visit? (
Emphasize the need to conduct staging at
every visit and its importance for monitoring
either progress in treatment or eligibility for
ART)
Is WHO stage documented at each visit?
Are
CD4’s
(Check
requested
whether
clinician
for
children?
knows
the
38
Area
Aspects to be observed
Response
Yes
Comment
No
frequency for doing CD4’s)
Are they recorded in Patient chart?
Can the clinician identify eligible patients
using WHO and CD4 clinical staging
criteria?
( Review criteria for initiation of ART in
children)
Are
all
children
given
cotrimoxazole
prophylaxis?
Are
the
doses
correct?
( Check for use of the Dosing charts if not
being used support the clinicians to use
these)
Psychosocial
ART readiness counseling and evaluation
and adherence for ART eligible patients done?
Is adherence counseling and assessment
support
done at every visit?
Are pill counts done? (Review how to
calculate adherence based on pill counts).
Is
all
the
psychosocial
information
documented on the charts?
39
5. CHART REVIEW FOR COMPLETENESS AND ART INITIATION
From the Pre ART register select 5 children (under 2 years of age) enrolled into care in the past 3-4 months. Retrieve these Patients
charts and do this review per chart. If the children under 2yrs are not five in number, pick other children above 2 years.
Use one column per chart
Patient 1
Patient 2
Patient 3
Patient 4
Patient 5
ASSESSMENT FOR ART ELIGIBILITY AND Tick box if the parameter was recorded in the ART card. Total number of ticks
INITIATION OF ART
Mark 0 if it was not done. Draw a line through the boxes that of number interviewed
are not applicable to the case. Use codes: 1-yes and 2-No.
on the subject
Was Weight taken?
Is MUAC done?
Was TB status filled?
Are any OI’s recorded?
Was functional status recorded?
Is WHO clinical stage done?
Was cotrimoxazole prescribed?
Was dose correct?
Was CD4 done?
40
Has this patient identified as eligible for
ART?
Was adherence counseling done?
How many adherence counseling visits has
the child had?
Was patient given weekly appointments for
adherence
counseling
(Longer
appointment
durations
for
adherence counseling often delays initiation
of ART)
Is the child Initiated on ART?
What is the ARV regimen? Is it the
recommended 1st line regimen
If patient was initiated on NVP based
regimen, was leading In done?
Are the ARV doses correct?
(
review use of dosing charts and check if
dispensing team as well has dosing chart)
If patient has had subsequent visits after
initiation
of
ART, Was
adherence
assessed?
41
6. CONDUCT EXIT INTERVIEWS (this will apply if your visit was on a clinic day where patients are available)

Select 5 caretakers of HIV positive children (0-14 yrs) leaving the facility and introduce yourself.

Interview patients/caretakers and record notes on the Exit Interview Form below
Use one column per interview
Patient
1
CARETAKER/PATIENT KNOWLEDGE
Patient
2
Patient
3
Patient
4
Patient 5
Tick box if patient has correct knowledge of all items mentioned. Total number of
Mark 0 if patient does not know all. Draw a line through the ticks of number
boxes that are not applicable to the case
interviewed on the
subject
Patient/caretaker given co-trimoxazole:
knows how many tablets to give child
per day; why is it important for the
child?
Patient/caretaker given ART: knows
correct number of tablets to give child;
times per day
Patient/caretaker given another drug:
knows how many tablets to take; times
per day
Patient/caretaker knows when next
follow-up appointment is
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PATIENT/CARETAKER SATISFACTION
Score on scale of (indicate the score per patient interviewed)
0
1
2
3
4
5
6
7
Poor
Patient1
8
9
10
Indicate the total
score for each
row.
Excellent
Patient2
Patient3
Patient 4
Patient 5
Time health worker spent with me
Way health worker examined child
Treatment given child
Way health worker talked with me
What I learned from health worker
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7. REVIEW OF DATA
From the Pre ART and ART Register, Please indicate the numbers of children enrolled into care and on ART for the months of Dec
2010 to May 2011. Please mark the month when training was done.
Dec
Jan
Feb
March
April
May
Pre ART
ART
8.

GUIDE FOR DEBRIEFING MEETING (Facilitate problem solving with the staff)
Congratulate the staff on progress they have made in implementing paediatric HIV care and explain that the purpose of meeting
is to solve problems they face.

Ask the staff what problems they have found in starting to provide paediatric HIV care and treatment. Listen as they discuss
each problem, summarize what you hear; and add any other problems that you have identified.

For each problem, ask about possible solutions. Listen; summarize decisions made; add and discuss any other practical
solutions from the Checklist of Facility Supports.

Remember: Give each staff member time to think

Ask questions to support good solutions

Make notes on your checklist

Support, do not undermine, the trained health worker

With the staff, identify problems to communicate to the district or national level to request assistance.

Review with the staff evidence of their progress implementing Paediatric HIV care and Treatment. Thank the staff.

Provide any Tools or Job aides
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9. WRITE SUMMARY REPORT OF THE VISIT
Leave copy of the report with facility and district
Strength
Areas of
Action taken
Pending Action
By who?
Improvement
45
3.0 SUMMARY REPORTS
46
MINISTRY OF HEALTH – UGANDA
PAEDIATRIC HIV/AIDS
TRAINING REPORT
Prepared By:
______________________________________________________
Name
Signature
Date
For Official Use Only: Training Report ID No.__________
47
INSTRUCTIONS
Please fill in all the parts on this report. Most of the participant information is on the Attendance
Form. The only information that is not on the Attendance Form that you need to include is
Facility Type (government, NGO, etc.), and Pre and Post Training Test scores. While the
training is taking place, it is good to check that you know all the Facility Types.
The report for this training should be completed IMMEDIATELY after the training.
The team leader is responsible and must e-mail the electronic copy and hard copies of this report
to the Ministry of Health AIDS Control Program Administration within a week after the training using
the following e-mail address: paedhivtrainings@gmail.com.
1.0 INTRODUCTION
1.1 Background Information:
(Please provide brief background information about this training.)
1.2 Overview:
Training Venue: _____________________ District of Training: ____________________
Organized By: _______________________ Funded By: __________________________
Total Number of Trainees: __________
Males: _________
Females: __________
Course Name: (Please check one box: (Double click the box, under default value click on
“checked”.)
1=Early Infant Diagnosis
5=Prevention of Mother-to-Child Transmission
2=Paediatric HIV/AIDS Counseling
6=Integrated Management of Adulthood
Illnesses
3=Paediatric HIV Care & Treatment
7=Integrated Management of Childhood
Illnesses
4=Trainer of Trainers (Specify) ________
8=Other
(Specify):__________________________
Actual Number of Training Days: __________ (Days)
Start Date: ____/____/____
(Day/Mon/Year)
End Date: ____/____/____
(Day/Mon/Year)
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2.0 OBJECTIVES OF COURSE
(Please provide specific objectives about this training.)
3.0 FACILITATION AND COURSE CONTENT
3.1 Trainers (Indicate names, cadre, and affiliated facility or organization):
1.
2.
3.
4.
5.
3.2 Course Content (Summarize Modules):
3.3 Methods of Delivery:
4.0 COURSE ASSESSMENT AND EVALUATION
4.1 Participant Assessment:
Pre Test
Post Test
Average Class Score
Best Mark
Worst Mark
Number Passed with ≥50%
Number Failed with <50%
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4.2 Evaluation: (Summarize participants’ evaluation of the course participants)
Training Item
Score
Training Content out of 30
Training Input out of 40
Training Process put of 40
Training Product out of 20
Total Evaluation Score out of 130
Summarize participants’ comments on the following headings:
1. Favourite session(s) in this training
2. Aspects of the training to which participants needed more information
3. Session(s) that participants felt need modification
4. Participants’ suggestion(s) to improve the quality of this training
5. Additional comments participants felt would be useful to enhance this training, to
develop new training programs, or to provide feedback to individual speakers.
4.3 Challenges:
4.4 Recommendations:
50
List of Participants
Serial
Surname
Given Name
Sex:
(M/F)
Cadre
(e.g
MO)
Facility Name
Facility
Level (e.g
HC IV)
Facility
Type (e.g
Gov)
Facility
District
PreTest
Post
Test
E-mail
Telephone
51
TOT OBSERVATION REPORT
Date:____/____/_______
Course
Name:___________________________________________
(Day/Mon/Year)
Supervisee Name:___________________ Number of Sessions Observed: __________
Training Venue:_____________________ District:_______________________________
Organized By:______________________ Funded By:____________________________
Rating Scale:
3=Excellent
2=Good
1=Developing
0=Poor
Serial Question
No.
1
How well did the trainer prepare for
the session ahead of time?
Sessions
Comments
1_______ 2_______ 3_______
3 2 1 0 3 2 1 0 3 2 1 0
2
How well did the trainer introduce the
session?
3
2 1 0 3
2 1 0 3
2 1 0
3
How well did the trainer conduct
practical exercises or group activities?
3
2 1 0 3
2 1 0 3
2 1 0
4
How well did the trainer conduct
games and interactive activities?
3
2 1 0 3
2 1 0 3
2 1 0
5
How well did the trainer conduct
interactive activities?
How well did the trainer provide
smooth transitions?
How well was feedback received from
the participants?
3
2 1 0 3
2 1 0 3
2 1 0
3
2 1 0 3
2 1 0 3
2 1 0
3
2 1 0 3
2 1 0 3
2 1 0
How well did the trainer close the
session emphasizing key points?
How well were the objectives of the
session met?
Summation of the ratings
3
2 1 0 3
2 1 0 3
2 1 0
3
2 1 0 3
2 1 0 3
2 1 0
6
7
8
9
10
11
In your opinion, how would you rate
the overall effectiveness of this
trainer?
12
Please describe your meeting with
this trainer and the key issues
discussed.
Any additional comments:
13
Overall, add all
individual ratings
per session out of
81:_____________
66 – 81 = Can train independently
54 – 65 = Can train with support
27 – 53 = Can train after mentorship
0 – 26 = Cannot train
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