Sustained Capacity Building of Local Health Workers in Detecting and Responding to Avian Influenza and Emerging Infectious Diseases Achievements and Lessons Learned

Background Vietnam Areas of virus activity for Avian and Pandemic Influenza (API) Human infections typically associated with backyard poultry farms Commitment by Government of the Socialist Republic of Vietnam (GVN) to control Emerging Infectious Diseases (EIDs)

USAID’s Avian and Pandemic Influenza Initiative Improve GVN capacity to prevent, detect, and respond to API and EIDs Implemented by Abt Associates Oct Sept 2013 $11.7 million budget

Project Components Animal Health – reduce risk of virus transmission during poultry raising, slaughtering, and selling through improved education and standardized procedures Human Health – prevent spread of infection by humans before and during an outbreak through early identification and implementation of infection control strategies Behavior Change Communication (BCC) – increase awareness and improve animal husbandry practices to reduce risk of transmission from animals to people Policy Advocacy and Coordination – improve GVNs ability to plan for and respond to outbreaks

Key Capacity Building Instrument: Training Human Health Train the Trainers Community-Based Surveillance (CBS) Infection Control Animal Health Train the Trainers Animal Health for animal health workers (AHWs) Biosecurity for AHWs and agriculture extension workers (AEWs) Behavior Change Communication Train the Trainers Communicators / Facilitators

Post-Training Assessment Objectives Determine outcomes and impact of training conducted under project (to date) Identify motivators and barriers for application of new skills and knowledge among trainees Sub-objectives: –6 months to 1-year post-training: Evaluate knowledge and skills of trainees Evaluate attitude and application of trainees –Evaluate impact of training on local community –Provide lessons learned –Provide recommendations

Post-Training Assessment Methods November 2011, undertaken by Asian Management and Development Institute Conducted: –Desk review –Self-administered questionnaire for KAP survey of trainees –In-depth interviews (IDIs) with trainers and key partner agencies –Focus group discussions (FGDs) with trainees and community members –On-the-job observation of trainees Multi-stage clustering sampling: –2 districts within each of 5 provinces –Random selection of participants based on participant lists

Methods cont’d Sample size: 1,316 trainees, 220 trainers, and 59 local animal and human health officers Quantitative data processed using SPSS and Excel; qualitative using Atlas to code transcribed data Limitations: –Participant lists sometimes required reorganization for IDI/FGD selection –Respondent availability - some participants were selected for more than one activity but could only participate in one –Local accent/dialect posed challenges to transcription –Data largely self-report

Post-training Assessment Results Knowledge and attitude 6 months – 1 year post-training –75-100% of respondents answered at least 50% of knowledge questions correctly (50% = pass) –Qualitative data indicated that participants believed their knowledge was increased Practice –48% and 53% BCC and AH trainers conducted diffusion training –100% CBS trainers conducted diffusion training AHWs –Trained AHWs provided AH services to 20 farmers/month (avg) –70-100% applying skills in veterinary and animal husbandry –Observed correct injection procedures, autopsy techniques, and good counseling skills to farmers

Results cont’d CBS collaborators –Visited 40 homes/month to collect disease information –83% AH and 97% HH reported suspected events immediately –42% believed surveillance activities would be smaller post-project Health workers –76% and 58% trained health workers at district and commune level reported applying hand washing skills –Observed hand disinfection liquid and proper sharps disposal Communicators –73-95% reported good performance of MC skills (time management, creating atmosphere, encouraging audiences and facilitating learning) –50-80% of FGD facilitators performed facilitation skills (encouraged participation, facilitated learning, clearly delivered messages, and managed time)

Results cont’d Impact on local community While baseline data was not collected to show improvement, data collected through this assessment indicates a high level of performance. This high level of performance can be seen as a proxy for improved knowledge and skill use in the community due to increased capacity of community members.

Lessons Learned Key barriers for practicing skills/knowledge learned: Lack of regular incentives (e.g. salary or allowances) for public AHWs Shortage of resources, standardized tools, and frameworks for follow-up, coaching, and continued on- site training and learning High turnover rates of AHWs (i.e., those trained are not retained)

Key Take-Away Messages Effectiveness/sustainability of TOTs enhanced by integration into GVN systems and implementation by local counterparts Trainings including 1) a training needs assessment, 2) development of full training curriculum, 3) TOT, and then 4) training diffusions were most successful Establishing selection criteria for trainers will improve quality of trainings Data collection during and after trainings should be systematic, usable, and uniform across components

Cam On / Thank you For more information : Lara Hensley Technical Coordinator

Authors Nga Le, MD, MPH, Avian Pandemic Influenza Initiative, Abt Associates, Hanoi, Vietnam Truong Bui, MD, MPH, Avian Pandemic Influenza Initiative, Abt Associates, Hanoi, Vietnam Lara Hensley, MPH, Abt Associates, Bethesda, MD, USA Jens Peter Dalsgaard, PhD, MBA, Abt Associates, Hanoi, Vietnam Duc Nguyen, Asian Management and Development Institute, Hanoi, Vietnam Manh Nguyen, Asian Management and Development Institute, Hanoi, Vietnam