ADP Area development programme ARI Acute respiratory infection ARV Antiretroviral ART Antiretroviral therapy ANC Antenatal care CHW/V Community health worker/volunteer CoH Channels of Hope COMM Community health committee CMAM Community-based management of acute malnutrition CVA Citizens Voice and Action DADD Do, assure, don’t do DPA Development Programme Approach EBF Exclusive breastfeeding EmOC Emergency obstetric care EmONC Emergency obstetric and newborn care
FP Family planning GAM Global acute malnutrition GBV violence GTRN Global Technical Resource Network HIV Human Immunodeficiency Virus HMIS Health Management Information Systems HVs Home Visitors ICT Information and communication technology ICCM Integrated community case management IMCI Integrated management of childhood illnesses IYCF Infant and young child feeding KMC Kangaroo Mother Care LBW Low weight (baby) LLIN Long-lasting insecticidal net MAM Moderate malnutrition MHPSS Mental health and psychosocial support MNCH Maternal, newborn and child health MoH Ministry of Health MUAC Mid-upper arm circumference NGO Non-governmental organisation NO National office ORS Oral rehydration solution PD/Hearth Positive Deviance/Hearth PHC Primary health care PLW Pregnant and lactating women PMTCT Prevention of mother-to-child transmission of HIV PNC Postnatal care PSS Psychosocial support RH Reproductive health RUSF Ready-to-use supplementary food RUTF Ready-to-use therapeutic food SAM Severe malnutrition SBA Skilled birth attendant SC Stabilisation centre SFP Supplementary feeding programme SO Support office SRH Sexual and reproductive health STI Sexually transmitted infection TA Technical approach TBA Traditional birth attendant ttC Timed and Targeted Counselling ttC-HVs ttC Home visitors U5MR mortality rate VCT Voluntary counselling and testing WASH sanitation and hygiene WFP World Food Programme WHO World Health Organization WV World Vision Vision International’s Global Health team first drafted this Facilitator’s Manual for Timed and Targeted Counselling (ttC) in 2010, in response to the need for a comprehensive curriculum for behaviour change counselling by community health workers and volunteer cadres which would encompass all of the seven interventions for mothers and 11 interventions for children identified in the 7-11 World Vision Health strategy0F. Whilst many diverse curricula exist, very few of these combine current approaches to behaviour change counselling, combining interventions in a life cycle approach from pregnancy through to the second year of life, with a comprehensive package of manuals, job aids, trainers’ guides and planning tools required to deliver quality programming. Since the ttC Core Curriculum was first developed it has been adapted in 20 countries globally and undergone several rounds of field testing in diverse contexts. Additionally, new
are many techniques for asking questions and listening. These include: asking open-ended questions using body language to show that you are listening reflecting back what the mother or other HH member has said empathising, to show that you understand what the person feels avoiding words that sound judgmental. There are also many skills for giving information, checking understanding and solving problems. These include: accepting or acknowledging what the HH member thinks and giving relevant information using simple language praising when appropriate. The process of counselling includes asking questions and listening to understand the family’s situation, giving relevant information on the situation, checking the family’s understanding, discussing what they plan to do and trying to solve any problems they anticipate in adopting new behaviours. Session 6: Psychological First Aid skills and maternal well-being and support Session plan Activity 1: Determine what they already know Activity 2: Discussion to identify signs of distress Activity 3: Introduction to PFA action principles Activity 4: Group work positive and negative coping strategies Activity 5: Role play Time: 1h40
Visit 1. Early Pregnancy or First Registration (see ttC Participants Manuals also) Topics Key messages and additional information Barriers: What makes it difficult to do? Enablers: What make it easier to do? Counselling response or solution Nutrition & Home Care Handwashing at appropriate times* e.g. Family / culture Money Home foods Family support Iodized salt Access, money Knowledge of benefits Savings / birth planning and preparation Access Increased quantity and variety of foods for pregnant woman* Knowledge, Beliefs Addiction Knowledge of risks Sleep under LLIN in high malaria prevalent areas*26F Family / culture More support in work Three food groups (discuss locally available foods) – eat a balanced diet. Include micronutrients foods, vitamin A-rich foods) Do not or drink alcohol during pregnancy Access to IFA, belief in effect, constipation, forgetting Reminder to take, knowing to take with food, constipation Adequate rest & assistance from family members Take iron and folic acid tablets daily* Antenatal Care & Danger Signs in Pregnancy Four ANC visits* attend as early as possible Services at ANC (iron-folate, tetanus vaccine, prevention of malaria, deworming) Access, distance, money Family support, money HIV testing TB testing rich
Visit 2. Mid Pregnancy Topics Key Messages and additional information Barriers: What makes it difficult to do? Enablers: What would make it easier to do? Counselling response or solution HIV&AIDS, TB and PMTCT Testing during pregnancy for HIV, TB and other STIs for women and their partners (HH handbook Visit 1) Partner testing, culture, stigma, fear Family support Accessing HIV & TB treatment and taking medicines every day (ART adherence for HIV-positive mothers) Stigma, access to medicines, family influencers, side effects Reminders, support for side effects, connecting to existing HIV support groups Early infant diagnosis and Co-Trimoxazole preventive treatment Access, beliefs Partner participation, knowledge Condoms during sexual intercourse pregnant and breastfeeding to prevent Gender dynamics, myths and inappropriate beliefs, knowledge, attitudes concerning condoms Partner participation, increased knowledge, increased self efficacy in negotiating and using condoms consistently Nutrition, rest and antenatal care for the for HIV-positive mother Family attitudes, work, poverty Family support All women, but especially HIV-positive women deliver in a health facility for special care and PMTCT Access to care, distance from health centre, costs ,lack of funds for facility delivery kit Increased facilitated alliance with TBAs, modified social norms that demand facility delivery Early and exclusive breastfeeding Beliefs, fear, familial, pressure to supplement feeding Knowledge, support from family community
Visit 3. Birth Planning and preparation – Mid to Late Pregnancy Topics Key Messages and additional information Barriers: What it difficult to do? Enablers: What make it easier to do? Counselling response or solution Birth Planning Health Timing and Spacing of pregnancy All women, but especially HIV-positive women should deliver in a health facility with a skilled birth attendant (Visit 2) Developing a plan Arranging finances and transport
5: First week of Life Topics Key Messages and additional information Barriers: What makes it difficult to do? Enablers: What would make it easier to do? Counselling response or solution Newborn Care first week of life Exclusive breastfeeding to six months* No other foods or water* No bottles or utensils Breastfeeding on demand day and at 8 times in 24 hours* Holistic development: talk, play and stimulate the baby for language and emotional development Access to services Immunisations: BCG/Oral as soon as possible Baby is seen for growth monitoring at the clinic Birth Registration for the newborn Post partum care of the mother Mother and baby sleep under long lasting insecticide treated bednet Mother takes iron and folic acid as recommended care at health facility as soon as possible after a home birth and within 45 days after delivery. Post partum mother should rest well, and have support of the family to not return to heavy work too soon