Modernizing the Training of Trainers in Primary Health Care

Abstract

Training community-based health care workers in ”Developing” countries is essential to improving the quality of life in both rural and urban areas. Two major obstacles to such training are the social distance gap between these community workers and their more highly-educated and upper class trainers (often medical officers and also the influence of the almost universal overly didactic, formal educational system. Bridging this gap demands a participant-centered, field-oriented app roach which actively involves the trainee in the design, implementation and evaluation of the training program. A philosophic learning approach based on self-initiated change, educational objectives related to planning, organizing, conducting and evaluating training and specific learning methodologies using participatory learning, non-formal educational techniques, field experience, continuing feedback are reviwed. Included are: structured experiences, flow charts, role playing, story telling, case studies, self-learning exercises, simulation exercises, Portapak videotape, visual illuatrations and models/teaching aids. The educational objectives set forth in this planned course for trainers of trainers, however, can be achieved only if they are carried out in a setting similar to the on e in which the primary health care worker will be in the future. This means that at least half the training ought to take place in the village or neighborhood -setting and the training officer should spend his evenings as well as days, intermingling with local people, sleeping. in similar housing, and eating local food: Such total immersion may violate some of the class orientations of the future trainers but should result in at least a minimal empathy with local conditions trainees will have to face. The means of providing sufficient creature comforts to keep the immersion approach from drowning the future trainers remains the job of the master trainer of trainers who will conduct this course.