Identify and train personnel

Operational guidance on the personnel required for ITN distribution in schools, and suggestions for their training.

Key SBD Considerations

In planning for and implementing ITN SBD, it is important to identify personnel with the appropriate experience to lead and support planning, implementing, monitoring and reporting at national and sub-national levels.

Personnel involved in ITN SBD may include for example:

  • Teachers, head teachers and health educators
  • District warehouse managers
  • Central and sub-national health and education directors and data managers
  • National malaria programme staff, education department teams
  • Staff from Central Medical Stores

Consider the following:

  • Personnel should be mobilized at all levels from among key SBD stakeholders, including the MoH, MoE, and sub-national administrative departments and authorities. See Step Four.
  • Involving both health and education personnel at all levels reinforces coordination, training and supervision. It builds on teachers’ and health educators’ roles in the classroom, school health curricula, national malaria programme technical expertise, as well as health personnel ITN distribution experience and on-going health facility-based distribution.
  • Teachers may be tasked with managing the distribution of left-over ITNs to pupils in non-eligible classes, as per the approach in Tanzania. Where surplus ITNs are provided to health facilities for distribution via routine services (e.g. ANC and EPI) following ITN SBD, as in Ghana, district storekeepers (warehouse managers) may be responsible for receipt, tracking and issuing of surplus ITNs to district health teams.

  • To ensure quality, accountable and harmonized implementation of ITN SBD activities, it will be important to develop a training plan, budget and related training materials, e.g. agendas, training guide, pre- and post-assessments, job aids and/or standard operating procedures (SOPs), etc.
  • The following points should be considered to ensure effective implementation of the plan so that all personnel involved in ITN SBD are trained and receive appropriate tools to effectively conduct ITN SBD activities:
    • A Gantt Chart or other planning matrix should be developed to identify key milestones and detailed activity timelines and progress, tracked through regular planning meetings (this should be part of the overall timeline developed for SBD, see Step Four).
    • Trainers should be identified and assessed according to an established ITN SBD terms of reference (TOR) for trainers.
    • To ensure the quality of trainings, supervision should be included in the ITN SBD training plan.
    • ITN SBD training may require significant financial, personnel and time resources for planning and implementing, particularly during the first year of implementation. Subsequent on-the-job training and refresher courses to manage staff turnover and streamlined annual updates can help to manage costs and resources needed for quality ITN SBD.

Important topics to include in the ITN SBD training plan include:

  • Overview of SBD, including its rationale, major processes, and related personnel roles and responsibilities.
  • Approaches and tools to insure, transport, receive, store, distribute and document distribution of ITNs, including:
    • ITN receipt procedures and the use of stock cards and other tracking tools to ensure accountability at each level
    • ITN storage and transport audit requirements
  • Social and behaviour change (SBC) messages and materials, health promotion approaches and messages, including education of children and teachers and use of job aids regarding the causes of malaria, malaria prevention and proper ITN use and care.
  • Procedures for ITN issuing to designated schoolchildren; documentation and verification procedures for ITNs distributed; and reconciliation of ITNs remaining after completion of SBD activities.
  • Expectations of monitoring visits, including review of accountability documents and distribution reports, checking storage sites and conducting physical counts of ITNs.
  • Community security.
  • Monitoring, reporting, and supervision protocols and tools:
    • Record-keeping and audit trails, particularly practical exercises that involve filling out forms and reviewing data for accuracy and accountability
    • Timely data collection and reporting process and tools
  • Logistics protocols after the end of ITN SBD activities for any ITNs remaining after the issuing activity.

Trainers are often identified from across MoH divisions and partner organizations. To harmonize ITN SBD approaches and key messages across all personnel involved, it is important to develop training materials and documents that will reinforce consistency.

As SBD is typically conducted annually, training or refresher orientation may be needed annually as well.

Country example: SBD training in Tanzania

In Tanzania, the NMCP SNP Implementation Guide stipulates that “implementers will be trained on school-based ITN distribution processes and procedures when the program is first introduced in a region and conduct a refresher training when there is a 15-20% staff turnover rate and conduct on-the-job orientation (one-to-one) during supervisions”.

Source: Tanzania NMEP (2023). School-based ITN Distribution Implementation Guidelines

Countries will need to choose whether ITN SBD personnel and teachers (if applicable) will be trained using cascade training or direct training. Similarly, countries can decide whether to plan and conduct a stand-alone SBD training or to integrate SBD topics with existing staff training plans. The decisions will depend on who is being trained:

  • In Ghana, for example, following a central training of trainers (TOT), school health education programme coordinators and circuit supervisors are trained at the district level.
  • In Tanzania, after personnel have been trained through standard cascade training, refresher trainings are planned only where staff turnover is 15—20 per cent or above.
  • In Zambia, training follows a standard training cascade from central to provincial to district to school levels.

These decisions, and pros and cons of each choice, are summarized below.

1. Will teachers and ITN SBD personnel be trained through a traditional cascade or direct training?

Approach Pros Cons
Cascade training Using TOT approaches, from central to sub-national to community and teacher levels. A tried-and-trusted method, used in many large-scale health campaigns. Requires mobilizing many trainers, and at each level undertaking training of trainers for the cadres at the level below. Across many trainers there may be differences in understanding and uptake of key material, and thus different messages may be conveyed, reducing standardization. If implemented, supervisors should be used to assess training quality, provide necessary feedback, and support ongoing programme quality improvements.
Direct training
In some cases, teacher training for ITN SBD is delivered directly to teachers.		 Central and regional level trainers directly train teachers and other ITN SBD personnel. Promotes harmonized messages directly delivered from a smaller number of trainers. ITN SBD activities are extended over a longer period, potentially leaving some populations uncovered by an effective vector control measure.

2. Will training be organized as a stand-alone training, focused only on ITN SBD or combined with other ongoing education or health meetings?

Approach Pros Cons
Stand-alone training

Dedicated solely to the ITN SBD training guide and tools, allows organizers and participants to focus on each component of ITN SBD planning and implementation.

 This focused approach can improve the quality of SBD. It also reinforces timing as stand-alone training can be conducted close to the implementation period. During the first round of ITN SBD it is particularly important that stand-alone training is organized to allow for sufficient time and focus for training for the first distribution through schools. Financial costs for organizers and time requirements for ITN SBD personnel.
Integrated training

Approaches to combine ITN SBD training with other ITN-related training (e.g. targeting ANC and EPI channels) and/or regular education or health meetings have also been implemented.

 Can lower training costs and reduce burden on the health system by avoiding multiple vertical meetings and trainings. Integrated training can also reinforce integration of malaria prevention and ITN use messages across health and education systems. Integrated training has shown mixed success. At programme start-up, it is difficult to communicate very specific information to multiple actors within and outside the health system. Furthermore, the timing of other planned trainings might delay programme start-up and thus effective coverage of ITNs for populations who need them.

Country example: ITN SBD TOT tool

Alongside narrative guidelines, the Ghana NMEP has developed a detailed slide deck for the orientation of key stakeholders. Updated annually, the slide deck aims to:

  • Equip participants with appropriate knowledge and skills to implement and supervise the primary school ITN distribution
  • Build effective planning and SBC capacity among district teams and school heads
  • Reinforce the use of Ghana’s Net4Schs digital application to collect data during distribution
  • Strengthen effective SBC and promotion of positive behaviours and behaviour change in relation to ITN acceptance, regular use and proper care and repair

Source: Ghana NMEP (2023). School-Based ITN Distribution slide deck for the orientation of key stakeholders

  • Information from previous supervision activities can identify areas to reinforce or clarify, thus informing updates for training plans.
  • It is important to minimize disruption for school and health facility personnel, to organize training during timeframes which do not conflict with exam preparation or administration, or key ANC, EPI or routine health days.
  • Payments to personnel involved in ITN SBD should leverage existing MoE and MoH systems and collect the necessary information to complete the transactions in a timely manner.
  • The ratio of trainers to trainees and number of hours/days needed for training will vary at different levels of the health and education systems. More time will also be needed the first time that ITN SBD is conducted.
  • Training plans and materials should be developed with an emphasis on participatory adult learning approaches in mind.
  • ITN SBD materials and tools for distribution, reporting, management, SBC and health promotion should be organized and shared with training teams who can manage the transport and allocation of materials to teachers and other SBD personnel as needed. This will reduce costs as well as logistical complexity and support timely availability of materials.
  • Key information to reinforce during ITN SBD training:
    • The importance of timely reporting of SBD results and demonstration of the tools to do so
    • Key messages and approaches to promote ITN use and reinforce that the ITN is for the household (except boarding schools)

Consider planning for supervision of SBD training. Supervision has often focused on the ITN distribution day(s) itself. However, supervision conducted during the planning, health promotion and reporting phases will provide additional benefits through strengthening these components. These benefits need to be weighed against the cost of additional supervision: ITN SBD has been successfully conducted in several settings with focused or limited supervision.

The training supervision cascade may include, for example:

  • Supervisors from the MoH pool of supervisors, national malaria programme and partner staff may supervise central- and sub-national-level trainings.
  • Central-level trained personnel may then supervise their sub-national counterparts as they are conducting trainings for school personnel.

See Step Eight  for further information on supervision.

Country example: Ghana

In Ghana, circuit supervisors in the education sector have provided a pivotal role in both training and supervision, significantly contributing to the efficiency and effectiveness of the SBD, building on their strong knowledge of transport networks, school personnel, and stakeholder networks.

Resources

  • ITN SBD training plan [Word] EN | FR | PT
  • ITN SBD pre- and post-training assessments [Word] EN | FR | PT