CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
HEALTH EDUCATION TRAINING GUIDE
\\
FOR
'ri-IE NA'i'IONAL DEVELOPMENT SERVICE PROGRAM IN NEPAL
A
graduat~e
project subrnitted in part.ial satisfaction
of the requirements for the deg:cee of
Master of Public H€:al th
by
Chiranjibi Bahadur Thapa
June, 1979
The graduat.e project of Chiranjibi Bahadur Thapa is
approved:
waleed A. Alkhateeb, Dr.P.H.
0a~
L.
Winkelman, H.S.D.
John T. Fodor, Ed.D.
Co'mmittee Chairman
California State Universi·ty, Northridge
ii
DEDICATION
'l'o my parents Prem Bahadur and Badan Kumari
for their affection,
To my beloved wife Bhagawati Devi
for her empa·thy and sacrifice,
To my children Anil, Anila, Anuj, and Anuja,
for their love and patience.
iii
ACKNOWLEDGEMENTS
The author expresses his sincere gratitude to
Professor Dr. John T. Fodor, the Chairman of his thesis
committee for his inspiration, encouragement, continuous
guidance and positive comments and suggestions that led to
the successful completion of this work.
Likewise, the
author wishes to express his sincere gratitude to
Drs. Waleed A. Alkhateeb and Jack L. Winkelman, the Committee Members for their continuous encouragement, guidance and valuable suggestions.
Sincere gratitude is also extended to His
Majesty • s Government of Nepal and the United Sta·tes Agency
for International Development for the opportunity provided
to the author to accomplish advanced training in Health
Education in the United States.
The author expresses his warm appreciation to
Hs. Jeannie McCormack, Nepal Project Coordinator, Management Sciences for Health, Boston, for the encouragement
and support provided to the author during his stay in the
United States.
iv
TABLE OF CONTENTS
Page
APPROVAL .
ii
DEDICA'l'ION •
iii
ACKNOWLEDGEMENTS
iv
v
'l'ABLE OF CONTENTS
LIST OF TABLES AND CHARTS
ABSTRACT .
.
vii
•
• viii
CHAPTER
I.
INTRODUCTION
1
Background Information and
Justification . • • . . • .
Purpose of the Project .
II.
III.
1
.
32
Limitation of the Project
32
Definitions of Terms .
33
METHODOLOGY . . . •
37
Task Analysis of Students Working Under
the NDS Program • . . • • • • . . . •
37
Identifying Knowledge and Skills • • • •
38
Developing a Health Education Training
Guide
. . . . . . . . . . . . . . . .
39
The Implementation Scheme
42
The Evaluation Scheme
47
The Revision and Updating Scheme .
51
PROPOSED TRAINING GUIDE • • • • • .
v
•
53
CHAPTER
Page
HEALTH PROBLEM AREAS
A.
Major Health Problems
1.
B.
C.
. • 55
Con@unicable Diseases and
Their Prevention . • • . .
3.
Water and Sanitat.ion
•
4.
Personal Hygiene
• • 67
Elementary First Aid .
. ..
• 63
• 69
1.
Preventing Accidents .
.
2.
Temporary Firs·t Aid Care .
• • 71
Organization of Health Services
. 75
Health Role of NDS Students
Solving Health Problems
• 69
. 75
Utilizing Community
Organizations
. . •
HEALTH EDUCATION AREAS
. 80
. • • 80
•
•
•
82
A.
Points of View on Health and
Health Education . • • .
. . . 82
B.
Providing Opportunities for
Health Education . . • • . • . . • 84
C.
Communication in Health Education
D.
~·1oti va tion
E.
Community Organizat.ion
SUMMARY
•
•
e
•
•
Selected Bibliography
• .
• 55
Malnutrition and Dehydration • 58
1.
APPENDIX A .
.
2.
1.
D.
• • 55
• .
in Health Education .
•
•
•
•
•
•
86
. 88
• • 90
•
•
• 95
• 97
100
• •
vi
LIST OF TABLES AND CHARTS
Table
1.
Page
Number of Heal t.h Personnel and the Ratio
of Health Personnel per Capita in Nepal
in 19 7 4 • • • • • • • • • • • • • • •
!iii
9
Chart
ORGANIZA'riON CHART OF MINISTRY OF HEALTH
11
INTERF.ACES
23
EDUCATIONAL STRUCTURE .
28
vii
ABS'l'RACT
HEALTH EDUCATION TRAINING GUIDE
FOR
THE NATIONAl. DEVELOPMENT SERVICE PROGRAM IN NEPAL
By
Chiranjibi Bahadur Thapa
Haster of Public Health
June, 1979
The purpose of this project was t.o develop a
health education training guide for the national development service program in Nepal that would be used to assist
health instructors in better
pro~iding
health education
training to Master-level students participating in the NDS
program.
'l'he training guide has been divided in·to t\vo main
areas:
1.
Health Problem Areas, and 2.
Areas.
The guide includes major topics, concepts, objec-
Health Education
tives, evaluative criteria, content and learning opportunities.
viii
The rationale employed in developing this guide
was as follows:
1.
Analyzing health education tasks of Masterlevel students participating in the NDS
program in Nepal,
2.
Identifying knowledge and skills required to
carry out these ·tasks,
3.
Developing major topics for the training guide,
4.
Selecting concepts related to the major topics,
5.
Developing objectives for each concept,
6.
Selecting evaluative criteria for each
objective,
7.
Identifying content to be covered for each
concept, and
B.
Developing appropriate learning opportunities.
Also included in the project are detailed plans
for implementing and evaluating the health education
training program.
It is suggested that the guide be used by health
instructors in providing health education training to
Master-level students during the pre-service training of
the NDS program.
ix
CHAPTER I
INTRODUCTION
Background_Information and Justification
The Country and its People.
Nepal can be divided
into three main geographic regions, namely the mountain
region along the northern side, hills and deeply-cut valleys along the central part of the country and the plain
region of the narrow belt known as the Terai along the
soui:hern border.
Approximately eighty-three percent of
its land consists of mountains and valleys including the
highest mountain of the world, Mt. Everes-t.
The remainder
of the land consists of plains (10:25-27).
Most of the mountains, the hills and the valleys
are particularly very difficult to be reached except by
trails.
The rough terrain as well as the lack of trans-
portation and communication facilities have caused great
hindrances to the even distribution of national and local
resources, thereby adversely affecting socio-economic
conditions and the health status of most of the Nepalese
people.
Administratively and politically, Nepal can be
divided into four regions, fourteen zones, seventy-five
districts, about 4,000 village panchayats (local units of
1
2
a village or villages) and nineteen town panchayats (city
units).
The administration of all the development pro-
grams including health care delivery in Nepal is being
carried out in accordance with the above-mentioned administrative divisions (1:3; 26:7).
'l'he 19 71 census of Nepal shows that its
population has totalled to 11.5 million.
On the basis of
an estimated 2.07 percent annual growth rate, the population at the end of 1978 would have reached a total of 13.2
million ( 2 8) .
'.rhis indicates that Nepal has a problem of
over-population and this problem is increasing.
Singh
{27:16) suggested that the population growth in Nepal
should be checked through more effective family planning
programs in order to prevent the increasing socio-economic
problems caused by over-population.
Nepal is basically an agricultural country.
Approximately ninety percent of its people draw their
livelihood from agriculture and allied activities through
the indigenous method of farming.
Ninety-six percent of
the people live in rural areas or villages and the remaining four percent live in cities.
Most of the people have
relatively small income and thus have low socio-economic
status (1:3).
The population of Nepal is ethnically complex.
This can be attributed to its varied and inaccessible
geographic terrain and the lack of communication and
3
transportation facilities.
The multi-lingual and the
multi-·ethnic characteristics of the Nepalese population
present problems in communicating health messages.
For
example, there are seventeen languages, nine of which are
spoken by more than 200,000 people each.
guages have a few local dialects.
Some of the lan-
Similarly there are
many ethnic groups, each having their own tradition and
culture (1:3).
However, the fact that the Nepali language, the
national language of the kingdom, is spoken by more than
si~ty
percent of the total population and understood by
many people, helps to facilitate communication.
Despite many ethnic groups witk their own tradition
and culture, the Hindu religion is practiced by approximately eighty-nine percent of the population.
Buddhism is
practiced by seven and a half percent of the population.
The rest of the population follow Muslim, Christianity and
other religions (28).
Nepal still has tradition-oriented societies with
wide-spread religious beliefs, age-old traditional practices and superstitions, especially in rural areas.
Most
people maintain unnecessary and often harmful traditional
practices and are ignorant of the fact that bad environmental conditions, malnutrition and unfavorable health
pract.ices briny about various kinds of communicable diseases and a poor health status (30:6).
4
Most of the rural people attribute many illnesses
to fate or visitations of an angry deity or an evil
spirit or to the wrong-doings in a previous life.
This
kind of belief and attitude have a negative impact on the
control of certain communicable diseases, such as leprosy
and tuberculosis.
Besides, indifference towards certain
illnesses is prevalent, and such illnesses are not considered to be serious enough to warrant attention until
the patient's condition becomes critical.
The patient is
then taken to the nearest health facility only at the
"eleventh hour" when it is too late (4:24-25).
!!_ealth problems.
The commonly used yardsticks of
mortality, morbidity and life-expectancy for determining
the health status of the Nepalese people are unfortunately
incomplete, unreliable or lacking, due to the absence of
systematic reporting and recording of births, deaths and
illnesses.
Under such a situation, rough computations
have to be based upon sources such as population census
and limited health surveys.
An estimated high infant mortality rate of
159.07 for every thousand live-births and an estimated
short life-expectancy of forty-five years at birth are
some of ·the main indicators of poor health status of the
Nepalese people (30:2).
The underlying reasons for this
poor health status include:
high illiteracy, ignorance,
5
age-old tradition and customs, religious beliefs,
superstitions, difficult geography, lack of transportation
and communication facilities, a shortage of trained health
manpower, unequal distribution of health service and malnutrition.
These factors contributed to a high prevalence
of a number of communicable diseases, such as malaria,
tuberculosis, diarrhea, dysentery and worm infestations
throughout the kingdom.
These communicable diseases are
shown to be the main causes of high morbidity, high mor-tality and short life-expectancy.
Malaria was the main cause of high morbidity and
high mortality in Nepal until the 1950's.
This disease
was regarded as a major obstacle to physical, intellectual
and economic development of the people,
Though the dis-
ease was brough·t under limited control for a number of
years, the incidence of the disease started to increase
again in 1972.
Malaria continues to be a major health
problem today (1:10; 30:35).
Tuberculosis is wide-spread throughout Nepal.
This disease, which is estimated to affect one percent of
the total population, is also one of the leading causes of
mortality in Nepal.
The highest incidence of the disease
is found in crowded cities, such as Kathmandu, the capital
city, and Birgunj (25:69).
Leprosy is also a major health problem in Nepal.
Like tuberculosis, this disease affects one percent of the
6
Nepalese people.
The problem .is intensified by ignorance
and superstition about the disease.
It is considered by
many t.o be caused by a divine curse or by the wrong-doings
in a previous life.
Until 1963, there was a law that con-
fined and isolated the leprosy patient to a leprosarium.
Patients and their families tried to hide the disease for
fear of being separated (1:12; 30:39).
Through the ages; smallpox has been an endemic
disease.
In Nepal there have been numerous epidemics of
the disease.
Many people in Nepal believed that smallpox
was caused by a goddess called, "Sitala Mata."
This
belief, in many instances created serious hindrances to
the smallpox immunization program (1 ;11.) .
In addition to the diseases mentioned above, there
are ot:her communicable diseases, widely prevalent in both
rura:t and urban areas of Nepal.
Cholera, typhoid and
infectious hepatitis take epidemic forms at times, especially during the rainy season.
Dysentery and other intes-
tinal disf.;ases are so cormnon that they are considered to
be normal rather than a disease condition (4:101).
Diphtheria, tetanus, whooping cough, measlt."!s,
rabies and filariasis are also prevalent and have played
t:heir part: in increa.s.:i..ng morbidity and mortal.i ty rates
among· the Nepalese populat.ion {4:98--99).
Lack of safe drinking water, lack of proper sewage
and garbag·e disposal system, lack of general sanitary
7
environment, poor and unhygienic housing conditions,
promiscuous and indiscriminate defecation practices of
the people in villages as vlell as in towns, poor personal
hygiene and a multiple of other factors have all contributed much to the high incidence of the above-mentioned
diseases (30:39).
A general lack of knowledge about food values,
food faddism, a low income and unequal distribtuion of
food throughout the nation due to transportation difficulties have all added to precipitate malnutrition among the
.Nepalese, especially among children.
Nutritional defi-
ciencies such as protein-calorie malnutrition and vitamin
deficiencies are found to be more previji.lent among children.
The commonly occurring deficiency diseases in children
are marasmus, night-blindness and kwashiorkor (3:75).
Endemic goiter, which is an iodine deficiency
disease, has been prevalent in Nepal for many years.
Hill
villages in general tend to have more goiter problem than
do t.he eastern terai villages, although some low altitude
villages have a very high prevalence of goiter (25:49-52).
During the last two decades, Nepal recognized the
fact that uncontrolled population growth has been an
obstacle to
socio~economic
progress.
Singh (27:15-16)
contended that if the rate of population growth in Nepal
was not controlled, the country would face serious economic, environmental and social problems in the future.
8
According to the long-term health plan, the population of
Nepal would double in just twenty-five years because of
high fertility rate, decreasing crude death rate and a
host of other factors (30:41-42).
As in other developing nations, there is a great
shortage of trained health manpower and health care facilities in Nepal.
In addition, the distribution of health
services has not been uniform.
Most of these services are
heavily concentrated in urban areas and are almost nonexistent in rural areas.
The shortage of trained health
manpower is intensified by the "brain-drain 11 of medical
doctors to other countries.
Many of the candidates who
are sent by the government to India for basic medical education and to the United Kingdom and other western countries for specialized training and higher education, do
not re·turn to the country because they get higher and more
attractive incentives in those countries (4:114-115).
The shortage of trained health manpower in Nepal
is shown in the following table.
9
·Table 1
Number of Health Personnel and the Ratio
of Health Personnel per Capita
in Nepal in 1974 (1:5)
Kind of Health Personnel
Medical doctor
Dentist
Number of
Health
Personnel
374
8
Ratio of Health
Personnel per
Capita
1:33,000
1:14,44,498
Nurse
335
1:34,498
Assistant-Nurse-Midwife
372
1:34,372
Health Assistant and
Auxiliary Health Worker
620
1!18,693
Laboratory Technician
Sanitarian
35
8
1:3,30,171
1:14,44,498
Health Educator
14
1:8,25,427
X-ray Technician
22
1:5,25,272
Kabiraj
93
1:24,258
Baidya
5·0
1:2,31,120
Efforts to Solve Health Problems
The Ministry
of Health of HMG/Nepal is primarily responsible for the
protection and the promotion of health of the Nepalese
people.
And as such, it formulates overall health ser-
vices policies and provides overall direction to all the
on-going health programs through the Department of Health.
The Ministry also reviews plans, programs and estimated
10
budgets of all health projects and submits them to the
National Planning Commission and to the Ministry of
Finance for the sanction of plans and programs.
In addi-
tion, it conducts periodic evaluation of the performance
of all health programs.
The Ministry of Health, along with the Department
of Health, also establishes relations with International
and Bi-lateral agencies, such as World Health Organization
(WHO), United Nations International Childrens Emergency
Fund (UNICEF), United Nations Development Program (UNDP),
and United States Agency for International Development
(USAID), in order to obtain their technical, material and
financial assistance required for
health programs.
diff~rent
kinds of
Similarly, the Ministry maintains co-
operative relationships and inter-sectoral coordination
with rela'ced Ministries and Departments of HMG/Nepal, such
as Ministry of Education, Ministry of Agriculture, Ministry of Home and Panchayat, Tribhuban University and
Department of Water and Sewage.
Under the Ministry of Health is the Department of
Health, with several projects and divisions.
The depart-
ment administrates, supervises and directs all curative,
preventive and promotional health programs throughout the
country.
(See Organization Chart of Ministry of Health
on page 11).
[oRGAt~IZATION CHART
Administration
oF
MINISTRY
oF
HEAI.TH
Department of Health
Director-genera!)
I
Malaria Eradication
Board
Indent, Procurement
and Supervision
Integration and
Community Health
E
-·
I
---,
rnational llealth
___and Trai.ning
and
l~uction
----M~~agement
I
[~~:~~e~
I
Zonal nealth Offices and Zonal Hospitals
[District "eoHh
I Health
Offiiioi,icC u,;;pic~
Centers and Health Posts
I
Source:
30:51
I-'
I-'
12
Until 1955, Nepal had limited health treatment
facilities.
For example, there were only thirty-four
hospitals with 625 hospital-beds and sixty-three ayurbedic
dispensaries for the whole country.
programs were non-existent.
Preventive health
It was only since the start
of the first five-year plan (1955/56 - 1960/61) that
health programs, both curative and preventive, started to
be planned and implemented on the basis of the degree of
severity of the health problems as perceived by health
experts as well as by community leaders.
Considering geographic, socio-economic and
cultural aspects of the country, a long-term health plan
for Nepal was planned in 1977.
This long-term health plan
was designed to provide basic guidelines and broad policies for three five-year health plans, namely the fifth,
the sixth and the seventh five-year health plans which
will continue up to the fiscal year 1989/90 (30:35-48).
As a result of systematic planning and execution
of health programs to solve various health problems, there
was a significant increase in the number of hospitals,
hospi·tal-beds and ayurbedic dispensaries.
nurr~er
In addi·tion, a
of preventive health programs were also initiated.
At the end of the fourth.
five-year plan, 1973/74, there
were sixty-two hospitals, 2,174 hospital-beds and eightytwo ayurbedic dispensaries.
Thirty-five health centers
and 351 health posts were established in different parts
13
of Nepal with the objective of providing basic curative
and preventive services to the people during the same
By 1979-80, 810 health posts are planned to be
period.
established under the integrated community health services
scheri1e.
In order to solve specific health problems, seven
major health projects were intiated and are being implemented with varying degrees of success.
These projects
are :Halaria Eradication, Tuberculosis Control, Leprosy
Control, Family Planning and Maternal and Child Health,
Integ-rated Com.-rnuni ty Health and Health Education ( 30:1) .
Malaria Eradication.
to control malaria in 1954.
Nepal started activities
But it was only in 1958 that
HM.G/Nepal v with technical and financial assistance of WHO
and USAID, launched the country-wide malaria eradication
program.
Spraying of insecticides in all houses and
structures in malarious areas, collection of blood from
all fever cases to detect malarial parasites and ·treatment
of all detected cases were the three main functions of
this Malaria Eraqication Project.
These efforts resulted
in the significant reduction of malaria morbidity and
mortality in the country (1:10).
Since 1972, however, malaria incidence started to
increase.
According to WHO, lack of resources, resistance
of malarial parasites to anti-malarial drugs and
14
resistance of vector mosquitoes to insecticides have all
hampered efforts to check the rising incidence of the
disease (11:27).
The Malaria Project has allocated its own health
education personnel.
Health educators within the project
work closely with the health education section of the
Department of Health in conducting school and community
programs.
Smallpox Eradication.
Smallpox is another dreaded
disease which has caused blindness, deafness and dumbness,
and even took the lives of many Nepalese through the ages.
In order to control this disease, HMG/Nepal first
I
started a smallpox control pilot project in 1961 in
Kathmandu valley.
This project was gradually expanded to
other neighbouring districts of Nepal.
Nepal responded to WHO's appeal to eradicate this
disease from the world by starting the eradication program
in 1967.
As a result of the extensive eradication program
in all the districts of Nepal, this program came to a suecess in mid-April, 1977, when WHO, amid a ceremony on the
eve of Nepal's New Year's Day, declared the country to
be free from smallpox.
However, the vaccination of the new-borns and the
surveillance of possible smallpox cases would continue
till the end of fifth five-year plan, 1979/80.
After
15
that, the epidemiology division of the Department of
Health will coordinate smallpox containment activities
through an expanded immunization program (30:37-38).
The project had a health education unit since the
start of the pilot project.
The health education unit was
involved in activities such as health education training
to the project staff, knowledge and attitude surveys about
smallpox and smallpox education to t:he public.
The cen-
tral health education section of the Department of Health
assisted the health education unit of the smallpox project
in carrying out the above-mentioned activities.
Tuberculosis control.
A tuberculosis sanatorium
was established in 1936 in Tokha locality of Kathmandu
valley.
Later in 1951, a Central Chest Clinic was estab-
lished in Kathmandu for providing treatment to tuberculosis
patients.
Then in 1964, HMG/Nepal, with the assistance of
WHO and UNICEF, initiated the Tuberculosis Control Project
in order to decrease the disease incidence and prevalence
in Nepal.
Activities carried out under this program are BCG
vaccination to new-borns and to children under fifteen
years of age, treatment of detected tuberculosis cases
and education of the general public about the disease.
Since the project does not have its own health
education unit, the central health education section has
16
been assisting this project with the needed health
education support.
Leprosy Control.
time immemorial.
Leprosy was known in Nepal since
With the objective of segregating lep-
rosy patients, HMG/Nepal established the first leprosarium
in Kathmandu valley approximately a hundred years ago.
About 25 years later, a second leprosarium was opened in
Syangja district, west of Kathmandu valley.
In 1934, the
Central Leprosy Clinic was established in Kathmandu in
order to provide modern treatment for leprosy patients.
HMG/Nepal started the Leprosy Control Pilot
Project in Kathmandu valley in 1963.
In 1967, the control
activities were expanded outside the valley.
1be main
activities of the control program are detection of cases
by conducting surveys, provision of treatment to detected
leprosy cases and health education of the public about the
disease.
In view of the adverse sociological impact of
the disease, the project has given much importance and
priority to its educational component.
The health education section of the Department of
Health provides all health education support to this project.
This includes health education training to project
personnel, planning and production of educational mateials and helping to organize workshops and seminars on
leprosy control activities.
17
Family Planning and Maternal and Child Health.
HMG/Nepal initiated this project in 1966 with the objectives of controlling population growth and ensuring safety
and security to children by providing various kinds of
services to married couples, mothers and children under
five years of age.
The International agencies that are
providing technical, financial and materials assistance
to this project are UNFPA, UNDP, WHO, USAID, and UNICEF.
Some of the obstacles to the family planning
program include:
rates, 2.
1.
high infant and child mortality
tradition that requires at least one or two
sons to be left alive for the security and the funeral
rites of their parents, 3.
the need for more manual
labour especially in rural areas where traditional agricul t.ural methods are still being practiced, and 4.
par-
ents could not accept family planning unless they were
assured of their child's safety and longevity.
Considering the magnitude of this problem, HMG/
Nepal created a semi-autonomous body called the Nepal
Family Planning and Maternal and Child Health Board.
This
board was expected to formulate plans and policies by
which family planning as well as maternal and child health
services could be provided in an integrated way.
The main activities of this project are:
1.
to
make available family planning services for married
couples, such as oral pill and condom distribution, IUD
18
insertion, and vasectomy and laparoscopy operations,
2.
to provide anti-natal and post-natal health care to
mothers, and 3.
to promote the health of children below
five years of age by providing services such as immunizations, nutrition supplements and health education to
mothers (1:7-9; 4:113; 27:2).
The FP/MCH project has its own health education
unit that carries out various health education activities
relating to family planning and maternal and child health.
However, the unit also works with the central health education section of the Department of Health in carrying
out its health education activities.
Integration and Community Health.
The provision
of minimum health care to the maximum number of people
throughout the country has been stated as the main objective of the long-term health plan (1975 - 1990) as well
as of the fifth five-year health plan (1975 - 1980) of
HMG/Nepal.
In order to attain this objective, more
community-oriented health services have to be delivered.
For this purpose, the integration of various health projects into one health project was felt to be more
economically practical for Nepal.
In order to determine the feasibility of this new
concept, HMG/Nepal established a division of Integration
and Community Health under the Department of Health in
19
1969.
Two pilot projects were launched, one in the mid-
mountain district of Kaski and the other in the Terai district of Bara.
After two years of studies in these two
districts, the integrated health project experiment was
expanded to four other districts.
The evaluation of these
pilot projects was conducted jointly by HMG/Nepal, WHO and
USAID in 1975.
The results of the evaluation showed that
the integrated health services approach was practical for
Nepa 1 ( 2 : 1- 3) •
Following this, the Division of Integration and
Community Health, with the assistance of WHO and USAID
developed a detailed scheme by which all health activities
of all vertical health projects would be integrated gradually in all of the seventy-five districts of Nepal.
Com-
munity health services were expanded gradually in accordance with the planned scheme by organizing existing
health posts, by establishing new health posts, by providing training for different categories of para-medical
workers and by gradually building up of the infrastructure of basic health services at health post, district, zonal, regional and national levels (2:1-3; 20:
2.4-25) •
A health post is a basic grass-root level unit of
the integrated community health services program.
It pro-
vides elementary curative, preventive and promotional services to rural people.
An ideal health post should be
20
staffed by four categories of para-medical workers which
are the health assistant or the senior auxiliary health
worker, the auxiliary health worker, the assistant-nursemidwife and the junior auxiliary health worker or the
village health worker.
All of these workers are required
to perform a significant proportion of health education
activities in their total job functions.
For example,
health education functions of the village health worker
constitute approximately seventy percent of his/her total
job requirements.
It is therefore, obvious that much
health education input is essential for the integrated
community health services in Nepal (18:3-6; 19:1-3).
The central health education section of the
Department of Health has been providing the necessary
health education support to this project since its beginning.
Some examples of this support are health education
training to various categories of para-medical workers;
planning and production of different educational materials; and mass education programs relating to the project.
Health Education.
In the context of the existing
social, cultural, educational and economic conditions of
Nepal, health education can contribute much to the solution of
~11
health problems, by not only disseminating
the relevant scientific health information to the general
public, but also by helping the public to help themselves
21
in adopting and/or continuing favourable health
practices.
Realizing the importance of health education,
HMG/Nepal, with the assistance of USAID, established the
Health Education section under the Department of Health
in 1961.
This section is the central organization for
health education in Nepal.
Goals for health education in Nepal have been
stated as follows:
1.
help people attain their optimum level of
health by favourably influencing their
health knowledge, attitudes and practices,
and
2.
make health education an integral part
of all school and community henlth
activities (23:4).
In order to attain the above-stated goals, the
health education section of the Department of Health has
been carrying out different health education activities
such as health education training and orientation programs
for various categories of health, education and social
workers; and individual, group and mass communication
activities.
The section also carries out specific educa-
tional campaigns in order to help prevent occasional outbreaks of certain communicable diseases in different parts
of Nepal.
In addition, the health education section has been
providing technical. guidance and educational materials to
22
various health projects as mentioned earlier under
individual projects.
The WHO health education assistance to Nepal,
started in 1967, has been a significant contribution to
the expansion of health education activities, especially
in the areas of school health education and health education training programs.
A health education project formulation
'~~'!as
and completed with the assistance of WHO in 1975.
started
The
purpose of this project formulation was to develop a comprehensive plan of operation for health education with
emphasis on health education manpower production within
the framework of the fifth five-year development plan.
The health education project so formulated has since been
an important basis for planning and implementing the
annual health education activities in Nepal.
Among the significant features of the health
education project are interfaces with various health and
health-related organizations--See page 23 for Interfaces
(1:15; 23:7)
0
One important function of this cooperation is
the health education training for the Master-level stutents of the National Development Service Program of
Tribhuban University.
INTERFACES
AND OTHER
INTERNATIONAL AGENCIES
- Consultants
- Fellowships
I•!HO,
MINISTRY OF HEALTH
VERTICAL HEALTH PROJECTS AND
DEPARTMENT OF HEAL T~j }-!~T_EG~ATION AND COMM. HEALTH SERVICES
- Ad,m. process
. / - Imp 1ementat.i on of he a1th educati en
- Supervi.sor
·
UNICEF~
f GOVERNMENT
AND
COMMERCIAL PRESS
- Media production
IMINISTRY
MINISTRY OF AGRICULTURE
- Nutrition education
- Rabies control
HEALTH EDUCATION
SECTION
I
OF EDUCATION
- School Health Education
planning and
impiementation
TRIBUHUBAN UNIVERSITY
Inst. of Medicine
Ir.st. of Education
- Training in Health Ed.
- Development of health
education manpower
~
l
il i~INISTRY OF COMMUNICATION
Radio Nepal
.
Information Department
and
il ZONAL HEALTH OFFICE
. DISTRICT HEALTH OFFICE
! HEALTH POST
.1
'
·
- Implementation of
health education
II
!MINISTRY
OF P/\NCHAY!!J
Health education training to
Pancha.~at worke~s .
- Commum ty orgam zat1 on
- Health educa·tion implementation
to-J
w
24
Manpower Production.
All medical doctors in Nepal
have been trained primarily in India.
Similarly, other
health workers such as health educators, public health
nurses, sanitarians and statisticians have received their
training abroad.
However, until 1972, the Department of Health had
been conducting different kinds of training programs and
producing a certain number of para-medical workersr such
as nurse, health assistant, auxiliary health worker,
assistant-nurse-midwife, laboratory technician and X-ray
technician.
After the introduction of the New Education
Plan in Nepal in 1972, the responsibility of training the
para-medical workers was taken over by the Institute of
Medicine, one of the several Institutes created under the
Tribhuban University.
Thus, since 1972, the Institute of Medicine has
been conducting qifferent vocational and certificate
levels of para-medical training programs.
The institute
has been expanding and improving its training programs to
fill the rising need of trained health manpower for Nepal.
As of August, 1978, the institute has been carrying out
different training programs in thirteen different campuses
scattered throughout the country.
The training programs currently being conducted
by the Institute of Medicine are as follows:
1.
tional courses in general nursing and mid-wifery
voca-
25
(assistant-nurse-midwife training), 2.
certificate
courses in general medicine (health assistant training},
and 3.
diploma courses in community medicine and mid-
wifery, which was started in August, 1978.
The opening of a diploma course in community
medicine is expected to solve the problem of physician
brain drain to a great extent, as physicians will be
trained inside the country itself.
Diploma level courses
in health education and environmental sanitation also are
planned for the near future.
A Brief Review of the Education System in Nepal.
Prior to 1970, the education system of Nepal was unrelated
to the aims and objectives of national plans.
The educa-
tional policies and objectives were not clear and welldefined.
As a
re~ult,
the education system produced
mainly the 'white collar' workers.
The increasing surplus
of young educated graduates, mostly with humanities
degrees, were being produced each year.
Besides, most of
these degree holders had negative attitudes about working
in rural areas of villages, where about ninety-six percent of the total population of Nepal were living (1:3;
16:3-7).
So, on the one hand there was the increasing
problem of unemployed educated personnel, while on the
other hand there was a serious shortage of skilled manpower
26
that possessed the positive attitudes needed for the
rural development of Nepal (12:15-17).
The elite public
was quite aware of the need for a relevant education systern for the country.
Recognizing this need, an eminent
educationist of Nepal stated:
Our experiences of the last two decades make
it clear that the nation-building process can
not be self-perpetuating unless our education
system and its processes are compatible with
the needs of national development and the
fundamental basis of national polity (13:1-2).
Various attempts were made to gradually replace
the then existing education system with a system relevant
for the country's development.
For example, HMG/Nepal
appointed the Nepal National Education Planning Conunission
in 1954, the Nepal All-round National Education Committee
in 1961 and the National Education Advisory Council in
1968.
After a number of studies and trials by t.hese
commissions, recommendations for drastic educational improvements were made to HMG/Nepal.
This led to the intro-
duction of the National Education System Plan {NESP) in
1971 {16:1).
The NESP is regarded as the blueprint for major
educational reforms in Nepal, because this plan visualizes
education as an investment in the human potential for the
development of the country rather. than just producing the
'white collar' workers.
This plan makes specific pro-
posals for restructuring the education system at all
27
levels, i.e., primary, secondary, high school and higher
education levels, with the main purpose of fulfilling the
manpower needs of the country's development--See Educational Structure on Page 28 {12:9).
The National Development Service Program.
Tribhuban University assumed various responsibilities for
bringing about reforms in higher education in Nepal under
the New Education Plan.
In this regard, the university
started a variety of measures, such as improving curricula,
introducing semester systems and modifying examination
procedures.
Among other responsibilities of the univers-
ity, planning and implementing the National Development
Service Program (NDS program) was considered no less
important.
Thus a National Development Service directorate
w~s
established under the jurisdiction of the university.
After a few years of planning and trials, the NDS program
was officially implemented for the firs·t time in 1974,
when the program was made a curriculum requirement for all
Master-level (Degree level) studies by the university.
The NESP originally had envisaged the NDS to be a requirement not only for Master-level studies but also for
Diploma-level studies of the university.
But the program
for Diploma-level studies has not yet been introduced
(9:11).
E 0 U C A T I 0 N A L
S T R U C T U R E
EIFICATE
Institute
Institute
Institute
Institute
Institute
Institute
Institute
Institute
GENERAL HIGH
SCHOOL
t!J ~J B
PRIMARY
[_!_L~
ID
SECONDARY
[~[~[_~_[?]
I
of
of
of
of
of
of
of
of
GIPT~~~1 ~~~~ ~E-S~ARCI~
Nepalese Studies
Asiatic Studies
Public Administration
Arts, Social Sciences and HumanitiesGeneral Sciences
Fine Arts
Business Administration and Commerce
Law
SANS. IIIGII SCII.
~Institute
-[~1 ~] [1~-'
VOCATIONAL
!IIG!I SCHOOL
-~l L~l ~l-
-·- - --- ·
~
Institute
Institute
' Institute
' Tnst.i. tute
Institute
Institute
I~~Institute
of Sankrit Studies
of
of
of
of
of
of
of
Agriculture
Forrestry
Medicine
Engineering
Applied Science and Technology
Education
Veterinary Sciences
(Source:
16:13)
N
(X)
29
The NDS program has become an integral part of
higher education in Nepal.
This program is regarded as
a manifestation of active student involvement with the
community to which students are assigned for a variety of
community activities.
This program has also provided stu-
dents with an opportunity for testing the relevance of
their academic knowledge.
The exposure to the rural con-
ditions for about a year can help students formulate their
own opinion and develop positive attitudes towards serving
in rural areas for the country's development.
Objectives of the NDS program are stated as
follows:
1.
to allow students to experience the
realities of the rural situation, thereby
making higher education broader in its
outlook and more practical, and attuned
to the real development needs of Nepal,
and
2.
to give students the opportunity to
help meet their country's development
needs during their academic careers
(8:3).
In order to achieve the above-mentioned
objectives, the NDS scheme requires that all Master-level
students spend one academic year (minimum of 300 days) in
rural areas, working as part-time teachers in local primary or secondary schools, and also as change agents for
a variety of general development tasks, such as agriculture extension, general construction works, water supply
30
schemes, reforestation, family planning and health
education (14:2-5).
The NDS scheme is wedged between the two regular
academic years prescribed for Master-level studies.
Stu-
dents participating in this program have been primarily
filling the shortage of teachers in rural schools.
In
addition to their primary teaching task, they have also
been actively involved in a wide range of developmental
activities mentioned above.
According to the NDS directorate, participating
students carry out a
nurr~er
of health education activities
depending upon health problems of rural communities to
which they are assigned.
These activities include:
1.
community organization for cleanliness, immunization,
mobile clinics and family planning services, 2.
zation of health fairs and exhibits, 3.
aid services, and 4.
organi-
elementary first-
general health education to village
people.
Statement of the Problem and Justification.
Under
the National Development Service (NDS) scheme, there is
provision for a month-long pre-service training and orientation program for all Master-level students.
The NDS
directorate is responsible for planning and implementing
the training program.
The main purpose of this pre-
service training is to provide students with the basic
31
knowledge about various on-going developmental activities
and with skills necessary for their effective performance
of developmental tasks that they are supposed to carry
out in rural areas.
The NDS handbook has stated the training
objectives as follows:
To make students capable of:
1.
2.
3.
4.
5.
providing class instruction to local
school children,
helping village people with basic skills
for improving agriculture,
helping village people in their general
construction activities,
providing health education to village
people for improving their health status,
and
helping village people in protecting and
preserving forests (14:5-6).
In order to attain the objectives of improving
the health status of village people, health education
training is included as one of the six major areas of the
total pre-service training program.
Six hours of instruc-
tion out of fifty-two hours of total training time, has
been set aside for health education training (15:7).
National Development Service students, after
adequate training in health education, can motivate people
and organize village communities for a variety of preventive and promotional health activities, such as environmental sanitation, water projects, nutrition and rehydration education and family planning.
So, the amount of
32
time set aside for health education training seems to be
inadequate and should be increased.
Nevertheless, the health education training is
being provided by medical doctors, nurses, health educators and sanitarians who are assigned by the NDS directorate.
But, due to the absence of a training guide,
health instructors can do no more than provide the health
education training in accordance with their own understanding and their own philosophy.
This might lead to an
irrelevant and inconsistent training in health education.
Thus there is great need for a health education
training guide that will help make the training program
more relevant to the needs of the community and more in
keeping with the principles of health education.
Purpose of the Project
The purpose of this project was to develop a
sound health education training guide for the NDS preservice training program.
It is the expectation of the
author that this training guide would help health instructors in better providing relevant health knowledge and
skills to students participating in the NDS program in
Nepal.
Limitation of the Project
This training guide is not intended to replace
the existing health education training component of the
33
total pre-service training program for the NDS
scheme.
However, this training guide could serve as an
alternative for providing health education training, if
it is properly implemented, evaluated, revised and updated periodically in accordance with the changing roles
and tasks of students under the NDS program.
Definitions of Terms
Antenatal - - - - The period before the delivery of a
child.
Ayurbedic - - - - An indigenous system of medicine.
Baidya
- - - The practitioner of ayurbedic medicine.
BCG vaccination - Bacillus Calmette-Guerin vaccination. The vaccination against Tuberculosis
named after its discoverers, Calmette
.and Guerin.
Endemic - - - - - The presence of a disease at any given
time in a population.
~idemic
- - - - The sudden and extensive prevalence of
a disease in a population.
Health Post - - - A grass-root level health institution
where there is the provision of elementary curative services as well as preventive and promotional services.
34
HMG/Nepal - - - - His Majesty's Government of Nepal.
Infant Mortality Rate - The rate calculated by dividing
the number of deaths of infants under
one year of age by total live-births in
a year and multiplied by one thousand.
IOE
- - - Institute of Education.
IOM
- Institute of Medicine.
IUD - - - -
- Intra-Uterine Device which is used for
preventing ovum fertilization and
implantation in the uterus.
Kabiraj - - - - - The practitioner of the indigenous
medicine, ayurbed and more qualified
than the Baidya.
Laparoscopy - - - A permanent surgical measure for women
in order to prevent ovum fertilization
in the uterus.
Literacy rate - - The ratio of number of people who can
read and write to those who can not
read and write in a given population.
Master-level student - Synonymous with .Degree-level (or
Graduate) student and refers to the
student who is enrolled in the Degree
or Master-level program.
NDS - - - - - - - National Development Service of
Tribhuban University.
35
NESP
- - - - - - National Education System Plan of
Nepal.
Panchayat - - - - A system of elected representatives to
the government comprising of the following four levels:
Panchayat, 2.
3.
1.
Village or City
District Panchayat,
Zonal Panchayat, and 4.
National
Panchayat.
Post-natal
Terai - - - -
- The period after the delivery of a child.
A thin strip of flat land along the
southern part of Nepal, bordering India.
UNDP
UNICEF
- - - - - - United Nations Development Program.
- - United Nations International Childrens
Emergency Fund.
UNFPA - - - - - - United Nations Fund for Population
Activities.
USAID - - - - - - United States Agency for International
Development.
Vasectomy - - - - A permanent surgical method for men in
order to prevent the passing of
spermatozoa to the female reproductive
organs during the process of sexual
intercourse.
36
Vertical Projects - A specific health project established
to control/eradicate a specific health
problem such as malaria, smallpox,
tuberculosis, leprosy and family
planning.
WHO - - - - - - - World Health Organization.
CHAPTER II
METHODOLOGY
This chapter includes the task analysis of NDS
students, identification of knowledge and skills of NDS
students, the process of developing the training guide,
implementation procedures, evaluation scheme and revision
and updating scheme.
Task Analysis of Students Working Under the NDS Program
In addition to the primary task of teaching in
local schools, each student is required to perform a wide
range of other activities.
(See Appendix A for detailed
activities to be performed by NDS students in rural areas.}
Health and health education activities to be carried out
by student have been vaguely stated in the NDS handbook.
However, they can be analyzed and grouped as follows:
1.
providing elementary first-aid measures to
local people.
2.
referring needy people to appropriate health
institutions for curative and preventive measures,
3.
educating and motivating people about
communicable diseases and their prevention, nutrition and rehydration, and family planning,
37
38
4.
organizing the community for water projects,
cleanliness campaigns, special health and family
planning camps, and
5.
establishing good inter-personal relationship
with village people.
These tasks will require knowledge relative to:
communicable diseases and their prevention, malnutrition
and dehydration problems, water and environmental sanitation problems, elementary first-aid measures, family
planning, health services organization in Nepal at different levels, meaning of health and health education,
opportunities for health education, methods and media in
health education, motivation, community organization and
the role of NDS students in helping solve health problems
Jn rural Nepal.
Since there will be separate family planning
training, this guide does not include the family planning
curriculum.
Identifying Knowledge and Skills
Knowledge and skills required by NDS students for
the effective performance of the above-mentioned health
and health education tasks are identified as follows:
1.
Knowledge about health problems and health
programs:
39
a.
communicable diseases and their prevention,
b.
malnutrition and dehydration problems,
c.
water and environmental sanitation problems,
d.
organization of health services to solve
health problems,
e.
elementary first-aid measures needed in
villages,
f.
role of the NDS student in helping solve
health problems.
2.
Knowledge about Health Education:
a.
points of view on health and health education,
b.
scope and opportunities for health education,
c.
communication in health education,
d.
techniques of motivation,
e.
ways of establishing rapport with village
people.
Developing a Health Education Training Guide
The proposed health education training guide has
been developed on the basis of health and health education
knowledge and skills required by NDS students in villages.
In so doing, the rationale for curriculum development as
suggested by Fodor and Dalis in Health Instruction Theory and Application was used.
the guide include:
The main features of
major topics, major concepts for each
topic, objectives for each concept, content for each
40
concept, learning opportunities for each objective and
evaluative criteria for each objective.
Development of Major Topics.
To fulfill the needs
of NDS students as well as of the country, major topics
were outlined from the analysis of students' job requirements in rural areas.
I.
These topics include:
Health Problem Areas
A.
Major health problems of Nepal
B.
Elemetary first aid
C.
Organization of health services in Nepal
D.
Role of NDS students in helping solve local
health problems
II.
Health Education Areas
A.
Points of view on health and health education
B.
Oppor;,tunities for health education
C.
Communication in health education
D.
Motivation techniques
E.
Community organization
Development of Concepts.
Concepts are to be used
for ordering and classifying specific knowledge and skills
that are to be emphasized in a topic.
Further, concepts
clarify the meaning of a particular content or topic and
serve as a basis for developing objectives, appropriate
learning opportunities, contents and evaluative criteria
(6: 303-304).
41
Concepts which are relevant to health and health
education tasks of NDS students have been developed for
each topic of the proposed training guide.
The following
criteria as recommended by Fodor and Dalis (7:29) were
considered:
A concept should be:
1.
a conceptual statement, not a topic or a word,
2.
in keeping with modern points of view on
health and health education,
3.
able to organize a body of knowledge under it,
4.
valid and can be substantiated,
5.
relevant to age group and culture, and
6.
non-directive or
non-presc~iptive.
Development of Objectives.
Properly stated
objectives are not only useful but essential for both
students and teachers.
They serve as guides to:
1.
the selection of specific content
2.
specific behaviors sought in the learner
3.
the selection of learning opportunities
4.
the evaluation of students as well as of
teachers (7:40-41).
Objectives have been developed for each concept.
These objectives have been stated in terms of knowledge
and skills to be attained by NDS students.
42
Development of Evaluative Criteria.
Specific
evaluative criteria for each objective also have been
developed.
These evaluative criteria will help assess
the minimum student performance level to be attained for
each objective.
Selection of Content.
The proposed health
education training guide contains an outline of specific
content for each concept and objective.
The content out-
line provides the scope of knowledge required to attain
specified objectives.
Development of Learning Opportunities.
Learning
opportunities are a means to achieve the state objectives
of the training program.
In order to actively involve
NDS students in the teaching-learning situation, a variety
of learning opportunities have been chosen and developed.
Activities to be performed by NDS students as well as by
health instructors have been specified.
While developing learning opportunities,
consideration was also given to the availability of
training time and space, and the availability and feasibility of training materials and equipment.
The Implementation Scheme
It is expected that the proposed health education
training guide will be implemented during the pre-service
43
training program for NDS students.
The following
specific procedures have been taken into account for
implementing this guide:
Administrative Support and Clearance.
The NDS
directorate of the Tribhuban University is responsible
for all aspects of the total NDS training program, such
as planning, coordinating, implementing, financing and
evaluating the training.
So, the proposed training guide
will be presented to the NDS directorate in order to
receive clearance as well as the administrative and
financial support required for implementing it.
It is suggested that the central health education
section of the Department of Health wi'll initiate the
process for administrative clearance from the NDS directorate and it will also play a key role in the formation
of a Health Education Curriculum Comrnittee for this
t.:raining in health education for the NDS program.
Health Education Curriculum Committee.
It is
suggested ·that a Health Education Curriculum Committee be
formed under the NDS directorate.
This committee will be
made responsible for establishing contacts and seeking
cooperation with the concerned institutes of the university as well as with the concerned ministries and departments of HMG/Nepal for the purpose of identifying training
resources in general and health instructors in particular.
44
In addition, the committee will also be made responsible
for drawing a detailed training schedule, and implementing, evaluating, revising and updating the training guide.
It will be recommended that the health education
curriculum committee consist of the representatives from
the following agencies:
1.
NDS directorate, Tribhuban University,
2.
Institute of Medicine, Tribhuban University,
3.
Curriculum Development Center, Tribhuban
University,
4.
Curriculum Development Center, Ministry of
Education, HMG/Nepal,
5.
Higher Education Division, Ministry of
Education, HMG/Nepal,
6.
Health Education Section, Department of
Health, HMG/Nepal, and
7.
WHO, UNICEF and other International agencies
interested in this training program.
Health Instructors' Workshops.
The curriculum
committee will identify various health instructors, such
as physicians, public health nurses, sanitarians, health
educators and other health workers from different agencies.
A two-day orientation workshop of these health
workers who are designated as heal·th instructors will be
organized one week prior to the start of the NDS training
45
program.
This orientation workshop will have the
following two main purposes:
1.
Orientation of health instructors to the rationale
of health instruction used in the guide.
2.
Development of a detailed training schedule.
Immediately after the actual training program,
health instructors will meet again for a day for the purpose of evaluating the training program.
They will iden-
tify strengths and weaknesses of each component of the
training program, such as the rationale used, the instructors' performance and the NDS studentsv achievements.
Physical Facilities and Training Materials.
As
the number of students is increasing each year, so is the
problem of seeking physical facilities for the NDS preservice training program.
For example, the nurooer of stu-
dents in the year, 1975/76 was 433 which was just 211 a
year ago (21:8-9).
Thus, the NDS directorate must find more classroom
space each year in different schools, colleges and other
institutions.
Because of the large number, students have
to be divided into several groups, all of which will be
simultaneously undergoing the training.
The health education curriculum committee will
be responsible for assigning as many health instructors
as there are groups.
46
In addition, the committee will identify and
make available relevant training materials, such as books,
reports, pamphlets and periodicals from different sources.
The Health Education Training.
The actual health
education training will be provided to NDS students by
health instructors after they have taken part in the orientation program.
The purpose of the health education
training, as mentioned earlier, is to develop health
knowledge and skills in NDS students so as to enable them
to carry out health and health education tasks more effectively in villages.
The timing for the health education training will
be corr®ensurate with the total training schedule set up
by the NDS directorate.
It is suggested that the health education
curriculum committee recommend that the current six hours'
time set aside for health education training be increased
to a minimum of twenty hours.
This twenty hours of
training time will be utilized as follows:
I.
Health Problem Areas
A.
Major Health Problems:
1. communicable diseases and their
prevention - - - - - - - - - 2 hrs.
2. malnutrition and dehydration - - - 2~ hrs.
3. water and sanitation - - - - 2 hrs.
4. personal hygiene - - - - - - 1 hr.
B.
Elementary First Aid -
C.
Organization of Health Services
- - - - 3 hrs.
- - -
1~
hrs.
47
D.
Role of NDS students in helping
solve health problems - - - - - - - - 1 hr.
II.
Health Education Areas
A.
Points of view on Health and
Health Education
- - - - - - - - - - 2 hrs.
B.
Opportunities for Health Education
C.
Communication in Health Education - - 1 hr.
D.
Motivation techniques -
-
E.
Community Organization
- - - - - 2 hrs.
-
-
Total Time:
- 1 hr.
-
-
1 hr.
- 20 hours
The Evaluation Scheme
Evaluation involves a series
~f
activities that
determine the effectiveness of a training program as well
as help improve the future training.
Further, it should
be regarded as a continuous process and an integral part
of a training program rather than as a terminal evaluation
usually done at the end of a training program (7:108).
The main purpose of evaluating this health
education training will be to determine the strengths and
weaknesses of its various components.
Thus the evaluation
scheme will include the evaluation of different aspects
of the training program, such as NDS students' achievements, health instructors' competencies and different
components of the training guide.
48
Evaluation will be performed during the training
period as well as during the health education task performance of NDS students in rural areas.
Evaluation during the
1.
~raining
Program.
Evaluation of NDS Students.
Health
instructors will evaluate students before,
during and after the training as follows:
a.
Pre-test.
The health instructor will
administer a pre-test questionnaire just
before the training program in order to
determine existing health and health education knowledge of students.
This will
I
help health instructors to
g~ar
the
training to the needs of students.
b.
Test During Instruction.
Health
instructors will use oral tests during
instruction in order to determine if students are progressing in accordance with
the objectives of the training program.
This will also help health instructors
make proper modifications during the
training period, if necessary.
c.
Post-test.
At the end of the training
program, health instructors will administer the same pre-test questionnaire that
49
was used in the beginning of the training.
The purpose of this test is to determine
to what extent NDS students have attained
the objectives of the training program.
Test results will show how effective the
training program had been and how future
training programs could be improved.
2.
Evaluation of Health Instructors.
The
constant feedback received from students
before, during and after the training will
not only help health instructors in evaluating themselves but also will serve as a basis
for improving future training programs.
For
this purpose, health instructors will prepare
and administer a separate questionnaire just
after the Post-test.
Such a questionnaire
should contain question items relating to the
competencies of health instructors, duration
and organization of the training program, and
comments and suggestions for improving future
training programs.
3.
Evaluation of the T.raining Guide.
The health
education curriculum committee will devise
means_ by which different components of the
training guide could be evaluated periodically.
The content or the topic will be
50
evaluated in order to make it valid, up-todate and in keeping with prevailing health
problems of the country.
Objectives will be
evaluated in terms of accuracy, feasibility
and consistency.
Similarly, learning oppor-
tunities and evaluative criteria will also be
evaluated in order to determine if they effectively quantify knowledge and skills to be
attained by NDS students.
Evaluation During the Task Performance of NDS
S-tudents in Villages.
One important basis for determin-
ing the effectiveness of the health education training
program is the capability of NDS students to effectively
carry out the required health and health education activities in villages.
The education supervisor of the dis-
trict in which the student is assigned to work, the headmaster of the school to which he/she is assigned to teach
and the local panchayat leaders will observe health and
health education activities of the student.
The headmas-
ter will keep appropriate records of these activities.
Periodic visits by the NDS instructor and local
health workers will help measure the students' performance.
Students' efficiency will be determined on the
basis of their ability to organize the community for
different projects, such as water and sanitation project,
51
family planning campaigns, mobile health camps,
cleanliness campaign and campaigns for preventing communicable diseases in the community.
The health education curr·iculum committee will
devise an appropriate health education evaluation component to be included in the total evaluation form which is
sent to the district education supervisor and the local
school headmaster who will fill out the evaluation form
and send it to the NDS directorate at the end
program in the village.
o~
students'
This will help identify strengths
and weaknesses of students in carrying out health education tasks in villages.
The Revision and Updating Scheme
The proposed training guide should be
periodically revised and updated in order to keep up
with the changing roles and tasks of NDS students in
rural Nepal.
It is suggested that the health education
curriculum committee meet once a year one month before
the start of the NDS training program.
Based upon pre-
vious evaluations the committee will determine if
revisions relative to topics, concepts, objectives,
evaluative criteria, content and learning opportunities
are needed.
52
The curriculum committee will make the necessary
revision on the guide on the basis of the following
criteria:
1.
The Results of Pre- and Post-test.
The results
of the analysis of pre- and post-test knowledge
tests will be utilized for the revision of any of
the training components and change in time allocation for a particular topic.
2.
The Performance Reports of NDS Students.
Reports
of students' involvement in health and health education activities in villages will be coilectea
from the district education office, the school
and the instructor's field visit report, and
analyzed.
The result of the analysis will deter-
mine strengths and weaknesses of students in performing the assigned health education tasks.
Where necessary, revisions in the training guide
will be made.
3.
Changes in Health and Health Education '.i'asks and
Roles of NDS Students.
The health education cur-
riculum committee will review morbidity and mortality data in order to determine if there are
changing patterns of communicable diseases and
other health problems.
As changes occur, the
guide will be modified accordingly.
CHAPTER III
PROPOSED TRAINING GUIDE
This chapter contains the proposed health
education training guide for the NOS program in Nepal.
The guide has been divided into two main areas:
Health Problem Areas, and II.
I.
Health Education Areas.
These have further been broken down into different topics.
Follo"Vling each topic are related concepts, objectives,
evaluative criteria, suggested content outline and suggested learning opportunities.
53
TOPIC OUTLINE OF THE GUIDE
Page
I.
HEALTH PROBLEM AREAS
A.
1.
B.
c.
D.
II.
.......
Major Health Problems
55
Communicable Diseases and Their
Prevention . . . .
55
2.
Malnutrition and Dehydration
58
3.
Water and Sanitation
63
4.
Personal Hygiene
67
Elementary First Aid
69
1.
Preventing Accidents
69
2.
Temporary First Aid Care
71
Organization of Health Services .
75
1.
75
Utilizing Community Organizations . . .
Health Role of NDS Students .
80
1.
80
Solving Health Problems .
82
HEALTH EDUCATION AREAS
A.
Points of View on Health and Health
Education
82
B.
Providing Opportunities for Health
Education
84
c.
D.
E.
. . .. . .
....
.... ...
...
Conununication in Health Education
...
Motivation in Health Education . . . . . .
Community Organization . . . . . . . . . .
. .
54
...
86
88
90
I.
A.
HEALTH PROBLEM AREAS
Major Health Problems
Topic 1:
Communicable Diseases and Their Prevention
Concept:
Scientific knowledge and understanding about communicable diseases
prevalent in Nepal can help NDS students to better educate people about
preventing these diseases.
Objectives:
Following instruction, the student will be able to:
1.
2.
3.
List important communicable diseases prevalent in Nepal.
Classify communicable diseases in accordance with their mode of
transmission, such as air-borne, food- and water-borne and insectand animal-borne diseases.
Discuss simple precautions that villagers can take for preventing
common communicable diseases.
Evaluative Criteria:
1.
2.
3.
The objective will be considered met when the student can:
List ten communicable diseases prevalent in Nepal.
Classify the identified ten communicable diseases correctly in the
three categories: a. air-borne diseases, b. food- and water-borne
diseases, and c. insect- and animal-borne diseases.
List and explain three main precautions to be taken for the
prevention of communicable diseases.
Suggested Content Outline
1.
Communicable diseases classification
according to the media of transmission:
a. air-borne diseases: smallpox,
S~ggested
1.
Learning Opportunities
The health instructor will give a
lecture on the nature and causes
of important communicable diseases
U1
U1
Topic 1:
Communicable Diseases and Their Prevention (Continued)
Suggested Content Outline
b.
c.
2.
3.
mumps, chickenpox, influenza
and common cold.
water- and food-borne diseases:
cholera, typhoid, dysentery,
diarrhea, infectious hepatitis
and worms.
insect- and animal-borne diseases:
malaria, filaria, rabies and
typhus fever.
Causes and Sources of Communicable
Diseases:
a. Causative organism:
i. bacteria
ii. ricketsia
iii. virus
b. Sources of infection:
i. infected persons
ii. infected animals
iii. contaminated water
iv. contaminated food
Preventive measures against
communicable diseases:
a. Healthful practices
b. Sanitary environment
c.
Immunizations
Suggested Learning Opportunities
that are common in Nepal. Then he
will explain the mode of transmission of communicable diseases with
the help of a chart that explains
the disease transmission cycle.
2.
Later, the instructor, with the
help of students, will list the
names of communicable diseases
common in Nepal and group them ac-:cording to their media of transmission on the chalkboard.
3.
Students will be assigned to study
different pamphlets and booklets
about prevalent communicable diseases in Nepal.
4.
The instructor will divide the
class into three groups, each of
which will discuss and make a list
of preventive activities concerning
the following:
a. healthful practices
b. sanitary environment
c. immunizations
Each group will then present their
report to the class. The
U1
m
Topic 1:
Communicable Diseases and Their ·preve·ntiol1 (Continued)
Suggested Content Outline
Suggested Learning Opportunities
instructor will suiTmarize the main
points of group reports.
lJ1
-..J
Topic 2 :
Malnutrition and Dehydra-t:_ion
Concept 1:
There are a number of things which can be done to help prevent
malnutrition in Nepal.
Objectives:
Following instruction, the student will be able to:
1.
2.
3.
4.
5.
6.
State the meaning of malnutrition and describe its cause with
reference to Nepal.
List the four basic foods and identify the important nutrients found
in each food group.
State the functions of nutrients found in each food group.
State unhealthful eating patterns of people in Nepal.
Suggest ways of selecting and utilizing available foods which are
nutritionally sound.
State the reasons why breast-feeding is important.
Evaluative Criteria:
1.
2.
3.
4.
5.
6.
The objective will be considered met when the student can:
State the precise meaning of malnutrition as defined in class and
list the three main causes of malnutrition.
List the four basic foods and name at leastone important nutrient
in each.
State two functions of each nutrient identified.
State three Nepalese food eating patterns that have negative impact
on health.
Give two reasons why a variety of food is required daily and why
pregnant and lactating mothers need more variety.
List two reasons for breast-feeding infants till the age of at
least two years.
l11
0)
Topic 2:
Malnutrition and Dehydration (Continued)
Suggested Content Outline
1.
The meaning of malnutrition
a. Under-nutrition: Low intake
of calorie, protein and vitamins
b. Over-nutrition: over-eating
2.
Causes of malnutrition
a. Faulty eating patterns due to:
i. eating habits
ii. socio-economic factors
iii.
food fads
b. Faulty cooking methods
c. Poor food hygiene
3.
Food Groups
a~
Nutrients in food groups:
i. milk products contain
protein, vitamins and
minerals
ii. meats contain protein,
vitamins and minerals
iii.
fruits and vegetables
contain vitamins and
minerals
iv. cereals and grains contain
carbohydrates and vitamins,
and beans and legumes are good
sources of proteins.
b. Functions of nutrients:
i. proteins for growth and repairs
of body cells
Suggested Learning Opportunities
1.
The health instructor will explain
the meaning of malnutrition, emphasizing the point that undernutrition is a major problem in
Nepal. He/She will also explain
the causes of malnutrition and
identify different nutrients in·
the four basic foods and their
functions.
2.
The instructor will divide the
class into four groups and assign
them as follows:
Group A:
list and classify local
foods into four basic
food groups.
Group B:
select a variety of foods
that will make a nutritionally sound diet.
Group C:
list healthful and
unhealthful patterns of
eating in Nepal.
Group D:
list the reasons for
breast-feeding infants
till the age of at least
two years.
U1
\.0
Topic 2:
Malnutrition and Dehydration (Continued)
Suggested Content Outline
ii.
iii.
iv.
4.
carbohydrates for heat and
energy
vitamins for protection
against diseases and body
metabolism
minerals for growth and
metabolism.
Suggested Learning Opportunities
After the discussion, each group
will report to the class.
The instructor will then summarize
the main points discussed by each
group.
Proper selection and use of available
foods:
a. Daily consumption of a variety
of foods
b. More variety for pregnant and
lactating mothers
c.
Importance of breast-feeding
infants till the age of at least
two years for
i. protection of the child
against diseases
ii. affection between the mother
and the child.
0"1
0
Topic 2:
Malnut·ri tion and Dehydration (Continued)
Concept 2:
A simple home-made rehydration solution can save people from dehydration
resulting from excessive diarrhea.
Objectives:
Following instruction, the student will be able to:
1.
2.
3.
State what is meant by dehydration.
List the common symptoms of dehydration.
Explain the proper method of preparing and feeding the home-made
rehydration solution.
Evaluative Criteria:
1.
2.
3.
The objective will be considered met when the student can:
State the meaning of dehydration as defined in class.
List five common symptoms of dehydration.
Give specific directives for preparing and feeding the home-made
rehydration solution with 100% accuracy.
Suggested Learning Opportunities
Suggested Content Outline
.1.
2.
The meaning of dehydration
a. Loss of water from the body
b. Drying up and death of body
cells
Common symptoms of dehydration
a. Dry lips and dry skin
b. Constricted eyes
c. Dilation of pupils
d. Lack of strength
e. Craving for water
1.
The health instructor will give a
mini-lecture about the meaning, the
common symptoms and the severity of
the dehydration problem especially
among children under five years of
age in Nepal.
2.
Following this, the instructor will
show the class how the rehydration
solution is prepared, administered
and stored properly.
0'\
1-'
Topic 2:
Malnutrition and Dehydration (Continued)
Suggested Content Outline
3.
4.
Simple home-made rehydration solution
a.
Two cups of boiled water
b. A pinch of salt
c.
If available, a pinch of caustic
soda and one teaspoonful of sugar
or honey or two teaspoonful of
glucose.
Administration of rehydration
solution:
frequent oral feeding
of the solution in proportion to
the amount of fluid lost from the
body of victim.
Suggested !.earning Opportunities
3.
Selected students will then
demonstrate the correct method of
preparing and administering as well
as storing the rehydration solution.
4.
The instructor will critique the
demonstrations asking the class to
help identify strengths and
weaknesses.
0'\
1:\)
Topic 3:
Water and Sanitation
Concept 1:
One can take a variety of measures in order to help prevent communicable
diseases caused by unsafe water.
Objectives:
Following instruction, the student will be able to:
1.
2.
3.
Identify different sources of water and state simple methods of
making water safe.
List the names of communicable diseases that can be prevented by
properly utilizing safe water.
Suggest ways of properly utilizing safe water at home.
Evaluative Criteria:
1.
2.
3.
The objective will be considered met when the student can:
List five sources of water. and two simple methods of making water
safe.
List the names of six communicable diseases preventable by the
proper utilization of safe water.
Correctly explain to class two ways of properly utilizing safe
water at home.
Suggested Learning Opportunities
Sugges·ted Content Outline
1.
Sources of water: river, spring,
well,· pond, lake and rain
2.
Communicable diseases caused by
unsafe water: cholera, typhoid,
diarrhea, dysentery, worm
infestations and infectious
hepatitis
1.
The health instructor will give a
mini-lecture on the sources of
water and the importance of safe
water. Using posters, the instructor will also explain simple
methods of making water safe at
horne, by boiling and filtering.
0'\
w
Topic 3:
Water and Sanitation (Continued}
Suggested Content Outline
Suggested Learning Opportunities
3.
How to make water safe
a. Boiling
b. Filtering
2.
Students will complete a list of
communicable diseases caused by
unsafe water on the chalkboard.
4.
How to utilize water properly
a. Covering the water jar or
vessel with lid
b. Using clean cups or glasses
3.
Selected students will play roles
of teaching villagers how to make
water safe and how to utilize
water properly.
4.
This will be followed by a
discussion of the correct and
incorrect procedures used.
m
.r:a
Topic 3:
Concept 2:
Objectives.:
Wat·er and Sanitation (Continued}
·A number of things can be done to help improve general sanitary
conditions in villages.
Following instruction, the student will be able to:
1.
2.
3.
4.
List simple methods of sewage and garbage disposal in villages.
State different types of latrines that can be utilized in villages.
Explain how to construct different types of latrines using
materials that are locally available.
Explain appropriate measures to be taken in the use and maintenance
of latrines.
Evaluative Criteria:
1.
2.
3.
4.
The objective will be considered met when the student can:
List two simple methods of sewage and garbage disposal in villages.
Write the names of four types of latrines that can be built in
villages.
Explain to class how to construct a soakpit and two other types of
latrines in villages, with 100% accuracy.
Explain two correct ways of utilizing and maintaining latrines in
villages.
Suggested Learning Opportunities
Suggested Content Outline
1.
Sewage and garbage disposal
a.
Soakpit
b. Proper collection of wastes
and its disposal
2.
Types of latrines
a. Pit privy
1.
The health
lecture on
methods·of
posal, and
latrines.
instructor will give a
the importance and
sewage and garbage disdifferent types of
0'\
U1
Topic 3:
~ater
and Sanitation (Continued)
Suggested Learning Opportunities
Suggested Content Outline
b.
c.
d.
3.
4.
Bucket type of latrine
Safety tanks
Trench latrine
Construction of different types
of latrines by:
a. Utilizing available local
materials
b. Utilizing local manpower
c. Using simple but scientific
techniques
2.
The instructor will explain the
method of construction of a soakpit and different types of latrines
with the help of diagrams.
3.
Students will then be divided into
three groups:
Group A will explain how to
construct a soakpit and how to
dispose wastes and garbage
properly.
Appropriate use and maintenance
of latrines by:
a. Flushing or covering the
latrine commode with lid
after each use
b. Cleaning the latrine
regularly
Group B will explain how to
construct a simple latrine in a
typical Nepalese village.
Group C will explain the
importance of and measures to be
taken for the proper use and
maintenance of latrines.
4.
Following the group reports,
the instructor and students will
critique the reports of each group.
0'1
0'\
Topic 4:
Personal Hygiene
Concept:
Sin~le
Objectives:
Following instruction, the student will be able to:
1.
2.
3.
List and .explain the reasons for practicing good personal hygiene
habits.
Correctly state the importance of rest and sleep.
Explain the correct ways of:
a. Taking care of different parts of body
b. Good body posture
c. Clothing
Evaluative Criteria:
1.
2.
3.
personal hygiene practices can help people maintain good health.
The objective will be considered met when the student can:
List and explain four reasons for practicing personal hygiene.
Explain two reasons why people need rest and sleep.
Demonstrate with 100% accuracy:
a. Correct ways of taking care of eyes, ears, face, teeth, hands,
feet and hair
b. Good body posture
Suggested Conten·t Outline
1.
2.
Reasons for practicing good
personal hygiene:
a. Health
b. Social
c. Aesthetics
d. Psychological
Rest and sleep for:
Suggested Learning Opportunities
1.
The health instructor will conduct
a lecture-discussion session on
the reasons for good personal
hygiene.
2.
Students will be asked to explain
some of their daily health
practices.
"'
-...I
Topic 4:
Personal Hygiene (Continued}
Suggested Learning Opportunities
Suggested Content Outline
a.
b.
3.
Physical relaxation
Mental relaxation
Personal hygiene practices:
Taking care of:
a. Eyes, ears, face, teeth,
hands, feet and hair
b. Good body posture
c. Clothing: cleanliness
and fitting
3.
Selected students will then explain
how people can take care of different parts of their body, such as
eyes, ears, face, teeth, hands,
feet and hair.
4.
The instructor will summarize the
discussion at the end of class.
0'1
CXl
0:
B.
Elementa·ry First Aid
Topic 1:
Preventing Aceidents
Concept:
One can help prevent accidents by following simple precautions.
Objectives:
Following instruction, the student will be able to:
1.
2.
List and describe different accidents that may occur at home and in
the community.
Suggest simple precautions for preventing accidents at home and in
the community.
Evaluative Criteria:
1.
2.
The objective will be considered me·t when the student can:
List and describe three kinds of accidents that may occur each at
home and in the community.
Explain to class simple precautionary measures to be taken while
working at home and while crossing roads, rivers and forests.
Suggested Learning Opportunities
Suggested Content Outline
1.
Kinds of accidents
a. At home:
cuts and bruises, burns, falls,
chemical poisoning and
unconsciousness
b.
In the community:
cuts and bruises, drowning,
snake-bites and insect-bites,
falls and vehicular accidents
and unconsciousness
1.
The health instructor will give a
mini-lecture on the kinds of accidents and their causes both at
home and in the community.
2.
Then students will complete lists
of the kinds of accidents that may
occur at home and in the community.
0\
1.0
Topic 1:
Preventing Accidents (Continued)
Suggested Content Outline
2.
Causes of accidents
a. Disobeying safety rules
b. Carelessness
c. Over-confidence
3.
Precautionary measures
a. Obeying safety rules
b. Being careful and patient
?uggested Learning Opportunities
3.
Each student will be assigned to
write a one-page report suggesting
specific precautionary measures to
be taken while working at home.
Students also will be assigned to
write another page report on the
precautions to be taken while
crossing roads, rivers and forests.
4.
Selected students will read their
papers in class. The instructor
will conduct a class discussion on
the papers presented.
-..1
0
Topic 2:
Temporary First Aid Care
Concept:
Providing immediate and tempnrary first. aid care to an injured or a sick
person can save his/her life.
Objectives:
Following instruction, the student will be able to:
1.
2.
Name and explain preliminary first aid measures to be taken.
Demonstrate first aid measures to be provided to victims suffering
from each of the following: cuts and bruises, insect- and snakebites, burns, unconsciousness, falls and vehicular accidents.
Evaluative Criteria:
1.
2.
The objective will be considered met when the student can:
List and explain correctly three preliminary first aid measures to
be taken.
Demonstrate with 100% accuracy how first aid measures are provided
to a victim suffering from: a. cuts and bruises, b. insect- and
snake-bites, c. burns, d. unconsciousness, and e.
falls and
vehicular accidents.
Sugqested Learning Opportunities
Suggested Content Outline
1.
Preliminary first aid measures
a. Talking to the victim, laying
him/her in easy and comfortable
position, and comforting him/her
b. Feel pulse, respiration and
heart beat
c. Observe the following:
bleeding site (if bleeding),
respiration, skin and face
colour, eye condition and
possible fractures
1.
The health instructor will start a
lecture-discussion session by explaining the preliminary first aid
measures to be taken when coming
upon a victim.
2.
Following this, the instructor
will demonstrate first aid measures that should be given for each
of the following cases: a. cuts
and bruises, b. insect- and
-...J
~
Topic 2.:
2.
Temporary First Ai'd Care (Continued)
Sugges·ted Content Outline
Suggested Learning Opportunities
Actual first aid measures
a.
Cuts and bruises:
i. stopping bleeding and
covering the wound
b.
Insect- and snake-bites
i. reducing the poison by
sucking the blood out or
by making a small incision
near the bitten site
ii. applying a constriction band
few inches above the wound
to slow the blood flow
between wound and heart
c. Burns
i. cool the burnt area with
ice or cold water
ii. cover the area with a clean
sheet of cloth to prevent
infection.
iii.
in case of severe burns, do
not clean the burn, break
blisters or do anything but
give the victim enough water
or fluids
d. Unconsciousness
Place the victim flat on back on
a hard suface and follow the
following procedure:
snake-bits, c. burns,
d. unconsciousness, and e.
and vehicular accidents.
falls
The instructor will also explain
that the victim should be taken to
the nearest health facility as
early as possible after the administration of first aid.
3.
4.
Students will then be divided into
five groups, each of which will
discuss and practice the different
first aid measures as follows:
Group A:
cuts and bruises.
Group B:
insect and snake bites.
Group C:
burns.
Group D:
unconsciousness.
Group E:
falls and vehicular
accidents.
Selected students from each qroup
will demonstrate to class the
first aid measures to be taken for
the cases assigned to the group.
......
(\.)
Topic 2:
Temporary First Aid Care (Continued)
Suggested Content Outline
i.
if unconscious, open
airway by neck lift and head
tilt or chin lift and head
tilt
ii.
if not breathing, provide
artificial breathing. Give
four quick full breaths mouth
to mouth.
If airway is
blocked, try back blows,
abdominal or chest thrusts
and finger probe in mouth
until airway is open.
iii. check carotid pulse
iv. if carotid is absent, begin
artificial circulation by
depressing sternum 1-1/2 to
2 inches 15 times and then
two quick breaths. Keep
repeating this until the
victim is taken to the nearby
health facility.
e. Fall and vehicular accidents:
i.
look for possible fractures
ii.
if there is a fracture,
immobilize the fractured bone
by splinting.
(Splinting is
putting stiff padded board or.
flat wooden pieces above and
below the injured bone and
Suggested Learning Opportunities
5.
The instructors and students will
critique demonstrations at the end
of the class.
.._J
w
Topic 2_:
Tero:po·.rary First Aid Care (Continued)
Suggested Content Outline
Suggested Learning Opportunities
tying
them together so
that the fractured bone can
not move.)
-...J
A:oo
c.
Organization of Health Services
Topic:
Utilizing Health and Health-related Community Organizations
Concept:
Knowledge and understanding about the structure and function of health
delivery system will help NDS students effectively carry out their
health education tasks.
Objectives:
Following instruction, the student will be able to:
1.
2.
3.
Identify and list different health and health~related government
and voluntary organizations which are active down to the village
level.
State the functions of each of thP. organizations identified in
objective 1.
Identify the health institutions at different levels of the
Ministry of Health.
Evaluative Criteria:
1.
2.
3.
The objective will be cons:idered met when the student can:
Name six important health projects of the Ministry of Health, HMG/
Nepal, two health-related government organizations and three healthrelated voluntary organizations.
State the two main functions of each of the health pro~ects and one
function of each of the health related organizations mentioned in
1 above.
List one institution in each of the four levels of organization
under the Ministry of Health, HMG/Nepal.
.......
01
Topic:
Utilizing Health and Health-related Community Organizations (Continued)
Suggested Content Outline
1.
Important Health Projects of
Ministry of Health, HMG/Nepal,
and their main functions
a. Malaria Eradication Project:
i.
spray1ng of insect1c1des
ii. collection of blood slides
1ii. treatment of malaria cases
b. Family Planning and MCH Project:
i. ante-natal and post-natal
services
ii. nutritional supplements and
immunization to children
iii.
family planning services
to couples
iv.
information, motivation and
education
c. Tuberculosis Control Project:
i. BCG vaccinations
ii. treatment of tuberculosis
cases
d. Leprosy Control Project:
1. detect1on of cases by
conducting surveys
ii. treatment of leprosy cases
1ii. education about leprosy
e.
Integrated Community Health
Project:
i. elementary curative services
to people
Suggested Learning Opportunities
1.
The health instructor will deliver
a lecture on the kinds, functions
and distribution of various levels
of the government health services
in Nepal, with the help of an
organization chart of the Ministry
of Health, HMG/Nepal.
2.
Students will be asked to identify
other non-health government and
non-government organizations
interested in health activities
and their functions.
They will
also discuss ways of utilizing
these functions in the NDS
students' tasks in villages.
3.
Students will be assigned to write
a two-page report of how they
should utilize these organizations
in carrying out their health and
health education tasks in villages.
4.
Students will also be required to
write a one-page report on how an
NDS student should work with local
school teacher and children with
regard to improving various aspects
of the school health program.
-..,)
0'1
Topic:
Utilizing Health and Health-related Community Organizations {Continued)
Suggested Content Outline
ii.
iii.
preventive health services
health education and nutrition
education
f. Health Education Project:
i. health education training
ii.
individual, group and mass
educational activities
2.
Organization of Ministry of Health,
HMG/Nepal
a. National level: department of
health and various health projects
b.
Zonal level: zonal health office
and zonal hospitals
c. District level: district health
office and district hospitals
d. Village level: health post and
health center
3.
Other government organizations
interested in health
a. Department of Local Development:
i. rural water supply projects
b. Department of Drinking Water and
Sewerage
i. urban water supply projects
ii. urban sewerage projects
c. Ministry of Education:
Suggested Learning Opportunities
5.
Selected students will present
their report to the class in which
the instructor and other students ·
will make critiques.
'"''"'
~epic:
Utilizing Health and Health-related or·ganizations (Continued)
Suggested Content Outline
Suggested Learning Opportunities
i.
school health education
workshops and seminars
ii. health education training
to teachers
iii. curriculum development in
health education
iv. extra-curricular activities
in local schools
d. Ministry of Agriculture:
i. nutrition education
ii. rabies control
e. Ministry of Communication:
i. media production and
utilization
f. Ministry of Panchayat:
i. health education training
ii. community organization
4.
Tribhuban University
a. NDS Directorate:
i. health education training
to students participating
in the NDS program
b.
Institute of Education:
i. health education training
to teachers
c.
Institute of Medicine:
i. training of health workers
in health education
....J
co
Utilizing
rl'2E_iC:
~ealth
and Health-related Organizations· (Continued}
Suggested Content Outline
ii.
5.
Sug9ested Learning Opportunities
health education manpower
production
Non-government organizations
a.
Nepal Red Cross
b. The Paropakar (An
philanthropic organization)
c. Nepal Tuberculosis Association
d. Nepal Junior Chamber
e. Town and City Panchayats
f. Women's Organization
f.
Children's Organization
-...1
\0
D.
Health Role of NDS Students
Topic_:
Helping Solve Health Problems
Concep·t:
'rhe initiative and the active participation of NOS students in health
education activities can help solve health problems in villages.
Objectives:
Following ins·truction, the student will be able to:
1.
2.
List major roles of NOS students in villages.
Explain the importance of each role in solving local health problems.
Evaluative Criteria:
1.
2.
The objective will be considered met when the student can:
List seven major roles of NDS students in villages.
State and explain one reason for each of these roles.
Suggested Content Outline
Major roles of NOS students in villages
1.
Providing elementary first aid
2.
Referring sick people to
appropriate health institutions
3.
Educating and motivating people
about communicable diseases
prevention and family planning
4.
Organizing health and family
planning campaigns
Suggested Learning Opportunities
1.
The health instructor will divide
the class into four groups, each
of which will discuss and make a
list of their points of view on
the health education roles of NDS
students in villages.
2.
There will be a group report
session after the discussion.
Following presentations, the
instructor and students will complete the list of NDS students'
roles on the chalkboard.
0)
0
Topic:
!.Ielping Solve Health Problen:,s
Suggested Content Outline
5.
Establishing rapport with the people
6.
Working cooperatively with local
health workers
7.
Helping school children adopt
favourable health habits
suggested Learning Opportunities
3.
The instructor will sun®arize the
health education roles of NDS
students in villages.
00
1-'
II.
HEALTH EDUCATION AREAS
Topic A:
Points of View on Health and Health Education
Concept:
NDS students who have a clear understanding of health and health
education can better carry out their health education tasks in the
villages.
Objectives:
Following instruction, the student will be able to:
1.
2.
3.
State the meaning of health and health education.
State the importance of health education in health programs.
Explain the areas where home, school and community can work
together for improving the health of the local people.
Evaluative Criteria:
1.
2.
3.
The objective will be considered met when the student can:
State the meaning of health as described in class.
Explain the importance of health education in health programs by
citing an example of how health education contributes to solve a
specific health program.
Give at least two examples of shared responsibility among home,
school and community health programs.
Suggested Content Outline
1.
Meaning of Health
a. Definitions in terms of
historical perspectives
b. Modern definitions of health
2.
Factors affecting health
Suggested Learning Opportunities
1.
The health instructor will lead a
class discussion about health,
health education and importance of
health education in health programs. Students will be provided
study materials on health and
health education.
co
1.\)
Topic A:
Points of View on Health and Health Education CContinuedl
Suggested Content Outline
3.
Meaning and importance of health
education
4.
Horne, school and community
working together to solve
health problems
Suggested Learning op·portunities
2.
3.
In the next class session, students
will be divided into three small
groups. Each group will prepare a·
report for the class on the
following topics:
Group A:
acceptable point of view
on health and health
education.
Group B:
importance of health
education in health
programs.
Group C:
a local health program
where horne, school and
community can work
together.
The instructor will summarize the
group·reports at the end of the
class.
(X)
w
TpEic B:
Providing Opportunities for Health Education
Concept:
NDS students can help people adopt/continue healthful behavior by
properly selecting and utilizing appropriate learning opportunities
in villages.
Objectives:
Following instruction, the student will be able to:
1.
2.
List factors to be considered in selecting and developing appropriate
learning opportunities for a community health education program.
Identify and suggest appropriate learning opportunities to be
utilized in a given community.
Evaluative Criteria:
1.
· 2.
3.
The objective will be considered met when the student can:
List three factors to be considered in selecting and developing
appropriate learning opportunities for a community health education
program.
List six kinds of educational media and four kinds of individual and
group processes that can be used as learning opportunities and list
at least. two values of each.
Given the characteristics of a community, suggest two appropriate
learning opportunities that could help bring about a desired health
behavior in villages.
Suggested Content Outline
1.
Factors to be considered in
selecting and developing
learning opportunities:
a. Needs and interests of the
community
Suggested Learning Opportunities
1.
The health instructor will give a
mini-lecture on factors to be considered in selecting, developing
and utilizing appropriate learning
opportunities in a community. The
instructor will also explain
(X)
~
Topic B:
Suggested Content Outline
Suggested Learning Opportun·ities
b.
different kinds of educational
media and individual and group
processes as educational opportun-'
ities that can be utilized in
villages.
c.
2.
Providing Opportunitie:s for Health Education (Continued).
Socio-economic and cultural
aspects of the community
Availability of materials
and resources
Types of learning opportunities
for villages:
a.
Educational media as
learning opportunities:
i.
films, filmstrips and slides
ii. charts, diagrams and photos
iii. chalkboard and flannelgraph
iv. pamphlet and flier
v. demonstration and exhibit
b.
Individual and group processes
as learning opportunities
i.
interview and personal contact
ii. question and answer session
iii. group discussion in panchayat
and other meetings
iv. socio-drama
2.
The instructor will demonstrate
how to use selected learning
opportunities, such as charts,
diagrams and flannelgraphs.
3.
The class will be divided into
small groups of seven or eight
students each. Each group will
discuss and prepare a report on
the types of learning opportunities
that would help bring about a
desired health behavior in a given
community.
4.
After group reports the instructor
will give a summary of all reports
on the types of different learning
opportunities that could be
·
utilized in a health education
program.
(X)
U1
'ES>E_ic C:
Communication in Health Education
.f!oncept:
Understanding and proper utilization of existing communication processes
in a community will help NDS students in getting across health messages
more effectively.
Objectives:
Following instruction, the student will be able to:
1.
2.
List and explain the channels of communication by which a message
gets across in the rural areas of Nepal.
Explain the factors that are to be considered in communicating a
message.
Evaluative Criteria:
1.
2.
The objective will be considered met when the student can:
State and explain correctly at least four communication channels by
which a message gets across in the rural areas of Nepal.
List and explain four factors to be considered in communicating a
message as discussed in class.
Suggested Content Outline
Suggested Learning Opportunities
1.
Existing channels of communication:
a. Panchayat meetings
b. Melas (Fairs and markets)
c. Women's meeting during
collecting water from wells,
working in the field, etc.
d.
Social and religious festivals
1.
The health instructor will lead a
class discussion asking questions
to students about existing communication channels in the villages
of Nepal. The instructor will then
list the main channels of communi..,.
cation on the chalkboard.
2.
Factors to consider in
communicating:
a. Who is to send the message?
2.
The instructor will explain the
four factors to be considered-in
communicating a message and the
(X)
"'
Topi.c C:
3.
Communication in Health Education
(Continued)
Suggested Content Outline
~uggested
b.
c.
d.
importance of each factor in
getting a message across in the
villages.
Who is to receive the message?
What is the message?
In what form is the message
delivered?
Learning Opportunities
3.
Selected students will then be
assigned specific health problems
and will be asked to formulate .
messages to the villagers as to
ways of solving the problems.
4.
The instructor will critique their
reports in the class.
Types of communication aids in
villages:
a. Printed communication
b. Radio
0)
-...I
Topic D:
Motivation in Health Education
Concept:
People can be motivated to change their behavior.
Objectives:
Following instruction, the student will be able to:
1.
2.
List Maslow' Hierarchy of Needs in proper sequence and explain why.
the first three needs are more important in the context of Nepalese
villages.
State and explain the principles of motivation.
Evaluative Criteria:
1.
2.
The objective will be considered met when the student can:
List the five human needs in proper sequence and explain the
importance of the first three needs in the context of Nepalese
villages as discussed in the class.
State and explain the four principles of motivation citing examples
of how each principle can be applied to bring about a desired
behavioral change.
Suggested Learning Opportunities
Suggested Content Outline
1.
Maslow~s Hierarchy of basic human
needs:
a. Physiological
b. Safety
c. Social (love and belonging}
d. Self-esteem
e. Self-actualization
2.
Principles of Motivation:
a. State of awareness
b. Relevancy to the needs
1.
The health instructor will lead a
class discussion on basic human
needs by asking specific questions
to students about the needs. The
instructor will then relate their
answers to Maslow' Hierarchy of
basic human needs and list them on
the chalkboard. Discussion on the
importance of the first three needs
in the context of Nepalese villages
will follow.
co
00
Top~c
D:
Motivation in Health Education (Continued)
Suggested Content Outline
c.
d.
Alternate solutions
Health Vs. Non-health
motives
Suggested Learning Opportunities
2.
Using a chart, the instructor will
explain four principles of motivation and relate these principles
to changing specific health
behavior.
3.
Selected students will be asked to
role-play situations on motivating
villagers for adopting a specific
health behavior. The instructor
and students will critique the
role-play.
CX)
1.0
Topic D:
Motivation in Health Education (Continued)
Suggested Content Outline
c.
d.
Alternate solutions
Health Vs. Non-health
motives
Suggested Learning Opportunities
2.
Using a chart, the instructor will
explain four principles of motivation and relate these principles
to changing specific health
behavior.
3.
Selected students will be asked to
role-play situations on motivating
villagers for adopting a specific
health behavior. The instructor
and students will critique the
role-play.
(X)
'-'>
Toplc E:
Community Organization
Concept 1:
The active participation of local leaders in a health program is vital
to the success of the program.
Objectives:
Following instruction, the student will be able to:
1.
2.
3.
4.
List and describe the local leaders in a typical Nepalese village.
Explain the importance of involvement of the local leaders in a
health program.
Explain methods that should be used when organizing a campaign.
Describe how a NDS student can help in a health campaign as
discussed in class.
·
Evaluative Criteria:
1.
2.
3.
4.
The objective will be considered met when the student can:
List five different types of local leaders in a typical Nepalese
village and give two roles of each.
Give three reasons why it is important to involve the local leaders
in a health program.
Suggest two proper ways of organizing a health campaign.
Explain with 100% accuracy how the NDS student can help in a health
campaign.
Suggested Content Outline
1.
Local leaders in a Nepalese village
a. Types of leaders:
i. panchayat president and
members
ii. religious priests
iii. local practitioners for
curing illnesses
Suggested Learning Opportunities
1.
The health instructor will ask
students to tell who they think
would be the leaders in a typical
Nepalese village. Types of leaders
will be listed on the chalkboard.
\J)
0
Topic E:
Community Organization (Continued)
Suggested Learning Opportunities
Suggested Content Outline
iv. money lenders and landlords
v.
school teachers
b. Roles of leaders:
i. transmitting health messages
to villagers
'ii. influencing villagers for
positive action in a health
program
c. Reasons for involving local
leaders in a health campaign:
i. respect of village people
ii. trust and confidence of people
iii. resourcefulness to people
2.
Health campaigns in schools and
communities (Cleanliness campaign,
family planning campaign and
mobile health camps)
a. How the NDS student can
organize the co~~unity for a
health campaign?
i.
formulation of a local
health committee
ii.
involving local leaders
in the committee
b. How the NDS student can assist
in the health campaign?
i. establishing link between
people and health workers
2.
After this* the instructor will
conduct a lecture-discussion on
the importance of involving leaders
in a health campaign.
3.
The class will then be divided into
small groups. Each group will prepare a report to be given in class
on ways of organizing the community
for a health campaign as well as
assisting in the campaign.
4..
Following the presentation of
group reports, the instructor will
conduct a class discussion about
the reports, summarizing the main
points on the chalkboard.
1.0
1-'
. "":
_Top1.c
~
Community Organization (Continued)
Suggested Content Outline
ii.
Suggested Learning Opportunities
providing consultation
and other assistance to
the health committee.
1.0
1\:)
Topic E:
Comm.unitv Organization (Continued)
Concept 2:
Establishing good rapport ·(inter-personal :t·elations) with people in the
corrununity can help the NDS student effectively organize the community
for a health campaign.
Objec·tives:
Following instruction, the student will be able to:
1.
2.
Explain the meaning and the importance of establishing rapport.
List and explain different ways of establishing rapport with the
local people.
Evaluative Criteria:
1.
2.
The objective will be considered met when the student can:
Give three reasons why it is important to establish rapport with
the local people.
List and explain five ways of establishing rapport with the local
people.
Suggested Content Outline
Suggested Learning Opportunities
1.
Establishing rapport
a. The meaning of rapport
b. The importance of establishing
rapport:
i. to get people's trust and
confidence
ii.
to get people's support and
cooperation for health programs
1.
The health instructor will lead a
lecture-discussion session on the
meaning, importance and different
ways of establishing rapport with
the local people in the villages.
All students will be encouraged to
participate in the discussion
session.
·
2.
Ways of establishing rapport:
a. Appreciating local customs and
traditions
2.
The instructor will then ask
selected students to play roles on
1,0
w
~opic
E:
Community Organizatio!l (Continued)
Suggested Content Outline
Suggested Learning OE)2·ortunities
b.
two different ways of establishing
rapport with the local people:
Respecting people's beliefs
and opinions
c. Being friendly and helpful
to people
d •. Addressing people respectfully
e. Being honest and sincere to
people
a.
b.
3.
How to talk to people in
respectable terms
How to respect beliefs and
opinions of the local people.
After the role-play, the instructor
will summarize the discussions on
establishing rapport to the class.
l.D
.&:a.
95
SU!~-:.RY
To help solve some of the problems facing Nepal
and to provide an opportunity for students to acquire
practical field experience, the NDS program was established under the Tribhuban University.
This program pro-
vides opportunities for students to actually participate
in various on-going developmental activities.
Students participating in the NDS program can
play significant roles in helping solve the rural health
problems of Nepal.
With adequate training in health edu-
cation, graduate students can effectively motivate and
involve local people in various health'programs for solving -different local health problems.
The purpose of this project was to develop a
health education training guide for the NDS program.
The
guide will assist health instructors in providing more
relevant health education training to the Master-level
students.
The following rationale was used for developing
the training guide:
1.
Analyzing health education tasks of Masterlevel students participating in the NDS
program in Nepal,
96
2~
Identifying knowledge and skills required to
carry out these
3.
tasks~
Developing major topics for ·the training
guide,
4.
Selecting concepts related to the major
topics,
5.
Developing objectives for each concept,
6.
Selecting evaluative criteria for each
objective,
7.
Identifying content to be covered for each
concept, and
B.
Developing appropriate learning
opportunities.
The guide included concepts, objectives, content
and learning opportunities relative to health knowledge
that should be understood and health.education tasks in
which graduate students should engage.
The proposed training guide also contains
suggested schemes for implementation, evaluation and
revision.
When properly implemented, the guide will assist
NDS students in carrying out their health education tasks,
thereby helping solve health problems in Nepal.
Selected Bibliography
1.
A Brief Note About the Development of Health Services.
Coronation Issue of Health Educat1on section,
Department of Health Services, Kathmandu, 1975.
2.
Annual Report of the Integrated Community Health
Division.
2033/34 (1976/77). HMG/Nepal: Ministry
of Health. Department of Health Services. November,
1977. Unpublished.
3.
A Report on Health and Health Administration in
Nepal - The Directorate of Health Services, Ministry
of Health, Singh Durbar, Kathmandu, Nepal, 1969.
4.
Country Health Programme: Nepal. Vol. 2. Country
Profile. HMG/Nepal. Department of Health, 1974.
5.
Fodor, John T. {Editor). Proceedings of Workshop on
School-Community Cooperation for Better Health in
Nepal. 19 November - 1 December, 1974. Dhulikhel,
Nepal. Unpublished.
6.
Fodor, ,John T.
"A Conceptual Approach to Curriculu..m
Development in Venereal Diseases Education," The
Journal of Sc~~ol Healt.h, 93:303-306, Nay, 1973.
7.
F'odor, John T. and Dalis, Gus T. Health Instruction:
Theory and Application.
Second Edltion.
Philadelphia: Lea and Febiger, 1974.
8.
Fussel, Diana and Quarmby, Andrew.
"Study-Service
in Nepal," Study-Service Newsletter, December, 1975.
9.
Fussel, Diana and Quarmby, Andrew (Editors}.
Service Newsletter, November, 1976.
10.
Harris, George and others. Area Handbook for Nepal,
Bhutan and Sikkim. U. S. Government Printing Office,
Washington, D. c., 1972.
I
11.
Study-
Health - A Primer for Progress. World Health
Organization, Sout.heast Asian Regional Office,
New Delhi, India.
97
98
12.
~1anandhar,
13.
Mohsin, r-Iohammad, "The National Education Plan - An
Analytical Introduction," On Education in Nepal,
National Education Committee, Keshar Mahal,
Kathmandu, 1974.
14.
National Development Service Handbook (Nepali
version}.
National Development Service Directorate,
Tribhuban University, Kirtipur, Kathmandu, 2033/34
(1976/77).
15.
National Development Service Handbook (Nepali
version).
National Development Service Directorate,
Tribhuban University, Kirtipur, Kathmandu, 2034/35
(1977/78).
16.
National Education System Plan for 1971 - 1976:
Nepal. Ministry of Education, HMG/Nepal, 1971.
17.
O'Connor, Bob. Thinking Life Through.
Third Edition.
Van Nuys, California: Delta Lithograph Company,
1977.
18.
Operations Manual - Health Post Technical St~ff.
HMG/Nepal, Health Ministry, Department of Health
Services, Kathmandu, January, 1975.
19.
Operations Manual - Village Health Workers (Junior
Auxiliary Health Workers).
HMG/Nepal. Health
Ministry, Department of Health Services, Kathmandu,
January, 1975.
20.
Poudel, Madan Raj. Curriculum Design forth~
Trainers in the Health Fields in Nepal.
Graduate
Project.
California State University, Northridge,
January, 1977.
21.
Pradhan, Ratna Man. The Role of the National
Development Service in Promoting National Development
in Nepal. A project paper submitted at the
Un1versity of Southern California, Los Angeles, 1978.
Unpublished.
22.
Project Formulation for Basic Health Services - Final
Draft. July, 1975 - January, 1976, Kathmandu, Nepal.
Unpublished.
Tirtha Bahadur.
"Manpower and Education
in Nepal- A Survey," On Education in Nepal.
National Education Committee, Keshar Mahal,
Kathmandu, 1974.
99
2 3.
Project Formulation Repor·t - Health Education.
Kathmandu, Nepal, 1975. Unpublished.
24.
Rongong, Rajendra K.
"The National Development
Service- A Reflection," Education and Development,
National Education Committee, Keshar Mahal,
Kathmandu, Nepal, 1975.
25.
Shah, N. K. and Worth, R. M. Nepal Health Survey,
1965-1966. University of Hawaii Press, Honolulu,
1969.
26.
Shrestha, ,Janaki Devi. A Training Program for
Voluntary Malaria Workers in Nepal. Graduate
Project. California State Univers-ity, Northridge,
January, 1977.
27.
Singh, Krishna Bahadur. A Comprehensive Family
Planning Program for Nepal. Graduate Project.
California State University, Northridge, .June, 1972.
28.
Summary Data from 1971 Census of Nepal.
Bureau of Statistics, HMG/Nepal, 1973.
29.
Swasthya Upachar Samsthaharoo.- Nepal (Health
Treatment Institutions- Nepal).
Fiscal Year,
2030/31 (1973/74). HMG/Nepal, Department of Health,
Health Education section, Pulchowk, Patan, Nepal~
30.
The Long-Term Health Plan of Nepal (Nepali version).
HMG/Nepal, Ministry of Health, Kathmandu, 2033
(1977).
Central
APPENDIX A
English Translation of NDS Students'
Tasks in the Village
(15:2-5)
After being posted to the rural areas as an
educational core member under the NDS program, a student
will be required to perform the following activities
compulsorily and will be evaluated accordingly.
1.
Attendance:
a.
in the training period (To be prepared
by training coordinator).
2~
3.
b.
in the village
c.
in the school
School activities:
a.
number of periods taught every week
b.
interest and sincerity in teaching
c.
influence in children
d.
Improvements to the school
Creative work in the village:
a.
Creation and/or management of a village
or a school library:
NDS sutdents will
help open a library with the help of local
people either in the school or in the village panchayat area to which ·they are
assigned, if a library does not exist.
100
101
Then they will teach the school children
about howto 1;1.se the library.
If it is
needed, they will spend some time on a
daily basis for properly managing the
library.
If a library existed in the
school or in the village, they will help
improve it, or they will help manage and/
or improve a 'development activities
review room' in the local village
panchayat area.
be
Quiz contents and cultural activities:
NDS students will help in the intellectual
development of local school children by
encouraging them to take part in periodic
quiz contests.
They will help in the
intellectual development of local children
by encouraging them to take part in
periodic quiz contests.
They will take
active roles in making school's cultural
activities a success.
c.
Participate in games, physical training
or
scouti~g:
NDS students will be active
in one of the three regular school
activities - games, physical training and
scouting.
If none of the activities
exist, they will have to initiate and
102
carry out -one of them.
For this, the
headmaster will provide the necessary
help.
d.
Adult education:
NDS students will adjust
their time so as to routinely conduct
adult education or literacy campaign in
local village.
They will seek the assis-
tance from the district education officer
or the school headmaster for this purpose.
e.
Reforestation and conservation:
The terms
reforestation and conservation refer not
only to tree transplan·tations but also to
activities, such as helping village people
understand the importance of forests and
benefits of preserving them and providing
them with the actual help in reforestation.
f.
Agricultural extension:
·NDS students will
teach farmers about the following:
i.
the importance of agricultural
development,
ii.
protective measures of crops from
animals,
iii.
modern methods of farming.
103
They will also assist local JTA's (Junior
technical assistants working for agricultural development) in their work.
g$
Health education and hygiene:
NOS
students will carry, out the. following
activities regarding health education
and hygiene:
i.
efforts to keep the school compound
neat and clean,
ii.
helping the school children adopt
healthful practices,
iii.
teaching village people abou·t the
prevention of chplera, typhoid and
other communicable diseases, and
iv~
helping people in keeping the water
clean and safe.
h.
Family welfare:
The term family welfare
refers to the activities relating to family planning.
NOS students will be
regarded to have taken part in this program, .if they have done any activity that
will promote the family planning and
maternal and child health program under
the Ministry of Health, HMG/Nepal.
Spe-
cifically, the motivational activities for
'
the need and the importan(!e of family
104
planning in villages are regarded as the
family welfare activity.
i.
Construction:
Any construc·tion activity
performed for the improvement of village
life falls under this category of NDS
students' tasks.
For example, activities
regarding the initiation and/or improvement of projects, "such as irrigation
canals, drinking water, latrines, roads
.
and forestation are expected from NDS
students.
j.
~apport
i.
with the community:
good inter-person,l relationship
with local people
ii.
k.
adaptation to the village life.
Morale and Discipline.