Team Training Program Manual of College of Health Science , Mekelle University

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MEKELLE UNIVERSITY
COLLEGE OF HEALTH SCIENCES
COMMUNITY BASED EDUCATION OFFICE
TEAM TRAINING PROGRAM
MANUAL FOR STUDENTS AND SUPERVISORS
January, 2016
Mekelle, Ethiopia

Contributors and Editors
Edited in September, 2015 by CBE office members.
Mrs. Azeb G/silasie (MPH)
Assist. Professor of Public Health
School of Public Health
Department of Environmental Health
Postgraduate program coordinator, CBE Public Relation, Project management & Research
officer
Mr. Haftay Berhane (MSc)
Assist. Professor of Clinical Pharmacy
Department of Pharmacy
Clinical pharmacy Unit
Clerkship program Coordinator, CBE Logistic officer
Mr. Haftom G/hiwot (MSc)
Lecturer in Pediatric Nursing
Department of Nursing
Pediatric Nursing Unit
Head of Students affairs, CBE Schedule & Monitoring Unit
Mr. Kedir Endris Mohammed (MSc & MPH in Nutrition fellow)
Assistant Professo in Adult Health Nursing
Department of Nursing
Adult Health Nursing Team
Coordinator, Community Based Education office
Mr. Selomon W/Mariam (MSc)
Lecturer in Midwifery
Department of Midwifery
RH and family planning team leader, CBE documentation and Evaluation unit offcer

II
Huruy Asefa (MPH)
Assistant Professor of Biostatistics
Department of Biostatistics, School of Public Health
Extension program Coordinator, CBE Evaluation and documentation officer

III
Acknowledgment
This Team Training Guideline (TTP) guideline document is prepared by community based
education office members in September 2015. They have devoted their time and energy in
searching for materials, literatures, write up and finally come up with such fruit full documents.
Preparing a working procedure and guideline document such as this rely on the input of many
people, besides the main editors and we are indebted to many of our colleagues for providing
helpful suggestions and comments in the text. In addition to this, there is unreserved contribution
of the former members of CBE office; they laid down the base for this program. So we are very
thankful for Mr. Belachewu Etana, Mr. Befikadu Legesse, Mr. Mulugeta Molla, Mr.
Hinsermu Bayu, Mr.Birhanu Demeke, Dr. Fasika Amdesilasie and Mr. Mulualem Merga for
all efforts they made in strengthening the office and the programs.
The establishment of Community Based Education (CBE) coordinating office, strengthening
CBE programs and preparation of this manual was not possible without institutional support of
College of Health Sciences. Hence, we would like to acknowledge the College management
bodies, all schools or departments, supportive staffs and all members of the College Health
Sciences.
We also thankful for students and supervisors who have been participated in the previous CBE
programs who gave us direct and indirect feedback which also helped us in further enrichment of
the document.
In addition to this, we would like also to thank both University of Gondar and Jimma university
CBE coordinators who gave us their experience on the program and for sharing of their working
documents.

IV
Preface
The social movements in many parts of the world in 1960‟s and 1970‟s have brought about
change in educational approaches from traditional to more innovative ones. Parallel to these
movements countries have been experimenting with new ways to educate their people. In some
higher learning institutions, these experiments began either by a government mandate or by
interested university officials and scholars. In these schools the program stresses relevance to
the needs of the community. Hence, the educational philosophy of being community-oriented,
which stresses the integration of training, research, and service to benefit society, was adopted.
In the late 1970s, Ethiopia had adopted the global movement of „Health For All‟ and the
Primary Health Care (PHC) approach for the health sector. This brought the need to reform the
health service system and the human resource development programs. Now days many
African countries has adopted CBE philosophy particularly in health personnel training
institution. To mention some South Africa, Uganda, Sudan, Algeria…etc are practicing CBE.
Community Based Education is a means of achieving educational relevance to community needs
and, consequently, of implementing a community oriented educational program. It consists of
learning activities the community extensively as learning environment in which not only
students‟, teachers and members of the community and representative of other sectors are
actively engaged throughout the educational experience.
The Community Based Education office of College of Health Science of Mekelle University
acknowledges the inputs from CBE office members, academic staffs and the College
Management bodies at large and those individuals who in one way or another contributed to the
production of this TTP document. The efforts of all are highly appreciated and we look forward
for their continuous support.
Let us join hands together to realize CBE objectives
Kedir Endris Mohammed (MSc)
Coordinator of Community Based Education office
October, 2015

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Contents
Contributors and Editors................................................................................................................................I
Acknowledgment.......................................................................................................................................VIII
Acronyms and abbreviations........................................................................................................................IX
Preface..........................................................................................................................................................X
1. INTRODUCTION ..............................................................................................................................12
2. CONCEPTS OF HEALTH TEAM TRAINING.................................................................................12
3. TEAM-TRAINING PROGRAMME (TTP) .......................................................................................17
3.1. Objective of TTP..........................................................................................................................18
General objective ................................................................................................................................18
Specific objectives ..............................................................................................................................18
3.2. Implementation of TTP ................................................................................................................18
I. Preparation phase..........................................................................................................................18
The major activities in this phase are giving training or orientation for instructors and students and
logistic activities. ................................................................................................................................18
a. Training and orientation............................................................................................................18
Orientation of supervisors and students on TTP.................................................................................19
b. Logistics arrangements .............................................................................................................19
II. TTP 8 weeks activities..............................................................................................................20
Week one: Situational analysis and planning......................................................................................21
4. MAJOR ACTIVITIES IN TTP...........................................................................................................34
4.1. Static health Services....................................................................................................................34
4.2. Outreach services..........................................................................................................................35
4.3. Mini – Project ...............................................................................................................................38
Seminars and case presentation...............................................................................................................39
Documentation and Reporting ................................................................................................................39
5. THE ROLE AND RESPONSIBILITIES CBE OFFICE, STUDENT SERVICE CENTER AND
TRANSPORT OFFICE ..............................................................................................................................40
5.1. The role of CBE office .................................................................................................................40
5.2. Student Service Center and Transport office................................................................................40
Meal, housing and related issues are handled by student service center. The transport service office and
facility office shall facilitate transport, maintenance and all related issues............................................40

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5.3. TTP site coordinator from CBE office .........................................................................................40
CBE office shall assign one TTP site coordinator from it office members for each team and will have
the following roles and responsibilities...............................................................................................40
Roles and responsibilities of TTP site coordinator ........................................................................40
5.4. The role of assigned supervisors ..................................................................................................41
The role of students and student representative in TTP ...................................................................43
5.5. Duties and responsibilities of each student in TTP programs ......................................................43
5.6. The role and responsibilities of students representatives .............................................................44
5.6.1. Job descriptions of student team leader.................................................................................44
5.6.2. Job descriptions of student team raporter..............................................................................44
5.6.3. Job descriptions of student team logistics.............................................................................45
5.6.4. Professional roles......................................................................................................................45
6. ACADEMIC REQUIREMENT, RULES AND REGULATIONS DURING TTP............................49
6.1. Attendance during CBTP and TTP...............................................................................................49
6.2. Academic requirements or Grading during CBTP and TTP: .......................................................50
6.3. Disciplines/Conduct during TTP:.................................................................................................50
6.4. Repeating CBE courses:...............................................................................................................50
7. STUDENT EVALUATION ...............................................................................................................51
7.1. Student Performance Evaluation in TTP ....................................................................................51
8. ACADEMIC STAFF WORKLOAD IN CBE PROGRAMS .............................................................52
8.1. Academic staff work load.......................................................................................................52
8.2. CBE office members work load.............................................................................................53
9. References...........................................................................................................................................54
10. Annexes............................................................................................................................................56
Annex I: action plan report guideline .....................................................................................................56
Static and outreach action plan format................................................................................................56
Document format ................................................................................................................................56
Mini project format.............................................................................................................................60
Annex II: Final document report format.................................................................................................64
Static and outreach final document report format...............................................................................64
Document format ................................................................................................................................64
Annex III: Case presentation guideline...................................................................................................69

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Annex IV: Seminar presentations and topics..........................................................................................72
Annex V: Evaluation formats .................................................................................................................73
Annex Va : Senior Supervisor evaluation format for action plan in TTP...........................................73
Annex Vb : Resident Supervisors’ (day to day) Evaluation Form for TTP........................................75
Annex Vc : Senior Supervisor Fortnight evaluation format for TTP..................................................76
Annex Vd: Senior Supervisor Evaluation format for final presentation in TTP.................................78
Annex Ve: Final written document evaluation check list for TTP .....................................................80
Annex Vf : Weekly Progress and Activity Report Form ....................................................................81
Annex Vg : Student team leader (day to day) evaluation form for TTP.............................................83
Additional annexes......................................................................................................................................84
TTP Action plan presentation format for PPT........................................................................................84
Weekly report guideline..........................................................................................................................84
TTP forty night presentation formats......................................................................................................86
Cover page ..............................................................................................................................................86
Presentation outline.................................................................................................................................86
Acronyms................................................................................................................................................86
Introduction.............................................................................................................................................86
Mission, Vision and Objective of TTP attachment.................................................................................86
Static plan ...............................................................................................................................................86
Current situation......................................................................................................................................86
Identified challenges...............................................................................................................................86
Priority criteria and prioritization table...................................................................................................86
Action plan..............................................................................................................................................86
Outreach plan..........................................................................................................................................86
Current situation......................................................................................................................................86
Identified challenges...............................................................................................................................86
Priority criteria and prioritization table...................................................................................................86
Action plan..............................................................................................................................................86
Mini project using challenge model........................................................................................................86
References...............................................................................................................................................86
Final TTP report format PPT ..................................................................................................................87

VIII
Acknowledgment
This TTP guideline and working document is revised and prepared by community based
education office members in September 2015. They have devoted their time and energy in
searching for materials, literatures, write up and finally come up with such fruit full document.
Preparing a working procedure and guideline document such as this rely on the input of many
people, besides the main editors and we are indebted to many of our colleagues for providing
helpful suggestions and comments in the text. In addition to this, there is unreserved contribution
of the former members of CBE office; they laid down the base for this program. So we are very
thankful for Mr. Belachewu Etana, Mr. Befikadu Legesse, Mr. Mulugeta Molla, Mr.
Hinsermu Bayu, Mr.Birhanu Demeke, Dr. Fasika Amdesilasie and Mr. Mulualem Merga for
all efforts they made in strengthening the office and the programs.
The establishment of Community Based Education (CBE) coordinating office, strengthening
CBE programs and preparation of this manual was not possible without institutional support of
College of Health Sciences. Hence, we would like to acknowledge the College management
bodies, all schools or departments, supportive staffs and all members of the College Health
Sciences.
We also thankful for students and supervisors who have been participated in the previous CBE
programs who gave us direct and indirect feedback which also helped us in further enrichment of
the document.
In addition to this, we would like also to thank both University of Gondar and Jimma university
CBE coordinators who gave us their experience on the program and for sharing of their working
documents.

IX
Acronyms and abbreviations
CBE Community Based Education
CBTP Community Based Training Program
Mr. Mister
TTP Team Training Program
PHC Primary Health Care
SRP Student Research Project
WHO World Health Organization

X
Preface
Consistent, planned and well integrated community based education (CBE) is becoming top
urgent issue in higher teaching-learning institutions in the course of addressing social,
economic, ecological and environmental problems of communities in global and regional
contexts. In line with this, Ethiopian has given due attention to the enhancement of teaching-
learning, research and community engagement to be undertaken in higher institutions in
compliance with existing policies and strategies.
Community Based Education is a means of achieving educational relevance to community needs
and, consequently, of implementing a community oriented educational program. It consists of
learning activities the community extensively as learning environment in which not only
students’, teachers and members of the community and representative of other sectors are
actively engaged throughout the educational experience.
The Community Based Education office of College of Health Science of Mekelle University
acknowledges the inputs from CBE office members, academic staffs and the College Management
bodies at large and those individuals who in one way or another contributed to the production of
this final document. The efforts of all are highly appreciated and we look forward for their
continuous support.
It is hoped that this document can help colleges, schools, departments, academic staff, researchers,
students of the University and other stakeholders as a reference material by providing valuable
information for consistent and integrated application of TTP. The guideline is also subjected to
future modification to incorporate any constructive comments that could be identified at any time
by consumers in the course of using it. Finally, the office would like to profoundly thank those who
willingly contributed their best in preparing this guideline.

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Let us join hands together to realize CBE objectives
Kedir Endris Mohammed (MSc)
Coordinator of Community Based Education office
October, 2015

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1. INTRODUCTION
Community based education is one of the educational philosophy in which students are learning
through working in and with the community to identify common health problems, designing and
implementation of possible interventions. Mekelle University college of Health Sciences makes
its curriculum innovative by integrating education, research and community service. To realize
this, it had adopted community based education as its major educational philosophy. One of the
three CBE strategic programs being implemented by CBE is Team training program.
Team training program (TTP) is a form of professional practice and a means of ensuring
different type of health personnel work together to meet health need of the population. It is part
of community health practice which enables students to identify community health problem at
rural settings and prepare a plan to intervene it. In the program students with different
professional learn to work as one health team.
Health team is a group of health professionals who share common health goal and objective of
determining community health needs to the achievement of which each team member contribute
in accordance with his/her professional competence and skill.
So, this program plays active role in inducing self-learning among students. It is achieved by
making the students to be assigned to urban and rural catchments community which allows
deeper understanding and full exposure to the social and cultural environment of the community.
2. CONCEPTS OF HEALTH TEAM TRAINING
2.1 Team
What is a team?
A team is a special type of group, which can be defined as a small number of consistent people
committed to a relevant shared purpose, with common performance goals, complementary

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and overlapping skills, and a common approach to their work. Team members hold
themselves mutually accountable for the team results or outcome.
What is team work?
The WHO definition of Team Work states as “Team work is coordinated action carried out by
two or more individuals jointly. It implies commonly agreed goals, clear awareness of, and
respect for other’s roles and functions. It also implies that on the part of each member of the
team, adequate human and materials resources, supportive cooperative relationships, open,
honest and sensitive communications, and provision for evaluations is practiced”.
What is health team?
The health team is a group of people who have common goal/objectives, determined by the
community health needs, to the achievements of which each member of the team contributes, in
accordance with his/her competence, skills and the functions of others. The goal or purpose of
the health team is to improve and maintain the health of the community it serves. In order to
achieve that goal, the health team is made up of different members who have been trained in
special skills. Each member has a role to play in a team.
Team leadership and cooperation
Like formal groups, teams have leaders. For the normal administrative work of the team, it is
often the most senior or experienced member of the team who organizes the team's activities at a
health center.
The leadership of a specific project will depend on what the project is about. If the project is
mostly concerned with the health of pregnant women, the midwife or the nurse will naturally
give leadership and direction to team efforts. If the project deals with environmental health
conditions, the environmental health professional/ health inspector will assume leadership.

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What we have said so far about sharing responsibilities and cooperation belongs to the domain of
the ideal. Teams do not always work so well together. While a football team practices together
regularly, members of a health team sometimes tend to work on their own. It is sad when they do
not share their experience and do not ask other team members for help.
When there are projects to work on, ways should be found for everyone to participate and
contribute their particular expertise.
Discussion groups and meetings are useful tools for helping the team plan and evaluate program.
It is through regular meetings that progress can be evaluated, relationships can grow among
members, and new problems can be identified and solved.
When the team does meet, observe the behavior of the members, including yourself. Do they
make for a healthy and successful group?
The health team is a place where members can work together to improve their health education
skills. These skills can serve to improve the quality of the team-work. They should also be used
when the team carries out any programme. During team meetings, members can decide who will
be responsible for which types of health education. For example in the child health programme,
the nurses can arrange program for informal groups of mothers at the clinic. They can also give
individual counseling to mothers and children with problems. The environmental health staff can
organize community meetings and projects. The dispensers can educate patients about their
drugs, so that they will be able to take them correctly.
What is a group?
The word 'group' may be defined as a gathering of two or more people who have a common
interest.
There are two main kinds of group. Those that are very well organized, such as farmers'
cooperatives, are formal groups. Those that are not organized, such as the people attending
market on a particular day, are informal gatherings.

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A group is successful if it can meet both of these needs for its members. If a group can never
solve a problem or plan a programme, members will lose interest and leave. If people in the
group are not friendly, always argue, or ignore the welfare of other members, there will not be
much feeling of belonging. A successful group will make people feel welcome and at the same
time accomplish tasks in a cooperative way.
The value of group education
Using the group approach to educate people has a number of advantages. First it provides
support and encouragement. Maintaining healthy behavior is not always easy. In a group one can
find the support and encouragement needed to promote and maintain healthy practices.
Secondly, it permits sharing of experience and skills. People learn from each other. A member
may have tried a new idea and found it successful. Through that experience the person has
gained skills that can be passed on to other group members.
Finally, working in groups makes it possible to pool the resources of all members. One family
may not have enough money to dig a well, but a group of families together could contribute
enough money for the purpose. Members of a group can give money, labour, or material to help
their members in times of personal or family crisis, or to promote community health through
projects such as improving sanitation. In general, because some problems are difficult to solve by
individuals alone, a group approach to health education is important.
ADVANTAGES OF TEAM WORK
There are at least five advantages of teamwork in health care setting, which are listed below:
ONE IS JUST ONE AND TWO ONES MAKE ELEVEN

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1. Improves performance outcomes
Improved performance outcomes are the most important reason to implement team functions.
When the work to be accomplished requires a collective effort (i.e. more than one person to
do it), the best outcomes occur when there is synergistic teamwork, with each team member
contributing to the effort and each team member’s quality of contribution being improved or
enhanced as a result of ideas and stimulus others bring to the process.
2. Increases employee’s acceptance of responsibility
Teams have the capability of increasing employees’ level of responsibility acceptance for
several reasons. When real responsibility and authority is transferred to the team, members
feel more ownership.
3. Empowers teams
Acceptance of accountability, responsibility, and authority increase a team-based
organization. Leaders who have shared responsibility with employees in the past can transfer
more responsibility and authority to a team.
4. Frees Managers for other functions
If teams take over responsibilities of the manager in a day to day operation, managers can
focus on long neglected aspects of their jobs such as coaching, mentoring and teaching
employees, or developing long-term plans for their work areas.
5. Creates higher employee satisfaction
When teams have real responsibility and authority, the decisions they make are theirs. The
feelings of increased ownership and control within their work life lead to higher levels of
employee satisfaction.

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3. TEAM-TRAINING PROGRAMME (TTP)
Team training program (TTP) is important community based learning activity that follows a
problem solving approach. It provides practical and significant development in field of health
professional training.
In this program students from different health disciplines are posted at training health centers as
a team in during their graduation year. In this program it is believed that students work as a
member of a team in addressing community problems by applying and integrating their
theoretical knowledge and skill with that of the other members of the team. It also helps students
to familiarize themselves to the primary health care units. In addition to this, it gives them a
chance to learn through the process of work in a natural setting.
The teams consisting of 30-40 students assigned in five different health centers for eight weeks.
Each team elects a team leader, secretary and logistics that facilitate the team work and
document the notable activities done by the team.
“A DREAM YOU DREAM ALONE IS ONLY A DREAM; A
DREAM WE DREAM TOGETHER IS REALITY”
Dr. Fasika A/silasie
“COMING TOGETHER IS A BEGNING, KEEPING TOGETHER IS A PROGRESS, AND
WORKING TOGETHER IS A SUCCESS”
Henry Ford

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3.1. Objective of TTP
General objective
The main objective of TTP is to make the student able to work as members of the health team in
addressing community health challenges by applying the knowledge and skills of one’s
profession and integrating these with the knowledge and skill of other members of the team.
Specific objectives
The TTP will enable the students to:
 Identify community health challenges through situational analysis
 Prepare a plan for selected health challenges
 Intervene community health challenges at outreach and health facility level according to their
specific profession in a team
 Identify one priority community challenge and design and intervene a mini project using
challenge model and project management methods , procedures and principles
 Work with community, Health Extension Worker (HEW), Voluntary community health
workers, Developmental Army and other governmental and non-governmental stakeholder to
intervene the selected health challenges
 Appreciate interdisciplinary nature of the health care provision
 Develop team spirit and create a solid foundation for their future work in a team
 Evaluate their interventions according to priory set plan
3.2. Implementation of TTP
I. Preparation phase
The major activities in this phase are giving training or orientation for instructors and students
and logistic activities.
a. Training and orientation
Training for new/un trained staffs
Training shall be given to all new employed instructors. The objective of this inductive training
helps students and new staff members to introduce to TTP program, models and theories applied
in TTP, to familiarize the TTP and CBE working guidelines. In addition the training may

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contribute ignite an interest to work together as members of a team, and necessary to formulate
and solve community development challenges. Through active CBE service within the
community, it is expected that students and academic staffs will increase their awareness of the
importance of community involvement and inter-sectoral collaboration in development.
In brief, the common objectives in the induction training should include: community diagnosis
(situation analysis); the related planning; implementation, and evaluation of activities through
community involvement, collaboration with different stakeholders, challenge model, Project
management and team approach.
Orientation of supervisors and students on TTP
In each phase of TTP before departing to the particular community of their assignment a one day
orientation will be given to students and supervisors. The orientation include about the
philosophy of CBE in general, TTP objective and activity in particular. In addition, students and
supervisors will be oriented about their roles and responsibilities, the time required to complete
the phase. Then the CBE office with respective department heads organize the students into
manageable groups taking into account the academic ability, knowledge of the local language
and culture. Each group shall democratically select one team leader, one reporter and three
logistics.
Besides introducing the objectives, philosophy of the university and activities they will be
introduced how to keep the cultural norms and rights of the society.
Team formation and Composition
The team in each group shall contain all health undergraduate disciplines’ proportional to the
total size of students and the number of female students in each department. CBE office shall
randomly assign students from each department and form TTP team s. unless special reason has
been presented to CBE office and decided, the students shall be not allowed to transfer from one
team or site to another.
b. Logistics arrangements
Student’s meal issues: the Student Service Center (SSC) is responsible and accountable to all
issues pertaining to students’ meal. SSC shall finalize all activities two weeks prior to the

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beginning of the programs (CBTP & TTP) shall report to the logistics unit of CBE. The role of
logistics unit of CBE office here is to make sure that SSC received a schedule on CBE programs
from CBE office and shall take reports on students meal issues from SCC.
Residential house rent or construction issues: the Student Service Center (SSC) is responsible
and accountable to all issues pertaining to residential house rent or construction issues. SSC shall
finalize all activities prior to three weeks before the beginning of TTP Programs. SSC shall
report of all necessary information and progress to CBE office. The student Service center shall
plan and provide all necessary service including, housing, water , electric, bed, mattress, pillow,
and related issues as necessary. The student representative shall communicate and solve
challenges regarding housing, electricity and water with student service center.
Transport Issues: the Transport and Facility Office is responsible and accountable to all issues
pertaining to transport services. The logistic unit of CBE shall plan and communicate transport
need to Transport office prior to the beginning of the programs.
Site selection: CBE office shall plan, conduct and select sites for TTP based on community
health need and infrastructures availability to the students. Priority shall be given to rural and
semi urban areas.
Stationary materials: provision of stationary materials is the task of CBE office. The office
shall plan, prepare and provide stationery materials to students prior to the beginning of the
programs
The student representatives shall communicate with the CBE office and Student Crevice center
take and handle all logistic issues.
II. TTP 8 weeks activities
The students will arrive on their respective site on the week end days preferable Saturday. They
will make self and team arrangements on the weekend days. Immediately on the coming
Monday, they will start their activities. The TTP program will be cascaded according to the
following arrangement. The activities will be done on weekly bases.

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Week one: Situational analysis and planning
Guiding Principles
 Trying all the best to dig out all the health and related challenges and the resources
available in the community
 The community may have many and variety of unsolved health challenges and the
solution is also the community itself, it has resources (human, materials, financial,
knowledge, wisdom ,experience, culture)
 Be sensitive for the community culture and belief. Respect and act according to the
community culture.
 Stake holder analysis : Identifying and communicating all potential stake stakeholders
 Alignment of your plans to health center, woreda, regional and national plans.
 Ensuring Sustainability
It is advisable to follow the following steps
Step I: Review Mekelle University College of Health Science and the Health Center’s
mission and vision
With your team, agree on a common understanding of your organization’s mission and strategic
priorities. This understanding will help your team to shape your vision within the context of your
organization´s priorities.
Step II: Create a shared Mission and vision for your team
With your team, imagine what you and others will see when your team has made its contribution
to improvements in your organization’s strategic priorities. This shared vision will inspire the
team to face each new challenge.
Step III: Asses the current situation or scanning
Situational analysis: involves assessment of the current situation from various perspectives to
establish the actual health situation in terms of needs and priorities. With your team, scan your
internal and external environments within the context of your organization’s and health center
priorities. Consider such factors as the prevalence of the health problems, government policies,

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and current interventions. This will help you form an accurate picture of the conditions that can
affect your team’s progress toward your shared vision.
TTP team need to find out what is going on, look for opportunities that will help you move
closer to your desired futures , and identify current and potential future obstacles. Think
creatively about how to overcome the obstacles and how to capitalize on the opportunities. When
scanning the external environment in relation to a specific service delivery result, you need to
find out:
o Why the current service is not up to standards;
o How people in the external environment view the services;
o How the service has operated in the past;
o Who is being served, which other groups ought to be served, and
o How clients feel about the services;
o What kinds of services are in greatest demand and in least demand;
In general during this phase, TTP teams should address the question, Where are we now?
So from these the situational analysis answers the first question, which is about where we are
now. So, it is the step which enables to identify current health problems, coverage of health
problems and other community challenges.
A situation analysis is a process of gathering and analyzing information to provide a synopsis of
a particular situation at a given point in time.
So, data which will answer the following question will be collected:
 Who is affected and why or how they are affected
 The severity of the problem
 Resources and strategies that might be employed to produce the desired outcomes.
Components of situational analysis
Situational analysis should address three broad areas.

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1. Health Services needs
2. Resources and Policy
3. Political environment
Depending on these general ideas, the student should address information:
• Catchment area characteristics: geographic, neighborhood characteristics
• Population distribution of the area (age, sex, occupation…)
• Health facilities performance: Last year performance or last three months performance
• Woreda or town health office performance: Woreda report on health and health related issues
• Identification of community need
Besides this, students should collect data on different private and public establishments like:
school, hotel and other food and drinking establishments, prison, and other institution which
have health importance. It should also include information on perceived community needs
through community assessment and interviewing community leaders. On the other hand the
policy and political environment should be assessed by interviewing different sectors.
Data /information sources
So many different data source can be used to collect data for situational analysis. The first will
be, reviewing documents and reports of the health center. In this, information on morbidity,
mortality and health service utilization is collected. In addition it is also to show the performance
of health center and focus our attention to pressing issue. The second one can be, interviewing
the community by preparing a data collection tools like observation check list and questionnaires
particularly for institutions.
In the situational analysis student should make sure that the important data is collected, because
it is the base for plan development for overall work during the two month stay. Depending on the
collected data, analysis should be done. Analysis in this sense is giving a meaning for data we
have collected not only putting it in numbers, graphs and texts. After successful situational
analysis is done the priority setting will be made.
Analyzing and mapping stakeholders

24
Stakeholders are those individuals or groups who have a stake in achieving the result you have
selected. This includes those who can affect, and are affected, by the result—in positive or
negative ways. Stakeholders can greatly influence the intended outcome and success of a health
intervention or project. Their involvement can take place during any stage of the TTP activities
or project; however, performing a stakeholder analysis during the planning stage can greatly
influence the development of an effective strategy.
Stakeholders can help make an intervention/project successful by:
o Providing valuable information regarding needs, resources, realistic objectives, and
practical considerations for a project
o Recognizing hidden items that might not be obvious in the planning stage
o Identifying points of opposition and prevent problems during implementation
o Encouraging a sense of ownership in the project and involvement during the
implementation stage
o Ensuring the focus of a project remains on the people it is meant to support/serve
The stakeholder population can be broad, so narrowing the field to key stakeholders is a main
objective of conducting a stakeholder analysis. The identification stage could start with the
program manager, especially if he or she is familiar with current or potential stakeholders.
Remember, the more involved stakeholders are in the health activities/ project, the more likely
the action / project will be successful.
Types of stakeholders can include:
a) Beneficiaries
b) Supporters
c) Opponents
d) Resource Providers
e) Vulnerable Groups
Step IV: Identify and prioritize the major health and health related challenges
After situational analysis completed, the TTP team shall identify the important health challenges
and prioritize the challenges identified from data that is collected earlier. After this, the

25
prioritized problem should be intervened because of resource limitations all health problems
cannot be addressed at a time. Priority setting is important routine activities which are done
during the attachment time. So during priority setting different considerations will be made:
these includes
 Geographic (underserved communities)
 Overall disease burden (basic care)
 Specific diseases or conditions (e.g. HIV/AIDs, TB, STDs)
 Population groups (poor, vulnerable, women, children, etc.)
 Programs (disease control programs)
 Facilities or levels of the health system (primary health care, community)
 Other (personnel and training needs)
In addition to the above considerations, there are different types of priority setting criteria
developed to select the most important health problem/s and selected actions to address the
identified problem.
Priority setting criteria for problem identification
 Magnitude of the problem: this shows us the proportion of population affected by the
problem. This can be showed by rates, ratio or percentages.
 Severity: How serious is the condition
 Vulnerability to intervention(feasibility):
 Cost-effectiveness of the intervention: worthiness of financial cost
 Political expediency (suitability): whether the problem is in the policy of the local and
country
 Community concern: whether the community perceive it as their need
To do priority setting according the above criteria, it is important to follow the following
steps:
First, list all identified challenges in a table. Then, write the above listed criteria on the column
of the table. To give the point for each problem rate them out five depending on the data you
have collected. Then, add all points for each problem and rank from highest to lowest.
Depending on this, the most important problem within our scopeis the one with the highest point.

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There is no rule to take a given number of problems, so it is good if the most top problem can be
addressed in a given time taken.
Table 1: sample priority setting Table
Criteria for priority setting which will be ranked from 1 to 5
List of
problem
Magnitude Severity Feasibility Cost-
effectiveness
Political
concern
Community
concern
Total
Problem
one
Problem
two
Step V: setting SMART objectives
Where do we want to go?
It is the description the desired direction of a service in terms of measurable parameters. It is
should be written in very clear terms and it show as “where we want to go”. So objective should
follow “SMART” criteria (Specific, Measurable, Attainable, Realistic and Time bound).
Specific: when the objective is clear enough so that others can understand what it will look like
when it’s accomplished. It should have indicator of what will change over time and limited to
one or two indicator.
Measurable: progress towards objectives can be measured using numbers, rates, proportions or
percepts. The objective should state the baseline and end line/target indicators and should be
expressed in numbers, rates, proportions or percepts.
Appropriate: the objective should align with the strategic MU CHS, health center and the team
plan. It should be basis on the existing, identified and priority challenges
Realistic: the objective should be achieved the current activities and resources.

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Time bounded: the objective should have a start and end date.
Examples of SMART objective
- To increase use of voluntary counseling and testing (VCT) services in one district by 50% (to
an average of 80 clients per month) by the end of the year.
- To streamline the intake process for new clients in our clinic so that, by the end of the year,
the prescreening process takes an average of 10 minutes.
Step VI: Identify the obstacles and their root causes
In your scan of the current situation, you may discover opportunities that you had not seen before
that will help you to achieve your result. It is important to be clear about which opportunities you
can reasonably take advantage of, given available resources and your team’s role or mandate.
Once you have identified the obstacles, you and your team need to determine the main cause(s)
of the obstacles in order to know how to address them. This process is called root cause analysis.
By examining the root causes of the obstacles, you will not only understand the obstacles better
but also be able to formulate solutions that address the underlying problem, not just its visible
symptoms.
It is important to stop at a “Why?” that is within your sphere of control or influence, not one that
is outside of your influence.
The goal of root cause analysis is to identify and remove the causes of problems or obstacles by
asking why the obstacles are occurring. It is based on the principle that only a few primary
factors are responsible for producing most of a problem, and it provides a systematic method for
gathering and analyzing evidence about a problem so that you can address it effectively. In the
health care setting, there are often many contributing factors to a challenge or obstacle.
Analyzing root causes helps to determine the primary underlying causes that are most
responsible for creating the problem, so you can focus your efforts (priority actions) on the
causes that are most critical to resolving the problem.
If you do a poor job of identifying the root causes of your problems, you will waste time and
resources putting remedies for the symptoms of the problem. Hence, the Ethiopian Hospital

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Reform Implementation Guideline (Volume I) explains, “Like peeling away the layers of anion,
finding the root cause requires careful analysis of multiple layers.” Analyzing root causes helps
to determine the primary underlying causes that are most responsible for creating the problem, so
you can focus your efforts (priority actions) on the causes that are most critical to resolving the
problem.
Several techniques exist (e.g. Fishbone diagram, The Five Whys, Flowcharting, Histogram, etc)
for the analysis of root causes. In this manual we will make use of the Fishbone diagram and The
Five Whys techniques since these are the most commonly used techniques and complement each
other.
The following makes up a list of examples of root causes for low flow of VCT clients in your
hospital/health center:
o People don’t know what VCT is and why it is important.
o People have fears, beliefs, and superstitions about HIV and AIDS.
o Some staff are not adequately trained to provide follow-up counseling to clients who test
positive for HIV.
o Clients are not being referred to clinics that provide VCT services.
o The layout of the VCT clinic makes privacy impossible.
o The delivery of test kits is erratic.
In the Fishbone diagram the causes can be grouped under four categories:
1. People: Knowledge, skills, feedback, motivation, support
2. Policies: Rules and regulations that you can affect
3. Processes and procedures: Standards, equipment
4. Environment: Woreda Health Office, Regional Health Bureau, community, other
stakeholders (or you can add more categories if required)

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Figure 1: The fish bone diagram used to identify the root causes of a challenge
Step VII: Develop an Action Plan
Action plan is a plan which helps to implement the objectives. It is done just immediately after
the situational analysis and priority setting done. So, it is developed in the first week of the
attachment. It is developed for all activities done during the stay, i.e. for static, outreach and
other activities like mini-project, outbreak investigation, etc…). Action plan for the routine
activities done at static (health center) can be by looking at the plan and performance of the
health center by considering human power, time and other resource. And action plan for other
activities will be prepared from the assessment done during situational analysis.
At a minimum, an action plan identifies the actions or activities that will be implemented;
responsible person/body for carrying out each action; the human, financial, and material
resources needed and a timeline showing when the actions will be carried out. So it is the main
part of the attachment.
Plans are much more likely to be implemented and bring results when they:
o are created and owned by the team and reflect the shared vision of the team;

30
o address a well-defined challenge that is based on an observable gap between desired and
actual performance;
o contain measurable indicators that allow you to see that the performance gap is closing;
o focus on prioritized actions that were selected after a thorough analysis of root causes;
o contain a clear timeframe for implementing each action and designate specific
individuals to carry out each action and be held accountable for results;
The following components are the most important for an action plan:
1. Prioritized challenges: this the component which shows what priority you had.
2. Objectives: describe well in the previous section
3. Strategy: How we will achieve our objectives?
It is the ways of achieving objectives. As a result, it shows; the technology to be applied,
procedure to be used, defining the role of the communities and other relevant sectors. Strategies
applied during TTP can be; health information dissemination, home-home visit, community
gathering, demonstrating how things are done and different other ways can be developed.
4. Actions: are specific works done to address the objectives
Priority actions are activities or interventions that directly target the root causes of the obstacles
you identified and, when implemented, will result in achieving your result. Prioritizing your
actions will help focus staff and others on actions that will lead to results. When you work on
your priority actions, try to keep the number of actions to a manageable level. Three to five
actions are oft en enough to focus your efforts on a single challenge and on the underlying root
causes of the obstacles.
Priority setting matrix to select actions
This tool can be used to prioritize strategies and actions as part of developing an action plan.
Priority matrix is used to prioritize actions selected for one of the problem.
 Time to implement: (1= the most time, 3= the least time)
 Cost to implement: (1= the highest cost, 3= the lowest cost
 Potential for improving quality in the long term: (1= the least potential, 3= the most
potential

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 Availability of resources: (1= the least available, 3= the most available)
Process
Step 1: Demonstrate the tool and list priority actions
Step 2: Rank each priority action on a scale of 1 to 3
Step 3: Calculate the total points for each priority action
Table 2: Example priority matrix for specific action
Criteria rank from 1 to 3
Action for implementation
Action one Action two Action three
Time to implement
 1= the most time
 3= the least time
Cost to implement
 1= the highest cost
 3= the lowest cost
Potential for improving quality in the long term
 1= the least potential
 3= the most potential
Availability of resources
 1= the least available
 3= the most available
Total
5. Indicator: It shows how the objectives are measured. E.g. no pregnant with ITN
6. Responsible person:

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Table 3: Sample static action Plan
Table 4: Sample outreach action Plan

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Table 4: Sample mini project action plan using challenge model
Action plan for the static activity will be done without stating the problem, because it is just
giving a service. So action can be listed and the number of clients seen per week will be
estimated.
Preparation of action plan for the overall 8 weeks
o Weekly plan
Action plan report
o Action plan should be reported to supervisor at the end of first week
Action plan presentation
From week 2 to week 8: Intervention according to action plan

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 Activities which will be addressed
o Clinical activities (all activities should be performed according to the profession of each
and every students)
o Outreach services including home visit and Special population health (prison, school
children, etc)
o Mini projects
 Fourteen night presentation
 Seminar or case presentation (it can be every other week)
Week 8: Finalizing interventions, monitoring and evaluation and Compilation of report
o Activities should be performed
 Evaluation of whether activities are performed according to the plan
 Evaluation of interventions
 Compilation of total performance report
 Final presentation and document report
4. MAJOR ACTIVITIES IN TTP
During TTP the student is considered as independent health professional. So they will take the
responsibility to plan, intervene, monitor and evaluate health problem under the supervision of
the college instructors. They may perform the following activities, but not limited to these
activities. They can do activities which are relevant to their specific situation of their attachment
areas which can address the community health problems.
4.1. Static health Services
Major activities at health facility

35
o Communicate effectively with the staff of the health institution, patients/clients and
families to maintain good relationship
o Provide integrated health services including night duty services
o Identify topics and conduct individual or group health education
o Conduct environmental health activities in the institution
o Disinfect and sterilize all medical equipment and materials
o Use appropriate diagnostic facilities to diagnose diseases and treat patients accordingly
o Refer cases to the next level of health institution when the need arises
o Follow up of patients and other interventions in the health institutions
o Consult other health professionals as needed
o Document and report all activities performed
o Arrange discussions, seminars and /or morning session on common health and health
related problems
o Work according to their profession in diagnosing and treating patients
4.2. Outreach services
Inspection of food and drinking establishments, pharmacy, water source and private health
institutions, provision of immunization, school health program, prison health, etc. Emphasis
should be given institutions or organizations providing services for larger community. The
following are some of the activities done in outreach programs
Health Education
o Identify major health and health related problems that can be targeted for health
education
o Plan how to give health education
o Selecting appropriate materials and methods for health education.

36
o Conduct health education at various appropriate settings (community gathering, school,
prison, health facilities)
o Evaluate the effectiveness of the health education
Home Visit
o Prepare check list based on the priorly identified problems
o Organize necessary resources for home visit
o Apply communication skill to create good relationship with people
o Provide treatment for minor illnesses; give health education on major health problems.
o Immediately refer cases with life threatening situations
o Summarize what has been discussed in order to point out the progress that has been
made
o Evaluate the effectiveness of home visiting
School Health Service
o Communicate with the school management
o Inspect the school compound and check the excreta disposal system, solid waste
disposal, water supply, whether the playground is safe for children, number of students
per class etc.
o Inspect the classrooms for cleanness, crowding, light entry, and ventilation
o Screen students for common health problems and take the necessary action with help of
health facilities management
o Check the availability of first aid services in the school
o Select topics and conduct health education according to the identified problem
o Establish health clubs and strengthen existing clubs.

37
o Follow up of the implemented interventions
o Document and give feedback for the school management and the health sector.
Prison Health Service
o Communicate and discuss with the prison management about the program
o Inspect the environmental sanitation of the prison
o Inspect the hygienic condition of the prisoners
o Screen the prisoners for presence of health problems
o Select and conduct health education according the identified problem
o Demonstrate on diseases prevention methods such as steaming for delousing
o Identify patients mainly with communicable diseases and take actions accordingly
o Design and implement interventions that promote health in the prison
o Follow up
o Give feedback to the prison management and the health sector
Health center outreach services
o Discuss with the health service providers in the locality
o Provide integrated health services such as family planning service, immunization,
growth monitoring, health education, etc.
o Inspection of different food and drinking establishments, private health institutions
o Follow up
o Document and report
Health Institution Supervision

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o Plan and organize for supervision
o Prepare check-lists, schedule and other relevant logistics to run the supervision
effectively: it could be any governmental , non-governmental or private health
institutions
o Conduct the supervision
o Summarize the outcome of supervision
o Report and give feedback to the relevant bodies
Environmental Health Services
o Plan and organize the different environmental health activities
o Mapping of the different localities of environmental health importance
o Inspect and check the adequacy and safety of water sources and take appropriate action
o Inspect waste handling practices and take the necessary action
o Inspect the availability and cleanness of individual, communal and public latrines and
assist in the construction and how they can utilize them
o Inspect eating and drinking establishments and take the necessary actions
o Identify vector-breading sites in the community and take measures accordingly
o Inspect local cottage industries, and other working areas where many people work.
o Assess the sanitation of health institutions with special emphasis on infectious waste
management, excreta disposal, sterilization /disinfection technique, construction of
incinerator, and placenta and still birth pits
4.3. Mini – Project
o Identify health and health related problems and prioritize them using challenge model
o Plan and organize mini projects that will help alleviate the prioritized problems

39
o Identify different resources in the community that are needed for implementation
o Implement the mini-project with full participation of the community and other
concerned bodies
o Monitor and evaluate the mini- project
o Arrange follow up mechanisms of the implemented mini-projects for their
sustainability
o Write the final report of the project and submit to the concerned bodies.
Seminars and case presentation
o Select the topic and prepare the seminar
o Invite concerned people for the seminar
o Arrange the necessary teaching aids for the seminar
o Conduct pretest on the selected topic
o Present the seminar in team
o Allocate adequate time for discussion
o Conduct the discussion
o Summarize important issues of the seminar
o Evaluate the process of the seminar in order to improve future seminars
Documentation and Reporting
o Document all the activities. What is not recorded is what is not done
o Properly arrange the documents
o Prepare and provide report on time for supervisors and CBE office

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5. THE ROLE AND RESPONSIBILITIES CBE OFFICE, STUDENT
SERVICE CENTER AND TRANSPORT OFFICE
5.1. The role of CBE office
The office is the central actor in CBE programs. It’s mandated to plan, implement, monitor and
evaluate CBE programs. The role and responsibilities are listed as follow. Preparing and publish
schedule, assign supervisors, giving orientation and training for students and instructors, assign
and monitoring student representatives, supervisors, provide stationary materials, evaluate and
document students grade.
5.2. Student Service Center and Transport office
Meal, housing and related issues are handled by student service center. The transport service
office and facility office shall facilitate transport, maintenance and all related issues.
5.3. TTP site coordinator from CBE office
CBE office shall assign one TTP site coordinator from it office members for each team and will
have the following roles and responsibilities.
Roles and responsibilities of TTP site coordinator
TTP site coordinator is assigned by CBE coordinator.
The following is a task performed by supervisory team leader throughout CBE program
attachment.
- The team leader is directly accountable to the CBE coordinator
- Plans, directs, coordinates and monitors overall activities of the team
- Confirms fieldwork is started on time as scheduled and facilitates the work of the team.
- Schedules supervision date and time for supervisory team members
- Conduct regular supervisory team member’s meeting to discuss student performance

41
- Compiles reports submitted by each supervisory , student’s group leader and submits to
the CBE coordinating office
- Makes sure that students receive proper supervision, guidance and consultation from
members of the supervisory team
- Performs all other tasks assigned by the CBE coordinator for the assigned team
5.4. The role of assigned supervisors
The role of Resident supervisors
Supervision is the responsibility of all supervisors assigned to the training sites and other
stakeholders in the training. Each assigned supervisor will be stationed in his/her assignment area
for a minimum of one week. For the sake of continuous and proper assessment of students, one
main supervisor will be assigned for a minimum of two weeks on rotation basis. The supervisors
supervise and guide the students while performing their activities.
The main responsibilities are summarized as follow.
 Shall take attendance, evaluation checklists , TTP manual and all other necessary materials
that is necessary for TTP supervision befor travelling to assigned TTP site from CBE office
 He/she shall provide support and feedback to students in the training program.
 He/she ensures greatest conducive learning atmosphere to students at the training program
 Makes sure that students conduct discussion sessions according to the program scheduled.
 He/she has to take student attendance every morning and recap daily activities at every
evening.
 He/she has to visit students at their actual working environment ( outreach, static and mini
project…etc)
 Shall submit report on evaluation of students and attendance and program for the CBE office
at most two day later of his/her returns from site.
 For a student who will be absent for two days ; the supervisor shall suspend the student from
the TTP program and immediately report and make a communication to CBE office

42
 Shall properly filled evaluation checklists for each students; failing to take attendance and/or
evaluation checklist; failing OR delaying to return back attendance and/or filled evaluation
check list to CBE office will result in accountability.
 Shall immediately report students disciplinary issues to CBE office and after discussion with
CBE office disciplinary measures will be made based on MU legislation and CBE working
guideline
The role of senior supervisors
The composition of the supervisory team should be multidisciplinary based on the students’ field
of training (department). The supervisory team members provide professional and educational
guidance to students through the process of community diagnosis, practical demonstration in the
field and/or discussions. Special emphasis will be made on the application of theoretical
knowledge and development of skill of students.
Based on the specific objectives of the TTP program, team members provide continuous
feedback and support to students and resident supervisors assigned in the program and are
expected to accomplish the following:
 Senior supervisor shall be at least master degree holder and above for other health
science students and specialist/subspecialists and above for medicine students and
assigned from respective department of the college by the CBE office.
 CBE office shall assign one group leader from list of assigned senior supervisors for
TTP site
 Group leader’s role
o Shall take active role to make the session in progress as to the best standard
o Shall be responsible for organizing the team and securing the necessary inputs
resources for the presentation
o should contact the students` leader, reporter, TTP site coordinator and CBE
Officers as deemed necessary

43
 The team shall attend presentation and seminars on fortnight report and give feed back
to the student, supervisor and CBE office as necessary as possible
 Based on the TTP guideline, senior supervisor evaluate the student and the presentation
in general
 Shall submit the evaluation of the site to the CBE office at most two days later of the
supervision.
 Shall properly filled evaluation checklists for each students; failing to take attendance
and/or evaluation checklist; failing OR delaying to return back attendance and/or filled
evaluation check list to CBE office will result in accountability.
 Shall immediately report students disciplinary issues to CBE office and after discussion
with CBE office disciplinary measures will be made based on MU legislation and CBE
working guideline
The role of students and student representative in TTP
5.5. Duties and responsibilities of each student in TTP programs
All students:
- Should be disciplined while evolved in CBE activities
- Be punctual for the day to day activity
- Should discharge individual and group tasks assigned to him/her
- Should actively participate in group meetings
- Should participate in implementation and evaluation activities
- Should participate in all TTP activities and report writing
- Should do all other tasks assigned to him/her by the group team leader, logistics ,
reporters and assigned supervisors
- Should learn and act according to enhance social and cultural skills
- Should be willing to learn cooperatively/collaboratively with peers
- Should strengthen university-community linkage

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- should be willing to learn from the community
- all MU university legislation rule and regulations are applicable
5.6. The role and responsibilities of students representatives
5.6.1. Job descriptions of student team leader
The Student team leader is selected by the students and will have the following job description:
 She/he is directly responsible to supervisory team leader
 Organize, lead and play a role model to other students
 Take attendances in every day activity
 Assign specific and individual tasks to members
 Leads team student members meetings
 Participate in evaluation of the students
 Makes sure all necessary materials to be used in the program is available before hand
 Participate in all CBE activities and produce reports
5.6.2. Job descriptions of student team raporter
The reporter of the student team is selected by the students democratically and will have the
following job descriptions:
 He/ she is directly responsible to students team leader
 Organize the students in the write-up process of the team report.
 Compiles findings and job accomplished by the team in the symposium.
 Assist the student team leader in leading and organizing activities
 Represent the student team leader during his absence.
 Present the findings of the study during CBTP symposium

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5.6.3. Job descriptions of student team logistics
One student team will have two or three logistic personnel. The students elect these personnel
democratically.
The students’ logistic personnel(s) will have the following tasks:
 Take responsibilities to receive and distribute stationeries and other materials
 Responsible for the foodservice that if provided by the university
 Responsible in taking out food and other utensils from the students cafeteria if taken
 Organize and lead students to participate in the preparation and distribution of field food
 They will be responsible to communicate logistic related issues to the coordinator assigned
from Student Service Center and CBE office
 Together with Team leader they will take all logistic responsibilities
5.6.4. Professional roles
Professional role of Public Health and medicine
 Provide comprehensive outpatient and inpatient services
 Handle health related emergencies and casualties including minor operative procedures
from the front line field set-up up to the higher level institutions
 Perform minor surgical and obstetric procedures
 Provide preventive, curative and rehabilitative health care services.
 Refer difficult cases to the next higher health institution and do follow-up to guarantee
continuity of care.
 Counseling and teaching of patient with regard to existing health problem of the
community. Coordinate and participate as a leadership role in the prevention and control
of communicable diseases management
Comprehensive Nurse professional role

46
 Provide nursing care for individuals, families and communities following sound scientific
ways of nursing processes.
 Demonstrate competence in the skills and techniques of nursing based on concepts and
principles from selected areas of physical, biological and behavioural sciences.
 Participate as members of health team in the promotive, preventive, curative and
rehabilitative health care delivery system of the country.
 Demonstrate leadership qualities and decision-making abilities in various situations.
 Recognize the need for continued learning for their personal relations and professional
development.
 Demonstrate skills in teaching, management, inter-personal relations and communication.
 Practice ethical values in their personal and professional life
Psychiatry Nurse professional role
 Provide basic physical care for patients with self care deficit and altered physiologic
functions in any clinical set up
 Use critical thinking ( collect and analyze relevant data, establish priorities, make
appropriate decision for implementation and evaluate achievements)
 Communicate effectively (includes individual , family and communities interaction,
written documentation and record keeping, formal and technical writing)
 Use the nursing process as a frame work for nursing care practice for individual, families
and community health needs
 Apply professional, ethical and legal principles as well as evidence based practice in
providing care to clients
 Guide, counsel and teach clients based on the need at all health settings
 Demonstrate leadership and management skill in all work settings
 Function as a leader and change agent concerning standards and quality of nursing in the
nation
 Actively participate in the promotion, prevention and rehabilitation program at the
community at large
 Function effectively as a member of primary/ community health care team
 Diagnose and manage common psychiatric problems and refer when needed

47
 Promote planned change to improve health care delivery system in any setting
 Conduct and participate need based research on the identified problems and utilize the
research findings as evidence based to improve the quality of care provided to clients
 Demonstrate awareness of own values and beliefs and respect for the right and belief of
others, appreciate the importance of cultural influences on life style and health practices
 Participate in the development of nursing curriculum including design, implementation
and evaluation process for curriculum change as a whole and in a specific courses
 Apply all the different methodological skills and teaching aids in the teaching-learning
process and evaluation techniques in the teaching institution
 Demonstrate the need for continuing learning for professional and personal enrichment
Midwife professional role
 Evaluate obstetrics and gynecology patient history, physical examination, laboratory
results, ultrasound and additional diagnostic data
 Diagnosis of normal and high-risk pregnancies, provide efficient care , managing minor
and major complications of pregnancy and refer them accordingly
 Develop appropriate obstetric and gynecological care plan consistent with the overall
medical midwifery/ nursing regimen
 Conduct a clean and safe delivery, and handle selected emergency situations to maximize
the health of women and their newborns;
 Diagnosis of common gynecological problems, prepare and assist for elective operation
 Diagnose and manage abortion Effectively
 Function effectively as a member of the clinical and community health team.
 Give integrated F.P counseling and services, mange related complication of various types
of contraceptive methods, diagnosing and treat Sexual transmit illness
Medicine professional role
• Intern/ graduating class students shall be enrolled in TTP
• Will be developed in future
Pharmacy professional role

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• Identify and prioritize pharmaceutical problems in line with the priority health problems
of the community
• Plan, implement, and evaluate specific activities to solve the prioritized health
/pharmaceutical problems
• Develop essential drug lists and formularies/ treatment guidelines for the priority health
problems
• Design, implement and monitor procurement and drug supply of essential medicines
• Design, implement and monitor appropriate storage and disposal of drugs
• Demonstrate good dispensing practice and patient medication counselling
• Provide drug information to patients and health care professionals
• Implement pharmaceutical care practices
• Participate and demonstrate your role in health promotion and education (e.g. the proper
use of medication; smoking cessation; immunization; prevention of drug abuse; hygiene;
family planning; AIDS prevention, health screening (e.g. Hypertension, diabetes,
cholesterol) )
Dentistry professional role
• counseling and management of oral symptoms of pregnant women, management of oral
symptoms of systemic diseases like diabetes, malnutrition, HIV/AIDS ,chronic renal diseases
• Management of infectious oral diseases
• management of odontogenic and non-odontogenic infections, minor surgical treatments like
extraction, abscess drainage, common benign growths and lesions like epulis, diagnosis of
benign and malignant lesions and referral ,diagnosis and management and referral of oral
maxillofacial traumas
• Understand the community aspects of dentistry
• To take up leadership role in solving community oral health programme.
• Preventive dentistry: in the application of pit and fissure sealants, folurid gel application
procedure, A. R. T
• Oral health awareness creation in different setups like schools, prisons, different social
gatherings including practical demonstrations on teeth brushing,
• Oral hygiene promotion, dietary counseling of oral health including bottle feeding practices,

49
• The effect of malpractices that cause malocclusion, management of teething
• Dental examination of patients coming to the health center
• Delivering health education on relevant oral health topics to patients & their attendants
visiting the health center
6. ACADEMIC REQUIREMENT, RULES AND REGULATIONS DURING TTP
Students are obliged to be abided by the rules and regulation of Mekelle University and CBE.
Violation of the rules and any misconduct by a student will result in disciplinary measures as per
the rules and regulations of the Mekelle University legislation and CBE office.
6.1. Attendance during CBTP and TTP
Mekelle University legislation states: Students are required to maintain 100% attendance to earn
credit in the CBE courses as per the legislation ARTICLE 83.2.2
However,
 If the student’s absence (not more than 10% attendance) is proven to have been for valid
reasons (such as sickness or death of any of his parents, child, spouse or sister/brother) to be
presented from relevant bodies, the office shall him/her allow to finish the program.
 If the student’s incomplete attendance was due to reasons that were not valid, the ‘IA’ grade
shall be changed to an “F” grade from the last date of summative assement or one week after
the next enrollment.
 Notwithstanding sub article 82.2.4 MU 2006 legislation of this provision, a student who has
missed more than 10% attendance in a given course in a semester shall be forced to take the
course afresh
- Supervisors shall be responsible for the follow up of program attendance of their
students and must report in written form to the CBE office.
- No makeup examination is to be allowed and the student should pass through the
actual practical learning process.

50
- Full attendance (100%) is mandatory during TTP to be equipped with skills unless
permission is given by the concerned CBE coordinating office of the Colleges.
Failure in punctuality at work and group meeting places is not acceptable.
6.2. Academic requirements or Grading during CBTP and TTP:
TTP will have four (4) credit hours. The minimum passing grade in TTP courses for those
programs that use fixed scale for grading is a "C". However, student who scores below C is shall
repeat the course.
6.3. Disciplines/Conduct during TTP:
- Disciplinary measures against academic nuisance, dishonest, misbehavior, cheating,
plagiarism, impersonation, will be taken [Accor. to MU legislation of part IX (Articles 128-
136)].
- Resident and senior supervisors from MU-CHS should be obliged to report to the respective
CBE coordinators or TTP site coordinator and the department head about the misconduct
[Refer to MU legislation of part IX (Articles 128-1136)].
- Any student in TTP attachment who misbehaves towards the health center staff, community
members and supervisors shall appear before the disciplinary committee.
- Any misconduct (insulting, quarrelling, sexual assault and other kind of inappropriate
behaviors) by the student during their stay will result in the student earning a grade of “F” in
the course and repeating it.
- Damage or loss of any material taken for the program shall be paid back/replaced by the
student who did the act with disciplinary measure.
- In all conditions of CBE and TTP programs in the campus or field work, the rule and
regulations of Mekelle University is functional.
- Any report from any source and confirmed action of substance abuse
6.4. Repeating CBE courses:
- Repeating a course or courses due to academic deficiency is not the right of a student
but a privilege granted by the CBE and the college higher management bodies.

51
7. STUDENT EVALUATION
7.1. Student Performance Evaluation in TTP
Generally there are four areas of consideration for each student evaluation
1. Day to day activities of student’s
These evaluation criteria consist of information on attendance, punctuality, subject matter
knowledge and ability to work in team. The resident supervisors evaluate students and a
team on day to day bases (Annex-I).
The students are expected to discharge their responsibilities as individual and as a member
of the team under supervision of the resident supervision
2. Fortnight report
These evaluation criteria focus on attendance, punctuality, scientific approach of the
presentation, student participation and the involvements of different stakeholder (Annex- ).
The senior supervisory team shall undertake fortnightly visits on Saturday. Multi-
disciplinary supervisors are given roles to supervise the team specific to their own expertise
and provide technical support and feed back to the students and students should present two
weeks activity report and management session seminar on selected topics of academic
interest
3. Final document( written report)
The written documents have to be submitted to the CBE office before the final written
exam. Students who are not able to produce such documents will not be able to sit for
comprehensive exam ( Annex-II).
4. Final written exam report
The written exam will be from the report produced by students and other necessary
documents.
5. Peer evaluation

52
The progressive assessment of 8 weeks will make the final grade. The grading system will be as
per Senate Legislation of the college/MU. Percentage of each evaluation share suggested is as
follows. The evaluation instruments are Annexed (Annex 6-51)
- Peer evaluation -5 %
- Resident supervisor- 40 %
- Senior supervisor -30 %
- Document evaluation -25%
8. ACADEMIC STAFF WORKLOAD IN CBE PROGRAMS
8.1. Academic staff work load
The workload for CBE programs follows the Mekelle University senate legislation. The work
load of an academic staff, in CBE programs, shall be expressed in terms of Lecture Equivalent
Hours (LEH) as expressed in the Mekelle University legislation [Article 51, MU legislation
2014]. For the purpose, course credits, laboratories, tutorials, senior projects/essay or Thesis
advising, etc. are expressed in terms of LEH. However CBE programs are field work activities
which are not explicitly stated in the categories of workload activities in the legislation,
accordingly Article 51.3 under teaching load the undergraduate student practical attachment
advising has 0.25 LEH teaching load. The workload of academic staffs who will be assigned in
CBE programs shall be calculated as follow.
TTP resident supervisor and /or CBTP Supervisors
The assumption here is the instructors spend one week, the teaching load will be calculated as
follow
0.025 LEH * number of students * number of Weeks
TTP Senior supervisor, CBTP & TTP presentation evaluators
For one senior supervision and/or presentation evaluation, the assumption is the instructor spend
two days shall be calculated as,

53
0.01LEH*number of students* number of supervisions or evaluations
One undergraduate student senior essay or/and project evaluation
0.5 LEH*number of papers
8.2. CBE office members work load
The coordinator shall devote 75% of his/her time with 9 credit hours of teaching /research load
The active CBE members shall devote half 50% of his/her time and energy to the post with 6
credit hours of teaching/research load.
The delegate CBE members shall devote half 25% of his/her time and energy to the post with 3
credit hours of teaching/research load.
A member who found a partner or grant with project for CBE programs, He/she shall be PI for
the project.

54
9. References
1. Wagdy Talaat, Zahra Ladhani. Community Based Education in health professionals:
Global perspectives. World Health Organization,Regional Office for the Eastern
Mediterranean: Jan. 2014
2. Hopkins working Group definition of Community Based Education;
http://www.jhu.edu/csc/cbl/documents/FinalCBLDefinition.pdf
3. Trostle, J. “Anthropology and Epidemiology in the 20th Century: A Selective History of
Colelaborative Projects and Theoretical Affinities, 1920-1970.” In: C. Janes and others
(eds.), Anthropology and Epidemiology. Boston: Reidel Publishing Co., 1986
4. World Health Organization (WHO): Report on ten schools belonging to the net work of
community oriented educational institutions for health sciences. Innovative schools for
health personnel, 1987.
5. WHO. Community Based Education for Health Personnel. Technical Report Series 746.
Geneva, 1987
6. R. Richards and Fulop T. Innovative schools for Health Personnel. WHO offset
Publication, No.102. Geneva 1987
7. UNESCO. International conference on education, 38th session, Geneva, 10-19 November
1981. Paris, UNESCO, 1982.
8. White, K.L. Life and death and medicine. Scientific American, 299 (3): 22-33 (1973)
9. The Network: Towards Unity for Health Official Website. (Last accessed on March 13th,
2013) http://www.the-networktufh.org/about.
10. Schmidt H.G. Neufeld V. R. Nooman Z. M. Ogunbode T. (1991). Network of
Community Oriented Education institutions for health sciences. Academic Medicine
1991, 66(5): 259-263.
11. WHO. Alma-Ata 1978: primary health care. Report of the international conference on
primary health care, Alma-Ata, USSR, 6-12 September 1978. Geneva, 1978 (health for
all series No.1)
12. Hamad B. (2000). What is community based education? , evolution, definition and
rationale. Chapter 1- Handbook of Community Based Education: theory and practice.
Maastricht, the Netherland: Network publications. 11- 27.

55
13. Villani C J. & Atkins D (2000). Community-Based Education, School Community
Journal, Vol. 10, No. 1, Spring/Summer 2000.
14. OECD. The university and the community: the problems of changing relationships. Paris,
OECD, 1982
15. Jimma University Guidelines and procedyres for CBE ,2013
16. University of Gondar , Manual on health team training

56
10.Annexes
Annex I: action plan report guideline
Contents: 7 week action plan (static and outreach activities) and Mini project proposal
Static and outreach action plan format
Document format
MEKELLE UNIVERSITY
TTP Action plan format for static and outreach
Instruction: TTP team static and outreach action plan document format should be developed
based on this guideline.
Part I. General information and formatting requirements:
1. Font name -Times Roman for all texts
2. Font size - 12 for the body of texts, 14 for main headings, 13 for 1st
subheading
3. Space among sentences - 1.5 line spacing
4. Margin – Normal
5. The page numbers have to be centered at the bottom of the page
6. The sections for the body of the mini project proposal should be labeled using numbers as
follows:
1) Introduction (The objective of TTP, the socio-economic and cultural condition of the
community, infrastructures (health care both governmental and private sectors, education
including private and governmental, electric, water, recreation) etc ), and stakeholders.
Describe briefly the main challenges and the rationale for designing this particular action
plan.
2) State the Shared Mission and vision of the MU CHS and the health center
3) Objective of the TTP program (clearly state the general and specific objective of TTP
program)
4) Current situation of the TTP site catchment area (write here the result of your
scanning results both internal and external environment the health center ; briefly explain

57
 The current situation and the identified health and related challenges in the
community {eg. Catchment area total population = 69, 599, Eligible population
= 12,966, Contraception prevalence rate = 13.4% (1st 6 months 2008 E.C ), Long
acting = 24.5% of the total users };
 the resources and opportunities available {E.g. Availability of all methods of
modern contraception, supplies and equipment's, Service is provided free of
charge, Free Service providers , Community has good awareness on family
planning , The community has positive attitude/trust towards the services of the
health center, Client provider relationship is friendly } ;
 Identified Obstacles and Root Cause{ Eg. Lack of adequate manpower, Lack of
teaching/counseling materials, Inadequate room for service provision, Clients
inquire immediate removal of long acting contraception methods }
 Analyzing mapping stakeholders Beneficiaries ( a deep analysis should be
done about your potential stakeholders ; the stakeholders could be Supporters,
Opponents, Resource providers, Vulnerable groups )
 Prioritizing the challenges using prioritizing criteria
 Formulate SMART objectives for each prioritized challenges
 Design appropriate strategy for each objective
 Identify Priority Actions ( Identify possible interventions to tackle the identified
root causes and Use the priority matrix to rank the various actions to intervene
the identified root causes )
 Identify available resources for the each priority activities
 Select appropriate indicator
5) Write the 7 week action plan for both static and outreach services in tables (the
action plan should contain : Priority challenge, Objectives, Strategy, Indicators , Actions
,Person responsible, Resource needed and Time line in weeks)
6) Annex (references, Map of catchment area , and other necessary documents if any)
7. It is preferred not to use abbreviations, other than those that are commonly accepted and a list
of abbreviations should be arranged alphabetically.
8. No Plagiarism! It is an academic crime.

58
Plagiarism is the presentation of the work, idea or creation of another person without the
acknowledgement of the owner. It is considered cheating and is a very serious academic offence
that may lead up to expulsion from the program. Plagiarism occurs when the origin of the
material used is not appropriately cited. Enabling plagiarism is the act of assisting or allowing
another person to plagiaries or to copy your work.
9. Style of reference: Vancouver style has to be used.
10. Minimum of 10 relevant articles/references need to be referred to prepare the mini proposal
11. For any reference material taken from Internet: date of access and the full URL (web) should
be indicated.
12. The mini project proposal is supposed to be a maximum of 25 pages. This refers to the
portion of the proposal guide specified by maximum number of pages.
Part II. TTP document summary tables submission form:
Name and/or site of TTP team
Name of team members
Name of supervisors (Resident
and senior supervisors)
Full title of the Program
Duration of TTP attachment
Catchment Area/ community
Address of Team Leaders/s Tel/cell phone No:
E-mail:
Next to cover pages

59
Summary
Acknowledgment
Acronyms/abbreviation
Table of contents Roman numbers should be used for pages of these elements
List of tables
List of figures
Summary --------------------------------------------------- (Only one/half page)
 Introduction
 Shared mission and vision
 TTP program objectives
 Summary o current situation and identified priority challenges
 Discussion (summary of a evaluation of achievements, the challenges that team face in
while making efforts to achieve stated objective , the reason/factors for success and
failure if any)
 Recommendations
 Duration

60
Mini project format
MEKELLE UNIVERSITY
Mini project Proposal Guideline for TTP
Instruction: each TTP team of enrolled in TTP program is expected to submit their Mini project
proposal based on the directions of this guideline. The main challenge that the TTP team will
plan to develop the mini project proposal shall be identified by using a challenge model.
Part I. General information and formatting requirements:
13. Font name -Times Roman for all texts
14. Font size - 12 for the body of texts, 14 for main headings, 13 for 1st
subheading
15. Space among sentences - 1.5 line spacing
16. Margin – Normal
17. The page numbers have to be centered at the bottom of the page
18. The sections for the body of the mini project proposal should be labeled using numbers as
follows:
7) Introduction (The objective of TTP, the socio-economic and cultural condition of the
community, infrastructures (health care both governmental and private sectors, education
including private and governmental, electric, water, recreation) etc ), and stakeholders.
8) Describe briefly the challenge and the rationale for designing this particular study; why is
it important to study now and in the proposed area/setting.
9) Background of the project (briefly explain what event lead the project idea to arise)
10) Goals and Objectives (what the mini project aiming to achieve)
11) Rational (why should these goals be pursued through this mini project )
12) Broad scope of the project (briefly state the boundaries of the mini project )
13) Deliverables (what will this project produce )
14) Identify Stake holders and stakeholders’ analysis table (who has power and influence
or material stake in the mini project …. Follow the stakeholder analysis table format in
the challenge model)

61
15) Time frame (what is the likely duration of the mini project)
16) Cost of project/Budget (what is the likely types and amount of resources, labor and non-
labor required ) what is the likely source of funding?
17) Risk and key assumptions (identify all known major risks the project faces and outline
the major assumptions made in this mini project proposal)
18) Annex (references and other necessary documents if any)
19. It is preferred not to use abbreviations, other than those that are commonly accepted and a list
of abbreviations should be arranged alphabetically.
20. No Plagiarism! It is an academic crime.
Plagiarism is the presentation of the work, idea or creation of another person without the
acknowledgement of the owner. It is considered cheating and is a very serious academic offence
that may lead up to expulsion from the program. Plagiarism occurs when the origin of the
material used is not appropriately cited. Enabling plagiarism is the act of assisting or allowing
another person to plagiaries or to copy your work.
21. Style of reference: Vancouver style has to be used.
22. Minimum of 10 relevant articles need to be referred to prepare the mini proposal
23. For any reference material taken from Internet: date of access and the full URL (web) should
be indicated.
24. The mini project proposal is supposed to be a maximum of 12 pages. This refers to the
portion of the proposal guide specified by maximum number of pages.

62
Part II. Mini proposal Project submission form:
Cover pages
TTP team Name and site
List of all TTP team members
Name of
Advisor/supervisors(s) (only
those who have contribution )
Full title of the mini project
proposal
Duration of the mini project
Project Area
Total Cost of the project
Address of TTP team leader/s Tel/cell phone No:
E-mail:
Summary
Acknowledgment
Acronyms/abbreviation
Table of contents Roman numbers should be used for pages of these elements
List of tables
List of figures

63
Mini Project Proposal Summary --------------------------------------------------- (Only one/half
page)
 Background of the project
 Goals and Objectives
 Rational
 Broad scope of the project
 Deliverables
 The project Stake holders
 The project Time frame and resources
 Risk and key assumptions

Team Training Program Manual of College of Health Science , Mekelle University

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