I first heard the term “TOT” about a year ago, when one of our 11 USAID-funded Proof of Concept projects told us they wanted to increase their number of pilot users from 10 to 40 ASHAs. I had trained 10 community health workers at 4 other sites when I learned about this exciting news. Several weeks before this ASHA training was scheduled, I had trained a group of 5 field staff and the project team on how to install a CommCare mobile application, troubleshoot common problems, and understand the reports from CommCareHQ, the website where data from CommCare applications is stored. It had essentially been the beginning of a CommCare “Training of Trainers” (TOT) session without fully knowing it was. At the time, I didn’t know that this would be the first of many CommCare TOTs in India. I was more concerned with how we were going to train 40 ASHAs over three days in Mahasthra.
Growth: Creating Training Programs for Large Groups of Users
I’m a planner. I start by outlining the big blocks, and then get down to the finest level of detail. For my own sanity, I immediately began creating a training checklist and schedule for this upcoming 40 ASHA training. The checklist included all tasks that needed to be completed before I arrived on site, what modules I would review over the course of three days, and what follow-up actions would need to take place after the training ended. A lot of what went into this checklist were ideas my colleagues and I had tested during previous trainings and things we wished we had done or planned for in those earlier trainings. Thanks to the checklist, the training went smoothly. We covered everything in the three days with ample time for fun.
Many of us ended up using various versions of this checklist during different types of CommCare trainings. We got better at predicting how much it would take to review different parts of the program, although to this day I’m still pretty bad at scheduling for tea breaks at the right time (note: this is very, very important). Eventually we transitioned from informal focus group-type trainings with 10 ASHAs during the design phases to more structured and planned trainings for larger groups. Looking back, I now know that this was the first evolutionary phase of a large CommCare training in India.
When we helped grow our pilot sites in Bihar to 500 health workers and 110 ASHAs in Uttar Pradesh, we deliberately planned an intensive and comprehensive TOT program months before the actual ASHA training. As part of a CommCare TOT, we prepare local staff to lead CommCare trainings for their organizations’ health workers. Instead of having a Dimagi Field Manager lead the group training, we enabled select local staff with the nuances of how the application worked so that they could teach it to the health workers.
It doesn’t end there. We also plan more technically focused trainings for field staff who will be tasked with resolving technical problems CHWs experience in the field. Advanced orientation is given to any ICT staff supporting the project. The project management team is taught how to interpret various CommCareHQ reports, while those analyzing data must understand how to create different exports and interpret the variables that show up in the real-time exports they download from their project space.
Throughout this process, we quickly realized that all project staff need to understand the content and design basics of CommCare. For example, even those participants tasked with demoing the application to government officials and funders need to understand how to operate the application, what comprises the application, how it sends data to CommCareHQ, etc.
Building Organizations’ Capacity To Manage Large (and Larger) Projects
These TOT sessions taught us a great deal about how to sustainably scale to more users. Perhaps more importantly, the sessions taught us how to identify which organization members needed to learn specific parts about CommCare and CommCareHQ to support and maintain the process after we left. The entire process showed us that a successful TOT session requires planning an exit strategy right from the beginning.
We realized that key people throughout an entire organization need to learn specific components of CommCare and CommCareHQ that are relevant for the parts that they oversee and/or interact with. If the right people with clear responsibilities are identified, through these various types of trainings, we can build the organization’s capacity to use the technology effectively long-term and help the organization truly own the technology.
As our CommCare projects start to scale and Dimagi sets up implementation plans for larger projects, we began thinking systematically about the best ways to build organizations’ capacity to manage these projects. In order to make these projects scalable, it’s important that specific tiers in organizations receive relevant training programs that lay out information about CommCare and CommCareHQ.
This chart tries to capture various tiers of organizations we have worked with in large CommCare programs. We developed training programs for health workers, supervisors, trainers, technical support staff, managers, and data analysis staff. You can call it “TOT on Steroids” because it went way beyond TOT. We think that CommCare is most effective in bringing efficiencies into data processes and improving service delivery at the frontline when all of the right people in these positions understand how their individual part of CommCare works.
Walking Away From A Project
After a successful organizational-level training program, you walk away knowing that this group is not going to need as much Dimagi support for the next launch. Soon enough we begin to see that field supervisors are beginning to know the users better, the technical support staff is resolving the majority of issues without Dimagi’s help, the staff are monitoring data routinely, and management teams have access and transparency on the overall program activities. Every time I return to the project site where we invested in building capacity across the entire organization, I learn more from them about the users, training methods, advocacy efforts with government, and monitoring processes than I could share with them about the technology itself. This becomes an invaluable experience to learn from the organizations about the innovative ways they have applied technology to delicate and complicated ecosystems.
Once the foundation had been set for the organization to own the technology and integrate it within their pre-existing systems, the equation (at least for me) had changed. During the early stages of the piloting, the focus and attention is on the technology, but once a project is mature and the organization understands how to leverage the technology to truly meet their needs – once we get to that level – that is when you really see that the technology is only an enabler in a change theory that is much greater. For me, the innovation is represented by the adoption of the technology and not the technology itself. It’s about the change an organization is advocating for based on a simple idea and a simple phone.