The needs described in the previous section can be strategically addressed under three themes, Content Development, Training operations and M&E of training. To address these needs effectively, the Modernized Training has three sub-systems and protocols working seamlessly with each other. These are:

1. Training content creation: This is first part, where there are systems and processes to create, update and maintain a repository of various training concepts and related standardized training content, along with other documents (guidelines, directives, etc). This would involve an online system called the Knowledge Base. This would be operated by a central team of experts and content creators, who maintain the knowledge base and its contents.
2. Training Operations: This component is where the actual training is performed using content prepared. It will include processes such as planning and execution of training and certification. It would include an online Learning Management System (LMS) such as Swasth-eGurukul. This would be operated by trainers and trainees from across the country to deliver and receive training.
3. Monitoring and evaluation of training: This component allows the monitoring of the ongoing training in real-time against the general goal of all human resources related to NTEP are "Trained". This would require the maintenance of training information of all related personnel and generate reports or dashboards to monitor the progress/ current status. This would need an online tool for managing the training information of all personnel, including training history and certifications and a dashboard where data can be visually explored to understand the status of training across the country. This system would also include process of training supervision and evaluation and identifying which personnel requires re- or update training.

 

The first component of the Knowledge Base is a map of all ideas that need to be imparted to a trainee in NTEP. This section describes the various concepts, principles, roles and processes related to maintaining and updating the knowledge map.

Concepts

1. KMNodes(Knowledge Map Nodes) :

   A KMnode may be a unique concept, process, idea, definition, algorithm, or any other aspect with a specified learning objective.

2. Relationships:

The KMnode will have defined relationships with other KMnodes which may further detail or explain the concepts or describe a higher-level concept. 

For example, there will be a node defined for the concept of ‘ZN microscopy’ and it will be related to further nodes such as ‘staining’, ‘smear preparation’ and so on, or link ZN microscopy and Fluorescent microscopy through the overall concept of ‘Microscopy’ in general. Thus, the nodes and their relationship will exist as a network / map where there is no defined hierarchy. The hierarchy will dynamically be identified when a trainee or training need is defined.

The KMnodes have the following attributes:

Table 2: List of Attributes of the KMnode

Attribute	Description
ID	This is a unique identifier for tracking the nodes in the knowledge map database.
Name	Title of the page. This should be able to identify the unit sufficiently and its difference to other pages should be clearly evident.
Description/ Learning Objective	Provides short synopsis of what the content associated with the unit should cover.
Maintainer	Name/ UserName of the expert who is currently responsible for the maintenance of the node and its related training content. The maintainer has to ensure that the node and its content are in line with the principles of the knowledge map and with the current guidelines/ directives.
Relationships	Describes the relationships of the node to other entities. This will include entities such as  KMnodes (Child/parent or links)  Training content (link to Page- described below)

The current version of the Knowledge Map can be viewed from the link. The knowledge map here is represented as a list of nodes linked with other units in the knowledge map. 

 

Principles of the knowledge map

1. Idea/ concept centric- Non audience dependent: The KMnodes and their learning objectives linked to it represent one defined idea/ concept. 
2. Unique Unit Based:  A learning objective will only be represented in one and only one node. 
3. Complexity in division: In cases where the concept or topic to be discussed has many aspects, a single node may be used to represent the overall concept in brief, while specific details or in depth concepts may be presented in other nodes.  
4. Dynamicity, Organic and iterative evolution: The knowledge map is meant to be a dynamic collection of nodes, where new nodes are constantly added with new program areas/ expansion, older nodes updated with changes in program structure and deleted with outdated concepts/ideas being removed. These changes are to be made  in real time as and when the program update/ change happens.

Roles

1. Maintainer: The maintainer is a person/ expert who is responsible for maintaining the integrity, comprehensiveness and quality of the knowledge map and ensuring adherence to the above described principles. The maintainer may perform additions, modifications, and depreciations(Deletions) of nodes on the knowledge map. There may be many maintainers organized into a committee/ group and may be collectively responsible for the knowledge map. Each maintainer may be assigned a group of nodes to maintain. All nodes will mandatorily need to be assigned to a maintainer. 
2. Content Creator: Content creators are people who develop training content for each KMnode on the knowledge map. A content creator may be assigned a node to develop content against. However, they only have view permissions on the knowledge map; but may be able to respond to comments made by anyone on the nodes assigned to them. 
3. Others: The knowledge map being open content, all users(including the above two) may have access to view the entire knowledge map. They may suggest new nodes on the knowledge map and add comments/ suggestions on existing nodes. New nodes will need to be approved by the assigned maintainer before it is published on the knowledge map. Each newly added node will also be assigned to any one of the maintainers. 

Processes

1. Add new node:
   1. Submit draft node: Any visitor on the knowledge map may suggest addition of a new node. New nodes need to be linked to any one existing “Parent” node and will be first added in a Draft mode. The maintainer of the parent node will be assigned to the new node. The visitor adding the node needs to fill in all the attributes of the nodes mandatorily.
   2. Review by Maintainer: New nodes added in Draft mode will be notified to the Maintainer, who will review the node and will perform the following actions
      1. Approve the new addition after it passes the following checklist. If the node does not pass it; the maintainer may outright reject the draft node or modify the attributes till it passess the checklist.
         1. The name of the node and the learning objective are clear and precise. For example, “Burden” is an unclear title; while “Burden of TB in India” is clear and precise.
         2. There are no other nodes in the knowledge map with overlap/ have duplicate learning objectives with the new node added.
         3. There is a training need that is attributable to the new node. For, example; in NTEP training, “Manufacture of 3FDC” may be considered as out of scope of training.
      2. Assign a different maintainer. The existing maintainer may judge that the node is better dealt with by a different maintainer, he/she may assign it to a different maintainer in the maintainers group.
   3. Publish the node: Approved new nodes get published on the knowledge map.
2. Update existing node:
   1. Maintainers of the node may update any of its attributes except the unique identifier. All changes to a node will be tracked as different versions of the node. The update may be performed for the reasons such as:
      1. Update in Name/ Learning objective: The update may be triggered by various needs/ events, such as change in policy/ guidelines; any error identified on the learning objective or better understanding of the purpose of the node.
      2. Adding/ changing node relationships: The maintainer may identify new connections with existing nodes on the knowledge map. 
      3. Re-assigning maintainers: The existing maintainer may assign a node to any other maintainer on the maintainers group.
3. Depreciate existing node: Any existing node may be depreciated when the node/ learning objective becomes outdated or no longer relevant. Such depreciated nodes effectively get removed from the published knowledge map.
4. Commenting/ Discussions: Any visitor on the knowledge map may comment/ provide suggestions on any of the existing nodes. Comments may be reviewed/ replied to by the node maintainer/ the content creator assigned to that node.

Concepts

1. Content Page:

   A Content Page is a unit of training content that expresses the learning objectives on a KMnode on the Knowledge map. There will be one page of training content for every KMnode in the knowledge map. The content on each page is based on technical training material / SOPs / guidelines of NTEP and may explain or demonstrate it in more detail. In addition to the training material itself, the Content Page will also have certain additional details/ materials such as 

   1. references to source documents or other credits/ acknowledgements
   2. attachments
   3. quick reference/ job aids/ posters
   4. raw editable versions of images/ graphics/ videos used in the main content.

2. Page Types:

   Based on the type of material that is used on the Content Page, it is classified into various types. The list below is ordered in ascending based on the level of effort needed to create the page.

   1. Basic Page: These are pages that are built using simple text and images. The text and images may be based on content available in any existing guidelines/ documents/ training material, as per the needs of the learning objective on the linked KMnode. The Basic page should at least serve the needs of training delivered in an instructor led mode.
   2. Improved Basic Page: Basic Pages may be redone, to explain the concept in a better way using better graphics/ text, either by changing the way of representation (infographics), or by including examples / cases etc. This would improve the ability of the page to deliver the learning objectives to a level such that the trainee may read and understand the concept without any instructor.  
   3. Video Lecture: This type includes where the content is a video of an expert explaining the concept in his/her own words in alignment with the learning objective. The delivery of the training will rely on the expert's ability to present the content in an easily understandable way. The video may use a slide deck with a video inset of the presenter, or a writing board/ background image along with the presenter. The voice of the presenter may be scripted and subtitled along with the video.
   4. Animation: These are pages with simple animated content in a video format. This page type may be used in cases where learning objectives may be delivered better using a schematic/ moving representation of the concept as opposed to other ones. For example, simple workflows involving different locations and people over time. This type excludes animations that can be created easily by tools such as power point and recorded as a video, and is meant to classify animations that require a professional animator to create it and is often commissioned. The content creation involves multiple stages such as scripting, key frame/ scene review, draft review, and final review and approval.
   5. Video Demos: These pages contain content that are video shots of actual locations where a procedure or a protocol is demonstrated. Here too the content creation involves multiple stages such as scripting, casting, field shooting, editing, draft production review, and final review.
   6. Interaction and Games : These are pages with many different types of user interactions, such as clicking, drag & drop, text entry and so on. It uses a combination of different types of raw material to achieve a learning objective including videos/ animations/ demonstrations and narration as needed. The interaction may require the user to apply the knowledge obtained to achieve and reinforce the learning objective. It may have one start point, but may branch out into different scenarios based on user interaction, with many end-points that  may backtrack and re-join at different places. This page type may be used when the learning objectives are complex, with decisions/ judgements that need to be made. For example constituting a DR-TB Drug regimen for a given diagnostic scenario. The content creation involves multiple stages such as concept scenario design, scripting, key frame/ scene review, interaction testing, and final  review

   In cases where combinations of types are included in a page, the more complex type will be considered; for example, a video recording of an expert with an animation will be classified as an Animation.

   The page may undergo evolution / upgradation with time based on changes in the program or based on need for better content representation. The page types will assist the upgradation process. The Basic Page type is the most easiest to create and is often the first created type. Based on the material on the Basic Page, which ensures basic technical accuracy of the training content, future upgraded versions of the page may be created. 

3. Question 

   Based on learning objectives of a page and the training content placed in it, one or more questions may be added/ linked to the page. These will serve to assess whether a trainee has acquired the necessary knowledge/ understanding expected. The questions will usually be of multiple-choice type.

Principles 

The broad principles that have to be followed while developing a page are as follows:

1. Self contained/ independent: The training content on a page should be self contained and should not be built on the context of content available on any other page or continue from another page. 
2. Specific to learning objectives: The page should be able to deliver the learning objective without having to refer to another page and should contain only content specific to the learning objective of the knowledge map node linked to the page. There should not be any content included for the purposes of introduction or conclusion.
3. As simple as possible: It should be possible to use any page for the training of any personnel. Hence the technical content should be explained in simple language as far as possible.
4. Delivered in 2-3 minutes: It should be possible for the average trainee to consume the training content present on a page in 2-3 minutes.   

Roles

1. Content Creator: These are personnel that will create content against the Knowledge Map node assigned to them. 
2. Maintainer: The maintainer for a page is the same as the maintainer for the corresponding knowledge map node. The maintainer reviews and approves pages before it is to be published. He/she also is responsible for deciding the page type to be used while upgrading the page to a higher level page. 
3. Trainees: All users are by default Trainees. Trainees access the page through one or the other training curriculum. They may provide feedback at the level of a page through the comments on the corresponding linked knowledge map node.

Processes

Note: Upgradation and Modification of a page will be considered as a new version of the same page, with the same unique identifier. Older versions of the page may be available at the back end of the LMS and may be accessed on special demand.

1. Creation:
   1. The content creator assigned to a knowledge map node will create the corresponding page and its content. He/She may interact with the Maintainer to identify learning objectives, source documents as required and prepare the training content before creating the page. On page creation the status of the page will be “Pending Review”
   2. Pages that are of the status “Pending Review” will be evaluated by the maintainer of the page/ corresponding knowledge map node. The maintainer may approve or reject pages based on whether it clears the following checklist
      1. Alignment of titles- The page title and the corresponding knowledge map node should have the exact same title.
      2. Specificity of content: The page content needs to be specific to the title and the learning objectives of the corresponding linked knowledge map node. It should not convey any message that is or may be represented in another page.
      3. Content independence: The content developed on the page should not be in the context of any other page and it should convey the learning objective completely.
      4. Simplicity: Generally any learned reader should be able to read and understand/ consume the content and its learning objective without additional reference/ reading.
      5. Duration: It should be possible to consume the content by an average reader within approximately three minutes. In exceptional cases it can be longer.
      6. Questions
   3. If the page does not pass the above checklist and is rejected by the maintainer then it will be converted to the stage “Pending Modification”. It will be passed back to the content creator for addressing the comments/ reason for rejection.
   4. The page will also need to be marked as “Pending Modification” once the corresponding KM Node (Title or learning objective) is updated.
2. Modification: Pages that are with the status “Pending Modification” may be reviewed by the content creator and he/she may make changes as per the requirement/ comments.
3. Upgradation: A page whose content has not been performing as well as expected and there is a scope to improve the delivery of the learning objectives by using another type of page, it may be tagged for upgradation. Once a page  has been tagged for upgradation it will be available to the content creator in an upgradation queue.
4. Translation: Certain pages after being built into courses for specific cadres who are less likely to understand English, may be tagged for translation into another regional/ local language. Once it is tagged for translation it will be available to the content creator in the Translation queue.
5. Deletion: Page deletion only occurs when the corresponding KM node is depreciated. Such deletions may also be available on the LMS backend, but are not available for viewing.
6. Prioritization: Individual pages depending upon the need to make available the published version it will have a certain priority value. Priority value of 10 means highest priority for content development, while 0 means least or no priority. The content creator may pick up pages from a queue for modification/ translation based on the order of priority. The maintainer of the page has the rights to set the priority of the page. 

Concepts

1. Course: A course is an organized sequence of sessions containing  Pages, demonstrations, practicals, field visits, role plays, quizzes, Pre-test and Post-tests, which will be used for the training related to the program. A course is always specific to a cadre of staff, with a define role and specified competencies under the programme. A course should comprehensively cover all training requirements of that cadre. 

   Each course will have pages organized under the Page ---> Chapter ---> Module structure. Different courses will have different pages, but they may also use the same page as per the requirement of the course (which is linked with the same knowledge unit or node, and hence based on the same training need). This is depicted in the following schema:

   Fig: Course structure

   Each course will have a number of attributes as outlined below.

   Course ID	This is the unique identifier assigned to the course at the time of creation.
   Title:	The course will be named according to the cadre it is intended to train. Eg. Course for Treatment Supporters on NTEP
   Course Description	This is a short description of the course, which will outline the objectives of the course and the topics covered under it.
   CourseStructure	The course structure will contain the data regarding the linkage of the various pages organized under chapters/ Modules and the corresponding quizzes at various stages within the course/ Module/Chapter.
   Intended Cadre	This will indicate the various cadres eligible to take the course.
   Status	This will indicate the status of the course in terms of whether it is in draft stage/ unpublished or published status. It may also include statuses such as depreciated.
   CourseMaintainer	This is the person assigned to this course as the maintainer.

2. Module: A module is created for a specific knowledge / functional area which is to be covered for a cadre based on the course objectives. A course may have different modules (knowledge areas) with different pages. For example, in the course for a Lab Technician, “ZN microscopy” may be a module. 

   NOTE: Modules may also have independent existence outside a course as well. These may be used for imparting a new knowledge area as a part of new expansion in the program or may be used for re/update training.

3. Chapter: Chapters will be the topics that are to be covered under knowledge areas (modules). As above, there may be different topics (chapters) under each knowledge area (module). For example, in the module on Microscopy, “staining using ZN technique” may be one of the chapters. Chapters will hold the standardized learning material in the form of pages.
4. Quiz: Courses will have quizzes at various stages (pre / post at the level of either course, module or chapter). The quizzes are created/ drawn from the questions attached to the pages that are contained within the course/ module/ chapter. The quiz, depending on how it is set up, will randomly draw questions from a set of questions that were associated with the pages. Based on configuration set by the course creator, the learners must pass/ clear the quiz to proceed and eventually complete the course and earn the certificate. The number of questions in an assessment and passing marks for each assessment will be set at the time of configuring the course/ module as per the need of the training. In the future a quiz may also be manually assessed/ scored.
5. Certificate: Each course / module at the end or at achieving completion of the post-test successfully will have a certificate. The certificate is awarded from NTEP, and / or relevant institutions / stakeholders. A sample certificate has been provided in the Annex.   
6. Webinar:  a webinar or an online training session would be scheduled inside the course whenever a remote facilitator would interact with the trainees for any particular purpose inside the course. This could be to deliver an instructor led session, conduct discussions or clarify queries. 

Principles

The broad principles to be followed while creating a curriculum/ course are as follows.

1. One cadre One course- At a time in the training system of NTEP a specific cadre/ designation will only have one active standard course. A course should be comprehensive, such that it allows all necessary content required to successfully execute the TOR/JD of the corresponding cadre. The monitoring of the training status of a trainee will be considered as Trained/ Untrained under his/her cadre based on whether he/she has successfully completed the single course for that cadre. The individual may undergo modules that are independently available outside his/her course and will count as additional credit.
2. Logical flow in sequencing of content: The training content will have to be placed in a sequence within the course. The pages will be sequenced within a chapter, followed by Chapters into Modules and finally modules into Courses. This sequence depending upon the intended audience/ cadre will have to be selected and ordered to ensure that both the appropriate high level concept is introduced and necessary in depth concepts are also discussed afterwards.
3. Inbuilt pre/ post test : All courses should have an inbuilt assessment mechanism to objectively identify whether he/she has completed the requirements/ gained all necessary knowledge and skills expected from the course.
4. Standard schedule: The course may be executed/ operationalized as per the convenience of the institution; however a standard scheduling pattern may be set. 

Roles

1. Content creator - The content creator(described above) will also double up as the course creator/ curriculum designer. They will select and organize the pages prepared into chapters> modules> Courses in a sequence appropriate to the cadre. The content creator can create the course in unpublished form.
2. Maintainer - The maintainer may review the draft/ unpublished courses and publish them. They may also unpublish existing courses and send them for revisions to the content creator or depreciate them altogether. 
3. Operational Roles
   1. Course Coordinator - The course co-ordinator at various states/ STDCs will schedule the various courses according to the plan and training needs of the state and coordinate the conduct of the course
   2. Trainee - The trainee may access the course if he/she is one of the cadres for which the course is listed
   3. Facilitator - Facilitators may access the course when it is scheduled and he/she is added to that schedule as a facilitator.

 

Processes

1. Create a new course: Once pages are available, a content creator may organize the pages into a course. After the Type A0 page is approved and published on the CTD e-learning platform, it may be included into a course. 
2. Review and Approval of the course: Once the course is configured, approval from CTD and other stakeholders will be sought. A meeting of relevant stakeholders will be called to discuss feedback and will be documented. Relevant changes will be listed and made by course creator,
3. Set up the course evaluation: As described in the previous section a course will have pre / post evaluation at the level of either course, module or chapter, randomly drawn from the questions attached to the pages that are contained within. The number of questions in an assessment and passing marks for each assessment will be set as per the need of the training in consultation with the relevant stakeholders.
4. Configure the course certificate: A certificate for successful completion of the course will be awarded to the participants based on their performance in the course evaluation. The certificate will be designed with appropriate logos of the awarding organizations and will be decided based on consultation with the relevant stakeholders. A sample certificate is provided in the Annex for reference.
5. Setup the feedback form: two types of feedback for a course will be sought from the facilitators and trainees: 
   1. Performance or retention of knowledge / skills from the course / module.
   2. Qualitative and Quantitative feedback from the end users on various aspects of the course/ module.
6. Scheduling the course: Generally, once a course is configured, it needs to be scheduled for it to be accessible to trainees. Scheduling a course involves setting the start and end date for the course, adding webinars, contact sessions/ evaluations, adding facilitators, enrolling participants etc. The scheduling is done by the course coordinator based on the training plan.

The style guide provide reference to what standard styles should be used while developing content. This would ensure uniformity of content appearance and will ensure that the trainee would identify the content as belonging to a whole. The style guide would specify standard content styles that can be applied to online content. This would include the following. ( Click the item to read more.)

1. Formatting Guide - (Note: Work in Progress)
   1. Basic Color Palette
   2. Text (Headings, Bullets and numbering, Quotes, Captions)
   3. Tables
   4. Images(Pictures/ photographs/Graphics)
      1. Library of standard graphics
   5. Videos and Animations
2. Language Guide (TB inclusive Language)

Roles and responsibilities of Key Institutions are as following:

Institution	Activity
State TB Office (STO)	Monitoring progress
State TB Training & Demonstration Center (STDC)	Update, review and monitor the training database in real time for the state. Prepare the training plan and secure necessary resources for the execution of training Coordinate with Central TB Division, National Institutes and relevant partners working in the area of training  Scheduling and sending invitations to trainees Logistics Management for trainings Tracking and reporting on Training progress including the pre and post assessment  Manage the trainings which are conducted at STDC (specified in the cadre-wise trainers guide) Oversee the Quality of trainings conducted in the state at District and sub-district levels Coordinate with the National Institutes for building the trainer resource pool and training of specific cadres at National Level (specified in the cadre-wise trainers guide). Conduct quality assurance of the training and review user feedback.
District TB Office	Update, review and monitor the training database in real time for the district. Coordinate with the STDC (Training coordinator) for Identifying trainees that require training or retraining. Ensure that the trainees attend the trainings as per the schedule Execute training for specific cadres (specified in the cadre-wise trainers guide)  Provide local level facilitation when local groups or in-person training is being conducted in the district

Roles and responsibilities of Key Personnel are as following:

Sr	Personnel	Activity
1	Training Coordinator (STDC)	Planning the trainings across all Cadres in close coordination and guidance from the State TB Cell and STDC Collecting and maintaining Training databases of all the staff of the state/ trainees, facilitators and training resources Identifying and assigning the facilitators and resources for the execution of training (training location, etc) Prepare Training Batches Scheduling the course in LMS Admitting the trainees into the Course Scheduling Webinars/ Q&A Sessions for the trainees. Training Monitoring  Make changes in the schedule of ongoing training (if required) and keep all the relevant stakeholders informed (Trainers)
2	Master Trainer - For designated cadres	Identify the Trainers in coordination with STDC/ STC  Provide training to the Trainers Participate in select training conducted in the state Quality assurance and Monitoring of Training Quality in the State
3	Trainer - For designated cadres	Coordinate with the STDC to get Trained as a trainer and get update-training as and when necessary. Coordinate with the STDC training coordinator to get assigned to various trainings conducted in the state Conduct the training as scheduled and act as a faculty the virtual / in-person Trainings of the heath staff Demonstration of the processes, equipment and lead the field visits as required for the trainings
4	Program Managers (STO, DTO,)	Competency assessment and assign staff for re-training

Learning Management System (LMS) is an IT Application which can be accessed via a computer or mobile device. Swasth-eGurukul is a LMS created by ‘World Health Organisation’ (www.swasth-egurukul.in). LMS enables effective management of large-scale training programs involving a large number of trainers and trainees. LMS could aid in the following activities. The key User roles in LMS are:

Sr.	User Role	Description
1	Course Coordinator	Schedule a Course and its components Assign the Trainer Admit Trainees Scheduling the Webinar Monitoring the Trainings
2	Trainer	A Trainer would be assigned to specific courses, modules or webinars The trainer would be able to access the content related to it.  Administering/delivering the course Trainer will be the Host of the Zoom meeting used for conducting the Webinar
3	Trainee	Trainee will register themselves on LMS For scheduled courses the Trainees need to register. As the Course Coordinator admits, the trainee will get enrolled and access the course content Trainees can access the training content, attempt assessments and obtain certificates. Trainees can access their training records such as - courses enrolled, completed, assessment scores, certificates received etc.

• Budgeting, PIP, Training calendar, infra
• States will have to have a designated a Course Coordinator at the STDC

This section is being elaborated. Please check back later for details.

Following is a set of activities which need to be taken up by the various stakeholders to plan and execute the training:

Sr.	Activity	Activity Type	To be done by	To be done when	Remarks
1	Collect information about trainees	Once per batch	Course Coordinator	Planning stage	Use format provided in Planning Tool To coordinate with DTOs
2	Identification of resources required for training	Once per batch	Course Coordinator	Planning stage	Training location, stay, food etc. to be identified in close coordination with STDC/ STC/ Districts
3	Batch Creation	Once per batch	Course Coordinator	Planning stage	Use format provided in planning tool to create batches and assign trainees
4	Scheduling the Course	Once per batch	Course Coordinator	Planning stage	Course coordinator needs to schedule the course as per the sanctioned/approved training plan/calendar. The necessary events in the training schedule(Webinar, virtual sessions, in-person sessions, demonstrations, training evaluations) should be decided at this stage.
5	Communication/ Invitation to Trainees	Once per batch	STDC/DTO	When the training is scheduled on the LMS	STDC/STC can direct the DTOs/incharge to relieve the trainees for the training
6	Registration of Trainees on LMS	Once for each trainee	Trainee	Before any training on LMS	The trainees should register on LMS and fill in the necessary details. The trainees who’ve already registered can use their existing login credentials for enrollment.
7	Enrollment of Trainees for the Course	Once for each course	Trainee	Once a course is scheduled on LMS	The trainees need to enroll for the course that has been scheduled on LMS
8	Admitting Trainees to the Course	Once a day/ on Need basis	Course coordinator	Before training starts	The course coordinators may admit the trainees
9	Pre-Test	Once per course	Trainee	Before Training starts	The trainees should complete the Pre-test before starting the training.
10	Training Delivery	Once per course	Trainer	During Training	The trainer/ facilitator should deliver the training as described in Chapter wise trainer’s guide.
11	Post- Test	Once per course	Trainee	After Training	The trainees should complete the post-test at the end of training.Passing of the post-test is mandatory for the successful completion of the training
12	Certification	Once per course	Trainee	After Training	Based on the performance of the trainee in the interim quizzes and post-test, a certificate is generated for the course
13	Analysis and Reporting	Once per batch	Course coordinator	Within 1 week of end of training

 

The excel based Planning tool (Ref: Annexure) will be used primarily for the following activities:

Sr.	Activity	Sheet Name
1	Collection of Trainee information (Name, Designation, District/TU/PHI, phone no, email ID, LMS details etc.	Trainee Database
2	Create Batches as per the resources available - specify no. of Trainees, training location, training dates, mode of training and Trainers’ details	Training Batch
3	Assign Trainees to the various Batches	Trainee Database

The Training Planning Tool can be downloaded from this link: 

 

For ensuring seamless and effective training, the trainers and trainees need to ensure that they adhere to the following prerequisites. This section lists down the prerequisites for the trainer and trainee for conducting the training.

1. Trainer
   • Attend and complete the Training of Trainers (TOT) for the Course
   • Register as a trainer for the course in NTEP/ STDC (in Swasth-eGurukul).
   • Thorough with the latest version of the Trainers’ guide available online. 
   • Well-acquainted with the training processes to be followed for conducting training in Swasth - eGurukul. 
   • Have access to the Course on Swasth-eGurukul
   • Have access to the participant list and the schedule of training on Swasth-eGurukul
   • Ensure that the necessary arrangements for demonstration are in place (such as equipment, NTEP physical forms, Login credentials of Nikshay/ Nikshay Aushadhi, etc.)
   • Have access to a computer or Laptop and good internet connection

2. Trainee 

   • Have access to a device (laptop, Tablet or Mobile) with good internet connection. 
   • Register on Swasth-eGurukul as a trainee. 
   • Enrol for the course (once the Course has been scheduled)
   • Attempted the Pre-Test before the training

To successfully conduct training at a large scale, close monitoring is critical and LMS enables the administrators to track the progress. As the trainees across the country register themselves in the portal, LMS would eventually have the database of the trainees trained in NTEP. Since training would be a continuous activity, this database would be updated as and when training is conducted. As the trainees would need to register for courses and go through the content and assessments using LMS, the system would know trainee wise - course wise - training status including the dates of the training and their performances in various assessments. This information would help the Program Managers in planning the refresher training. Analysis of the assessment scores would help the Program Managers understand the training needs of the staff. Based on the analysis, focussed training sessions on specific topics (which are less understood) could be conducted. 

Mode of Training may be described in terms of two aspects, physical presence and the role of the instructor. 

1. Role of instructor
   1. Instructor-led learning - The trainer, using the standardized content available, explains the concepts mentioned therein. They will emphasize the necessary aspects and may demonstrate the processes/ equipment.
   2. Self-learning - Trainees using the standardized content may read/ consume it and learn the related concept.
2. Physical Presence
   1. Remote/ Virtual: The trainee attends the training and uses the content at their own locations.  
   2. In-person: The trainees are present at a training venue in-person.

Mode Of Training	Instructor-Led	Self-paced
Present in-person	Classroom training led by a trainer	Modular reading at the training centre
Present virtually	Webinars by facilitators	Remote, self-paced

Blended training - Through the NTEP training System, a mix of the above two training aspects may be used to complete the training. Sessions that require hands-on training, especially in cases where demonstrations/ practical exercises are required, need to be conducted in an an instructor led physical mode, while basics and theoretical aspects may be left for remote self-paced learning. The blended approach would leverage the best of virtual/ in-person and instructor-led and self-learning. It would enable the program to make the best utilization of time, money, instructors, venue to give the best possible outcome.

The most widely used training evaluation method is the one provided by Donand Kirkpatric in 1959 & 1998 to assess the effects and impact of training programme at four different levels. These levels are arranged in the order of improvement in the desired work output by the individual due to training.

Level	Component	Objective Measure
I	Reaction	Participants satisfaction
II	Learning	Change in knowledge, skills & attitudes of the participants
III	Behaviour	Measuring the behavioural change in the participant
IV	Results	Assessing the impact of the training

Level-I Reaction Evaluation: 

The assessment of immediate effect of the training programme that need to be evaluated during or immediately after the training session. This will be ensured by providing a session evaluation checklist after each session in the training.  This can be implemented at two levels either orally or by written feedback. Immediately after each session separately or at the end of the day separately for each session / combined as per the objectives of the day’s schedule.

Date & Time of the session:
Topic / Title:
Faculty:
A. Objective evaluation:	Response
	Very poor	Poor	Average	Good	Very good
1. The topic was relevant to me
2. The topic was relevant to its contents
3.Appropriate knowledge of the facilitator/ presenter
4. Clarity in the facilitation/ presentation
5. The contents of the discussion/ presentation were appropriate
6. The contents were adequately covered
7. Participant interaction : Aroused interest of the participant
8. Participant interaction: Allowed participant questions
B. Qualitative evaluation:	Response
Enlist two best things of the session, you like most?
Enlist two important things you suggest for improvement?
C: Overall Evaluation:	Grade the overall performance of the presentation on 1-5 scale as above.
	Very poor (1)	Poor (2)	Average(3)	Good(4)	Very good(5)

Level-II Learning: 

This type of evaluation is commonly performed by pre/post-test evaluation. A framed set of questions are put forth to the participants before they are exposed to any of the course content. This is pre-test evaluation. Pre-test evaluation provides valuable information about the status of knowledge and attitudes of the participants before attending the training programme. Then they are exposed to the training as per the schedule. At the end of the course again the same set of questions are provided to the participants and their scores are tallied to assess the performance of the training programme with respect to the knowledge and perception/attitudes of each of the participant. 
Following is the checklist for pre/post-test evaluation of the training programme to assess the performance of the programme. 

1. The pre/post-test evaluation is to be done for assessment of the training programme and should never be viewed as the performance of the participant.
2. The pre/post test questions should be alike and it should not differ, so as to evaluate the performance of individual trainee based on their performance before and after the training programme.
3. The pre/post test questions should contain proportional representation of the course contents. Such questions can be derived from the curriculum contents as provided in the training design component of this document.
4. The pre/post test questions should be in the form of multiple-choice questions (MCQ). These questions should be pretested and validated for quality and contents. Item analysis should be performed for the set of questions being used in the questionnaire.  
5. The pre/post test questions should be based on the contents taught in the session, however some logical interpretations out of the didactic sessions can be expected but number of such questions should be only a few. 

The questions in the pre/post-test questionnaire need to be updated frequently. 10% revision of the questions according to the operational programme modifications being done time to time can be adjusted in the course contents as well as in the evaluation formats. Many times, it is felt that the participants should learn everything. Unfortunately, it is not possible to learn everything! Knowledge of human body and medicine, understanding of traditions and ways of behaving in a society, skills in administration and in educational methods are all relevant to health care staff. Learning all that is known in all of these fields would be beyond the scope of the most able student in the largest course.  Therefore, the choice has to be made about what details should be left out of the course. It is simply not possible to learn everything that is known about medical sciences and health care. So, some selection is essential.
The content evaluation of any session needs to be designed based upon:

1. Work profile of the participant in the implementation of the programme.
2. The expected level of improvement from the participant

To fulfil the above needs the technical content evaluation sheet require to be covering the must know, desirable to know and nice to know topics in appropriate proportions.  
The contents of any training session should address the need of the participants. 70% proportion of the content evaluation sheet should contain the basic programme expectation from the participant, which is the most important expected gain from the participant, desirable gain and nice to gain the knowledge need 20% and 10% proportion in the evaluation.

Level-III Behaviour: 

To assess the behaviour, change in the participants of the training programme, they should be allowed to work in their specified location and position. The performance of the worker in the field after the training programme can also be assessed by an assessment questionnaire. Such evaluation should be preferably carried out after 6-12 months of the training programme. The behaviour change assessment can only be performed with the cooperation from the supervisor of the person to be evaluated. To avoid subjective bias in the assessment of the behaviour change in the training participant, supervisors of the trainee can be blinded by the exact questions of evaluation. But the assessment of effectiveness of the training programme should invariably include the supervisor’s perception about the individual’s performance before and after the training programme in a positive manner.  Such evaluation can be performed based on several activities of the health personnel such as case finding activities, treatment compliance etc. Behavioural performance assessment can be done in two stages. 

• Stage 1: Self-assessment of the performance: In this evaluation the individual is asked to assess his/her own performance with respect to contribution to various components of the programme. E.g., case finding, ensuring treatment compliance, stigma reduction in the community, patient education on DOT etc. This set of activities are pre designed into as per known enlisted components of the programme and individual contribution to these components.
• Stage 2. Assessment by the supervisor: The assessment of the performance of an individual with respect to the self-assessment of the contribution towards various programme components. To avoid subjective bias the performance of several other individuals (employees) also can be asked.

The common observations between the self-assessment and supervisor’s assessment are enlisted and graded for further evaluation.  The pre and post training behavioural change can be noted and assessed for further evaluation of training. The requirement of training of an individual can be assessed based on the performance, weaker areas need to be identified and improved subsequently.
 

Level-IV: Result/ Impact
The ultimate impact of the training programme can also be assessed in the form of several indicators. This type of evaluation should be carried out every 6-12months. Performance of the trainees field area can be assessed by various indicators such as number of cases detected before the training and 12 months or more after the training keeping in mind the targets fixed for each area, proportion of paediatric cases among new cases detected and various other indicators listed in the training module. Initially these cases may increase due to detection of more cases due to training of the individual but eventually over a period of time the number of cases detected will decrease. Service components also will be increased such as proportion of private practitioners sensitised, proportion of total general out patients referred for testing, positivity rate, number of practitioners and subordinate staff trained etc. the implementation of innovative approaches for addressing specific field level problems required to be identified and appraised accordingly.

The National level Institutions/ CTD will assess the level III and level IV performance, while level I and level II performance need to be assessed at the respective training sites. The formats for the evaluation at the institution level should be in consultation with the training team as listed above. 

The Course coordinator's guide can be accessed here: 

WIP

The role of course coordinator is of paramount importance for training the TB workforce using the modernized training system. S/he needs to coordinate with different stakeholders for smooth conduction of training.

For eg. Coordination with the trainer/facilitator for his/her availability for taking the training.
Coordination with ECHO relationship manager for the ECHO-zoom links for webinar. He needs to perform

Login to the platform:

Step 1: Open Swasth e-Gurukul | Spreading Knowledge Faster (swasth-egurukul.in)) on your browser window. (https://cms. swasth-egurukul.in)

 

Step 2: Enter your login credentials (Provided to you during your training). The dashboard page will open in the browser window.

Scheduling the course on Swasth-eGurukul:
1. Click on ‘Schedule a course’ and the tab will open which requires certain fields:

I. The field needs to be filled meticulously:
1. Course name: to be selected from the drop down menu. Select ‘Course Name’ for the target audience
2. Rename selected course name as ‘<Full State Name> State Health Volunteers training on NTEP <Month Year>’. For eg. Uttar Pradesh State Health Volunteers training on NTEP July 2021

 

3. Start Date: to be selected from the calendar. Date may be selected 2-3 days before the scheduled date of course starting. This will enable participants to complete enrolment, access and complete pre-test.
4. End date: to be selected from the calendar that pops up after clicking the field. The end date will be based on the number of days the course is expected to run.
5. Stage type: The frequency of sessions may be adjusted here. In Health Volunteers course it is recommended that the stage type is kept as Daily. On the basis of the stage type (daily/weekly/monthly) and the number of corresponding intervals between the start-date and the end-date, there will be a related number of stages available for dividing the course sessions into. Eg if the start date is 1/2/2021 and end date is 28/2/2021, corresponding to 28 days; setting stage type as daily will give 28 stages, and setting stage type as weekly will give 4 stages.
6. Certificate: The certificate for the course needs to be chosen from the list of templates available from the drop down menu.
7. State: This field helps filtering the training aspirants from a particular state. The registered trainees from the selected state will be able to join the course.
8. Moderator: From the drop-down menu, facilitator/trainer needs to be selected. One or multiple facilitator may be selected for the same course but for different sessions.
The facilitators are registered by the Project-admin and login credentials are created for them. After this, their names are included in the drop down menu.

The filled up fields appears like this (image below):
II.The next important step is setting the stages in which course needs to scheduled. Only on this particular date and chronology the course will become live on portal.
All the stages (at the level of chapters) needs to be set individually.
The dates and facilitator may be changed as per the training plan. Once the date is changed for a particular session inside a stage, all the dates for the subsequent sections changes automatically and is set to be after that date.(image below)

 

After clicking ‘Schedule’ the course scheduling progress tab opens. It may take while to schedule the course. Do not stop or refresh your browser window during this process.(image below)

 

Admitting trainees to a course:
1. On opening this tab, the course list is available. The course coordinator needs to click the course s/he has scheduled and the list of people who have enrolled for the course will be displayed.
2. The course-coordinator need to approve the trainees who have been shortlisted for this particular course (on the basis of training plan) and may disapprove the rest/non-qualified enrolees.(image below)

 

Scheduling webinars:
Webinars need to be scheduled inside the course for various virtual sessions that the participants need to join. The Course Coordinator needs to get in touch with the corresponding ECHO relationship manager to create the ECHO Meeting link.
1. The webinars are scheduled for the instructor to train the participants virtually using the ECHO-zoom link. The fields name is to be entered in a standardised manner.
2. Course: To be selected form the drop down menu. The course which has scheduled by the course-coordinator should be selected as the choice here.
3. Webinar title: The webinar to be titled in standardised manner as: Course name - Day 0 and so on. Eg. Uttar Pradesh State Health Volunteers training on NTEP July 2021 - Day0, Uttar Pradesh State Health Volunteers training on NTEP July 2021 - Day 1, etc.
4. Starting date and time:
a. The webinar may be scheduled on or after the start date of the course.
b. A webinar Day 0 may be planned as an ice-breaker session to establish rapport between and the trainer and the trainees and to explain the participants the structure of the training and to share other relevant details.
c. Upon scheduling the enrolled trainees will get the webinar link. The trainees also receive a reminder email from LMS on the day of webinar. The link will also be sent to the facilitators The trainees and facilitators may click the link and access the zoom meeting.
5. Duration of meeting: To be entered in minutes
6. Facilitator: It has to be selected from the drop down menu from the list of facilitators already added by project admin.
7. Use meeting licence: It has to be changed to “External” and the Echo zoom link provided by the ECHO relationship manager for the specific webinar needs to be entered here.
8. Webinar enrolment limit: By default, it has been set to 500. But, it may be changed depending on number of participants expected to join the webinar. After entering all these details, on clicking the ‘schedule’ button, the webinar is scheduled. (image below):

 

 

9. After scheduling, the tab displays the number of participants enrolled for course. The participants enrolled and approved for the course automatically becomes the recipient of webinar link. The course coordinator may see the list and status of webinar scheduled by him under the tab- ‘my webinars’(Image below)

 

Discussion board
It may be used by the trainees and trainer alike to post queries and respond to the comments and
queries. (Image below)

 

Monitoring the progress of Training
Training report: This tab gives the summary of scheduled courses. It also gives the overall summary
of the course progress, like how many trainees have enrolled for course, how many have started the
training, how many have completed the training, feedback received, etc. (Image below):

 

On clicking the course, the detailed training report of all the trainees opens. The course-coordinator
can see the progress of each trainee- the enrolment date, trainee’s progress on course, etc. This is
particularly helpful in reaching out to those trainees who are facing difficulty with the training.
(Image below):

 

 

 

Trainees

The targeted trainees for this course are generally those persons at the community level who would be interacting with the population for the purpose of on-ground TB activities related to awareness, screening and Treatment Support. These may include:

1. ASHA Workers
2. Volunteers from NGOs, Community Representatives/ Youth Volunteers
3. TB Champions / Survivors/ Family Members
4. Workplace Representatives who volunteer for becoming focus for TB Services
5. Educators/ Teachers from Schools and Colleges

 

Trainers

The following cadres are supposed to be trained to become trainers on this course.

1. STS
2. TB HV
3. MO-PHI
4. MPHW/ Block Coordinators (NHM trainers)
5. DPC/ PPM Co-ordinators
6. NGO coordinators/ Supervisors
7. Representatives from Private/ Corporate sector

The capacity of these trainers to conduct the training for health volunteers will be in-built into their training and is considered as one of their essential competencies.

Training Methods

Teaching and discussing the course content using the standardised training content available on the NTEP approved LMS (such as Swasth-eGurukul). This training may use blended training delivery methods that are appropriate to the local context. This would include a mix of the following options

1. Training Premises
   1. In-person
   2. virtual 
2. Mode of delivery
   1. Facilitator led
   2. Self learning
   3. Demonstrations
   4. practical exercises. 

In the blended mode, an instructor-led session should be conducted for each chapter. Simultaneously the trainees would go through the content available online themselves according to the schedule. Trainees need to attempt the quizzes after each chapter/module. 

At the end of each chapter/session the trainer/ facilitator should summarise the key messages of the chapter by engaging trainees through questions and discussions. The discussion should focus on aspects related to the competencies listed below. These sessions should also help the trainees to clarify doubts and queries. 

For the training areas which require hand-holding of trainees like to perform actual processes such as filling of forms, counselling/ addressing stigma, screening, sample collection, adherence monitoring, a demonstration/ role play mode may be adopted.

The duration of training content including discussions/ demonstrations/ role play, pre/post training assessments, is expected to be completed 6 hours. The course coordinator may schedule the course in multiple sessions totaling to this duration as appropriate.

Pre-training Preparation

Before starting a batch of training, the following preparations need to be completed.

1. Creation/ confirmation/ Issue of Ni-kshay Usernames to the Health Volunteers
2. Preparation of Props (Drug Blister packs, PWB, Specimen collection container, falcon tube, Specimen carry bags, IEC Materials)

Chapter wise Trainers notes

The course is divided into three modules, with a total of 12 chapters, each with specific learning and training objectives in alignment with the competencies of the person.   
The different scenarios and probes for the conversation and discussion have been covered in details at relevant sections. Three standard role plays have also been incorporated at the end of each module in the training course.

Session	Activity	Duration
Session-1 (Introduction)	Introduction and Overview of course    (The course structure should be explained that there are 3 modules and modules are further divided into chapters) NOTE: This session may be used as an ice-breaking session and to establish a rapport with the participants. It may also be emphasized here the importance of pre-test, quizzes and post-test assessment to successfully finish the course and obtain the certificate.	5 mins
Pre-test assessment	Note: This is Mandatory before proceeding with course content	10 mins
Module 1. Basics of TB and NTEP (120 mins)
Chapter 1: Tuberculosis	Emphasis points during the session burden of TB Disease in terms of new cases, deaths and suffering the causative bacteria   mode of transmission, progression to TB disease and the difference between TB infection and active TB disease. 4 major symptoms of Pulmonary TB and how to enquire about these symptoms.  Types of TB disease on the basis of sites of TB disease. The various sites of EPTB may be mentioned and explained in local language/context.    Post Session activity:   Facilitator may ask the audience one after the other "50-Year-old ASHA died due to TB. Why did she die?". Write responses on board and classify them into biological, behavioural, socio-economic and occupational determinants. Trainees may be asked about difference between TB infection and active TB disease. Ask any one trainee to enumerate the 4 symptoms and may ask other trainees to explain the meaning of each symptom.	30 mins
Chapter 2: NTEP	Emphasis points during the session The goals of NTEP. The TB Unit and its significance and the HR posted there. The TB case classification in NTEP The TB patient care cascade and their interaction with the health system. The role of the health volunteer and Treatment Supporter in NTEP Post Session Activity:   Ask the participants to enumerate and various stages of TB patient care ecosystem and what all activities are carried out in each of the stage.	15 mins
Chapter 3-TB diagnosis and Case Finding	Emphasis points during the session Identifying Presumptive Pulmonary TB using the 4 Symptom complex of TB  Process of referral for testing and specimen collection and transport. Discuss the video on the sputum collection. Post Session Activity:   Ask the participants to enumerate the 4 chief symptoms of PTB and explain each of the symptom. May ask one of the participants to demonstrate how they would refer a case and sample for testing. Ask the participants about the dos and don'ts regarding sputum collection.	15 mins
Chapter 4: Nikshay & Treatment Supporter	Emphasis points during the session Nikshay portal and various features available in it which are relevant to treatment-supporters. Explain the trainees the pre-requisites and process to get themselves registered on Nikshay platform How they will enroll cases, request for test, and add sample details on Ni-kshay.    Post Session Activity:  1.    The Nikshay Mobile app may be demonstrated.	20 mins
Role play #1:	A short role play with the trainees to explain the process of screening and case finding, identifying the presumptive cases, and referring them to the nearest DMC for TB diagnosis. The trainer may act as the case/patient and one participant may act as an ASHA. Scenario Brief On a routine community visit, ASHA came to know about Ashish who works in a brick kiln on daily-wages. Ashish has been coughing and unexplained weight-loss for more than a month. He’s also reluctant to get tested and is relying on a nearby Pharmacist to get a cure for his long-standing cough issues. Probes: Identification of vulnerable population Enquiring about the chief symptoms of Pulmonary TB and signs and symptoms of EPTB (with constitutional symptoms life fever, night sweats and weight loss) Information about nearest testing facilities and process of sputum collection Provision for free diagnostic and treatment services and patient support for TB patients. Educating the patients and family about the signs and symptoms of TB disease and addressing their doubts and concerns. How the enrolment, referral for testing and sample is collected and transported through Ni-kshay	10 mins
Quiz #1	The participants need to attempt the quiz based on training content covered in Module 1.  Participants should complete the quiz before moving on to Module 2. This is a pre-requisite for final certificate	10 mins
Module 2: Treatment Support and Monitoring of TB Patient (90 mins)
Chapter 5- TB Treatment and Care	Emphasis points during the session Explain Drug Sensitive Tuberculosis and the treatment phases. Describe the treatment regimen for Drug-Sensitive TB (DS-TB) – Adult FDC & Paediatric formulations. Explain the patient flow for DSTB Treatment Explain the various Adverse drug reactions and their management. Explain the DR-TB and the factors that lead to development of DR-TB. Explain the Adverse Drug Reactions to drugs used in DR-TB Treatment and its identification, management and timely referral to health facility. (It may also be emphasized here that the DR-TB treatment is more complex and involves more toxic drugs, hence ADRs are more frequent and there is need to identify the ADRs early and manage these at nearest health facilities/referral centre to N/DDR-TB centre.) Explain the TB Infection and two therapies for TB Prevention    Post session activity: Have a practical demo of the drug formulations (blister packs/ pouches/ FDCs) of an Adult and paediatric DSTB Treatment regimen. The participants may be asked to enumerate common ADRs to first/ second-line anti-TB treatment and subsequent action by Health Volunteer. May ask about the options for TPT regimen	40 mins
Chapter 6- Treatment Adherence	Emphasis points during the session The meaning and importance of Treatment Adherence. The various options available to record patient adherence. Monitoring of adherence in Nikshay The recording of adherence and missed dose in Nikshay portal. The role of Health Volunteers in TB Treatment and care. Post session activity: One-two participants may be asked about how they enquire about adherence to TB patients.  Adherence recording and monitoring can be demonstrated through Nikshay app or through videos)	30 mins
Role play #2:	Scenario 1: Mr Ashish who is diagnosed with TB has been initiated on first-line ATT. He was hesitant to start treatment after learning about his TB disease. He lives in an over-crowded chawl with poor hygiene.  ASHA visits him on Day-5 after his treatment initiation. She speaks to him and convinces him to continue the treatment. She further discovers that Ghanshyam (father of Ashish) who has diabetes is also living in the same household. Probes: 1. Whether DBT has been initiated or not 2. Identification of ADR. (The different ADRs may be explained and enquired about) 3. Importance of adherence 4. Contact tracing also needs to be carried out 5. TPT and its eligibility. 6. Counselling about TB to Ashish and his family. 7. The need to control blood sugar of Ghanshyam Scenario: 2: ASHA visits Ashish’s house after 7 weeks after his treatment initiation. He is now feeling healthy. His TB symptoms have subsided and he has gained weight. He is now thinking about taking up some construction work in some far off place in Mumbai. Probes  • Identification of ADRs if any • Change in weight and accordingly change in dosages. • Importance of follow-up at DMC for end of IP lab investigation. • The option of transferring the treatment centre for TB care and management.  • Importance of adhering to the ongoing treatment and recording it electronically. Key message at the end of role play : In the form of summary and important areas to be covered while visiting a patient after his treatment initiation. Need to take healthy food and even if they feel healthy, they shouldn’t stop the treatment	10 mins
Quiz #2	The participants need to attempt the quiz based on training content covered in Module 2.   Participants should complete the quiz before moving on to Module 3. This is a pre-requisite for final certificate	10mins
Module 3: Patient Support (120 mins)
Chapter 7 - Public Health Action	Emphasis points during the session The concept of Public Health action Various components of PHA carried out under NTEP for a diagnosed TB patient The contact tracing and investigation carried out for TB patient under NTEP Tasks are carried out by Health Volunteers on home visit to a TB patient The meaning of Treatment Supporter and who qualifies to be TS to a TB patient Post Session activity Ask the participants to enumerate the 6 public health actions that are carried out after the TB Notification Ask other participants to explain each of the PHAs	25 mins
Chapter 8: TB Arogya Sathi Application	Emphasis points during the session Explain the trainees about the TB Arogya Sathi Application, its multilingual interface, various information available in it and how TB patients can use it to mark their adherence in it and see their DBT status in the application. Post Session Activity: The TB Arogya Sathi App may be demonstrated to participants or videos can be displayed at the end of session. The use of TB Screening tool in TB Arogya Sathi app may be demonstrated and the utility of this tool in enrolment of presumptive TB.  Participants may be asked to demonstrate the use of application and clear their doubts.	20 mins
Chapter 9- Counselling	Explain the importance of TB awareness generation in community and how it is carried out in community Describe counselling for TB patients, at what stages it is carried out and what components are explained during different stages of TB treatment and care Explain Do's and Don'ts for Patient Communication Explain Nutritional Counselling and its importance related to TB patients Post Session activity Give the participants different scenarios(Like pre-treatment/During treatment/post-treatment) and Ask the different participants about the components of counselling at different scenarios	20 mins
Chapter 10- Social inclusion and wellness activity	Explain about the Stigma and discrimination faced by TB patients and its adverse effects at individual level and community level. Explain the gender aspects of TB and hoe to address gender inequalities. Explain about various wellness activities meant for TB patients	20 mins
Chapter 11: Community Engagement	Explain the meaning of community engagement and its importance in TB care. Explain about the various strategies of Community engagement in NTEP Explain about the TB champions. Explain the role of HVs in Community engagement. Post Session activity Ask the participants, in what ways the TB Champions help the TB patients	20 mins
Chapter 12: Linkages to Social Support Scheme	Explain the meaning of DBT Explain the DBT schemes in NTEP including NPY, Tribal SS, TS honarium and incentives for notifications and outcomes Explain the various criteria for availing DBT Scheme benefits under NPY	10 mins
Role play #3:	Scenario:  A newly diagnosed TB patient initiated on treatment comes to his hometown for home based care and treatment. ASHA worker visits his home to verify his address and upon enquiring with neighbours she learnt that Ashish is being stigmatised for contracting TB and his family is being discriminated against. Now ASHA has to give correct information regarding TB to the neighbourhood. Probes:  Correct information about TB  Appreciation for Ashish to initiate the treatment early.  Motivating the community to support Ashish and his family.  Counselling to Ashish and his family to prevent TB infection.  Complete PHA  Precautions to be taken while visiting a TB patient’s home	15 mins
Quiz #3: Post - Test	All module content will be covered in this quiz.  Completion of this final quiz successfully, along with the two quizzes in-between the course is mandatory for certificate generation	10 mins

 

 

Roles and responsibilities of Key Stakeholders  

Please refer to the general roles of various stakeholders for training of Health Volunteers (click here). 

Apart from these general roles, the state NHM has an important role to play in the training of Health Volunteers, especially those who are ASHAs in the state. The state NHM needs to ensure that all the ASHAs are being trained on TB and NTEP as per the standard training content. The state ASHA cell at the NHM, should ensure that the following steps are being taken:

• Support STDC/ STC in planning the training and inclusion in PIP 
• Prepare and share the list of ASHA’s in the prescribed format with the respective STDC Team
• Guide and provide directives to the respective District/ Blocks to deploy ASHA’s along with concerned supervisors to ensure active participation.

1. Introduction

The purpose of this document is to provide the course coordinators and trainers for the “Course for Lab Technicians (Microscopy & NAAT) on NTEP” guidance for planning and executing the training. The targeted trainees for this course would be:

●     Laboratory technicians (Microscopy & NAAT) working under NTEP (program staff and General health system staff)

 

This training may be provided by utilizing the blended approach where a mix of training methods and modes will be used to deliver content. This would include either in-person/ virtual training or facilitator led/ Self learning/ demonstrations/ practical exercises. Training sessions which require hands-on training will be conducted only in a physical setting. Keeping in mind the aforesaid best practices of the Modernised Training System, each State may decide to choose the approach which is most suitable for their State.

For virtual sessions, the trainees will be going through the online content, and attempt quizzes after each module. An instructor-led session will also be conducted at the end of each module. This will help the trainees for better clarification of contents and to address the queries and doubts. 

For the training areas which require hand-holding of trainees like demonstration of processes- Specimen collection and transportation, smear microscopy, Using different NAAT, patient workflow in Ni-kshay, maintaining Lab Supplies, etc in-person training sessions need to be conducted.

The training course content has  modules and 56 chapters. Based on different modalities used for the training, the training delivery should take at least 45 hours.

For the purpose of assessment of trainees, a pre-test before the beginning of training, interim quizzes at the end of each module and a post-test at the end of training has been configured in the course content. The certificates are auto generated for the trainees in their LMS account on successful completion of post-test and their performance in interim quizzes.

The training of LTs needs to be conducted at DTC where the required lab facilities are available.

The batch size for Physical Session should not be more than 7 participants and not more than 15 participants for virtual sessions.

2. Training curriculum / Agenda

 

3. Trainers

         For this course, following personnel may be appointed as the trainers

• DTO
• STLS

 Eligibility -

Trainers are selected based on their ability to conduct training in an interactive and interesting manner. They must possess strong knowledge about TB laboratories and related processes in NTEP. The Trainers should have completed the ‘Course for LT(Microscopy & NAAT) on NTEP’’.  The Trainers should be well versed with the IT systems such as, Zoom (for video conferencing), Swasthya-eGurukul (Learning Management System) and Nik-shay. The Trainers need to go through the Chapter- wise Training Guide for this Course, provided as an Annexure

Chapter wise detailed instructions for Trainers 

The aim of providing chapter-wise detailed instructions provides the Trainers with the following:

• Module-wise and Chapter-wise, modality that may be adopted (virtual/ Physical/ In-person)
• The estimated time to complete the content.
• The key messages that a trainer should emphasize upon, while delivering the training
• The activities which should be conducted at the end of each chapter / session to ensure learning effectiveness. This may include asking specific questions, demonstrating processes, discussing various forms and equipment. If any Module specific physical visits are required to be conducted, such details are also provided here. 

This guiding document will also aid in bringing uniformity with respect to the content and quality of training conducted across the entire state and nation.

 

Module 1: Basics of TB and NTEP                                              Virtual Session (4 hours)
Chapter 1.1	TB & TB Epidemiology	Virtual Session (60 min)
Emphasis Points	Differences between TB Infection and active TB Disease TB has many determinants- behavioral, socio economic, biological Vulnerable population for TB Concepts of TB Notification Rate and TB Incidence Rate
Post Session Activity	The participants may be asked to (i) enumerate the various determinants of TB and (ii) difference between TB Infection and TB Disease  Give an exercise to calculate the Notification rate of a TU. In a TU with a population of 2 lakhs, 100 TB cases were diagnosed and reported during the year 2022.. A total of 90 people with TB were initiated on treatment, 5 died and  2 migrated  before initiation of treatment.and 3 could not be contacted at all. What is the annual TB notification rate for that TU in 2021? [ Answer: 50 per lakh] Discuss - Can we call the above obtained Notification figure as the incidence of TB in that TU? If not Why? [Discussion Points: Notification and Incidence are not the same. Notification includes all diagnosed TB cases and reported to the system. It includes both new and previously treated cases. There may be cases diagnosed, but not reported. It is possible that there will be cases in the community not diagnosed at all.]
Chapter 1.2	NTEP	Virtual Session (45 min)
Emphasis Points	Explain what India is committed to achieve in 2025 in relation to SDG related to ending TB. Clarify that the country has preponed the 2030 SDG targets related to ending TB to 2025. Organizational structure of NTEP with broad functions of each institution (state level and below) Different stages in the patient’s life cycle need to be explained in detail and emphasis on the concept of continuum of care from ‘presumptive TB to post treatment follow up’. Concepts of ‘’Standards of TB Care’’ as a minimum set of care that every citizen in India should receive irrespective of where he/she seeks care from
Post Session Activity	Discuss- ‘What India is committed to achieve in 2025 in relation to ending TB?’’ [Clarify that the country is only trying to achieve the SDG goals related to Ending TB] Discuss- ‘Can Medical College be a PHI?’
Chapter 1.3	Integration of NTEP with Health System	Virtual Session (30 mins)
Emphasis Points	Need for integration of NTEP with the general health system & NHM and how that integration is envisioned.
Post Session Activity	Discuss - "What are the opportunities available to NTEP through Health & Wellness Centers? How could that be materialized’?
Chapter 1.4	Patient Management	Virtual Session (60 mins)
Emphasis Points	How the information of patients are managed through Ni-kshay (Enrollment, Request for Test).
Post Activity Session	Call two participants to demonstrate how they (1) enroll a subject and (2) request for Test in Ni-kshay Make all participants to view their task list in Ni-kshay and discuss how they are going to use the feature
Module 2	TB Diagnosis and Case Finding	Virtual Session (4 hours)
Chapter 2.1	Diagnostic Technologies	Virtual Session (30 min)
Emphasis Points	Names of different tests, their uses, advantages and disadvantages
Post Session Activity	Ask what are the advantages and disadvantages of FL- LPA over NAAT?
Chapter 2.2	Diagnostic Network & Hierarchy	Virtual Session (30 min)
Emphasis Points	Network and hierarchy of laboratories and their basic role
Post Session Activity	Ask “ how many sputum collection and transportation facilities are there in their concerned TU? Make one participant explain how it functions and what are the benefits out of it”?- Bring out the following benefits (1) prevents leaks in cascade of care (reduce loss from presumptive TB identification to TB Testing)  (2) minimizes patient inconveniences (3) minimize patient Turnaround Time (4) reduce out of pocket expenditure (5) helps in infection control as people with symptoms need not travel
Chapter 2.3	Approaches to TB Case Finding	Virtual Session (30 min)
Emphasis Points	Differentiate between screening and testing.  The three approaches may be discussed by giving suitable examples to fit into the three scenarios
Post Session Activity	Discuss the following scenarios and ask the participants which case finding those are (i) Screening for active TB in a Diabetic Clinic & testing those who screened positive (ii) Screening for active TB in an elderly home & testing those who screened positive (iii) Screening for active TB in cancer wards & testing those who screened positive
Chapter 2.4	TB Case Finding in NTEP	Virtual Session (30 min)
Emphasis Points	Diagnostic algorithm for Pulmonary TB- Role of Chest X ray as a screening tool and the need to complete the diagnostic algorithm. Classification of TB on the basis of site,diagnosis, drug resistance
Post Session Activity	Discuss: “What proportion of presumptive TB patients in your TU completes the diagnostic algorithm? What are the implications if the people are not completing the diagnostic algorithm?”
Chapter 2.5	Active Case Finding Campaign	Virtual Session(45 mins)
Emphasis Points	Step by step process in planning and execution of an ACF campaign with special emphasis on identification of target population, need for micro planning and need to prevent the leaks in the cascade of care.
Post Session Activity	Discuss how they monitor the ACF in their TU against ‘Cascade of Care? What are the measures they undertake to prevent the leaks in ‘’Cascade of care’’?

Introduction

The purpose of this document is to provide the course coordinators and trainers for the “Course for Pharmacists and storekeepers in NTEP” guidance for planning and executing the training. The targeted trainees for this course would be:

• State Drug Stores Pharmacists cum storekeepers
• District Drug Stores Pharmacists

This training may be provided by utilizing the blended approach where a mix of training methods and modes will be used to deliver content. This would include either in-person/ virtual training or facilitator led/ Self learning/ demonstrations/ practical exercises. Training sessions which require hands-on training will be conducted only in a physical setting. Keeping in mind the aforesaid best practices of the Modernised Training System, each State Office may decide to choose the approach which is most suitable for their State. 

For virtual sessions, the trainees will be going through the online content, and attempt quizzes after each chapter. An instructor-led session will also be conducted for each module. This will help the trainees for better clarification of contents and to address the queries and doubts of the training participants.

For the training areas which require handholding of trainees like demonstration of processes- like filling of forms, verification of supplies, stacking, etc. in-person training sessions need to be conducted.

Training curriculum / Agenda

Trainers 

For this course, following personnel may be appointed as the trainers

• SDS Pharmacists
• DDS Pharmacists (select)
• DTO (select)
• MO - STDC 
• MO - STC

• WHO-consultants

  
  Eligibility - 

  
  Trainers are selected based on their ability to conduct training in an interactive and interesting manner. They must possess strong knowledge about Supply Chain Management and related processes in NTEP. The Trainers should have completed the ‘Course for Pharmacists’.  The Trainers should be well versed with the IT systems such as, Zoom (for video conferencing), Swasthya-eGurukul (Learning Management System), Nikshay and Nikshay Aushadhi. The Trainers need to go through the Chapter- wise Training Guide for this Course.

  The training of pharmacists of District and TU level to be conducted at state level.

  
  It is recommended that the trainers are appointed from all regions of the State, so that subsequent refresher training can be conducted locally by these trainers.

Chapter wise detailed instructions for Trainers

The aim of providing chapter-wise detailed instructions provides the Trainers with the following:

• Module-wise and Chapter-wise, modality that may be adopted ( virtual/ Physical/ In-person)
• The estimated time to complete the content
• The key messages that a trainer should emphasise upon, while delivering the training
• The activities which should be conducted at the end of each chapter / session to ensure learning effectiveness. This may include asking specific questions, demonstrating processes, discussing various forms and equipment. If any Module specific physical visits are required to be conducted, such details are also provided here. 

This guiding document will also aid in bringing uniformity with respect to the content and quality of training conducted across the entire state and nation.

 

Module 1: Basics of TB and NTEP                                                 Virtual Session (90 min)
Chapter 1.1			TB & TB Epidemiology		Virtual Session (26 min)
Emphasis Points
Post Session Activity			The participants may be asked to raise their doubts/questions.  The participants may be asked to unmute themselves and may be asked to enumerate the various determinants of TB, difference between TB Infection and TB Disease etc.
Chapter 1.2			NTEP		Virtual Session (34 min)
Emphasis Points			Different institutions may be explained and discussed with respect to its coverage geographically, its organogram, the functions that particular institution is carrying out.
Post Session Activity			The institution from which participants have come may be explained in detail and its relationship with other institutions. (e.g. District level functionaries may be asked about their relation with the state level and TU level institutions) The stages in TB patient’s care cycle may be elaborated as a story with special emphasis on long term post-treatment follow-up
Chapter 1.3			Diagnostic Technologies		Virtual Session (16 min)
Emphasis Points			Names of different tests, their significance in Diagnostic algorithm
Post Session Activity			The consumables required for different diagnostic technologies may also be mentioned here briefly to make it more relevant for the trainees
Chapter 1.4			Approaches to TB Case Finding		Virtual Session (6 min)
Emphasis Points			The three approaches may be discussed by giving suitable egs to fit into the three scenarios The different case definition may be mentioned.
Post Session Activity			The participants may be given the scenarios like visit to HIV Clinic, ANC Clinic, Covid clinic, OPD visit to a tertiary hospital, etc
Module 2			TB Treatment		Virtual Session (203 min)
Chapter 7.1			General concepts in TB Treatment		Virtual Session (45 min)
Emphasis Points			The other formats like Tb Treatment Card and NTEP ID card may also be shown and the different fields along with the significance may be discussed The transfer of patients on Ni-kshay also demonstrated and the impact of this transfer on the patients on the trainees may be asked first and discussed in detail The importance of monitoring the transfer of the patient should also be explained
Post Session Activity			The FDCs may be shown to the trainees over camera, (Various regimens and packaging should also be shown to them on their physical visits for training) The wrongly filled treatment cards may also be shown and discussed.
Chapter 2.2			DS-TB Treatment and care		Virtual Session (10 min)
Emphasis Points			Explain the basis of categorization of regimen i.e. age and weigt Explain the significance of weight measurement of patient on every follow-up visit Explain the importance of weight change and changes in regimen required. The weight bands may be explained and subsequent increase in dosage required. The importance should be given on the fact that weight change of the patient requires change in drug dosages and hence the practice of one time dispensation of medicines for the complete course or the complete phase should be discouraged The ADRs due to DS-TB treatment may be explained and when should one seek medical attention. It should be explained to the participants that not each patient will develop ADRs and tolerance develops for the drugs with due course of treatment and when should patient seek medical care.
Post Session Activity			The participants may be asked to enumerate the ADRs and when to seek medical care Some participants may also be asked – how to counsel the patient about the ADRs
Chapter 2.3			DR-TB Treatment and care		Virtual Session (20 min)
Emphasis Points			The meaning of DR-TB should be explained emphasizing on the fact that that once a patient develops DR-TB, he’ll be transmitting the DR-TB to the community.  The different factors that lead to development of drug resistance should be explained. The role of incomplete and inadequate treatment should be emphasized connecting it to the importance of monthly follow-up and weight monitoring. It should again be emphasized that the practice of one-time dispensation of DS-TB drug to be discouraged. The different types of drug resistance may be explained with the different regimens available. The need for creation of different PWBs should be explained here. The MERM and its importance should be explained.
Post Session Activity
Chapter 2.4			Shorter Oral Bedaquiline-containing MDR/RR-TB Regimen		Virtual Session (14 min)
Emphasis Points			The salient features of regimen, its composition, the weight bands, the duration and some common ADRs of the regimen may be explained. The action to be followed after ADRs identification, whom to contact need to be explained.
Post Session Activity			The regimen may be shown to the participants- over the camera The composition of regimen and duration may be asked
Chapter 2.5			Longer Oral M/XDR-TB Regimen		Virtual Session (10 min)
Emphasis Points			The salient features of regimen, its composition, the weight bands, the duration and some common ADRs of the regimen may be explained. The action to be followed after ADRs identification, whom to contact need to be explained.
Post Session Activity			The regimen may be shown to the participants- over the camera The composition of regimen and duration may be asked
Chapter 2.6			Isoniazid (H) Mono/Poly DR-TB Regimen		Virtual Session (5 min)
Emphasis Points			The salient features of regimen, its composition, the weight bands, the duration and some common ADRs of the regimen may be explained. The action to be followed after ADRs identification, whom to contact need to be explained.
Post Session Activity			The regimen may be shown to the participants- over the camera The composition of regimen and duration may be asked
Chapter 2.7			TB Infection treatment and care		Virtual Session (14 min)
Emphasis Points			The TB infection may be explained here. The different tests available for TB infection testing may be mentioned here.  The two regimens should be explained.
Post Session Activity			The regimen may be shown to the participants- over the camera. The composition of regimen and duration may be asked.
Chapter 2.8			TB-Comorbidities and special situations		Virtual Session (26 min)
Emphasis Points			Various Comorbidities and special situations like Pregnancy and lactation may be enlisted. The significance and impact of having these comorbidities to a TB patient should be explained. Bidirectional screening and its importance for HIV, Diabetes, COVID should be explained.
Post Session Activity			The details of the facilities for alcohol cessation and tobacco cessation may be shared with the participants.
Chapter 2.9			General Concepts in Adherence Management		Virtual Session (48 min)
Emphasis Points			What is adherence, importance of adherence, their role in adherence management, different ways of recording adherence- 3 ways(on Treatment Card by TS/STS, Self-reporting (99DOTS, MERM, TB Arogya Sathi), in Ni-kshay by TS, STS),  How to assign TS and role of TS
Post Session Activity			Demonstration of the following at the end of the session: TB Arogya Sathi app and adherence recording Ni-kshay and adherence recording
Module 3: General concepts and Principles of SCM in NTEP             Virtual Session (114 min)
Chapter 3.1		Key Concepts and Principles in SCM			Virtual Session (33 min)
Emphasis Points		Explain the flow of supplies through different tiers in SCM various types of drugs with emphasis on Minimum & Maximum stock, Buffer stock and its significance. May be explained by giving suitable examples from the local context and stories. Situational examples and past experiences to be shared, explain the various stocks like lost in transit, quarantine, substandard etc. The drug distribution flow and Stock types may be explained through a storyline (i.e. Some quantity of stock was transferred to State- in the transit some got damaged, some was quarantined for testing, and so on Identification of short expiry drugs and broad principles of management of Short expiry drugs. Outline the principle of FEFO and its scenario-based usage Indicating the various stocking points along with the purpose of respective stores.
Post Session Activity		The participants may be asked about the significance of SCM in their own words to check their understanding and their role clearly in the SCM To ask what will happen if SCM is not maintained efficiently Situational based examples for different types of stocks may be asked
Chapter 3.2		Drugs and consumables in NTEP			Virtual Session (14 min)
Emphasis Points		The different drugs and consumables handled by different stores may be shown over the camera or the images of the commodities may be flashed These supplies should be arranged beforehand by the trainer and should be present on the demonstration table The lab consumables handled by the respective store (by the trainees) and the importance of maintaining the efficient supplies of lab consumables The consequences of poor SCM of lab consumables should also be explained
Post Session Activity		Different Drugs and consumables may be shown over camera/physically The participants may be asked to identify the different supplies by asking them to unmute themselves Various registers and forms may also be displayed and brief intro about it may also be mentioned.
Chapter 3.3		Stores in NTEP			Virtual Session (14 min)
Emphasis Points		Different stores at State, district, TB, PHI may be explained ( Covering its geographical coverage, the infrastructure requirements, HRs posted there and the functions carried out by the respective stores.
Post Session Activity		The trainees may be asked about the existing gaps in stores with respect to stores infra, and the gaps in functioning of stores which are under their jurisdiction
Chapter 3.4		Patient-wise Boxes			Virtual Session (29 min)
Emphasis Points
Post Session Activity
Chapter 3.5		Information Systems in NTEP SCM			Virtual Session (10 min)
Emphasis Points		Ni-kshay Aushadhi and its significance, Detailed discussion on the Dashboard and various reports available in the Ni-kshay Aushadhi
Post Session Activity		Demonstration of the demo version of the portal and the navigation through it to discuss the different dashboard and its significance, generation of different reports Data to be fetched from Dashboard / various reports of Ni-kshay  to be shown and participants may be asked to give their observation
Chapter 3.6		Roles and responsibilities in SCM			Virtual Session (14 min)
Emphasis Points		Explain the roles and responsibilities of different HR involved associating it with the functions of the stores Explain the importance and role of Pharmacists in NTEP emphasis on SCM, stock-keeping, and expiry management and use of Ni-kshay Aushadhi
Post Session Activity		Some of the participants may be asked to enumerate the roles of the position they are holding
Module 4: Inventory Management in NTEP                      Physical Session (125 min)
Chapter 4.1		Overview of Inventory management in NTEP			Physical Session (8 min)
Emphasis Points		Explain about the concept and the significance of it. discuss the process involved therein and significance of each step and also associate it with their role (trainees role in inventory management) discuss the different stocking norms at different levels and importance of it (norms at a particular level and why)
Post Session Activity		Different scenarios from daily life may asked to shared Essentials for Robust Supply Chain Situational questions may be asked to participants
Chapter 4.2		Indenting and receipt			Physical Session (24 min)
Emphasis Points		Types of method to be explained (Quarterly/ ADR along with its significance The different process involved in Indenting of supplies should be explained in detail giving example of drugs or any other supplies. Various sources of receipt to be indicated along with the purpose of them Steps to be followed physically to be explained  The storytelling methodology may be adopted - where to request supply, supplies come from where, what to do in receipt of supplies and how to record the process in Nikshay Aushadhi Step wise procedure in Ni-kshay Aushadhi for receipt to be shown
Post Session Activity		Demonstration of the indenting in Ni-kshay Aushadhi, The processes of requesting supplies in Ni-kshay Aushadhi. The recording of receipt of supplies from different stores should be demonstrated in Ni-kshay Aushadhi. After the Module all the process should be demonstrated to the participants on live supplies- like checking for documents, inspection, check for damaged stocks, acknowledgement , followed by documenting in Ni-kshay Aushadhi (recording and reporting) for the said supplies.
Chapter 4.3		Issue and consumption			Physical Session (48 min)
Emphasis Points		Various sources to explained  Essential steps  required to be taken up by the Pharmacist upon the issue of Various methods for issue of drugs to be explained, with emphasis on the scenarios where these methods to be used
Post Session Activity		Demonstration of the issuing of supplies in Ni-kshay Aushadhi, The processes of issuing supplies in Ni-kshay Aushadhi. The recording of issue of supplies to different stores should be demonstrated in Ni-kshay Aushadhi. After the Module all the process should be demonstrated to the participants on live supplies- like checking for documents, inspection, check for damaged stocks, acknowledgement, followed by documenting in Ni-kshay Aushadhi (recording and reporting) for the said supplies. The same demonstrations to be made for issue of supplies as well. The drug dispensation module may be demonstrated to the participants (in real-time while dispensing the medicines to the patient at the PHI)
Chapter 4.4		Reporting of Stocks			Physical Session (13 min)
Emphasis Points		Importance of forecasting and follow-up actions following forecasting. Data for forecasting to be discussed with focus on the which data and from which date to be considered  the need of forecasting may also be emphasized by giving the national perspective like that will happen if forecasting goes wrong and how to different levels forecast the supplies of different commodities and the factors affecting it.
Post Session Activity		Explain the participant about the consequences of not forecasting and doing it incorrectly. The participants should have clarity about the process and their role in making the process efficient Hypothetically situation (excess stock, shortage and short expiry) to be created and data of stock, expiry, consumption to be given and participant may be asked to forecast the requirement for 12moths.
Chapter 4.5		Expiry Management			Physical Session (19 min)
Emphasis Points		The end to end process- like what's expiry, how to identify expiry supplies, shelf-life of different supplies, forecasting of expiry drugs, reporting it and the follow-up actions to forecasting of expiry drugs including the scientific disposal of expiry drugs may be explained.
Post Session Activity		the participants may be asked to enumerate the different steps and the consequences if any of the step is not done efficiently. Demonstration of whole process in Nikshay Aushadhi
Chapter 4.6		Stocking NTEP drugs in Private sector			Physical Session (13 min)
Emphasis Points		Importance of stocking drugs in private sector to be explained
Post Session Activity		Participants may be sked to share their methods currently being sued for stocking and recording of drugs in private sector
Module 5: Procurement in NTEP                                                     Physical Session (39 min)
Chapter 5.1		Key concepts in Procurement			Physical Session (13 min)
Emphasis Points		Procurement – Goods, Works and Services Types of Procurement
Post Session Activity		Participants to be asked to explain procurement of goods, works and services with examples  clearly set out the differences between them
Chapter 5.2		Procurement Processes			Physical Session (8 min)
Emphasis Points		Type and Process of procurement to be explained
Post Session Activity		Following the types of procurements (direct, tender, single source / sole etc, situation to be provided and participants may be asked which process to be followed and also asked to indicate the process from end to end.
Chapter 5.3		Government e-Marketplace [GeM]			Physical Session (18 min)
Emphasis Points		the GeM, its significance and the processes involved
Post Session Activity		Demonstration of GeM and the different processes involved for the supplies at the participants level if any. Participants may be asked to explain upon the methods of evaluation, custom bids, various different options available under the GEM
Module 6: Logistics and Distribution of Drugs and consumables  Physical Session (89 min)
Chapter 6.1	Flow of Supplies			Physical Session (23 min)
Emphasis Points	Explain the difference in flow of DS-TB drugs and flow of DR-TB Drugs, flow of Bdq and Dlm need to be explained separately. Flow of supplies of CBNAAT cartridges and Truenat chips may be explained in state-specific context.
Post Session Activity	The participants may be asked to discuss the issues they are facing in the supplies and solutions may be suggested.
Chapter 6.2	Packaging			Physical Session (35 min)
Emphasis Points	The importance of packaging, specifications, labelling requirement, packaging instructions, preparation of PWB for different regimens and its recording in Nikshay Aushadhi should come out clearly.
Post Session Activity	The different PWBs (physically) may be shown to the participants along with the constituents (with attention on the details of specification of boxes, labelling of boxes). The recording of the whole process in Nikshay Aushadhi (PWB prep in real-time may also be demonstrated)
Chapter 6.3	Return and Reconstitution			Physical Session (18 min)
Emphasis Points	The overview of the process and importance of it.
Post Session Activity	Participants may be asked about the circumstances when return and reconstitution is carried out Demonstrate the entire process in Nikshay Aushadhi Situational Questions may be asked about Bdq and Dlm return and reconstitution.( Eg 10 Bdq tablets need to be returned- the process of return and reconstitution may be discussed) Some participants may share their experiences with respect to this process, the challenges they have faced and solutions may be suggested.
Chapter 6.4	Transportation			Physical Session (13 min)
Emphasis Points
Post Session Activity	The transportation facility available at the store may be demonstrated and the best practices may be discussed with the participants
Module 7	Supervision, Monitoring and Evaluation and QA			Physical Session (76 min)
Chapter 7.1	Quality Assurance of Drugs			Physical Session (33 min)
Emphasis Points	Type of Quality Assurance (Pre Dispatch / Post dispatch) Step to be followed for collection of sample for testing and in case of repeat testing Explain the process of recording the sample collection in Ni-kshay Aushadhi
Post Session Activity	The drug collection process for testing may be demonstrated to the participants. ( One batch of any drug and take out 10 strips for testing and packing. The remaining drugs need to be put in quarantine.  Demo on Ni-kshay Aushadhi  to record the transaction
Chapter 7.2	Monitoring of sub-stores			Physical Session (10 min)
Emphasis Points	Explain the significance of Monitoring and why it is reuired Different types of Monitoring methods to be explained with examples
Post Session Activity	Different groups may be formed, and the groups may be asked to do analysis of the reports, performance of sub-stores through Nikshay Aushadhi.  The sample reports will be provided by the facilitator. The reports prepared may be reviewed jointly and follow-up actions may be discussed.
Chapter 7.3	Store Visits and Physical Verification			Physical Session (15 min)
Emphasis Points	Key points to be considered while visiting a store Post Visit, what steps to be taken What steps to be followed for conducting Physical verification and at what Intervals Importance of recording of physical verification
Post Session Activity	For store visit and Physical verification, the two demonstrations may be clubbed as a single exercise. The batch may be divided into subgroups (not more than 5) and may visit different stores (SDS, DDS, TU, PHI). The participants may be asked to fill the checklist. After the visit, the checklists filled by different trainees may be evaluated and discussed. Team to propose recommendation  An Audit Trail may also be undertaken by the team, one batch to be selected from SDS (preferably issued to district almost 5-6 months back). Team to visit said district and to check upon the date of receipt, documentation and to check in which district it was issued. Then team to visit said TU and again take out the trail of same batch and figure out the PHI. Similarly visit said PHI and check. Afteward, team to enlist the observations and propose recommendation if required
Chapter 7.4	Physical Verification[SS1]			Physical   Session (13 min)
Emphasis Points	What steps to be followed for conducting Physical verification and at what Intervals Importance of recording of physical verification
Post Session Activity	The site may be visited and the different processes may be explained.
Chapter 7.5	Evaluation of Stores and Stocks[SS2]			Physical Session (5 min)
Emphasis Points
Post Session Activity