Training-of-trainers program for community health workers involved in an innovative and community-based intervention among goldminers in the Guiana Shield: a quality and effectiveness evaluation

Introduction: An innovative and community-based intervention is implemented in the Guiana Shield to eliminate malaria among people involved in artisanal and small-scale gold mining. The intervention is possible in the field thanks to community health workers (CHWs) who are previously trained to master all interventions procedures, including training gold miners to treat themselves for malaria. This article describes thus a training-of-trainers (ToT) program for CHWs, as well as the method and results of its evaluation in terms of quality and effectiveness. Methods: A mixed-method case study was implemented in two steps and based on knowledge survey, satisfaction test, observations and semi- structured interviews. Quantitative and qualitative data were triangulated. Results: The project teams previous experience and the Guiana Shield countries commitment to the WHO E-2025 initiative were identified as levers for the quality of the ToT training, while the complexity of the project context was a challenge. Group dynamics and adaptations were found to be central elements of a high-quality training program. CHWs satisfaction was elevated especially regarding training format and learning results. Improvements on knowledge level demonstrated good effectiveness of the training. Nevertheless, some difficulties persisted regarding certain tasks to be carried out by CHWs during the intervention procedure. Further on-the-job training permitted to address them, improving CHWs practices in the field. Discussion: High-quality, effective, and appropriate training programs are required for effective and sustainable intervention involving CHWs profiles. Training design is a crucial point to attend quality and effectiveness. ToT model has been shown to allow a high level of satisfaction, good learning results and satisfactory implementation in the field. Initial and continuing training is an indispensable continuum to sustain good practices in the field and CHWs motivation. Training evaluation permits to standardize methods and facilitate transferability of successful efforts.