A training for monitoring and evaluation in community-based rehabilitation: using a relational approach as a keystone to capacity building

Background: Founded in 2008, Kafika House aims to provide high love, low cost rehabilitation for children with surgically-correctable conditions causing disability. Kafika House formed a community-academic partnership with an interdisciplinary university-based team from St. Catherine University to advance their monitoring and evaluation capacity. Over time, the teams worked collaboratively to develop the Medical Assessment Checklist (MAC), one of the tools used to measure medical outcomes of children admitted to Kafika House with a variety of diagnoses. Aims: The aims of this paper were to describe the development and delivery of a training of trainers (ToT) for monitoring and evaluation of patient outcomes in a community-based rehabilitative organization. Methods: The Kafika House ToT program was designed based on the talent, resources, alignment, implementation, and nurture (TRAIN) framework proposed by Mormina and Pinder and procedural and design factors highlighted by Harper et al and Hayes. The program was developed through the following steps: 1) identify staff to participate in the ToT; 2) develop curriculum and training materials on the MAC; 3) request feedback on the curriculum from a community advisory board of stakeholders; 4) revise the curriculum based on community advisory board input; 5) deliver the curriculum; and 6) evaluate mastery of knowledge. Results: Together, the community-academic partnership developed a training focused on the MAC to build capacity for sustainable monitoring and evaluation. The ToT approach, using both traditional and relationship-focused training elements, invited collaboration and knowledge-sharing to strengthen training outcomes. This resulted in substantive and structural additions and changes to create a comprehensive monitoring and evaluation training for Kafika House. The knowledge and confidence of the trainees (n=4) regarding the MAC increased substantially post-training. Conclusion: Challenging historical frameworks of ToT to incorporate relationality and active learning and reflection strategies can strengthen training outcomes. Moreover, embedding partnership principles of trust, resource and power sharing, and reflection allowed for a training in which the trainees are empowered and motivated to utilize similar strategies as they impart their knowledge on the next generation of trainees.