Healthy People, Healthy Community: Evaluation of a train-the-trainers programme for community health workers on water, sanitation and hygiene in rural Haiti

Objective: This evaluation examined the effectiveness and cultural compatibility of a community health worker (CHW) training programme on water, sanitation and hygiene (WASH) in Haiti. Design: Mixed-methods including pre- and post-course tests of WASH knowledge, focus group discussions and semi-structured observation. Setting: Haiti is among the world's most underdeveloped nations for WASH infrastructure. In rural areas of the country, fewer than half of households have access to clean water and 22% have adequate sanitation facilities. The study evaluated a 'train-the-trainer' programme in rural southeast Haiti. Methods: Participants were 22 CHW supervisors responsible for training and monitoring the work of rural junior health agents (JHAs). The training programme was delivered by international trainers and consisted of 1 week of classroom training and 1 week of community-based experiential learning. Paired-samples t-tests were used to assess changes in knowledge, and robust qualitative methods were used to analyse focus group discussion and observation data. Results: Participants showed statistically significant improvement in WASH knowledge from pre- to post-test. In experiential supervisor-led training sessions, participants effectively conveyed course content to JHAs, and successful home visits demonstrated the potential for content to reach community members. The programme would benefit from providing educational materials to enhance dissemination. Participants expressed dissatisfaction with translations of course content and requested more frequent training, more emphasis on leadership development and specific content areas for future training. Conclusion: The CHW training programme enhanced trainees' WASH knowledge and capacity to educate JHAs to disseminate the knowledge to local residents. The train-the-trainer model offers a cost-effective strategy for building local capacity for health education.