Africa AHEAD at the Gates Convening in Hanoi

Representatives from all the Bill and Melinda Gates funded projects convened in Hanoi recently for a four day brain storming on the achievements of the year.

Africa AHEAD was represented by the Director of Programmes, Anthony Waterkeyn who presented a poster summarizing the sucess of the Classic CHC in Rusizi District in Rwanda, where a randomised control trial is underway.

Hanoi 2015 Rusizi Poster final

For more details 

‘Its time we focused on the Community’ says Minister of Health for Zimbabwe

Minister of Health
Dr. David Parirenyatwa, Minister of Health and Child Welfare, Zimbabwe

Minister Visit to Chigure CHC

April 2014

Dr. David Parirenyatwa, the Minister for Health and Child Welfare  in Zimbabwe comments on a visit to a Community Health Club in Chipinge District. He came  to see for himself the claims of Mr Goldberg Mangwadu, the Director of Environmental Health Services who believes that Manicaland is ahead in prevention of common diseases due to the CHC Approach. This is a direct transcript of his speech:

‘This community is  privileged to be the first district outside of Mutare to be visited by the new Provincial Medical Doctor for Manicaland, Dr Mafaune. I would also like to acknowledge the presence of the Country Director of Zimbabwe A.H.E.A.D (Applied Health Education and Development), Mr. Matimati. I have heard you speak and you are quite an orator! I understand that you have a nursing background and have been involved in many fields. Your foundation was within the Ministry of Health from where you spread you wings and you have become an asset to the nation.

I would also like to acknowledge the presence of Mr Mangwadu the Director of Environmental Health Services; Mrs Gerede,  a heavy-weight nurse in Zimbabwe – not in terms of weight, but because of her position as the senior most nurse in Zimbabwe Government; the District Administrator Dr Seenza. We also have Dr Kuvengwa, the District Medical Doctor who has been with the District of Chipinge since 2012. As you have noticed women are occupying the most senior positions in this District, showing that they are being empowered. Even within the Chigure Community Health Club, it is self evident that women dominate with only 6 male members in the club and 66 female. However for gender balance, there should be more male participation within health clubs.

What brought me here, as the Minister of Health and Child Welfare, is the preventative aspect of health.  We tend to concentrate on hospitals, like Parirenyatwa, Mpilo, Mutare District or Provincial hospitals – that is where our efforts as Government have been. People have go to hospitals when they are already ill. Our idea here now, is to prevent diseases before they reach the people. What is referred to as preventative medicine. 

That is our objective today. The Director of Environmental Health Mr. Mangwadu has been pestering me every Monday morning at our meetings. He bragged that Manicaland was already miles ahead of the other provinces in terms of preventative medicine because they have  a high coverage of  Community Health Clubs (CHCs). I did not believe him and expressed my doubts to him verbally. We finally agreed that we should visit the area together to see for ourselves.

Today we are here  and as they say the proof of the pudding is in the eating. We need to feel it with our own nose,  like smelling snuff. We need to see if  there is something different happening in the (Manicaland) communities. Now I have seen it and I say we should not continue to emphasize the curative aspect of medicine – it’s time we focused on the community (like you are doing here) to see what they can contribute in terms of prevention.

Hospitals are treating diseases that are preventable. Mr. Matimati says that at the CHC people are taught that when they cough or blow their nose they are supposed to wash their hands.  If you shake someone’s hand without washing your hands after you sneeze, you are passing on the ‘gift’ of the disease. Simple things like spitting any and everywhere can be stopped.

You have been blowing your trumpet about  the rate of toilet construction here.  We know that in Zimbabwe, Blair (VIP) toilet construction had reached 55% – that is 55 out of every 100 households  would have a Blair toilet. Then (in 2000) our economy took a tumble and right now (2015) we are at 32% sanitation coverage. Here in Manicaland you are within that range, but in less developed areas like (UMP) Uzumba Maramba and Pfungwe sanitation is around 27%. As Government, we want to get back and exceed 55%. We must aim to get to 90% of toilet coverage in the country.

Village Heads and the District Administrator, let us ensure that when a person is constructing his/her homestead, they realize the importance of a constructing a toilet as well. I cannot do a snap survey of this area to count how many homesteads have toilets, but I would want you to ponder on this point after my departure.

If you have constructed nice Blair toilet, like the one I visited earlier then encourage the trend and it will  catch on like wild fire in the area. You have just told me that this health club built 18 Blair toilets without any assistance over and above the initial 39 subsidized latrines. This is true development – the kind  that we want to see.

If we look at Bilharzia this should be researched in schools to see how many children are being affected by the disease. We should also look at skin diseases and tuberculosis. When you cough for over 3 weeks and your cough is not improving, if you are sweating at night and if you are losing weight, then maybe you are suffering from TB.  Go seek treatment quickly as TB is curable. This is what we want people to know. If a child is eating healthy food and he/she is not gaining weight or growing then maybe that child has worms in their stomach. Things like that help us in ensuring the health of our children. We acknowledge the importance of Community Health Clubs like Chigure.

But Mr Matimati, Mrs Radio 2 and Mr Mangwadu – is what you have done here is replicable in other areas? We want to see if we can incorporate this model into our policies on heath and copy this everywhere in the country so that it helps us. We want to verify the replicability of the strategy then implement it nationwide.

Other countries are copying us. This idea was born from a doctor originally from Zimbabwe – a white Doctor (Dr. Juliet Waterkeyn. CEO Africa AHEAD).  Rwanda quickly copied it and implemented it nationwide. It is now a law in Rwanda that all communities must have a health club.

We want the idea (of the CHC) to be further refined so that it is stronger here. I came because I doubted what Mr. Mangwadu was always telling me about the CHCs. I thought he just said these things to make our Monday morning meetings more interesting. I am happy I came here to verify for myself.

Zim AHEAD Director, Mr. Mangwadu and Mrs. Radio 2, please come up with a Roadmap showing how the CHC programme this can be replicated in other districts. The Ministry would then hold workshops to discuss and try and replicate the Community Health Club approach.

Let us start within our homes so that we have high standards of hygiene then hospitals will not bear the burden of treating preventable diseases. In this way we ensure that we have healthy men, women and children.’

Africa AHEAD’s new Country Directors in Zimbabwe and Rwanda

Africa AHEAD  has grown from the bottom upwards since 1999 when we first started as a Trust in Zimbabwe. In 2005 we registered in South Africa, a middle income country, so as to replicate  regionally based out of Cape Town. When our main programme became  based in Rwanda we also registered in that country as a branch of Africa AHEAD. 

 We are still growing  upwards as we adopt an international profile,  registered as a British charity providing a highly professional  umbrella organisation for our implementing  branches in three countries in Africa: South Africa, Zimbabwe and Rwanda. Africa AHEAD is now also registered as Private Voluntary Organisation (PVO) in Zimbabwe.

Advisory Board in Zimbabwe

In our AGM  this month the local Zimbabwean Board of Trustees  passed a motion to  dissolve Zim AHEAD and confirmed that the original Zimbabwe AHEAD Trust will be now  be fused with Africa AHEAD, becoming Africa AHEAD-Zimbabwe,administered by the UK Board.  As such Anthony Waterkeyn stands down as Chairman of Zim AHEAD, a post he has held for the past five years.


Mrs Janette Hetherton becomes Chairperson of the Zim AHEAD Advisory Board
Mrs Janette Hetherton becomes Chairperson of the Africa AHEAD – Zimbabwe Advisory Board

We welcome Mrs Janette Hetherton who becomes Chairperson of a Board of Advisors which will provide support to Africa AHEAD in Zimbabwe. We also welcome Dr Jaap Kuiper as a new Advisory Board member. The Advisory Board in Zimbabwe will be represented on the UK Board of Trustees attending the AGM in London each year.

Therefore it is  with great pleasure that we officially announce the appointment of two Country Directors as from January 2015.

In Zimbabwe, the founding Executive Director for Zim AHEAD, Dr. Juliet Waterkeyn who has been steering the Organisation from a distance for many years, finally  hands over to  Mr. Regis Matimati who has been assisting for the past four years as Acting Director since 2010.

Regis (2)
My Regis Matimati, Country Director, of  Africa AHEAD in Zimbabwe

Mr Matimati who has ably performed his task of building the profile and capacity of Zim AHEAD is already in place and therefore can take up his role as Country Director  immediately as from January 2015.

Joseph photo
Mt Joseph Katabarwa, Country Director, Rwanda

In Rwanda, Mr Anthony Waterkeyn, has been acting as Country Director for the first year of registration. He now hands over  to Mr Joseph Katabarwa , recently retired from the Ministry of Health,  as Head of Environmental Health Desk, who becomes Country Director in January 2015.

Zacchary Bigirimana, Regional Representative of East Africa, based in Uganda
Zachary Bigirimana, Trustee, Africa AHEAD, Rwanda

We are also pleased to welcome Mr. Zachary Bigirimana, recently retired Dean of the Faculty of Community Development, who has been given the task of Regional Representative for East Africa to assist the Country Director, so provide support to the Rwandan and Ugandan programmes.

Mr Anthony Waterkeyn remains overall Director of Programmes for Africa AHEAD (UK), and is  line manager for both the Country Directors. Together with Dr Juliet Waterkeyn, who remains  CEO of Africa AHEAD, they continue to lead the team, as we build the strength of our organisation from the bottom up, as a ‘southern’ NGO.

Our intention is to have two operational  hubs, one in Harare and the other in Kigali, from which we can provide strong teams  to train other NGOs as well as implement our own programmes as we seek to scale up our programmes in Central, East and Southern Africa.

Our strategy for long term sustainability is to remain essentially  a ‘southern’ NGO.  – a local African organisation but operating  at the same standard as  other international  NGOs. Being indigenous, we are here for the long term,  to provide an institutional memory of best practice in our countries. Primarily we work through  our government to build capacity in the Ministries with which we partner. This is the way we believe that our CHC methodology can have the most impact, scaling up through governmental institutions, who mandate it is to provide a healthy environment for their citizens.



Minister of Health called for CHCs nationwide in Zimbabwe

Minister of Health
Minister of Health and Child Welfare: Dr D. Parirenyatwa

Minister of Health and Child Care, Dr David Parirenyatwa Visits  Community Health Club in Chipinge District, Manicaland, Zimbabwe

11th April, 2014


In the Water Policy of 2013, the Government of Zimbabwe directed that every village should have a functional Community Health Club (CHC) that seeks to empower communities to take full responsibility in preventive health. The National Sanitation and Hygiene Strategy of 2011 states the Community Health Club approach as the methodology through which Participatory Health and Hygiene Education should be channeled.

The Minister of Health Dr Parirenyatwa Minister  wanted   to see for himself the benefits of the CHC Model and accordingly as visit was arranged by the Environmental Health Department to visit Chipinge District in Manicaland, where the  Cholera Mitigation Programme funded by USAID and implemented by Zim AHEAD was able to show case the classic CHC programme.

Upon arrival at the Clinic, the Minister was welcomed by a large committee of local representatives, and District Medical Officer gave  an overview of Chipinge District where  CHCs  were operational  in the 10 wards.  She highlighted that although Chipinge was in a state of malarial outbreak in the areas where the clubs were running there was no increase in cases.

Chigure Club

Chigure club

The delegation then went to see Chigure Club where the members had gathered at their regular venue.  The meeting place was a model site and included permanent seating and even flooring plastered by the CHC members, so no one sat on the ground.


The CHC members greeted the delegates with song and dance, singing in Shona: “What can we give the flies to eat, because we have hidden the poo in the Blair toilets. The toilet are better than the bush. We have good sanitation. The flies are crying because they can  peep into the toilet but they cant get in to eat the poo. What can I give you flies, because we have buried the poo? Flies are crying because we have buried the poo.”


The community based facilitator (CBF), an ordinary village woman who leads the club,  gave a history of the Club and how it was started when Zim AHEAD came into their village. She highlighted that the CHC project had changed their lives as it inculcated a self belief system that weaned them off the dependency syndrome.

People used to pooh everywhere, and we said to ourselves,  ‘People what can we do with this poo?  - it is everywhere.’

There were only 4 Blair toilets in the village and it was easy for the flies to go into pit latrines. Because of lack of knowledge, the people used to run away from the health workers  because they thought the health worker were bothering them. 

Then Zim AHEAD came and said, ‘Come together and we will teach people about health’, and they started with the women. The village people started to listen to what the health workers were teaching people. The whole village got the knowledge.  Mr Muche and Mrs Kumbula taught people once a week for two hours and what we learnt,  we had to do at home – so we built latrines, handwashing tippy taps and many things like rubbish pits. That was the policy, and we taught people not to poo everywhere.  Whatever you eat makes you poo and the flies go there and it is going to be a health hazard, you get sick! After the many teachings  we got certificates. Allelujah!

She told how they had contributed their own money and purchased cement to make a permanent structure and a Blair Toilet at the venue. The village also received cement from World Vision to partially construct 39 toilets as they were only 3 bags each for the 39 toilets, but due to the knowledge they had acquired from the CHC they were able to construct an additional 18 from their own resources. The club has 72 members of which most are women as there are only 6 are males including  the kraal head.

blair toilet
The Minister is shown one of the many Blair latrines constructed by CHC members.

She went on to tell the gathering that disease transmission had reduced as compared to times before the CHCs. The club had appointed some elderly members who assisted the CBF in supervising the village to observe compliance and adherence to learnt health and hygiene behaviour. She also mentioned that the CHC has become a way of life in her village and 7 months after ZimAHEAD withdrew at the end of the USAID funded project,  the CHC is still going strong.

ZimAHEAD speech

Mr Matimati, Zim AHEAD Country Director, explains how the CHC empowers women to protect their children from disease

Mr. Matimati the Zim AHEAD Program Director spoke of how the Organisation empowers communities through Health Clubs. He pointed out that most diseases that afflict our communities are preventable and through the vehicle of CHCs communities can be empowered to deal with them on their own as it will be viewed as a homegrown and not prescribed by outsiders but it will be the community itself monitoring each other as neighbor becomes the police of neighbor.

Through common unity and peer pressure CHCs make societal changes wherever they are implemented. The CHCs become effective because of the applied health method where after sessions participants have practical work to do at their homesteads. Sustainability of the CHCs was ensured as villagers took it upon themselves to prevent and control diseases with technical support from the local health providers going up through the structures at District, Provincial and National Level. The certificates that each CHC member gets after completion testify to the fact that a person has completed sessions and that they actively participate in hygienic practices for the rest of the life.

Chigure Community Health Club is just one of 114 such CHCs formed on the one year USAID funded project up to 2013.

Mr. Matimati further stated that ZimAHEAD has not only worked in Chipinge District – both urban and rural, but also in the towns of Mutare, Chimanimani, Bindura, Chiredzi, and Masvingo, which has been cleaned up thanks to the CHC campaigns to keep the towns clean. Since 1999 Zim AHEAD has worked  in the rural communal lands of  Tsholotsho, Makoni, Buhera, Mberengwa and Gutu Districts.

Home visit

hand wash demo
Demonstration of a Tippy Tap – the home made washing facility now found at every CHC home.

The delegation visited the home of Mrs. Mhlanga who is a club member. At the homestead the kitchen was viewed which was typical of thousands that are now throughout Zimbabwe as a result of the CHCs. It had shelving along the walls, with all the cups and plates displayed showing that each person has their own utensils to stop spread of germs.

Water which is properly protected and safe to drink
Water which is properly protected and safe to drink
A rural kitchen with shelving moulded in the mud walls of the kitchen hut
A rural kitchen with shelving moulded in the mud walls of the kitchen hut

They saw the water protected with a good lid and the ladle to take the water. The minister also went into the spotless Blair latrine and was delighted by the standard of hygiene.


A short drama was presented to show how club had started, depicting the feedback meetings, the  registration of members and a CHC session was enacted showing the benefits of being a club member.

A drama showing how – before the health club taught then the cause of diarrhoea- they would go to the traditional healer when their child is sick to put a spell on the people who are believed to cause the sickness.

There were several people enacting the part of people who refused to join health clubs and continued in their unhygienic ways until they fell ill. Upon falling ill they sought different remedies from religious leaders  to traditional healers (nanga’s) until, at their wits end, they seek medical intervention. At their Clinic they are told that they have not been bewitched as they thought, but have fallen ill due to their filthy practices which have led to their suffering from diarrhoeal diseases. They then join the health club and are converted to good hygiene and from then on they are healthy.

Minister’s speech

“Prevention, prevention, prevention… that’s what we need now through Community Health Clubs” says the Minister.

After the tour of the homestead the Minister gave a speech praising  the effort that had been made at homestead.  He went on to say that there was need for use of fuel efficient stoves to save on firewood. The siting of Blair toilet should ensure that even at night people do not resort to going behind the house for fear of the long walk in the dark. He discouraged the use of cow dung in houses as it predisposed to environmental enteropathy which causes stunting in children. The Minister commended the efforts that had been made by ZimAHEAD. He said that there was need to document this case study and to learn from the villages and then scale up to national level.

The Minister further cited that in Rwanda CHC had been adopted at a national level that each and every village has a CHC as the main tool for disseminating primary health care information. The CHC technique should be revisited in the light of new information coming up of how stunting in child growth may be a result of damage occurring on the ileum (intestine) as a result of children under 2 taking in harmful pathogens in cow dung.

There is a  potential of using the CHC methodology in the SHINE Project which is researching how to protect young children by providing a clean eating environment. After seeing how clean the kitchens are in CHCs, encouraging the scale up of model kitchens  is an obvious focus for the Ministry of Health nationally.

He emphasized that we always spend so much money on the hospitals and clinics but said we should now concentrate on ‘Prevention, Prevention, Prevention’ and this can be done through CHCs.

Vote of thanks

The vote of thanks was given by a representative of the Member of Parliament who was not able to attend due to Parliament commitments and had sent his apologies to the Minister of Health and Child Care. He thanked the Minister for coming to the district then went to highlight the challenges they were facing in relation to health in the District. The delegation included Director of Environmental Health Department Mr Goldberg Mangwadu, 2 Senior officials in the Minister’s office responsible for Policy Planning and Public Relations in the Minister’s Office, the Minister’s aide and the Personal Assistant, Ms. Gerede Community Nurse from the National Office, the Provincial Medical Director Dr. Mafaune, the Provincial Environmental Health Officer Mr. Mufambanhando, the Provincial Health Services Administrator Mr. Charangwa, the DMO Dr. Kuwengwa, the DA Mr. Seenza, the DEHO Mr. Makundenyika and his staff, local leadership which included the Kraal Head and Councilor and the ZimAHEAD Program Manager Andrew Muringaniza and Country Director, Regis Matimati.

CHCs to start in DRC

Extract from SWIFT Consortium Weekly Newsflash – 5 February 2015

Click here for link

The SWIFT Consortium aims to deliver sustainable access to safe water and sanitation and encourage the adoption of basic hygiene practices in DRC and Kenya. 

It is funded with UK aid from the British people.

The Tearfund team in DRC has completed one gravity-fed water system (GFS) in North Kivu and is now busy constructing a second. In South Kivu, a Memorandum of Understanding has been signed with Africa Ahead, which is now preparing to begin setting up Community Health Clubs, or CHCs, in the region.

Membership of CHCs is voluntary, free and open to all, with between 50 and 100 people in each club. Members take part in weekly, two-hour training sessions on a number of health and hygiene promotion topics, such as the safe storage of drinking water, or making soap. The activities are designed to interest and entertain members, who are given practical assignments each week. Training lasts a minimum of six months, and SWIFT expects to set up 20 CHCs in the first year of the programme.

Oxfam’s partners in DRC continue to implement training sessions and public health promotion under the Villages et Ecoles Assainis (‘healthy villages and schools’) approach, and establish springs as water sources. However, last week PPSSP had to suspend activities near Kichanga, about 100km north of Goma, as a result of gunfire in the road. They continue to monitor population movements carefully.

CHC Training Hub in Rwanda

Africa AHEAD in Rwanda is now launching monthly training courses for  those applying as individuals as well as group workshops for  NGO staff who need training in the CHC Model.

Training Modules are  designed to strengthen individuals and organisations currently engaged in or wanting to  implement the CBEHPP or CHC both in Rwanda and in other developing countries The training modules are appropriate for both Government and NGO employees as a group or individuals who want to strengthen their skills in participatory methodologies for working with communities in health promotion.

Ideal trainees include, but are not limited to environmental health personnel, social workers, teachers  in primary & secondary schools, nurses and social workers. Whilst no prior qualification is necessary to join this training, experience with development is advantageous. The training is also useful for domestic and international students wanting to augment developmental studies  with practical field experience as an intern.

These workshops will take place at scheduled times each month and comprise of  different Modules as follows:

  • Module A. Orientation on the CHC Model : for National/District staff – one day
  • Module B. Planning a CHC Programme: National/District staff – 3 days
  • Module C. Training of  CHC Facilitators: District down to village- 4 days
  • Module D. Field Practical using CHC tools: Trainers only – 2 days
  • Module E. Monitoring: National/District  staff
  • Module F. Use of the CHC Registry and online monitoring system: National Staff – 2 days

The training employs participatory methods appropriate for adult learning. This will include group discussions and presentations in plenary, video and interactive games. Kinyarwanda, Swahili, English and French will be used. Training handouts will be provided.

A pre and post test will be conducted in addition to an overall evaluation of the training and Graduation Certificate for the full training (13 days).

Trainees, who have demonstrated full understanding will be awarded a certificate of  competence by Africa AHEAD and be registered as a certified trainee on the Africa AHEAD website.


Internationally, Africa AHEAD  has some of the most experienced trainers on the CHC Model and in Rwanda, this is being applied by some of the top practitioners in the country.  Our team  also includes researchers who have specialised in community health approaches with long experience academically and practically in the field, providing ongoing consultancies in the region.  

For more information: Brochure_Training_CBEHPP_final_jw



Local Leaders support district CHCs

Report on a meeting with Local Leaders in Rusizi District on sustainability of CHC activities

by Joseph Katabarwa, Country Director, Africa AHEAD Rwanda

22nd January, 2015

Hygiene behavior change is a process which cannot be achieved immediately. It is only by constant reinforcement and monitoring that the CHC members will all reach the required standard. It is in this line that AA sponsored a discussion meeting for (participants) so that they can own, develop and sustain CHC activities. Indeed, from the 50 Classic CHC Villages established since February 2014, tangible results are observable in terms of safe water use (23% increase), sanitation (50% increase in terms of latrine covered and 30.4% increase inside latrine hygiene), hygiene(41.1% increase) and need reinforcement for sustainability.

The meeting-discussion that attracted more than 100 participants (90% of attendance) aimed at discussing the challenges and solutions for better implementation of CBEHPP/CHC and to strengthen leadership participation and ownership. Under the guidance of the District leadership and Africa AHEAD Rwanda staff the debate was very successful and included;

  1. Updates on CHCs dialogue sessions, recommended practices, initiatives and challenges;
  2. CHC activities-practices’ sustainability and way forward and;
  3. Strategies for prevention and control of hygiene related diseases and ill-health conditions.

It is after discussions that the participants resolved to engage themselves in monitoring of CHC activities and integrate CHC activities in different programmes for sustainability such as income generation activities e.g. soap making, social cultural and sustainable hygiene practices in planned performance contract between a household and the head of the village (Imihigo y’ingo).

Very happy, the participants to the meeting agreed with the District representatives to refine the resolutions and submit them to the District for follow up.

What a success story, in Rusizi district! CHC is in the heart of local leaders and this will enable the prevention of health, hygiene and nutrition related diseases and in so doing so will  enhance sustainable community development.

The Joy of a CHC Graduation

I came to witness the first of the Graduation Days organised at village level in Rusizi District, in Rwanda in the deep south, a remote area on the border with DRC and Burundi – the dark heart of Africa. A ‘Graduation Day’ is the standard CHC event at the end of six months of weekly sessions, designed to award the Community Health Club members who have completed all 20 sessions.

In Gasharu Village, Girisuku Club  (Have Good Hygiene) the training took place  every week between March and September 2014. Out of a club of 78 people, there were 55 dedicated members who attended every session and were to receive their certificates   Girisuku  Health Club is one of the most organised of the 50 CHCs in the district and is under the supervision of the Environmental Health Officer  Odette Uwizeyimana, who assists the village level ASOC  (Affaire Sociale).

The so called ‘ASOC’  are  one of four cadres of health workers per village. They  are semi voluntary government field workers working with fellow villagers on primary health in every one of the 15,000 villages in Rwanda. They have been designated to conduct health sessions for the Community Based Environmental Health Promotion Programme, (CBEHPP), which was started in 2010.

Africa AHEAD has been instrumental in getting the CBEHP programme rolled out in Rwanda, providing the advocacy to get it accepted at the highest level with the President himself calling for it to scale up to every village in the country. Four years later there is indeed a registered CHC in 99% of the villages in Rwanda and over 30% have completed the six months of weekly training sessions.

Rusizi District is being put in the spot light as it is the focus of a Randomised Control Trial, funded by Bill and Melinda Gates Foundation to evaluate the efficacy of this hygiene promotion strategy to reduce infant and child morbidity and mortality. Africa AHEAD having sourced the funds, is supporting the Ministry of Health to implement a Classic CHC Programme which can be properly research to see if the Model really does reduce disease through good hygiene

As the co-Founders of Africa AHEAD,  my husband, Anthony Waaterkeyn and I, are the original instigators of the CHC Model,  so I am always delighted to see how our ideas  have translated into reality. I have attended many ‘Graduation Ceremonies’  in Zimbabwe where there are now over 5,000 CHCs, in Sierra Leone, Guinea Bissau, Uganda and South Africa. However, this is the first one I have attended in Rwanda, so I am intrigued to see how it goes.

It never fails to amaze me how throughout Africa the recipe for celebration is so similar in each country and the community  always has the same traditional procedure when a formal occasion takes place. We were invited for  10.30 in the morning and arrived  in a car full of VIPs: the District Health Team, the Sector Head, the Health Centre Supervisor.

Our team from Africa AHEAD consists of the Monitoring Officer Andrew Ndaririo and Marcie Mbirira, our glamorous Field Officer.  We are also with Mr.Joseph Katabarwa,  who until recently headed up the Environmental Health Desk in the Ministry  of Health and  has now left government to join us as Country Director of Africa AHEAD in Rwanda. During his time in government he had the vision to   initiate  the CBEHPP,  working closely with my husband, who was then representing WSP (World Bank) to replicate the CHC approach in a national  programme. Rwanda is the first country in Africa to have the courage to scale up the CHCs to every village. It is also one of the few countries in Africa able to meet the Water and Sanitation Millennium Development Goal Targets.

We all take pleasure  seeing the happiness of the community, the proud recipients of certification, who now greet us with song and dance weaving towards us in a wave of  rhythm and song. We sit down in the row of school chairs laid out for the occasion, and water is brought and placed before us. Introductions are done as the visitors greet the crowd and then the official opening song invites us to relax and enjoy the festivities. More and more people gather to watch the occasion and children hang on the trees wide eyed and entranced by the grown-ups having fun for once.

The entertainment is a drama, and the theme is as predictable in its content, as it is charming in its sincerity. It tells the story of a health worker coming to the village to invite the people to start a health club. Inevitably, there is a cynic who refuses to join and instructs his wife to avoid such a waste of time. ‘I am the head of the house’, he tells her, ‘You come home with me now, and I warn you, I will divorce you if you go to those meetings.’ She tries to explain how the club will benefit him but he says, ‘I am healthy and strong. Why should I worry about disease?’ Then, of course, he gets very ill and has to be taken to the clinic. He is carted off on a bench, carried along with the wailing of siren supplied by a chorus, much to the delight of the audience.

When he gets to the hospital, he is ignored by the doctor because he has no health insurance and no money to pay for the treatment. Rwanda is one of the few countries in Africa offering  health insurance at a nominal cost to all citizens. The CHC are helping to ensure that everyone pays this small fee, to avoid just such an eventuality as is happening in this play. The wife is desperate and goes to plead for money from a relation, she tries to sell their only piece of land, but to no avail. She is finally helped out by the CHC, as members club together to raise the fees for the treatment.

The man recovers and returns home. He recognises the error of his ways and apologises to the community for his stubbornness and joins the CHC. He cleans up his house and instructs his wife that now they will build a toilet and practice safe hygiene. The children in the audience all fall about with amusement as they see how the proud man has learnt his lesson. The dramatic tension eases as the group comes back to reality, having been completely transfixed by the story. Drama is the way to transfer messages such as this in Africa and song is the way to unite people. They break into dance again, and  the drum throbs to the memorising rhythm of the chanting.

The ASOC comes forward and gives a short catalogue of all the changes that have taken place in the village since the CHC began six months ago. She tells us that toilets are being built and the old ones are being cleaned up and covered, that hand wash facilities are being constructed next to the toilets to ensure people wash their hands, and that they are building pot racks to keep their plates of the ground, as well as wash shelters so they can wash in private every day. She  claims that many diseases are decreasing in the villages, less diarrhoea and vomiting, less malaria, and the children are growing strong. It is everything that we want to hear, but can it really be true? The Head off the Cell, congratulates the CHC members and says that she has never seen such community participation and that she is going to tell all her other district leaders about the CHC.

When my turn comes to speak, I congratulate them but  tell them to beware as a certificate hanging in their home is a dangerous thing. I ask them why.  Immediately the Chairperson of the Club cottons on. He explains  the CHC member will have to continue to meet the standards of hygiene that the certificate represents or he will be castigated by his neighbours for being a fraud. The all agree solemnly that   they will be true to their CHC  standards. Like the Boy Scouts, people in Community Health Cubs change their core values, and CHC Members  have  a ‘culture of health’ whereby they must always be hygienic in all their ways.

I challenge the members to let the VIPs at the ceremony to  come and  see their clean homes. They agree without hesitation, so I ask for all the membership cards as a means of random selection. They all hand in their green cards and each of the VIPs  select one at random.  The person who owns the card has to take that visitor to their home to verify the standard of hygiene.

The card that I select  belongs to the oldest woman in the group, who totters forward delighted to have nabbed the only white person in the group. She leads me off chuckling to herself. She calls to her friends, ‘You see? This is the same white woman that I greeted  in the path, when she came last time, and I told her ‘Be blessed in the name of Jesus Christ’and now He has sent her back to see my home.’ The ancient woman’s  name is Valaria, skinny as a rake, rheumy beady little eyes, but as sharp as a button. She powers her way up a slippery path to her home, stabbing the treacherous path with her stick, and then asks  me if I can manage the hill!

She turns off the slimy path to a little muddy shack, and with great pride beavers off to show me her clean water container, her cup, her plate, all clean and well stored. Outside the hut her son  sits in a drunken stupor. She says it is surprising that he is here, as normally she lives alone, but he did build her latrine a few years before. We go to see the ‘long drop’ which even has a hand washing facility next to it, a plastic jerry can, hanging from a tree, but with no water.

One wonders how she collects water, and she tells us she has to ask others to help her. She has been given a  DelAgua water filter through a goverrnment programme, which is providing filters throughout the District. She now is able to purify  her drinking water and demonstrates how clear it is.

She shows us where she will put her certificate and says, ‘This is the first one I have ever got. I was born in 1935, and I didn’t go to school, but I attended every one of the sessions at the club. I know what to do.’  Despite her  absolute poverty she is an example of great resilience.

My own mother is nine years older than Valarie,  goes to church once a week just to socialise and have some interaction with others.  Valaria  goes to the health club meeting for the same reason  every week, to get out of her little hovel and  she says she never missed one session . Hygiene training in the CHC is not just about learning and improving physical well being, but also the alleviation of mental stress of isolation.  CHCs build community and trust between neighbours. My visit has focused the spotlight on her latrine which needs a better cover. The neighbour says he will be sure they get one for her. They have built latrines for other old women in the village already. We part reluctantly. I was enjoying her ancient vivacity and inspired by her survival in such a dire existence.

Community Health Clubs in Haiti


Jason Rosenfeld volunteered for Africa AHEAD for a year in 2008, before managing a pilot project for us in Kwa Zulu Natal, and then being posted as a Techincal Advisor to our office in Harare. He is a great supporter of our approach and is now the first to have taken the CHC MOdel to the Caribbean. This is now best practice, is spread : by practitioners who can apply their experiences and adapt it to their own areas. Jason has developed a visual aid tool kit for Haiti and can provide training  this side of the Atlantic.

Extracted from his blog:

This summer, a team of graduate student researchers from Yale University and the University of Texas Health Science Center at San Antonio, spent 2 months in Haiti evaluating our Community Health Clubs in Port au Prince. The preliminary results of this evaluation were presented at the 2014 UNC Water and Health Conference in October; the poster we presented is available here: RosenfeldJ_UNC Poster_Haiti Case Study_2014.

Read More about CHCs in Haiti


Apiculture at Schools in Gokwe North, Zimbabwe

6th  Oct – 7th  November, 2014

Zim AHEAD staff conducted a training on Apiculture for 250 Community Based Facilitators and 4 School Health Masters and 3 School Development Committee members drawn from 5 wards trained in Gokwe North for ADRA Japan.

In fact the same group of Community Based Facilitators had already been trained  in 2011 by Zim AHEAD  in their WASH project so when ADRA approached Zim AHEAD for a refresher training  we suggested an add on for the communities. This is consistent with our long term process of development which provided on going training for community not only in health and hygiene but in income generation.

The training included 5 public health topics (one per day) in addition to  the apiculture sessions. District and ward officials from Environmental Health Department of MoHCC, MoWAGCD and Agritex attended the trainings forming district and local level support systems for the Apiculture projects.

Canaan Makusha, one of Zim AHEADs most effective trainers  was the lead trainer in  support these training.

We also  translated the CHC Training Manual into Shona for this project.