After 6 months of health promotion modules, impressive improvements have occurred at the Johanna Road Informal Settlement in the eThekwini Municipality, as measured by our Household Observations Survey, and as observed through communal changes and activities.

Research

From the baseline surveys, it was identified that the most problematic areas were low practice of zero open defecation (ZOD) (7%) and pour-to-waste method (16.3%), and a high presence of ringworm infection (18.6%).  After 6 months of health promotion sessions, 100% of CHC member households have ZOD and no visible ringworm, while pour-to-waste method has increasd to 88.5% of CHC households.  In addition to ZOD and no ringworm, 100% of CHC households now use a ladle, safely store their water and food, have a pot rack, and know how to make salt-sugar-solution to treat dehydration from diarrhea.

None of the CHC members have a handwashing facility, which Africa AHEAD believes is due to the majority of club members being located near a standpipe or ablution block.  Therefore, they use these facilities to wash their hands, to limit the amount of grey water they need to dispose of near their house.

CHC Activities

Demonstration grey water agri-tube garden at Johanna Road

Gardening

As documented in previous reports, the Johanna Road CHC communal and personal gardens have flourished.  In recognition of the CHC’s talent and hard work, the eThekwini Department of Water provided 15 grey water agri-tube gardens designed by Khanyisa Projects to club members on 2 February, with seedlings delivered 3 March.  Another round of approximately 20 agri-tubes will be delivered in the middle of March, to the remaining graduating club members.  One or two “Coke Bottle” grey water gardens will also be piloted in the settlement to determine which system better fits the environment.

Projects

The CHCs have plans for a very exciting community wide project – a tyre-step pathway to link Boxwood Place to Johanna Road.  As the settlement is located along the side of a steep hill, it can be very difficult and dangerous to traverse the settlement, especially in rainy weather.  The tyre-step pathway will help to make this task easier, as the current dirt trail will be replaced with steps.  Africa AHEAD has contacted companies to supply the tyres, and the DWS has agreed to provide tools (10 spades, 10 hoes, 10 forks, and 30 pairs of gloves) for the project.  The CHC has communicated with the community leaders and other residents, as they envision this to be a community-wide project.  They hope to commence work on the project second Saturday in March.

CHC members are also continuing to collect glass bottles as part of their new recycling project.  Africa AHEAD has approached the Municipality about the possibility of organizing transport for CHC members to Pinetown in order for them to learn more first hand about recycling.

In recognition that only so much improvement can be made to the grey water and drainage issues with education, the DWS is rehabilitating the bottom ablution block.  In addition to fixing the bottom ablution block, the DWS has agreed to put in a channeling system at the standpipe on Boxwood Place, so excess water from the tap can be diverted to the vegetable gardens located behind the standpipe.  The DWS began the project 4 March, with plans to complete it by 10 March.

Graduation

In recognition of the completion of the health promotion sessions, a graduation for the CHC members successfully completing the modules, will be held 11 April at the Northern Water Treatment Works.  The festivities will commence at 8h30 am, with a short walking tour through the settlement, where the new tyre-step pathway will be utilized.

Next Steps

As the CHCs have reached a point of transition. Africa AHEAD will assist Impiloyethu and Sakhimpiloyethu with their merge into one club.  After this is complete, the club will elect an executive board, draft and ratify a constitution, register as a CBO, and open a bank account.  Africa AHEAD plans to help the executive board ease into facilitation of the sessions so the transition goes smoothly.  The CHCs have told Africa AHEAD that they plan to continue to meet on a regular basis to discuss community issues and to plan community activities.  They have also expressed interest in Africa AHEAD’s module on nutrition.

The City of Cape Town has requested that Africa AHEAD provide another Community Health Club (CHC) training for the City’s Environmental Health Practitioners (EHPs) and Community Workers (CWs).

Africa AHEAD will provide training in the AHEAD methodology for 20 CWs and 16 EHPs over the course of 7 days in April 2010. Upon completion of the sessions, each CW will start a new health club in the informal settlements of Cape Town, bringing the total number of CHCs in the city to over 150.

The training, to be held at Look Out Hill in Khayelitsha, will be facilitated by Dr. Juliet Waterkeyn (Africa AHEAD Director), Jason Rosenfeld (Africa AHEAD Project Manager), and Ngcwele Dyani (Cape Town City of Environmental Health & Metro Health Club Co-ordinator).  In addition to the modules on CHCs, facilitation and health promotion, the training will include a site visit to an active CHC in the area, allowing participants to have a first-hand experience of CHCs.  The trainings will culminate in a graduation ceremony for all the participants.

For the past four years Africa AHEAD has been trying to introduce the concept of the Community Health Club Methodology into the informal settlements of the Western Cape. This has presented quite a challenge and it was open to debate whether the CHC approach, so effective in the rural areas, could really have the same appeal in the squatter camps of the Mother City, where there is little community cohesion, and where alienation of marginalized communities and political infighting by gate keepers has undermined so much development.

In 2005 the CHC idea was introduced into Khayelitsha through the University of Western Cape who sponsored a workshop facilitated by Africa AHEAD, where the first 25 facilitators were trained. The training was poorly received by existing stakeholders, and only one facilitator managed to establish a CHC the first time round which did at least demonstrate that a health club could work with the right facilitator.

Later that year working with Africa AHEAD, Hygiene Promotion Partnership, a research wing of BYU University adopted many of the concepts of the Community Health Club approach to start over 75 health clusters (groups of ten families) in the informal settlements of Du Noon, Phillippi Sweet Home and Kwa Five.

In 2007, the City Health Department  sponsored Africa AHEAD in the development of training materials to scale up the CHC training, and with the new Tool kit of visual aids and the manual,  two workshops have been held in the past two years, with another 50 participants trained in the CHC Approach. City Health Department has been working hard to integrate all development in the informal settlements through CHCs but with over 240 informal settlements this is a real challenge. Ngcwele Dyani was appointed as liason between the CHCs and Health Department and in June 2009, a large graduation ceremony was held for the CHCs in Phillipi. Mr. Armien Petersen of Environmental Health in City of Cape Town Health Department  was amazed by the response, as it has shown that Health Clubs are as attractive to women in town, who just like their counterparts in the villages love to come together for self improvement. It is also clear that although the CHCs are well received in informal settlements, to make any impact on preventing diseases like diarrhea there has to be a thicker diffusion of health clubs throughout every informal settlement.

There are now 120 active Community Health Clubs in the Western Cape and in July 2009, they formed an umbrella group to coordinate their activities. The Metro Health Club is the ideal mechanism for replication as it has been started by CHC leaders themselves, and is a genuine bottom up initiative. The executive board gave us a vision  with great enthusiasm of how  MHC plans to expand the activities of the health clubs through an holistic approach. Currently drafting their constitution in order to get registered, the MHC will focus on coordinating all CHCs in five different fields: Water and Sanitation, Health, Special Projects, Education, Recruitment, Finance. Each health club will have a representative for each field and these will meet regularly to facilitate development initiatives throughout the informal settlements, acting as grass roots instruments for change within their community. The MHC is encouraging those living in the informal settlements to take ownership of their problems and like the ethos of the CHCs the main focus is to stimulate self-help. The Metro Health Club is the best proof yet of the viability of the Community Health Club approach, as a vehicle of change in informal settlements, to uplift communities using health promotion to galvanise the energy of women.

Since the creation of Metro Health Club, the City of Cape Town and the Health Clubs have embarked on a truly special and beneficial relationship.  The City has created a database of all the CHC members, to use for employment for city projects involving water, health, sanitation, and hygiene.  As all CHC members have a basic training in these subjects, this allows the City a quick and easy way to find knowledgable and reliable employees, while offering much needed employment opportunities for CHC members.

Metro Health Club held its first event on National Hand Washing Day, 15 October 2009, where the health clubs gathered to promote hand washing with soap in the informal settlements of Cape Town.

Africa AHEAD has pledged to support the Metro Health Club, to enable more training and skills development in the 120 CHCs of the Western Cape.

For more information, please contact info@africaahead.com

In 2005 the CHC idea was introduced into Khayelitsha through the University of Western Cape who sponsored a workshop facilitated by Africa AHEAD, where the first 25 facilitators were trained. Later that year working with Africa AHEAD, Hygiene Promotion Partnership, a research wing of BYU University adopted many of the concepts of the Community Health Club approach to start over 75 health clusters (groups of ten families) in the informal settlements of Du Noon, Phillippi Sweet Home and Kwa Five. The main trainers in this project were Charlotte Adams and Joyce Ntombomzi , who have been leading lights since then working voluntarily to support Community Health Clubs in their own areas.

Charlotte Adams, head of mobilisation for Imbasa Community Resources

In late 2009, Adams and Ntombomzi joined forces with two other women (Nokwezi and Nozuko Nxasana) previously trained in the AHEAD Methodology to form the non-profit organisation, Imbasa Community Resources. Like Africa AHEAD, Imbasa has a vision of holistic, sustainable community development through health promotion and encouraging an ethos of self-help amongst the community.  They hope to achieve this vision by working with existing Community Health Clubs, as well as creating new clubs in interested areas. The organisation has four areas of focus: mobilisation (Charlotte), education and training (Joyce), water and sanitation (Nokwezi) and skills development (Nozuko). Imbasa has a variety of projects planned for 2010, including creche work in Du Noon, meeting with vendors to educate on proper food hygiene practices, and linking community health clubs with their local health inspectors to address water.  They also hope to open dialogue between South Africans and their neighbours from other African countries, to begin to create better relations between the different nationalities, in light of 2009’s xenophobic attacks.

Joyce, a tireless Community Worker, is now helping to promote hygiene education and training through Imbasa Community Resources

Africa AHEAD is excited to announce that they will be partnering with Imbasa Community Resources to implement a new Community Health Club project in the Western Cape, starting in February 2010.  This project will see the creation of health clubs in informal settlements new to the AHEAD methodology (Vrygrond, Masiphumelele, and Redhills), as well as expansion in areas with existing health clubs (Philippi and Mitchell’s Plain) (read more).

For more information on Imbasa Community Resources, please contact Joyce from Imbasa or info@africaahead.com

In response to a strong request by the Ministry of Health, Danida agreed to sponsor the introduction of the Community Health Club (CHC) Approach, and the originator of the methodology, Dr. J. Waterkeyn (JW) was invited  to provide training and mentor local consultants so that  a pilot project could beset up to test its effectiveness.  The consultant was engaged for a preliminary assignment to review progress to date and to assist in providing sound training material so that the approach could be scaled up.

The Provinces chosen for the Pilot Project were Son La, PhuTho, Ha Tinh and Ninh Thuan.  Twelve villages in each Province will start CHCs making a total of 48 CHCs if each facilitator runs one club, although it would be hoped that they could manage two or three clubs depending on the size of the area, distance between homes and availability of transport and incentives to participate.  It is expected that each facilitator will aim for a CHC of 100 members, and if this is multiplied by the number in the households who will benefit from improved hygiene, it can be estimated that the programme will serve a minimum of 2,400 people, or twice that if each facilitator runs two clubs.

The Pilot project will be integrated into existing structures such as the Women’s Union, although it should be appreciated that CHC’s embrace the whole community, not just women, as men are as important as women when it comes to disease transmission., and the CHC provides a forum for open debate on subjects that my otherwise be taboo or ignored.

The CHC will also try to mould the training so that it results in outputs that will enable families to be recognised as Cultural Families, and for CHC Villages to have the honour of Cultural Villages. Thus the graduation which will reward those who have completed 24 topics, may also include the Cultural Family awards. It is expected that local dignitaries and village leaders will avail themselves and support those who attain this level of hygiene and that the Graduation will become a day of celebration that can be an ongoing reminder to maintain good hygiene standards.

It is expected that the training will begin in December and be completed by July 2010. However before this time it would be ideal if a second Stage of the Training were planned to enable all the criteria for a Cultural Family to be met. The 1^st Stage focuses on water and sanitation, and home  hygiene, and aims to prevent common diseases such as diarrhoea, dysentery, cholera, helminthes, skin and eye disease, ARI’s as well as Swine flu, Avian Fly and Malaria. The 2^nd stage should ensure that nutrition, child care, immunisation, good parenting, substance abuse and other social issues are addressed in a complete Tool Kit which will build on the knowledge gained in Stage 1.

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