Association for Applied Health Education And Development

Village Network Africa

africaahead — Mon, 06 May 2013 17:46:33 +0000

by Anita Boling,Director

Using the Africa AHEAD program materials, Village Network Africa (ViNA) trained 28 Community Health Club (CHC) volunteer leaders in the rural Kibaale district in Uganda in 2009. The leaders were elected by residents from 14 villages. Jihan Mandilawi, MPH and Anita Boling, RN, MSN, PhD trained the health leaders and David Kyamanywa, MSW assisted and translated. The seminar was held 8 hours a day for a week, and ViNA supplied lunch for all participants. The health volunteers were very enthusiastic and eager to learn the material. Upon completion of the seminar, CHC leaders were given certificates and supplied with a canvas bag filled with laminated Africa Ahead materials, attendance sheets and membership cards. CHC leaders who started the clubs and followed through with holding club meetings were given bikes donated by the Wheels for Life non-profit to facilitate their transportation and to attend meetings held by local nurses and a clinical director. The CHC leaders were trained recently on malaria prevention and use of mosquito nets. Following CHC meetings on malaria, ViNA and HisNets supplied 2000 family sized mosquito nets to villagers from the 14 village target area. Concomitant with the club meetings, 18 shallow wells were installed by Rotary; the Africa Ahead education complimented this major change. A Peace Corp water engineer, Caleb Fader, reported that the medical clinics now report a 98% decrease in the incidence of diarrhea. Mijumbi Gabriel, our previous local ViNA employee, reported that the community health club continues to grow and that CHC leaders remain motivated to hold the health club meetings. We found this program to be very successful at disseminating basic health principles and practices in very rural areas of Africa and are thankful to Africa Ahead for their excellent work! RESPONSE FROM AFRICA AHEAD Thank you to the Village Africa Network Team for this feedback: it is exactly what we were hoping to receive and pass on to others via our website, which should reflect the achievments of other organisations, and not just Africa AHEAD. Here is an enterprising organisation that can appreciate a good thng when they see it , and is able to take theory and translate it into a practical programme without any help from Africa AHEAD staff. It is truly encouraging that Village Africa Network that has successfully used the CHC Methodology as it was designed, including the training materials and membership card and they can already report such a massive drop in diarrhoea: 98% is a huge claim and we would love you to fill in more detail of this.

Dominican Republic pilot project

africaahead — Mon, 06 May 2013 16:43:30 +0000

¡Bienvenidos Clubes de Salud Comunitaria a la República Dominicana!

Jason Rosenfeld, who worked with Africa AHEAD from 2007-2010, is now at the University of Texas Health Science Centre, San Antonio, as Senior Program Coordinator, and has sucessfully transplanted the concept of the CHCs from Africa to the Caribbean and shares with us this report.

In March 2012, the Center for Medical Humanities & Ethics (CMHE) at the University of Texas Health Science Center at San Antonio, in collaboration with the Children of the Nations (COTN) organization and the Universidad Iberoamericana (UNIBE), trained the first six Community Health Club (CHC) facilitators from five communities in the Barahona Province, Dominican Republic. Those facilitators will start the first CHCs in Latin America and the Caribbean in an effort to contribute to a reduction in water, sanitation and hygiene-related health conditions and demonstrate the effectiveness of this methodology in laying a sustainable foundation for community-based health and development. With cholera poised to pose a continuous threat from across the border in Haiti for the foreseeable future, it is hoped that this small pilot project will be the impetus for a rapid expansion along the remaining bordering provinces of the Dominican Republic and ultimately across the border into Haiti.

Since 2010, the CMHE has been operating mobile clinics in Independencia Province, providing free medical care to some of the most vulnerable communities in the Dominican Republic. While providing health care services to residents of bateyes (unincorporated settlements of low-wage Haitian and Dominican laborers and displaced Haitian migrants), students and faculty realized that to truly make a positive health impact in these communities, a long-term, sustainable approach would better address the underlying causes of locally prevalent diseases. At the same time, the cholera epidemic that began in the Artibonite Province of Haiti in October 2010 rapidly spread, resulting in over 531,000 confirmed cases and over 7,000 deaths in Haiti[1], and almost 20,000 cases (predominantly border provinces) in the Dominican Republic[2]. In response, the CMHE began partnering with COTN to pilot the CHC approach in the five communities where COTN has been operating since 1997.

After a year of research, material development and planning, residents of the communities of Altagracia, Algodon, Los Robles, Don Bosco and Pueblo Nuevo are set to join the international network of Health Club members who have used health education as an entry point to holistic community health and development. Over the past year, formative research has been conducted to recreate the drawings used during the weekly health education sessions so as to better mirror life in the Dominican Republic and two artists have been commissioned to complete the approximately 270 drawings.

In addition, baseline data has been collected from almost 400 households across the five communities to demonstrate the impact of the program and its adaptability to the local context in Barahona. The first phase of this research was completed in June 2011 when three M.D./M.P.H. students from the UT Health Science Center collected data from 88 households in Altagracia. The results of this research were instrumental in identifying the need for a CHC program, in advocating for the required resources for this pilot project, and have been published in Fall 2011 issue of the Journal of Global Health. In March 2012, the remainder of the baseline data was collected by eight M.D. students from UNIBE, with supervision from CMHE staff member Jason Rosenfeld and UNIBE’s Dr. Francisco Paulino. In one week, these eight students worked tirelessly to visit over 300 households in Los Robles, Algodon, Don Bosco and Pueblo Nuevo, completing the work started by their colleagues from the Health Science Center the previous summer.

At the same time this research and program development was being completed, Mr. Rosenfeld was introducing the program to the five communities and mobilizing them to join their local Health Club using the time-tested participatory activity, Nurse Ana (also known as Nurse Tanaka in Africa). In this activity, community members act out a role play at their local clinic, with one person acting as Nurse Ana and the rest as community members. Patients visit the clinic with common conditions from their community; Nurse Ana diagnoses the condition and shares his/her thoughts about the causes of the condition. The purpose of this activity is to learn about each community’s perceived health issues, while demonstrating that the majority of the conditions can be prevented through improved water, sanitation and hygiene practices.

The response from each of the five communities was overwhelmingly positive, so the decision was taken to move ahead with implementation. Therefore, from March 12-15 six community-based facilitators, two nurses from COTN, and the COTN Field Officer, Dr. Charinson Feliz, participated in the first of two training workshops for this project. During this four-day workshop, participants were trained in the CHC methodology, best practices in how to mobilize their community and start a CHC, and how to use the CHC Toolkit and participatory activities to conduct the first two months of health education.

During this workshop, participants were given an opportunity to create their own Health Club, which they named Club de Salud en Acción (Health Club in Action) and created the slogan, ¡Salud Total! (Total Health!). The remainder of the training will be completed in May/June 2012, when students from both Universities will also collaborate to conduct two studies: a process evaluation of implementation to date and an intestinal parasitology study as part of the overall impact evaluation.

Over the course of the next year, Health Club members in these five communities will participate in weekly health education sessions and will begin making incremental improvements to their households and communities.

The goal of this program is to prevent the transmission of preventable conditions such as intestinal parasites, skin diseases, malaria/dengue, and diarrhea, most importantly cholera. So far the six CHC Facilitators have mobilized and registered over 150 people across the five communities and are set to begin the health education sessions in the coming weeks. Stay tuned as this exciting new program grows. ¡Salud Total!

[1] Ministry of Public Health and Population, Pan American Health Organization, Mar 2012.

[2] Weekly Epidemiological Bulletin: Oct 30 – Nov 5, 2011. Ministry of Public Health, Department of Epidemiology, National Epidemiological Surveillance System. Week 44, 2011.

Evolution of CLTS in Sierra Leone

africaahead — Sat, 16 Feb 2013 09:46:00 +0000

How to evolve CLTS was the challenge we were given. CLTS was first introduced into Sierra Leone five years ago in 2008, and Unicef has been coordinating implementing partners here to an impressive degree with a frenzy of triggering across the country. However, despite the mushrooming of latrines, there has been doubt as to the ‘sustainability’ of the approach (ie how many latrines are still standing. In addition it has been doubted whether any health benefits have accrued to the population which seems to have built latrines but have not changed their hygiene and appear to have little understanding of the reason for this activity.

Africa AHEAD was asked to do a Rapid Rural Appraisal and our findings were every bit as disappointing was was expected. Having done a spot check on 100 latrines in six different sites, randomly chosen from villages that were triggered in 2009 or 2010, we found not one latrine was covered and most were ‘fly factories’. Far from breaking the fecal-oral route, the shoddy shacks with no slabs, over pits as deep as mine shafts, which had been constructed by thousands of villages across the countryside, have become, in effect, ’fixed point open defecation sites’ and many abandoned ones are deathtraps. This makes a mockery of the ostentatious billboards at the entrance of many of these villages, declaring that the village is ‘Open Defecation Free’.

For a country that has the unenviable misfortune to have a rural population where 50% of household heads are completely uneducated with not even a single year of school, the signboards in English are merely a photo opportunity for the donor. They mean nothing to the villagers and signal only that the authorities are satisfied that the project has been successfully concluded. The villagers relax, as no further effort is required to satisfy the strangers and their weird request to build latrines.

Triggering: shitty hair in a bottle test to see if villagers will drink the water!

We attended an impressive display of this one day CLTS ’triggering’ of a community and saw the horror as the impoverished villagers were shown their own shit lying in dumps around the edge of the village, they the NGO staff calculated the amount of shit produced per year. The gathering was threatened with a public exposure of their foul ways on the local radio station, which depressed them further but the chief could think of no response.

As they sat in a depressed state of anxiety wondering how on earth they were going to ‘stop eating their own kaka’, the joyous sound of their children rang out across the villages, as the school kids swarmed in to the centre of the gathering like an army of soldier ants singing to their parents, ‘Mama, Papa, Please build us latrines, we dont want to eat our own kaka’! This wonderfully choreographed event was intensely moving, as we saw the parents face light up having been provided with a solution to all their insanitary ways, by their clever children primed and rehearsed by the team from the NGO.

Within minutes the chief was on his feet vowing that latrines would be built immediately and there was no need to tell the world on the radio about the village unfortunate sanitation. The strangers went on their way vowing to return within a month to see if the villages had done what they promised. It was a brutal but effective handling of what would appear to be a sensitive subject to a society careful never to say the foul words in public – zero shit disposal. But not with CLTS, which takes a subversive delight in embarrassing villagers into action and getting them to talk dirty, all in the name of improving sanitation.

CLTS might be acceptable if the means did justify the end, but it seems this is not the ‘quick fix’ that many hoped it might be. Behaviour change just isn’t that easy, and whilst latrines might pop up to save face, there is no attempt to keep them clean, let along rebuild them after the collapse with the first rains. It is estimated that only 30% of the villages that were successful in achieving ODF are still squeaky clean. In fact they never were completely ODF, as the term has come to mean anything from 38% – 78% coverage but never 100% as it would imply.

So as we went from village to village, seeing nothing but shitty latrines open to flies, and no attempt at handwashing or general hygiene. It was clear that a much deeper programme than latrine triggering would have to be done if hygiene standards were to be improved in the depths of Sierra Leone. There is simply no short cut to progress or good development.

Luckily our observations served only to confirm what most practitioners, both government and NGO have also realised – that the current CLTS has to be ‘evolved’ to make any long lasting impact on health. This was our task – to see how we could combine CLTS with the CHC approach to strengthen the levels of hygiene behaviour change.

Chief and the village learn about nutrition in a CHC

It was therefore a relief to find that the CHC methodology which we had introduced in Sierra Leone in 2001, had a life of its own, and was quietly being used by CARE for reproductive health training with mothers clubs. We visited one such session and the contrast to the moronic CLTS session was striking.

Here women sat together working out the intricacies of how to provide a balanced diet to wean children properly, and the meeting called on the intelligence of the women and was clearly an enlightening and entertaining experience. The illiterate chief was present at the weekly session, a regular member along with his wife.Afterwards we walked through the village and visited their home to find she had done the CHC WASH training years before and had an exceptionally clean home – an example to the rest of the village.

The contrast between the two methodologies was striking: CLTS – shocking and embarasing vs CHC - intelligent and enlightening… which would you choose if you were a village women?

At the feed back workshop for the WASH sector in Freetown, we tried to paint a picture whereby the initial triggering of CLTS, so effective for mobilising the community, was used, not to build shitty latrines, but only to ensure ‘cat’ sanitation, the burial of faeces as well as to encourage the village to form a CHC and start to got through a process of transformation which would be informed every week by facts and recommendations so that people could make informed decisions and build a decent latrine that would last and be replaced. A process of development rather than bullying into conformity.

There is great scope for modifying CLTS into a more enlightened process, so that the shock and horror is turned into hope and knowledge. Only this way will CLTS succeed in changing people’s hygiene behaviour for long term sustainability of safe sanitation. It was encouraging that all the 50 participants from Government and NGOs at the workshop endorsed our ideas and we look forward to piloting a way to elevate current WASH practice.

USAID/OFDA supports massive scale up in Zimbabwe

africaahead — Thu, 01 Nov 2012 02:04:17 +0000

The emergency wing of USAID has today finalised a direct grant to Zimbabwe AHEAD which will see a role out of Community Health Clubs in the coming year into four of the most hard hit districts of the country in a effort to mitigate against future Cholera and Typhoid epidemics.

This programme will establish a total of 480 new CHCs in four districts: Makoni District (pop.272,578), Mutare-Urban (pop.389,988), Chimanimani (pop 115,250) and Chipinge (pop.283,671), with an estimated total population of 1,061,487 people (2005). The CHC health promotion and hygiene training will take six months during which time 36,000 CHC households will be trained in all basic practices including the use of Water Guard to purify drinking water in the home. Taking into account their families (calculated at 6 per household) that will benefit from improved hygiene in the home, it is estimated there will be 216,000 direct beneficiaries at a cost of US$2.83 per beneficiary

This generous assistance by the United States government is seen as an indication that our methodology is being recognised by major donors as being one of the most effective means of enabling communities in some of the most challenging environments to take control of their own health despite lack of service provision by the responsible authorities.

The CHC approach has been gaining increasing attention at high levels in the WASH Sector at the 2012 Health and Water Conference in North Carolina where the Director was honoured with one of 6 scholarships presented to participants presenting papers on cutting edge development subjects.

At the side event to promote the CHC approach, Africa AHEAD is hosting speakers from the Gates Foundation, London School of Hygiene and Tropical Medicine, Path, World Vision, as well as the Univeristy of Texas, and Emory North Carolina. We are highlighting case studies from Dominican Republic, Tanzania, Zambia,Rwanda and our own from Zimbabwe, presented by our Acting Director, Regis Matimati in his first visit to North America.

Dr Jamie Bartram, the Director of the Water Institute of North Carolina is activity seeking partnership with Africa AHEAD to devset up a research reciprocity enabling students from the North to visit and learn practically from our programmes with the hope that Zimbabweans may also have the chance and to study in North America.

Monitoring and Evaluating the Community Health Club approach in Rwanda

africaahead — Wed, 12 Sep 2012 07:57:44 +0000

At a Conference convened in Seattle, at the Bill & Melinda Gates Foundation, in November 2011, top experts discussed how to achieve ‘Impact at Scale’, in order to more effectively reduce infant and child mortality. One of the key recommendations of the convening was the use of Community Health Workers in every village as a strategy to control preventable diseases. This resonates very strongly with the Community Health Club (CHC) Model of development which depends entirely on the Community based field workers to train and monitor community.

This insight also is reflected in Rwanda, one of the few countries in Africa likely to meet the MDG targets. President Paul Kagame, in his Presidential Initiative (2010) directed each of the 15,000 villages in the country to start Community Hygiene Clubs, using existing Community Health Workers to conduct weekly hygiene sessions, through the Community Based Environmental Health Promotion Programme (CBEHPP) which was launched at that time. The latest figures (August, 2012) show that already 95% (over 12,000 CHCs) have been registered, but that only 8% of the hygiene clubs have started the training of the community, although this should increase significantly this year with many NGOs starting to implement the CBEHP programme.

The CHC Model which is incorporated in the CBEHPP of Rwanda were highlighted at a presentation given by the Directors of Africa AHEAD in Seattle at the Gates Foundation (October, 2011) to the Water, Sanitation, and Hygiene program. A follow-up convening hosted in Kigali, (December, 2011) by the Environmental Health Department of the Ministry of Health, brought together representatives from the WSH program of the Gates Foundation, NGOs in the WASH, and a group of public health researchers. A field visit to Rulindo District, enabled the participants to see that CHCs were indeed a reality, and that MoH officials and Mayors of each of the 30 districts, are responding to the challenge. It was an obvious opportunity to measure the ability of village level training by CHWs to impact on the health of the population.

Although the CHC approach has been in operation for more than 15 years with strong evidence of hygiene behaviour change taking place (Waterkeyn and Cairncross, 2005), the health impact has never been objectively evaluated. Innovations for Poverty Action (IPA), funded by Gates Foundation, will evaluate the CBEHPP program over the next four years, providing for the first time, rigorous evidence into the health impact, and the cost-effectiveness of the CHC approach. 150 randomly selected communities will serve as the study sample. One third of these communities will be randomly selected to receive training and monitoring by MoH.

Africa AHEAD, having been involved from the inception of CBEHPP, with the introduction of the CHC Approach into Rwanda, will be a sub-grantee of the Gates Foundation through the Ministry of Health, building capacity for the monitoring and quality control for the program. The randomized control trial will take place in just one district, in the far south-west of the country, Rusizi District, on the borders with Burundi and DRC. Africa AHEAD will be registering in Rwanda to provide support to optimize the methodology and ensure through MoH that a classic demonstration is available for Innovations for Poverty Action to evaluate the CHC Model properly. In July 2012, the Gates Foundation, IPA and Africa AHEAD met with the Director of Maternal and Child Health, Ministry of Health, and an agreement was signed for the monitoring and evaluation of the CHC Approach in Rwanda.

With many NGOs conducting the CBEHPP throughout Rwanda there is still much work to be done to coordinate this programme and ensure the CHC approach loses nothing by replication at such a scale. Africa AHEAD will be working closely within Ministry of Health Environmental Health Desk to monitor the programme effectively through the use of cell phone surveys, and coordination through a CBEHPP website. It is a great bonus internationally, that this program will be properly monitored and documented. The expectation is that when the MDG tally is made in 2015, Rwanda, is likely to be a shining example of the effectiveness of using CHWs to reduce infant and child mortality. By this time objective findings on the CHC approach, should be available, which will inform decisions on how best to enable the rest of Africa to improve hygiene behaviour in a post MDG world.

Profile of Zimbabwe AHEAD Organisation

africaahead — Thu, 16 Aug 2012 09:13:48 +0000

Name of Organization: Zimbabwe Applied Health Education And Development (ZimAHEAD)

Registration Status: Registered Trust – MA1380/2001

Address: 28 Tweed Road, Eastlea,Harare

Contact Person: Dr. Juliet Waterkeyn: Executive Director

cc Regis Matimati: Director of Programmes

Contact phone: 0773 038 700

E-mail: juliet@africaahead.com

cc regis@africaahead.com

Website: www.africaahead.org

Management Structure: Board of Trustees (7 members)

Executive Director: Dr. Juliet Waterkeyn

Background

Zimbabwe AHEAD (Applied Health Education and Development) is a local Zimbabwean NGO that was founded in 1995 to address the needs of rural communities through the Community Health Club (CHC) Methodology. CHCs provide a structured health and hygiene promotion program that provides an entry point to holistic development that is cost-effective with a high impact and is sustainable in nature. By combining time-tested Participatory Health and Hygiene Education (PHHE) activities and ZimAHEAD’s specially designed toolkit with the structure of weekly health promotion sessions, this approach stimulates sustainable behaviour change through social pressure to conform that alters community water, sanitation and hygiene (WASH) norms and values. This ‘Common-Unity’ helps to establish a culture of health that evidence has shown is sustained over time and is leveraged beyond the immediate goals of WASH programs. In this way, the CHC Methodology utilizes WASH promotion as an entry point to a process of development that involves a series of stages, whereby the CHC acts as a vehicle for a sequence of development initiatives, with each stage building upon the successes and lessons learned from the previous.

Since 1995, ZimAHEAD has successfully implemented CHCs across Zimbabwe, from Tsholotsho in the west to Makoni and Buhera in the east. CHCs have been started across most wards throughout the 7 Districts of the Manicaland Province, particularly the Buhera, Chipinge, and Makoni Districts. Recently, as part of the national humanitarian response programme, ZimAHEAD utilized the CHC Methodology to prevent the transmission of cholera in the Urban Mutare District as well as in neighbouring Chiredzi and Masvingo (Urban and Rural) Districts in the Masvingo Province. To further support the water and sanitation needs of the end beneficiaries, ZimAHEAD has the technical expertise and skills to support the construction of Blair VIP latrines, Upgraded Family Wells and rehabilitate communal boreholes and other water points. Under a 3 year EC funded livelihoods programme in the Buhera, Chipinge and Chiredzi Districts, ZimAHEAD has recently developed Food, Agriculture and Nutrition (FAN) Club model as an immediate follow-on to the health and hygiene promotion activities engaged in by CHC members. During this 6-12 month programme, club members learn about balanced diets and nutrition and how to achieve both through basic gardening and permaculture techniques at household level. Since its inception, ZimAHEAD has always had an eye on its own sustainability, which is achieved through the sales of specially designed PHHE toolkits as well as providing consulting services for government and non-governmental organisations on the CHC Methodology. To this effect on the PRP project, 22 national and international organisations have been trained and have received technical backstopping support on the CHC methodology across the country.

ZimAHEAD is currently implementing a 2 year public health promotion EC funded project in Gutu and Mberengwa districts in partnership with Action Contra la Faim (ACF) who are doing the water and sanitation hardware of the project after ZimAHEAD has triggered demand for sanitation through its renowned CHC methodology.

Operational Strategy

ZimAHEAD Organization works to stimulate and support holistic and sustainable community-driven development in urban and rural Zimbabwe. Pursuant to this, we follow a four phased methodology in project implementation as follows:

Phase 1: Water and sanitation software

Phase 2: Water and sanitation hardware community self supply

Phase 3: Income generation projects to support community development starting with WASH

Phase 4: Community social responsibility where disposable income generated for IGAs is ploughed back into the OVCs, the elderly, community home based care programmes among others as determined by the community themselves.

Recent Past Projects

2007-2010

EC WASH and Livelihoods independence project in Buhera, Chipinge and Chiredzi in partnership with Mercy Corps ($ 451 910.00)

2008-2011

OFDA funded Rural and Urban Public health Promotion in Humanitarian emergencies Mutare City(2008-2009), Chiredzi Rural and Urban (2009-2010) and Masvingo Rural (2010-2011) in partnership with Oxfam GB ($305 636.00)

2009-2012

PRP II Consultancy work with IWSD offering CHC ToTs and backstopping support to 22 national and international NGOs on the GRM managed PRP II project ($ 24 000.00)

2010

ERF- Emergency Public Health Promotion in Urban Areas in Masvingo City with support from UNOCHA through Oxfam GB ($ 27 500.00)

2010

Consultancy WASH ToT and backstopping support for ADRA Zimbabwe in Gokwe North District (26 980.00)

2011

Consultancy WASH ToT and backstopping support for Medair in Gokwe North District ($ 50 162.00)

2012-2014

EU Water facility: WASH promotion for the MDGs in Gutu and Mberengwa Districts in partnership with Action Contra La Faim (ACF) ($ 500 172.00)

(See reference letters from the districts)

Qualifications and Competences of Management Staff

Juliet Waterkeyn PhD: Executive Director

PhD. London School of Hygiene & Tropical Medicine, London University

M.Phil. London School of Hygiene & Tropical Medicine, London University

B.A. Degree. (Social Science) UNISA. Majoring in Sociology and Religious Studies

Dip. Fine Art. Michaelis School of Fine Art, University of Cape Town

Regis Matimati: Director of Programmes

BSc Development Studies (Student)

Post Graduate Diploma in Water Supply and Sanitation

Certificate in Project Management

Registered General Nurse

Innocent Marivo: Finance and Admin Manager

Higher Diploma in Accountancy

Post Graduate Diploma in Management

READ LATEST NEWS FROM ZIMBABWE

Zimbabwe AHEAD is the original organisation which was started in 1997 to replicate the Community Health Club Approach that had proved so successful in field trials during the previous 2 years. As the original pioneer in the Community Health Club approach, Zim AHEAD has the longest experience in this methodology and in the past decade has developed the CHC Model to its full extent. Zim AHEAD has played a catalytic role in pioneering a workable solution to achieve sustainable development and is the resource centre for a participatory PHAST Tool Kit of visual aids for health promotion which is provided to other NGOs with training to set up Community Health Clubs.

2009 Zimbabwe AHEAD Staff

The AHEAD approach has taken a firm root in Zimbabwe where the Ministry of Health continues to implement health promotion through Community Health Clubs. In Makoni District the programme has diversified to become a sustainable livelihoods programme, with over 5,000 nutrition gardens growing herbs and vegetables. The Health Clubs in Makoni have become famous thanks to international exposure through research findings, and Tsholotsho District remains an example world-wide of some of the most cost-effective health promotion to be accurately documented in the literature.

: Andrew Muringaniza, responsible for the sucessful Tsholotsho Project 1997-2001, now Project officer in Chipinge

: Morgan Haiza, starting some of the first CHCs in Zimbabwe in 1995, now Project Officer in Chipinge

THE GOLDEN YEARS (1997-2000)

During this start-up period, Zim AHEAD was well supported by funding agencies such as DFID, Danida and Oak Foundation. Two substantial health promotion, water and sanitation programmes were completed in three districts of Zimbabwe, Makoni District (Danida) and Tsholotsho and Gutu District (DFID).

Zimbabwe AHEAD was directly responsible for initiating over 265 Community Health Clubs in this area, with a total number of members trained in under three years being 11,450 with an estimated number of beneficiaries being 68,700. Through training support to other agencies a further 72 CHC started in all wards of Bikita, and seven wards in Lupane (IWSS-DFID), as well as in Zaka District with CARE International. By 2001 there was an estimated number of 17,282 members in 5 districts, with over 103,692 beneficiaries. In Makoni the cost per beneficiary for two years of health promotion amounted to US$ 0.63 per year, whilst in Tsholotsho the cost was only US$0. 35 per beneficiary. A total of 3,600 latrines had been constructed with subsidy of US$15-20 per latrine. In 1998-9 the 2400 latrines constructed in only two of the 57 districtsÂ amounted to 24% of the 8,000 latrines constructed nationwide that year. PhD Research was to show that levels of hygiene behaviour change was exceptionally high with an average of 43% in underdeveloped Tsholotsho for 21 indicators with less in Makoni of 13% average, accounted for by higher standards of hygiene due to being a more developed area . See Publications for details.

THE LEAN YEARS: 2001-2006

: Mrs Josephine Mutandiro, as District Coordinator developed the Herb and Nutrition Programme in Makoni from 2002 which has become a life savour for over 5000 families.

When Zimbabwe disintegrated in 2001, donors abandoned the funding of projects and the Zim AHEAD was forced to scale down operations. The Head office was moved to the District where most activities were taking place and from 2003, the organisation has been based in Rusape. Importantly, although there was little funding during this difficult period, the Community Health Clubs kept themselves busy and many self reliance project were started with minimal outside inputs. During these lean years, some support for Zim AHEAD activities was given by LEAD, FAO and New Zealand Aid , but the organisation struggled to keep going. However, despite the economic, political and social crisis in Zimbabwe (with inflation well over 10,000% and unemployment at 70%), the Community Health Club members were not only surviving but actually prospering! Sales from over 500 income generating groups enabled women to support their families financially through the sale of produce. The income generating groups are engaged in are beekeeping (there are currently over 10,000 beekeepers in the programme), the propagation and sale of dried herbs and vegetables, carpentry, sewing, tin-smithing, and paper making. All of these activities have brought significant wealth to the area. In addition, ten health clubs built a Training Centre and Community Market as a means of developing an outlet for their produce between 2002 and 2005, but this brave effort was damaged by arson in 2007.

Importantly, although there was little funding during this difficult period, research into the achievements of CHCs in ZimAHEAD Project areas was conducted at the London School of Hygiene and Tropical Medicine which has ensured the survival of valuable lessons learnt through this approach. This has resulted in the spread of academic understanding of the power of this methodology to produce cost-effective hygiene behaviour change, and giving the parent Zim AHEAD a place at the cutting edge of good development practice.

Sustainability of Community Health Clubs

The unfortunate situation in in Zimbabwe has provided an opportunity to test the viability of the CHC Approach to sustain self reliant development in the most challenging of circumstances. Interviews in 2003 showed that of the 20 health clubs that were randomly selected in each of the 20 wards of Makoni, all were still operational after three years without external support despite the melt down of the country economically. CHC members were responsible for coordinating development initiatives such as health promotion and surveillance, water point rehabilitation, sanitation, nutrition, HIV/AIDS Care, Orphan and Widow support and sustainable livelihoods, as well as playing netball, discussions of health and hygiene, and planning income generating activities. (See: What the community says: Quotations posted on this website were collected at this time (Research and Dissemination Project funded by DFID )

NEW HOPE (2007 -2009)

: FAN Club members are given a starter kit of 30 main herbs and taught the medicinal properties of each to enable home treatment of common ailments, providing a self help solution in the face of the collapse of health services in Zimbabwe.

In Stage 3 of the programme, Zimbabwe AHEAD is now converting the Community Health Clubs into Food and Nutrition Programme (FAN) clubs, growing herbs and vegetables to ensure food security in these difficult times, supported by the EU. Since February 2007, Mercy Corps has been Zim AHEAD’s main partner, funded by British Lottery Fund and EU. Despite the political and economic turmoil of that time, and the hardships of minimal support, the unswerving commitment of the staff ensured that a successful programme was started in Chipinge District. Within six months there were 27 health clubs with over 2705 members. The following year community monitoring with household inventories showed that there was a 43% improvement of hygiene practice as measured before and after the project.

In Rusape, Zim AHEAD continues to assist play schools started in some CHCs providing much needed supplementary feeding for orphans and vulnerable children. There are currently five centres, where a midday meal is provided and children are taught games and cultural songs and dances by the volunteers. this Ambuya Asistance Programme (Grandmother support) is supported by New Zealand Aid, who also helped build the Wild Honey Sangano Centre, providing a focus for CHC activities.

A Programme implemented by Zimbabwe AHEAD, supported by OXFAM has now started in two urban high density suburbs of Mutare, where health clubs have become one of the most viable means of arresting the spread of cholera which is ravaging the country.

TRAINING MATERIALS

Zim AHEAD has produced an innovative Herb Poster and training material to enable the community to have reference material

to help use the 30 variety of herbs that are now being used within Community Health Clubs. (See Training Material).

Zim AHEAD 2011 Annual Report

africaahead — Sat, 04 Feb 2012 15:09:58 +0000

Full layout can be downloaded in four parts (20 pages in total) … Please be patient, it takes a bit of time!

Meanwhile please read the excerps…

2011 AHEAD Annual Report_part_1

2011 AHEAD Annual Report_part_2

2011 AHEAD Annual Report_part_3

2011 AHEAD Annual Report_part_4

EXCERPS:

ZIMBABWE AHEAD, 2011
Anthony Waterkeyn, Chairman

The year ended very sadly with the passing away of Josephine Mutandiro on 27th December, 2011. She was a founding staff member who on retirement in 2009 became a Board Member and Trustee. She will be sorely missed but very fondly remembered by all those of us who have been privileged to work with her and who have greatly appreciated her deep humanity, wisdom and wonderfully innovative understanding of grass-root community development.

ZimAHEAD has continued to play an ever increasing role in the WASH sector, not only in Zimbabwe, but also in the region at large. During the well attended SADC WASH Conference that took place in Maputo in May this year, the final recommendation sent forward to the AfricaSan Conference in Rwanda (July 2011) highlighted the effectiveness and impact that CHCs achieve in cost-effective hygiene behaviour change. This has stimulated increasing interest from various NGOs in the region to find out more about CHCs.

To-date, 22 NGOs in Zimbabwe have been trained and mentored by Zim AHEAD as part of the Protracted Relief Programme 11, funded by DFID.

Click here for Map of PRP Districts 2011

Requests from various NGOs in the region have been received to provide Look andlearn tours to Zimbabwe. This once again highlights the urgent need for establishing a regional Research & Training Centre to enable international visitors to study CHCs in action and provide them with the quality of training that will enable them to replicate and scale up CHCs back in their own countries. It will also provide an opportunity for students to research the cost effectiveness of CHCs and such research, if it generates objective evidence of success, should in turn increase the prospects for ZimAHEAD to extend our influence. All this should bode well for future funding and overall growth prospects for ZimAHEAD.

In 2012 we expect to attract direct support from leading agencies rather than simply being sub-contracted through international NGOs as has been the case over recent years. This should allow us to grow and expand as an organisation in the near future in stark contrast to the many challenges we faced through the latter-half of 2011 as a result of delayed start of projects and funding constraints. With the EUWF/ACF project finally starting and good prospects of direct USAID funding, the outlook for 2012 is definitely a bright one!

ANNUAL REPORT BY EXECUTIVE DIRECTOR
Dr. Juliet Waterkeyn

2011 started out with great promise. Zimbabwe AHEAD had consolidated its reputation with government as an innovative leader in the sector, contributing to the national effort in WASH and SAG networks, as well as spear-heading the development of new Health Promoting Schools Curriculum. We were also considered a strategic local partner by many international NGOs wanting to use the CHC methodology as it spread throughout the country thanks largely to our role in Protracted Relief Programme (PRP II), where we had trained 22 NGOs in our methodology. Through our sister Association, Africa AHEAD, we were invited to provide community mobilization in massive engineering contracts by prestigious UK firms, who were bidding for rehabilitation of sanitation in 5 towns in Zimbabwe. By the end of 2010, eight international partners had submitted joint proposals with us for EC Funding and in early 2011 we were delighted to hear the ACF bid was successful. Our team was gearing up to begin this ambitious programme starting 450 CHCs in Gutu and Mberengwa districts. Although we expected to start in May, delays ensued while ACF worked through their own bureaucratic demands from the EU, and ZimAHEAD was left hanging. As our project with OXFAM wound up in mid year, and the ACF programme still showed no signs of start up in July, many field staff were laid off , while others were on half salaries for the rest of the year.

The second half of 2011 taxed our small NGO to near breaking point. As the political situation in Zimbabwe remained locked in stale-mate, we, like many other NGOs this year, found direct funding elusive. To minimize core costs, Regis Matimati, our Director of Programmes has stood in for me as Acting Director most of the year and continued valiantly to keep up morale despite the many challenges, whilst Innocent Marivo, our Admin and Finance Manager patiently kept us in business, with sale of training materials and consultancy training workshops for Medair and PRP II. I would like to recognize the loyalty of our staff, who have all come back to the Zim AHEAD family ready to work again now the ACF project is finally going ahead. We are happy to announce that in January 2012 we are taking on 9 new staff for the ACF Programme, and another 8 new staff for the emergency USAID-OFDA that we expect to start up soon. This will enable Zim AHEAD to go back to our old project areas of Makoni District, Chiredzi and Masvingo, training 240 CHCs with 216,000 beneficiaries in one year. 2012 should be a record breaking year for us as we continue to scale up CHCs throughout Zimbabwe. May this happen as planned!

COLLABORATION AND ADVOCACY
Regis Matimati, Director of Programmes

ZimAHEAD maintained its position in working on the National WASH Strategic Advisory Group (SAG) where we presided and deliberated over national WASH issues and gave recommendations and advice to the National WASH steering committee.

Monthly we attended the national WASH cluster in Harare and a couple of times we attended the Masvingo Provincial WASH cluster as we had projects going in the province. The several meetings we had in the Education cluster may involve us a school health project in collaboration with VVOB and UNICEF.

We worked and contributed on the MoHCW Community Based Environmental Health Promotion Programme (CBEHPP) and we were invited to make presentations and be discussants on CHCs at a 2 day National Environmental Health Officers’ forum in Nyanga which we attended together with the ZA Board Chairman.

We joined the NCU led National Sanitation and Hygiene taskforce that came up with the National Sanitation Strategy. We met and deliberated for over 8 months to come up with the document. Due to representations we made at such meetings, CHCs feature in the Strategic document as the way to go for Zimbabwe.

We have been assigned by National WASH cluster to lead the engagement of partners on Urban PHP and to that effect we have presented at the Urban Rehab Technical Working group and the National WASH cluster. A lot of interest has been generated and other organizations are wanting to learn from us about urban PHP picking from our Mutare, Chiredzi and Masvingo urban experiences.

We have been invited to several National forums on the WASH and Education front such as the Regional WASH in School workshop which was attended by representatives from South Africa, Namibia, Botswana, Zambia, Kenya, Malawi and Zimbabwe MoEASC and the National NAC planning and review workshops and that signifies how we are perceived by our significant partners in the sector namely NCU and Unicef who invited us.

WORKER OF THE YEAR: 2011:

Admin and Finance Manager: Innocent Marivo

We would like to recognize the good work of Innocent Marivo, our Administration and Finance Manager, who has kept his cool through thick and thin and managed to show all our donors that no matter how small or large the budget, our systems are in place and our books are squeaky clean.

Innocent took over the accounts in 2007, at the time of hyper-inflation, when the dollar had been in free fall and accountants throughout Zimbabwe were despairing of being able to balancing their books, with the number of zero’s they had to juggle with, and which changed as they were doing the sums. Methodically he went through the previous years, redoing them to meet the exacting standards of Mercy Corps, and passed all compliance tests, whilst setting up systems that have impressed other partners like Oxfam and ACF. In 2010, we had our books audited and they measured up to the international standards which enable us to apply for direct funding from the likes of USAID. Most impressive of all is how he has managed to stretch the limited income this year, prioritizing expenditure and making careful decisions that have enabled us to stay in business through the sale of training materials and consultancy work. At the same time he was able to complete his Masters degree in Accounts! Thank you Innocent and congratulations!

MASVINGO BOREHOLE REHABILITATION

Andrew Muringaniza, Programme Manager

Thanks to OXFAM, which based on our past performance gave ZimAHEAD the chance to demonstrate its ability to implement hardware projects in addition to our usual software role.

In total 82 Water User Committee members and 15 Village Pump Mechanics were trained and in total, 15 boreholes were rehabilitated.

An extra 7 boreholes above the target of 8 boreholes were rehabilitated. This was achieved by making it mandatory for each VPM to successfully rehabilitate a borehole in order to qualify for a certificate!

There were 121 CHC with 5,400 CHC members. The size of CHC was smaller than our customary target of 100 per club due to partner’s proposal which limited CHCs to an average of 45 members, which was well below demand.

The project also pioneered the involvement of local business community in providing soap to identified beneficiaries using a voucher system. The shops were paid upon completion of distributing 10,000 bars of soap. Health knowledge and good hygiene practice increased from a baseline of 40% to 80%, exceeding the project target of 75%.

TOUR OF PROGRAMMES:

Kate Brogan (2011 Intern)

On completion of my Masters Degree in Water and Sanitation, from Cranfield University, ZimAHEAD (the Zimbabwean arm of Africa AHEAD) kindly agreed to accept me as an intern to enable me to see first-hand how this approach is achieving sustainable development through the creation of a Health Community Club, the vehicle for change. Travelling with Acting Director, Mr Regis Matimati, to do a follow-up visit on some of the projects, I was able to see how the Community Health Clubs are faring.

Our first stop was the town of Masvingo where a project had been carried out from July to November 2010 in an area called Garikai. This is a high density area that was formed after ‘Operation Murambatsvina’ to rehouse some of the displaced people that were affected. Houses consist of two rooms and have no water or sanitation facilities. As many as two families can reside in one dwelling, as the number of houses built is not nearly enough for all those made homeless.

While driving through Garikai I am struck by how clean it is. Gardens are found surrounding every home, with tippy taps suspended on structures outside each. No litter is to be seen anywhere and rubbish pits have been dug to burn any rubbish that does need disposing of. As our car drives along the narrow dirt road through Garikai we are greeted with broad smiles and ladies coming up to the vehicle to greet Mr Matimati. They vigorously shake his hand and proudly tell him how clean their house it. They say that their life has now been transformed as they now know how to keep their house and area clean and free from illness.

The close proximity of houses and fact that these people are only renting their homes means that the building of latrines is not a simple matter for them; however they are proud to advise that now they practice ‘Cat Sanitation’ ensuring a clean environment is maintained. To see such respect and appreciation for the education provided here was very moving, and showed that behavioural changes can be achieved in a short amount of time and in difficult circumstances if the approach taken is participatory.

The following day we travelled to the rural areas of Masvingo to visit a project that is still running where we heard testimonies from members about how their life had changed as a result of the club. The support within the group for all its members is obvious, and through this support the people appear to feel encouraged to continue their home improvements.

One lady stood up and told us how she would carry out all her daily duties and never once wash her hands. Then she would prepare the meals and serve them to her family with dirty hands. Now she knows this is not good, and washes her hands regularly and cleans her house daily. Another lady then stood to verify that the testimony was true. She said she had known this lady for years and that she used to be very dirty, to which they all laughed in agreement. They applauded the changes she has made her family is proud of their home -positive peer pressure!

When leaving we were begged by some members to visit their homes. Kitchens have been beautified with shelving moulded into the clay walls and a clay fuel efficient stove are the fashion contributing to the greening of the area, as less firewood is used and valuable time is saved.

Our next visit was to a School Health Club in ward 27 of Masvingo Rural. The headmistress guided us around the school grounds were a tippy tap was to be found outside each classroom as well as outside the latrines. She advised that now the books are lasting longer as the children are keeping them clean and that it is the responsibility of the teacher and pupils within each class to ensure soap and water are kept at the tippy tap station at all times. The grounds of the school were immaculate and even the teachers homes which are found on the school grounds must now be maintained to a high standard of cleanliness.

The children all gathered under trees in the school grounds and proceeded to sing songs and recite poems they had written in thanks for Zim AHEAD’s project.

The school mistress said that the borehole that had been rehabilitated on the school grounds will never break again, as she now has the skills to repair it herself. She feels she is now as good as any village pump mechanic!

Key Staff 2011

Tribute to Josephine Mutandiro, Trustee of Zimbabwe AHEAD

africaahead — Thu, 29 Dec 2011 09:28:51 +0000

“Development is a Process, step by…step”

It is with great sadness that we mark the passing away of Josephine Mutandiro, who devoted her life to alleviating the suffering of others, and was a truly committed development practitioner in a class of her own. She came to Zimbabwe AHEAD Organisation when it was newly formed in 1999 and brought with it a wealth of experience from her long years with Save the Children Fund. She has contributed her wisdom to our ethos, and her words have become our mantra.

We will always remember her with joy as she would take the stage at a workshop, timing her entrance to proclaim her motto, ’Development is a Process’ and how everyone was spell bound by her rhetoric. It was heart-warming how she preached her message to the Community Health Clubs, and would dance before the multitudes inspiring them to progress, ‘step by step’. It is impossible to count the number of people she helped, not only in her work, but privately, counselling and assisting where ever she could.

Josephine taught herself how to grow and use herbs from books, and was one of the first to scale up the use of herbs for treatment in the rural areas. When she was District Coordinator in Rusape, the office hosted a constant stream of people coming for herbal treatment or counselling. Every morning at dawn she was in her garden, tending her plants which have been spread to gardens all over the country, from Bindura to Chiredzi. At the height of her work in 2006, when all else was falling apart, she had a network of Ward Coordinators in Makoni running a project with over 4,000 individual gardens, 1,000 communal gardens and an estimated 5,000 bee-keepers. So much income was generated and so much hope was raised by these projects!

All these people knew and loved Josephine and will be affected by her passing, and we at Zim AHEAD want to be sure her memory survives and her work continues to expand. It is sad that she leaves us just as the programme she loved, is scaling up throughout Zimbabwe, and as a Trustee in her retirement, she was to have witnessed the fruits of her labour and help guide the organisation onwards. Her life will be our guide.

Josephine’s family must be proud to have such a wonderful mother, and we thank you for lending her to us for such a long time. We will find a way to honour her memory.

CHCs take off in Rwanda

africaahead — Tue, 20 Dec 2011 21:13:32 +0000

October, 2011

The training of Training in Rwanda for the scaling up of the CHC Approach was completed in November 2010, and since then the process has been rolling out across the country in an unprecedented fashion. Supported personally by a presidential directive from President Paul Kagame, the Environmental Health Department is jumping around establishing CHCs in all districts.

By July 2011, detailed data was kindly made available to Africa AHEAD from EHD, which showed that an astonishing 79% of the 15,000 villages in Rwanda have already registered a CHC and that the monitoring structure is being put in place throughout the country. All Districts (100%) have the umbrella hygiene committee in place, and the structure reaches down the country at each level: 86% of the Sectors have committees, 74% of the cells, and 79% of villages have already elected their hygiene committee at village level. In addition 65% of schools also have hygiene committees, and 82% of hospitals are also ready to start CHCs.

This is a phenomenal amount of activity and is essential to lay the foundation for the CHC training to be rolled out throughout the country in the next year. Whilst many believe that scaling up at this rate will prove impossible the initial response by villagers and all levels of government bodes well for the future.

Africa AHEAD is currently sourcing funding to enable detailed monitoring of this process to be done so as to capture the changes in behaviour that is expected to be achieved. Not only is Rwanda going to be one of the few sub Saharan countries to meet the MDGs, but will also meet it’s own standards that all these latrines will be hygienic and properly used.

GATES Foundation team visit Rwanda

africaahead — Tue, 20 Dec 2011 14:19:32 +0000

The Bill & Melinda Gates Foundation have been quick to recognise the importance of monitoring and evaluating the scaling up of the CHC Approach in Rwanda, through the Presidential Initiative which has directed everyone of the 15,000 villages in the country to start CHCs, through the Community Based Environmental Health Promotion Programme (CBEHPP). The latest figures show that already over 12,000 CHCs have been registered, and 18% have started the training of the community.

When this programme was highlighted at a recent presentation given by the Directors of Africa AHEAD in Seattle at the Gates Foundation Campus, in October, 2011, there was an immediate response. Headed by Jeff Raikes, the man who invented Microsoft Office, the culture of innovation is strong at the Foundation. No messing around like so many of the complacent old Agencies have done for years in the face of the CHC opportunity. At Gates there is a genuine committment to find responses that work at scale. This was shown by a high powered Conference convened in November bringing together top experts to discuss ‘Impact at Scale’, idenfiying the use of Community Health Workers as a key strategy. Thanks to this participation Africa AHEAD was able to show case the CHC approach which enables Community Health workers to be so effective spreading their influence through the structure of a CHC. Within two months they had identified a highly experienced team to visit Rwanda and see for themselves if it the CHC approach is as good as it claims!

Between 11th – 16th November, 2011, the Environmental Health Department of the Ministry of Health made them welcome and a meeting of all stakeholders was convened in Kigali. A field visit to Rulindo District, appears to have convinced the Gates Team this is no scam… CHCs are indeed mushrooming across the country, and officials everywhere are responding to the challenge to scale up within the year.

Having verified the CHCs in the field to their satisfaction they are now planning how to evaluate the programme over the next four years, providing for the first time an objective research into the cost-effectiveness of the CHC approach at scale.

Africa AHEAD, will be back stopping the Ministry of Health, building capacity for the monitoring and quality control for the programme, and hope to be able to demonstrate how to optimise the methodologly and pave the way for a successfull process of scaling up throughout Rwanda.

There are already NGO partners identified for almost all the districts, with World Vision taking 12 districts, Unicef and WaterAid both doing 2 districts, and Unicef already implementing in 4 districts, with numerous smaller NGOs taking part at sector level. There is still much work to be done to coordinate this programme and ensure the CHC approach looses nothing by replication. It is important that CBEHPP is properly monitored and documented, but we are confident that with the expectation of the spot light that can be shone on the project by the Gates Foundation, it will progress. Rwanda, a tiny country in the heart of Africa is going to shine, when the MDG tally is made in 2015.