Association for Applied Health Education And Development » Diarrhoeal Diseases

Comparing CHC to CLTS

africaahead — Wed, 28 Dec 2011 15:17:10 +0000

The debate about the pros and cons of different strategies that are being used to mobilise communities and induce them to change their behaviour rolls on and this well reserached paper can add some factual information to the discussion. It summarises the outputs of latrine construction in three different projects areas in Zimbabwe. The CHC programme is our own project in Chiredzi run by Zimbabwe AHEAD which is compared to a CLTS programme run by PLAN International. They are then compared to an area where both strategies of CHC and CLTS have been used.

” CHCs were significantly more effective than CLTS in two key respects. Firstly, more people disposed of their faeces by some method other than OD (92% versus 77%), and secondly, the number of people who owned a HWF was far greater in the case of CHCs (64% versus 10%, p,0.0001). In terms of sanitation, only 26% of CHC respondents owned a latrine, although all of them had been built since the intervention started. A large number therefore (66%) claimed to practise cat sanitation; 44% of CLTS respondents owned a latrine, and it is interesting to note that 57% also shared their latrine with others, as opposed to 0% in the case of CHCs.”

The authors note the following:

Firstly, the CHC sample was a much poorer group and as they points out, building a latrine is strongly related to cash flow of the household. However despite lower income, 26% of the CHC households had built latrines since the project started with no subsidy. With another 66% practicing cat sanitation, there is a 92% sanitation coverage in CHC areas, with only 8% still defecating in the open. In the richer areas where CLTS was sampled, 57% claimed to share a latrine but this as this isrreported rather than observed, it is doubltful whether this is in fact the case, they are likely to be embarrased to admit they are using the bush! Although there was a better coverage of latrines in CLTS, none of them had been build since the triggering, so surely this is the point: CHCs have resulted in action, CLTS has not.

The second point which is in this paper is that whilst CLTS has a negligable effect on handwashing with only 10% with a handwashing facility, the CHC areas show a 66% improvement in handwashing, which goes a long way in blocking the fecal-oral route. The use of a latrine on its own, does not decrease diarrhoea effectively as there are so many other routes for germs to spread.

Finally, it is worth remembering that the building and maintainence of latrine and hand washing were the only two indicators that were compared in this research. Although this is the sum of the CLTS outputs, there are a wealth of other behaviour changes which have been achieved in the CHC Project. There is no mention at all about the immaculate kitchens and compounds, the management of solid waste and the cleanliness of the beneficiaries themselves because the research is narrowly focused on WATSAN issues in order to stay within the limited length and scope of a Masters Thesis.

Neither does ithe paper attempt to discuss the ethical aspects of the two approaches and there is little focus on whether the approaches are appropriate for the culture of the area.

However with more and more stories about the appaling way in which some community leaders in India have been assert their authority in order to coerce villagers into ODF, many planners are going off the quick fix that is the CLTS approach. They are beginning to look for a less contentious methods, which are in line with cultural values in Africa for equity and respect for elders. ‘Naming and Shaming’ may be acceptable in the caste-ridden culture of Asia, but in Africa to expose ones mother-in-law to shame because her turd was identified near her home is tantamount to an outright insult and could damage family relations permenantly. Perhaps this sensitivity is one of the reasons so many African countries are trying to find an alternative to CLTS, despite the hard sell by the proponents of the approach, who have been touring Africa in an agressive attempt to sell their dubious product. This is a pity as there are other more beign and more sustainable ways of achieving a demand for sanitation.

This paper provides a scientific rationale for using the more holistic CHC approach which uses positive, rather than negative peer pressure, to persuade people rather than embarass them into changing their traditional behaviour. Why have a narrow programme which goes only for sanitation with the limited CLTS approach when you can get the whole raft of public health measures achieved, and be sure to not only minimise diarrhoea but also malaria, bilharzia, skin disease, and worms all for the same cost. Its a no brainer, but it has needs research of this type to provide the proof. So here it is!

Give this a read: link http://africaahead.org/publications/2011_Whaley_CHC.pdf

12,000 CHCs formed in Rwanda

africaahead — Thu, 06 Oct 2011 16:20:15 +0000

The Training of Trainers by Africa AHEAD for the Communited BasedEnvironmental health PromotionProgramme in Rwanda for the scaling up of the CHC Approach to national level was completed in November 2010. Since then the process has been rolling out across the country in an unprecedented fashion. Encouraged by a Presidential directive from President Paul Kagame, the Environmental Health Department is jumping around establishing CHCs in all districts, and the communities are responding with alacrity.

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.

Towards EDPRS ideals: Water access, hygiene and sanitation in Rwanda give new hopes and opportunities

africaahead — Mon, 05 Sep 2011 08:37:40 +0000

SUNDAY TIMES, KIGALI.

Friday September 2, 2011 by Thomas Kagera

Rwanda has committed itself to reaching very ambitious targets in water supply and sanitation, with the vision to attain 100 per cent service coverage by 2020. The importance of adequate water supply and sanitation services as drivers for social and economic development, poverty reduction and public health is fully acknowledged in Rwanda’s flagship policy documents and political goals. But by the look of things and according to the Permanent Secretary Ministry of Infrastructure, Marie Claire Mukasine, the sanitation coverage as a sub-component is likely to be 100 per cent by 2012.

“Even though our country is among the four sub-Saharan African countries that will meet the MDG on sanitation, we have our own targets and goals. We are planning 100 percent improved sanitation coverage countrywide by 2012,” the Permanent Secretary is quoted as having noted in one of the preparatory meeting for the AfricanSan3 that was recently concluded. The other countries are Angola, Botswana, and South Africa.

Access to improved sources of drinking water has reached about 74 per cent (rural: 71 percent, urban: 88 percent), according to the national inventory. Sanitation levels have evolved to write numbers from 38 per cent to 56 per cent. Coverage is currently rising at a rate which is close to the value needed to stay on track towards the flagship targets (EDPRS, MDGs, Vision 2020). However, to meet the targets it will have to continue to rise for another 4 percentage points every year. Given that population growth partly compromises the efforts to raise coverage this is equivalent to supplying on average 460,000 additional people every year (until 2012). Total latrine (or toilet) coverage in Rwanda is 96 percent.

Today, 32 per cent of Rwandans use piped water, but only 3.4 per cent have access to it within their house or plot (urban: 17 per cent, rural: 0.9 per cent). On average, households – women and children spend 29 minutes per day on fetching water in rural areas (9 minutes in urban areas).
By 2012, it is planned to increase the proportion of the rural population living within 500m of an improved water source from 64 per cent to 85 per cent, and to raise the proportion of the urban population residing within 200m of an improved water source from 69 per cent to 100 per cent.

Special efforts have been made to provide water services in grouped settlements in rural areas; Imidugudu and small towns or trading centres. The Electricity, Water and Sanitation Authority (EWSA), as a major partner in the cleaning and distribution of water, has engaged the services of cooperative movements in the supply of water. Of the 800 water supplying systems in the country, 30 per cent of these are operated and managed by Small and Medium Enterprises that have formed cooperatives.

Open defecation has practically been eradicated and most of Rwandan households have already financed and built their on-site private sanitation premises, and are now being encouraged to match them with the international standard definitions of an improved sanitation facility.
The excreta are disposed with waterless latrines, which is a rational solution considering the scarcity of the average water supply.

Major hotels, hospitals and some industries have installed their own (pre-) treatment systems. A conventional sewerage and treatment system for Kigali’s centre is in the planning process.

Rwanda’s schools benefit from the HAMS (Hygiène et Assainissement en Milieu Scolaire (School Sanitation) program since 2000, which focuses on behaviour change in hygiene practice including considerations for menstrual hygiene. The Community Based Environment Health Promotion Programme (CBEHPP) is particularly focusing on the communities to impart the values of and create the demand for behavioural changes.

In managing solid waste, the major towns are undertaking considerable efforts to maintain the urban environment clean. Plastic bags are forbidden within the bounds of the country. Sector harmonization is making significant progress and has prepared the ground for a Sector-Wide Approach (SWAp).

There is a very strong government commitment for sanitation exemplified by a sanitation community service day, at the last Saturday of every month. Well elaborated environmental health policy is also in policy and the Ministry of Health takes the lead in household sanitation and hygiene promotion, of course with a strong collaboration with the Ministry of Local Government.

Strategies

Private investments in Water and sanitation infrastructure have been encouraged and supported. The Ministry of Infrastructure is considering options to leverage private capital investments by providing low-interest loans, through output-based aid (OBA) or co-financing. Community management has continued to be the most common approach to ensure the organization and management of point water sources, such as protected springs and boreholes equipped with hand pumps. Communities and User Committees are supported and supervised by the Districts, with technical assistance from the Ministry of Infrastructure.

The concerned sector institutions – the Agency, RURA and the Ministry of Health – will cooperate to develop and implement a system for rural water quality control. This involves the clarification of responsibilities, the definition of standards, the development of viable operational procedures and the creation of decentralized laboratory capacities. The costs of urban water services are fully covered by user fees, in order to redirect public funds to extending service coverage (or, if need be, to rural areas where financial viability is more difficult to achieve).

Investments are funded by a mix of public grants, loans and internal cash generation as per a financial model. While external aid accounts for a large share in the short and medium term the EWSA will endeavor to access loans and increase the share of investment financed by internal cash generation.

A firm, permanent framework of cooperation has been established to coordinate the interventions of the different government institutions involved in sanitation and health promotion – essentially the Ministry of Health, the EWSA and the Districts. The Ministry of Health will continue to be the lead in the promotion of individual sanitation at the community level, essentially through its national Community Based Environmental Health Promotion Programme (CBEHPP).

The EWSA on the other hand, will be responsible for the development, evaluation and support of adequate technical sanitation solutions. Sanitation and hygiene components shall also be incorporated in each water supply project. The Water and Sanitation Fund (WSF) will be one of the sources of funding of the joint programme.

Ownership and behaviour change are critical steps for sustainably increasing sanitation coverage and improving hygiene practices. Government institutions therefore focus on promotion and facilitation, while households remain the main investor. Well designed sanitation programs have shown leverage ratios of up to 1:10 between public and private investments.

The demand for improved sanitation shall be promoted through a combination of; awareness campaigns related to visible and non-visible health impacts of poor sanitation and aiming at behaviour change, marketing the sanitation offer, targeting on people’s expectations and preferences such as comfort, status, health benefits, value or safety and education and training in schools and universities;

Other measures include the provision of limited material incentives or subsidies to accelerate the improvement, construction or replacement of sanitary facilities and using the provision of water supply services as an incentive and opportunity to improve sanitation facilities.

Rwanda homegrown initiatives that augment sanitation and hygiene

The government of the Republic of Rwanda has crafted a number of initiatives to extricate Rwandans from the depredations that emanate from poor hygiene and sanitation. Most of the interventions hinge on changing people’s mindset, but there are others in which considerable sums of money have been sunk.

The government’s resolve to eliminate grass-thatched houses (Nyakatsi) in the country is one such initiative of improving the living domestic environments. The plan has succeeded in getting people out of scattered grass thatched houses to decent houses in planned villages (Umudugudu). The government has taken advantage of local initiatives like community work, Army and Police week, Youth and Women week to engage in activities aimed at helping the vulnerable get decent housing.

The establishment of grouped settlements (Imidugudu) makes it easy and less costly to connect such areas to the national electricity and water grids, as the cost per individual connection substantially goes down. The use of clean renewable energy, is not only hygienically rewarding, but is as well environmentally friendly and sustainable. Through community work (Umuganda) that takes place every month, the general cleaning, tree planting and other activities all ensure a clean, green, inhabitable and hygienic environment.

The Step and Wash (Kandagira Ukarabe—being implemented by the Community Based Environment Health Promotion Programme under the Ministry of Health), is a campaign that has widely been commissioned across the country and embraced by Rwandans.

The use of local materials such as silt and cow-dung for the final coating and finishing of rural homesteads for those that cannot afford cement, has also improved the state of sanitation and hygiene among the populace.
Currently, the government is working with AFRITANK, to provide mobile toilets, as well as toilet slabs, all in effort to provide clean hygiene and sanitation facilities and services.
The government also mobilizes through radio and TV drama programmes such as Urunana, booklets and posters. Besides, after the community work that takes place at the last Saturday of every month, people are advised on the best hygiene and sanitation practices.

The Ministry of Health has trained Community Health Workers that number to over 45,000—three per village—who participate in peer education and collection and dissemination of health-related data. A lot of useful information on sanitation and hygiene is also compiled by the Community Health Workers and Environmental Health officers who remit it the Ministry of Health, which is then routed to respective ministries concerned for action.

The government of Rwanda through the Community Based Environment Health Promotion Programme, under the Ministry of Health, has encouraged the establishment of Community Hygiene Clubs (CHCs). A Community Hygiene Club (CHC) is a discussion group of peers from the same locality, who meet, identify their sanitation, hygienic and health problems or needs, and, through dialogue and using stimulant tools, get engaged in identifying solutions—together.

The CHC approach appeals to an inate need for health knowledge which is then reinforced by peer pressure to conform to communally accepted standards of hygiene, thereby creating a ‘culture of health.’ Members can, for example, decide that after two months, all members shall have built a drying rack, or a standard latrine or a bathing shelter. The ideas and concepts originate from the members and implemented by them. The government however, always comes out to give technical support and guidance.

Discipline and mindset change are some of the tenets that the government has fervently emphasized to ensure clean hygiene and sanitation. The government emphasizes upholding the dignity of every Rwandan, and sanitation and hygiene are some of the components that the leadership of President Paul Kagame has relentlessly put to the fore and, actually, helped implement.

CHCs take off in Vietnam

africaahead — Tue, 19 Apr 2011 14:35:44 +0000

April, 2011

Vietnam is the first country in Asia to pioneer the Community Health Club (CHC) Model of development to bring about hygiene behaviour change and improve sanitation coverage, adapting it to suit local cultures. If sucessful, Vietnam could lead the way as a powerful change agent for sound development in Asia ensuring that CHCs are as cost-effective as they have been in Africa for the past 15 years. Out of 48 CHCs established since 2009, six were assessed in the three Provinces of Son La, Phu Tho and Ha Tinh over a 10 day period. In each district a structured interview of provincial, district and commune MoH officials was conducted by the consultant to verify the CHC report for 2010. Existing MoH data from a pre and post intervention household inventory of all CHC members were used to measure knowledge and levels of behaviour change. Standard monthly reported cases in each Commune Health Centre Changes were examined to see if there was a pattern of disease reduction. The findings of this evaluation should provide lessons inform more effective replication and scaling up through the National Target Programme, now entering its 3^rd phase.

Under the Hammer and Sicle Muong Bu Community Health Club is thriving

There is clear evidence that the training in the CHCs, in 24 sessions spread out over the past two years has improved knowledge of health issues and that peer pressure within the CHCs is leading to very significent levels of behaviour change. For example there was a 42% increase in Ha Tinh and a 59% increase in Son La in good knowledge of how to make Sugar Salt Solution. Changes in hygiene behaviour are highly significant with a 58% increase in hand washing with soap in Ha Tinh . There has been a great effort at improving sanitation in the CHC areas, as demonstrated in Son La where 387 households (70% of the CHC members) improved their sanitation facilites, without any subsidy, and the household inventory showed that only 4 families out of 1,036 were found to still practice open defecation. Phu Tho Health Centres in CHC communes have recorded a sharp decrease in diarrhoeal disease since the CHCs started, by 90%, 93% and 59%. Although all communes in Thach Ha district (Ha Tinh Province) were targeted with the same IEC materials, diarrhoeal disease cases decreased by 35% in two CHC Communes but actually increased 18% and 31% in two non-CHC Communes. The CHC programme can be measured for cost per beneficiary at only US$1.30 for one year. This is remarkably cost–effective by any standards and compares well with similar projects in Africa. As one MoH official from Ha Tinh remarked the CHC Model is ‘low cost- high impact’.

Achievements in all three provinces were made despite the fact that the CHCs were started without using membership cards, an incentive which has always been a draw card for joining CHC. With the training material complete, there is little doubt that the CHC Model will be replicated easily, scaling-up by using recommendations and lessons learnt. The Pilot Project has demonstrated that the CHC model can improve sanitation coverage and with very little subsidy, significantly reduced diarrhoea within two years, simply by harnessing the power of peer pressure to ensure safe hygiene standards. Within an emphasis on group consensus, the CHC Model resonates with cultural norms in Vietnam, whilst the training enables Village Health Workers to run CHCs at very little extra cost within their duties. This pilot project should provide the NTP3 with a sound methodology that can be predicted to achieve the Millennium Development Goals in CHC districts.

Letter from the field

africaahead — Tue, 15 Mar 2011 15:58:52 +0000

Andrew Muringaniza, Programme Manager

Regis Matimati, Director of Programmes

14^th March, 2011

By Regis Matimati

Masvingo

‘The events lined up for us were pregnant with palpable emotion as communities felt they had been given their lives back by the provision of water.’

Once again we saw how our officers are doing wonders with CHCs. We got complimented by the community, schools and DWSSC for the borehole rehabilitation. Some of the boreholes had been down for the past 10 years and then came Andrew and the Zim AHEAD team.

One School Headmistress impressed me when she told the gathering that she was trained by our team to repair the school borehole and would repair it in future breakdowns as she was now as good as a VPM. Talk of community capacity building!

Chipinge District

We then proceeded to Checheche where cholera is wreaking havoc at ARDA estate. I am proud to tell you that our Community Based Facilitators are holding their own with the CHCs. They quickly mobilised the community back into active sessions upon realization that cholera was close by. Massive CHC sessions were held on the water and sanitation related topics. The Nurse in Charge as well as the Ward Health Team Chairman for Vheneka Clinic were full of praise of how the CHCs have reorganized to prevent cholera. The clinic needs repairs to a storm damaged roof.

You will remember ARDA estate (now Macdom Investiments) lies in the middle of our project catchment area but we did not have CHCs in there. The estate has a new investor who buses in workforce from as far afield as Buhera. They use raw water from the Save river and water quality tests by the MoHCW revealed no residual chlorine at all in the water at point of use. The outbreak started with 2 people being affected 3 weeks ago and cumulatively the estate clinic has treated 54 cases and nearby St Peters reportedly treating over 50 cases. ACF and MoHCW had distributed NFIs, aquatabs, soap and water treatment. However when we got there they had 5 cases on active treatment with one case

having arrived at the clinic that morning meaning to say the out-break is not over even though ACF and MoHCW staff had withdrawn from the estate. While we were still at the clinic a team from Masvingo province arrived at the clinic as Masvingo is worried after having seen about 30 cases at their 4 clinics across the Save River all being linked with the Macdom Estate. They were hoping to meet with the MoHCW crew from Manicaland and were visibly disappointed not to see their counterparts in the area even though there where still some active cases of cholera. The Masvingo MoH left and we hope they will be able to collaborate efforts with Manicaland MoH to stop the outbreak.

Mutare Town and Sakubva Township

We then left for Mutare where I talked to the Director of Health Services. He was full of praise for the work we started 2008/09 as he says they have managed to get 2 refuse trucks but still up to now there was not much litter to collect from Sakubva as residents were sorting their litter by themselves with much of it now being used as compost and very little finding its way to the refuse bin. He is so proud of how he has become a very highly respectable official since our time together where he would go with us to meet the residence/ CHC members and address them. A very constructive working relationship between Council and the residence was forged there and to date Mutare is regarded as a shining example of how residents work in harmony with the Council. He said he owes all that to ZimAHEAD for providing such a forum (CHCs) for dialogue.

We toured Sakubva and it is hard to believe that this is a high density suburb as it is so clean. All the usual overflowing of old sewers is now history. The residents have held on to their taught behaviour around waste management.

Next we visited Sakubva Hospital where the Clinic Manager said the disease prevalence was very different from the patterns of the period before our project. He said KAP had changed remarkably with cases of WSRD(water and sanitation related disease) coming mainly from the provincial marketplace where people come from other districts to trade their wares and at times seek treatment from the hospital. He was quite upbeat about how the residents of Sakubva had managed to stay healthy since our project there in 2009.

We then visited the Community Nurse and she said good health and hygiene had generally been maintained. She hoped the volunteers would get support as they were behind the achievements and maintenance of health and hygiene in the location. She also appealed for support for the Girl Child Project they were running at the centre where they enroll OVC (girls only) and they gave a year long-life skills training. Their challenge was with tutor remuneration, lunches and a graduation package like sewing materials and machines for the girls. They take in 22 girls annually.

We finally met up with the CBFs who could not hide their joy at seeing us. They said they were continuing with CHC but more on internal saving and lending schemes, Community Home Based Care, Vulnerable Group Feeding with other NGOs (ASAP, Mercy Corps and Plan International) among other things.

VILLAGE NETWORK AFRICA

africaahead — Fri, 14 Jan 2011 15:17:57 +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.

The Pride of the Poor: Garikai, Masvingo

africaahead — Sun, 21 Nov 2010 12:15:10 +0000

turning a dust bowl into a place of pride: recyled coke tins are used to border the veg gardens in Garikai

Five years ago during the infamous Marimbatsvina Campaign, that eradicated most informal settlement in Zimbabwe, many shack dwellers of Masvingo Town found themselves homeless. Some of those displaced were finally given ‘core houses’, small two room boxes, on a patch of dry bushland on the outskirts of Masvingo, which although undoubtably better than their shacks, were without any sanitation or solid waste collection. There was limited water with only a few communal taps for the 100 households that were resettled. Garikai became synonymous with the poorest of the poor in Masvingo, a place where no one was proud to belong. The residents of Garikai felt ostracised by the rest of Masvingo town, as their place was considered a filthy dumping ground. Litter was everywhere, and everybody agreed that if cholera was to start again, Garikai was the place where it would begin.

‘Canaan our facilitator, is, how can I say … he is like God, because when he came there was only death, and now there is life! We people in Garikai now know how to survive! Those people in town they now respect us and our place is not looked down on as a dump anymore.’

Smoldering in the October heat, we were borne along on a wave of singing women and conducted round the dusty little settlement. We were infected by their own enthusiam and sense of worth and the way they had coordinated to clean up their place. Not a single scrap of litter was to be seen, each house had a tippy tap for hand washing and, unlike many informal settlements where even soap cannot be left out for fear of theft, every tippy tap had soap and water.

Tippy Taps are all over Garikai, the way handwashing is being done in the CHC areas

They told us that 28 households had already built latrines and they were continuing to save so the rest of the settlement would have safe sanitation, but meanwhile they were practising ‘cat sanitation’ and burying their excrement. ‘You wont find a fly in Garikai’, they told us. Each home had a vegetable garden, and some had decorated each vegetable bed with used used cans. As there were not enough cans to complete the design, one person had even collected used cans discarded in town and carted thousands home to decorate her yard. The effect of the cans and the carefully swept yards was almost like a Zed Buddhist garden, and the care lavished on this barren land was touching. All the women had joy in their hearts, were united in achievement and were delighted with the environment they had created.

We had come in the wake of a recent visitation to Garikai from the two of the most influential WASH officials in the country, the Head of the National Coordination Unit (NCU), Mr Bernard Mashingaidze, and the Head of Environmental Health Training in Zimbabwe Mr Naboth Mawoyo. They had returned from the field visit raving about the achievements of the Community Health Clubs. After years of trying to influence the top officials to adopt the CHC Approach throughout Zimbabwe, this first hand experience of Garikai may at last be the advocacy trigger for the institutioal scaling up the CHC Approach in Zimbabwe. They told Zim AHEAD that they would like the CHC methodology to be integrated into the exisiting training for Environmental Health Techicians throught the country.

President calls for CHC throughout Rwanda

africaahead — Tue, 19 Oct 2010 14:58:40 +0000

RWANDA IS THE FIRST COUNTRY WORLD WIDE TO MAKE CHCS A NATIONAL INSTITUTION.

His Excellency the President of Rwanda, Paul Kagame, launched the Hygiene and Sanitation Presidential Initiative (HSPI) in July 2010 and this has dramatically raised the profile of the Community-Based Environmental Health Promotion Programme (CBEHPP) that was officially launched on 17 December last year by the Minister of Health. CBEHPP was developed by the Environmental Health Desk of the Ministry of Health (with support from WSP) in order to achieve sustainable and progressive hygiene behaviour change and improved sanitation. This is all spelled out in the CBEHPP Roadmap (see article).

As per this Roadmap, actual implementation is now taking off in the five selected start-up districts. By mid 2011 the programme will rapidly expand in order to cover all thirty districts. However, because of the HSPI, all 30 district administrations, under the direct supervision of the District Mayors, are even now actively mobilising and laying the ground-work for the full implementation of CBEHPP in coming months.

The challenge is immense as CBEHPP requires the establishment of active Community Hygiene Clubs (CHCs) in all 15,000 villages across the country.

Anthony Waterkeyn, WSP consultant, World Bank

October, 2010

Masvingo is the latest town to be cleaned up by CHCs

africaahead — Tue, 19 Oct 2010 14:37:23 +0000

ERF-UNOCHA through Oxfam, is providing community capacity building in cholera mitigation. Based on the success in Mutare and Chiredzi, ZimAHEAD has been contracted to provide yet another Community Health Club programme in high density urban areas of Masvingo Town. All the 10 wards under the Masvingo City Council Authority are being covered by 9 Community Based Facilitators (CBFs) and 10 School Based Facilitators (SBFs). Community participation has been infectious with targets being surpassed and clubs being over subscribed so much that the CBFs are forming new clubs owing to community demand. With the resultant improved understanding of disease causality, communities will be better able to prevent outbreaks and will manage any disasters that may visit upon them.

Clean Up campaigns

There are now ten new health clubs in Masvingo Town, with 930 members. The CHCs have embarked on massive clean up campaigns that have removed tonnes of waste from illegal dump sites as well as cleaning out storm water drains. These activities are being done following a PHHE session on community mapping as communities felt compelled into action to clean their surroundings upon realisation that dirty environments were potentially hazardous to their health. Councillors are also participating in the exercise. Some of them are reportedly buying refreshments for clean up participants.

The PHHE sessions are moving smoothly with the pace towards the time frame of the project. Meanwhile we are on the eighth session with high participation by club members of different age groups and phenomenal behaviour change is taking place daily.

To quote an elderly woman

“…… we used to have a clean city but lately things had deteriorated. This organisation of community effort will leave the city very clean. This is what we want for our city to be rid of diseases…….”

New health clubs are being registered as demand is increasing especially in wards 1, 2, 3 and 6.

Evidence of positive behaviour change noted in the wards is by the increasing number of health club activity attendance, mushrooming of tippy tapes, several clean up campaigns, high knowledge on WSRD and a demonstrated increase in hygiene consciousness by club members.

In Garikai an area, an area that is situated northeast of ward 3 behaviour changes is more marked as shown by adoption of the recommended hygiene practises such as constructing pot racks, digging and using refuse pits, hand wash facilities (tip taps).

The community is exited about the club activities and are happy to see the changes that are coming in their community through health clubs as this community says they were previously looked down upon by their counterparts from the old location as theirs was a fast trekked settlement in response to the government’s Operation Restore Order (Murambatsvina) that saw massive destruction of all informal houses in Zimbabwe and thus their location has inadequate water and zero sewer system and no electricity. Now they see themselves moving up on the sanitation ladder and water ladder.

Health promotion through Community Health Clubs and School Health Clubs has once again encouraged community ownership, community control and has increased community responsibility over health and developmental issues.

Report by Regis Matimati, Programme Manager, Zim AHEAD,

September 2010

Johanna Road Pilot Project Graduation

africaahead — Tue, 10 Aug 2010 09:56:51 +0000

Africa AHEAD is excited to report that 31 members of Impiloyethu Community Health Club graduated 10 April 2010. In recognition of their efforts, a morning ceremony was held at the Education Centre at the Northern Treatment Works in Durban.

Impiloyethu members sing about the importance of health and hygiene

The events began with a public viewing of the CHC’s agri-tubes, tyre-step project and communal improvements attributed to the CHC at Johanna Road/Boxwood Place. After which, the attendees gathered at the Education Centre for a Welcome Address by eThekwini Water Services Education Trainer Lucky Sibiya, who has been part and parcel of the project. Master of Ceremonies, Africa AHEAD project officer Ndyebo Mgangqizana then introduced Impiloyethu who treated guests to song and dance, centered around the importance of health and hygiene.

An EWS senior official delivered the keynote address of the morning. He stressed the importance of health and sanitation in our communities, noting the important improvements that Impiloyethu has been the driving force of at Johanna Road. He encouraged them to continue on their mission of making their community a better place for all of its residents.

A mother takes her baby suffering from diarrhea and dehydration to the clinic in Impiloyethu's drama

Africa AHEAD Project Manager Nancy Maksimoski followed with a powerpoint presentation which visually highlighted the changes that have occurred at Johanna Road since the formation of the CHC on both a household and communal level.

The highlight of the afternoon was most certainly Impiloyethu’s educational drama involving the importance of hygiene and proper treatment of diarrhea in children, which they wrote themselves. Impiloyethu hopes to show other communities and groups their drama to raise awareness about these issues.

The ceremony concluded with a presentation of certificates to all graduates and closing remarks from Africa AHEAD Dr. Juliet Waterkeyn.

CHC member Mpanza receives his certificate from Lucky Sibiya, while Africa AHEAD facilitator Ndyebo Mgangqizana looks on

Africa AHEAD and EWS are both very proud of the work done by Impiloyethu in the past few months and look forward to their upcoming projects at Johanna Road.

“Community means strength that joins our strength to do the work that needs to be done. Arms to hold us when we falter. A circle of healing. A circle of friends.” -Starhawk, Human Rights & Eco-Activist