Association for Applied Health Education And Development » Hygiene Behaviour & Practices

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

World Vision do Hygiene Clubs in Rwanda

africaahead — Mon, 07 Nov 2011 08:30:05 +0000

World Vision has joined the Commnity Based Environmental Health Promotion Programme and posted this presentation at the 2011 WASH Conference in Australia

http://www.slideshare.net/WaterCentre/wash-2011-community-based-environmental-health-promotion-programme

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.

AMCOW AWARD FOR AFRICA AHEAD

africaahead — Fri, 04 Mar 2011 10:55:49 +0000

Distinguished Woman Leader in Sanitation

The AMCOW AfricaSan Awards are dedicated to recognizing outstanding efforts and achievements in sanitation and hygiene in Africa which result in large-scale, sustainable behavior changes and tangible impacts. They aim at raising the profile of sanitation and hygiene by drawing attention to successful approaches, promoting excellence in leadership, innovation and sanitation and hygiene improvements in Africa, and providing incentives for action.

The awards initiative is organized by the African Ministers’ Council on Water (AMCOW), in collaboration with the Water Supply and Sanitation Collaborative Council, the Water and Sanitation Program (WSP), the African Development Bank (AfDB), UNICEF, the UN Secretary General Advisory Board on Water and Sanitation (UNSGAB), UN Water Africa, WaterAid and the Africa Civil Society Network on Water and Sanitation (ANEW), among other partners that comprise the AMCOW Sanitation Task Force.

Dr. Juliet Waterkeyn as pioneer of the Community Health Club Approach, was a Finalist in the Distinguished Woman Leader in Sanitation category for 2010, which honors women for their commitment and outstanding contributions to improving the state of sanitation and hygiene.The award carries an honorarium, trophy and certificate, and was presented at a special ceremony at the 3rd Africa Water Week in Addis Ababa in Ethiopia. The ceremony took place on Wednesday, 24th November 2010 at the Hilton Hotel.

WASH Response to Humanitarian Crisis in Zimbabwe

africaahead — Mon, 07 Feb 2011 10:19:52 +0000

Masvingo Community Health CLlub Project

Goal:

To reduce the vulnerability of at-risk rural populations in rural Masvingo to Water and Sanitation Related Disease (WSRD) transmission.

Objectives:

1) To increase levels of Water, Sanitation and Hygiene (WASH) knowledge, attitudes and practices through Community Health Clubs and School Health Clubs so as to decrease vulnerability to WSRD transmission.

2) To increase access to sufficient quantity and quality of water for drinking and domestic purposes through the rehabilitation of existing boreholes for communities in rural Masvingo affected by severe water shortages.

Introduction

A lot of activities were undertaken during the reporting period since the last meeting. It is our great pleasure to inform the house that there were no cholera cases in the project area. However we remain vigilant in the face of reported cholera and H1N1 cases in other parts of the district and nearby disticts with which we share boundaries. (221210 MoHCW WHO Zimbabwe Epidemiological Bulleting Number 88 Week 48).

CHC, SHC and CBM activities are running in earnest as the report will show.

Public Health Promotion

A community driven baseline inventory was conducted at 3872 households by the 33 CBFs prior to PHHE sessions with the following results:

Many of these practices have beeen recommended by other projects that have been implemented here in the last few years as shown by the high pencentage of refuse pits pot racks, covered water storage containers, individual cups. In addition it appears that many kitchens are decorated and there are many nutrition gardens. There is also a high percentage with knowledge of how to mae Sugar Salt solution. However there is still a gap where hand washing, water sources, use of ladle, sanitation coverage, and malaria prevention and control are concerned. The project will focus on these gaps and will seeks to redress the knowledge and this will be evaluated at project end.

Community Health Clubs

The project has now exceeded its project CHC target of 108 CHC as it now stands at 119 and still counting due to popular demand. Club membership stands at 5120 (360 to reach target) with sex aggregation at 1185 males (23%) and 3935 females(78%). Male participation is encouraging this part of the project as compared to other areas we have worked before. It will be interesting to find out what makes this difference.

School Health Clubs

9 SHC are running with a total club membershipof 1,115. They have just reopened after the holiday and more info will be available in the next meeting as they are settling down at the moment.

9 School headmasters participated in a day long WASH in schools capacity building workshop we conducted and this was also attended by the District Education Office.

Global Hand Washing day Commemoration

98 CHCs (then) in the 6 wards were mobilized to commemorate hand washing day. The occassions were marked by public health promotion in the form of hand washing demonstrations, dramas, poems, songs and dance. ZimAHEAD distributed IEC materials sourced from UNICEF in the form of 400 t-shirts and thousands of pamphlets and posters.The objective was to completely cut out WSRD during the festive season and this was achieved as none were reported.

Water Supply

WPUC (Water Point Upgrading Committee) trainings have started with ward 30 where 21 WPUC were established . The other wards will be trained in due course. Rehabilitation will start once the WPUCs are trained. VPM (Village Pump Mechanic) tools sets were delivered from Oxfam and ZA is chasing the variances.

NFIs

ZimAHEAD has procured the NFI (Non Food Items) vouchers and 3 suppliers have been identified as well as 1,700 beneficiaries drawn from the OVCs, the elderly, the chronically and the very poor as defined by the communities themselves. We hope to round up the process soon. What is left is the procument of soap. Close consultation with Oxfam is being maintained given the shooting prizes of soap on the market.

Notes from the Field

Regis Matimati, Director of Programmes Zim AHEAD

February 2011.

“The trip was fantastic. I drove with the Directors of Ministry of Health and Department of Infrastructure down to Chiredzi. We got to the village to a gathering of about 40 club members. I can’t start to describe the immaculate home and surroundings at the venue of the meeting. The kitchen, launch, temporary toilet, the flowers around the homestead, the infectious singing and dancing by other club members and the high KAPB. both the Directors Mr. Goldberg and Sibanda could not help but heap praise on ZA and the community for taking the CHC method up.

….

We then toured another household picked at random and there we saw a self initiated permanent toilet which was constructed following CHC participation. The club member, an elderly male was so proud of his home and ZA. His wife stays in Chiredzi town to be close to the hospital as she has a bad case of arthritis but the home looked so clean that one would think their was a maid doing the chores there but when asked the Sekuru (uncle) said “…..how can I leave in dirt when I am a club member? …… I attended the club to learn and after the lessons I can’t go back to dirt…” This bowled over both our visitors. The Sekuru’s children had even laminated Sekuru’s graduation certificate!

…

The next day we started by visiting the PMD (Provincial Medical Director) who was not in the office but we then met the PEHO Provincial Environmental Health Officer) and the Chief Hygiene Officer (CHO) and his team. The CHO, a

very charismatic man gave an update of ZA’s work in Masvingo. After that we went into the locations where we saw 3 clubs including a new one.

…

The Garikai club was a delight to see and the club leader gave a splendid over view of the project. We then toured their area.

Everyone was impressed by the urban CHCs as they thought it was impossible for urbanites to form a strong community like that.

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

Sing Song CHCs

africaahead — Mon, 09 Aug 2010 10:30:54 +0000

August 2010. J. Waterkeyn

CHCs are spreading rapidly in Africa, but the question remains, ‘Can they appeal to more sophisticated rural communities in Asia?’ How can we adapt the CHC methodology to suit this very different scenario.

Since November 2009, when Ministry of Health (MoH) in Vietnam first decided to use the CHC Approach, they have, without any external support from Africa AHEAD, simply got on with the job of establishing a pilot project in four provinces: Son La, Ha Tinh, Phu Tho, and Ninh Tuan. One of the initial barriers to starting up CHCs is always the lengthy process of developing a Toolkit and Manual, and this has been done in the past six months by Africa AHEAD, supported by Danida for Vietnam MoH. However having decided to ‘do’ CHCs, there was no sitting around in Vietnam whilst waiting for the training materials to be developed.

Participants at the ToT workshop in Phu Tho, July 2010.

Dr Bang of the MoH e4njoys the sessions on Open defecation having contributed his own drawing

When I returned in July 2010 for the ‘start up workshop’ equipped with the new manual and toolkit , we found we were lagging behind our participants, who said, ‘Yes, interesting, we know all this, we already have CHCs!’ I was surprised to find that CHCs were not only formed up, but operating, and there are about 40 CHCs in total, 10 in each Province. Two provinces had already started the health sessions without assistence and had done 12 sessions, half of the course. They had even developed a monitoring system based on the membership cards, having printed attendence books. Such is the power of an organised governmental system, where if the directive is given from above, the cadres below simply do it… no excuses, just get on with the job. From my experience in Africa where most external initiaitives, like a cow being driven to market on a long dusty road, need constant prodding by the driver, here I was runnng to keep up with the pace of the Asian buffalo, a symbol of hard work and fortitude in Vietnam mythology.

A Sing Song at the first CHC we met in Vietnam

A field trip was arranged to go to Da Du village in Phu Tho Province, three hours north of Hanoi. We drove up to the village Community House in the evening, where hundreds of scooters were parked, whilst people squeezed into the hall, waiting for our party of 10 outsiders to arrive. The hall was packed with around 60 men, women and children, as fascinated to see us as we were to see them. One after another, men and women provided the entertainment, without a shread of self consciousness singing gloriously into the microphone.

A traditional Vietnamese instrument provided fascinating wailing music

The Master of Ceremonies was a dedicated community organiser and a war vet with one arm. He introduced the community members: women bravely warbling out their strong patriotic songs full of love for Vietnam, a man who played a mean mouth organ, which must have survived from the war against the American GIs in the 70’s and a more traditional musician playing a one stringed instrument, adding a surreal Chinese tinge to our spirits which soured as each speech became more and more fired up with energy for the universal cause of Health for All by 2015.

They told us that they gather every week like this for one hour of song and the second hour of health education, and using the PA system makes it all the move enthralling. Karioke in Vietnam, like most of urban Asia is very popular, and here the rural folk were having home grown plugged in performance.

Under the sagaceous gaze of Ho Chi Minh, the saviour and hero of Vietnam, the times were a-changing, but really were they? I couldnt help feeling the CHC approach fits perfectly into a society used to celluar socialist organisation. In Africa we have largely dyfunctional rural communities as the brain drain to the towns leaves the less able and more conservative in the ‘rurals’, eeking out a basic subsistence whilst living largely on remittances from their folk in town.

Here in Vietnam, one of the last communist countries, the north still operates from the top down and the people are organised by the party, and unlike Africa they are not disorganised communities in the rural areas.

The rural areas of Vietnam are highly regulated, with ‘mass organisations’ like the Womens Union, that plays a key role in development in Vietnam. The people have survived years of war and poverty and in their desperation are highly motivated to progress. It appears they only need a good reason to get together with an agenda to improve and they will achieve.

Community Health Clubs resonate with their needs. Unlike the Womens Union which are purely for women, CHCs provide a forum for men and women to get together and solve some of their health issues together.

Our Vietnamese counterparts said that they had been ‘nerveous’ as to whether the CHC would work, but having seen this CHC in the flesh, they were now ‘confident of success’ of the Methodology. I felt just the same, with a new generation primed for take off.

A child identifies key messages on the visual aids developed for the programme

The Johanna Road Project: 6-Month Report

africaahead — Mon, 08 Mar 2010 09:17:16 +0000

March 2010

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

Research

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

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

CHC Activities

Demonstration grey water agri-tube garden at Johanna Road

Gardening

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

Projects

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

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

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

Graduation

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

Next Steps

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

Vietnam :the first CHC Country in Asia

africaahead — Wed, 20 Jan 2010 12:47:19 +0000

COMMUNITY HEALTH CLUBS TO BE STARTED IN VIETNAM

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

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

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

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

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