Association for Applied Health Education And Development » Hygiene Promotion

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

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.

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

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.

The Metro Health Club: Grassroots Action for Improved Community Health in the Western Cape

africaahead — Fri, 05 Mar 2010 09:08:36 +0000

The Metro Health Club: Grassroots Action for Improved Community Health in the Western Cape

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

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

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

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

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

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

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

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

For more information, please contact info@africaahead.com

Imbasa Community Resources

africaahead — Mon, 25 Jan 2010 10:49:46 +0000

January 2010

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

Charlotte Adams, head of mobilisation for Imbasa Community Resources

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

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

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

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

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.

South Africa, KZN Poster

africaahead — Wed, 20 Jan 2010 12:25:44 +0000

This poster is a visual summary of the Danida funded IWRM project in South Africa, where 10 CHCs achieved high levels of behaviour change within an 8 month period.

2009.KZN poster.pdf

Zimbabwe Case Study

africaahead — Wed, 20 Jan 2010 11:31:15 +0000

A short summary of hygiene behaviour change in Zimbabwe, updating from the ground breaking early projects in 2001 in Tsholtsho, to recent projects in Chipinge where similat levels of change are being recorded. It points a way forward as to how the MDGs can be achieved by scaling up the CHC approach as is being done in Rwanda and Vietnam where the model is being institutionalised within the Ministry of Health.

Zimbabe Chipinge Case Study

South Africa

africaahead — Mon, 18 Jan 2010 06:51:55 +0000

READ THE LATEST NEWS FROM SOUTH AFRICA – (click here)

PROJECTS UNDERTAKEN IN SOUTH AFRICA

Development of generic CHC Training manual and extensive PHAST Tool Kit for Informal Settlements (City Health Department- Danida)
Training for City Health Department of facilitators to start CHCs in Informal Settlements near Cape Town
Support to Hygiene Promotion Partnership for base line survey to ascertain level of hygiene behaviour change in 4 informal settlements
Feasibility study for Integrated Water Resource Management (IWRM)to start CHCs in 3 water catchment areas in South Africa ( DWAF-Danida)
Planning and implementation of a comprehensive CHC programme in the rural areas of Kwa Zulu Natal for DWAF-IWRM (See Map: A)
Training of 25 Sangoco facilitators to start CHCs in North West province (Sangoco NGOs- DWAF-Danida) (See Map: B)
Training of Water and Sanitation Forum facilitators to start health clubs in Khayelitsha (for University of Western Cape)
Planning and implementation of a pilot CHC project in eThikweni (Durban) informal settlement

1.PHAST Manual and Tool Kit to enable scaling up of training

In 2008 Africa AHEAD, in conjunction with the City Health Department, developed and published a dedicated manual

Community Health Clubs in Informal Settlements: A training manual for community workers using participatory activities. Developed by J. Waterkeyn for City of Cape Town Health Department. Funded by Danida. Illustration by Itayi Njagu.

This manual comes with a comprehensive PHAST Tool Kit for informal Settlements consisting of 13 essential topics related to home hygiene.

The training comprises of three Modules:

Module 1: Feasibility: the Rationale for the Community Health Club Approach

A one day training for Managers and decision makers to enable them to visualise and understand the reason for ‘doind development’ through Community Health Clubs)

Module 2: Planning: How to start a Community Health Club Project:

A three day training for middle management and supervisors as well as the facilitators of the CHCs.

Module 3: PHAST Participatory Activities for Informal Settlements

A six day training for facilitators only to enable them to use all the PHAST toools and carry out 24 training sessions with community Health cubs

Please contact juliet@africaahead.com for more information if you are interested in this training.

2. City Health Department Pilot Community Health Clubs in the Cape Flats

2008. Belleville Cape Town: the first CHC facilitators to be trained

The first batch of trainees were passed after a six day workshop in March 2008, and are expected each to start one health club. Although the xenophobic riot of 2008 affected the start up of health clubs in many areas there is at least one success story in Phillippi. There are over 200 members in three health clubs and their training is providing an inspiration to replicate the project in other areas. In the near future all the CHCs will be assessed by Africa AHEAD with a view to learning lessons as to how the health clubs are being received in the Cape Flats. It appears that there have been several challenges including the difficulty of the members to meet during the xenophobic unrest that swept the informal settlements in South Africa last year. there are also concerns as to how the health club facilitators were supported and if there was enough supervision by Environmental health Personel to ensure that the sessions were heald as planned in the workshop.

Another training is to due to be hele in April / May supported by the Health Department , when the next intake of community members will be trained by Africa AHEAD to start Community Health Clubs in different areas.

3. Feasibility Study for Integrated Water Resource Management

In 2000, the South African Department of Water Affairs and Forestry (DWAF), with the assistance of the Royal Danish Government (DANIDA), initiated a program to pilot Integrated Water Resource and Management (IWRM) approaches in three Water Management Areas (WMA) of South Africa: the Olifants-Doorn (Western Cape Province), the Crocodile-Marico (North West Province), and the Mzimkhulu-Mvoti (Kwa-Zulu Natal Province). These WMAs were selected as they represent a cross-section of water resources conditions as well as water use conditions and user interests. Phase 2 of this project, which focuses more on direct support and partnerships at local, regional and national levels, was begun in 2006 and is set to last until 2010. For more information about IWRM activities in South Africa, please visit www.iwrm.co.za.

The CHC Approach will contribute to the goals of IWRM by building a strong foundation of knowledge, cooperation and behavior change in each of the targeted communities. This foundation will then be used to successfully implement a variety of projects such as rain water harvesting, nutrition gardening, income generation, HIV/AIDS case management, and improved management of sanitation facilities.

In May 2008, Africa AHEAD was invited to assess the feasibility of piloting Community Health Clubs (CHC) in targeted areas within the three WMAs. Between May and September 2008, stakeholders were engaged, situational analyses and site visits were conducted, and project proposals and plans were submitted.

4. Community Health Club Pilot Project in Umzimkhulu: Kwa Zulu Natal

Participants in a Health Club Training Workshop in Umzimkhulu - Jan 2009

The team: Project Officer Moses, Council Representative Tabiso and Jason Project Manager for Africa AHEAD in Umzimkhulu

Africa AHEAD has been contracted to implement a pilot project in the Mzimkhulu-Mvoti WMA, within the Umzimkhulu Municipality. Umzimkhulu which is located in the foothills of the Southern Drakensberg Mountains. Until recently Umzimkhulu was a part of the Eastern Cape Province, and as a result the levels of development in this district are far below the standards found in the rest of the Kwa Zulu Natal. According to the Municipality’s 2008 Integrated Development Plan, 40.2% of the population has access to piped water sources, with the remainder using unprotected sources such as rivers, streams and springs. In addition, while 92.9% of households reportedly have access to sanitation facilities, the majority of these facilities are neither safe nor hygienic. This low level of development is ideal territory to start a community health club programme as past research has shown.

The project in Umzimkhulu began to take shape from Septemeber 2008, as the Municipal Council approved the implementation of CHCs in all 18 Wards, a Project Steering Committee was constituted, the sites for implementation were selected and Africa AHEAD welcomed its newest team member, Mr. Moses Mncwabe, Project Officer for the Umzimkhulu project. The site selection process was a competitive one, with interested Ward Councilors submitting an application form indicating the communities they wanted to participate and the names of potential facilitators to be trained by Africa AHEAD. 10 Councilors who submitted applications, to join the programme and the Project Steering Committee selected one community and facilitators from each ward. Community Health Clubs have now formed up and facilitators have been trained in base line research. the base line survey was completed in January 2009, and the PHAST training is to be started in mid February, and continue every second week. Facilitators will then rely the training back to their ward where their health clubs will meet every week. The training will be complete with six months, by the end of August 2009.

5. Replicating through local NGOs: North West Province

Africa AHEAD is working closely with the South African National Non-Governmental Organization Coalition (SANGOCO) to start up CHCs through training the staff of existing local NGO’s in the North West Province and Gauteng. Unlike other projects which are implemented directly by Africa AHEAD, the input in this project is merely to train and mentor the staff of 3 local NGO’s, who will then manage the implementation and activities of CHCs in their catchment areas. While most of the CHCs in this WMA will be formed in communities in and around Mafikeng and Zeerust (North West Province), there is one Community Based Organization in Majaneng (Gauteng Province), near Hammanskraal, that will also be implementing CHCs.

NORTH WEST PROVINCE: Africa AHEAD will be collaborating with SANGOCO and two NGO’s based in the North West Province to implement CHCs, Tlhoafalo Advice Center and Lethabo Water and Sanitation. Each NGO will have between 7-9 staff trained in the CHC Approach by Africa AHEAD and will develop CHCs in 5-6 communities.

GAUTENG PROVINCE: Majaneng is a small rural settlement located on the border of the Gauteng and North West Provinces. In this area, Africa AHEAD will again be collaborating with SANGOCO and one local Community Based Organization, the Kekanastad Traditional Mothers Organization (KETRAMODEO). Africa AHEAD will train 5 members of this organization who will then develop CHCs in 5 sub-areas of Majaneng.

A three day training workshop was held from 11th-13th August 2008, on Module 2: How to start up Community Health Clubs. At this training the NGO staff were given activities to help map and analyse the areas to prioritise within their areas of operation. They were also trained to carry out a base line survey of 100 household in the selected area. This was done through the innovative method of using ordinary cells phones to capture data in the field. (See Publications, Rosenfeld and Waterken, 2008). The data is then automatically collated and preliminary result have been collected and a report issued by Africa AHEAD who are to process the data and provide on going support to enable any behaviour change to be measured effectively. The CHCs have now been formed up, the base line data collected and facilitators from the NGOs are now waiting for the next phase of the training which is being delayed by funding constraints. Local NGO are begging to start the next training as their communities have been mobilised and are loosing interest with such delay.

6. Hygiene Promotion Partnership Research

Brigham Young University, (on behalf of Rickett Benkisser) started a research programme in four informal settlements to establish whether the use of antiseptic cleaning material in home could reduce diarrhoea in low income homes. In order to conduct this research an intervention was planned to monitor 140 clusters in four informal settlements: Phillipi, Du Noon, Kwa 5, and Sweet Home. The model was that each of the 65 facilitators would hold weekly sessions in a cluster of ten homes. As the strategy was very similar to the CHC approach, Africa AHEAD was called on to help develop the training materials for the modules which were prepared by HPP. The beneficiaries of the programme were able to assist in the development of the PHAST Tool Kit and HPP supported the development of the illustrations, and HPP trainers were trained by Africa AHEAD to use the materials. Although this programme has now been completed, many clusters have become viable grass roots groups and anecdotal evidence is strong that they have improved in their home hygiene practices.

Participants learn how to make a squezzy bottle: a practical solution to handwashing outside informal shacks

New Research Findings on Behaviour Change

PUBLICATION:

Comprehensive Family Hygiene Promotion in Peri-urban Cape Town: Gastrointestinal and Skin Disease Reduction in Children Under Five. Cole, E, Hawkley, et al. Brigham Young University.

‘Community based PLA proved to be a powerful approach for reducing illness through supporting families in the adoption of new hygiene practices and in mobilising the communities for health and social change.

Achievements of facilitators and study participants included the health and hygiene situation in households and neighborhoods, setting up of hand-washing stations, teaching children and neighbors correct hand washing methods, instituting child safety practices, influencing vendors to practice hygienic food preparations, managing communal toilet and rubbish pick ups and determining how to link health to local economic development.’

Reduction in disease
Findings from this paper indicate that Skin infections were reduced by 39.1% in formal housing but interestingly not in informal housing.

Gastroinstestinal infections were reduced by 14% in formal housing and by 11% in informal housing.

7. University of the Western Cape – Khayelitsha Sanitation Forum

The concept of Community Health Clubs was first floated in South Africa in 2005, supported by the University of the Western Cape, in a pilot project in Khayelitsha, one of the most challenging informal settlements in the Cape Flats. 25 Facilitators were nominated by the Khayelitsha Sanitation Forum, and training was provided by Africa AHEAD. Due to insufficient support most of the health clubs never took off, but one determined facilitator has shown that CHCs in informal settlements can play an important role in providing support to the needy.

Saviour Maqaloti : The first facilitator to start a Community Health Club in the Cape Flats

Philisanani Community Health Club

One of the facilitators, Saviour ran with the idea and mobilised a huge following of over one hundred members. trained the group over the next six months and Africa AHEAD was delighted to be able to provide certificates for the 25 core members who had completed every session. Some of the group have become voluntary clinical assistants, while another has started a play school and yet another has a voluntary service assisting the pensioners access their pensions and ensure they are properly cared for. The group has become a registered CBO called Philisanani and has recently secured government funding for a second training in home hygiene for which Africa AHEAD is providing certification.