Report by Morgan Hayiza

ZimAHEAD Project Officer.

Oxfam staff from UK, Germany, Scotland and Zimbabwe had an opportunity to visit the Community Health Clubs and rehabilitated water points in Masvingo Rural District of Zimbabwe, where ZimAHEAD implemented an OFDA funded Water and Sanitation Project through OXFAM GB. The project ended [...]]]> 01 December, 2011

Report by Morgan Hayiza

ZimAHEAD Project Officer.

Oxfam staff from UK, Germany, Scotland and Zimbabwe had an opportunity to visit the Community Health Clubs and rehabilitated water points in Masvingo Rural District of Zimbabwe, where ZimAHEAD implemented an OFDA funded Water and Sanitation Project through OXFAM GB. The project ended in June 2011.

The WASH Response to Humanitarian Crisis in Zimbabwe was implemented through the Community Health Club Approach, or simply the AHEAD Model. It was aimed at reducing the vulnerability of the at risk rural populations in the southern part of Masvingo Rural District to water and sanitation related diseases.

Masvingo RDC

The OXFAM team of six members met the  Masvingo Rural District Council, received by Mr. Nyatsanza who was representing the CEO for the District. Mr. Nyatsanza explained what the project had brought to the district in terms of behaviour change in  health and hygiene as well as infrastructure development in the form of rehabilitation of the water points. He expressed gratitude also with the level of capacity building that the district had received through the various trainings that ZimAHEAD and OXFAM had done.

He also explained how ZimAHEAD did the Health Promotion and the effects thereafter to the population of their district  in the form of increased number of household pot racks, refuse pits, and hand washing facilities (the tippy tap). He also mentioned that the rehabilitation of boreholes had come as a relief to the district and stressed that although good work was done, there still was a need to scale the good work up in other wards which still have water problems. He commended the tremendous exceeding of the targeted 8 boreholes to an actual of 15 boreholes rehabilitated achieved during training.

On behalf of the district he appealed to the visitors for more funding to enable blanket coverage of the district in rehabilitation as well as health promotion. Mr. Nyatsanza then accompanied the team to the Field where we visited ward 23.

The team had an opportunity to see  for themselves the characteristics of a model home. The point was well swept with a refuse pit; a pot rack and a hand wash facility. Along the road in the ward, we could see these health enabling facilities clearly in the households nearby- the presence of such signifies membership and subscription to a community health club.

Thenthe team visited the home of one of the Community Based Facilitators (CBF), Mrs. Kokerai. She explained how she had started her club and the hygiene sessions which led to the graduations. She proudly showed the team her certificate of graduation. Her home actually depicted a model home with all the health enabling facilities present and nicely kept. Her husband who is also a member of their club reiterated how the program had helped in addressing problems of communicable diseases such as malaria, diarrhea and skin diseases in their area.

Asked about how she felt about being a facilitator, Mrs. Kokerai told the visitors that she felt great to have been leading big group of 196 people in her club. She was particularly exited by the response by the people in putting up the health enabling facilities at their individual homes.

She told the delegation that almost every household in her village had started in one way or the other construction of a BVIP without any subsidy. All questions were answered satisfactorily and the team was impressed by the confidence and knowledge that the CBF exhibited.

The team had a chance to visit Nyajena Rural Hospital where we were welcomed by the Nurse in Charge there, Mr. Chimhundu. He briefed the team on the impact of the program with regard to disease control. Diarrhoeal diseases related deaths were said to be high before the intervention but now it was a thing of the past. The prevalence of skin diseases and ARIs were also said to have gone down significantly owing to the improved KAPP because of the project.

From his own observation, personal and home hygiene had improved remarkably for the first time in eight years, the time he had been working at the centre.  He made mention of the cleaning campaigns which were held periodically at the health centre, schools and in the villages. He also told the team about his attendance to some of the graduation ceremonies held in the ward and said that these were very influential in the dissemination of information, especially the songs, drama and dances which were performed.

Lastly the team went to view one of the rehabilitated boreholes about two kilometers from the health centre. As we got there we found the water point locked as a sign of management and responsibility. Mr. Chimhundu who was still with us said the people gave each other timetables for drawing water from the borehole. He  also talked about the rehabilitation of boreholes which came as huge relief to their community as they were drawing drinking water from shallow wells and the nearby river.

Mr. Nyatsanza from The RDC gave a vote of thanks to the visitors for taking interest to visit their district and again he appealed to OXFAM to provide more support so that the work could be spread to other areas in the district. We then wished our visitors a safe journey back to Harare as well as their various destinations beyond the Zimbabwean boarders.

City Authorities and Residents Joining Up

by Regis Matimati - Director of Programmes, ZimAHEAD

ZimAHEAD  has observed that city councils and residents can jointly own up to the waste menace if they sit together to identify and plan on ways to solve the sanitation challenge. What needs to be done first [...]]]> December, 2011.

City Authorities and Residents Joining Up

by Regis Matimati - Director of Programmes, ZimAHEAD

ZimAHEAD  has observed that city councils and residents can jointly own up to the waste menace if they sit together to identify and plan on ways to solve the sanitation challenge. What needs to be done first is creating a full realization that waste is everyone’s problem and shifting from the ‘blame game’ where residents blame council for none collection of refuse and councils blaming residents for illegal dumping.

Background

The economic meltdown of 2008 in Zimbabwe affected the ability of local councils to effectively manage service delivery in the cities.  Urban authorities became incapacitated to deliver services like waste management and refuse started pilling up blocking and barricading roads in most places. City environments became an eyesore due to waste and the stench that emanated from the waste was so severe and overpowering. Residents waited in vain for the refuse trucks and eventually emptied their refuse bins on any available open spaces until these became unreachable and the trash encroached onto the roads. City councils, the duty bearers, could not collect the refuse as their refuse trucks where breaking down or in a state of disrepair due to the economic downturn.

The Project

With funding from OFDA and UNOCHA through Oxfam, ZimAHEAD went into Mutare (2009) and Masvingo  (2010). Contracts were signed between the cities and ZimAHEAD for the organisation to run community and school health clubs with residents and schools. The clubs would facilitate community action to bring back the glory to the cities by clean ups which were ran by the communities themselves through the community and school health clubs. The clubs created an increased awareness on waste related diseases as well as ways and means through which communities could take action to be safe. Jointly working with both the residents and the city health departments, an increased responsibility, accountability, control and ownership was created within both parties.

The residents started segregating their household waste; burying the biodegradable, reusing the plastics as plant and flower pots, taking the composted refuse into their gardens as manure and that left very little to throw away. Refuse bins became less heavy and council staff and trucks became better able to move the greatly reduced waste bulk.

Collectively the Community Health Clubs  and School Health Clubs mobilized themselves and carried out mass clean up campaigns that left the cities very clean. Subsequent clean ups mopped up the ever dwindling illegally dumped waste until such a time when almost every one in the city became conscious of proper waste  management and the habit of illegal dumping died. During the clean up campaigns councils prioritised and provided waste removal vehicles in sync with the cleaning schedules.

Commitment from the City Fathers.

The AHEAD (Applied Health Education And Development) model of the community health clubs can galvanise communities to take action but this would not achieve much where there is no equal commitment from the city fathers. Both councils in Mutare and Masvingo measured up by providing clean-up equipment and tools, refuse removal trucks through committed Environmental Health Departments. We worked together from the start to the finish with the departments of health. Dedicated environmental health staff was deployed to this cause and hence there was improved communication between council and residents.

Everyone in Zimbabwe will agree that Sakubva (Mutare) and Mucheke (Masvingo) are the cleanest high density suburbs in the country at the moment owing to the Common Unity that prevails between the city fathers and the residents as facilitated by the Community Health Clubs.

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 [...]]]> 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.

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Notes from the Field

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

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 [...]]]>

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.

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.

Africa AHEAD Project Manager Nancy Maksimoski conducted a 3-day workshop on the CHC Methodology for EWS staff 17-19 August 2010 in Durban. The training covered Modules 1 (Feasibility: Rationale for the Community Health Club Approach) and 2 (Planning: How to Start a Community Health Club Project) of Africa AHEAD’s CHC Manual.  For this [...]]]> August 2010

Africa AHEAD Project Manager Nancy Maksimoski conducted a 3-day workshop on the CHC Methodology for EWS staff 17-19 August 2010 in Durban. The training covered Modules 1 (Feasibility: Rationale for the Community Health Club Approach) and 2 (Planning: How to Start a Community Health Club Project) of Africa AHEAD’s CHC Manual.  For this project, 8 EWS Health Promoters will each be responsible for forming and facilitating 5 CHCs, to be implemented in a combination of informal settlement and rural communities.

Health Promoters discuss Siyathuthuka's Challenges

After an introduction to the AHEAD methodology on the first day, the group discussed the challenges facing informal settlements, and the HPs feared there was little that could be done to convince community members to take ownership of the communal facilities – a problem that is seen as the core issue behind many of the challenges the HPs identified.

On the second day of the training, Africa AHEAD led the HPs on a transect walk and mapping exercise of Siyathuthuka, with the assistance of community leader Nhlanhla and resident Innocent.  As Khethokuhle (Siyathuthuka’s CHC) has only just begun its CHC sessions, its current state is very similar to that at baseline. The group noted that while the container toilets provided by EWS are very well maintained by its caretaker, grey water, illegal dumping, and illegal taps are problematic in the community.  Participants engaged Nhlanhla and Innocent in discussion about many of the issues they highlighted earlier in the workshop, in order to understand these matters from the perspective of a community leader/resident.

Impiloyethu has started a glass recycling project which will help to keep the community free of glass litter and serve as an income generating project for the club members involved

To illustrate the difference CHCs can have on communities, the HPs were then taken next door to Boxwood Place, where Impiloyethu has been active for the past year. Not only could the group visibly see the differences between the two communities and view Impiloyethu’s projects, but they were able to talk with CHC members and hear their stories about how health clubs have improved their lives.

After the site visits, the attitudes of the Health Promoters towards the concept of ownership had noticeably changed. Although still thought to be a challenge, they agreed that it was something the health clubs could achieve and their enthusiasm became very tangible.

In order to better understand the dynamics of a CHC, the group formed their own mock CHC, Vukuz’ thatha (Get up and do it for yourself), which they will continue to be members of for the remainder of the upcoming trainings.

In addition to the site visits and presentations, Africa AHEAD facilitated discussions on the roles and responsibilities of the project’s stakeholders, mobilisation, and other important topics. Participants also acted in several helpful role-playing exercises, such as how one engages with community leaders, which can be problematic as these people often act as gatekeepers to the community.

By the end of the three day training, the group had a clear understanding of the CHC methodology, plans to begin engagement of Councillors and Community Leaders, and were enthusiastic to start the project.

Africa AHEAD left the group with the homework of choosing the communities they wish to implement the project in, engaging the relevant project stakeholders for each community, as well as to begin the mobilisation and registration process for the health clubs.  Africa AHEAD is very pleased with the results of the workshop and is looking forward to seeing what the group is able to achieve in the upcoming weeks before September’s workshop.

In response to the results of the Johanna Road Pilot Project, eThekwini Water Services (EWS) has decided to extend the project by 6 months so that Impiloyethu can continue onto the next phase in the Applied Health Education and [...]]]>

Bountiful gardens at Johanna Road show that CHC members are ready for the next phase

In response to the results of the Johanna Road Pilot Project, eThekwini Water Services (EWS) has decided to extend the project by 6 months so that Impiloyethu can continue onto the next phase in the Applied Health Education and Development (AHEAD) methodology, where graduates are invited to participate in weekly Food Security, Agriculture, and Nutrition (FAN) modules.  These sessions stress the importance of proper nutrition – information which is much needed in informal settlements. In addition to weekly meetings, EWS’ Agriculture Management Unit (AMU) will be assisting the club with building a large communal garden across the street from the Johanna Road settlement.

Grey water is a large problem at Siyathuthuka

The project extension will also see the creation of an another CHC in the neighbouring settlement of Siyathuthuka, also located along Johanna Road on the way to the Northern Treatment Works.  Siyathuthuka, home to approximately 600 households, is in need of health and hygiene training, as well as better maintenance of their communal facilities.  Despite being more than twice the size of Johanna Road, the community only has one container ablution block and four chemical toilets. The combination of a shortage of facilities and poor communal management has left the container toilets in a very unhygienic state. Grey water, illegal dumping, and open defecation are also problems within the community that the CHC will work to address.

Impiloyethu members Nokuthula Mathetha and Nthabeleng Molusi, who have shown to be outstanding club members by their participation in CHC activities and acting as role models in the community, will be trained to be community facilitators for the new clubs.

Impiloyethu members sing about the importance of health and hygiene

The events began with a [...]]]> 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

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 [...]]]> 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.

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

Africa AHEAD providde training in the AHEAD methodology for 20 CWs and 16 EHPs over the course of 7 days in April 2010. Upon completion [...]]]> June, 2010

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

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

The training was  held at Look Out Hill in Khayelitsha, facilitated by Dr. Juliet Waterkeyn (Africa AHEAD Director), Jason Rosenfeld (Africa AHEAD Project Manager), and Nancy Maksimoski (Africa AHEAD Project Manager), assisted by Charlotte Adams and Joyce Cwayi from Imbasa.

A graduation ceremony arranged by the Health Department was subsequently held on the 3rd June 2010 for all those who had been trained.