Association for Applied Health Education And Development

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.

August 31st, 2010 | Tags: Community Health, Durban, Health Clubs, Informal Settlements, KwaZulu-Natal, Solid Waste Disposal, SOUTH AFRICA, Water And Sanitation, Women | Category: KwaZulu-Natal, SOUTH AFRICA, Training/Consulting | Leave a comment

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.

March 8th, 2010 | Tags: Baseline Data, Behaviour Change, Community Health, Diarrhoeal Diseases, Durban, Health Clubs, Health Promotion, Hygiene Behaviour & Practices, Informal Settlements, KwaZulu-Natal, Pilot Projects, SOUTH AFRICA, Vegetable Gardens, Water And Sanitation, Women | Category: Community Health Clubs, Countries, KwaZulu-Natal, SOUTH AFRICA | Leave a comment

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

January 20th, 2010 | Tags: Baseline Data, Behaviour Change, Case Study, Community Health, Danida, Diarrhoeal Diseases, DWAF, Hand Washing, Hygiene Promotion, Integrated Water Resource Management, KwaZulu-Natal, Poster, SOUTH AFRICA, Water And Sanitation, Water Storage, Women | Category: Download PDFs, Health Promotion, Hygiene, KwaZulu-Natal, SOUTH AFRICA | Leave a comment

This is a summary of the achievements of a pilot project which was using Community Health Clubs to promote hygiene behaviour change in  Kwa Zulu Natal, and shows that this is an effective methodology for sound development in rural South Africa

South Africa KZN Rural Case Study

January 20th, 2010 | Tags: Behaviour Change, Case Study, Community Health, Diarrhoeal Diseases, DWAF, Health Clubs, Hygiene Behaviour, Integrated Water Resource Management, KwaZulu-Natal, Methodology, Mexico, Millennium Development Goals, Rural Areas, SOUTH AFRICA, Water And Sanitation, Women | Category: Countries, Download PDFs, Health Promotion, Hygiene, IWRM, KwaZulu-Natal, SOUTH AFRICA | Leave a comment

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

PROJECTS UNDERTAKEN IN SOUTH AFRICA

1. Development of generic CHC Training manual and extensive PHAST Tool Kit for Informal Settlements (City Health Department- Danida)

2. Training for City Health Department of facilitators to start CHCs in Informal Settlements near Cape Town

3. Support to Hygiene Promotion Partnership for base line survey to ascertain level of hygiene behaviour change in 4 informal settlements

4. Feasibility study for Integrated Water Resource Management (IWRM)to start CHCs in 3 water catchment areas in South Africa ( DWAF-Danida)

5. Planning and implementation of a comprehensive CHC programme in the rural areas of Kwa Zulu Natal for DWAF-IWRM (See Map: A)

6. Training of 25 Sangoco facilitators to start CHCs in North West province (Sangoco NGOs- DWAF-Danida) (See Map: B)

7. Training of Water and Sanitation Forum facilitators to start health clubs in Khayelitsha (for University of Western Cape)

8. 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.

January 18th, 2010 | Tags: Africa Development, Baseline Data, Behaviour Change, City Health Department, Community Health, Danida, Diarrhoeal Diseases, Durban, DWAF, Feasibility Study, Home Hygiene, Hygiene Behaviour, Hygiene Promotion, Informal Settlement, Informal Settlements, Integrated Water Resource Management, KwaZulu-Natal, North West Province, Participatory Activities, Pilot Projects, Sangoco, SOUTH AFRICA, University Of Western Cape, Water And Sanitation, Water Resource Management, Women | Category: Countries, KwaZulu-Natal, SOUTH AFRICA | Leave a comment

Community Health Clubs Graduating in Umzimkhulu

August 2009

In January 2009, 10 communities within Umzimkhulu, one Local Municipality within the Sisonke District, began training as members of Community Health Clubs (CHC), a new initiative piloted by Africa AHEAD for the Department of Water and Environmental Affairs’ (DWA) Integrated Water Resources Management (IWRM) program. This Government pilot project, with funding provided by Danida (the Danish international aid organization), was initiated so as to improve community use and management of water resources. Since January, almost 1,000 community members have joined the ten community health clubs and have been meeting weekly to learn how to improve their lives through a structured health promotion program that encourages sustainable water, sanitation and hygiene behavior change. Now, seven months later, 550 members have completed the health promotion curriculum and are ready to celebrate their achievements during the Community Health Club Graduation Ceremony scheduled for Wednesday, September 16, 2009.

Fig.1. Women gather for the weekly health club session

The Community Health Club (CHC) approach enables the poorest of the poor in urban and rural communities to take full control of their own development by building effective social structures at the grassroots level known as Community Health clubs. The CHC strategy and training pioneered by a South African NGO, Africa AHEAD Association, builds the capacity of communities to manage their own health and development, ensuring that all initiatives are fully sustainable and holistic in scope. Informed decision-making through active participation and consensus building, changes a loose connected community into a ‘real community’ with ‘Common-Unity’. The inspiration for the CHC concept is closely linked to the South African understanding of ‘Ubuntu’, community togetherness and mutual support, which is an indication of a healthy Community. This attention to social cohesion is the hallmark of the CHC strategy, which should ideally be a process of development that begins with health promotion and hygiene behavior change. Once club members have completed the health promotion activities, they are then encouraged to move on to larger and sometimes more difficult developmental challenges such as the provision and management of water and sanitation resources; sustainable livelihoods through skills development and agriculture; and social responsibility for less advantaged community members. This phased approach allows club members to build upon each successive achievement, building ‘Common-Unity’ along the way.

This CHC Pilot Project in Umzimkhulu took place from February to August 2009, with six months of health promotion sessions (Phase 1 of the AHEAD Model), where members were given the opportunity to discuss issues surrounding common health problems through the use of visual aids and participatory activities. Members were also encouraged to support each other as they put their new knowledge into practice at home, and within weeks it was possible see the changes they had made to their homes and lifestyles. These concrete changes are the observable indicators of this new ‘Culture of Health’ that the CHC Approach emphasizes. At regular intervals throughout the project, a household inventory was taken, which notes the levels of uptake of 10 recommended practices that are vital if common diseases such as diarrhea, worms and skin disease are to be prevented through improved hygienic practices. It has been proved that if these practices are widespread within a community, these diseases can be greatly reduced, with a consequent saving of lives and cost to health services.

Figure 2: Members of the Bhulebezwe CHC discuss issues about personal hygiene

To date, over 80% of all registered members are following the recommended practices promoted during the weekly health promotion sessions. These practices include the safe storage and use of water, improved kitchen hygiene through safe food storage, the creation of a dedicated hand washing facility with soap at or near household latrines, and the use of a safe water source. To begin with, almost all registered members now store their water in a safe and sealed container, fetch their water using a ladle or pitcher, and store all food in containers that prevent contamination by flies. In addition, whereas only 29% of member households had a dedicated hand washing facility near their latrine at the beginning of the project, 82% have now constructed a simple facility that allows them to wash their hands immediately upon exiting their latrine. Even more impressive is the use of soap for hand washing. Finally, while 38% of member households had soap for hand washing in February, 94% of member households had provided soap by the end of July. This huge change in hand washing practice together with safe food and water will insure there is a drop in the prevalence and incidence of diarrhea, one of the most common health problems which threaten young children especially in Umzimkhulu. With these changes occurring within participating communities, there is little doubt that family health has been improved where health clubs have been established.

As can be appreciated from the chart above, the Community Health Clubs have responded enthusiastically to the information they have been learning in their clubs and applying the knowledge to improving their home hygiene. Taking ten indicators of their response we find that from the first month (blue bars) to six months later (red bars) the change has been extensive. Firstly all ten indicators show that over 80% of all the members are following the recommended practices. Secondly if we take the average of all ten practices we find that there is 36% change in six months. Some of the practices were already quite high (above 60%) but even so, it is clear that the members who did not practice the hygiene at the start of the project are almost all practicing the recommendations now. We find almost all the members are now using safe drinking water, using a ladle to take water, covering their drinking water well, keeping their food well stored and practicing zero open defecation. Use of soap when handwashing has shot up a staggering 56% (from 38% to 98%), and 53% (from 29% to 82%) have constructed a hand washing facility. This huge change in hand washing practice together with safe food and water will insure there is a drop in the prevalence and incidence of diarrhea, one of the most common health problems which threatens young children especially in Umzimkhulu.

Most impressive of all, however, are the self-motivated improvements that some Health Clubs have made to their water sources. It was observed that at the beginning of the project that approximately 50% of participating households obtained their water from an unprotected source, such as springs, streams and rivers. After learning about the importance of obtaining water from a protected source (i.e. water that is sealed or protected from contamination at the surface) club members have been actively taking measures to protect their water sources. Two of the health clubs have even made technical improvements to protect their water without any financial or technical assistance from government. Each and every achievement of these Health Clubs highlights the objective of the CHC Approach, which is to help communities take their health into their own hands and manage their own resources more effectively, at least until government can provide the required services.

On Wednesday, September 16, 2009, over 500 graduates throughout Umzimkhulu will be honored at the Hall at the Umzimkhulu Teachers College. During this public ceremony, each of the Health Clubs will demonstrate to the rest of their municipality, district and province what it means to be a member of a Community Health Club. Prizes will be given for the best homestead and most proactive health club and there will be much celebration of good hygiene achieved. Songs about the importance of hand washing will be sung, dramas highlighting the knowledge shared and gained throughout the 7 months of health promotion will be performed, and all those who have attended all 24 sessions will be given a certificate of achievement.

Fig 3: over 50% of the health club members get water from a source like this.

This is not only the moment to celebrate the achievements of these CHC members, but it is also as a coming of age of each Health Club. As the project funders (DANIDA) and implementers (Africa AHEAD, and DWA) withdraw from their role as initiators of the scheme, local leadership is now set to take their rightful place as instigators of future development through the health clubs. While all councilors have been fully behind the clubs since their inception in their respective communities, the celebration being hosted by Umzimkhulu Municipality is a very public demonstration of this determination to support local community efforts and ensure every family has a healthy future. It is now up to the graduated membership to become the standard bearers of health and development for their community. Now is the time for these communities to demonstrate the power of Ubuntu that Nelson Mandela saw within each and every one of his South African brothers and sisters. With President Zuma’s clear focus on the welfare of rural people, the municipality of Umzimkhulu is set to become an example of sustainable development and how the combined effort of a critical mass of women can bring new standards of home hygiene and improved family health.

January 18th, 2010 | Tags: Community Health, DWAF, Hand Washing, Health Clubs, Health Promotion, Hygiene Behaviour & Practices, Integrated Water Resource Management, KwaZulu-Natal, Participatory Activities, Pilot Projects, Rural Areas, Water And Sanitation, Water Storage, Water Supply Projects, Women | Category: Countries, KwaZulu-Natal, SOUTH AFRICA | Leave a comment

Johanna Road Informal Settlement

October 2009

The eThekwini Metro is giving Africa AHEAD the chance to pilot the CHC concept in one of the most challenging informal settlements in the City of Durban. The settlement is situated on a steep slope of a hill next to the Sea Cow sewerage works, which has long been a black spot in otherwise genteel suburbs, north of Durban. The authorties have supplied two ablution blocks, water and solid waste collection, but have been unable to get the residents to dispose of solid waste properly, whilst the facilities were constantly vandalised.The project start up due in February 2009, was delayed by two months as the election campaigning was taking place. A base line survey was done in March of 100 households in order to be able to present achievements of this pilot project to inform the Municipality of the feasibility of replication. It was found that employment was unexpectedly high and therefore the mobilisation of the community took longer than expected as it was difficult to get members to gather during the day when many were working. The process of getting the approval of the committee that runs this informal settlement involved further delays but this is now a great advantage as the the leadership are solidly behind the establishment of health clubs.

There are over 500 residents of Johanna Road, and so two health clubs have been formed, Impiloyethu (“Our Health”) and Sakhimpiloyethu (“Building Our Health”). Currently Impiloyethu has 36 members and Sakhimpiloyethu has 18 members.  Iis expected that the training for both clubs will be completed by February 2010, when a graduation is planned.

After six months there are some observable changes in the community. The upper Ablution Block is being better maintained and community pride is rising each week. In September a daylong clean-up was held with over 100 people participating and this has given the authorities the encouragement they needed to support the efforts of the residents of Joanna Road. Over 100 black bags were filled with garbage and the Municipality provided the collection vehicle.

It was also a good indication to see how one of the more squalid corners has been transformed into a vegetable garden. Plans are afoot to help all those who are active in the CHC to have a garden patch in the nearby wasteland. There is still a lot to be done to clean up the area and sort out the paths which become impassable in the heavy tropical rains. However the settlement is starting to enjoy the new community cohesion and the hope that CHCs will transform the area is likely to be met.

January 18th, 2010 | Tags: Community Health, Durban, eThekwini, Health Clubs, Hygiene Behaviour & Practices, Informal Settlements, KwaZulu-Natal, PHAST, Pilot Projects, Solid Waste Disposal, Training Materials, Water And Sanitation, Women | Category: Countries, KwaZulu-Natal, SOUTH AFRICA | Leave a comment

BACKGROUND

Umzimkhulu Municipality in Sisonke District of KZN was selected by the Department of Water Affairs to pilot this project that was initiated as part of the IWRM (Integrated Water Resource Management) programme being funded by the Danish Embassy (DANIDA). Umzimkhulu was part of the Eastern Cape until it was recently absorbed into Kwa Zulu Natal. The area has one of the lowest levels of development in KZN as demonstrated in this base-line survey which highlights that safe drinking water supply is a major challenge with only 15% of households having access to a safe water source whilst the remaining households have to use open ground water, usually in the form of unprotected springs. As this surface water is open to contamination it needs to be treated or boiled before consumption. Sanitation usually consists of a household pit latrine and although the coverage is high at 90%, around 50% are unhygienic, smell and attracted flies which would account for the high levels of diarrhoea in the area. Most social scientists would agree that changing people’s hygiene habits is notoriously difficult, and there are few good case studies to-date. Africa AHEAD was commissioned as service provider to introduce a health promotion campaign in the 1st phase of an holistic development package that would build the capacity of the community through health clubs, with the objective of developing a community-led demand for improved water and sanitation. Although Africa AHEAD has initiated Community Health Clubs in informal settlements, this is the first pilot project in South Africa to be implemented in a rural community.

THE COMMUNITY HEALTH CLUB APPROACH

It has been shown in a review of over 100 studies that Health Promotion alone can reduce diarrhoea by 33%, while hygiene changes such as ensuring safe drinking water can diminish diarrhoea by 15%, safe sanitation by 35%, and safe handwashing with soap by 47% (Esrey, 1991). As the Community Health Clubealth promotion campaign in nine wards of Umzimkhulu. In February 2009, worki
Approach is known to be capable of achieving high levels of behaviour change (Waterkeyn & Cairncross, 2006) it was chosen as the strategy for a hng with the Umzimkhulu Municipality and local councillors, a Community Health Club was started in each ward. Africa AHEAD trained facilitators from the community in how to conduct health promotion sessions using PHAST participatory activities to promote hygiene behaviour change. Almost 1,000 members were registered and weekly sessions were held in all nine wards. Attendance rates varied according to the proficiency of the facilitator, but although most members attended some sessions, there were 550 hard-core members who completed all 24 health topics within six months. Certificates were awarded at a Graduation Ceremony in September 2009, attended by district and provincial representatives which marked the end of the pilot project. In the next phase, relevant government departments are planning to use these well mobilised communities to improve water, sanitation and quality of life through agricultural and income generating activities.

RESULTS

The levels of behaviour change as a result of this project are exciting, with an overall average of 20%. In the post intervention survey (September 2009), it was found that 76% of all registered members are now following the recommended practices promoted during the weekly health promotion sessions. Whereas before the project only 18.1% had safe water, there is an 41% change. Although the water source is still not safe, 51% now treat their water,86.1% store it safely and 87% take it using a ladle, so minimizing contamination. Sanitation has improved by 14%, from 71.1% with no open defecation to 87.8% of members having ZOD (Zero Open Defecation) defined as clean covered latrines with no faeces. In addition, whereas only 29% of member households had dedicated hand washing facility near their latrine at the beginning of the project, 70.1% have now constructed a simple facility that allows them to wash their hands immediately upon exiting their latrine. Even more impressive is the use of soap for hand washing that has risen from 40.1% in February to 68.4% six months later. An observable indicator is an 18% drop in Ringworm seen in CHC households, a disease caused by infrequent washing and lack of soap, 87.7% mother can now prepare SSS correctly, so saving babies that might have died from dehydration. There is little doubt that family health has been improved where health clubs have been established in Umzimkhulu, and demand to scale up this programme to all other wards is high. Meanwhile the self-motivated improvements that some HealthClubs have already made contingency measures to protect their water sources.without any external financial or technical assistance. Each CHC now has a trained building group, now constructing safe latrines on demand for members. This display of self reliance validates the CHC Approach, which aims to empower communities so that they manage their own health and utilize existing resources more effectively, at least until government can provide the required services.

RESEARCH METHODOLOGY

METHOD

Study Type: Intervention Study
Sampling: Purposeful
Technology: Mobile Research Platform
Enumerators: Seven local CHC facilitators
Health Clubs: Seven
Total Membership: 1000
Hard Core membership: 550
Sample Size Baseline: 469
Sample Size Post Intervention: 538

Demography of the CHC Respondents

Total Female Male
Total Number of Respondents 251 311 60
Median Age 40 38.5 39.2
Married 45% 45% 45%
Single 22% 50% 36%
Widowed 24% 3% 13%
Household size 5 4 4.5
Christian Denomination 46% 48% 47%
Christian Apostolic 53% 43% 48%
Traditional Religion 0.4% 5% 2.7%
Education & employment
No schooling 7% 4% 5%
Primary only 37% 33% 35%
Secondary 38% 35% 36%
Matric + passed 18% 28% 23%
Unemployed with Matric + 70% 56% 63%
No formal income 51% 58% 54%

Prior to the training a base line survey was conducted in all nine wards, with most Community Health Club members being interviewed. Each month, this ‘household inventory’ was redone, and hygiene changes as represented by the 12 observations in household inventory were tracked by the community facilitators. There are more respondents in the post intervention as members increased. Two of the facilitators failed to complete the surveys correctly and the data was rejected. Although preliminary finding in were higher in Round 5, (August 2009) the data in this poster shows the final round 6 data using only 7 out of 9 CHCs to ensure correct claims (September 2009). One observation ‘pour to waste’ hand-washing method was ignored as it was obsolete when members adopted the hand washing facility which was a more reliable indicator , being more observable.

TECHNOLOGY

Most household surveys are conducted on paper, and this leads to much human error and spoilt forms. To speed up data collection and collation and minimize human error, an innovative tool has been used in this research. A standard mobile phone was issued to each facilitator with the Household Inventory installed. Responses could be keyed eliminating human error, and data sent like an sms to a central website where results were updated automatically and instantaneously. This eliminated manual computer entry, and thus much time and error was saved. The monthly monitoring with cell
phones gave facilitators a more glamorous role, and the members responded to this monitoring (Hawthorne Effect) by making changes
that were recommended. Thus the monitoring has contributed as much as the methodology to the high rates of behaviour change.

Observed Home Hygiene changes before and after 6 months of weekly health promotion training sessions

Baseline Post Increase
Treated Drinking Water 18.1 59.3 41
Use of a Ladle 73.3 87.7 14
Safe Water Storage 78 86.1 8
Safe Food Storage 79.7 92.4 13
Use of Pot Rack 72.1 89.4 17
Zero Open Defecation 71.1 84.8 14
Hand Wash Facility 29 70.1 41
Use of Soap 40.9 68.4 28
Use of Rubbish Pit 74.2 86.6 12
No Ringworm 72.3 89.6 17
Make SSS 69.3 87.7 18

Average Increase in behaviour change 20%

Recommended Practices p>0.001

Active Members of CHCs

Baseline n=469 Post Intervention n=538

Purposeful sample of 3 wards

Demography of the CHC Respondents

CONCLUSION

• The hygiene practices of Community Health Club members have been significantly improved as a result of the health and hygiene promotion using the CHC approach.

• There is a high demand for safe sanitation (Ventilated Improved Pit latrines) & safe water sources (protected springs)

• As the faecal-oral transmission route has been broken in all CHC areas by safe water, food, sanitation (Zero Open Defecation), and hand washing with soap, diarrhoea should be effectively minimised in Umzimkhulu.

January 18th, 2010 | Tags: Baseline Data, Danida, Diarrhoeal Diseases, Health Clubs, Health Promotion, Integrated Water Resource Management, KwaZulu-Natal, Latrines, Participatory Activities, PHAST, Pilot Projects, Rural Areas, Skin Diseases, Solid Waste Disposal, Water And Sanitation, Water Sources, Women | Category: Countries, KwaZulu-Natal, SOUTH AFRICA | Leave a comment

8th April, 2009

Umzimkhulu is one of the most disadvantaged of all areas of South Africa. Levels of water provision by government are unacceptably low, with 80% of the community within this project still using unprotected open water sources. In addition, the recent base line survey shows that hygiene and sanitation practices are equally appalling, and health knowledge is negligible, with only 18% of the community having a good knowledge of 6 health topics. The combination of poor facilities, poor hygiene and poor knowledge is causing high levels of infectious diseases : diarrhoea from unsafe food and water, skin diseases from lack of washing and worm infestations which inhibit child growth and damage levels of achievement at school. However change is in the air. In ten wards of Umzimkhulu communities are stirring and wakening from their sleep. In January 2009, Community Health Clubs were started in nine out of the ten projected Wards, and there are now a total of 883 members. Given an average of 5.4 persons per household this means there are already 4,768 direct beneficiaries of this project. From past experience we know the diffusion of information from each member extends to neighbours who often change their hygiene habits due to peer pressure even if they do not become a CHC member and attend the health club sessions. Therefore it can be assumed that the impact of the project will be on over 10,000 indirect beneficiaries.

In the first two months since mobilisation started in February 2009, there has been a good response to the project. As hoped the average size of a health club in Umzimkhulu is 98 members per club, with the largest club being in Ward 4 with 144 members. However the size of the club does not always mean that it is the most effective club, as large clubs can merely reflect a more dense population or be because people in some areas are more prone to hope to receive something, but may not continue to attend if there are no handouts. The success of a club will depend on the number of active members who attend regularly, not just those who are registered. The most accurate measurement of a successful facilitator is that of average attendance for each session, because this shows that members continue to find their sessions interesting and worth attending. Ward 15 and Ward 18 have equally the highest attendance rates (both at 60%) whilst the lowest is Ward 8 with only 23% attendance.

March Star Facilitator: Buyisiwe Majola, Ward 13, Zibambele Club, enjoys her role as facilitator and is setting a high standard for her colleagues to follow, having conducted over 200 household visits.

Five facilitators have done four sessions at their clubs, whilst the remaining have done two or three sessions. Only one facilitator has failed to form a club in Kwa Gijima (Ward 17) which was one of the villages selected as a case study. Her failure to conduct any sessions after two months has resulted in the Project Steering Committee requesting her counselor to find a replacement facilitator. As this project is attempting to use community members rather than trained health personnel as facilitators in an effort to ensure sustainability and build capacity at the grass roots, it is inevitable that there will be some poorly chosen facilitators who do not have the capacity for the job required. However we are delighted that 90% of the facilitators are coping well, although they need considerably more training and support than is normal when NGO or government Environmental Health staff are used as CHC facilitators. Normally when higher educated staff are facilitators Africa AHEAD provides a one-off training workshop at the beginning of the programme. However in Umzimkhulu, most selected facilitators have only a basic education,and therefore need more regular support. A full time Project Manager and Project Officer are on site and provide continual top-up training and monitoring as needed. Monthly training sessions provide support for facilitators who are taught the next four sessions for the forthcoming month.

The facilitator of the month is Buyisiwe Majola from Ward 13, who has shone out this month for her enthusiasm and hard work. She has registered 96 members, and conducted 205 surveys. While some facilitators are battling to visit all their members homes, she has completed not only the base-line household inventory but is now on the second round of household visits checking on whether there have been any changes within the past two months. Her health club, named Zibambele has 96 members, and she has conducted the four sessions as instructed. Other facilitators are also doing well, particularly Gladys Mkhise, who has successfully galvanised her community into action, surprising people with her energy and ability to mobilise, dispite being a pensioner. She says, ‘One is never too old to learn or contribute to the well being of one’s community.’ The slogan her members have adopted ‘Vukamawulele!’ means ‘Rise up from your sleep!’

January 18th, 2010 | Tags: Baseline Data, Community Health, Diarrhoeal Diseases, Hand Washing, Health Clubs, Hygiene Behaviour & Practices, KwaZulu-Natal, Pilot Projects, Rural Areas, Skin Diseases, Solid Waste Disposal, Water And Sanitation | Category: Countries, KwaZulu-Natal, SOUTH AFRICA | Leave a comment