Association for Applied Health Education And Development » Participatory Activities

Urban Waste management in Zim

africaahead — Mon, 19 Dec 2011 14:11:57 +0000

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.

Rwanda in the fast lane, IRC sanitation field visit confirms

africaahead — Mon, 31 Oct 2011 08:57:27 +0000

Thursday 11 August 2011

Around 30 percent of the national budget of Rwanda is made available to district authorities. This high share makes Rwanda a front-runner in Africa, Stephan Klingebiel and Timo Mahn, two German banking specialists write in the June 2011 edition of Development and Cooperation, Vol. 38.2011:6. In only a few years, the country has considerably improved its public financial management. And the reform impetus started in the country itself. Donors helped to mobilise reform forces, but no one questions Rwanda’s leading role.

A similar drive can be reported on sanitation. ‘From the ruins of years of war and genocide, Rwanda has moved to improve household access to hygienic sanitation facilities faster than in any country in Sub-Saharan Africa””, writes Nitin Jain in the July 2011 Getting Africa to meet the sanitation MDG: Lessons from Rwanda.[1]. And from my four days in Rwanda during the AfricaSan3 Conference I can confirm this reality.

I had talks with a national planner who finances district level Training of Trainers on Sanitation and Hygiene, district level officials who were trained and Community Mobilisers who trained village level Community Health Workers. I also visited and talked to the Community Hygiene Club in Rwanagala umudugudu (village) in Kazence cell, in sector Ntamara, in district Bugesera, Easter Province, some 30 kilometres out of the capital Kigali.

Rwanda sanitation programme scores better than many richer African countries

The very first Tuesday morning of the conference Johnson Nkusi, CEO of the Rwandan Environmental NGO Forum, Rwanda brought me in contact with Mr. Jackson Mugisha. Jackson, Environment Facilitator of the Ministry of Local Government in Kigali, Rwanda. His ministry is implementing the national sanitation and hygiene policies from various ministries at district and local level. He is integrating environmental issues in the national planning and budget, including sanitation and hygiene. Every three months he helps organise three to five day training sessions for new local authority staff, 50 to 60 persons at the time. They are in turn training community health workers.

I mentioned to both that I would be interested in doing a reality field check on the sanitation situation on the Friday on which I could write one or more stories with pictures for our web site and our Source news and feature service. They were keen to organise this field trip for me.

Impact at the district level

In the next few days various people from various districts in Rwanda collected materials from our stand, listened to my introduction on our products and services and my plans for the field trip. I interviewed some of them. They confirmed that they had received the training of trainers that Jackson had organised and financed.

Charles Kwabayo is chairing the Dusukure PHAST Cooperative in Burere District in the Northern Province that covers 336,800 people in 567 villages. They have done 36 Participatory Hygiene and Sanitation Training of trainers workshops throughout the district in two rounds of 12 days each who in turn trained 3,400 households in good sanitation and hygiene behaviour since 2008. Around 1,000 farms are using Ecosan fertilizers for their crops. They also trained 124 schools in PHAST.

Sophy Mategego (see picture AfricSan 012.jpg) is Social Mobiliser in the WASH project in the Rubaru district responsible for 525 villages. Her colleague Fidele Nzejimana is doing the same work in the Musanze district covering 432 villages.

Sophy Mategego at the IRC stand. Photo: IRC/Dick de Jong

They do two visits per week and spend two days per village training the community WASH teams at the sector level that in turn are sensitising the communities on hygiene. In Rwanda the cell is the lowest level administration for a group of villages.

Three one-week trainings

Sophy and Fidele received three one-week trainings in two months last year from the Ministry of Infrastructure that was supported by UNICEF and SNV. They can use an SMS help line at the central server of the Ministry of Health to report hygiene concerns that require immediate action. But it usually takes a month for the Ministry to get back to them what action to take.

Three key elements of success

Three key elements stand out from Rwanda’s experience that other countries can adapt and implement to improve access to sanitation and improved hygiene:

Turning crisis into opportunity
Formalizing traditional elements into administrative frameworks
Forging strong political will to be supported at all levels of decentralization.

“We should be able to start sanitation initiatives like the provision of clean water, availability of toilets and clean and tidy neighbourhoods without having to wait for outside support”, President Paul Kagam said in his speech to delegates of the AfricaSan 3 Conference. At the beginning of the conference he received an award for his government’s exemplary leadership in ensuring sanitation. He told the delegates that he shares the award with the entire Rwandan people in recognition of their collective commitment and participation to raise the quality of life through better sanitation and hygiene.

[1[ Getting Africa to meet the sanitation MDG: Lessons from Rwanda, WSP, July 2011

In another story I’ll explore the sanitation reality in the field.

Dick de Jong

http://www.irc.nl/page/65772

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

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

SUNDAY TIMES, KIGALI.

Friday September 2, 2011 by Thomas Kagera

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

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

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

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

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

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

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

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

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

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

Strategies

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

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

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

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

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

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

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

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

Rwanda homegrown initiatives that augment sanitation and hygiene

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

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

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

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

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

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

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

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

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

VILLAGE NETWORK AFRICA

africaahead — Fri, 14 Jan 2011 15:17:57 +0000

by Anita Boling, Director

Using the Africa Ahead program materials, Village Network Africa (ViNA) trained 28 Community Health Club (CHC) volunteer leaders in the rural Kibaale district in Uganda in 2009. The leaders were elected by residents from 14 villages. Jihan Mandilawi, MPH and Anita Boling, RN, MSN, PhD trained the health leaders and David Kyamanywa, MSW assisted and translated. The seminar was held 8 hours a day for a week, and ViNA supplied lunch for all participants. The health volunteers were very enthusiastic and eager to learn the material. Upon completion of the seminar, CHC leaders were given certificates and supplied with a canvas bag filled with laminated Africa Ahead materials, attendance sheets and membership cards. CHC leaders who started the clubs and followed through with holding club meetings were given bikes donated by the Wheels for Life non-profit to facilitate their transportation and to attend meetings held by local nurses and a clinical director. The CHC leaders were trained recently on malaria prevention and use of mosquito nets. Following CHC meetings on malaria, ViNA and HisNets supplied 2000 family sized mosquito nets to villagers from the 14 village target area. Concomitant with the club meetings, 18 shallow wells were installed by Rotary; the Africa Ahead education complimented this major change. A Peace Corp water engineer, Caleb Fader, reported that the medical clinics now report a 98% decrease in the incidence of diarrhea. Mijumbi Gabriel, our previous local ViNA employee, reported that the community health club continues to grow and that CHC leaders remain motivated to hold the health club meetings. We found this program to be very successful at disseminating basic health principles and practices in very rural areas of Africa and are thankful to Africa Ahead for their excellent work!

RESPONSE FROM AFRICA AHEAD

Thank you to the Village Africa Network Team for this feedback: it is exactly what we were hoping to receive and pass on to others via our website, which should reflect the achievments of other organisations, and not just Africa AHEAD. Here is an enterprising organisation that can appreciate a good thng when they see it , and is able to take theory and translate it into a practical programme without any help from Africa AHEAD staff. It is truly encouraging that Village Africa Network that has successfully used the CHC Methodology as it was designed, including the training materials and membership card and they can already report such a massive drop in diarrhoea: 98% is a huge claim and we would love you to fill in more detail of this.

Cholera Mitigation Case Study

africaahead — Wed, 20 Jan 2010 11:39:31 +0000

Community Health Clubs were started in Mutare, Zimbabwe in an effort to combat the rapid spread of Cholera in Zimbabwe in 2009. This is an inspiring account of how well mobilised women were able to role back this deadly threat and prevent any daths from cholera in this high risk area. The paper presented at IWA Conference in Mexico 2009, also includes an example from Uganda where overcrowding and poor sanitation in IDP Camps was similarly addressed through Community Health Clubs.

Cholera Mitigation in Zimbabwe and Uganda 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.

Celebrating Ubuntu

africaahead — Mon, 18 Jan 2010 06:47:04 +0000

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.

Hygiene Behaviour change monitored in Umzimkhulu

africaahead — Mon, 18 Jan 2010 06:40:57 +0000

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.

Hygiene Promotion Partnership

africaahead — Sun, 06 Jan 2008 13:53:07 +0000

The Hygiene Promotion Partnership (HPP) intervention will consist of training communities in safe hygiene at household level, coupled with the use of cleaning products, particularly soap for hand washing. There are 70 community based facilitators each responsible for two clusters of 10 households. The clusters are in effect small scale health clubs and the methodologies used are similar. The cluster members have a strong identity, and meet regularly to discuss health issues, and monitor their own health problems each week. At each session participatory sessions with illustrated cards are used and this helps them focus on key hygiene practices which put them at risk from debilitating diseases. The most common of these are diarrhea, dysentery, pneumonia and other bronchial diseases, skin diseases such as scabies and ring worm and intestinal parasites that cause malnutrition. Africa AHEAD is developing the training material and mentoring trainers in the training methodology used in the intervention group.

A manual is being developed that will enable training to be scaled up in South Africa. Africa AHEAD has commissioned almost 200 pictures to be drawn, which will be used in card sets for participatory (PHAST) activities. The 50 page manual will be divided into two main sections:

1. Training in the Community Health Club Methodology

2. Training in Participatory activities with particular focus on issues in informal settlements in South Africa

The manual has been supported by the City Health Department of Cape Town, and will be printed by the end of July.