Report by Morgan Hayiza

ZimAHEAD Project Officer.

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

Report by Morgan Hayiza

ZimAHEAD Project Officer.

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

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

Masvingo RDC

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

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

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

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

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

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

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

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

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

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

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

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, [...]]]>

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:

1. Turning crisis into opportunity
2. Formalizing traditional elements into administrative frameworks
3. 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

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

Goal:

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

Objectives:

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

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

Introduction

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

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

Public Health Promotion

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

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

Community Health Clubs

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

School Health Clubs

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

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

Global Hand Washing day Commemoration

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

Water Supply

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

NFIs

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

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Notes from the Field

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

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

Since November 2009, when Ministry of Health (MoH) in Vietnam first decided to use the [...]]]> August 2010. J. Waterkeyn

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

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

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

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

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

A Sing Song at the first CHC we met in Vietnam

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

A traditional Vietnamese instrument provided fascinating wailing music

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

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

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

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

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

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

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

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

In response to a strong request by the Ministry of Health, Danida agreed to sponsor the introduction of the Community Health Club (CHC) Approach, and the originator of the methodology, Dr. J. Waterkeyn (JW) was invited  to provide training and mentor local consultants so that  [...]]]> COMMUNITY HEALTH CLUBS TO BE STARTED IN VIETNAM

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

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

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

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

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

South Africa KZN Rural Case Study

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 [...]]]>

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.