Village Network Africa Replicate CHCs
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.
Comparing CHC and CLTS
The debate about the pros and cons of different strategies that are being used to mobilise communities and induce them to change their behaviour rolls on and this well reserached paper can add some factual information to the discussion. It summarises the outputs of latrine construction in three different projects areas in Zimbabwe. The CHC programme is our own project in Chiredzi run by Zimbabwe AHEAD which is compared to a CLTS programme run by PLAN International. They are then compared to an area where both strategies of CHC and CLTS have been used.
” CHCs were significantly more effective than CLTS in two key respects. Firstly, more people disposed of their faeces by some method other than OD (92% versus 77%), and secondly, the number of people who owned a HWF was far greater in the case of CHCs (64% versus 10%, p,0.0001). In terms of sanitation, only 26% of CHC respondents owned a latrine, although all of them had been built since the intervention started. A large number therefore (66%) claimed to practise cat sanitation; 44% of CLTS respondents owned a latrine, and it is interesting to note that 57% also shared their latrine with others, as opposed to 0% in the case of CHCs.”
The authors note the following:
Firstly, the CHC sample was a much poorer group and as they points out, building a latrine is strongly related to cash flow of the household. However despite lower income, 26% of the CHC households had built latrines since the project started with no subsidy. With another 66% practicing cat sanitation, there is a 92% sanitation coverage in CHC areas, with only 8% still defecating in the open. In the richer areas where CLTS was sampled, 57% claimed to share a latrine but this as this is reported rather than observed, it is doubtful whether this is in fact the case, they are likely to be embarrassed to admit they are using the bush! Although there was a better coverage of latrines in CLTS, none of them had been build since the triggering, so surely this is the point: CHCs have resulted in action, CLTS has not.
The second point which is in this paper is that whilst CLTS has a negligible effect on hand-washing with only 10% with a hand-washing facility, the CHC areas show a 66% improvement in hand-washing, which goes a long way in blocking the fecal-oral route. The use of a latrine on its own, does not decrease diarrhoea effectively as there are so many other routes for germs to spread.
Finally, it is worth remembering that the building and maintenance of latrine and hand washing were the only two indicators that were compared in this research. Although this is the sum of the CLTS outputs, there are a wealth of other behaviour changes which have been achieved in the CHC Project. There is no mention at all about the immaculate kitchens and compounds, the management of solid waste and the cleanliness of the beneficiaries themselves because the research is narrowly focused on WATSAN issues in order to stay within the limited length and scope of a Masters Thesis.
Neither does the paper attempt to discuss the ethical aspects of the two approaches and there is little focus on whether the approaches are appropriate for the culture of the area.
However with more and more stories about the appalling way in which some community leaders in India have been assert their authority in order to coerce villagers into ODF, many planners are going off the quick fix that is the CLTS approach. They are beginning to look for a less contentious methods, which are in line with cultural values in Africa for equity and respect for elders. ‘Naming and Shaming’ may be acceptable in the caste-ridden culture of Asia, but in Africa to expose ones mother-in-law to shame because her turd was identified near her home is tantamount to an outright insult and could damage family relations permanently Perhaps this sensitivity is one of the reasons so many African countries are trying to find an alternative to CLTS, despite the hard sell by the proponents of the approach, who have been touring Africa in an aggressive attempt to sell their dubious product. This is a pity as there are other more beign and more sustainable ways of achieving a demand for sanitation.
This paper provides a scientific rationale for using the more holistic CHC approach which uses positive, rather than negative peer pressure, to persuade people rather than embarrass them into changing their traditional behaviour. Why have a narrow programme which goes only for sanitation with the limited CLTS approach when you can get the whole raft of public health measures achieved, and be sure to not only minimize diarrhea but also malaria, bilharzia, skin disease, and worms all for the same cost. Its a no brainer, but it has needs research of this type to provide the proof. So here it is!
Give this a read: link http://africaahead.org/publications/2011_Whaley_CHC.pdf
I’m Not Nobody Now: Story is a winner
IRC has recently selected the story that we submitted as one of the winners in their competition for articles that inspire good development.
It is the moving story of Mrs Toriro and stands as our epitaph for a courageous and hard working women whom we have selected as a role model for other Community Health Club Members. She rose from being an unknown rural women to being a District Trainer with Zimbabwe AHEAD, but sadly died prematurely in 2010.
Distinguished Woman Leader in Sanitation
The AMCOW AfricaSan Awards are dedicated to recognizing outstanding efforts and achievements in sanitation and hygiene in Africa which result in large-scale, sustainable behavior changes and tangible impacts. They aim at raising the profile of sanitation and hygiene by drawing attention to successful approaches, promoting excellence in leadership, innovation and sanitation and hygiene improvements in Africa, and providing incentives for action.
The awards initiative is organized by the African Ministers’ Council on Water (AMCOW), in collaboration with the Water Supply and Sanitation Collaborative Council, the Water and Sanitation Program (WSP), the African Development Bank (AfDB), UNICEF, the UN Secretary General Advisory Board on Water and Sanitation (UNSGAB), UN Water Africa, WaterAid and the Africa Civil Society Network on Water and Sanitation (ANEW), among other partners that comprise the AMCOW Sanitation Task Force.
Dr. Juliet Waterkeyn as pioneer of the Community Health Club Approach, was a Finalist in the Distinguished Woman Leader in Sanitation category for 2010, which honors women for their commitment and outstanding contributions to improving the state of sanitation and hygiene.The award carries an honorarium, trophy and certificate, and was presented at a special ceremony at the 3rd Africa Water Week in Addis Ababa in Ethiopia. The ceremony took place on Wednesday, 24th November 2010 at the Hilton Hotel.