The Community Health Club Strategy is an entirely new methodology in Sierra Leone. As such Watershed is being carefully scrutinised by other NGOs and Government Ministries who are interested to see whether this strategy can be replicated in other projects in the country. Being a pilot project, it has been particularly important to monitor and assess the effectiveness of this approach with a view to replicating it in the next area of operation.
Community Health Clubs provide a social structure within each village that should ideally take full responsibility for the health and well being of all members of that community. It is thus a long-term strategy that is particularly appropriate in the Sierra Leonean context where communities are only now returning to their villages to rebuild their shattered lives after ten years of civil war. It was projected that the CHC approach would assist the restructuring of village life and provide an entry point for other development initiatives within the villages both by CARE and by other agencies. Within ten months of operation the Community Health Clubs have in fact exceeded all expectations, and have already provided empirical evidence of their effectiveness, not only in providing a solid social foundation for development, but in their ability to rapidly improve home hygiene.
The perception of the communities consulted in a survey of 19 out of the 29 villages in this project, is that the health education sessions have already reduced many diseases, particularly diarrhoea and skin diseases, purely through improved health knowledge and change of attitudes and beliefs. Although it is hard to believe, the communities repeatedly mentioned that levels of fly and mosquito infestation have indeed dropped and they believe this is as a result of their improved hygiene practices and safe drinking water. If this is so, the project will be unique, as it is notoriously difficult to achieve a decrease in these diseases due to the raft of improvements that need to be consistently made by all members of the village. However, given the strong cohesion of these villages, which have enacted mandatory by-laws to enforce CHC practices, and the fact that in all 19 villages visited, every household was represented by one or more CHC member, (i.e. 100% coverage) this may well have been achieved.
There is also empirical evidence on the ground that there have been many fundamental changes in hygiene behaviour. It is now obvious, even to the casual observer, driving on the main Freetown-Moyamba-Bo road, which villages have CHCs. Each house has its own plate rack, numerous bamboo washing poles have been erected and clothes are hung to dry, whereas in other villages both utensils and clothes are left on the ground. The CHC villages tend to be very well swept, and have designated refuse disposal sites at the edge of the village. They are also identified by the new Community Health Wells, which use a windlass rather than a hand-pump. Most houses are in the process of constructing their own latrines, although with the superstructure being made of local materials, resembling the huts themselves, they are difficult to identify from afar. The level of demand for improved sanitation is outstanding by general development standards in Africa. A walk through any CHC village will confirm that, whereas before this intervention there was widespread open defecation practiced, there is now minimal fouling around the nearby bush. According to all the CHC villages visited in this evaluation, cat sanitation is now mandatory, as are all other recommended CHC practices. If this is so, there may well be disease reduction. It is evident that in some of the more successful CHC villages the levels of child malnutrition is decreasing. In one instance, the steep reduction of outpatients from a CHC village has been noted by the local clinic. Most importantly, the villagers themselves are confident in their ability to prevent and cure diarrhoea in particular, and have taken responsibility for their own health.
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