Zimbabwe – Scaling up the Community Health Club Model

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Zimbabwe – Scaling up the Community Health Club Model, 2009. (pdf, 645KB)

Juliet Waterkeyn & Andrew Muringaniza. Africa AHEAD Association.

It is clear that CHCs are not only a popular strategy but that they do in fact produce high levels of hygiene behaviour change. Zimbabwe is not the only country to report good case studies of the CHC approach. In West Africa, Community Health Clubs are being used to rebuild society after a devastating civil war. In Guinea Bissau CHCs in remote rural villages complement an intervention to improve infant mortality, and in Uganda, CHCs have been used to improve home hygiene and create a demand for sanitation in the war toen IDP camps of the north. Whilst in these examples the CHC approach is being done through NGOs on a fairly small scale, in Rwanda the Ministry of Health is planning to introduce health clubs into everyone of the 14,000 villages in the country. In Asia, Vietnam leads the way with training through the MoH which aims to start CHCs in all 25,000 villages. Countries where this can be scaled up may well be able to meet the MDG
targets, given the power of CHC to stimulate demand led safe sanitation.

Zimbabwe – Community Health Clubs in Urban Areas

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Zimbabwe – Community Health Clubs in Urban Areas, 2009. (pdf, 446KB)

Juliet Waterkeyn & Regis Matimati. Africa AHEAD Association.

Most countries in Africa will fall short of meeting the MDG targets for the provision of water and sanitation due to lack of financial and institutional capacity (WSP-Africa, 2006). Although safe sanitation has been found to be the most effective single intervention in reducing diarrhoea (Esrey, et al.1991), this does not necessarily mean the building of latrines, as these can become a fly breeding ground if they are not sealed properly, and further compound the spread of diarrhoea. The faecal-oral route can be broken much more easily and a lot more cost-effectively through faecal burial and hand washing with soap (Curtis & Cairncross, 2003). After more than a decade of pilot projects in many countries in Africa the Community Health Club (CHC) Approach can reasonably predict behaviour change, and ensure zero open defecation and handwashing with soap. By creating a strong demand for safe sanitation and a ‘Culture of Health’ that insures good hygiene (Waterkeyn & Cairncross, 2005) Community Health Clubs can become a potent mobilisation strategy in emergencies not only in rural areas but, as this case study shows, in urban areas as well. During the cholera outbreak that affected 12,700 people and claimed 420 lives in Zimbabwe, the a high density suburb of Sakubva, in Mutare, only had 4 cases and no deaths. This has been attributed to an environmental clean-up and improved the hygiene behaviour due to the efforts of 5,400 members in 36 Community Health Clubs.

Uganda – Community Health Clubs in IDP Camps

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Northern Uganda – Community Health Clubs in IDP Camps, 2009. (pdf, 444KB)

Juliet Waterkeyn. Africa AHEAD Association.

CHCs can be successfully replicated in a variety of contexts: urban and rural, informal and high density, underdeveloped and partially developed as well as within both Christian and Moslem societies. It has also been demonstrated that the Community Health Club Approach is particularly cost-effective when it is scaled up and that family health can be improved for as little as 33 cents per beneficiary (Waterkeyn & Cairncross, 2005). There is now no doubt that the CHC approach can achieve high-impact and sustainable hygiene behaviour change but it is questionable whether scaling up can be achieved fast enough through local NGOs or international agencies. As it is unlikely that the water & sanitation MDG targets will be achieved in many African countries, it is perhaps more realistic to invest in health promotion for self reliance and halve the number suffering from many preventable diseases through improving family hygiene. As demonstrated by countries like Rwanda and Vietnam, it should be possible to roll out health promotion through existing health extension staff and, at a minimal cost, introduce Community Health Clubs into every village in the country. If using this process, the minimal standard of Zero Open Defecation is the target in every village, the MDGs could in fact be achieved to some limited extent.

South Africa – Monitoring Hygiene Behaviour Change Through Community Health Clubs

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South Africa – Monitoring Hygiene Behaviour Change Through Community Health Clubs, 2009. (pdf, 366KB)

Juliet Waterkeyn & Jason Rosenfeld, Africa AHEAD Association.

Umzimkhulu Municipality in Kwa Zulu Natal Province has one of the lowest levels of development in South Africa. The base-line survey highlights that only 15% of households have access to a safe water source whilst the remaining households have to use open ground water, usually in the form of unprotected springs. Sanitation usually consists of a household pit latrine. Although the coverage is high at 90%, around 50% were unhygienic and attracted flies. A health promotion campaign was introduced to build the capacity of the community, with the objective of developing a community-led demand for improved water and sanitation. As the Community Health Club Approach is known to be capable of achieving high levels of behaviour change (Waterkeyn & Cairncross, 2006) it was chosen as the strategy for a health promotion campaign in nine wards of Umzimkhulu. Although Africa AHEAD has initiated Community Health Clubs in informal settlements in Cape Town, this is the first pilot project in South Africa to be implemented in a rural community.