A Community Health Club programme in 150 villages in Rusizi has been running since 2013 as part of intervention for a Randomised Control Trial to test the efficacy of Community Health Clubs in to mobilise communities to take action in safe hygiene so as to prevent diarrhoea. Africa AHEAD, responsible for supporting the monitoring of the intervention, hosted a two day workshop to consult the District stakeholders as to how the intervention had measured up to expectation in terms of community mobilisation and hygiene behaviour change.
Twelve representatives, Environmental Health Officers from the Health Centers, who had taken part in the intervention were all present as well as the Vice Secretary of the District and Hygiene and Sanitation Officer. The senior district leadership were divided into two groups to discuss if the intervention had shown any impact and if so in what way, as well as any issues arising. The feed back by the two groups was consistent as both noted there had been a lot of health improvement, especially with child hygiene and sanitation. There was unanimous agreement that the CHCs had clear impact, which they believed was reflected in the data collected over the period. More detailed project records from the ASOC would be able to corroborate their impressions.
They listed some challenges which included the ‘short time to get through session’, and that ‘monitoring and follow up was not done properly due to lack of transport allowance’, and that the Health Centers could not always provide access to a motorbike for EHOs to go to the CHC sessions, although the project had been provided with 6 new Motorbikes for this purpose. However, due to shortage of transport allowance, the EHOs had not visited as often as was prescribed and the CHCs were largely run by the local ASOC (voluntary field worker) had been left to organise themselves without external support. ASOC had been called in to run the programme nationally, instead of the village health worker who was taken off the job to focus more specifically on child growth and montoring. However, ASOC are only responsible for community mobilisation and do not have any background in health. The CHC training was not enough for them to be effective as health workers leading the CHC. Therefore whilst some were successful other relied on the EHO for support but this support was limited. Those EHOS who lived within the community were able to achieve better response.
Once the EHOs had presented their interpretation of the intervention, the CEO of Africa AHEAD presented the project monitoring data, collected by the EHOs over the past 3 years from the base line in 2013, the midline in 2015, and the endline in 2016. The preliminary results of three data collections collected over past two years were encouraging in most villages, although there was a wide range of response. The villages had been ranked in order of response, measured in terms of % coverage of CHC member households, number of members, number of sessions completed, average attendance of sessions and number who completed all 24 sessions. The District were able to see which were the top performing CHCs and which villages still needed more support to get going. The data also showed that although the response in Rusizi was not as high as the expected 80% coverage, the coverage increased over time and the 50 Classic villages had achieved an average of around 60% coverage by the time the IPA final data collection took place. Whilst it is difficult to take a mean of the levels of behaviour change, project records show that the 40% improvement in Sanitation and handwashing in 50 classic villages after only 6 months was on a par with some of the better projects in Zimbabwe, which is seen as a bench mark for CHC performance internationally. The Head of Health was provided with a copy of the study, still in draft awaiting the final data collection in March 2017.
See full Process Evaluation of Community Response in CHCs in Rusizi
Click here: 2016-10-process-analysis-of-rct-in-rusizi_jw-web
The Vice Secretary of the District had received nothing but positive feedback from Sector Heads who were reporting great changes in their areas. He opened the meeting with a fervent speech on the changes that have apparently taken place in Rusizi. He credited the CHCs as having contributed in large part to the fact that Rusizi District has risen in the national Imihigo league tables from 4th bottom to 4th top out of 30 Districts in the Country. He said, ‘whilst they had seen cholera outbreaks each year but now it is seen that where the project has been implemented cholera is reduced a lot.’ He was disappointed that Africa AHEAD had only worked in 150 villages out of the nearly 600 villages in the district and he urged the organisation to remain and complete the job, and they are preparing a report on AA performance. He said Africa AHEAD had been ‘a good partner from the beginning with strong cooperation and strengthening the environmental health structures by involving the EHOs in monitoring.’