HOW WE DIFFER

How Africa AHEAD is ‘doing development’ differently from other organizations?

As explained in the Section describing the CHC Model, we have an integrated approach to community development which is inter-sectorial. However we use Health Promotion and Hygiene Education as an entry point and this our model of Community Development starts in the WASH Sector. Of the various strategies used in the past decade we are most often in competition with two established alternatives PHAST and CLTS, both of which have some common features but as built on different assumptions (see below).

Whilst there is nothing new about Women’s Groups, ours is a ‘Community’ group made up of men and women trying to bridge the understanding gap together. There are few, if any other mobilization  strategies ‘on the market’ that create community structures in villages in Africa, which are able to address ALL issues that threaten infant and child survival at village level.

Community Health Clubs may be compared to the Scout Movement or a religious group, which has a captured membership who adhere to specific values. We use the same social mechanism: appeal to group values to develop a certain ‘culture of health’ which then directs all behavior. This is very different from initiatives that target the outputs without seeking to change the core values which dictate these outputs. We seek to address the cause rather than treat the illness.

The Community Health Club (CHC) Model, developed by Africa AHEAD, is a practical and proven strategy that achieves the following:

1. HOLISTIC PACKAGE: The CHC Model addresses all preventable diseases (diarrhoea, cholera, malaria, pneumonia, skin disease, HIV/AIDS, worms bilharzia, ebola etc.) that are jointly responsible for 87% of infant mortality. 
2. WHOLE COMMUNITY:  CHCs build capacity of everyone within the community, and it especially empowers women and mothers so that families themselves can manage their own health.
3. BROADLY FOCUSED: The CHC model targets 50 different indicators related to all preventable disease.
4. INTEGRATED: The CHC Model is cross-sectorial (Health, Water, Sanitation, Gender, Education, and Nutrition).
5. CULTURALLY SENSITIVE: The CHC model reinforces cultural norms of respect and politeness which are important in traditional societies in Africa and thereby encourages group consensus and support.

Comparison to PHAST

Our work is often compared to PHAST, Participatory Hygiene and Sanitation Transformation) which was a popular community mobilisation strategy of the 1990’s.

The Director of Africa AHEAD was involved in PHAST in the early days and helped to develop the Tool Kit for PHAST which was used nationally and which Africa AHEAD still uses in the weekly sessions in the community Health Clubs.

We have adopted many of the PHAST participatory activities but we have grounded this training in a more comprehensive and structured approach.

How we have Built on PHAST

The CHC Model is an evolution of PHAST, which is explained further in an article intitled Taking Phast the Extra Mile (Waaterkeyn J  & A. 2005)

Click here for full paper  2005_PHAST

The  various gaps in PHAST that we  identified which could account for lack of sustained Hygiene Behaviour Change include:

1. Not enough community interface: usually 5-7 sessions – we extended this to 20 sessions

2. Not a well defined target group: PHAST sessions targeted the whole village loosely and were not able to identify the most active people from gatherings:  we enroll a definite committed membership representing each household which enable us to meet the same people each week so we are able to move forward, building and reinforcing our messages  over six months.

3. PHAST only addresses diarrhoea: we address all preventable diseases.

4. PHAST is focused only on water and sanitation  related activities: we address most  aspects of community development (livelihoods, gender, rights)

5. The objective of PHAST is the maintenance of water/sanitation facilities : our objective is the prevention of all common disease.

Comparison to CLTS

Our work is routinely held up as an alternative to Community Led Total Sanitation (CLTS).

Whilst we are concerned about improving open defecation this is one of 20 different topics which we are focused on in the course of our community training.

Sanitation, in terms of latrine construction is not an end point for us, but merely an observable  indicator of hygiene consciousness. We can however also claim that all our projects are community led and also result in total sanitation. But the comparison ends there as we approach the community in a very different style.

Five reasons we do not use the Classic CLTS method

1. CLTS has only 1-2 triggering sessions. Whilst we do a similar village walk it is not linked to ‘shame or embarrassment’ but is constructively done by the group themselves once they have understood the issues of open defecation. It is therefore the community who lead the process rather than outsiders pointing out that they are ‘open defecators’.

2. We consider this full frontal attack on a community being visited by visitors for the first time, is unacceptable in Africa. It is culturally insensitive and ignores norms of politeness in most,  if not all, African societies. It is simply rude to address chiefs and leaders in the manner required by the triggering of CLTS.

3. The triggering in CLTS is meant to throw up ‘natural leaders’ self styled volunteers who have been shamed into a declaration that they will dig a pit latrine. As these are invariably young able bodied men, they are not necessarily the leaders who would have been selected by the community had they been consulted. This process marginalises women. – The CHC Model enable women to organise themselves to get their latrines dug.

4. There is little is any technical support provided to villagers who have to work out how to build a latrine for themselves. With sometimes no experience of a ‘proper latrine’ the product is usually a shoddy imitation of what they imagine should be built.  These temporary latrines seldom last a season. They collapse in the first rains leaving a death trap of an open pit  in the middle of a village. This is a public danger for drunks and toddlers.

5. The opjective of building a latrine is not primarily for the ‘dignity’ of the person’s privacy, although this is often sited as desirable. Open feaces attract flies which then settle on food, spreading diarrhoea. Therefore by defecating into a pit it is important prevent flies entering the pit, for the same reason. However, as most CLTS temporary latrines are left open they are in fact merely ‘fixed point open defecation’ and fly breeding sites which probably add, rather than decrease the level of feacal oral transmission which results in more, not less diarrhoea. Therefore the objective of  safe sanitation is not met.

Read the only evaluation which directly compares CLTS and CHC

Click here for full paper: 2011_Whaley_CHC