AHEAD Model
The AHEAD Model of development uses Community Health Clubs as a ‘vehicle for development’. The model is a simple, but structured training methodology that leads to sustainable livelihoods through improved family health and hygiene. The ‘entry point’ in this strategy is health education, which empowers Health Club members with the confidence of knowledge. This leads to informed decision making, an essential foundation for positive behavioural change. The training uses lively Participatory Techniques (PRA/PHAST) that fully involve and actively amuse members whilst also teaching primary health care. The AHEAD model promotes a holistic approach to development and views it as a long term process that has to meet the socio-psychological needs of each particular community. The initial focus on ensuring community cohesion through structured health promotion activities has proven to be ‘the missing link’ that can help achieve sustainable development.
The AHEAD Model in its fullest sense is a Four Phase process, which encourages the holistic development of a community over a four year period. However, in an emergency context this process can be reduced to a quick 6 month intervention involving minimal health promotion focusing on water and sanitation. Below is a table outlining the Four Phases of the AHEAD Model and the major activities that occur during each Phase.
| Community Mobilisation | Applied Health Education | Skills Training | AIDS Awareness |
| Formation of Health Clubs | Safe Water | Income Generation | Creation of Home Based Care |
| Creating Common Unity | Safe Sanitation | Financial & Management Training | Care of Orphans and Widows |
| Health Promotion | Productive Water Points | Adult Literacy Training | Use of Medicinal Herbs |
| Home Hygiene Improvements | Counselling & Coping Mechanisms |
The AHEAD Model aims to develop a sense of identity amongst health club members combined with a dedication to standards and norms of behavior developed and endorsed by the group. The basic assumption is that a genuine community does not exist until it is purposely manufactured. A collection of people living in the same area does not automatically imply that they are a ‘community’. This has to be developed through a patient process of stimulating a ‘common unity of perception’ and shared values. However, as soon as this social process begins, members of the club begin to establish their own standards of hygiene and a sustainable ‘demand-led’ approach will be the result.
A key misconception in past development initiatives has been the ethnocentric belief that a person will necessarily change when presented with a rational reason, or opportunity for self-improvement. This ‘Health Belief Theory’ derives from the individualistic Western outlook and is in direct conflict with the consensus-seeking traditional African worldview, where the individual is subordinate to the group. In conventional approaches one will find that individuals who wish to avoid the criticism of more conservative neighbours will simply ignore hygiene recommendations. Contrary to the cynics who may mistake this laissez-faire attitude for idleness or stupidity, this passive resistance indicates that recommendations are in conflict with majority behaviour. To be outside the group is dangerous in a society based on consensus. Therefore, it is the designers and managers of programmes, not the recipients, who are mistaken in their endeavours. The AHEAD Model, on the other hand, encourages the whole group to endorse decisions, thus removing any individual fears or risks of ‘going it alone’.
The Community Health Club Strategy is effective because it appeals to the whole village, and once there is consensus, most individuals make an effort to conform. This strategy may take longer at the start of an intervention project, but can achieve far greater results in the end. For example, 11,000 latrines were built within 8 months in IDP Camps in Uganda with demand far outstripping the capacity of the programme. This contrasts sharply with many sanitation programs which report that they are unable to convince ‘beneficiaries’ of the need for improved household sanitation.
In summary, the Community Health Club Strategy is consistent with the school of development thinking that argues for long-term, broad development, rather than vertical programmes that address particular problems, but yet ignore the fundamental problems that have retarded development. The basic assumption of the ‘Community Development’ approach is that ‘communities’ are dysfunctional, and that until the ‘social capital’ within them is increased in terms of knowledge, organisation and capacity, no amount of aid will produce sustainable improvement. The promotion of self-efficacy is the key objective in the process of empowerment and is one of the basic assumptions of this strategy. It is for this reason that communities need to be assisted through capacity building interventions, such as participation in a health club, before implementation of development projects can succeed.
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THE AHEAD MODEL IS ATTRACTIVE TO FUNDING AGENCIES BECAUSE…
- Stimulates a demand for sanitation to meet United Nations Millennium Development Goals (2000)
- Quantifiable achievements in hygiene behaviour change
- Proven to be a Cost-Effective Model (under US$1 per person)
- High levels of hygiene improvement
- Proven strategy over past 10 years
- Can be scaled up to national level
- A reliable vehicle for all development (health, agriculture, poverty reduction, HIV/AIDS)
- Replicable in Developing Countries
- Appropriate in peri-urban or rural areas
- Appropriate in for long term development or emergency
- Clear exit strategy
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