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Hygiene Promotion in Burkino Faso and Zimbabwe: Two new approaches to Behaviour change.

This Field Note, published in World Bank/Water & Sanitation Programme Blue Series  in 2002 describes two African hygiene promotion programmes that have successfully used new approaches: Programme Saniya in Burkina Faso, and ZimAHEAD in Zimbabwe. They both concentrated on understanding how people actually behave and hence how to change that behaviour, and they both demonstrated ideas that can be applied at a larger scale.

2002_WSP.pdf


 Taking PHAST the Extra Mile

In 2004 there was a hot debate in the WASH Sector as to the effectiveness of PHAST as a methodology for achieving hygiene behaviour change.  WSP-EA (World Bank) was trying to do a U-turn on the support it had been giving to PHAST projects which had just been piloted in 5 countries in Africa. Africa AHEAD founders instead advocated for a more thorough use of the participatory activities used in the Classic PHAST training. We had used PHAST within a more structured programme in the CHC approach and found this to be effective in achieving high levels of behaviour change. We wanted WSP to support this rather than turning its back on a programme that could be made to work. Our arguments went unheard!

2005_PHAST


In 2006, there was a general call to scale up programmes that worked in order to meet the MDG targets. With the CHC methodology largely unknown and where known often ignored by sceptical individuals who were the gatekeepers of influential agencies, The Founder wrote this appeal to funders following her findings from her PhD  at the London School of Hygiene and Tropical Medicine  and recently published papers showoing evidence of community adherence to recommended practices in Community health Clubs (Waterkeyn and Cairncross, 2005).

2006. Waterkeyn J. 


Celebrating Ubuntu: Community Health Clubs Graduating in Umzimkhulu

Jason Rosenfeld

‘Informed decision-making through active participation and consensus building, changes a loose connect


ed community into a ‘real community’ with ‘Common-Unity’. The inspiration for the CHC concept is closely linked to the South African understanding of ‘Ubuntu’, community togetherness and mutual support, which is an indication of a healthy Community. This attention to social cohesion is the hallmark of the CHC strategy, which should ideally be a process of development that begins with health promotion and hygiene behavior change… ‘ so wrote Jason Rosenfeld the Project Manager for this project.

2009 Rosenfeld J. Umzimkhulu a place with a bright future


 The Metro Health Club: Grassroots Action for Improved Community Health in the Western Cape.

Juliet Waterkeyn.

Since 2005  Africa AHEAD has been trying to introduce the concept of the Community Health Club Methodology into the informal settlements of the Western Cape. This has presented quite a challenge and it was open to debate whether the CHC approach, so effective in the rural areas, could really have the same appeal in the squatter camps of the Mother City, where there is little community cohesion, and where alienation of marginalized communities and political infighting by gate keepers has undermined so much development

2009.10.Cape Town Metro Health Club


 Garikai: the Pride of the Poorest of the Poor

Juliet Waterkeyn

Five years ago during the infamous Marimbatsvina Campaign, launched by government to clean up Zimbabwe, the shack dwellers of Mavingo were displaced by draconian measures that eradicated most informal settlement. Some of those displaced were finally given core houses on a patch of dry bushland on the outskirts of Masvingo, which although undoubtably better than their shacks were without any sanitation or solid waste collection. There was limited water with only a couple of communal taps for the 100 households that were resettled. Garikai became synonymous with the poorest of the poor in Masvingo, a place where no one was proud to belong. Then Zimbabwe AHEAD started a community Health club and a transformation took place.

2010. The Pride of the Poor


‘I am not Nobody Now’

Dorothy Toriro

‘This is the story of how my life changed when I became a health club member. In 1995, I was dumped by my husband. At first I was in difficult times as we had no money, until I joined the Community Health Club started by Zimbabwe AHEAD Organisation and we were taught how to self realise. We called our club ‘Rujeko’ meaning Light!’ Read the full story.

2011. I am not Nobody now


Empowerment Not Aid  

Juliet Waterkeyn

Community Health Clubs, like the famous Boy Scout Club can bring light and change to a community and enable people to take charge of their own health and prevent common diseases that kill their children. Knowledge can divide infinitely and as Nyerere said, ‘ In Africa, we sit under a tree until we agree.’ With the immense difficulties of meeting the vast demands for Africa, the  targets can only be met if the people themselves change their own life. Self reliance brings dignity, not dependence. This is not AID but empowerment.

2011. Empowerment not Aid


Low cost-high Impact: Hygiene Behaviour Change in Vietnam in Community Health Clubs

Juliet Waterkeyn and Nguyen Huy Nga

Vietnam is the first country in Asia to use the Community Health Club (CHC) Model of development in a pilot project by Ministry of Health in 3 Northern provinces in Son La, Phu Tho and Ha Tinh districts. In Son La district, 387 households (70% of the CHC members) improved their sanitation facilities, without any subsidy during a one year period (Ministry of Health, 2010). Diarrhoea, dysentery and food poisoning, have all shown a steep reduction of reported cases: an average of 61 saved cases per commune with total number of reported cases dropping from 134 to 17 cases in one year per commune, as opposed to non CHC communes, which reduced on average 24 cases per commune (from 99 cases to 75). At an estimated cost of only US$1.30 per beneficiary for six months of weekly health promotion sessions, the CHC model is considered by Ministry of Health as ‘low cost – high impact’. Within an emphasis on group consensus, the CHC Model resonates with cultural norms in Vietnam and has demonstrated that sanitation coverage can be improved with no subsidy, and communicable diseases have been significantly reduced, simply by harnessing the power of peer pressure to ensure safe hygiene standards.

2011.9.Vietnam_Waterkeyn__Nga


Community Health Clubs to ensure women benefit from the Arab Spring

A woman alone cannot stand up to her husband, but the club members are a force to be reckoned with! Community Health Club a build confidence and self-efficacy in every mother so she can take control of her own health (body and mind). In this way we can infiltrate traditional structures of power and undermine the conventional wisdom without causing a back-lash. This subtle approach would also be useful in Muslim countries, rather than attack the status quo head on. The combination of endorsement by authority and the enlightened information given in the health clubs, makes an ideal transition phase for the peasant ignorance to becoming fully informed.  You mention the need for rational education, the need for Christian missionary work to convert Muslims, and advocacy by feminist groups but I want to recommend our method, Community Health Clubs as one of the ways forward to operationalise this change in a practical way. This  programme could be introduced in Muslim countries where the macro environment is now enabling change, in Tunisia, Libyia and Eygpt, and others which are following their example, providing women with a sanctioned opportunity once a week to meet and support each other, and have some intellectual stimulation.

2013. Letter to Ayaan Ali Hirshi

 


Participatory implementation of sanitation infrastructure in urban areas of north-central Namibia

Dr. Jutta Deffner & PD Dr. Thomas Kluge

The CuveWaters sub-project on sanitation and water reuse is implemented by the Institute for Social-Ecological Research ISOE and Technische Universität Darmstadt IWAR in collaboration with the local Town Council (OTC) and Roediger Vacuum as the German industrial partner. It involves putting in place different sanitation-enhancing options to allow infrastructure to adapt to urban transformations and to improve basic sanitation conditions in general. The options to be considered are sanitary installations in private houses (individual solution), sanitary facilities for small neighbourhoods in informal settlements (cluster solution), and the concept of a communal sanitation house in a densely populated informal settlement (community solution). A re-use concept of sewage comprises the treatment and preservation of plant nutrients for agricultural use along with production of the energy required to operate the facilities. The construction and operation of the pilot installations are accompanied by participatory processes and academic monitoring and evaluation. The idea of participation plays a particularly important role as the project team is only too aware of the socio-cultural challenges that can arise with the introduction of such technically advanced solutions. For this reason, the aspect of behaviour change is tackled by means of a comprehensive, community-based approach (Waterkeyn et al. 2010; Deffner and Böff 2012). The IWRM project is furthermore embedded in existing political and administrative processes.

2012.Namibia Water_and_Risk_Vol_21_print


Common Unity in Community

Juliet Waterkeyn (2015)

This article questions whether we can assume that all Communities are functional, and  provides the rational for using the CHC Model as a means of creating social capital and organisation with a community so that shared values result in coordinated hygiene behaviour change.

Common Unity or community


Segni should have lived 

This moving article describes the tragedy of the death of one baby dying in Guinea Bissau and serves to wake us up to the reality of the 800,000 babies who die annually in Africa from preventable diseases. The argument is that these deaths would never have happened if there had been a Community health Club to support the mothers.

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