Half an hour from the beautiful city of Cape Town, where a green ribbon of sophistication wraps around the famous Table Mountain, stretch the infamous Cape Flats, a flat gray carpet of chaos and crime where the less fortunate flock to seek work. The swelling numbers of migrants, mainly from the Eastern Cape, dwell in the squalor of 240 ‘informal settlements’, a flattering name for a shack-land of permanent squatters. The active City policy claims ‘We work for you’ but the lack of adequate sanitation is a critical issue, and beleaguered civil servants battle with limited staff to meet the promise of providing free sanitation facilities to all. With 600,000 in the Western Cape using poorly maintained chemical toilets, or even a simple bucket, the great un-served still have to defecate in the open. The problem is immense, and there is little chance that the target of eradicating the ‘bucket system’ by 2012 will be achieved as a never ending stream of migrants continue to pour into the Cape Flats.
Africa AHEAD was asked by the City Health Department to start a pilot project using Community Health Clubs to minimise preventable disease and to help build a more responsible attitude to sanitation and the disposal of solid waste. The training started this month (10th – 15th March 2008) and the project is to operate in four main areas: Khayelitsha, Philippi, Eastern and Klipfontain. Apparently this is also the first project ever to combine the resources of the Health Department with the Water Department in Western Cape and will hopefully pave the way for more integrated programmes between the different sectors in the future.
Accustomed to a more rural environment for training ‘the community’, the second floor of a smart office block in Bellville was an unusual venue for our Community Health Club Training. In addition, the challenge of turning community members into health workers in five days of training was indeed interesting. The majority of the participants had a limited education and had never been called upon to speak in public, let alone coordinate their neighbours in the sometimes rough areas in which they operate. Of the 24 participants, only three were trained Government Environmental Health Practitioners (EHPs) who are to supervise the health club facilitators once the clubs are active. Five others are Community Health Workers with basic training in public health issues and their experience immediately became apparent during the training. The balance of the participants are newcomers to facilitation and community mobilisation, being currently employed as sanitation attendants charged with monitoring the community use of water and sanitation facilities. Xhosa was the most comfortable language for most, with a few speaking a little English and Afrikaans. The Africa AHEAD team consisted of the Director of Africa AHEAD, Juliet Waterkeyn, Facilitator Jason Rosenfeld and Saviour Maqaloti, Xhosa Facilitator. The approach was simple: to build ‘common unity’ within a group through participatory PHAST activities to enable informed decision-making, in order to solve common problems such as poor use of communal water and sanitation facilities and risky hygiene behaviors.
The training manual, ‘Community Health Clubs in Informal Settlements‘, has just been published by Africa AHEAD after 18 months of development. Together with the 13 packs of illustrated cards, the participants were provided a simple and effective Toolkit for the participatory activities that we were to use during the week. The training covered all aspects of personal and home hygiene, in particular, relating to diarrhoea transmission, with a strong focus on water and sanitation. Well known PHAST activities such as ‘Blocking the Route’, Three Pile Sorting, and ‘Story with a Gap’ became familiar to the participants and slowly their reserve disappeared and the training became more relaxed. People who had never sung in public before were coming out of their shells.
Participants were grouped into their operational areas, each having to form a miniature health club, provide a name for their hypothetical club, develop a health song, and rehearse a short play illustrating some of the issues they would be tackling. Just as would be the case in the community, the development of these plays and songs enabled team building during the week and the clubs presented their efforts at a ‘Graduation’ at the end of the week long training. The short dramas they produced were instructive and fun. A ‘good family’ encouraging a ‘dirty family’ plagued by enormous flies to join the club and reform their unhygienic ways was a familiar plot, and an amusing skit on how to deal with a drunken husband had everyone collapsed with laughter. However, the play which showed someone trying to report the dumping of rubbish to the local officer illustrated a problem unique to the informal settlements in South Africa, where so much is expected of government, and so little is done. Together we planned with participants how to mobilise the community, how to start up health clubs and how to implement the sessions. With the management, we planned how to set up systems for reporting, monitoring and evaluation.
On a Saturday morning, twenty four certificates were handed over in a touching little ceremony to mark the beginning of this innovative project. It was agreed that these certificates would be validated only once each participant had shown themselves capable of running a health club effectively in the community. We parted with a sense that the PHAST system of training had enabled a lot of bonding and bridging and there was no doubt that social capital within our group had been developed. We are looking forward to seeing whether this can be replicated in the more challenging rough and tumble of the Cape Flat shack dwellers. Watch this space for updates on the project.