In Rwanda, the methodology referred to internationally as the ‘Community Health Club’ Model has been embeded into the Community Based environmental Health Promotion Programme (CBEHPP). The intervention is being implemented by MoH, assisted by Africa AHEAD, working in close collaboration with Local Government at district level and below. Through this project, EHO’s and CHW’s receive adequate training, quality Training Materials and appropriate transport (motor-cycles for EHOs, bicycles for CHWs) in order to perform at optimal levels. By clearly demonstrating the impact that can be achieved through working directly through government structures (i.e. MoH and LG) rather than through third parties (i.e. INGOs), this project should provide useful lessons in cost-effectiveness and sustainability for the Health and WASH Sectors at large.
For the CHC model to be cost-effective it has been found by long experience through Africa AHEAD, that best practice for the ‘classic CHC Model’ is contingent on some key inputs. As it is surmised that the success of the outcomes may be contingent upon the degree to which these various inputs are provided. this project will ensure the following:-
- CHC Membership Cards, as a key to the whole programme
- A quality Tool Kit of Visual Aids to ensure effective participation in all activities by members
- Graduation Ceremonies where certificates are awarded to those who achieve full attendance,
- Household Inventory which enables regular monitoring of behavior change, and
- Model Home Competitions to encourage households to attain high standards of hygiene.
In addition, through the provision of the mobile-phone monitoring system, it is anticipated that MoH will become a competent driver of the monitoring process which will be embedded within the EHD Head Office in Kigali.
This project in Rusizi will provide a controllable ‘experiment’ in the use of the CHC Model that will promote accurate monitoring and collection of data while also providing the required sample sizes for an objective evaluation of the CHC approach to be undertaken. The intervention, as outlined in this proposal, will address this need in the following ways:
- Community self monitoring: At village level, CHWs will have consistent records as a result of a standardized monitoring tool, enabling them to follow up and monitor every household within their catchment with standards that apply nationally.
- Sector Monitoring: At Sector level the Health Centers will gain accurate data on hygiene facilities and practices within all villages of their respective catchment areas;
- District Monitoring: At District level, the Monitoring and Information System that will be established as a result of this project will provide EHOs and their supervisors in MoH with reliable data.
- National Statistical Information: At National level, the National Data Manager (NDM) in EHD will be able to keep up-to-date and accurate accounts of hygiene behavior changes and to provide this data to the Minister of Health as and when required.
- National Replication: Through first-hand experience gained in the demonstration district, EHD will be in a strong position to ensure that other NGO partners adopt the same monitoring systems which will contribute to a national data base and enable MoH to track progress over time.
- International Understanding: At international level, results and case studies will be published in peer reviewed academic journals as well as being disseminated at conferences and thereby contribute to international and regional understanding of behaviour change.
- International Replication: If the impact on reduction of preventable diseases can be scientifically proven within just four years through the anticipated Evaluation, then the Rwandan case study in assessing ‘Impact at Scale’ will provide good rationale for the CHC model to be taken up by other developing countries.
[i] MoH EHD. (2010) Manual for Community based environmental health promotion Programme (CBEHPP): Manual for Training of Environmental Health Officers. Rwanda.
[ii] MoH EHD (2011) Gahunda y’abaturage yo guteza imbere ubuzima bushingiye ku Bidukikije: Inyoborabiganiro yagenewe abazahugura kelebe z’isuku n’abajyanama b’ubuzima. Rwanda.