CONFERENCE: The Water & Health Conference: where Science Meets Policy
VENUE: The Water Institute: University of North Carolina. USA
AUTHORS: Waterkeyn J.
TITLE: A Practical Model to meet eight of the Sustainable Development Goals through Community Health Clubs
Powerpoint Presentation: 2015.10_ CHCs in SDGs_Waterkeyn
The presentation demonstrates how the Community Health Club Model of Development is an ideal vehicle for ensuring that many of the Sustainable Development Goals can be addressed within a particular community through a tried and tested process of ‘Applied Health Education and Development’ (AHEAD).
The four stage process starts with Health Education which is able to address Goal 3, which is to improve ‘Health and Well-being’, whilst also ‘Empowering Women’ which is Goal 5. Given that the training women receive enable women to prevent 88% of all likely causes of infant mortality through safe hygiene. In Year 2, the goals of ‘Safe Water and Sanitation’ are addressed which is the aim of SDG Goal 6. In Year 3, the CHCs morph into Food Agriculture and Nutrition Clubs, whereby all women have their own nutrition gardens and are taught organic farming practices and increased and varied food production which addresses Goals 2, to ‘Eliminate Hunger’ as well as Goal & 7 which is a ‘Sustainable Environment’. In the final year the skills which women learn enable them to start micro enterprises and loan schemes to ensure ‘Economic Empowerment’ and the ‘Alleviation of Poverty‘ (Goal 8 and 1 respectively). The paper shows how this theoretical model has been applied in numerous case studies over the past 20 years showing the high levels of achievement that have already been demonstrated by the CHC Model in Zimbabwe, Uganda and Vietnam in hygiene behavior change, water & sanitation self-supply, as well as significant success income generating projects. ‘Women’s Empowerment’ is addressed not only in the community where uneducated women find their voice and become experts in their home care, but through School Health Clubs enabling girl friendly latrines and coping mechanisms for menstruation ensuring girl students do not miss classes, in part addressing ‘Gender Equity in Education’ which is Goal 4.
TEXT OF PRESENTATION:
At the United Nations Sustainable Development Summit in September, 2015, world leaders adopted the ‘Agenda for Sustainable Development’. This includes a set of 17 Sustainable Development Goals (SDGs) to end poverty, fight inequality and injustice, and tackle climate change by 2030. How can the Community Health Club Model contribute to this?
DEFINITION of CHC
Community Health Clubs are community based organisations consisting of a representative from most, if not all, of the households in an area, whose members meet regularly for the purpose of improving living standards in their area, by sharing knowledge and understanding leading to group consensus and positive action.
Goal 1: END POVERTY BY 2030
Women are disproportionately more likely to live in poverty than men due to unequal access to paid work, education and property.
Community Health Clubs provide a means for women to earn their own money through producing food for sale within their own club as well as crafts and produce, marketed as a group for sale externally.
CASE STUDY: In Makoni District, Zimbabwe 5,052 women were trained in 12 types of skills, with 518 groups and in one year they raised US$44.530 through sale of produce.[i]
GOAL 2: ZERO HUNGER
SDG CHALLENGE: End all forms of hunger and malnutrition by 2030, making sure all people – especially children and the more vulnerable – have access to sufficient and nutritious food all year round.
CHC SOLUTION: FAN CLUBS (Food Agriculture and Nutrition Clubs) enable all members, especially women, a plot for growing vegetables and FAN training ensures all mothers provide children with a balanced diet with community support for vulnerable families with widows, orphans, aged and disabled.
CASE STUDY: In 2010, 134 FAN clubs were started in 3 districts in Zimbabwe, within 10,670 households, enabling better nutrition for 64,020 people – clinic staff reported decrease in malnutrition.[ii]
GOAL 3: GOOD HEALTH AND WELL BEING
SDG CHALLENGE: each day, nearly 1,000 children die due
to preventable water and sanitation-related diarrhoeal diseases
CHC SOLUTION: The six month weekly sessions train women on hygiene which can prevent not only diarrhoea which accounts for only 17% of all infant deaths.
- Community Health Clubs can prevent 88% of all causes of infant death including malaria, pneumonia, bilharzia, malnutrition, cholera, Ebola, poor birthing, HIV, and minimize malnutrition due to poor nutrition, intestinal helminthes, environmental enteropathy which contributes 35% of deaths due to other causes, as well as prevent skin and eye disease.
- This is achieved by correct knowledge, common understanding and community support in case of childhood sickness.
CHC CASE STUDY: Toriro Clinic, Makoni District, Zimbabwe. 2003.[iii]
Number of reported cases per annum fell steadily between 1995 and 2003 with 80% of the clinic catchment households being in a CHC over a period of 8 years.
- Diarrhoea from 404 to 26 cases
- Malaria decreased from 488 to 119 cases
- Skin disease from 1,204 to 67
- Eye disease from 277 to 62 cases
- Acute Respiratory disease from 2,136 to 159!
- Bilharzia from 924 to one case!
GOAL 4: EQUITABLE EDUCATION FOR ALL
SDG Challenge: To ensure that all students can manage their own health through non risk hygiene practices and develop a culture of health as they become adults.
CHC SOLUTION: School Health Clubs ensure that all students learn to manage their own health and learn life skills to preventable disease and coping mechanisms to avoid substance abuse and other social challenges.
In 2013, in Zimbabwe, Africa AHEAD / ACF trained facilitators for 53 school health clubs resulting in 3,101 students in hygiene promoting schools, with 62% female and 38% male with emphasis on male participation in health and hygiene impacting on 15,825 households in two districts.[iv]
In 2014, 120 School Health Clubs in Zimbabwe were formed with (250 students per school) and taught how to make reusable sanitary pads, thus breaking taboos and with the provision of 20 girl friendly latrines to ensure girls can continue to attend school during menstruation with shame.[v]
GOAL 5: WOMEN’S EMPOWERMENT
CHC Members become
- House proud
- Expert house keepers
- Knowledgeable mothers
- Confident public speakers
- Respected by their husbands and in-laws
- Recognized publically
The certificate gives them confidence:
“I have my birth certificate and the next one should have been my death certificate but now I have this certificate and I am proud that I am not nobody now!”
GOAL 6: CLEAN WATER AND SANITATION
SDG CHALLENGE: Invest in adequate infrastructure, provide sanitation facilities and encourage hygiene at every level.
CHC SOLUTION: Community Health Clubs have some of the highest levels of hygiene and sanitation behaviour change and can mobilize every household in a community to improve their facilities with zero subsidy, protecting existing water sources and building their own latrines
HYGIENE: In 2012, in two districts of Zimbabwe, (Mberengwa & Gutu Districts, ACF-Zim AHEAD)[vi] in 429 villages there were 457 CHCs with a membership of 17,578.
After one year there were
- 21,101 new hand washing facilities;
- 12,976 new pot racks
- 7,771 new latrines, with Zero Open Defecation (ODF).
Approximately 250,000 family wells have been upgraded and protected in Zimbabwe. Over 3 million people since 1993 have benefitted, many of these through the Community Health Clubs.
In Vietnam sanitation in CHCs improved over six months from 98% open defecation to zero open defecation with 49% with permanent latrines and 50% with temporary structures. (2010)[vii]
In Uganda 11,860 latrines were built in 8 months in 120 CHCs in 15 IDP Camps where sanitation had been almost non-existent prior to the CHC training. (2003)[viii]
GOAL 7: SUSTAINABLE ENVIRONMENT
To have community preparedness for mitigation against such disasters such as floods, drought, tsunami, and earthquakes as a result of global warming.
‘Fore warned is fore armed’. CHCs are the perfect platform to develop preparedness for likely disasters. When communities are organised they will be able to respond with better coordination to any life threatening event.
Through the CHCs people can be made aware of the dangers of deforestation as well as introducing models of fuel efficient stoves which minimize the use of firewood, thus preventing deforestation.
In 2014, in Uganda, Africa AHEAD assisted International Lifeline Fund to start up 70 CHCs in order to enable better dissemination of the fuel efficient stoves that they were promoting.[ix]
GOAL 8: ECONOMIC EMPOWERMENT
The Africa AHEAD model is a phased approach which takes one stage at a time over a period of our years. A.H.E.A.D: stands for Applied Health Education & Development. [x]
- Stage 1: HEALTH EDCATION
Health education and hygiene promotion is used as the entry point in a six month weekly sessions for all members, to enable them to discuss challenges and local solutions.
- STAGE 2: WATER AND SANITATION:
Health education leads to high levels of hygiene behaviour change, when members APPLY THEIR KNOWLEDGE and ensure they have safe drinking water and practice zero open defecation.
- STAGE 3: FOOD AGRICULTURE NUTRITION
CHC morph into Food Agriculture and Nutrition (FAN Clubs) where an opportunity for income generation through the establishment of Nutrition Gardens leads to improved health of all the family.
- STAGE 4: SKILLS TRAINING FOR SUSTAINABLE LIVELIHOODS
Women are trained in a variety of skills which enable them to process food for their own use and for sale to ensure all round food security.
The ability to earn their own money from growing and selling, crafts and trading enables women to control their own money and alleviate poverty
The CHC is a local engine at village level that can successfully power eight of the Sustainable Development Goals within a four year period.
[iii]Waterkeyn, J. (2005) Decreasing communicable diseases through improved hygiene in community health clubs. 31st WEDC International Conference, Kampala, Uganda
[iv] 2014 Zimbabwe AHEAD Annual Report. p.9.
[v] 2015 Africa AHEAD Annual Report p.20.
[vi] 2013 Zimbabwe AHEAD Annual Report p7-11.
[vii] Waterkeyn.J. and Nguyen Huy Nga. (2010) Low cost-high Impact: Hygiene Behaviour Change in Vietnam in Community Health Clubs.
[viii] Waterkeyn, J, Okot, P. and Kwame.V (2005) Rapid sanitation uptake in IDP Camps of Northern Uganda
[ix] Wolf. D. (2014) Mobilising villagers for Water Energy and Sanitation in Uganda. Presentation at Word Water Week Stockholm.
Waterkeyn, J & Cairncross, S. (2005) Creating a demand for sanitation through Community Health Clubs: a cost effective intervention in two districts of Zimbabwe. Journal of Social Science and Medicine. 61. p.1958-1970
Waterkeyn, JA and Waterkeyn, AJ. (2013) Creating a culture of health: hygiene behaviour change in community health clubs through knowledge and positive peer pressure. Journal of Water, Sanitation and Hygiene for Development Vol 3 No 2. 144–155.