Zimbabwe, Makoni

Makoni District is the first place in the world where Community Health Clubs were started in a field trial supported by Unicef in 1995. After the first   5 CHcs in Rwombwe Ward proved successful, the CHC  model was taken   to 10 wards (supported by Oak Foundation)  in 1997 with 30 CHCs and 2,864 members.  Exceptionally high levels community response convinced Danida to  support the  scale up to 265 CHCs in 21 wards in Makoni  from 1999-2001, resulting in 11,450 CHC members.

From 2002-2007, a series of income generating project were started in 100 out of the 265 CHCs that were operational. This resulted in approximately 1,000 communal gardens and 4,000 individual gardens, as well as roughly 5,000 bee keepers, resulting in the greening of  Makoni District. Other projects included paper making, soap making, oil pressing, peanut butter making as well as livestock rearing and sewing groups.

As a result of the high density of CHCs,  Makoni District largely escaped the Cholera epidemic of 2008/9, with fewer deaths than other Districts, as the community were able to respond to the symptoms and seek medical assistance, so saving many   lives.

  • Country: Zimbabwe
  • Period: 1995- 2007
  • Donors: Unicef, Oak foundation, Danida, NZ Aid, FAO
  • Partner:  Zimbabwe AHEAD
  • Province: Manicaland
  • District: Makoni
  • 21 Wards:
  • Number of Villages: 265
  • Number of households: 11,450


  • Number of CHCs: 265 (by 2002)
  • Number of Members: 11,450
  • Percentage CHC coverage of district: 60%
  • Number of EHTs: 14
  • Number of CHC facilitators: 265
  • Number of beneficiaries: 68,700
  • Number of health sessions done: 3,731 (in one year)
  • Cost of Project: US$45,660
  • Cost per beneficiary: 0.35c (US$) for hygiene training
Above: % adherence to recommended practices between Community Health Club Members and non CHC Members in Makoni District , Zimbabwe, 2002.

In 21 different practices the CHC households had  from 12% to 33%  higher safe practices than non CHC households.

The practices that are new in the area, recommended by the AHEAD intervention show highly significant difference (p=<0.001):

  •  29% more practice safe faecal disposal,
  • 32%  more built latrines in the last year,
  • 25% more have hand washing facilities,
  • 19% more have nutrition gardens,
  • 26% more  have rubbish pits
  • 32%  use of individual plates’
  • 33% use of individual cups

The  practices that showed some significance (p<0.05) i.e. between 3% and 11%,  were those practices that had been consistantly promoted by the Ministry of Health and other Agencies working in the many water and sanitation programmes in Makoni for the past 20 years. These practices include:

  • 3% more use of ladle
  • 7% more sweeping of yards
  • 7% more keeping latrines clean
  • 11% more having a rubbish pit
  • 12% more pot rack
  • 11% more use pouring  for hand washing


Waterkeyn, J. 2006. Cost-effective Health promotion and Hygiene Behaviour Change through Community Health Clubs. PhD thesis. London School of Hygiene and Tropical Medicine. 

Waterkeyn, J. & Cairncross, S. (2005). Creating demand for sanitation and hygiene through Community Health Clubs: a cost-effective intervention in two districts of Zimbabwe. 61. Social Science & Medicine. p.1958-1970

Down load full paper:  2005_SS&M

Above: Reduction in reported cases of most common diseases in Rwombe Health Centre, Makoni District 1995-2003 in areas of high CHC adherence.

Community Health Clubs in Zimbabwe have proved an effective way to sustain  hygiene behaviour change. In 2001, a survey of households indicated  significant  improvement in hand washing, safe sanitation, good water protection and  food hygiene showing 16% difference between health club and control areas (p>0.001) in Makoni and 50% in Tsholotsho District. (Waterkeyn 2003) Recent research confirms that in areas of high coverage of health clubs, there have been significant decreases in reported clinical cases of communicable diseases over the past nine  yeas. In Ruombwe,  where health clubs  have been operating since 1995 and where 80% of the  households have members,  diarrhoea has fallen from 404 cases in 1995  to 38 in 2003, and Bilharzia almost eliminated from 1,310 in 1995 to only one case. In addition, acute respiratory diseases have decreased from 2,136 to 159 and skin diseases have fallen from 685 to 41 in  2003.


Warterkeyn, J. (2005) Decreasing communicable diseases through improved hygiene in Community Health Clubs.31st WEDC International Conference, Kampala, Uganda, 2005

Down load full paper: 2005 _WEDC_JW.pdf