What do people do in Community Health Clubs?

For the first  six months of health promotion members meet weekly to discuss different health topics. The sessions last one to two hours and cover at least 20 different topics related to health and hygiene. The health topics are identified by the community and programme managers and are listed on the membership cards that issued to each member. Typically, the facilitators use participatory activities to encourage active participation and enable members to find their own solutions to common problems. Each week members are encouraged to make changes within their own household in terms of upgrading their facilities and improving their hygiene practices.

In the second phase, those who have finished the health promotion sessions qualify if there are any water and sanitation programmes. During this year households make bricks, dig pits and line them to build latrines.

In the 3rd year other  those who have completely upgraded their homes with safe warer and sanitation qualify to join any income generating initiatives.  Appropriate home industries are  identified using PRA activities. This phase is supported by skills training in financial management, start up costs, standing surety for loans, and the donation of appropriate technologies needs for home industries.

In the 4th year health club members start to  organise more demanding facilities for their community. For example they may  run  play schools, drop in centres, youth activities, arrange soup kitchens or assist the elderly, help as nursing assistants or home based carers  or arrange adult literacy classes depending on community  needs.

Why do the clubs have to keep meeting  for so long?

A weekly meeting enables each topic to be dealt with separately and in depth, allowing enough time for discussion and diffusion of the messages between meetings.

Each week, key messages from the past week are systematically reinforced by club members, ensuring that within a few months all members share a common understanding about health issues.

A six month period of weekly meetings also enables enough time for all members to organise themselves effectively, so that the benefits of  safe water and sanitation are not undermined by poor home hygiene.

After learning about the need for safe water sanitation and hygiene CHC  members will value to inputs and be more likely to manage water and sanitation programmes effectively themselves with a reliable well informed leadership.

What is the attraction of using health promotion in the beginning?

Whilst knowledge can be multiplied infinitely and shared between all members, the inputs of programmes are usually limited which causes division within a community competing for this ‘limited good’ (not enough benefits to go around).

This strategy therefore minimises the usual jealousies that so often hamper ‘hardware’ programmes that offer physical improvements to infrastructure. By contrast the provision of  early provision of hand-pumps or latrines to a community often cause division as each household scrambles for the benefits.

By starting with knowledge dissemination, a fair system of distribution develops, which is then managed by the club members who ensure that only those who have completed all the health sessions benefit from the ‘inputs’. This has repeatedly proven to be a non-divisive strategy that can also block high-jacking of project benefits by local elites

How do you get so many people to join health clubs without incentives?

In every country where CHCs have been started the  certificate  has been enough to attract large numbers of membersetween 50 to 200 members in each health club.

They not only to join the clubs, in large numbers  but  at least half of the members manage to  complete all of the 20-24 sessions.

Why do people join Community Health Clubs?

TO GET A QUALIFICATION: It is surprising but a simple certificate is all the incentive there is to attend 24 sessions, week after week for 6 months.

FOR LOVE OF KNOWLEDGE: Research in Zimbabwe amongst community members shows without any doubt that knowledge in itself is highly valued.

TO HAVE MEMBERSHIP CARDS: when people see the card listing all the topics, they are convinced of the seriousness of the programme.

TO HAVE  FUN: There are a series of participatory activities using illustrated cards which  provoke discussion and involve every member in the club.

TO SOCIALISE: When all your friends and nieghbours join, you will want to join too.

Why dont you call them Mother’s Clubs?

A CHC is a place where women can, and do, express themselves individually and as a group; where they gain confidence in their solidarity and make informed decisions. A woman by herself is often fairly powerless in traditional society. However, women as a group can be a dynamic force for change. Many women derive their pleasure from the obviously feminine solidarity within the group and can often talk more freely together without their dominant male relatives. Family health care in traditional African society is typically a woman’s duty and health clubs are often perceived as primarily women’s business. It is for this reason that in many clubs over 80% of the members are women.

However, the most successful clubs are often those that involve the whole community and are not just groups for women. The weekly sessions can become an important forum where both men and women can share ideas as equals and taboos can be modified, helping to break many gender barriers. Husbands and wives who attend as couples are held up as progressive people. Young men are often enthusiastic members in the clubs and the village elders who may seem to sit passively at the back of the proceedings arein fact essential according to traditional culture, in that they can provide public endorsement of  the objectives of the health club if they are converted to the importance of good hygiene.

The members of a health club are bonded by a common ethos and can identify each other by their practices and beliefs, almost like a church congregation. As dedicated members attend every week, facilitators can build upon their health knowledge. This knowledge can then be reinforced by additional information until in six months they, the club members, become experts themselves. The peer pressure within the club develops a shared understanding, common ethos and objective, and genuine commitment to change. By calling it a community health club, we emphasize that they are for the whole community, not just women. Health is a public issue and men are essential to ensuring the control of communicable diseases.

Can you graft a health club onto groups that are already formed?

Whilst the wisdom of starting yet another community organisation instead of using existing structures has been questioned, community members have never complained about this issue. As health clubs are for the specific purpose of improving health, their objectives are seldom compatible with existing groups formed for other purposes (e.g. a farmers club or saving clubs), as the ethos is entirely different.

It is also important that existing traditional leadership do not automatically take control of the health club without being elected.

Often women  leaders emerge through  a health club and this is an opportunity for real community empowerment, which can act as a buffer to traditional control particularly related to sensitive issues like HIV/AIDS.

Furthermore, this enables the community to get to know each other and identify reliable leaders to ensure the success and sustainability of the project.

Why do only those with certificates have the chance to join the next stage?

In the first year (Phase 1), during the health promotion, there are no expectations given to the community that there will be any material benefits. However, if the programme does progress to the provision of water and sanitation stage (Phase 2), or to income generating projects (Phase 3), conflict may arise as to who in the community will first benefit from the  limited resources. To avoid high-jacking of benefits by local elites, health clubs have in the past ruled that those who complete the sessions will be benefit first. This ensures that limited resources will benefit those who have proved their commitment and have put in most dedicated effort by attending all 20 sessions. This has the added bonus for the donor that inputs are seldom misused because those who complete the sessions have a solid understanding of the need for safe water and sanitation.

This does not keep non-club members or those who have not completed their sessions from benefiting. People can join a club at any stage and continue the sessions, which roll on to a second intake if there is enough demand. In areas where health clubs have been running for nine years, most people have ‘graduated’, and do qualify for assistance. However, this requires long term funding. Given the fact that most funding is limited, it makes sense to target the most reliable members of the community if there is ‘limited good’. This ensures equity, as qualification for benefit does not rely on wealth, educational status, gender or influence, but only on the amount of previous commitment. Thus, the criteria does promote the poorest of the poor, who lacking other means of influence, often make the most effort. In addition, the ethos of the health club is to assist the most disadvantaged (widows, orphans or terminally ill) who are often nominated for priority assistance even if they do not meet the criteria.

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