2013. Waterkeyn J & A – IWA

1. 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.

Abstract: Understanding the mechanisms that trigger behaviour change to overcome risky hygiene is critical to improving family health. Research in an integrated health promotion programme in 382 Community Health Clubs (CHCs) in three districts of Zimbabwe showed clearly the value members attached to gaining ‘knowledge’, which was their strongest motivation for joining CHCs. In these rural areas, where only 38% had completed primary school, randomly sampled CHCs ranked the ‘Need for Knowledge’ second highest after ‘Safety’. A survey of 880 CHC members showed that an average of 80% of CHC members who had ‘full knowledge of diarrhoea’, also practised ten recommended hygiene practices (P > 0.001), compared to 17% who had ‘some knowledge’, and 6% who had safe hygiene, but ‘no knowledge’. In the control group only 50% with ‘full knowledge’ of diarrhoea, also practised safe hygiene, 30% fewer than the CHCs. Therefore, thorough training is needed to ensure a critical mass have ‘full knowledge’. This justifies the CHC Model with 24 weekly sessions reinforcing key messages over a six month period. Positive peer pressure through shared knowledge, understanding and experience, combines to change group values ensuring that even uninformed individuals adopt safe hygiene practices through the adoption of a ‘Culture of Health’. For full paper  click


 2013_IWA_Health Knowledge in CHCs  


2.  Waterkeyn, J & Cairncross, S. (2005)

Creating a demand for sanitation through Community Health Clubs:  a cost effective intervention in two districts of Zimbabwe. 61.Soc.Sci. & Med. p.1958-1970

Abstract: Unless strategies are found to galvanise rural communities and create a demand for sanitation, we cannot achieve the Millennium Development Goal of halving the 2.4 billion people without sanitation by the year 2015. This study describes an innovative methodology used in Zimbabwe – Community Health Clubs – which significantly changed hygiene behaviour and build rural demand for sanitation. In one year in Makoni District, 1,244 health sessions were held by 14 trainers, costing an average of US$0.21 per beneficiary and involving 11,450 club members (68,700 beneficiaries). In Tsholotsho District, 2,105 members participated in 182 health promotion sessions held by 3 trainers which cost US$ 0.55 for each of the 12,630 beneficiaries. Within two years, 2,400 latrines had been built in Makoni, and in Tsholotsho latrine coverage rose to 43% contrasted to 2% in the control area, with 1,200 latrines being built in 18 months. Although Zimbabwe has historically relied on subsidies to stimulate sanitation, this intervention shows how total sanitation could be achievable; the remaining 57% Club members without latrines in Tsholotsho all practised faecal burial, a method previously unknown to them. Club members’ hygiene was significantly different (p < 0.0001) from a control group regarding 17 key hygiene practices including hand washing, showing that if a strong community structure is developed and the norms of a community are altered, sanitation and hygiene behaviour are likely to improve. This methodology could be scaled up to contribute to ambitious global targets.

Waterkeyn J. (2006)


3. District Health Promotion using the Consensus Approach.

WELL/DFID/ London School of Hygiene and Tropical Medicine.

This 25 page manual is a guideline for those planners looking for a practical methodology for conducting a health promotion project at District Level. The focus is primarily on applying this approach to rural areas; however the approach is still applicable to an urban setting. The manual takes approximately 1 ½ hours to read and is divided into three main sections.