2008 WWW


YEAR: 2008

AUTHOR: Waterkeyn. A.

TITLE: CHCs with a focus on Urban Areas: two case studies (Zimbabwe and Uganda)

PAPERS: 2009. Zim Cholera Case Study      2009_Case_Uganda.pdf



Uganda: In 2005 Community Health Clubs were started in IDP Camps in Northern Uganda, where numerous NGOs had been trying to introduce safer sanitation for the past 18 years in one of the worst ongoing conflicts in Africa.  In spite of much skeptism  that nothing could be done to alleviate this chronic public health situation, the 120 CHCs managed to achieve unheard of changes in the camps, with the most convincing indicator being the construction by the community of over 11,000 latrines in eight months, not only meeting but exceeding  ambitious targets. If ever there was a proof of the effectiveness of CHC to create a demand for sanitation this case study is it!

Zimbabwe: Most countries in Africa will fall short of meeting the MDG targets for the provision of water and sanitation due to lack of financial and institutional capacity (WSP-Africa, 2006). Although safe sanitation has been found to be the most effective single intervention in reducing diarrhoea (Esrey, et al.1991), this does not necessarily mean the building of latrines, as these can become a fly breeding ground if they are not sealed properly, and further compound the spread of diarrhoea. The faecal-oral route can be broken much more easily and a lot more cost-effectively through faecal burial and hand washing with soap (Curtis & Cairncross, 2003). After more than a decade of pilot projects in many countries in Africa the Community Health Club (CHC) Approach can reasonably predict behaviour change, and ensure zero open defecation and handwashing with soap. By creating a strong demand for safe sanitation and a ‘Culture of Health’ that insures good hygiene (Waterkeyn & Cairncross, 2005) Community Health Clubs can become a potent mobilisation strategy in emergencies not only in rural areas but, as this case study shows, in urban areas as well. During the cholera outbreak that affected  12,700 people and claimed 420 lives in Zimbabwe, the  a high density suburb of Sakubva, in Mutare, only had 4 cases and no deaths. This has been attributed to an environmental clean-up and  improved the hygiene behaviour due to the efforts of  5,400 members in 36 Community Health Clubs.