South Africa, Durban

Objective of the project:  to improve the living standard of residents of Joanna Road informal settlement which is perceived as one of the problem areas within the municipality. This project should breed awareness and communal action to contribute to the environmental cleanup  of the area affected by poor solid waste disposal and the consequent public health risks.

The Johanna Road informal settlement 10 kilometres north of Durban,
KZN was selected by the Water and Sanitation Department in eThekwini Muncipality to pilot the use of community health clubs as a means for cleaning up informal settlements and improving the quality of life for their  residents. Despite being well supplied by the municipality in terms of services (two communal ablution blocks, standpipes, and solid waste pick-up), the area is very problematic in terms of health, hygiene, and sanitation.  In a baseline survey of 104 households, 88.5% believed that solid waste was a problem in the community. Although Johanna Road is relatively small (200-250 households), lack of community cohesion was identified as one of the major obstacles for maintaining facilities.   The CHC approach was identified as a possible means of  creating social capital and improving community relations, as well as improving home hygiene.

  • Country: South Africa
  • Period: 2009
  • Donor: eThekwini Municipality
  • Partner: eThekwini Municipality
  • Province: Kwa Zulu Natal
  • Number of Villages: one
  • Number of households: 200
  • Number of CHCs: 2
  • Number of Members: 120
  • Percentage CHC coverage: 57%
  • Number of EHTs: 1
  • Number of CHC facilitators: 2
  • Number of beneficiaries: 800


In February 2009, working with the Umzimkhulu Municipality and local councilors, a Community Health Club was started in each ward. Africa AHEAD trained facilitators from the community in how to conduct health promotion sessions using PHAST participatory activities to promote hygiene behaviour change. Almost 1,000 members were registered and weekly sessions were held in all nine wards. Attendance rates varied according to the proficiency of the facilitator, but although most members attended some sessions, there were 550 hard-core members who completed all 24 health topics within six months. Certificates were awarded at a Graduation Ceremony in September 2009, attended by district and provincial representatives which marked the end of the pilot project. In the next phase, relevant government departments are planning to use these well mobilised communities to improve water, sanitation and quality of life through agricultural and income generating activities.


Above: Hygiene Behaviour Change indicators in Joanna Road Informal Settlement after six months of CHC Training (2009)


The levels of behaviour change as a result  of this project are exciting, with an overall average of 30%, which is considered high comparing similar programmes (WSP-World Bank, 2002). In the post intervention survey (February 2010), it was found that 89% of all registered members are now following the key recommended practices promoted during the weekly health promotion sessions.

As is shown in the chart above, whereas before the project only had 7% zero open defecation before, there is a 93% change for 100% of CHC households having zero open defecation within five paces of their homestead.

Marked improvements in pour-to-waste methods (72.2%) and no visible ringworm (18.6%) were also observed.

CHC members measured 100% for  7 of the recommended practices (safe water storage, use of ladle, safe food storage, use of pot rack, zero open defecation, knowledge of sugar-salt-solution, no visible ringworm).


Grey Water reuse through Community Health Clubs In eThikweni informal settlement Gounden.T, Sibiya, L, Waterkeyn, J & Maksimoski, N (2010)