New CHC Country in Africa

Improving Hygiene Behaviour of Communities throughout Rwanda

Community-Based Environmental Health Promotion Programme



1.  The Community-Based Environmental Health Promotion Programme (CBEHPP) is a hygiene behaviour change approach to reach communities and empower them to identify their personal and domestic hygiene and environmental health-related problems (including access to safe drinking water and improved sanitation) and to solve them. The Programme is being launched by the Ministry of Health, in December 2009.


2.  Purpose of the Programme

By 2012, the CBEHPP aims to reduce Rwanda’s existing disease burden by at least 50% and thus contribute meaningfully to poverty reduction and EDPRS outcomes. The Programme further seeks to place Environmental Health firmly on Rwanda’s Development Agenda.

3.  Priorities of the CBEHPP

Based on an assessment of the prevailing  environmental health threats to the Rwandan population, the achievement of national and global development targets requires the following to be prioritised:-

  • Improved household and institutional hygiene practices and sanitation:-
  • Safe excreta disposal with zero open defecation (ZOD) and hygienic use of toilets / latrines
  • Hand-washing with soap and water
  • Safe drinking water handling
  • Safe disposal of solid and liquid wastes
  • Food safety and improved nutrition
  • Minimise indoor air pollution to reduce Acute Respiratory Infections
  • (e.g. promote fuel-efficient stoves with chimneys)
  • Improved Vector Control

The Programme seeks to build on the strong foundations and successes of the PHAST and HAMS (School Hygiene and Sanitation Programme)  experiences and will also encompass similar ‘best-practice’ initiatives currently being undertaken by NGOs.

4.  Implementing CBEHPP

The Programme will be implemented in three phases, with the first two lasting 6 months each, before rolling out the program to the rest of the country. The capacity of all 45,000 Community Health Workers will be strengthened, under close mentoring and supervision by Environmental Health Officers who are based at Health Centres. The health promotion training focuses on the most common diseases dealt with by local Health Centres as long as they are preventable, namely:- diarrhoea, acute respiratory infections, skin diseases, eye diseases, intestinal worms, bilharzias and malaria (i.e. 80% of the national disease burden).

The Community Health Workers will facilitate the formation of Community Hygiene Clubs (CHCs) in every village as a means towards rapidly achieving sustainable and cost-effective hygiene behaviour change in every homestead. The CBEHPP will also target institutions (schools, clinics and prisons) for hygiene behaviour change.

5.  How the Community Hygiene Club (CHC) Approach works

Syllabus and certification

The Community Hygiene Clubs will cover 20 preventative health topics during a six-month course of weekly, 1-2 hour sessions. This syllabus is listed on the CHC Membership Card and includes safe water chain (safe storage and use of water); sanitation ladder (avoiding faecal-oral diseases); sanitation planning and improving household latrines); environment (garbage pits and faecal-free yards); and self monitoring (CHC self-monitoring tools in use).

The CHC Facilitator (i.e. the Community Health Worker) signs off the Health Topics on each member’s card as soon as these topics and the associated ‘homework’ have been completed. The CHW also has his/her membership card signed off by the CHC Chair for verification. This procedure empowers the Community and strengthens the ‘contractual obligation’ to mutually follow through with the whole syllabus.

Governance of the Club

The CHC Executive Committees (Chair, Treasurer and Secretary) should be established as soon as all members

6.   Improved monitoring of behaviour change

The CHC approach can quantify behaviour change using community self-monitoring tools as an integral part of the process of change. Seven ‘Golden Indicators’ to be achieved by CBEHPP :-

1. Increased use of hygienic latrines in schools and homes (from 28% to 80%)

2. Increased hand-washing with soap at critical times (from 34% to 80%)

3. Improved safe drinking water access and handling in schools and homes to increase to 80%

4. Establishment of Community Hygiene Clubs (CHCs) in every village to increase to 100%

5. Achieve Zero Open Defecation in all villages: 100% ZOD!!

6. Safe disposal of children’s faeces in every household (from 28% to100%)

7. Households with bath shelters, rubbish pits, pot-drying racks and clean yards to increase to 80%

7.  Sector collaboration through CBEHPP

Water and Sanitation

Whilst safe drinking water can reduce diarrhoea by about 15% improved personal and domestic hygiene practices can reduce diarrhoea by over 65% (e.g. hand-washing with soap at critical times is estimated to reduce diarrhoea by 47%).

Hygiene Behaviour Change, as proposed under CBEHPP, is critical to all water and sanitation initiatives to ensure they meet their enormous potential to improve national health and living standards.

CBEHPP absolutely complements the Ministry of Infrastructure (MININFRA) efforts to provide safe drinking water & sanitation infrastructure by ensuring that the potential health & poverty reduction outcomes can also be achieved and sustained.

Local Government  (MINALOC)

The Programme provides a practical opportunity for the Ministry of Local Government (MINALOC) to achieve even greater collaboration & coordination at the district and sector levels that will result in increasing synergies through the efficient mobilisation and deployment of existing human & material resources.