2013 CHC/CLTS Scoping Study

In 2008, the Ministry of Health & Sanitation (MoHS) decided to actively address the serious shortfall in sanitation coverage across the country which was estimated at 13% (AMCOW, 2010) with a target of reaching 66% by 2015. Through active promotion by UNICEF, many Implementing Partners (IPs) within the WASH sector adopted the methodology of CLTS (or CATS) for achieving ‘Open Defecation Free’ (ODF) villages and within five years a significant number of unsubsidised household latrines were constructed in over 5,000 communities in Sierra Leone.  Relative to past performance this was indeed a positive achievement in sanitation.

However it was clear that the CLTS methodology had resulted in little impact on  the two equally important arms of health promotion in WASH, namely water and hygiene – there had been little improvement in  proper hand-washing  in CLTS areas with 90% still not washing hands with soap after defecation and of the 47.5% who had constructed a pit latrine over 60% were uncovered thus causing a health threat from flies (Unicef, 2011).  In addition the challenge of safe drinking water continued.  Food and water contamination through poor hygiene had not been linked to the CLTS programme in many areas. Of particular concern was that although in some of the highest CLTS coverage areas such as Kenema, where  sanitation had increased from 17% to 83%, anecdotal observations by key stakeholders suggested  that as many as half of the ODF communities had in fact regressed to open defecation. This is cause for concern as to the sustainability of sanitation through the triggering process of ‘Classic CLTC’.

In light of the above, MoHS is seeking to enhance safe hygiene behaviour and evolve the CLTS approach within the national hygiene and sanitation promotion programmes towards achieving a more integrated strategy that will address all transmission routes of diarrhoea and other preventable diseases. To this end Africa AHEAD, the organisation which first pioneered the Community Health Club (CHC) model in 1995, was commissioned to undertake this Scoping Study (funded by UK-Aid and managed by Adam Smith International) in order to ascertain if some key ingredients of the CHC model which have resulted in Sustainability, Integration, Self-Sufficiency and Institutionalisation (SISI), can also be used within the Sierra Leone context. The CHC Model has been developing over the past 18 years and is also a ‘community led’ approach which results in ‘total sanitation’ and has demonstrated cost-effective hygiene behaviour change  in a range of 50 behaviours in Zimbabwe (Waterkeyn and Cairncross, 2005).  A Randomised Control Trial to measure the reduction of disease as a result of the CHC Model is currently being funded by the Gates Foundation in Rwanda where it is being scaled up nationally into every village (15,000 villages)  in order to address the national disease burden and poverty due to WASH related diseases.

Building on the achievements of CLTS, Africa AHEAD was requested to identify opportunities in Sierra Leone  to support the MoHS and Implementing Partners (IPs) to ‘evolve’ the existing programme into a more integrated, holistic and cost-effective strategy. The aim is to achieve hygiene behaviour change and total sanitation through more concrete structures where communities themselves would take greater responsibility for their own health and hygiene, as has been repeatedly done through Community Health Clubs in other countries. Previous experience of CHCs in Sierra Leone that were introduced by Africa AHEAD through CARE International in 2002, have led to many successful Mother’s Clubs which are now supported by Unicef through the Wipikin Movement.

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2013.5.1 _AHEAD_SL_Final REPORT_JW_AW