Understanding behaviour and choice in context: accessing local knowledge to enhance energy access and sanitation interventions”

Amans Ntakarutimana and Nelson Ekane

Presentation for World Water Week, Stockholm. August 2016

For full presentation click here

2016.08.23 Performance of CHC in transforming sanitation practices AN_NE KTH 2016


There  is  a need to integrate policies and practices to prevent common and lifestyle associated diseases (CDs & NCDs) for healthy communities, socio economic development and sustainability.

Beneficial effect of safe practices on reducing disease is well established, but most of population is not regularly active (Addy et al., 2004) because  community rules and organizational relationships influence the peoples’ behavior and practices (Cohen, 2014).

Social and environmental factors  have influence on safe practices (Addy et al., 2004),  on life style practices (Cohen, 2014; Addy et al., 2004, Hernandez & Blazer, 2006 ) and morbidity  (Wilkinson & Pickett, 2011).

Social support  (the way we are connected) includes emotional, instrumental, informational and appraisal support and contributes to the improved practices (MOUSAVI & ANJOMSHOA, 2014) , prevention, management and treatment of diseases  cases (Chavez, 2013) at community level.

Providers of key social support are families, friends, and healthcare providers and play a significant role in clients’ behaviour change, practices  and well being (Paz-Soldán et al., 2013).

This presentation demonstrates how the Community Health Club (CHC) approach for behaviour change and practices can:

  • Create and strengthen a diverse natural social networks (Waterkeyn & Waterkeyn, 2013; Lewis, 2014) = supportive/enabling environment
  • Prevent and control disease and ill health conditions (MOUSAVI & ANJOMSHOA, 2014) for healthy communities.


Purposive selection of four villages, 2 from Rusizi District (rural) and 2 from Kicukiro district (peri urban). In each district we have one non exposed village and one exposed village to the CHC approach (the exposure).

Data collection was performed through desk review, interview of 2 key local leaders, 4 sanitation professionals from each targeted district. We conducted household survey and spot observation (total = 798 households randomly selected from the two districts, with a confidence limit of 95%). We conducted 2 focus group discussions with village members, opinion leaders, community health workers and in charge of social affairs at village level separately in each village.


The CHC Model uses three channels of influence:

  1. Motivational: song, dance, drama, competition
  2. Knowledge: Health topics, demonstrations, discussions
  3. Group consensus: mutual assistance, home visits

Behaviour chance was evident as this is attributed to the CHC activities.


The findings of this research showed the potentiality of the CHC approach to engage and empower communities from rural and peri urban contexts for safe practices.

CHC is a potential approach for SDGs in general and SDGs 6, target 6.2 for sanitation and hygiene in particular.

Further adapted researches are needed for a complete investigation of the CHC approach from different eco socio economic environments as well as a comparative pilot together with other approaches in similar conditions for an informed choice for replication.