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Demand-led Sanitation & ZOD through Community Health Clubs

Demand-led Sanitation & ZOD through Community Health Clubs . AfricaSan Conference . February, 2008. Dr. Juliet Waterkeyn Africa AHEAD Noma Neseni, IWSD, Zimbabwe. The MDG Challenge : 234 million ODs in Africa now WHO has set these targets? What has changed?.

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Demand-led Sanitation & ZOD through Community Health Clubs

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  1. Demand-led Sanitation & ZOD through Community Health Clubs AfricaSan Conference February, 2008. Dr. Juliet Waterkeyn Africa AHEAD Noma Neseni, IWSD, Zimbabwe The MDG Challenge : 234 million ODs in Africa now WHO has set these targets? What has changed? ‘You can build a person a toilet, but you cant make him sit!’

  2. People only change… What makes people change? 1960’S: Social Planning when forced 1970’SHealth Belief Model know the reason 1980’sVLOMM invest time / effort 1990’s PHAST if they participate 2000’sSocial Marketing appeal to status 2000’sCLTSshame/ self respect

  3. 1995: COMMUNITY HEALTH CLUB (CHC) Approach People change through peer pressure / Group Consensus Structured participation In Community Health Clubs 50-200 people per club PHAST activities Membership cards provide a structure Graduation days: public recognition Source: Waterkeyn, J and Cairncross, S. (2005) www.africaahead.com

  4. Vertical Strategy: • Following recommendations by Loevinsohn, 1990 (3/67 papers) • one disease / practice • a few simple messages Horizontal Strategy : Holistic & sustainable Community Health Club (CHC) Approach: Focus : Diarrhoea, Dysentery, Cholera, Malaria, Bilharzia, Worms, Trachoma, Bilharzia, TB, Skin diseases, HIV/AIDS 24 topics in 6 months, weekly, 2 hours Number of messages = 50 + Causes, prevention, symptoms and treatment of 10+ preventable diseases + safe hygiene

  5. Recommended Practices No. Theory Topic 1. Safe Water Chain Cover water; 2 cups 2. Safe Food Chain Pot rack; hanging basket 3. Sanitation Ladder Clean latrine; cat sanitation 4. Sanitation Planning Dig pits 5. Diarrhoea ORS Build latrines 6. Hand washing Tippy Tap 7. Cholera/ typhoid Clean Water Source 8. Skin/eye disease Washing Bedding 9. Worms Deworming 10. Nutrition Food processing 11. Good kitchen Lorena Stove 12. Drama and songs Practice drama 13. Environment Hay basket 14. Malaria Drainage & clearing 15. Coughs and colds Mats and ventilation 16. Bilharzia Bathing Shelter 17. TB Community Project 18. HIV/AIDS Community Project 19. Home based Care Community Project 20. Family Planning Community Project Membership card Topics

  6. Measuring Behaviour Change (19 indicators) Difference of Prevalence of Observed Hygiene Indicators between Community Health Club Members and non Members in Tsholotsho District, Zimbabwe. 2001 Average 41%

  7. Decrease in reported cases of communicable diseases 18 health clubs 1,777 h/holds in one ward 80 % coverage Period of Health Promotion 1995 - 2001 Source: Ministry of Health, Makoni District Hospital, Zimbabwe. Ruombwe Ward. Makoni District, Manicaland

  8. Sidibe & Curtis (2002) Hygiene Promotion in Burkina Faso and Zimbabwe: New Approaches to Behaviour Change. World Bank-WSP/AF Field Note 7: Blue Gold Series. Comparing Cost-Effectiveness SOCIAL MKT. CHCs LENGTH OF PROGRAMME 3 years 2 Years 302,000 50,380 US$ COST OF PROGRAMME NUMBER OF BENEFICIARIES A city A district 63,720 COST PER BENEFICIARY 30c 22c % BEHAVIOUR CHANGE 13% 41% NUMBER OF INDICATORS 4 19 VIP LATRINES CONSTRUCTED ? 2,500

  9. CHCs can deliver demand-led sanitation & ZOD (Zero Open Defecation) 1999-2000 Zimbabwe 3,800 VIPs in 2 years 30% of total constructed in Zimbabwe 2003 Sierra Leone 0% - 98% ZOD in 1 year (post conflict villages being reconstructed) 47% construction of latrines 2004/5 Uganda IDP Camps : 11,750 Trad. latrines in 8 months, 50% with sanplats CHCs can be replicated in diverse conditions and scaled up to national level given the political will and resources See Publications: www.africaahead.com

  10. CURRENT SITUATION They need to be pro poor technologies We have to standards to maintain Did anyone ask us what we wanted? How about child friendly latrine

  11. Sanitation coverage and access is declining in Zimbabwe Why are health clubs important Socio-economic challenges have meant that we can not be in a business as usual mode Poor are more likely not to meet the sanitation target by 2015 Its not only about rural but also urban

  12. Health clubs are promoted so : • To monitor hygiene improvements • That they become drivers of hygiene at the household and local level • That they provide peer pressure that seems to trigger change • To support other livelihoods such as income generation and nutrition gardens • To offer support to peers • As a mechanism of sustaining hygiene education at the local level. • They are alternative delivery mechanism

  13. Benefits of using Health clubs • Given the lack of institutional capacity to follow up hygiene at the micro level, health clubs seem to be a reasonable approach that will not only promote hygiene but will also monitor progress. • The advantage of peer education is manifold including, peer pressure, sense of belonging and use of appropriate locally acceptable methods.

  14. CHC Methodology A Process of Development using Community Health Clubs as a Vehicle for Change Community Health Club Hygiene Promotion Water & Sanitation IG projects Home based Care / HIV The End ..... Thank you for your interest

  15. Health Education & Hygiene Promotion • Projects Costs per Annum in US$ Makoni District 1st year 2nd year Per trainer (14) 2,580 1,017 Per Health Session (746) 48 19 Per Member (10,620) 3.40 1.34 Per Beneficiary (63,720) 56c 22c TOTAL COST 36,120 14,238

  16. APPEAL TO STATUS : SUBLIMINAL METHOD People are more interested in being smart than healthy Social Marketing • National health days • Radio and TV programs • Flyers and pamphlets • Advertising on posters • Celebrity advertising • Community drama Source: Curtis et al. (2001) Photo: Matthews B. 2005. Malawi Sanitation Programme

  17. Social Marketing : SANIYA : Burkina Faso Focus : Diarrhoea Vertical Approach Number of messages = 4 Potty training : 74% to 85% 82% (8%) Excretain a latrine : 80% to 90% 90% (10%) Handwashing after cleaning child: 13% to 30% 31% (18%) Soap to wash hands after latrine 1% to 15% 17% (16%)

  18. Difference between health club and non health club members in health knowledge of preventable diseases

  19. BEHAVIOUR CHANGE IN UGANDA: PHAST STUDY Only 7 out of 24indicators showed significant difference (p >0.05) Average = 13.3% Source: (PGA, 2004)

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