COMMUNITY HYGIENE CLUBS

CURRENT STRATEGY FOR PREVENTION OF DISEASES RELATED

TO POOR SANITATIONTHROUGH COMMUNITY HYGIENE CLUBS

Community Based Environmental Health

Promotion Programme (CBEHPP)

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RUGIRA Jean BaptisteDistrict Hygiene and Sanitation officer/ Kayonzarugira2020@gmail.comCell number: +250 785027409/0788239859

WHY CBEHPP ?

Repeated episodes of diarrhoea and intestinal parasites infection increases < 5 morbidity and mortality, malnutrition and poverty outcomes

Some of the main causes of morbidity and mortality in Rwanda are infectious diseases including diarrhoea, intestinal parasites, skin and eye infections:

The prevalence of diarrhoea has hardly decreased between 2005 and 2010, 14 % and 13 % respectively (DHS 2010)

WHY CBEHPP ? 25% of school children in Rwanda are infected

with intestinal worms (source: CFSVA & Nutrition, 2009)

44% of primary school children are infected with amoebiasis (source: SPH, 2007)

Those diseases can be prevented through improved hygiene practices which are currently insufficient (eg. Households having water and soap at handwashing places is 10% (DHS 2010)

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PREVENTING DIARRHOEAL DISEASES THROUGH COMMUNITY HYGIENE

CLUBS• Annually, more than 80% of the cases of

diarrhoea worldwide are the result of fecal-oral contamination

• They can be avoided through cost-effective environmental health improvement interventions (EHP etal., 2004)

• The key interventions for prevention of diarrhoeal diseases (Val Curtis etal., 2003). : – Handwashing (reduced risk of 47%)– Hygiene promotion (reduced risk of 35%)– Drinking safe water (reduced risk of 15%)

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Difference of Prevalence of Observed Hygiene Indicators between Community Health Club Members and non Members in Tsholotsho District, Zimbabwe. 2001 Source: Waterkeyn,J. 2005 (Africa AHEAD)

Expectations of success through the Community Hygiene Clubs

CBEHPP

The CHC Approach has been tried and tested in Zimbabwe, Sierra Leone, Guines Bissau, Uganda, South Africa and in Vietnam. Every time it has delivered reliable results, varying according to the level of development in each context. We expect the same in Rwanda that has been achieved in the example opposite (Zimbabwe, 2002)

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Vision 2020: all households will have mastered and be practicing ‘good hygiene and waste disposal.’

Economic development and poverty Reduction Strategy (EDPRS): Streamline interventions required to implement the vision

Health Sector Policy: Promoting good hygiene contributes to healthier lifestyles and prevention of diseases

Environmental Health Policy and National policy for Water and Sanitation Services: Determines the modalities of implementation of the CBEHPP strategy for improved health of the population.

NATIONAL VISION AND POLICIES FOR IMPROVING HEALTH OF THE

POPULATION

MINEDUC: Enhancing human resources

MOH: Sustainable Hygiene behavioral change

MINALOC &MINECOFIN:

National development &

poverty alleviation

MININFRA:Increasing access to

rural /urban WSS

Community-Based Environmental Health Promotion Programme

Cross-cutting Sectors & Ministries

CBEHPP

CBEHPP (CHCs)

CHWs

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The purpose by 2017:

Reduce by 2017, the national disease burden due to hygiene preventable diseases through Community Hygiene Clubs to contribute to the improved health and poverty reduction outcomes

Community based Environmental Health Promotion Program

SOME OF CBEHPP OBJECTIVES The CBEHPP strategy was launched in Rwandaon December 2009 to harmonize hygienepromotion efforts and instillation of deep rootedsustainable hygiene behaviour change throughthe following strategic interventions.

1.Establishment of Community Hygiene Clubs (CHCs) in all villages

2.Increase use of hygienic latrines in homes, schools and health facilities

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SOME OF CBEHPP OBJECTIVES3. Increase hand washing with soap at critical times in

homes, schools and health facilities 4. Increase drinking of safe water in homes, schools and

health facilities5. Achieve Zero Open Defecation in all villages through

construction and use of improved toilets6. Improve safe disposal of children’s faeces in all

households7. Increase households with bath shelters, rubbish pits,

pot-drying racks and clean yards

Community-Based Environmental Health Promotion

ProgrammeCBEHPP:• Aims to reach all 15,000 villages in Rwanda• Establish a Community Hygiene Club (CHC) in every village• All households in each village will be CHC members• One member represents the household in a Club session

CBEHPP

• CHC Members required to meet every week for 2 hours• Informed decision making through good information• Creating a common unity/goal through activities• Action oriented with weekly hygiene improvements (e.g. making existing toilets hygienic).

CLTS CHC Approach: Implementation strategy

APPROACHES FOR HYGIENE BEHAVIOR CHANGE

• 6 months, 20 sessions ( two hours each week)• Learning through fun

participatory activities reinforce good practice (song, drama)

• Informed group decision making and weekly homework

• Voluntary household improvements

• One ‘Triggering’ day + a few follow-up visits

• Community shamed into action

• Village walk to shock community that they are eating their own faeces

• Enforcement of change with fines

• Zero Open Defecation (ZOD) & 20+ other hygiene improvements

• Open Defecation Free (ODF) Village or move on the sanitation ladder

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APPROACHES FOR HYGIENE BEHAVIOR CHANGE PHAST

Participatory approach

•black and white posters

No defined structure

• addressed problems of sanitation, diarrheal diseases, water and common diseases

STEP ACTIVITY TOOL

1 Problem identification 1. Community stories2. Health problems in our community

1. Unserialized poster 2. Nurse Tanaka

2. Problem analysis 1. Mapping water and sanitation in our community2. Good and bad hygiene behaviors3. investing community practices4. how diseases spread

1. Community mapping 2. Three-pile sorting 3. Pocket chart 4. Transmission

3. Planning for solutions

1. Blocking the spread of diseases2. Selecting the barriers3. Tasks of men and women in the community

1. Blocking 2. Barriers chart 3. Gender role analysis

4. Select options 1. Choosing sanitation improvements2. Choosing improved hygiene behaviours3. Taking time for questions

1. Sanitation options 2. Three- pile sorting 3. Question box

5.Planning for new facilities and behaviour change

1. Planning for change2. Planning who does what3. identifying what might go wrong

1. Planning poster2. planning posters 3. Problem box

6.Planning for monitoring and evaluation

1. Preparing to check our progress

1. Monitoring (checking) chart

7.Participatory evaluation

1. Checking our progress 1. Various tool options

Comprised of 7 steps

•black and white posters

Training Manuals for CBEHPP developed

CBEHPP

District Environmental Health Officers3 day training in all aspects of the CHC Approach to be used in CBEHPP to enable planners to have an understanding of the CHC approach.

Community Health Workers5 day workshop, to enable Environment Health Officers and Community Health Workers to effectively facilitate the 20 topics.  

Tool kit of Visual Aids developed for participatory activities

(PHAST)

CBEHPP

• Design & development of more than 300 illustrations for 20 topics.

• These were all individually pretested and altered to ensure they are 80% comprehensible for illiterate/semi literate and to fully represent the Rwandan context.

Pretesting visual aids. Photo credit: Waterkeyn J.

Training of National Core TrainersCBEHPP

In November 2010 the core team were trained in order to scale up training.

Roll out of ToT Training in 5 Districts in December 2010, and 4 other districts in 2011.

Training session held for core trainers. Photo credit: Waterkeyn J.

ToTs in the training sessions

What is a Community Hygiene Club?

 • A Community Hygiene Club is a group of people who are responsible for improving public health standards, focusing more hygiene problems and living conditions in the village

• A CHC is a voluntary, non discriminatory club to which everyone can belong

• If the CHC gets more members than 100 members, the club should be split into two clubs

Cont..

• Members meets once a week for a few hours to learn about health and hygiene with an view to monitoring all public health issues of the community

• The Community Health Worker should be the facilitator for the CHC, but not the chairperson who should be an elected volunteer.

CHC Approach Facilitating Live Discussions?

1 Introduction Bring friends and family2 Common Diseases Know common diseases3 Personal Hygiene Family wash shelter4 Hand washing Handwash facility/ soap5 Skin diseases Children no skin diseases6 Diarrhoea Knowledge of SSS/ORS7 Infant Care Correct Immunization8 Intestinal Parasites/Worms Children no Worms9 Food Hygiene Clean Drying Rack10 Nutrition Good Road to Health11 Food Security/Safety Kitchen Garden12 Water Sources Clean Water Source13 Safe Drinking Water Safe Storage and Usage14 Adequate Sanitation ZOD/Clean Safe Toilets15 The Model Home Waste Management and Greening16 Good Parenting Clean Children17 Respiratory Diseases Good Ventilation18 Malaria Use of Treated Bed Nets19 Bilharzia Treatment for Bilharzia20 HIV/AIDS VCT and PMTCT

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CHC Approach Facilitating Live Discussions?

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Reinforcement: Peer pressure / home visitsHomework: Recommended PracticesMeasurable: Specific Targets Each Week

CHC Approach Facilitating Live Discussions?

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Reinforcement: Peer pressure / home visitsHomework: Recommended PracticesMeasurable: Specific Targets Each Week

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Community diagnosis

Participatory planning

Monitoring & Evaluation

Concept of community participatory programming

Implementation of activities

No Material Handouts: The Only Reward is a Certificate

Progress Measurement of CBEHPPProgram data:• % of established CHCs (99% - District reports May, 2013)• % of fully functioning CHCs (20% - District reports May, 2013)• CBEHPP implementing Districts: Nyaruguru, Rulindo, Kicukiro, Bugesera,

Musanze, Burera, Rubavu, Nyabihu, Kayonza, Gatsibo, Gakenke, Nyamagabe and Rwamagana

• Evaluation of CBEHPP impact in Rusizi District

Progress measurement Baseline assessment of key indicators (survey) Monitoring: • Quarterly households’ hygiene and sanitation data collection by CHWs and

CHCs executive committee members• Yearly households hygiene and sanitation survey by CHWs and executive

committee of CHCs

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Best practices Gatsibo District Nyabihu District - 590 HHs use hygienic latrine - 123 latrines constructed to vulnerable families - 215 handwashing facilities have been installed -68 drying racks installed -CHC have been able to save money and buy mattresses for their houses. After 4 months from the establishment of the CHC and 1 month from their initiative of savings, they have been able to buy 11 - saving money to pay for mutuelle in CHC located in Ryarukaza Village in cell of Bukomane

- CHC have developed cooperatives in sectors of Mulinga and Rugera for payment of Mutuelle, construction of latrines and borrowing money.- 1200 latrines have been constructed to vulnerable families - 110 kitchen gardens were constructed-89 water sources were protected -12 villages in sector of Jomba have initiated evening education to children “Umugoraba w’Abana” for promotion of hygiene

Rwamagana District Bugesera District- 341 latrines were constructed by club member in Munyiginya, Mwulire, Muhazi, Kigabiro and Gishari- Constructing latrines for poor and vulnerable families to improve sanitation within their communities through brics making, digging pits in UMUGANDA by club’s members.- Contributing money for buying ion sheetsContributing money for provision of hand wash facilities local kandagirukabe and agatanda k’amasahani) , water filter and sur’eau - Conducting hygiene club competition to encourage and motivate others where 5 clubs have been awarded at district level

- 32,401, 112 francs has been mobilised and facilitate in implementation of CBEHPP- 127,822 HHs use hygienic latrines- 1,248 schools use hygienic latrine- 20,442 HHs use kandagirukarabe and soap for hand washing - Availability of hand washing in 184 food establishments and others public places - Orientation meeting on CBEHPP in 60 Churchs and sensitize the community on CHCs methodology. - Strengthening of morning hygiene programs in 54 schools and 15 health centers on H& S

Best practices

Integrated Community Development

Education

Wate

r &

Sanita

tion

Primary

Health

Environment

Food

Security

Home-based careSkills

TrainingInco

me

Gene

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POVERTY ALLEVIATION

THROUGH CHCs

Given that CBEHPP will be implemented in all 15,000 villages in the next few years, it is expected to induce significant levels of behavior change with the resultant decrease in prevalence of hygiene preventable disease (diarrhea, intestinal infections etc.) throughout Rwanda

Conclusion CBEHPP

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MURAKOZE CYANE!!!!!!!!!!!!!!!!!!!!!!!

ESTABLISHED BY : RUGIRA JEAN BAPTISTECbehpp training facilitator