A PRACTICAL MODEL TO MEET EIGHT SUSTAINABLE DEVELOPMENT GOALS

THROUGH COMMUNITY HEALTH CLUBS

PRESENTED BY DR. JULIET WATERKEYN

WATER AND HEALTH CONFERENCE

OCTOBER 30TH 2015

UNIVERSITY OF NORTH CAROLINA

THE SUSTAINABLE DEVELOPMENT GOALS At the United Nations sustainable development summit in September, 2015,

World leaders adopted the ‘Agenda for Sustainable Development’.

This includes a set of 17 Sustainable Development Goals (SDGs) to

end poverty, fight inequality and injustice, and tackle climate change by 2030.

How can the Community Health Club Model contribute to this ?

DEFINITION of CHC

Community Health Clubs

are community based

organisations consisting

of a representative from

most, if not all, of the

households in an area,

whose members meet

regularly for the purpose

of improving living

standards in their area, by

sharing knowledge and

understanding leading to

group consensus and

positive action.

WHAT ARE COMMUNITY HEALTH CLUBS?

GOAL 1: END POVERTY BY 2030

SDG CHALLENGE: Women are disproportionately more likely to live in poverty than men due to unequal access to paid work, education and property.

CHC SOLUTION: Community Health Clubs provide a means for women to earn their own money through producing food for sale within their own club as well as crafts and produce, marketed as a group for sale externally.

CASE STUDY: In Makoni District, Zimbabwe 5,052 women were trained in 12 types of skills, with 518 groups and in one year they raised US$44.530 through sale of produce

GOAL 8: DECENT WORK & ECONOMIC GROWTH

GOAL 1: ALLEVIATE POVERTY

SKILLS TRAINING IN CHCs:

946 trained in bee keeping

240 in fence-making

163 making bee hives

488 planting woodlots

163 making clay bee hives

796 with organic farming

831 with oil pressing

42 sewing school uniforms

49 making soap

36 making peanut butter

84 making paper,

31 with agri-inputs business

GOAL 2: ZERO HUNGER

SDG CHALLENGE: End all forms of hunger and malnutrition by 2030, making sure all people – especially children and the more vulnerable – have access to sufficient and nutritious food all year round.

CHC SOLUTION: FAN CLUBS (Food Agriculture and Nutrition Clubs) enable all members, especially women, a plot for growing vegetables and FAN training ensures all mothers provide children with a balanced diet with community support for vulnerable families with widows, orphans, aged and disabled.

GOAL 2: FOOD AGRICULTURE NUTRITION (FAN)

In 2010, 134 FAN

clubs were started

in 3 districts in

Zimbabwe, within

10,670 households,

enabling better

nutrition for 64,020

people – clinic staff

reported decrease

in malnutrition.

GOAL 3: GOOD HEALTH AND WELL BEING

SDG CHALLENGE: each day, nearly 1,000 children die due

to preventable water and sanitation-related  diarrhoeal diseases

CHC SOLUTION: The six month weekly sessions train women on hygiene which can prevent not only diarrhoea which accounts for only 17% of all infant deaths.

• Community Health Clubs can prevent 88% of all causes of infant death including malaria, pneumonia, bilharzia, malnutrition, cholera, Ebola, poor birthing, HIV, and minimize malnutrition due to poor nutrition, intestinal helminthes, environmental enteropathy which contributes 35% of deaths due to other causes, as well as prevent skin and eye disease.

• This is achieved by correct knowledge, common understanding and community support in case of childhood sickness.

GOAL 3: GOOD HEALTH AND WELL BEING

Toriro Clinic, Makoni District, Zimbabwe. 2003. Number of reported cases per annum fell steadily between 1995 and 2003 with 80% of the clinic catchment households being in a CHC over a period of 8 years.

• Diarrhoea from 404 to 26 cases

• Malaria decreased from 488 to 119 cases

• Skin disease from 1,204 to 67

• Eye disease from 277 to 62 cases

• Acute Respiratory disease from 2,136 to 159!

• Bilharzia from 924 to one case!1995 1996 1997 1998 1999 2000 2001 2002 2003

0

500

1000

1500

2000

2500

2136

1715

1422

1684

1286

770

341

251

159

Diarrhoea Bilharzia Skin diseases ARI

Eye disease Malaria

GOAL 4: EQUITABLE QUALITY EDUCATION FOR ALL

SDG CHALLENGE: To ensure that all students can manage their own health through non risk hygiene practices and develop a culture of health as they become adults.

CHC SOLUTION: School Health Clubs ensure that all students learn to manage their own health and learn life skills to preventable disease and coping mechanisms to avoid substance abuse and other social challenges.

GOAL 4: EQUITABLE QUALITY EDUCATION FOR ALL

CASE STUDY

In 2013, in Zimbabwe, Africa AHEAD / ACF trained facilitators for 53 school health clubs resulting in 3,101 students in hygiene promoting schools, with 62% female and 38% male with emphasis on male participation in health and hygiene impacting on 15,825 households in two districts.

GOAL 5: GENDER EQUITY & WOMEN’S EMPOWERMENT

SDG CHALLENGE: To ensure that Girls do not drop out of school early through pregnancy or miss lessons during menstruation days

SCHOOL HEALTH CLUBS ensure that girl students (as well as boys) know their rights and learn to learn life skills and coping mechanisms to avoid sugar daddies, early pregnancy, and what to do incase of rape and domestic violence.

COMMUNITY HEALTH CLUBS empower women as they become able to manage their family health and prevent unnecessary sickness. They learn to express themselves through participatory activities within the club each week and become expert mothers, respected by their husbands and in-laws.

GOAL 5: GENDER EQUITY AT SCHOOL

In 2014 120 School Health Clubs in Zimbabwe were formed with (250 students per school) and taught how to make reusable sanitary pads, thus breaking taboos and with the provision of 20 girl friendly latrines to ensure girls can continue to attend school during menstruation with shame.

GOAL 5: WOMEN’S EMPOWERMENTCHC Members become

• House proud

• Expert house keepers

• Knowledgeable mothers

• Confident public speakers

• Respected by their husbands and in-laws

• Recognized publically

The certificate gives them confidence:

“I have my birth certificate and

the next one should have been

my death certificate but now I

have this certificate and I am

proud that I am not nobody now!”

GOAL 6: CLEAN WATER AND SANITATION

SDG CHALLENGE: Invest in adequate infrastructure, provide sanitation facilities and encourage hygiene at every level.

CHC SOLUTION: Community Health Clubs have some of the highest levels of hygiene and sanitation behaviour change and can mobilize every household in a community to improve their facilities with zero subsidy, protecting existing water sources and building their own latrines

GOAL 6: HYGIENE AND SANITATION

In 2012, in two districts of Zimbabwe, in 429 villages there were 457 CHCs with a membership of 17,578.

After one year there were

• 21,101 new hand washing facilities;

• 12,976 new pot racks

• 7,771 new latrines, with Zero Open Defecation (ODF).

Approximately 250,000

family wells have been

upgraded and protected in Zimbabwe.

Over 3 million people since 1993 have benefitted, many of these through the Community Health Clubs.

GOAL 6:SAFE WATER

GOAL 6: SAFE SANITATION

In Vietnam sanitation in CHCs improved over six months from 98% open defecation to zero open defecation with 49% with permanent latrines and 50% with temporary structures. (2010)

In Uganda 11,860 latrines were build in 8 months in 120 CHCs in 15 IDP Camps where sanitation had been almost non existent prior to the CHC training. (2003)

GOAL 7: SUSTAINABLE ENVIRONMENT

CHC SOLUTION

‘Fore warned is fore armed’. CHCs are the perfect platform to develop preparedness for likely disasters. When communities are organised they will be able to respond with better coordination to any life threatening event.

Through the CHCs people can be made aware of the dangers of deforestation as well as introducing models of fuel efficient stoves which minimize the use of firewood, thus preventing deforestation.

GOAL 13: CLIMATE ACTION

SDG CHALLENGE:

To have community preparedness for mitigation against such disasters such as floods, drought, tsunami, and earthquakes as a result of global warming.

GOAL 7: SUSTAINABLE ENVIRONMENT

CASE STUDY:

In 2014, in Uganda, Africa AHEAD assisted International Lifeline Fund to start up 70 CHCs in order to enable better dissemination of the fuel efficient stoves that they were promoting.

A.H.E.A.D: APPLIED HEALTH EDUCATION & DEVELOPMENT

Stage 1: HEALTH EDCATION

Health education and hygiene promotion is used as the entry point in a six month weekly sessions for all members, to enable them to discuss challenges and local solutions.

STAGE 2: WATER AND SANITATION:

Health education leads to high levels of hygiene behaviour change, when members APPLY THEIR KNOWLEDGE and ensure they have safe drinking water and practice zero open defecation.

WOMENS EMPOWERMENT;

The combination of knowledge, understanding, management of health and hygiene in the home and the ability to make money empowers women.

STAGE 3 :FOOD AGRICULTURE & NUTRITION CHC morph into Food Agriculture and Nutrition (FAN Clubs) where an opportunity for income generation through the establishment of Nutrition Gardens leads to improved health of all the family.

Organic farming leads to better conservation of land and the use of fuel efficient stoves promoted in the CHCs minimizes deforestation

STAGE 4: SKILLS TRAINING FOR SUSTAINABLE LIVELIHOODS

Women are trained in a variety of skills which enable them to process food for their own use and for sale to ensure all round food security.

The ability to earn their own money from growing and selling, crafts and trading enables women to control their own money and alleviate poverty

A.H.E.A.D: APPLIED HEALTH EDUCATION & DEVELOPMENT

This is Integrated Community Development

Education

Wat

er &

Sanita

tion

Prim

ary

Health

Environm

ent

Food

Security

Home-based care

Skills

TrainingInco

me

Gen

erat

ion

END POVERTY

THROUGH

CHCs

7

CONCLUSIONThe CHC is a local engine

that can successfully powerThe Sustainable Development Goals

Safe Water & Sanitation

Community Health Club

Gender Equity in Education

Reduce Poverty & Hardship

Zero Hunger & Good nutrition

Good Health & Well being

Women’s Empowerment

123456

CHC at less than $ 5 per person per

annum

Acknowledgement: Africa AHEAD Teams in Rwanda and Zimbabwe and the countless field based trainers who have been responsible for refining CHC Model based on practical experience over the past 20 years

All case studies and references can be found on the Africa AHEAD Website

www.africaahead.com

 REFERENCES:  Waterkeyn, J. (2005) Decreasing communicable diseases through improved hygiene in community health clubs. 31st WEDC International Conference, Kampala, Uganda

Waterkeyn, J & Cairncross.S. (2005) Creating a demand for sanitation through Community Health Clubs:  a cost effective intervention in two districts of Zimbabwe. Journal of Social Science and Medicine . 61. p.58-71.

Waterkeyn, J, Okot, P. and Kwame.V (2005) Rapid sanitation uptake in IDP Camps of Northern Uganda

Waterkeyn.J. and Nguyen Huy Nga. (2010) Low cost-high Impact: Hygiene Behaviour Change in Vietnam in Community Health Clubs.

Waterkeyn, JA and Waterkeyn, AJ. (2013) Creating a culture of health: hygiene behaviour change in community health clubs through knowledge and positive peer pressure.