Creating Demand for Sanitation and Hygiene Through Community Health Clubs

In this article published in the journal Social Science and Medicine, researchers at the London School of Hygiene and Tropical Medicine report from rural Zimbabwe where a model of community mobilisation is working to change hygiene and sanitation practices because achieving the Millennium Development Goal of halving the number of people without access to sanitation by 2015 will require both better infrastructure and a necessary change in people's health behaviour. The project involves community health clubs which have been set up to change health behaviour and increase demand for better sanitation. A study of the clubs' impact suggests that they have helped to change up to 17 key hygiene practices using an approach that, according to this article, could now be replicated in other countries.

The project began in 1995 in the form of a pilot study and has since led to the creation of hundreds of community health clubs (CHCs) across rural Zimbabwe. The CHCs are voluntary groups led by local health technicians. CHCs aim to improve health and sanitation in villages by providing information and group support through weekly meetings. The study reports on the results of this approach in two rural districts with more than 13,000 CHC members. The researchers found that:

• The CHCs were very popular and increased the sense of unity within communities. Participants felt a sense of achievement from improving their hygiene practices through the clubs.
• Women were more prominent in CHCs in communities where men were absent. Participation in the clubs increased women’s confidence and social standing in their communities.
• Many families who attended the clubs improved their sanitation practices, including the correct methods of hand washing with soap. Families who had no access to latrines began to practice faecal burial.
• Levels of demand for sanitation and latrines increased substantially in the population. As a result, 47 percent of the population in the areas with functioning CHCs had access to latrines as compared to 2 percent in the non-CHC control area.

In short, the study found that CHCs were an effective way to improve the sanitation and hygiene practices in poor rural areas because they create a culture of cleanliness among a population. It also showed that a strong community structure can help improve sanitation and hygiene behaviour. The policy implications that can significantly improve the replication of CHCs in other countries include:

• reliance on committed trainers for managing individual health clubs;
• providing a membership card with a clear schedule of training sessions;
• maintaining the availability of training sessions until every person who wants to join has had a chance to do so;
• making the health club a vehicle for other initiatives such as income generation, adult literacy, human rights and primary health care services; and
• obtaining funding from agencies with a long term commitment to development.