A Pilot Project on Community Health Clubs and Rural Sanitation - - PowerPoint PPT Presentation

A Pilot Project

• n Community

Health Clubs and Rural Sanitation Marketing

An Overview of the Approach, Initial Findings & Next Steps

GOAL Sierra Leone September 2015

Background & Community Approaches

• Many initiatives at community level, establishing different committees/clubs and often

training different volunteers

• Social mobilisation
• Community health
• WASH - CLTS (health development committees) and water point committees
• Nutrition
• Maternal and child health
• Reproductive health
• WiPikin clubs / education
• …..??
• Ministry of Health and Sanitation – are the different aspects of preventative, curative,

health education, social mobilisation etc integrated enough?

• Are there overlaps between programmes?
• Plan to consolidate training and services through 1 person – the CHW. Current activities

curative and surveillance, some prevention

• Is there a consistent platform for the CHW to work with in the communities?

Background & CLTS

• Open defecation (OD) relatively common nationwide. Dakar declaration (2015) and SDGs

aim to eliminate OD

• Community Led Total Sanitation (CLTS) piloted 2008, scaled to 6+ districts, included in

RWSSP and national policy

• >5000 communities triggered, >1000 ‘OD Free (ODF)’ by 2013
• CLTS has made major progress across the country
• Recent studies (Plan, NBI, AfricaAHEAD..) indicate challenges of sustainability of toilet

usage/handwashing, and ‘slippage’

• Challenges of achieving ‘improved’ sanitation, hygiene of toilets
• Relatively limited scope on other hygiene and health issues
• Challenges of institutionalising hygiene and san promotion in the communities, and need

for sustained follow-up/ ‘re-mobilisation’

CLTS made considerable progress and impact on OD, but may have been the ‘start’ rather than the ‘end’..

Background & Rural Sanitation Marketing

• CLTS managed to get people on the first step of the ‘sanitation

ladder’, but some may have regressed/not climbed higher

• NBI study (2011) followed by pilot by GOAL/MoHS in Kenema rural

(plus some urban studies by FWC)

• GOAL rural SM pilot – 2 chiefdoms, 2012-14:
• Product development (e.g. slabs, toilet seats etc)
• Training of business partner (urban) and extension/franchise to rural masons

to produce products

• Marketing (radio, IEC, community visits, dramas, demo sites @ section level)
• Sanitary ‘reps’ (sales agents), positive marketing not only on health issues

Source: www.collecitons.infocollections.org

Background & Rural Sanitation Marketing

Findings / Lessons Learned from GOAL Rural SM Pilot (inc. findings from CMDA-SL 2014)

• High interest from the communities (>400 products sold, further 500 orders)
• Challenges (and costs) in supplying in remote areas, especially if piecemeal orders
• Interest of urban businesses to leave ‘urban’ market and added value of their

involvement – need to rethink business models

• Decentralised production and transport
• Quality control – lack of molds, product range and disease prevention (fly control,

handwashing) limited

• Operating capital of local artisans – challenges in maintaining ‘stock’ and providing

customer financing options

• Customer financing – meeting capital costs in one go can be a challenge
• Launched a little late, and missed the opportunity of harvest time (when people have

money), and VSL too late/not enough focus

Sanitation Marketing holds great potential, but approach needs to be further evolved for viability in the rural context

Background & Health Clubs/CHWs

• Community Health Clubs (CH Clubs) established in

Zimbabwe in 1994, now implemented in many African countries (DRC, RSA, Uganda, Guinea Bissau, Sierra Leone, Namibia… (national policy of Zim, Rwanda..)

• Piloted by Care in Sierra Leone since 2005 (Moyamba,

Koinadugu)

• AfricaAHEAD study (2013) showed good potential for

CH Clubs to compliment and build upon CLTS to address some identified issues

• Various community ‘clubs’ in SL, varying objectives

and memberships

• Concept – a community club that work together to

improve the health of their community

A Community Meeting A Club

Source: AfricaAHEAD (undated presentation)

Background & Health Clubs/CHWs

What are CH Clubs?

• Mobilised community group that is taken through a structured participatory

‘syllabus’.

• Meet weekly to cover certain topic. Participatory techniques, action-oriented

learning

• Clubs often around 20 members (1/hh), voluntary membership. Larger

communities have multiple groups

• Every member gets a membership card, and graduates (with certificate) at the

end of the course

• Works on motivating factors of belonging, unity, fun social engagement,

progress and self achievement, peer pressure, competitiveness.. Some introduce savings and loans schemes

• Clubs established and (normally) facilitated by a trained community based

facilitator (often the CHW)

Background & Health Clubs/CHWs

Club mobilisation Community Health, Hygiene & Sanitation MCH, Reproductive Health, Nutrition Drug and alcohol abuse, domestic abuse, rights… Agricultural projects, income generation …..?

• Club meets weekly, especially if administering club savings and loans scheme
• No limit to range of topics that could be covered – good opportunities for integrated approaches
• Entry point for community activities, consolidates various initiatives into one unit, can have sub-groups if need

to reach only certain demographic on specific topics (e.g. preg. and lactating mothers)

The Pilot Project - Overview

• Implementing Organisations / Donor: GOAL, DHMT / IrishAid
• Duration: Feb 2015 – 2016 (end date TBD)
• Location: Kenema District, Gaura Chiefdom
• Objectives:
• To test an adapted approach to rural WASH and wider community health in Sierra Leone, for possible scale-up
• To improve the health status of 26,000 people in Gaura Chiefdom
• Approach:
• Train Peer Supervisors, cascade to CHWs. Peer Sup monitor and support CHWs. Give manual and demo items to CHWs
• Club Savings & Loans (ability to pay), promotion/social marketing (demand), link with private sector suppliers (vendors, san

mark artisans)

• Establish a health understanding for behavioural change (not mainly shame/disgust)
• ‘Piggy back’ on CHW programme and minimal costs (e.g. incentives) to maximise replication potential.
• Stats: 56 communities, 254 clubs, 6,257hhs, 8 PHUs, 78 CHWs, 7 Peer Supervisors, 4 GOAL Field Staff
• Monitoring: Community checklist, health statistics, KAP survey, membership cards

Background & Health Clubs/CHWs

• Clubs allow a community platform for CHWs (and others)

to engage with, rather than ad-hoc committees and meetings

• Club has management committee that can support the

CHW to organise meetings, follow-up actions, support M&E, support session delivery

• In other countries, clubs can help support community

level nutrition surveillance, community organisation for vaccinations etc. Could support on contact tracing etc..

• Allows a clearer link between the communities and

health services – good to re-build trust and utilisation in health services, also to build public accountability of health services

• Monthly meetings and PHUs, regular support visits by

Peer Sups/GOAL. Follow-up by Chiefdom Health Overseer

District

DHMT

Peer Supervisors CHW PHUs (CH Centre) CHW CHW Club Club Club

Chiefdom Village

Topics / Courses Covered

1. Club formation, communication skills 2. Identifying health issues in community 3. Body mapping/germ transmission 4. Health seeking behaviours 5. Handwashing 6. Personal hygiene and skin diseases 7. The body’s immune system 8. Water sources 9. Water treatment and storage

• 10. Importance of total sanitation
• 11. Planning for total sanitation
• 12. Building a hygienic toilet
• 13. Child and farm sanitation
• 14. Domestic and compound hygiene
• 15. Food hygiene
• 16. Diarrhoea
• 17. Worms
• 18. Malaria
• 19. ARIs
• 20. Lassa Fever
• 21. Schistosomiasis & Onchocerciasis
• 22. Ebola
• 23. Using & Maintaining a hygienic toilet
• 24. Revision
• 25. Graduation!!

Form Club Health understandings, WASH, communicable diseases (prevention) MCH, reproductive health, nutrition Agricultural projects, income generation ….?

Building on and expanding from CARE SL Manual

Jul-Dec 2015 Jan- Jul 16 Jan- ? (likely Dec) 16

Health Clubs are a natural extension on existing MoHS community health services. Health Clubs provide for more holistic / integrated health (and WASH) programming

Sanitation & Community Financing Approach

• Training local masons (3/section), less emphasis on involvement of ‘central’ business. Focus on

basic range (dome slab) plus higher options

• Create mason-mason pressure for quality control (1 broken slab will affect all mason’s demand)
• Masons ‘market’ products/services at the end of club sessions plus section demo sites and radio
• Re-triggering community, and strong emphasis on community planning for total sanitation
• Education on the features of a quality, hygienic toilet, pit digging.. Aim to climb san ladder..
• Aim to consolidate community demand – reduce transport costs and encourage in-community
• production. CHW and club helping to organise this.
• Harvest time – moving quickly while people have cash.
• Communities have ‘deposits’ box to save their cash for their individual orders, can use osusu
• Longer term Club Savings & Loans (CSL) approach for households to raise capital
• Competitive approach between clubs, communities and sections for ODF progress

Initial Findings / Lessons Learned

• Demand for membership exceeding 1 person/hh – considering adding more clubs
• Current demographic 40% male, 60% female – membership is voluntary and not guided
• Marked improvements in coverage of tippy taps, pot racks, clothes lines – checklist is a powerful tool.
• Clean-up days re-established. Some noted improvements in personal hygiene of members. Anecdotal

reports of reduction in diarrhoea by PHU staff (TBC)

• (Before San Mark activities and CSL) Club members already making orders for products, and some clubs

started savings scheme

• Increased spending on health and hygiene items, vendors started selling more hygiene products in the

communities to meet the demand

• Meetings held at convenient times – often the same times. Some communities have many clubs for 1
• CHW. Agreed with DHMT to train additional ‘CH Club Facilitators’ to support the CHWs in some areas

(29 trained, adding to 78 CHWs)

• Quality deterioration of training sessions as they are ‘cascaded’ different levels – needs close

mentoring/practicing before sessions and revisions/quizzes to check understanding

Next Steps

• Strong focus on drive for sanitation during harvest

time

• Strengthening the ‘competition’ aspect between

clubs/chiefdoms/communities

• Club Savings & Loans roll-out
• Strengthen the M&E aspects to derive more impact

data

• Graduation
• Designing Phase 2 of the training programme
• Sector learning visit (October 2015)

Thank You! Tenki! Momo! Baikar!

Any Questions / Thoughts?