A Pilot Project on 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 A Community Meeting A Club 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 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 Community MCH, Drug and Agricultural Club Health, Reproductive alcohol abuse, projects, …..? mobilisation Hygiene & Health, domestic income Sanitation Nutrition abuse, rights… 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 District DHMT • 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 Chiefdom CHW to organise meetings, follow-up actions, support PHUs (CH M&E, support session delivery Centre) • In other countries, clubs can help support community level nutrition surveillance, community organisation for Peer vaccinations etc. Could support on contact tracing etc.. Village Supervisors • 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 CHW CHW CHW • Monthly meetings and PHUs, regular support visits by Peer Sups/GOAL. Follow-up by Chiefdom Health Overseer Club Club Club
Topics / Courses Covered MCH, Agricultural Health understandings, Form reproductive projects, WASH, communicable ….? Club health, income diseases (prevention) nutrition generation Jul-Dec 2015 Jan- Jul 16 Jan- ? (likely Dec) 16 1. Club formation, communication skills 10. Importance of total sanitation 19. ARIs 2. Identifying health issues in community 11. Planning for total sanitation 20. Lassa Fever 3. Body mapping/germ transmission 12. Building a hygienic toilet 21. Schistosomiasis & Onchocerciasis 4. Health seeking behaviours 13. Child and farm sanitation 22. Ebola 5. Handwashing 14. Domestic and compound hygiene 23. Using & Maintaining a hygienic toilet 6. Personal hygiene and skin diseases 15. Food hygiene 24. Revision 7. The body’s immune system 16. Diarrhoea 25. Graduation!! 8. Water sources 17. Worms Building on and expanding from CARE SL Manual 9. Water treatment and storage 18. Malaria
Health Clubs are a natural extension on existing MoHS community health services. Health Clubs provide for more holistic / integrated health (and WASH) programming
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