Dr. Juliet Waterkeyn Africa AHEAD IWA Conference, November ...
Dr. Juliet Waterkeyn Africa AHEAD IWA Conference, November ...
Dr. Juliet Waterkeyn Africa AHEAD IWA Conference, November ...
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<strong>Dr</strong>. <strong>Juliet</strong> <strong>Waterkeyn</strong><br />
<strong>Africa</strong> <strong>AHEAD</strong><br />
<strong>IWA</strong> <strong>Conference</strong>, <strong>November</strong> 2009, Mexico
Outline of presentation: the issues...<br />
How to mobilise people in emergency situations<br />
Is the Community Health Club Approach viable<br />
for emergency programmes<br />
We examine two case studies where CHCs were used<br />
in 6 month emergency programmes:<br />
IDP Camps in Northern Uganda: 2005<br />
High density suburb in Mutare, Zimbabwe: 2009
NORTHERN UGANDA<br />
Insurgency for the past 18 years<br />
33 IDP Camps<br />
Population in each camp<br />
15,000 to 68,000
Camps guarded against continued rebel attacks<br />
Limited access to water<br />
Diarrhoea common<br />
>5% sanitation coverage<br />
Cholera outbreaks
AMBITIOUS TARGETS<br />
WITHIN 6 MONTHS<br />
HOW <br />
• 10,000 latrines<br />
• 120,000 people exposed to health promotion<br />
In each of the IDP 15 camps<br />
-<br />
• 50% households within a Community Health Club<br />
• 50% of Health Club members with household latrine<br />
NEEDED:<br />
120 clubs x 100 members (5-20 health clubs per IDP Camp)
87% completed<br />
all 20 sessions<br />
18,844 members were registered and given membership cards<br />
Cards were signed each time a member attended a session
Weekly health sessions were held for each club in 15 camps
75% CHC<br />
members<br />
11,709 health club members built drying racks in 6 months
11% CHC<br />
members<br />
53% CHC<br />
members<br />
1,682 Hand washing facilities (Tippy Taps) constructed<br />
8,145 bathing shelters constructed in 6 months
In each of<br />
15 camp a<br />
Sanitation<br />
CBO was<br />
formed.<br />
2,120<br />
wooden<br />
covers for<br />
sanplats<br />
Women<br />
trained to<br />
produce<br />
cement<br />
sanplats<br />
49 latrine<br />
pedestals<br />
made for<br />
disabled
72%<br />
constructed<br />
latrines<br />
New Technology introduced into Uganda<br />
for emergency sanitation in IDP Camps -<br />
effective in breaking the faecal-oral route<br />
+2,500 Poly sanplats installed + 2,120 cement sanplats
ACHIEVEMENTS<br />
Item Target 6 months<br />
Health Clubs 120 116<br />
Members 12,000 15,522<br />
Beneficiaries 120,000 93,132<br />
Latrines 10,000 11,256 (72%)<br />
Health sessions 2,400 2,760<br />
Sessions per club 20 +20
ZIMBABWE<br />
MANICALAND PROVINCE<br />
MUTARE<br />
High population mobility<br />
• 10 km from Mozambique also with cholera
NATIONAL CHOLERA EPIDEMIC<br />
Manicaland: 12 700 cases : 420 deaths<br />
Mutare City : 198 cases : 8 deaths<br />
‘We suspected that Sakubva would become the hot spot<br />
but it never developed......... The health clubs did their job’
Expected to become the hot spot for Cholera<br />
Blocked sewer system<br />
Overflowed in the rains<br />
Cracked water pipes<br />
4 cases suspected<br />
No deaths in Sakubva
• Started in October 2008<br />
• 37 Community Health Clubs formed<br />
• More than 5000 members across Sakubva<br />
• Meeting once weekly for health sessions<br />
• Massive clean-up campaign held
• Each club with about 130 members<br />
• Total number of members = approx. 5,000
STREET PRIDE<br />
Each household:<br />
Keeps drains unblocked<br />
Removes garbage<br />
Fill pot holes in road<br />
Use compost for plants
Street and Market Clean up<br />
Estimated saving to Council: US$20,000
Council is attending to sewers
1. Cases in Sakubva were far fewer than expected<br />
and no deaths recorded.<br />
2. In Buhera (one of worst Districts in Manicaland)<br />
No cholera where CHCs before the epidemic.<br />
3. Anecdotal reports Makoni District testify<br />
that CHCs have been able to control Cholera
Sakubva<br />
has<br />
changed :<br />
the place<br />
is clean<br />
now !<br />
Community<br />
participation in<br />
CHCs bring<br />
about<br />
community<br />
ownership of<br />
the sanitation<br />
Community<br />
responds positively<br />
for health when<br />
they see it as their<br />
responsibility
Lessons learnt<br />
Community Health Clubs<br />
are ideal in times of emergency<br />
Help communities get organised<br />
regain their sense of control over disaster<br />
Enables community surveillance and monitoring<br />
Can convert to long term programme<br />
Enable future preparedness
Community Health Clubs ensure a<br />
critical mass of organised people in effective<br />
community structures which can prevent all<br />
communicable diseases<br />
by good home hygiene.<br />
Cholera can be prevented because<br />
CHCs ensure high levels of<br />
positive behaviour change<br />
Reinforced and sustained by peer pressure.
<strong>Waterkeyn</strong>, J. and Cairncross, S. (2005) Creating demand for<br />
sanitation and hygiene through Community Health Clubs: a<br />
cost-effective intervention in two districts of Zimbabwe. Social<br />
Science & Medicine. Vol 61, pp.1958-1970.<br />
<strong>Waterkeyn</strong>, J, Okot, P., and Kwame, V. (2005) Rapid Sanitation<br />
Uptake in the Internally Displaced People Camps of Northern<br />
Uganda through Community Health Clubs. Kampala. 31 st WEDC<br />
<strong>Conference</strong>.<br />
For all publications, articles and more details on Community<br />
Health Clubs:<br />
www.africa ahead.com<br />
juliet@africaahead.com
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