Sustained and Sustainable hygiene

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Sustained and Sustainable hygiene

• A PRESENTATION BY
• NOMA NESENI
• IWSD, Harare, Zimbabwe
• A presentation made at the Stockholm Water Week,
  WSSCC workshop 12 August, 2007

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Presentation format

• Introduction
• Why positive hygiene behaviors
• Participatory Methods in Zimbabwe
• History of Health Clubs
• Health Clubs as an opportunity for promoting
  sustainable positive behavior change
• Impacts, challenges and limitations
• Conclusion

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Introduction Socio economic Context

• Difficult socio- economic environment
• Aid is under humanitarian and maintenance support
  and not developmental
• Effective coverage for sanitation has dropped
  from 40 to 25 ( VIP) and from 100 to 60 for
  water in rural areas
• Urban areas coverage that was once 100 has
  dropped to about 80 and access for the poor and
  homeless not there.

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Why do we need positive hygiene behavior change?

• Socially and culturally unacceptable behavior
  still persistent in the country
• Poor hygiene behaviors that compromise Health

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Why do we need positive hygiene behavior change

• Open defecation passing on a variety of
  diarrhoeal diseases,parasitic infections.
• Civil eye saw

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Challenges in hygiene
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Why do we need positive hygiene behavior change
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Why do we need positive hygiene behavior change
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Why do we need positive hygiene behavior change
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Why do we need positive hygiene behavior change

• HIV and Aids pandemic is bringing in new hygiene
  challenges particularly for infected and affected
  (care givers)
• Health systems are not bale to cope and home
  based care is becoming the only option

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Why do we need positive hygiene behavior change

• Children's faeces- acceptable and not seen as
  dirty 
• Yet these care givers are mostly the ones who
  prepare food

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Participatory methods for Hygiene promotion
Zimbabwe

• Started off in 1994 through joint effort of WHO ,
  WSP and GoZ
• Have since been adopted as a way for hygiene
  promotion in the country
• Environmental health technicians trained in the
  approach

• Training approach
• National Level
• Provincial level
• District level
• Sub district
• Village level

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PHHE coverage in Zimbabwe
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Philosophy of PHHE

• The guiding principles in PHHE follow the SARAR
  approach
• Self- Esteem
• Associated Strengths
• Resourcefulness
• Action Planning
• Responsibility
• - These are the attributes promoted through
  Health Clubs

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Evolution of Health Clubs

• While PHHE is a success- there are
• challenges of sustainability of the
  programme.
• Reliance on Environmental Health technician
• for facilitation and monitoring
• Facilitator centered
• Actions at village level yet hygiene is very
  much a personal and household issue

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History of Health Clubs cntd

• Late 90s Zim Ahead introduced the concept of
  health clubs
• Initially idea was to take club members through a
  process of hygiene awareness following a twelve
  step curriculum
• Curriculum focused on household and personal
  hygiene environment cleanliness, safe water
  collection and storage and waste disposal.
• On completion members received certificates and
  t-shirts

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History of Health Clubs

• The second approach was to improve income for
  members so that they could then effect the
  changes learnt.
• Income generation projects included
• - soap making
• -paper making
• -brick making
• -Vegetable gardens

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History of health clubs

• Another important facet of the Health clubs is
  monitoring
• Club members monitor progress at household level
  and where necessary offer assistance e.g.
  sweeping the yard to demonstrate the value of
  cleanliness

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In planning for change, form health clubs that
will be the mode for effecting change
Awareness created desire to change
Through PHHE share latent knowledge on Hygiene
and sanitation
Monitor support each other
Tackle hygiene change at household and village
level, focus on livelihoods
Small incremental changes Priorities as
identified by that particular club
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Health clubs evolution

• Challenges with the original approach of health
  clubs were linked to external drive as opposed to
  internal spontaneous evolution
• Dependence of external facilitator
• Driven by genuine desire to change or the lure of
  a T-shirt ?
• Financial resources needed for supporting
  external facilitator

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Evolution of health clubs

• From the initial concept promoted by ZimAhead-
  clubs have evolved on their own in many districts
• Now more internally drive as per need to address
  specific problems
• Example in a village south of Harare in Bulilima
  4 members decided to form a club and it grew to
  27 members by 2004 with very minimal external
  support.

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Evolution of health clubs

• Not only focus on hygiene but also health and
  livelihoods.
• Livelihoods include
• herbal gardens
• Nutrition gardens
• Income generating projects
• Mobilization of labor e.g. for latrine
  construction
• Psycho-social support

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Outcomes from health clubs

• Improved hygiene practices such as
• - building and using of latrines
• - improved water collection and storage
• - hand washing methods (run to waste)
• -building and use of kitchen utensil facilities
  ( pot racks)
• - rubbish disposal pits

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Outcomes of PHHE and Health clubs
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Outcomes of PHHE and Health clubs
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Outcomes of PHHE and Health clubs
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Outcomes from health clubs
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Why health clubs and PHHE offer sustainable
hygiene behavior change

• Health clubs utilize the following
• opportunities
• - Use of latent knowledge within communities
• -Empowerment
• -Peer pressure
• -Practical tangible benefits
• -Local solutions to local problems
• - handing over the stick
• - Use of inherent culture of self help ( burial
  societies)

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challenges

• Taking health clubs to scale
• Institutional attitudes
• Sometimes they have resource limitations e.g. a
  health club identified laviciding as a priority
  and had no gumboots, grassroots medicine kit

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challenges

• Hygiene tool kits for their use (PHHE materials)
• Competing priorities on time e.g. food security,
  HIV and Aids, political demands etc.
• Current approaches are adult centered and not
  child focused
• Lacking in a menu of technologies form where they
  can select what is suitable for their needs

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Conclusion

• Health clubs are an efficient and effective
  delivery mechanism for adults.
• The challenge is now to have innovative clubs for
  school children

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Hygiene should not be like a fuel pump where the
car has no say
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Thank you for showing an interest in a subject
that is not so sexy