africasan 2011, rwanda: behaviour change session - joseph katabarwa, ministry of health, rwanda
TRANSCRIPT
Making ‘what works’ work: Changing behaviour in sanitation and hygiene
Community Based Environmental Health Promotion Programme
(CBEHPP) Rwanda
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Ministry of Health, RwandaMr. Joseph [email protected] number: +250 788 461 076
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Vision 2020: All households ‘will have mastered and be practicing hygiene and waste disposal.’
Economic Development and Poverty Reduction Strategy (EDPRS): Streamline intervention to implement the vision.
Health Sector Strategic Plan II (HSSP II): Promote healthier lifestyles and prevention of diseases.
Environmental Health Policy and National Policy for Water and Sanitation Services: Determine the modalities of implementation of the strategy for the sub sector.
Government seeks a cost effective strategy, not only to meet the sanitation MDG, but also to decrease the burden of disease and alleviate poverty throughout Rwanda.
ADDRESSING POVERTY AND DISEASES IN RWANDA
Integrated Community Development
Education
Wat
er &
Sanita
tion
Prim
ary
Health
Environment
Food
Security
Home-based care
Skills
TrainingInco
me
Gen
erat
ion
POVERTY ALLEVIATION
through Community Hygiene
Clubs (CHCs)
CLTS ApproachImplementation strategy
CHC Approach: Implementation strategy
APPROACHES FOR HYGIENE BEHAVIOR CHANGE
• 6 months PHHE 20 sessions (each week)
• Learning through fun participatory activities reinforce good practice (song, drama)
• Informed group decision making and weekly homework
• Voluntary household improvements
• One ‘Triggering’ day + a few follow-up visits
• Community shamed into action
• Village walk to shock community that they are eating their own faeces
• Leaders enforce change with fines
• Zero Open Defecation (ZOD) & 20+ other hygiene improvements
• Open Defecation Free (ODF ) Village or move on the sanitation ladder
Milestone Events
2009 2010 2011 2012
Q4 Q 1 Q2
Q3 Q4 Q1
Q2
Q3 Q4 Q1
Q2 Q3 Q4
Programme Launch
Programme design & advocacy.
Development of road map
Phase I Start-up
Start-up in4 Districts 1 Province
Phase II Consolidate
Consolidate & add 4
new Districts
Launch of HSPI
Phase III Scale-Up
Roll-out to all remaining 22 Districts
MINEDUC: Enhancing human resources
MoH (EHD) : Sustainable hygiene
behavior change
MINECOFIN & MINALOC:
National development &
poverty alleviation
MININFRA :Increasing access to
rural /urban WSS
Community-Based Environmental Health Promotion Programme
Cross-cutting Sectors & Ministries
CBEHPP
CBEHPP (CHCs)
CHWs
Community-Based Environmental Health Promotion Programme
Community Based:• Aims to reach all 15,000 villages in Rwanda• Establish a Community Hygiene Club (CHC) in every village• All households in each village will be CHC members
CBEHPP
• CHC Members required to meet every week• Informed decision-making based on good information• Creating a common unity/ goal through activities• Action oriented with weekly hygiene improvements
(e.g. making existing toilets hygienic)
Training Manuals for CBEHPP developed
CBEHPP
District Environmental Health Officers3-day training in all aspects of the CHC Approach to be used in CBEHPP to enable planners to have an understanding of the CHC approach.
Community Health Workers5-day workshop to enable Environment Health Officers and Community Health Workers to effectively facilitate the 24 topics.
Tool kit of Visual Aids developed for participatory
activities (PHAST)
CBEHPP
• Design & development of more than 300 illustrations for 24 topics.
• These were all individually pre-tested and altered to ensure they are 80% comprehensible for the illiterate/semi literate to fully represent the Rwandan context.
Pretesting visual aids. Photo credit: Waterkeyn J.
Training of National Core TrainersCBEHPP
In November 2010 the core team were trained in order to scale up training.
Roll-out of EHO Training in 5 Districts in December 2010, and 4 other districts in 2011.
Training session held for core trainers. Photo credit: Waterkeyn J.
1. Increased use of hygienic latrines in schools and homes from 28% to 80%
Measuring Behaviour Change by 2015: The 10 Golden Indicators
CBEHPP
2. Increased handwashing with soap at critical times from 34% to 80%
3. Improved safe drinking water access and handling in schools and homes to 80%
4. Establishment of CHCs in every village from 0% to 100%
5. Achieve Zero Open Defecation ZOD in every household from 28% to 100%
6. Safe disposal of children’s faeces in every household from 28% to 100%
7. Households with bath shelters increase to 80%
8. Households with well managed rubbish pits increase to 80%
9. Use of pot racks for drying dishes increase to 80%
10. Households with clean yards increase to 80%
Difference of Prevalence of Observed Hygiene Indicators between Community Health Club Members and non Members in Tsholotsho District, Zimbabwe. 2001 Source: Waterkeyn,J. 2005 (Africa AHEAD)
Expectations of successCBEHPP
The CHC Approach has been tried and tested in Zimbabwe, Sierra Leone, Guinea- Bissau, Uganda, South Africa and in Vietnam. Every time it has delivered reliable results, varying according to the level of development in each context. We expect the same in Rwanda that has been achieved in Zimbabwe (see graphs below).
0
500
1000
1500
2000
2500
1995 1996 1997 1998 1999 2000 2001 2002 2003
Diarrhoea
Bilharzia
Skin diseases
ARI
Eye disease
Malaria
Ruwombe Ward, Makoni District, Zimbabwe. Reported Cases of communicable disease 18 health clubs PHHE: 1995 - 2001 # h/holds 1,771 CHC Coverage of area: 80 %. Source: MoH Zimbabwe; Waterkeyn, J. 2005
Expected Reduction in Poor Hygiene and Sanitation Related Diseases
CBEHPP
Based on past experience of disease reduction in CHC
areas where there is at least 80% adherence to CHCs
over at least three years, we expect to induce significant
levels of behaviour change with the resultant decrease
in reported cases of preventable disease (diarrhoea,
ARIs, malaria, bilharzia, skin disease and worms)
throughout Rwanda given that CBEHPP will be
implemented in all 15,000 villages in the next few years.
Conclusion CBEHPP
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THANK YOU FOR YOUR KIND ATTENTION
With technical and financial support of
CONTACTS:• Mr. Joseph Katabarwa, Ministry of Health; [email protected] •Mr. Bruno Mwanafunzi, Water Sanitation programme (WSP); [email protected]•Mrs. Juliet Waterkeyn, Africa Ahead; [email protected]•Mr. Guy Mbayo Kakumbi, UNICEF Rwanda CO; [email protected]