SEATTLE, Washington — In Rwanda, only 64% of people have adequate access to basic sanitation. Basic sanitation is defined as every household having its own toilet that it does not share with another household. In addition to a lack of access to basic sanitation, only 5% of households have a space available for family members to regularly wash their hands with soap. As a result of poor sanitation and hygiene in Rwanda, 66% of school-aged children were infected with worms in 2010.
In an effort to address issues of hygiene and sanitation, the government of Rwanda implemented Community Health Clubs as a solution.
Community Health Club Goals and Implementation
The government of Rwanda made significant progress in meeting the Millennium Development Goals for hygiene and sanitation. In 2009, Rwanda implemented Community Health Clubs to address poor hygiene practices and access to sanitation services. Community Health Clubs are an initiative meant to teach children and other community members appropriate hygiene and sanitation practices with the hope of improving current hygiene and sanitation habits.
Rwanda’s Community Health Clubs set important goals and benchmarks to meet by 2020. Some of these goals include:
Increased use of toilets in schools and households
Increased rates of handwashing
An improvement in access to safe drinking water
Safe disposal of human waste
Eradication of open defecation in all villages
Implementation of Community Health Clubs in all villages nationwide
The government aims to meet these goals through the education of its citizens in these community-based programs. The Community Health Club programs operate in a way that is intended to be both sustainable and cost effective.
The government approaches these programs by utilizing a standard set of materials for each village. Each village that is selected to participate in the program will have trained community health workers giving weekly trainings on 20 different sanitation and hygiene-related topics. Those from the community who attend the meetings receive a membership card. The membership card includes a list of tasks that each member and household can do to improve their hygiene and sanitation at home. Individuals can participate in tasks from building a homemade hand washing station to practicing safe water storage.
Perhaps the most significant challenge is bridging the gap between policy and implementation. One of the largest gaps is inadequate funding at the national and district levels. Funding largely comes from donations and international NGOs.
Further, those who are working in the village communities are not always given clear instructions about what their roles are within the larger organization. These factors lead to an uncoordinated implementation of the programs, which often leaves communities without a continuation of the Community Health Club activities after the projects conclude.
As of 2012, there were 45,000 community health workers who were trained by The Ministry of Health. With the high volume of trained health workers, the program was able to send three community health workers to each village selected to participate in the program. Beyond being responsible for community education and spreading awareness for healthy sanitation habits, these health workers also collected sanitation and hygiene information about each village to report to The Ministry of Health.
When compared to programs such as Community-Led Total Sanitation, the Community Health Club model fosters change by promoting healthy behaviors as a cultural norm rather than using shame-based communication in the community to create change. In general, surveys of participants in these community health programs responded positively to the community-based approach, citing a good fit with Rwandan culture.
The challenges these Community Health Clubs face, while significant, are not impossible to overcome. In continuing to study the outcomes of these community-based programs and listening to participant feedback, these clubs are well on their way to improving sanitation and hygiene in Rwanda.
– Maddi Miller