Cost-effective health promotion and hygiene behaviour change through community health clubs in Zimbabwe

Doctoral thesis English OPEN
Waterkeyn, Juliet Anne Virginia

Although safe sanitation and hygiene is critical \ud for improving family \ud health, \ud rural communities \ud in Sub Saharan Africa have shown little inclination to \ud change their traditional \ud behaviour, \ud and \ud sanitation coverage has now dropped to 47% \ud (Cairncross \ud 2003). \ud With the \ud Millennium \ud Development Goals seeking to halve the \ud 2.4 billion \ud people \ud without sanitation \ud by the \ud year \ud 2015, there is an urgent need to find cost-effective \ud health \ud promotion \ud strategies \ud that \ud will \ud actively engage rural householders in modifying risky \ud hygiene \ud behaviour. \ud This thesis \ud evaluates an approach, developed over the past \ud ten \ud years \ud in Zimbabwe, in \ud which \ud Community \ud Health Clubs have successfully galvanised \ud rural \ud communities \ud into \ud active \ud behaviour \ud change \ud leading to a strong demand for sanitation. \ud In Tsholotsho \ud District, \ud after \ud six months of \ud weekly \ud hygiene promotion sessions, at the cost of \ud US 35c \ud per \ud beneficiary, \ud good \ud health knowledge \ud of \ud nine different topics was 47% higher in the intervention than for the \ud control, and \ud latrine \ud coverage rose to 43% contrasted to 2% in the control \ud area, with \ud the \ud remaining \ud 57% \ud members \ud without latrines practicing faecal burial, a method \ud previously unknown \ud (p>0.0001). Spot \ud observations of 736 Health Club households in two \ud districts \ud was contrasted \ud to \ud 172 in \ud a \ud control group, and showed highly significant changes \ud in \ud 17 key hygiene \ud practices \ud (p>0.0001) \ud including hand washing. The study demonstrates that if \ud a strong community \ud structure \ud is \ud developed and the norms of a community are altered \ud by \ud peer pressure \ud from \ud a cyclical \ud to \ud linear world view, hygiene behaviour change will \ud ensue and a \ud demand for \ud sanitation \ud can \ud be \ud created. Maslow's Hierarchy of Needs (1954) is \ud adapted \ud to \ud a rural context \ud to \ud analyse \ud the \ud qualitative data, providing some insight into the \ud socio-cultural mechanisms \ud at \ud work. \ud Despite \ud adverse socio-economic conditions in Zimbabwe over \ud the \ud past \ud five \ud years, \ud Health \ud Clubs \ud have \ud flourished, providing a sustainable and cost-effective \ud case study.
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