Activating communities for sustainable services

Published on: 02/09/2014

The seminar at World Water Week in Stockholm on Securing Water, Energy, Sanitation and Livelihoods through Consensus: Community-Led Approaches in Africa was organised by Africa AHEAD and Stockholm Environment Institute (SEI). It examined community-led approaches in Africa including the Community Health Clubs Model in Zimbabwe and other community based sanitation and hygiene approaches in Rwanda, Uganda, Kenya and Benin.

Community Health Cls

Dr. Juliet Waterkeyn from AHEAD Africa described the Community Health Clubs (CHC) model as comprising of voluntary community associations dedicated to increasing knowledge on health-related issues and hygiene practices and promoting a culture of health in the communities and families. She said that the CHCs were being implemented in Zimbabwe, Rwanda and Uganda and were “helping to reduce transmission of diseases via water through promotion of better sanitation and hygiene and encouraging long term behavioural change particularly due to women’s participation.”

The 50-150 CHC members are motivated through various approaches including a shared vision and common understanding of the community health challenges and membership cards, certificates of achievement and recognition that enables them to feel part of their clubs and of the solutions to the community health problems. This has especially empowered the women who now describe themselves and “recognised people that are part of their communities”.

In Rwanda, the CHC model has been scaled up throughout the country and has been integrated as part of a health preventive process with clear quality control standards, all within the Environmental Health Directorate, that was formerly a small desk in the Ministry of Health.

Clean water, clean cooking by the International Lifeline Fund (ILF)

Dan Wolf, founder of the International Lifeline Fund (ILF) described the H2O project work in Northern Uganda that has promoted clean water and clean cooking.  He shared on-going plans to work with Rotary International and the Apac District Local Government and to use Community Health Clubs to achieve 100% water and sanitation coverage in the district. 

This was quite interesting for me because of the on-going discussions to work with the Uganda Rotary WASH+ project and Water for People in Apac district as part of the Everyone Forever Initiative. It is already interesting given its near link with the Triple-S Uganda work on Sub County Water Supply and Sanitation Boards and the Hand Pump Mechanics Associations in Lira district which is about 65kms from Apac and both districts being located within the same Technical Support Unit 2 (TSU2). Working with Community Health Clubs can be an appropriate avenue of enabling the Sub County Water Supply and Sanitation Boards and Hand Pump Mechanics Associations to closely work with communities to address operations, maintenance, functionality as well as health related challenges.

I asked Dan how they plan to link the CHC approach with the existing government of Uganda structures as provided in policy, including the Water Source Committees and the extension teams (health assistants, community development officer, agriculture officers etc.) at district, sub county and parish levels. Dan responded that “the ILF recognises the importance of local government structures and is hinged on broad community development, strong leadership, active member participation and an instilled sense of empowerment” all of which ensure that whatever interventions and approaches introduced and used are compatible and in line with government policies and ways of implementation. “In this way, sustainability of the interventions is right from the start embedded in government policies and even after the project ends and ILF leaves, the local governments can continue with the work”.

Dan further emphasised that the Apac district local government already recognises the benefits of the project and had provided office space for the project and both the political and technical leadership was participating in choosing the locations for the over 300 water sources to be constructed. That the local government had committed to working with ILF to enable the community members many of who were in internally displaced peoples’ camps during the 20 year Lord’s Resistance Army  insurgency to “feel whole again and to be recognised and appreciated as stakeholders, contributors and beneficiaries of the whole reconstruction and rehabilitation process for northern Uganda. The CHCs will be appropriate channels to enable the people to innovate, participate in decision making processes and to drive the rehabilitation agenda”.

Using ICT platforms to share information from CHCs and to monitor their progress Lisa Nash from Blue Planet described how dashboards were being used to share information about the work of CHCs in Uganda and the learning agendas and benefits that were being promoted. The dashboard shared is similar to what IRC has with details of the inputs, outputs, outcomes and impact. It also includes testimonies and stories of learning influenced by the communities, how collaboration is being promoted, information about transparency and accountability at community level and the level of scale.

Lisa explained that “what is shared using the dashboards is evidence of community engagement and accountability, capacity building and income generation and CHC adaptability to support multi-dimensional community needs.

Is the information in monitoring dashboards relevant, accessible and used to plan and budget?

The question I asked Lisa was how Blue Planet was ensuring that the beneficiaries, policy and decision makers and all the other stakeholders were providing inputs to the monitoring dashboard and accessing and using the information to further their community work and engagements. Lisa confessed that this was a challenge given that ICTs as a whole were not easily accessible by all community members or even in all the areas. Secondly, very few community members had the interest, time and money to allocate to internet connection given many other competing needs.

I thought that this was also a challenge that IRC needs to look into for its dashboards. Questions related to who is accessing the information on the dashboards and how the information is being used could be relevant to pursue. I was also reminded of the Water for People dashboard that captures data and information through the Reimagine Reporting (RiR) tool which is being widely used by the Kamwenge district local government to plan, budget and monitor. In this way, there is evidence that the communities and the local government planners actually use the information for a purpose. This makes the dashboards relevant and usable.

Feasibility and sustainability of financial incentives for health in a Kenyan community

Dr. Caroline Ochieng from SEI presented plans for rolling out and operationalizing the Afya Credit intervention in Kenya that will give cash incentives to pregnant women for every antenatal and postnatal visit to a health facility and those who deliver at such as facility. “This will improve hygiene and reduce the country’s high maternal mortality rate”, Dr. Ochieng said. She indicated that the intervention was developed in response to low attendance rates of pregnant women in antenatal and postnatal care, hence the aim to “increase the number of pregnant women who access and use health facilities during pregnancy, delivery and after delivery, which this will eventually reduce maternal mortality and under-five mortality rates”.

The presentation highlighted the key role of women in health, education and clean water and sanitation and indicated that though expensive, “if it is linked to the community health clubs, a lottery could become a further reward for participating in the clubs”.  I wondered how the intervention could be sustained and whether non-cash incentives (ITNs, fortified food stuffs, baby clothes etc.) could also be considered. I also wondered whether the women would actually use the money to improve their health or would be forced by their male partners to submit the cash received to them or even be forced to use it to meet other household needs like buying food, paying utility bills etc.

Community sanitation and hygiene in Benin

George de Gooijher from the Embassy of The Netherlands in Benin described how The Netherlands Government was working with and supporting the Government of Benin to address the different sanitation and hygiene challenges through a long time programme of over 10 years (2008 – 2018). George stressed that the programme’s “intervention logic was developed together with the communities and government of Benin and therefore focussed on actual needs of the people of Benin.

He explained how they were using AKVO FLOW ito generate evidence and to track proof required to bring about changeand how they are promoting and supporting the Community Led Total Sanitation (CLTS) approach to address open defecation. He noted that the CLTS triggering process “is not enough and requires subsequent quick interventions that can be sustainably managed by the local governments”. This was spot on for me especially knowing that the same challenge is being experienced in Uganda and is causing a lot of slippage in villages previously declared ‘open defecation free’ (ODF). Local governments do not have the required resources to sustain the process after triggering and most NGOs that support the process only do that and rarely plan for the embedding activities that will ensure that the triggered communities continue with the next processes up to ODF and beyond.

An interesting debate ensued from George’s reference to “how effective naming and shaming during the CLTS process can be and how this can prevent relapses to OD”.  Some participants (many from UNICEF) felt that naming and shaming was appropriate and had forced many household to construct toilets. Other participants also felt that naming and shaming was promoting levels of stigmatisation and humiliation that were preventing CLTS from achieving its intended goals. The two views however enabled the sharing of experiences of where naming and shaming had worked and where it had not.

My experience in Uganda is that the naming and shaming processes are determined by the community members who decide whether to name and shame. Government discourages the naming and shaming and provides for avenues to identify those who do not have toilets and how to deal with them without necessarily “broadcasting them” in the whole village.

Community based sanitation programmes in Burera district, Rwanda

Dr. Nelson Ekane from SEI Described how in Rwanda, sanitation and hygiene guidelines and standards for toilet technologies were being enforced at the community level – specifically in the Rugarama sector, Burera District. He explained that “health, hygiene, convenience, and safety aspects of sanitation were still inadequate and not aligned with national guidelines and standards”. He further explained how PHAST Community groups in Burera district in Rwanda were promoting the re-use of human waste to improve agriculture products in terms of high yields (quantity and size).

I noted that there were no recommendations of two issues identified as challenges. That is: how to deal with the treatment of the waste given that the studies had identified lots of pathogens in the waste that was being sold to farmers and secondly, how to address the negative attitudes by people who felt that manure from human waste was not good for use to produce food.