MUKAMUNANA Alphonsine COMMUNITY BASED ENVIRONMENTAL HEALTH PROMOTION PROGRAMME (CBEHPP) IN RWANDA MUKAMUNANA Alphonsine Ministry of Health TEL: 0788673500 Email: munana01@yahoo.fr

What is CBEHPP Community Based Environmental Health Promotion Program uses a Community Health Clubs (CHC) Approach/Strategy to reach all communities and empower them to identify their personal, domestic hygiene, nutrition and environmental health related problems (including drinking water, appropriate utilization of latrines, handwashing, food safety etc.) Community Health Club during a CHC dialogue session (RUSIZI)

SPECIFIC STRATEGIES The Government of Rwanda launched CBEHPP in December 2009 with an objective of reducing significantly by 2017 the debilitating national disease burden (Diarrhea, Intestinal Parasites and Respiratory infections) and therefore contributing to poverty reduction through sustainable hygiene behaviour change through the following strategic interventions. Establishment of Community Hygiene Clubs (CHCs) in all villages Increase use of hygienic latrines in homes, schools and health facilities Increase hand washing with soap at critical times in homes, schools and health facilities

SPECIFIC STRATEGIES Increase drinking of safe water in homes, schools and health facilities Achieve Zero Open Defecation in all villages through construction and use of improved toilets. Improve safe disposal of children’s faeces in all households Increase households with bath shelters, rubbish pits, pot-drying racks and clean yards

CBEHPP APPROACH 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 One member represents the household in a Club session CHC Members required to meet every week for 2 hoursInformed decision making through good information Creating a common unity/goal through activities Action oriented with weekly hygiene improvements (e.g. making existing toilets hygienic).

CBEHPP PARTNERSHIP CBEHPP PARTNERS MoH MIGEPROF MINECOFIN MINEDUC Environmental Health MINECOFIN MIGEPROF CBEHPP (CHCs) MINALOC/DISTRICT MINEDUC MINAGRI PARTNERS MININFRA WASAC

CBEHPP IMPLEMENTATION STRUCTURE Ministry of Health (Environmental Health Desk) MINALOC, MINIFRA, MINEDUC, MINAGRI, MIGEPRO, MINECOFIN District (District Health Unit) District Hospital (EHO) Sector (Social Affairs) Health Center (EHO) CHC MEMBERS: 1-President 2- Vice President 3- Secretary 4- Vice Secretary 5- Treasurer 6- Vice Treasurer 7- HH Representatives Cell (Social Economic Development Officer) CHC Committee Village (Head of village) Village ASOC (CHC Facilitator) CHC

ROADMAP FOR IMPLEMENTATION OF CBEHPP Milestone Events 2009 2010 2011 2012 Q4 Q 1 Q2 Q3 Q1 Program Launch Program design & advocacy. Development of road map   Phase I Start-up Start-up in 5 Districts /Province Phase II Consolidate Consolidate & add 5 new Districts Launch of HSPI Phase III Scale-Up Roll-out to all remaining 22 Districts

CBEHPP TRAINING OF NATIONAL CORE TRAINERS Roll out of EHO Training in 5 Districts in December 2010, and 4 other districts in 2011. In November 2010 the core team was trained in order to scale up training

CHC Approach: Key Implementation aspects The Community Health Club Methodology is facilitated by Village Social Affairs who in turn are supported and mentored by Environmental Health Officers located at Administrative District and Health Facility level. 6 Months Community Health education - 20 Dialogue sessions. Target group Inclusive Structured Participatory Group consensus Homework Reinforcement Certification Quantifying behavior change

KEY LESSONS LEARNED DURING CHC DIALOGUE SESSIONS AND HOMEWORK 1 Introduction Bring friends and family 2 Common Diseases Know common diseases 3 Personal Hygiene Family wash shelter 4 Hand washing Handwash facility/ soap 5 Skin diseases Children no skin diseases 6 Diarrhoea Knowledge of SSS/ORS 7 Infant Care Correct Immunization 8 Intestinal Parasites/Worms Children no Worms 9 Food Hygiene Clean Drying Rack 10 Nutrition Good Road to Health 11 Food Security/Safety Kitchen Garden 12 Water Sources Clean Water Source 13 Safe Drinking Water Safe Storage and Usage 14 Adequate Sanitation ZOD/Clean Safe Toilets 15 The Model Home Waste Management and Greening 16 Good Parenting Clean Children 17 Respiratory Diseases Good Ventilation 18 Malaria Use of Treated Bed Nets 19 Bilharzia Treatment for Bilharzia 20 HIV/AIDS VCT and PMTCT  

CHC MEMBERS IN INTERACTIVE CLUB ACTIVITIES CHC Committee election CHC Members during a village mapping session

CHC MEMBERS IN INTERACTIVE CLUB ACTIVITIES Village WASH Mapping during a CHC session Sanitation and hygiene Promotion Songs

CHC APPROACH FACILITATING LIVE DISCUSSIONS Reinforcement: Peer pressure /home visits Homework: Recommended Practices Measurable: Specific Targets Each Week

HOMEWORK IMPLEMENTATION AT HOUSEHOLD AND VILLAGE LEVEL Construction of a pot/plate rack Maintaining their water source and cleaning up the solid waste to preserve a clean environment

FAVORABLE ENVIRONMENT FOR CBEHPP Availability of political will - all levels Supportive DPs Availability of qualified personnel to implement CBEHPP CBEHPP Roadmap though a review is needed Existence of Health Clubs in all Villages Positive involvement of the Media.

CONCLUSION We are inviting all our partners to actively support the programme (CBEHPP). While the Village Social Affairs and Environmental Health Officers are already available, their capacity to achieve positive results through CHCs requires technical support and motivation. Appropriate training materials and financial resources for this noble cause are critical towards achieving effective implementation.

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