1. Anthony Waterkeyn UNC- 2 nd Nov 2012 UNC- 2 nd Nov 2012

2. Zimbabwe 1995 Graduation Day for this Community Health Club!

3. Community Health Clubs in Sierra Leone (2002)

4. Northern UGANDA : IDP Camps (2004)

5. A CHC in an ethnic Thai community of Vietnam

6. Over 380 Community Health Clubs started in the 200+ informal settlements in Cape Town & Durban, SOUTH AFRICA

7. 11 million children die each year 88% deaths could be prevented by good hygiene HOLISTIC HEALTH: Which DISEASES / conditions are addressed by health promotion in your model?

8. Roll-Out of CHCs since 1995 Sierra Leone: 2002 150 Guinea Bissau: 2007 120 Uganda: 2004 150 Rwanda 2012 >14,000 Villages Zimbabwe: 1995 -2002 500 CHCs 2003-2012 1,950 South Africa: 2008 400 Vietnam: 2010 48 Namibia : 2011 30

9. GOOD 85% households have latrines “Culture of Sanitation” BAD Only 10% are hygienic UGLY 80% Disease Burden in Rwanda caused by poor personal, domestic & community hygiene practices

10. 10 MoH was seeking a practical, holistic & cost-effective strategy, not only to meet sanitation MDGs, but also to decrease the burden of disease and to ALLEVIATE POVERTY in Rwanda. Rwanda has developed policies to address poverty and disease Rwanda: Background 11 million people; 30 districts, 4 Provinces Well organized MoH that values & enhances its EHD; One of few African countries set to achieve MDG WS targets High coverage of traditional latrines but very poor hygiene standards.

11. Poverty, Health, & Environment Placing Environmental Health on Countries’ Development Agendas

12. Poverty, Health & Environment Box 6 p33 “ Behavior Change can be Cost-effective: DFID funded the Community Health Clubs in rural Tsholotsho District, Zimbabwe. The project increased the proportion of households using a ladle to draw water from 3 % - 93 % and the proportion with an improved pit latrine from 40 % - 80 %, as well as improving other aspects of hygiene behavior, at a cost of $3.33 per household”.

13. “Here in Rwanda we have NO time for Piloting. You have been piloting. We want to go to scale! Go and develop a Roadmap for national roll-out of CHCs” Minister of Health: Dr Jean-Claude Damascene

14. Community-Based Environmental Health Promotion Programme CBEHPP Development of Road Map and Training Manuals and Tool Kit of >300 cards PLANNING TO START COMMUNITY HYGIENE CLUBS IN RWANDA ABOUT THE CBEHPP TRAINING The training for CBEHPP is designed at three levels: Module 1: Advocacy for the CBEHPP Target audience: Opinion leaders in government and Development Agencies This one day Orientation Workshop is conducted by MoH for stakeholders at National and District level, based on the Road Map for CBEHPP launched in Nov. 2009. Module 2: Planning to start up CBEHPP in Rwanda using Community Hygiene Clubs Target Audience: District Environmental Health Officers The workshop is a 3 day training in all aspects of the CHC Approach to be used in CBEHPP, which is contained in this manual. As it is largely theoretical to enable planners to have an understanding of the CHC approach, it is not designed to be passed on to Community Health Workers in the village. Module 3: Participatory Sessions for Community Hygiene Clubs Target Audience: Community Health Workers at Village level This is a 5 day workshop, to enable Environment Health Officers and Community Health Workers to effectively facilitate the 24 topics which comprise the CBEHPP training, in the weekly sessions held within the Hygiene Club. This is a practical rather than theoretical training on the methodology, and not the health knowledge which is also needed for effective facilitation of Public Health. CBEHPP Tool Kit for the Participatory Sessions in CHCs Target Audience: semi-literate and illiterate villagers in Rwanda This is a Kit of 24 topics, each with 20 illustrated cards, which is used by the facilitator and CHC in the 24 sessions, in a participatory approach to training. The cards are visual aids with no written text, and can therefore be used at every level of education. They are culture specific to Rwanda and have been pretested in the field to ensure over 80% comprehension by the. Membershi p number MANUAL FOR FACILITATORS AND COMMUNITY HEALTH WORKERS PARTICIPATORY ACTIVITIES FOR TRAINING IN COMMUNITY HYGIENE CLUBS MANUAL FOR TRAINERS OF ENVIRONMENTAL HEALTH OFFICERS Ministry of Health Environmental Health Desk Drinking Water Community Based Environmental Health Promotion (CBEHPP) Programme Republic of Rwanda Topic. 17. PLANNING TO START COMMUNITY HYGIENE CLUBS IN RWANDA ABOUT THE CBEHPP TRAINING The training for CBEHPP is designed at three levels: Module 1: Advocacy for the CBEHPP Target audience: Opinion leaders in government and Development Agencies This one day Orientation Workshop is conducted by MoH for stakeholders at National and District level, based on the Road Map for CBEHPP launched in Nov. 2009. Module 2: Planning to start up CBEHPP in Rwanda using Community Hygiene Clubs Target Audience: District Environmental Health Officers The workshop is a 3 day training in all aspects of the CHC Approach to be used in CBEHPP, which is contained in this manual. As it is largely theoretical to enable planners to have an understanding of the CHC approach, it is not designed to be passed on to Community Health Workers in the village. Module 3: Participatory Sessions for Community Hygiene Clubs Target Audience: Community Health Workers at Village level This is a 5 day workshop, to enable Environment Health Officers and Community Health Workers to effectively facilitate the 24 topics which comprise the CBEHPP training, in the weekly sessions held within the Hygiene Club. This is a practical rather than theoretical training on the methodology, and not the health knowledge which is also needed for effective facilitation of Public Health. CBEHPP Tool Kit for the Participatory Sessions in CHCs Target Audience: semi-literate and illiterate villagers in Rwanda This is a Kit of 24 topics, each with 20 illustrated cards, which is used by the facilitator and CHC in the 24 sessions, in a participatory approach to training. The cards are visual aids with no written text, and can therefore be used at every level of education. They are culture specific to Rwanda and have been pretested in the field to ensure over 80% comprehension by the. Membershi p number MANUAL FOR FACILITATORS AND COMMUNITY HEALTH WORKERS PARTICIPATORY ACTIVITIES FOR TRAINING IN COMMUNITY HYGIENE CLUBS MANUAL FOR TRAINERS OF ENVIRONMENTAL HEALTH OFFICERS Ministry of Health Environmental Health Desk Drinking Water Community Based Environmental Health Promotion (CBEHPP) Programme Republic of Rwanda Topic. 17. MANUAL FOR FACILITATORS AND COMMUNITY HEALTH WORKERS PARTICIPATORY ACTIVITIES FOR TRAINING IN COMMUNITY HYGIENE CLUBS PLANNING TO START COMMUNITY HYGIENE CLUBS IN RWANDA MANUAL FOR TRAINERS OF ENVIRONMENTAL HEALTH OFFICERS

15. PLANNING TO START COMMUNITY HYGIENE CLUBS IN RWANDA ABOUT THE CBEHPP TRAINING The training for CBEHPP is designed at three levels: Module 1: Advocacy for the CBEHPP Target audience: Opinion leaders in government and Development Agencies This one day Orientation Workshop is conducted by MoH for stakeholders at National and District level, based on the Road Map for CBEHPP launched in Nov. 2009. Module 2: Planning to start up CBEHPP in Rwanda using Community Hygiene Clubs Target Audience: District Environmental Health Officers The workshop is a 3 day training in all aspects of the CHC Approach to be used in CBEHPP, which is contained in this manual. As it is largely theoretical to enable planners to have an understanding of the CHC approach, it is not designed to be passed on to Community Health Workers in the village. Module 3: Participatory Sessions for Community Hygiene Clubs Target Audience: Community Health Workers at Village level This is a 5 day workshop, to enable Environment Health Officers and Community Health Workers to effectively facilitate the 24 topics which comprise the CBEHPP training, in the weekly sessions held within the Hygiene Club. This is a practical rather than theoretical training on the methodology, and not the health knowledge which is also needed for effective facilitation of Public Health. CBEHPP Tool Kit for the Participatory Sessions in CHCs Target Audience: semi-literate and illiterate villagers in Rwanda This is a Kit of 24 topics, each with 20 illustrated cards, which is used by the facilitator and CHC in the 24 sessions, in a participatory approach to training. The cards are visual aids with no written text, and can therefore be used at every level of education. They are culture specific to Rwanda and have been pretested in the field to ensure over 80% comprehension by the. Membershi p number MANUAL FOR FACILITATORS AND COMMUNITY HEALTH WORKERS PARTICIPATORY ACTIVITIES FOR TRAINING IN COMMUNITY HYGIENE CLUBS MANUAL FOR TRAINERS OF ENVIRONMENTAL HEALTH OFFICERS Ministry of Health Environmental Health Desk Drinking Water Community Based Environmental Health Promotion (CBEHPP) Programme Republic of Rwanda Topic. 17. 2009: Roadmap developed for dissemination of CHCs RWANDA Community-Based Environmental Health Promotion Program (CBEHPP) 45,000 Community Health Workers in Rwanda now being trained in CHC Approach RWANDA WILL BE THE 1 ST COUNTRY TO TAKE CHCs TO SCALE THROUGHOUT THE COUNTRY Gates Foundation : Evaluation of Health Impact of CHCs (Tom Clasen - RCT 2012 - 2015) 2010: President Paul Kagame calls for CHCs to be established in all 15,000 villages across Rwanda

16. Stage 1: Entry point is Health Promotion all common diseases are addressed Malaria WormsBilharzia HIV/AIDS Skin diseases Acute Respiratory Infections CHCs : Vehicle for Holistic Integrated Development Health Club Nutrition Hygiene Sanitation Water Livelihoods Diarrhoea Cholera Stage 2:Water and Sanitation Stage 3: Food and Nutrition Stage 4:Social development: HIV/AIDS, Human Rights

17. Integrated Community Development Education Water & Sanitation Primary Health Environment Food Security Home- based care Skills Training Income Generation POVERTY ALLEVIATION THROUGH CHCs

18. MINEDUC: Enhancing human resources MOH : Sustainable Hygiene behavioral change MINALOC & MINECOFIN: National development poverty alleviation MININFRA: Increasing access to rural /urban WSS Community-Based Environmental Health Promotion Programme Cross - cutting Sectors & Ministries CBEHPP CHWs

19. CHC Dissemination  Locate HBC within overarching context of achieving preventative health (i.e. national disease burden) & poverty reduction Outcomes.  Provide a practical, low-cost, high-impact approach to enable MoH to generate Political Will and DP support  Provide a model that does not depend on external funding for start-up but can be initiated by LG and MoH extension staff (e.g. CHWs)  Capacity-build and motivate CHWs  Provide appropriate Tool-kits and Training Manuals

20. Community Health Clubs Common Unity Shared Understanding Shared norms and values THANK YOU & GOOD LUCK!!