Two similar Community Health Club (CHC) interventions to achieve hygiene behaviour change and improved family health in Africa took place - one in Zimbabwe implemented by an NGO and the other in Rwanda part of Randomised Control Trial. Both interventions achieved high levels of community response, although Zimbabwe project was more cost-effective, achieving blanket coverage of all households in the area in 8 months with over 90% compliance in 12 recommended practices at a cost of US$4.5 per beneficiary. In Rwanda the spread of the intervention reached only 58% of the households with compliance of over 80% in 10 new practices costing US$13.13 per beneficiary over the first year. Although the Zimbabwe program showed better Value for Money, being more efficient, long term sustainability to prevent slippage of hygiene behaviour change depends on a strong monitoring system. This is best achieved systematically by building the capacity of the Environmental Health Department to take responsibility for the supervision of CHCs in every village. Investing in a national program which can enable Government to coordinate NGO efforts through an integrated development program is a more cost-effective use of scarce resources in the long term