Cost-effective health promotion and hygiene behaviour change through community health clubs in Zimbabwe
Waterkeyn, Juliet Anne Virginia;
(2006)
Cost-effective health promotion and hygiene behaviour change through community health clubs in Zimbabwe.
PhD thesis, London School of Hygiene & Tropical Medicine.
DOI: https://doi.org/10.17037/PUBS.00682348
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Although safe sanitation and hygiene is critical
for improving family
health,
rural communities
in Sub Saharan Africa have shown little inclination to
change their traditional
behaviour,
and
sanitation coverage has now dropped to 47%
(Cairncross
2003).
With the
Millennium
Development Goals seeking to halve the
2.4 billion
people
without sanitation
by the
year
2015, there is an urgent need to find cost-effective
health
promotion
strategies
that
will
actively engage rural householders in modifying risky
hygiene
behaviour.
This thesis
evaluates an approach, developed over the past
ten
years
in Zimbabwe, in
which
Community
Health Clubs have successfully galvanised
rural
communities
into
active
behaviour
change
leading to a strong demand for sanitation.
In Tsholotsho
District,
after
six months of
weekly
hygiene promotion sessions, at the cost of
US 35c
per
beneficiary,
good
health knowledge
of
nine different topics was 47% higher in the intervention than for the
control, and
latrine
coverage rose to 43% contrasted to 2% in the control
area, with
the
remaining
57%
members
without latrines practicing faecal burial, a method
previously unknown
(p>0.0001). Spot
observations of 736 Health Club households in two
districts
was contrasted
to
172 in
a
control group, and showed highly significant changes
in
17 key hygiene
practices
(p>0.0001)
including hand washing. The study demonstrates that if
a strong community
structure
is
developed and the norms of a community are altered
by
peer pressure
from
a cyclical
to
linear world view, hygiene behaviour change will
ensue and a
demand for
sanitation
can
be
created. Maslow's Hierarchy of Needs (1954) is
adapted
to
a rural context
to
analyse
the
qualitative data, providing some insight into the
socio-cultural mechanisms
at
work.
Despite
adverse socio-economic conditions in Zimbabwe over
the
past
five
years,
Health
Clubs
have
flourished, providing a sustainable and cost-effective
case study.