3.3.3 Community health club approach – Case study of Katakwi in Uganda

The approach relies entirely on community empowerment for health and development issues. There are four major components being implemented in phases.

The first component is the Knowledge Base focussing on (i) mobilising and sensitizing the community on hygiene and sanitation through participatory approaches - PHAST, (ii) organising communities into the 'club' arrangements based on voluntary basis, creating common unity and purpose of community health clubs (CHCs), (iii) conducting health/hygiene education through a card system and identifying practicable hygiene and sanitation interventions.

The second component is Practical Skills Application focussing on construction of hygiene and sanitation facilities identified through the knowledge base phase and improvement of existing infrastructure and behavioural change practices.

The third component is Economic Empowerment which focuses on promoting identified simple income generating activities, skills training in simple income generating activities, skills in improvement of financial management and environmental management skills / initiatives.

The fourth component is the Social Activities / Initiatives which looks at literacy training, care of HIV/AIDS victims/orphans and other relevant social community identified development activities promotion.

The main activities of the project include conducting community meetings/training, home visiting of fellow club members, drama activities rehearsals and performances (music, dance and drama), self-help in constructing necessary infrastructure, training of local community artisans, conducting inter and intra community club visits to learn from each other and monitoring progress of CHC activities - participatory - using household sanitation and hygiene monitoring forms.

The triggers for change included the low levels of sanitation and hygiene in the district (43% latrine coverage, now at 55%), and the fact that the LWF as an NGO had worked in the district for over 5 years without realising/registering good progress. Success factors include the adoption of the 10 point KDS strategy for action (1997) and the direct support from the key lead ministries of health, water and environment.

The resources for the project are provided jointly by an NGO (Lutheran World Foundation), the district authorities and the central government. The LWF provides funding of relevant and related activities, human resource development and support, relevant provision development and dissemination of materials and labour by the target community (CHC members). The district provides human resources and communication materials whilst the Central Government offers resource persons and facilitators for capacity building.

The main achievements include increased latrine coverage from 44 to 55%, well organized non-government structures (CHC), ownership of the initiatives, increase in related hygiene infrastructure (e.g. tippy taps - a hand washing facility), increased collaboration between district and the NGOs.

Success factors include (i) effective triggers for change, (ii) the low levels of sanitation and hygiene in the district (43% latrine coverage, now at 55%), (iii) the LWF as an NGO having worked in the district for over 5 years without realising/registering good progress, (iv) replication of the concept from CARE which had tried it out in IDP camps of Northern Uganda, (v) the 10 point KDS strategy for action (1997!!), and (vi) the improved sanitation and hygiene strategy (ISH) by key lead ministries (health, water and environment education).

Some of the lessons learnt are that (i) membership cards are powerful incentives, (ii) CHCs provide a unity of purpose, (iii) the approach encourages members to be more analytical in linking poor hygiene to poverty and try to apply acquired knowledge, (iv) strong exemplary leadership in CHC members is crucial, (v) use of demos raises a lot of interest, and (vi) by-laws cement the groups and encourage slow takers.