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AfricaSan 2011, Rwanda: Behaviour change session - Joseph Katabarwa, Ministry of Health, Rwanda
 

AfricaSan 2011, Rwanda: Behaviour change session - Joseph Katabarwa, Ministry of Health, Rwanda

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  • GC’s edits: Who will present this work? Will it be you Guy, or Joseph Katabarwa as he is mentioned on the opening slide? Whoever is to present should be mentioned on the first and last slides.
  • GC’s edits: Corrected “Adressing” typo to “Addressing” in title. Have deleted “required” from 4 th line. Have condensed “The promotion of” to “Promote” on 5 th line. Have also added sentence on Government’s overall strategy from the 3 rd original slide, which I have now deleted to shorten the presentation.
  • GC’s edits: I have spelled out Community Hygiene Clubs in the centre of the slide as some people may not know this acronym.
  • GC’s edits: For the 5 th bullet point, I have replaced “through” with “based on.”
  • GC’s edits: Over what period are these indicators to be achieved? Important to include this fact.
  • GC’s edits: Corrected “Guines” typo to “Guinea-Bissau.” I’ve changed “achieved in the example opposite (Zimbabwe, 2002)” to “achieved in Zimbabwe (see graphs below).”
  • GC’s edits: Please provide contact details and website addresses if appropriate.

AfricaSan 2011, Rwanda: Behaviour change session - Joseph Katabarwa, Ministry of Health, Rwanda AfricaSan 2011, Rwanda: Behaviour change session - Joseph Katabarwa, Ministry of Health, Rwanda Presentation Transcript

  • Making ‘what works’ work: Changing behaviour in sanitation and hygiene Community Based Environmental Health Promotion Programme (CBEHPP) Rwanda 1 Ministry of Health, Rwanda Mr. Joseph Katabarwa [email_address] Cell number: +250 788 461 076
  • Vision 2020: All households ‘will have mastered and be practicing hygiene and waste disposal.’ Economic Development and Poverty Reduction Strategy (EDPRS): Streamline intervention to implement the vision. Health Sector Strategic Plan II (HSSP II): Promote healthier lifestyles and prevention of diseases. Environmental Health Policy and National Policy for Water and Sanitation Services: Determine the modalities of implementation of the strategy for the sub sector. Government seeks a cost effective strategy, not only to meet the sanitation MDG, but also to decrease the burden of disease and alleviate poverty throughout Rwanda. ADDRESSING POVERTY AND DISEASES IN RWANDA
  • Integrated Community Development Education Water & Sanitation Primary Health Environment Food Security Home-based care Skills Training Income Generation POVERTY ALLEVIATION through Community Hygiene Clubs (CHCs)
  • CLTS Approach Implementation strategy CHC Approach: Implementation strategy APPROACHES FOR HYGIENE BEHAVIOR CHANGE • 6 months PHHE 20 sessions (each week) • Learning through fun participatory activities reinforce good practice (song, drama) • Informed group decision making and weekly homework • Voluntary household improvements
    • One ‘Triggering’ day + a few follow-up visits
    • Community shamed into action
    • Village walk to shock community that they are eating their own faeces
    • Leaders enforce change with fines
    • Zero Open Defecation (ZOD) & 20+ other hygiene improvements
    • Open Defecation Free (ODF ) Village or move on the sanitation ladder
  • Milestone Events 2009 2010 2011 2012 Q4 Q 1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Programme Launch
    • Programme design & advocacy.
    • Development of road map
      Phase I Start-up Start-up in 4 Districts 1 Province   Phase II Consolidate Consolidate & add 4 new Districts Launch of HSPI   Phase III Scale-Up Roll-out to all remaining 22 Districts  
  • Community-Based Environmental Health Promotion Programme Cross-cutting Sectors & Ministries CBEHPP MINEDUC: Enhancing human resources MoH (EHD) : Sustainable hygiene behavior change MINECOFIN & MINALOC: National development & poverty alleviation MININFRA : Increasing access to rural /urban WSS CBEHPP (CHCs) CHWs
  • Community-Based Environmental Health Promotion Programme
    • Community Based:
    • 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
    CBEHPP
    • CHC Members required to meet every week
    • Informed decision-making based on good information
    • Creating a common unity/ goal through activities
    • Action oriented with weekly hygiene improvements
    • (e.g. making existing toilets hygienic)
  • Training Manuals for CBEHPP developed CBEHPP District Environmental Health Officers 3 - day training in all aspects of the CHC Approach to be used in CBEHPP to enable planners to have an understanding of the CHC approach. Community Health Workers 5-day workshop to enable Environment Health Officers and Community Health Workers to effectively facilitate the 24 topics.    
  • Tool kit of Visual Aids developed for participatory activities (PHAST) CBEHPP
    • Design & development of more than 300 illustrations for 24 topics.
    • These were all individually pre-tested and altered to ensure they are 80% comprehensible for the illiterate/semi literate to fully represent the Rwandan context.
    Pretesting visual aids. Photo credit: Waterkeyn J.
  • COMMUNITY BASED ENVIRONMENTAL HEALTH PROMOTION PROGRAMME Training of National Core Trainers CBEHPP In November 2010 the core team were trained in order to scale up training. Roll-out of EHO Training in 5 Districts in December 2010, and 4 other districts in 2011.
      • Ministry of Health, Rwanda
    • COMMUNITY BASED ENVIRONMENTAL
    • HEALTH PROMOTION PROGRAMME
      • Ministry of Health, Rwanda
    • CHC NAME
    • MAIN MEMBER:
    • 2ND MEMBER
    • EHO NAME:
    • CHC NAME:
    • PROVINCE:
    • DISTRICT:
    • SECTOR:
    • UMUDUGU:
    • START DATE
    • COMPLETION DATE
    No. Topic Date Signature of Facilitator Weekly Homework Signature of Facilitator 1. Introduction Bring friends and family 2. Common Diseases Know common diseases 3. Personal Hygiene Family Wash Shelter 4. Hand washing Hand Wash Facility / soap 5. Skin Diseases Children no Skin Disease 6. Diarrhoea Knowledge of SSS / ORS 7. Infant Care Correct Child Immunisation 8. Worms Children no worms 9. Food Hygiene Clean drying rack 10 Nutrition Good Road to Health 11. Food Security Kitchen Gardens 12. Water Sources Clean Water Source 13. Safe Drinking Water Safe storage and usage 14. Adequate Sanitation ZOD / Clean safe latrine 15. Green & clean home Waste management and greening 16. Good Parenting Clean children 17. Respiratory Disease Good Ventilation 18. Malaria Use of treated bed nets 19. Bilharzia Treatment for Bilharzia 20. HIV/ AIDS VCT 1. Starting up a CHC 2. Cause and cure of disease 3. Personal Hygiene 4. Skin Diseases 5 Hand washing Times & Method 6.a. Infant Care 6.b. Immunisation 7. Worms 8.a. Diarrhoea: Transmission 8.b. Diarrhoea: Dehydration 9.a. Malnutrition 9.b. Balanced diet 10. Child Care 11. Kitchen hygiene 12.a. Rat control 12.b. Solid waste 13. Food Security 14. Water Sources 15.a. Water Storage 15.b. Water Usage 16.a. Zero Open Defecation 16.b. Improved Sanitation 17. Respiratory Disease 18. Malaria 19. Bilharzia 20. HIV/ AIDS Family Cases in 6 Months 1 2 3 4 5 6 Diarrhoea Dysentery Miasmas Kwashiorkor Scabies Ringworm Worms Lice Colds Flu Measles Malaria Bilharzia Bronchitis Pneumonia TB HIV AIDs Typhus Cholera Meningitis STIs Depression P D S C U CHC H/h
      • Ministry of Health, Rwanda
    • COMMUNITY BASED ENVIRONMENTAL
    • HEALTH PROMOTION PROGRAMME
      • Ministry of Health, Rwanda
    • CHC NAME
    • MAIN MEMBER:
    • 2ND MEMBER
    • EHO NAME:
    • CHC NAME:
    • PROVINCE:
    • DISTRICT:
    • SECTOR:
    • UMUDUGU:
    • START DATE
    • COMPLETION DATE
    No. Topic Date Signature of Facilitator Weekly Homework Signature of Facilitator 1. Introduction Bring friends and family 2. Common Diseases Know common diseases 3. Personal Hygiene Family Wash Shelter 4. Hand washing Hand Wash Facility / soap 5. Skin Diseases Children no Skin Disease 6. Diarrhoea Knowledge of SSS / ORS 7. Infant Care Correct Child Immunisation 8. Worms Children no worms 9. Food Hygiene Clean drying rack 10 Nutrition Good Road to Health 11. Food Security Kitchen Gardens 12. Water Sources Clean Water Source 13. Safe Drinking Water Safe storage and usage 14. Adequate Sanitation ZOD / Clean safe latrine 15. Green & clean home Waste management and greening 16. Good Parenting Clean children 17. Respiratory Disease Good Ventilation 18. Malaria Use of treated bed nets 19. Bilharzia Treatment for Bilharzia 20. HIV/ AIDS VCT 1. Starting up a CHC 2. Cause and cure of disease 3. Personal Hygiene 4. Skin Diseases 5 Hand washing Times & Method 6.a. Infant Care 6.b. Immunisation 7. Worms 8.a. Diarrhoea: Transmission 8.b. Diarrhoea: Dehydration 9.a. Malnutrition 9.b. Balanced diet 10. Child Care 11. Kitchen hygiene 12.a. Rat control 12.b. Solid waste 13. Food Security 14. Water Sources 15.a. Water Storage 15.b. Water Usage 16.a. Zero Open Defecation 16.b. Improved Sanitation 17. Respiratory Disease 18. Malaria 19. Bilharzia 20. HIV/ AIDS Family Cases in 6 Months 1 2 3 4 5 6 Diarrhoea Dysentery Miasmas Kwashiorkor Scabies Ringworm Worms Lice Colds Flu Measles Malaria Bilharzia Bronchitis Pneumonia TB HIV AIDs Typhus Cholera Meningitis STIs Depression P D S C U CHC H/h Training session held for core trainers. Photo credit: Waterkeyn J.
  • 1. Increased use of hygienic latrines in schools and homes from 28% to 80% Measuring Behaviour Change by 2015: The 10 Golden Indicators CBEHPP 2. Increased handwashing with soap at critical times from 34% to 80% 3. Improved safe drinking water access and handling in schools and homes to 80% 4. Establishment of CHCs in every village from 0% to 100% 5. Achieve Zero Open Defecation ZOD in every household from 28% to 100% 6. Safe disposal of children’s faeces in every household from 28% to 100% 7. Households with bath shelters increase to 80% 8. Households with well managed rubbish pits increase to 80% 9. Use of pot racks for drying dishes increase to 80% 10. Households with clean yards increase to 80%
  • Difference of Prevalence of Observed Hygiene Indicators between Community Health Club Members and non Members in Tsholotsho District, Zimbabwe. 2001 Source: Waterkeyn,J. 2005 (Africa AHEAD) Expectations of success CBEHPP The CHC Approach has been tried and tested in Zimbabwe, Sierra Leone, Guinea- Bissau, Uganda, South Africa and in Vietnam. Every time it has delivered reliable results, varying according to the level of development in each context. We expect the same in Rwanda that has been achieved in Zimbabwe (see graphs below).
  • Ruwombe Ward, Makoni District, Zimbabwe. Reported Cases of communicable disease 18 health clubs PHHE: 1995 - 2001 # h/holds 1,771 CHC Coverage of area: 80 %. Source: MoH Zimbabwe; Waterkeyn, J. 2005 Expected Reduction in Poor Hygiene and Sanitation Related Diseases CBEHPP
  • Based on past experience of disease reduction in CHC areas where there is at least 80% adherence to CHCs over at least three years, we expect to induce significant levels of behaviour change with the resultant decrease in reported cases of preventable disease (diarrhoea, ARIs, malaria, bilharzia, skin disease and worms) throughout Rwanda given that CBEHPP will be implemented in all 15,000 villages in the next few years. Conclusion CBEHPP
  • THANK YOU FOR YOUR KIND ATTENTION With technical and financial support of
    • CONTACTS:
    • Mr. Joseph Katabarwa, Ministry of Health; [email_address]
    • Mr. Bruno Mwanafunzi, Water Sanitation programme (WSP); [email_address]
    • Mrs. Juliet Waterkeyn, Africa Ahead; [email_address]
    • Mr. Guy Mbayo Kakumbi, UNICEF Rwanda CO; [email_address]