Cost-effective health promotion and hygiene behaviour change through community health clubs in Zimbabwe

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.