* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
Community health clubs are becoming fashionable in parts of rural Zimbabwe
By Pamela Ncube Murakwani, Zimbabwe Country Director, International Medical Corps
In the more exclusive neighbourhoods around the world, it’s often the shiny four wheel drive which is the sign of status – the unspoken symbol of a successful and comfortable life.
In the parts of rural south-west Zimbabwe in which my teams work with communities facing some of the lowest standards of living in the world, it is a plastic container suspended from a line of rope – otherwise known as a ‘tippy tap’: a system from which families can pour water and wash their hands.
In the two provinces of Matabeleland North and Matabeleland South, water is scarce and families are often among the very poorest living in the country. Soap is an expensive luxury – often ash is the only equivalent that people can hope to use. In these conditions, it is often hard to convince communities of the importance of basic hygiene measures such as refuse pits, appropriate racks for drying pots and equipment for washing hands when survival itself is such a constant battle.
While having access to all of these provisions is essential, what is becoming more and more apparent is that the psychology of a community is an invaluable tool in a humanitarian organisation’s box of tricks, and with this revelation comes a dramatic shift in the way in which aid programmes are run and the results they provide.
Where once well-meaning expat staff focused exclusively on drilled boreholes and building latrines, we now work to combine these projects with community health clubs led by aid workers drawn from the communities in which we work– our secret weapon.
These groups become a central point within villages – assemblies to which locals aspire to be part of, events of social cohesion in which participation begins to define the participant’s status among their peers.
Many involved in these community clubs - even those from poor-hunter gatherer communities such as the San - like to create new uniforms to advertise their membership - beautiful rainbow coloured uniforms becoming the San equivalent of a chief executive’s sleek Armani suit. Roughly three out of every four groups we support will produce their own uniform to mark them apart.
These groups are platforms from where the importance of washing hands with soap or ash is discussed, where good practice is outlined and where the seed of behaviour change is planted. These groups are shown how to create their own hand washing stations (the tippy taps) and build in the racks and pits needed to keep their families safe. At that stage, the groups themselves become champions for hygiene in their communities, advocating for improved hygiene practices. Using songs, plays, dance and other creative outlets – the message is broadcast loud and clear by the participants themselves in a lively and engaging manner.
These so-called ‘soft’ interventions are proving exceptional in their success rates in the districts in which the Amalima programme – a project funded by USAID and carried out by International Medical Corps with CNFA and other partners. The project has seen a rise in the number of people using soap or ash to wash their hands from just over 1.6% to 23% in just over two years - a remarkable shift in behaviours which saves lives: reducing the cases of potentially life-threatening diarrhoea and helping in the battle against cholera.
However the impact of these physiologically delicate interventions should not just be measured in terms of lives saved, but also in the quality of life that is improved – the social behavioural change accompanied by this feeling of inclusion. I cannot help but smile when I think of Anna Madhumane from Mtshina village in south-western Zimbabwe.
The great grandmother, who lives with her 16-year-old son, two grandchildren and a 3-month-old great-grandchild, was awarded the first place ‘model home’ award when she and her club members graduated – recognition of the fact that she had not just constructed a tippy tap, rubbish pit and pot drying rack for her homestead but had also maintained clean dishwashing practices and become a champion of hygiene standards. What was so heart-warming was the impact that the award had had – sitting in pride of place in her home, she said that if she felt too lazy to clean her yard, she would look to the certificate and know that she must complete her work, her motivation verified by the paper mounted on her wall.
In terms of legacy that is a clear sign of what these ‘soft’ interventions can achieve – long-lasting positive change. In her community, she now has all the mod-cons, her home setting the standard which her neighbours will strive to meet.
These items may viewed much like the four-wheel drive parked on next door’s driveway – but they are almost certainly possessed by a much prouder owner.
