After an emergency, traumatised individuals can benefit greatly by supporting each other in a group, becoming community volunteers in Emergency Community Health Clubs (eCHC) and coordinating their efforts to improve WASH practices in the area. The result can be positive hygiene behaviour change, building-back infrastructure and increasing social capital through shared understanding and increased trust.

In a crisis, emergency-affected people themselves can prevent the outbreak of epidemics such as cholera through good hygiene and sanitation. Even those with limited resources can dig a hole before defecating and cover their faeces, wash their hands thoroughly with soap and keep themselves and their children clean. After such trauma, people can best support each other by working together in an organised group. By becoming a member of an eCHC, individuals are strengthened by helping each other to adhere to basic standards of personal hygiene. Through practical action, they can start recreating the community with the support of (new) neighbours and friends. Although external humanitarian interventions may be required if infrastructure has been destroyed, wherever possible the affected population should be involved in making the decisions and supported to maintain their dignity. The eCHC is a shorter version of the standard 24-session training in Community Health Clubs (CHC, F.1) and consists of only eight WASH topics that address the immediate issues of water and sanitation-related diseases such as cholera, typhoid, or dysentery. The speed of implementation is dictated by the circumstances, but the training normally takes two months, with all members meeting once a week for a two-hour session. However, the training can also be condensed into a fast-track daily training or a one-day workshop, depending on the context, or extended to include other infectious diseases – especially if there is a need for regular handwashing with soap, safe water and sanitation. As with the standard CHCs, the ideal is to register members and issue membership cards (though lack of time may prevent this).

Tools and Methods used

Participatory activities to stimulate dialogue and problem identification 

• Transect Walks T.52
• Community Mapping T.7
• Ranking T.39

Community organisation and identification of local solutions

• Story with a Gap
• Transmission Routes and Barriers T.53
• Demonstrations and Show and Tell T.10
• Three-Pile Sorting T.51
• Songs and Stories T.47
• Community Drama and (Puppet) Theatre T.6
• Role Play T.41
• Peer Education T.29
• Radio T.38 incl. jingles, slogans and call-in programmes
• Social Media and Text Messaging T.44

Applicability

The eCHC is ideal for the stabilisation and recovery phase in post conflict or disaster situations, to ease individual trauma through collective problem-solving. Once the acute crisis has passed and the stabilisation phase begins, the eCHC can be used (and potentially extended to become a standard CHC F.1 by registering members and enabling the full training to be completed with certification). This qualification can provide the affected population with a sense of achievement in a time of unprecedented difficulty and they may retain the knowledge and non-risk hygiene behaviour once the situation normalises or they are resettled.  

As a response to COVID-19 eCHCs have had to adapt when large groups cannot gather safely. In these situations, the eCHC should be divided into smaller digital clusters of ten households each. Each cluster elects a head who leads the sessions following instructions from a local radio broadcast. Alternatively, cluster heads can be sent pictures through a messaging app such as WhatsApp. This adaptation in a time of COVID-19 still needs to be further piloted and researched.

Main Requirements / Investments Needed

The main costs are for the tool kit, training of trainers, transport and fuel to ensure adequate access to the community. The training can be face-to-face or via radio or virtual meeting platforms (e.g. Zoom, WhatsApp). A corresponding toolkit and online training of facilitators is available from Africa AHEAD. The toolkit, however, may not always fit the local context; generic toolkits may have to be used and adapted. A programme coordinator is needed and a project officer should be based in every camp and run at least five CHCs each.

Evidence of Effectiveness

Emergency CHCs have been used in Internally Displaced People’s (IDP) camps in Northern Uganda between 2003 and 2006. The CHC model was also adapted to meet the post emergency situation in Haiti after the earthquake where cholera was running out of control. Both programmes elicited a strong, positive community response. However, there is little documented evidence for eCHCs and more research is needed.

Do

• Aim to include over 80% of the IDPs in an eCHC so that unity is built up in the camp

• Use project officers in an emergency context to mobilise and train IDPs/refugees

• Use radio programmes [T.38] and messaging/WhatsApp groups [T.44] to reinforce on-the-ground training in a remote response

• Aim to convert eCHCs into standard CHCs for longer-term sustainability of good hygiene practice

Don't

• Do not reduce the duration of the training unless doing so is unavoidable

• Do not exclude anyone from joining; it does not matter how big the CHC becomes. CHCs can be split if they reach more than 100 members

• Do not meet in a large eCHC group during COVID-19 outbreaks

Practical Example

In Northern Uganda (2002) 89% of the population had fled from their villages to live in 33 IDP camps in Gulu District. 25 clinicians from a local NGO were trained as CHC facilitators and sent to 15 IDP camps. They started 116 CHCs and mobilised a total of 15,522 regular members (42% of all households) who met weekly for 25 hygiene sessions over six months. Before the intervention, latrine coverage was 5% with widespread open defecation. After only 4 months, CHC members had constructed 8,504 latrines, as well as 6,020 bath shelters, 3,372 drying racks and 1,552 handwashing facilities, with an estimated 100,000 direct beneficiaries at less than five USD per person. The CHC model was successfully replicated in Pader District.