Creating demand for sanitation and hygiene through Community Health Clubs: a cost-effective intervention in two districts in Zimbabwe.

This study describes the development of Community Health Clubs which significantly changed hygiene behaviour and built rural demand for sanitation. In one year in the Makoni District, 1,244 health promotion sessions were held by 14 trainers involving 11,450 club members (68,700 beneficiaries). In the Tsholotsho District, 2105 members participated in 182 sessions held by three trainers involving 12,630 beneficiaries. Within 2 years, 2,400 latrines had been built in Makoni, and in Tsholotsho latrine coverage rose to 43% contrasted to 2% in the control area, with 1,200 latrines built in 18 months. The remaining 57% of club members without latrines in Tsholotsho all practised faecal burial, a method previously unknown to them. Club members’ hygiene was significantly different (p=0.0001) from a control group across 17 key hygiene practices including hand washing, showing that if a strong community structure is developed and the norms of a community altered, sanitation and hygiene behaviour are likely to improve. This methodology could be scaled up to contribute to ambitious global targets. Social Science and Medicine 2005;61:1958-70.