Putting heads and hands together to change knowledge and behaviours: Community Health Clubs in Port-au-Prince, Haiti
Jessica Brooks | Alexandra Adams | Samy Bendjemil | Jason Rosenfeld
Although interventions that emphasize the role of knowledge in invoking behaviour change have recently become unpopular, the Community Health Club (CHC) model has demonstrated how group knowledge, consensus building, and peer pressure can be applied to achieve hygiene behaviour change. To date, the model has predominantly been implemented in rural settings, with limited testing in urban communities. In 2012, CHCs started in Haiti as a grassroots initiative, growing from six clubs in six Port-au-Prince communities to 66 clubs across 30 communities in 2015. This paper focuses on the 23 clubs formed between March 2012 and July 2014, when a retrospective process and outcome evaluation was conducted. Using a mixed methods study design, this evaluation used interviews with CHC facilitators and household surveys in three case neighbourhoods to assess how the CHC model was implemented and if differences exist between CHC graduates and non-members. The CHCs have successfully facilitated social bonding, while graduates demonstrated significantly higher preventative WASH knowledge and were seven times less likely to report openly defecating than non-members. However, programmatic and structural factors such as recruitment methods, non-members’ distrust, urban living conditions, and market deficiencies hindered wider uptake of some behavioural changes. These findings inform how the CHC model operates in an urban context.Bartram, J., Charles, K., Evans, B., O’Hanlon, L. and Pedley, S. (2012) ‘Commentary on community-led total sanitation and human rights: should the right to community-wide health be won at the cost of individual rights?’ Journal of Water Health 10(4): 499–503 <http://dx.doi.org/10.2166/wh.2012.205>.
Biran, A., Schmidt, W., Varadharajan, K., Rajarman, D., Kumar, R., Greenland, K., Gopalan, B., Aunger, R. and Curtis, V. (2014) ‘Effect of a behavior-change intervention on handwashing with soap in India (SuperAmma): a cluster randomized trial’, The Lancet Global Health 2(3): 145–54 <http://dx.doi.org/10.1016/S2214-109X(13)70160-8>.
Borghi, J., Guinness, L., Ouedraogo, J. and Curtis, V. (2002) ‘Is hygiene promotion cost-effective? A case study in Burkina Faso’, Tropical Medicine & International Health 7(11): 960–9 <http://dx.doi.org/10.1046/j.1365-3156.2002.00954.x>.
Cairncross, S. and Shordt, K. (2004) ‘It does last! Some findings from a multi-country study of hygiene and sustainability’, Waterlines 22: 3–5 <http://dx.doi.org/10.3362/0262-8104.2004.003>.
Cameron, L., Shah, M. and Olivia, S. (2013) Impact Evaluation of a Rural Sanitation Behavior Change Project in Indonesia, World Bank Policy Research Working Paper 6360, Washington, DC: World Bank.
Chase, C. and Do, Q.T. (2012) Handwashing Behavior Change at Scale: Evidence from a Randomized Evaluation in Vietnam, World Bank Policy Research Working Paper 6207, Washington, DC: World Bank.
Clasen, T., Boisson, S., Routray, P., Torondel, B., Bell, M., Cumming, O., Ensink, J., Freeman, M., Jenkins, M., Odagiri, M., Ray, S., Sinha, A., Suar, M. and Schmidt, W. (2014) ‘Effectiveness of a rural sanitation program on diarrhea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomized trial’, The Lancet Global Health 2(11): 645–53 <http://dx.doi.org/10.1016/S2214-109X(14)70307-9>.
Crocker, J. and Venkataramanan, V. (2014) ‘Testing community-led approaches for sustainability: project briefing’, Proceedings of the 37th WEDC International Conference, Hanoi, Vietnam [pdf] <http://waterinstitute.unc.edu/files/2015/03/project-briefing-crocker-venkataramanan.pdf> [accessed 1 May 2015].
Dreibelbis, R., Winch, P., Leontsini, E., Hulland, K., Ram, P., Unicomb, L. and Luby, S. (2013) ‘The Integrated Behavioral Model for Water, Sanitation, and Hygiene: a systematic review of behavioral models and a framework for designing and evaluating behavior change interventions in infrastructure-restricted settings’, BMC Public Health 13(1015) <http://dx.doi.org/10.1186/1471-2458-13-1015>.
Freire, P. (1970) Pedagogy of the Oppressed, New York: Continuum Publishing.
Galiani, S., Gertler, P. and Orsola-Vidal, A. (2012) Promoting Handwashing Behavior in Peru: The Effect of a Large-Scale Mass-Media and Community-Level Interventions, World Bank Policy Research Working Paper 6257, Washington, DC: World Bank.
Hanchett, S., Khan, M., Krieger, L. and Kullmann, C. (2011) ‘Sustainability of sanitation in rural Bangladesh: World Bank Water and Sanitation Program’, Proceedings of the 35th WEDC International Conference [pdf] <http://wedc.lboro.ac.uk/resources/conference/35/Hanchett-S-1036.pdf> [accessed 1 May 2015].
Janz, N. and Becker, M. (1984) ‘The Health Belief Model: a decade later’, Health Education Quarterly 11(1): 1–47 <http://dx.doi.org/10.1177/109019818401100101>.
LaRose, S. (1975) ‘The Haitian Lacou, land, family and ritual’, in A. Marks and R. Romer (eds.), Family and Kinship in Middle America and the Caribbean, pp. 482–501, Willemstad, Curaçao: Institute of Higher Studies.
Maksimoski, N. and Waterkeyn, A. (2010) ‘The Community Health Club approach in informal settlements: case study from eThekwini municipality, Kwa Zulu Natal, South Africa’, Proceedings of the Water Institute of South Africa Conference, Durban [pdf] <www.africaahead.org/wp-content/uploads/2015/08/2010_WISA_eThekwini.pdf> [accessed 1 May 2015].
Malebo, H.M. (2007) Evaluation of PHAST in Tanzania Focusing on the Effectiveness and Sustainability of Water, Sanitation, and Hygiene Activities in Four Districts of Mainland Tanzania, Tanzania: WaterAid, UNICEF, WSP and the Ministry of Health and Social Welfare, Tanzania.
Okot, P., Kwame, V. and Waterkeyn, J. (2005) ‘Rapid sanitation uptake in the internally displaced people camps of northern Uganda through Community Health Clubs’, Proceedings of the 31st WEDC Conference, Kampala, Uganda [pdf] <http://wedc.lboro.ac.uk/resources/conference/31/WaterkeynJ.pdf> [accessed 1 May 2015].
Patil, S., Arnold, B., Salvatore, A., Briceno, B., Ganguly, S., Colford, J. and Gertler, P. (2014) ‘The effect of India’s Total Sanitation Campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial’, PLoS Med 11(8): e1001709 <http://dx.doi.org/10.1371/journal.pmed.1001709>.
Peal, A., Evans, B. and van der Voorden, C. (2010) Hygiene and Sanitation Software: An Overview of Approaches, Geneva, Switzerland: Water Supply & Sanitation Collaborative Council.
Pruss-Ustun, A., Bos, R., Gore, F. and Bartram, J. (2008) Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health, Geneva: World Health Organization.
Rosenberg, T. (2012) Join the Club: How Peer Pressure Can Transform the World, New York: W.W. Norton & Company.
Rosenfeld, J., Berggren, R. and Paulino, F. (2013) ‘Measuring behavioral changes associated with Community Health Clubs in the Dominican Republic’, Proceedings of the 2013 Water Institute at UNC Water and Health Conference, Chapel Hill, North Carolina.
UNICEF (2014) ‘New sanitation campaign aims to end cholera in Haiti’ [press release], UNICEF Haiti <www.unicef.org/media/media_74287.html> [accessed 22 August 2015].
Waterkeyn, J. and Cairncross, S. (2005) ‘Creating demand for sanitation and hygiene through Community Health Clubs: a cost-effective intervention in two districts in Zimbabwe’, Social Science & Medicine 61(9): 1958–70 <http://dx.doi.org/10.1016/j.socscimed.2005.04.012>.
Waterkeyn, J. and Nga, N. (2011) ‘Low cost-high impact: hygiene behaviour change in Vietnam in Community Health Clubs’, Proceedings of the 2011 Water Institute at UNC Water and Health Conference, Chapel Hill, NC, 3–7 October 2011.
Waterkeyn, J. and Rosenfeld, J. (2009) ‘Using cell phones to monitor and evaluate behaviour change through Community Health Clubs in South Africa’, Proceedings of the 34th WEDC Conference [pdf] <http://wedc.lboro.ac.uk/resources/conference/34/Rosenfeld_J_-_192.pdf> [accessed 1 May 2015].
Waterkeyn, J. and Waterkeyn, A. (2013) ‘Creating a culture of health: hygiene behavior change in Community Health Clubs’, Journal of Water, Sanitation and Hygiene for Development 3(2): 144–55 <http://dx.doi.org/10.2166/washdev.2013.109>.
Waterkeyn, J., Matimati, R. and Muringaniza, A. (2009) ‘ZOD for all – scaling up the Community Health Club model to meet the MDGs for sanitation in rural and urban areas: case studies from Zimbabwe and Uganda’, Proceedings of the International Water Association Conference, Mexico City [pdf] <www.africaahead.org/wp-content/uploads/2015/08/2009_IWA_Zim.pdf> [accessed 1 May 2015].
Bartram, J., Charles, K., Evans, B., O’Hanlon, L. and Pedley, S. (2012) ‘Commentary on community-led total sanitation and human rights: should the right to community-wide health be won at the cost of individual rights?’ Journal of Water Health 10(4): 499–503 <http://dx.doi.org/10.2166/wh.2012.205>.
Biran, A., Schmidt, W., Varadharajan, K., Rajarman, D., Kumar, R., Greenland, K., Gopalan, B., Aunger, R. and Curtis, V. (2014) ‘Effect of a behavior-change intervention on handwashing with soap in India (SuperAmma): a cluster randomized trial’, The Lancet Global Health 2(3): 145–54 <http://dx.doi.org/10.1016/S2214-109X(13)70160-8>.
Borghi, J., Guinness, L., Ouedraogo, J. and Curtis, V. (2002) ‘Is hygiene promotion cost-effective? A case study in Burkina Faso’, Tropical Medicine & International Health 7(11): 960–9 <http://dx.doi.org/10.1046/j.1365-3156.2002.00954.x>.
Cairncross, S. and Shordt, K. (2004) ‘It does last! Some findings from a multi-country study of hygiene and sustainability’, Waterlines 22: 3–5 <http://dx.doi.org/10.3362/0262-8104.2004.003>.
Cameron, L., Shah, M. and Olivia, S. (2013) Impact Evaluation of a Rural Sanitation Behavior Change Project in Indonesia, World Bank Policy Research Working Paper 6360, Washington, DC: World Bank.
Chase, C. and Do, Q.T. (2012) Handwashing Behavior Change at Scale: Evidence from a Randomized Evaluation in Vietnam, World Bank Policy Research Working Paper 6207, Washington, DC: World Bank.
Clasen, T., Boisson, S., Routray, P., Torondel, B., Bell, M., Cumming, O., Ensink, J., Freeman, M., Jenkins, M., Odagiri, M., Ray, S., Sinha, A., Suar, M. and Schmidt, W. (2014) ‘Effectiveness of a rural sanitation program on diarrhea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomized trial’, The Lancet Global Health 2(11): 645–53 <http://dx.doi.org/10.1016/S2214-109X(14)70307-9>.
Crocker, J. and Venkataramanan, V. (2014) ‘Testing community-led approaches for sustainability: project briefing’, Proceedings of the 37th WEDC International Conference, Hanoi, Vietnam [pdf] <http://waterinstitute.unc.edu/files/2015/03/project-briefing-crocker-venkataramanan.pdf> [accessed 1 May 2015].
Dreibelbis, R., Winch, P., Leontsini, E., Hulland, K., Ram, P., Unicomb, L. and Luby, S. (2013) ‘The Integrated Behavioral Model for Water, Sanitation, and Hygiene: a systematic review of behavioral models and a framework for designing and evaluating behavior change interventions in infrastructure-restricted settings’, BMC Public Health 13(1015) <http://dx.doi.org/10.1186/1471-2458-13-1015>.
Freire, P. (1970) Pedagogy of the Oppressed, New York: Continuum Publishing.
Galiani, S., Gertler, P. and Orsola-Vidal, A. (2012) Promoting Handwashing Behavior in Peru: The Effect of a Large-Scale Mass-Media and Community-Level Interventions, World Bank Policy Research Working Paper 6257, Washington, DC: World Bank.
Hanchett, S., Khan, M., Krieger, L. and Kullmann, C. (2011) ‘Sustainability of sanitation in rural Bangladesh: World Bank Water and Sanitation Program’, Proceedings of the 35th WEDC International Conference [pdf] <http://wedc.lboro.ac.uk/resources/conference/35/Hanchett-S-1036.pdf> [accessed 1 May 2015].
Janz, N. and Becker, M. (1984) ‘The Health Belief Model: a decade later’, Health Education Quarterly 11(1): 1–47 <http://dx.doi.org/10.1177/109019818401100101>.
LaRose, S. (1975) ‘The Haitian Lacou, land, family and ritual’, in A. Marks and R. Romer (eds.), Family and Kinship in Middle America and the Caribbean, pp. 482–501, Willemstad, Curaçao: Institute of Higher Studies.
Maksimoski, N. and Waterkeyn, A. (2010) ‘The Community Health Club approach in informal settlements: case study from eThekwini municipality, Kwa Zulu Natal, South Africa’, Proceedings of the Water Institute of South Africa Conference, Durban [pdf] <www.africaahead.org/wp-content/uploads/2015/08/2010_WISA_eThekwini.pdf> [accessed 1 May 2015].
Malebo, H.M. (2007) Evaluation of PHAST in Tanzania Focusing on the Effectiveness and Sustainability of Water, Sanitation, and Hygiene Activities in Four Districts of Mainland Tanzania, Tanzania: WaterAid, UNICEF, WSP and the Ministry of Health and Social Welfare, Tanzania.
Okot, P., Kwame, V. and Waterkeyn, J. (2005) ‘Rapid sanitation uptake in the internally displaced people camps of northern Uganda through Community Health Clubs’, Proceedings of the 31st WEDC Conference, Kampala, Uganda [pdf] <http://wedc.lboro.ac.uk/resources/conference/31/WaterkeynJ.pdf> [accessed 1 May 2015].
Patil, S., Arnold, B., Salvatore, A., Briceno, B., Ganguly, S., Colford, J. and Gertler, P. (2014) ‘The effect of India’s Total Sanitation Campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial’, PLoS Med 11(8): e1001709 <http://dx.doi.org/10.1371/journal.pmed.1001709>.
Peal, A., Evans, B. and van der Voorden, C. (2010) Hygiene and Sanitation Software: An Overview of Approaches, Geneva, Switzerland: Water Supply & Sanitation Collaborative Council.
Pruss-Ustun, A., Bos, R., Gore, F. and Bartram, J. (2008) Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health, Geneva: World Health Organization.
Rosenberg, T. (2012) Join the Club: How Peer Pressure Can Transform the World, New York: W.W. Norton & Company.
Rosenfeld, J., Berggren, R. and Paulino, F. (2013) ‘Measuring behavioral changes associated with Community Health Clubs in the Dominican Republic’, Proceedings of the 2013 Water Institute at UNC Water and Health Conference, Chapel Hill, North Carolina.
UNICEF (2014) ‘New sanitation campaign aims to end cholera in Haiti’ [press release], UNICEF Haiti <www.unicef.org/media/media_74287.html> [accessed 22 August 2015].
Waterkeyn, J. and Cairncross, S. (2005) ‘Creating demand for sanitation and hygiene through Community Health Clubs: a cost-effective intervention in two districts in Zimbabwe’, Social Science & Medicine 61(9): 1958–70 <http://dx.doi.org/10.1016/j.socscimed.2005.04.012>.
Waterkeyn, J. and Nga, N. (2011) ‘Low cost-high impact: hygiene behaviour change in Vietnam in Community Health Clubs’, Proceedings of the 2011 Water Institute at UNC Water and Health Conference, Chapel Hill, NC, 3–7 October 2011.
Waterkeyn, J. and Rosenfeld, J. (2009) ‘Using cell phones to monitor and evaluate behaviour change through Community Health Clubs in South Africa’, Proceedings of the 34th WEDC Conference [pdf] <http://wedc.lboro.ac.uk/resources/conference/34/Rosenfeld_J_-_192.pdf> [accessed 1 May 2015].
Waterkeyn, J. and Waterkeyn, A. (2013) ‘Creating a culture of health: hygiene behavior change in Community Health Clubs’, Journal of Water, Sanitation and Hygiene for Development 3(2): 144–55 <http://dx.doi.org/10.2166/washdev.2013.109>.
Waterkeyn, J., Matimati, R. and Muringaniza, A. (2009) ‘ZOD for all – scaling up the Community Health Club model to meet the MDGs for sanitation in rural and urban areas: case studies from Zimbabwe and Uganda’, Proceedings of the International Water Association Conference, Mexico City [pdf] <www.africaahead.org/wp-content/uploads/2015/08/2009_IWA_Zim.pdf> [accessed 1 May 2015].
Bartram, J., Charles, K., Evans, B., O’Hanlon, L. and Pedley, S. (2012) ‘Commentary on community-led total sanitation and human rights: should the right to community-wide health be won at the cost of individual rights?’ Journal of Water Health 10(4): 499–503 <http://dx.doi.org/10.2166/wh.2012.205>.
Biran, A., Schmidt, W., Varadharajan, K., Rajarman, D., Kumar, R., Greenland, K., Gopalan, B., Aunger, R. and Curtis, V. (2014) ‘Effect of a behavior-change intervention on handwashing with soap in India (SuperAmma): a cluster randomized trial’, The Lancet Global Health 2(3): 145–54 <http://dx.doi.org/10.1016/S2214-109X(13)70160-8>.
Borghi, J., Guinness, L., Ouedraogo, J. and Curtis, V. (2002) ‘Is hygiene promotion cost-effective? A case study in Burkina Faso’, Tropical Medicine & International Health 7(11): 960–9 <http://dx.doi.org/10.1046/j.1365-3156.2002.00954.x>.
Cairncross, S. and Shordt, K. (2004) ‘It does last! Some findings from a multi-country study of hygiene and sustainability’, Waterlines 22: 3–5 <http://dx.doi.org/10.3362/0262-8104.2004.003>.
Cameron, L., Shah, M. and Olivia, S. (2013) Impact Evaluation of a Rural Sanitation Behavior Change Project in Indonesia, World Bank Policy Research Working Paper 6360, Washington, DC: World Bank.
Chase, C. and Do, Q.T. (2012) Handwashing Behavior Change at Scale: Evidence from a Randomized Evaluation in Vietnam, World Bank Policy Research Working Paper 6207, Washington, DC: World Bank.
Clasen, T., Boisson, S., Routray, P., Torondel, B., Bell, M., Cumming, O., Ensink, J., Freeman, M., Jenkins, M., Odagiri, M., Ray, S., Sinha, A., Suar, M. and Schmidt, W. (2014) ‘Effectiveness of a rural sanitation program on diarrhea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomized trial’, The Lancet Global Health 2(11): 645–53 <http://dx.doi.org/10.1016/S2214-109X(14)70307-9>.
Crocker, J. and Venkataramanan, V. (2014) ‘Testing community-led approaches for sustainability: project briefing’, Proceedings of the 37th WEDC International Conference, Hanoi, Vietnam [pdf] <http://waterinstitute.unc.edu/files/2015/03/project-briefing-crocker-venkataramanan.pdf> [accessed 1 May 2015].
Dreibelbis, R., Winch, P., Leontsini, E., Hulland, K., Ram, P., Unicomb, L. and Luby, S. (2013) ‘The Integrated Behavioral Model for Water, Sanitation, and Hygiene: a systematic review of behavioral models and a framework for designing and evaluating behavior change interventions in infrastructure-restricted settings’, BMC Public Health 13(1015) <http://dx.doi.org/10.1186/1471-2458-13-1015>.
Freire, P. (1970) Pedagogy of the Oppressed, New York: Continuum Publishing.
Galiani, S., Gertler, P. and Orsola-Vidal, A. (2012) Promoting Handwashing Behavior in Peru: The Effect of a Large-Scale Mass-Media and Community-Level Interventions, World Bank Policy Research Working Paper 6257, Washington, DC: World Bank.
Hanchett, S., Khan, M., Krieger, L. and Kullmann, C. (2011) ‘Sustainability of sanitation in rural Bangladesh: World Bank Water and Sanitation Program’, Proceedings of the 35th WEDC International Conference [pdf] <http://wedc.lboro.ac.uk/resources/conference/35/Hanchett-S-1036.pdf> [accessed 1 May 2015].
Janz, N. and Becker, M. (1984) ‘The Health Belief Model: a decade later’, Health Education Quarterly 11(1): 1–47 <http://dx.doi.org/10.1177/109019818401100101>.
LaRose, S. (1975) ‘The Haitian Lacou, land, family and ritual’, in A. Marks and R. Romer (eds.), Family and Kinship in Middle America and the Caribbean, pp. 482–501, Willemstad, Curaçao: Institute of Higher Studies.
Maksimoski, N. and Waterkeyn, A. (2010) ‘The Community Health Club approach in informal settlements: case study from eThekwini municipality, Kwa Zulu Natal, South Africa’, Proceedings of the Water Institute of South Africa Conference, Durban [pdf] <www.africaahead.org/wp-content/uploads/2015/08/2010_WISA_eThekwini.pdf> [accessed 1 May 2015].
Malebo, H.M. (2007) Evaluation of PHAST in Tanzania Focusing on the Effectiveness and Sustainability of Water, Sanitation, and Hygiene Activities in Four Districts of Mainland Tanzania, Tanzania: WaterAid, UNICEF, WSP and the Ministry of Health and Social Welfare, Tanzania.
Okot, P., Kwame, V. and Waterkeyn, J. (2005) ‘Rapid sanitation uptake in the internally displaced people camps of northern Uganda through Community Health Clubs’, Proceedings of the 31st WEDC Conference, Kampala, Uganda [pdf] <http://wedc.lboro.ac.uk/resources/conference/31/WaterkeynJ.pdf> [accessed 1 May 2015].
Patil, S., Arnold, B., Salvatore, A., Briceno, B., Ganguly, S., Colford, J. and Gertler, P. (2014) ‘The effect of India’s Total Sanitation Campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial’, PLoS Med 11(8): e1001709 <http://dx.doi.org/10.1371/journal.pmed.1001709>.
Peal, A., Evans, B. and van der Voorden, C. (2010) Hygiene and Sanitation Software: An Overview of Approaches, Geneva, Switzerland: Water Supply & Sanitation Collaborative Council.
Pruss-Ustun, A., Bos, R., Gore, F. and Bartram, J. (2008) Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health, Geneva: World Health Organization.
Rosenberg, T. (2012) Join the Club: How Peer Pressure Can Transform the World, New York: W.W. Norton & Company.
Rosenfeld, J., Berggren, R. and Paulino, F. (2013) ‘Measuring behavioral changes associated with Community Health Clubs in the Dominican Republic’, Proceedings of the 2013 Water Institute at UNC Water and Health Conference, Chapel Hill, North Carolina.
UNICEF (2014) ‘New sanitation campaign aims to end cholera in Haiti’ [press release], UNICEF Haiti <www.unicef.org/media/media_74287.html> [accessed 22 August 2015].
Waterkeyn, J. and Cairncross, S. (2005) ‘Creating demand for sanitation and hygiene through Community Health Clubs: a cost-effective intervention in two districts in Zimbabwe’, Social Science & Medicine 61(9): 1958–70 <http://dx.doi.org/10.1016/j.socscimed.2005.04.012>.
Waterkeyn, J. and Nga, N. (2011) ‘Low cost-high impact: hygiene behaviour change in Vietnam in Community Health Clubs’, Proceedings of the 2011 Water Institute at UNC Water and Health Conference, Chapel Hill, NC, 3–7 October 2011.
Waterkeyn, J. and Rosenfeld, J. (2009) ‘Using cell phones to monitor and evaluate behaviour change through Community Health Clubs in South Africa’, Proceedings of the 34th WEDC Conference [pdf] <http://wedc.lboro.ac.uk/resources/conference/34/Rosenfeld_J_-_192.pdf> [accessed 1 May 2015].
Waterkeyn, J. and Waterkeyn, A. (2013) ‘Creating a culture of health: hygiene behavior change in Community Health Clubs’, Journal of Water, Sanitation and Hygiene for Development 3(2): 144–55 <http://dx.doi.org/10.2166/washdev.2013.109>.
Waterkeyn, J., Matimati, R. and Muringaniza, A. (2009) ‘ZOD for all – scaling up the Community Health Club model to meet the MDGs for sanitation in rural and urban areas: case studies from Zimbabwe and Uganda’, Proceedings of the International Water Association Conference, Mexico City [pdf] <www.africaahead.org/wp-content/uploads/2015/08/2009_IWA_Zim.pdf> [accessed 1 May 2015].
Bartram, J., Charles, K., Evans, B., O’Hanlon, L. and Pedley, S. (2012) ‘Commentary on community-led total sanitation and human rights: should the right to community-wide health be won at the cost of individual rights?’ Journal of Water Health 10(4): 499–503 <http://dx.doi.org/10.2166/wh.2012.205>.
Biran, A., Schmidt, W., Varadharajan, K., Rajarman, D., Kumar, R., Greenland, K., Gopalan, B., Aunger, R. and Curtis, V. (2014) ‘Effect of a behavior-change intervention on handwashing with soap in India (SuperAmma): a cluster randomized trial’, The Lancet Global Health 2(3): 145–54 <http://dx.doi.org/10.1016/S2214-109X(13)70160-8>.
Borghi, J., Guinness, L., Ouedraogo, J. and Curtis, V. (2002) ‘Is hygiene promotion cost-effective? A case study in Burkina Faso’, Tropical Medicine & International Health 7(11): 960–9 <http://dx.doi.org/10.1046/j.1365-3156.2002.00954.x>.
Cairncross, S. and Shordt, K. (2004) ‘It does last! Some findings from a multi-country study of hygiene and sustainability’, Waterlines 22: 3–5 <http://dx.doi.org/10.3362/0262-8104.2004.003>.
Cameron, L., Shah, M. and Olivia, S. (2013) Impact Evaluation of a Rural Sanitation Behavior Change Project in Indonesia, World Bank Policy Research Working Paper 6360, Washington, DC: World Bank.
Chase, C. and Do, Q.T. (2012) Handwashing Behavior Change at Scale: Evidence from a Randomized Evaluation in Vietnam, World Bank Policy Research Working Paper 6207, Washington, DC: World Bank.
Clasen, T., Boisson, S., Routray, P., Torondel, B., Bell, M., Cumming, O., Ensink, J., Freeman, M., Jenkins, M., Odagiri, M., Ray, S., Sinha, A., Suar, M. and Schmidt, W. (2014) ‘Effectiveness of a rural sanitation program on diarrhea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomized trial’, The Lancet Global Health 2(11): 645–53 <http://dx.doi.org/10.1016/S2214-109X(14)70307-9>.
Crocker, J. and Venkataramanan, V. (2014) ‘Testing community-led approaches for sustainability: project briefing’, Proceedings of the 37th WEDC International Conference, Hanoi, Vietnam [pdf] <http://waterinstitute.unc.edu/files/2015/03/project-briefing-crocker-venkataramanan.pdf> [accessed 1 May 2015].
Dreibelbis, R., Winch, P., Leontsini, E., Hulland, K., Ram, P., Unicomb, L. and Luby, S. (2013) ‘The Integrated Behavioral Model for Water, Sanitation, and Hygiene: a systematic review of behavioral models and a framework for designing and evaluating behavior change interventions in infrastructure-restricted settings’, BMC Public Health 13(1015) <http://dx.doi.org/10.1186/1471-2458-13-1015>.
Freire, P. (1970) Pedagogy of the Oppressed, New York: Continuum Publishing.
Galiani, S., Gertler, P. and Orsola-Vidal, A. (2012) Promoting Handwashing Behavior in Peru: The Effect of a Large-Scale Mass-Media and Community-Level Interventions, World Bank Policy Research Working Paper 6257, Washington, DC: World Bank.
Hanchett, S., Khan, M., Krieger, L. and Kullmann, C. (2011) ‘Sustainability of sanitation in rural Bangladesh: World Bank Water and Sanitation Program’, Proceedings of the 35th WEDC International Conference [pdf] <http://wedc.lboro.ac.uk/resources/conference/35/Hanchett-S-1036.pdf> [accessed 1 May 2015].
Janz, N. and Becker, M. (1984) ‘The Health Belief Model: a decade later’, Health Education Quarterly 11(1): 1–47 <http://dx.doi.org/10.1177/109019818401100101>.
LaRose, S. (1975) ‘The Haitian Lacou, land, family and ritual’, in A. Marks and R. Romer (eds.), Family and Kinship in Middle America and the Caribbean, pp. 482–501, Willemstad, Curaçao: Institute of Higher Studies.
Maksimoski, N. and Waterkeyn, A. (2010) ‘The Community Health Club approach in informal settlements: case study from eThekwini municipality, Kwa Zulu Natal, South Africa’, Proceedings of the Water Institute of South Africa Conference, Durban [pdf] <www.africaahead.org/wp-content/uploads/2015/08/2010_WISA_eThekwini.pdf> [accessed 1 May 2015].
Malebo, H.M. (2007) Evaluation of PHAST in Tanzania Focusing on the Effectiveness and Sustainability of Water, Sanitation, and Hygiene Activities in Four Districts of Mainland Tanzania, Tanzania: WaterAid, UNICEF, WSP and the Ministry of Health and Social Welfare, Tanzania.
Okot, P., Kwame, V. and Waterkeyn, J. (2005) ‘Rapid sanitation uptake in the internally displaced people camps of northern Uganda through Community Health Clubs’, Proceedings of the 31st WEDC Conference, Kampala, Uganda [pdf] <http://wedc.lboro.ac.uk/resources/conference/31/WaterkeynJ.pdf> [accessed 1 May 2015].
Patil, S., Arnold, B., Salvatore, A., Briceno, B., Ganguly, S., Colford, J. and Gertler, P. (2014) ‘The effect of India’s Total Sanitation Campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial’, PLoS Med 11(8): e1001709 <http://dx.doi.org/10.1371/journal.pmed.1001709>.
Peal, A., Evans, B. and van der Voorden, C. (2010) Hygiene and Sanitation Software: An Overview of Approaches, Geneva, Switzerland: Water Supply & Sanitation Collaborative Council.
Pruss-Ustun, A., Bos, R., Gore, F. and Bartram, J. (2008) Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health, Geneva: World Health Organization.
Rosenberg, T. (2012) Join the Club: How Peer Pressure Can Transform the World, New York: W.W. Norton & Company.
Rosenfeld, J., Berggren, R. and Paulino, F. (2013) ‘Measuring behavioral changes associated with Community Health Clubs in the Dominican Republic’, Proceedings of the 2013 Water Institute at UNC Water and Health Conference, Chapel Hill, North Carolina.
UNICEF (2014) ‘New sanitation campaign aims to end cholera in Haiti’ [press release], UNICEF Haiti <www.unicef.org/media/media_74287.html> [accessed 22 August 2015].
Waterkeyn, J. and Cairncross, S. (2005) ‘Creating demand for sanitation and hygiene through Community Health Clubs: a cost-effective intervention in two districts in Zimbabwe’, Social Science & Medicine 61(9): 1958–70 <http://dx.doi.org/10.1016/j.socscimed.2005.04.012>.
Waterkeyn, J. and Nga, N. (2011) ‘Low cost-high impact: hygiene behaviour change in Vietnam in Community Health Clubs’, Proceedings of the 2011 Water Institute at UNC Water and Health Conference, Chapel Hill, NC, 3–7 October 2011.
Waterkeyn, J. and Rosenfeld, J. (2009) ‘Using cell phones to monitor and evaluate behaviour change through Community Health Clubs in South Africa’, Proceedings of the 34th WEDC Conference [pdf] <http://wedc.lboro.ac.uk/resources/conference/34/Rosenfeld_J_-_192.pdf> [accessed 1 May 2015].
Waterkeyn, J. and Waterkeyn, A. (2013) ‘Creating a culture of health: hygiene behavior change in Community Health Clubs’, Journal of Water, Sanitation and Hygiene for Development 3(2): 144–55 <http://dx.doi.org/10.2166/washdev.2013.109>.
Waterkeyn, J., Matimati, R. and Muringaniza, A. (2009) ‘ZOD for all – scaling up the Community Health Club model to meet the MDGs for sanitation in rural and urban areas: case studies from Zimbabwe and Uganda’, Proceedings of the International Water Association Conference, Mexico City [pdf] <www.africaahead.org/wp-content/uploads/2015/08/2009_IWA_Zim.pdf> [accessed 1 May 2015].
Healthcare Access - Regional Overviews [Working Title]
Comparative Assessment of Hygiene Behaviour Change and Cost-Effectiveness of Community Health Clubs in Rwanda and Zimbabwe
Anne Virginia Waterkeyn, Juliet
Matimati, Regis
Muringaniza, Andrew
Chigono, Agrippa
Ntakarutimana, Amans
Katabarwa, Joseph
Bigirimana, Zachary
Pantoglou, Julia
Waterkeyn, Anthony
Cairncross, Sandy
2019
https://doi.org/10.5772/intechopen.89995 [Citations: 4]Adapting a water, sanitation, and hygiene picture-based curriculum in the Dominican Republic
Nordhauser, Jennifer
Rosenfeld, Jason
Global Health Promotion, Vol. 27 (2020), Iss. 3 P.6
https://doi.org/10.1177/1757975919848111 [Citations: 5]Approaches to promote handwashing and sanitation behaviour change in low‐ and middle‐income countries: a mixed method systematic review
De Buck, Emmy
Van Remoortel, Hans
Hannes, Karin
Govender, Thashlin
Naidoo, Selvan
Avau, Bert
Veegaete, Axel Vande
Musekiwa, Alfred
Lutje, Vittoria
Cargo, Margaret
Mosler, Hans‐Joachim
Vandekerckhove, Philippe
Young, Taryn
Campbell Systematic Reviews, Vol. 13 (2017), Iss. 1 P.1
https://doi.org/10.4073/csr.2017.7 [Citations: 46]Rural Health
A Comparative Study of the Efficacy of Community Health Clubs in Rural Areas of Vietnam and Zimbabwe to Control Diarrhoeal Disease
Waterkeyn, Juliet
K. Nyamandi, Victor
Huy Nga, Nguyen
2022
https://doi.org/10.5772/intechopen.97142 [Citations: 0]A Review of the Community Health Club Literature Describing Water, Sanitation, and Hygiene Outcomes
Rosenfeld, Jason
Berggren, Ruth
Frerichs, Leah
International Journal of Environmental Research and Public Health, Vol. 18 (2021), Iss. 4 P.1880
https://doi.org/10.3390/ijerph18041880 [Citations: 3]Use of group maturity index to measure growth, performance, and sustainability of community health clubs in urban water, sanitation and hygiene (WASH) program in Zimbabwe
Hirai, Mitsuaki
Cole, Arnold
Munyaka, Moreblessing
Mudhuviwa, Steven
Maja, Taurai
Cronin, Aidan
Journal of Water, Sanitation and Hygiene for Development, Vol. 10 (2020), Iss. 4 P.1026
https://doi.org/10.2166/washdev.2020.023 [Citations: 1]Community health clubs improve latrine construction through savings, lending, and income-generating activities
Murakwani, Pamela Ncube
Sibanda, Wellington
Dube, Sijabulisiwe Beatrice
Weber, Nicole
Journal of Water, Sanitation and Hygiene for Development, Vol. 12 (2022), Iss. 2 P.227
https://doi.org/10.2166/washdev.2022.084 [Citations: 1]- A call to action: organizational, professional, and personal change for gender transformative WASH programming
- Providing municipal faecal sludge management services: lessons from Bangladesh
- Menstrual hygiene management: education and empowerment for girls?
- Webwatch
- Transgender-inclusive sanitation: insights from South Asia
Browse our other journals
