1. Making ‘what works’ work: Changing behaviour in sanitation and hygiene Community Based Environmental Health Promotion Programme (CBEHPP) Rwanda 1 Ministry of Health, Rwanda Mr. Joseph Katabarwa [email_address] Cell number: +250 788 461 076

2. Vision 2020: All households ‘will have mastered and be practicing hygiene and waste disposal.’ Economic Development and Poverty Reduction Strategy (EDPRS): Streamline intervention to implement the vision. Health Sector Strategic Plan II (HSSP II): Promote healthier lifestyles and prevention of diseases. Environmental Health Policy and National Policy for Water and Sanitation Services: Determine the modalities of implementation of the strategy for the sub sector. Government seeks a cost effective strategy, not only to meet the sanitation MDG, but also to decrease the burden of disease and alleviate poverty throughout Rwanda. ADDRESSING POVERTY AND DISEASES IN RWANDA

3. Integrated Community Development Education Water & Sanitation Primary Health Environment Food Security Home-based care Skills Training Income Generation POVERTY ALLEVIATION through Community Hygiene Clubs (CHCs)

6. Community-Based Environmental Health Promotion Programme Cross-cutting Sectors & Ministries CBEHPP MINEDUC: Enhancing human resources MoH (EHD) : Sustainable hygiene behavior change MINECOFIN & MINALOC: National development & poverty alleviation MININFRA : Increasing access to rural /urban WSS CBEHPP (CHCs) CHWs

8. Training Manuals for CBEHPP developed CBEHPP District Environmental Health Officers 3 - day training in all aspects of the CHC Approach to be used in CBEHPP to enable planners to have an understanding of the CHC approach. Community Health Workers 5-day workshop to enable Environment Health Officers and Community Health Workers to effectively facilitate the 24 topics.

11. 1. Increased use of hygienic latrines in schools and homes from 28% to 80% Measuring Behaviour Change by 2015: The 10 Golden Indicators CBEHPP 2. Increased handwashing with soap at critical times from 34% to 80% 3. Improved safe drinking water access and handling in schools and homes to 80% 4. Establishment of CHCs in every village from 0% to 100% 5. Achieve Zero Open Defecation ZOD in every household from 28% to 100% 6. Safe disposal of children’s faeces in every household from 28% to 100% 7. Households with bath shelters increase to 80% 8. Households with well managed rubbish pits increase to 80% 9. Use of pot racks for drying dishes increase to 80% 10. Households with clean yards increase to 80%

12. Difference of Prevalence of Observed Hygiene Indicators between Community Health Club Members and non Members in Tsholotsho District, Zimbabwe. 2001 Source: Waterkeyn,J. 2005 (Africa AHEAD) Expectations of success CBEHPP The CHC Approach has been tried and tested in Zimbabwe, Sierra Leone, Guinea- Bissau, Uganda, South Africa and in Vietnam. Every time it has delivered reliable results, varying according to the level of development in each context. We expect the same in Rwanda that has been achieved in Zimbabwe (see graphs below).

13. Ruwombe Ward, Makoni District, Zimbabwe. Reported Cases of communicable disease 18 health clubs PHHE: 1995 - 2001 # h/holds 1,771 CHC Coverage of area: 80 %. Source: MoH Zimbabwe; Waterkeyn, J. 2005 Expected Reduction in Poor Hygiene and Sanitation Related Diseases CBEHPP

14. Based on past experience of disease reduction in CHC areas where there is at least 80% adherence to CHCs over at least three years, we expect to induce significant levels of behaviour change with the resultant decrease in reported cases of preventable disease (diarrhoea, ARIs, malaria, bilharzia, skin disease and worms) throughout Rwanda given that CBEHPP will be implemented in all 15,000 villages in the next few years. Conclusion CBEHPP