REPORT APRIL 2014 Introduction This project seeks to address underlying challenges facing water, sanitation and hygiene in Zimbabwe through an integrated approach that aims to improve access to better sanitation, safe drinking water and encourage health and hygiene behaviour changes, to reduce the incidence of illness. Its broad objective is to contribute to the attainment of the water and sanitation Millennium Development Goals (MDGs), that of halving the proportion of poor people without access to safe water and basic sanitation and reduce the health risks caused by the same in the rural areas of Zimbabwe by 2015. Specifically the action will adapt and promote community led approaches as a model for complementing other sustainable service delivery modes of safe water, adequate sanitation and application of health and hygiene practices in Gwanda and Mwenezi districts. Executive summary showing key highlights or successes The project has promoted the community based management concept through trainings held in latrine building, water point management; community based planning, hygiene promotion and knowledge facilitation. Awareness of the negative impact of open defecation has gone a long way as evidenced by the outcome of Community Led Total in Sanitation (CLTS) triggering sessions which have seen community members volunteering to construct the latrines at their households. At the institutional level, school development committees have worked, with support from parents, in mobilising materials for school latrines construction. HEALTH AND HYGIENE PROMOTION Health and Hygiene Promotion in Community Operational Structure The project carried out 15 trainings on Health and Hygiene. The objectives of the CBO trainings were: To capacitate Community Based Organisations (CBOs) adoption of Participatory Health and Hygiene Education (PHHE) tools for use in the community. To equip CBOs’ with knowledge and skills on using participatory methodologies in identifying problems and solving them. To develop and design plans for implementation of participatory hygiene promotion at ward level as well as monitoring and evaluation. 1 The trained community members were obtained from existing CBOs in the community. The CBOs would work hand in hand with the Inter Personal Communicators (IPCs) in Mwenezi who were trained earlier on in the project. The already existing Village Health Workers (VHWs) in Gwanda would be supporting the trained CBOs in disseminating health and hygiene information within the districts from village level. Both groups would operate with an aim of preventing disease and promote a healthy lifestyle amongst community members. Below is a table showing details of the trainings held. Summary of CBO Trainings District Date Mwenezi 08-12/10/2012 15-19/10/2012 12-16/11/2012 Gwanda 15-19/05/13 04-08 /06/13 Venue Rata School (Ward 2) Murawi centre (Ward 3) Chimbudzi Ward 4 Chikwalakwala Sch (Ward 6) MDTC (Ward 1 & 5) MDTC (Ward 7,9,10 & 11) Women 8 11 9 15 22 24 Men 16 13 18 9 18 26 Total 24 24 27 24 40 50 01-05/07/13 MDTC (Ward 13 & 14) 27 23 50 04-08/06/2013 Sub- Total Mwenezi 05-07/02/13 11-15/02/13 02-06/04/13 09-13/04/13 08-12/05/13 13-16/05/13 13-16/05/13 Sub-Total Gwanda GRAND TOTAL MDTC 24 140 17 8 14 13 13 20 17 102 242 26 149 10 18 13 16 12 12 11 92 241 50 289 27 26 27 29 25 32 28 194 483 Bhalula Primary (Ward 14) Bengo Primary (Ward 17) Nhwali Sec.(Ward 24) Mkhalipe Primary (Ward 20) Ntalale Clinic (Ward 11) Selonga Clinic (Ward 15) Buvuma Clinic (Ward 18) The feedback from trainings provide a guide in determining appropriate issues to highlight during hygiene promotion sessions. Some of these were captured during trainings and are discussed below. The trained groups were urged to be the drivers in mobilising communities to go for voluntary counselling and testing for Human Immune Virus (HIV) as it allows individuals to come up with their health plan in order to live longer. During the training sessions it was gathered that most men don’t like to use condoms when they are having sex and have misconception that the fluid inside the condom has the HIV virus. Participants were urged to promote safer sex through correct and consistent use of condoms and avoid the spread of sexually transmitted diseases. CBOs realised that they must fight stigma and discrimination and also involve everyone in the project despite their HIV status and work closely with already existing support groups in order to improve their living standards in terms of health and hygiene. 2 During training, CBO members also appreciated the need for considering gender equity and equality when carrying out developmental duties as they noted that most women were not included in decision making and there was less involvement of men in health and hygiene issues. The participants were able to differentiate sex and gender roles of both men and women. Three quarters of the CBOs trained had myths and misconceptions about the causes of climate change as they thought that the breaking of cultural beliefs by the community is one of the major causes and they believed their God will provide them with rain once they carry out traditional ceremonies. After the presentation of the topic on climate change, the CBO members realised that they have much work to do in order to improve their climate conditions like promoting planting of trees and educating the community on the effects of deforestation. Prior to these meetings, the communities had knowledge of public health hygiene but no health clubs existed within the communities. This gap meant that not all the communities had access to the public health and hygiene education which is critical to the well-being of individuals as well as improvement of their health. Prevention of diseases that are caused by the use of unsafe water as well as from improper disposal of the wastes could only be possible once the communities are informed of the best ways to prevent them. Much emphasis was put on the issues of safe potable drinking water, hand washing and use of latrines to stop open defecation. This we did because most people are drinking water from unprotected water sources such as dams, deep well, sand abstraction and rivers and most community members are not treating water or boiling it before drinking. Most people don’t wash their hands after using or visiting toilet/and some practise open defecation, but with the training the participants appreciated the need for stopping open defecation. The issue of promoting hand wash was discussed at length and the participants realised that they were ‘eating’ their own waste. Participants stated that traditionally they use one dish when washing their hands and they realised that it’s a bad hygiene practise so they have appreciated the use of run to waste hand washing method. Challenges Participation of community members is very difficult during farming season. Health and Hygiene Promotion in Schools To date a total of 284 school health masters have been trained from schools within both Gwanda and Mwenezi district. The main objective of the training has been to raise awareness on health and hygiene promotion to teachers and in turn orient them on participatory methodologies used in sharing health and hygiene knowledge. The PHHE methodology was used throughout the training. Sessions on how to establish and run school health clubs were also held, with a view to them becoming a vehicle for transmitting health and hygiene lessons to fellow school pupils within schools. Following the School Health Masters’ training program, teachers have managed to strengthen the component of hygiene promotion within learning institutions. Health clubs have been established as a result of the training. It would be to the discretion of the Health master to determine the most appropriate lesson for the club to discuss at a specific time. Factors which determined the selection 3 of topics would include the season, target group and risk factors. Amongst the sessions held, topics have included: personal hygiene, awareness on the importance of hand washing, the importance of using the latrine, spread and prevention of cholera, awareness on bilharzia transmission, presentation and prevention, food hygiene and safe water storage. Demonstration on making tippy taps was done in schools and pupils were fascinated by the technique. This saw more pupils developing interest in washing hands through using this new technology. The practice of washing hands has an impact of reducing diarrheal diseases in the long run. Diagram to show how the tippy tap works Reports were received on a monthly basis, however some submissions were delayed due to nonattendance by the school headmaster at their monthly meetings. The school Health Masters were encouraged to ensure that reports were presented on time so as to have current and up to date information. Monitoring to ascertain the impact of these activities is still in progress. Concern has been raised that some activities may not be completed due to tight school schedules and holidays, nevertheless health masters are envisaging keeping up the momentum. The table below details the number of schools who reported, sessions held and total audience reached by the sessions; Summary of Hygiene Promotion sessions School Type Secondary Primary TOTAL Total Schools reporting 10 52 63 Sessions Held 60 302 362 Boys Reached Girls Reached Total Audience 502 5134 5636 643 5505 6148 1145 10639 11784 Health Clubs Existing 9 42 51 Some health clubs are still at initial stages of establishment whilst others are keen on starting income generation projects. At one school in Gwanda, pupils are reported to have contributed a $1 each and have managed to start up a tuck-shop with the funds. Meanwhile another school has been reported to have started nutrition gardens. A vibrant health club exists which has established a chicken rearing project in order to raise its finances - these are yet to be visited for lesson sharing with other colleagues. 4 School Health Clubs are reported to be having membership varying from 15 to 40, and are involved in clean up campaigns, keeping the school environment clean by encouraging fellow pupils to pick papers in the school and make use of the available refuse pit. Child to child learning is enhanced and cleanliness promoted as pupils motivate each other. Local Environmental Health Technicians (EHT) are invited to conduct a hygiene promotion session in schools. School health clubs are encouraged to have a working relationship with the community health clubs within the ward. Some schools have noted that the third term is the most appropriate for reinforcing health club activities within the year. This implies that the rate at which club members meet may be lower in the first two terms than the last term of the year, however, such challenges vary with institutional planning and arrangements. Events A hand washing competition was supported in ward 16 for Matulungundu cluster during the cluster prize giving day in November 2012. Prizes, in the form of stationary, were donated to the schools for the pupils that had participated in the hand washing competition. Two commemoratory events were conducted with the first event being an inter-zonal sports festival held at Selonga primary were primary schools competed in football and netball. Schools in attendance included Dombo, Nhwali, Patana, Selonga, Nkalange, Tshanyaugwe and Sukwi primary. The schools received a soccer ball and netball ball each for participating in the tournament as well as caps, hats and t-shirts. The second event involved the community health clubs and schools of ward 15 namely Nkalange, Dombo, Selonga primary and Selonga High. The event was commemorated through drama and singing competitions. The participants received brooms to help in cleaning their sanitation facilities. The EHT gave a speech on the importance of using sanitation facilities to dispose excreta as well as the need to wash hands properly using soap or ash. The proper hand washing technique was imparted to the participants through demonstration. Challenges Progress of club activities may be disturbed by the absence of trained Health masters in the case that one goes on leave and those left are too busy to provide similar attention. It is the case that some Health teachers have been absent on leave and as such no activities have been carried out. In some schools however, fellow staff members have been appointed to take over the school health master roles whilst he/she is on leave. Some schools do not have enough sanitation facilities to cater for the enrolment, causing a delay in promoting zero open defecation. However, this challenge is being addressed through the subsidised component of the project where 30 schools were selected and approved to benefit a minimum of 10 squat holes each. To date a total of 14 schools have started the construction process which should improve sanitation coverage. The newly introduced technology on washing hands (tippy taps) is being vandalised by mischievous pupils. This is evidence that the process of behavior change is accepted differently by varying age and social groups. As such this technology though cheap and affordable proves to be not very 5 effective where large numbers are involved unless thorough education is accomplished first. Other challenges include; Late submission of reports by school heads. Lack of safe water in some schools who rely on boreholes that are either located more than 500metres from the school or rely on unsafe water sources which close to them and may vary from open streams, rivers, dams and unprotected wells. Lack of detergent in schools to use when cleaning latrines. Tight school schedules disturb the smooth flow of activities. There is need to have regular meetings with health club members despite the tight scheduled activities at schools Recommendation More sessions should be held to educate the school children and the community to change their behavior in terms of health and hygiene practices The need to hold awareness campaigns on health and hygiene practices is critical. Need for safe sources of water near the school such as boreholes as well the construction of latrines in schools To organize with community health agents for reach out activities to parents by the children Tippy taps not appropriate to use on schools with big enrolment, big containers with taps maybe be appropriate to use Billboard development Hygiene promotion marketing messages for 100 schools including two billboards have been developed. In Gwanda, schools were encouraged to develop their own messages with the District Water and Sanitation Sub Committee (DWSSC) coming up with the message for the bill board, whilst in Mwenezi the same message has been adopted for all the 65 schools. Samples have been discussed and production is currently underway with the designers. PODCASTING Podcasting is an information dissemination technology adopted in the project to reach the general public in schools and community with issues that relate to their welfare. Though initially these were brought in to support hygiene promotion activities, it has been noted that some topics on animal health, farming, water point management, just to mention a few, can be shared using the same technology. In Mwenezi District, 17 Content developers were trained (6 women and 11 men), and 16 Knowledge facilitators were trained (10 women and 6 men). Content developers were obtained from Government stakeholders whilst Knowledge facilitators were selected from Government departments and communities. Meanwhile podcasting sessions were monitored in Gwanda district with an average of four sessions held in one month. Monitoring of sessions being carried out has realised the need for more content to be developed. Ninety-eight MP3 players were procured and given to the trained knowledge workers for their use in sessions. The podcasting technology was also used to share information on livelihood, livestock, HIV and AIDS AND Gender issues other than health and hygiene promotion. 6 The workshop objectives for Content Developers were to acquire skills and knowledge on how to produce good quality content for Pod Casting technology and to adopt pod casting devices to be used in the community, hence ensuring improved access to technical options and knowledge. Objectives of training Knowledge Facilitators were to equip them with skills to disseminate information to communities through Pod casting device and to train them skills and knowledge on how to use pod casting technology. Topics covered included: Overview of departmental activities at District level, Knowledge needs /challenges gaps within the District; Digital Extension ( POD CASTING) Presentation; Role as Content Developers and Technology. During Knowledge facilitators’ training, topics covered were: Overview of participants activities at the community level; Challenges /knowledge needs/gaps within communities; Digital Extension (Podcasting) Presentation; Roles as knowledge facilitators and trainers and use of technology training. Challenges Lack of adequate budgetary resources for research and development, technological development, field extension and education Donor dependency syndrome Lack of literacy to understand messages, ignorance Roads and communications infrastructure poor or non-existent Brain drain Use of uneducated leaders Mobility to cover wards Poor road networks. Lesson learnt Information and dissemination of messages can reach more people by using modern technology like Pod Casting during gatherings. Recommendations Co-ordination with community stakeholders. Provision of transport to support knowledge facilitators’ reach out to distant communities. Training of local leadership on the use of new technology. Right person at right time on information dissemination Technology interaction centre DWSSC members to have a knowledge node centre where they research. Formation of Content Developers’ centre 7 Some of the knowledge workers trained in podcasting SANITATION Latrine Builder Training A total of 122 latrine builders were trained by facilitators from the Ministry of Health and Child Care (Environmental Health Technicians) and expert community builders trained within previous projects and recommended by the same Ministry. The project has a target of training 180 builders. Each builder is given a toolkit to facilitate their operations within the community. The trained 122 have been involved in constructing latrines at schools and within the communities. Sanitation in schools The project has a target of improving sanitation coverage in the district and as such a 5 bags of cement model Blair Ventilated Improved Pit Latrines (BVIP) has been targeted for selected schools and vulnerable community members. Selection of schools to benefit from the subsidised latrines was done through consultation with the DWSSC and the district Education Office. To date a total of 30 schools have been identified and recommended to receive cement for this purpose. Each school was required to mobilise bricks, aggregate(quarry stones) and sand before receiving bags of cement for construction to commence. The number of squat holes range from 10 to 14 depending on the school enrolment. Follow ups were made to the schools benefitted from latrine construction, and the table below shows progress to date in respective schools. The School Development Committee (SDC) and parents were engaged in the mobilisation of materials whilst the trained builders were considered to take a leading role in constructing the facilities. Payments for the builders would be agreed upon by the builder and the SDC without the project staff influence. The Builder payment negotiations agreed was considered an issue which determined the schools’ preparedness before receiving cement. This approach enables community involvement and empowerment and in turn enhances ownership by 8 the concerned beneficiaries. The siting was done through technical guidance from local EHT. A few siting challenges were faced especially where sites were located in rocky terrain. The school is currently in the process of acquiring dynamite for deepening the pits. From the 30 schools which have benefited, 14 have started construction and look forward to completing within the current year. Pictures showing progress in some schools by February 2014 are shared below: Bubi Secondary showing progress made within two weeks:28/02/2014 Takura Primary (left) faced challenges of rocky surface whilst Takunda Primary (Right) were progressing well: 21/02/2014 Progress made over two weeks at Mukume Primary: 28/02/2014 9 Sanitation in the Community The process of distributing cement has started. Vulnerable community members will be supported with cement for latrine construction. The elderly, child headed, disabled and the sick have been deemed vulnerable thus eligible to receive 5 bags of cement for constructing a single squat holed BVIP. After mobilising aggregate, sand, bricks and the builder payment issues finalised, each beneficiary will receive the cement. To date a total of 720 have been identified whilst 120 from wards 14, 17 and 20 of Gwanda district have yet to start construction. Challenges Community members are currently engaged in field work during this season and as such have one day in a week devoted toward household work and developmental activities which include mobilisation of latrine building materials. For that reason, the delay in getting an output is inevitable. Excessive rains have also flooded the dug pits resulting in progress delays in lining the pits. Sengezane Village (Ward 14) beneficiaries receiving cement as Project Officer observes them signing: Photography by Tendere Tendai 7 Feb 2014 10 Community Led Total Sanitation (CLTS) The Community Led Total Sanitation (CLTS) concept seeks to address people’s mind-set towards the importance of safe disposal of human excreta. A total of 356 community members attended these triggering campaigns, together with their local leadership. Issues that came out from the sessions were that the communities were now used to getting external aid for them to have household toilets. There was no ownership of the toilet by the community members hence theit being labelled according to either the government or the donor agencies depending on who provided the facility. It is this mentality that this project aims to get rid of to encourage community demand of such sustainable facilities. After a triggering session, communities made a concerted effort to build themselves toilets without any external assistance, upon realising that without toilets they were simply ‘eating’ their faeces through either drinking contaminated water or eating contaminated food by the flies. More so, they did realise that even those that have toilets are affected by those without which therefore called for everyone to come up with one solution of building toilets so as to prevent diseases. CLTS triggering tools used in the sessions included namely: the walk of shame; shit calculation which left communities disgusted and ashamed after realising that they were eating their faeces. As a result community members came up with a work plan and time lines of building the toilets on their own. Some came up with village toilet committees who will be responsible for coordination, monitoring of the progress of having toilets. The Ministry of Health will be responsible for siting the toilets as well as ensuring that the minimum standards for the toilets are met. The common water sources are open wells which present health hazard to the people in this ward since they can easily get contaminated. Everyone one who was there agreed to practice new measures and stop open defecation. In the same vein the project aims at promoting the upgradable BVIP so as to ensure fly control since other technologies such as the ecosan could not be adopted at national level. CLTS Triggering campaign in ward 17 Makugwe (Picture by: S. Musarurwa) CLTS Training of Trainers participants at Gwanda Hotel 11 WATER Water point Management Training Identification and mobilisation of water point management committees was carried out in consultation with village development committees (VIDCO) and communities. It was found that some of the water points did not havethe requisite number of members and as such they had become dysfunctional, leading to the mismanagement of the water points, thus rendering access to water futile. Each committee has seven members comprising chairperson, vice chairperson, secretary, vice secretary, treasurer and 2 committee members. The WPMC were encouraged to work closely with trained VPMs in ensuring the water points are kept clean, functional and well managed. The roles of these committees were not clear to some of the members and as such there was either a conflict or duplication of duties. More water points could stay for long time without being attended due to donor dependency syndrome. It was against this background that training workshops were held with the broad objective of achieving sustainable access to water by the communities themselves. The objectives of the trainings were as follows: To understand how the community Based Management (CBM) concept works and who is involved To understand the importance of practising hygiene around the safe water sources To discuss the roles and responsibilities of the water management committee members To come up with a water point constitution To discuss conflict resolution strategies As a committee they were mandated; To come up with fundraising mechanisms for maintenance and operation of water points To guide the communities in coming up with their water point constitutions. To come up with agreed methodology of keeping inventory To explain to the communities the modalities of meeting procedures Gaps which were realised during the training were that some water points were not kept in a clean state, which creates a risk of disease transmission. The workshop did help communities to maintain their water points by explaining the roles of the water point management committees (WMPCs) in making sure that a duty roster existed which will be followed by the communities to reduce or prevent disease prevalence. Participants were made to develop constitutions on water point management and to ensure that the constitution was understood by all users who should contribute to its development The constitution would be used as guide on how they manage, maintain as well as operate their water points. 12 Table below highlights the WPMCs trainings held in various wards during the period under review; Date Ward Men Women Total 20-22/04/13 14 01-3/05/13 & 07-09/05/13 9-11/04/2013 14-16/05/13, 21-23/05/13 & 4-6 \06\13 05-07/06/13 11-13 \06\13 18-20/06/13 18-20/06/13 03-05 /07/13 31/08- 01/09/13 11-13/09/13 36 44 36 17 12 20 16 30 102 34 16 30 36 65 36 13 24 11 15 19 18 3 12 13 19 22 24 31 27 40 26 36 50 393 50 33 39 24 38 32 46 70 19 596 19 22 24 31 27 40 26 36 50 989 Challenges Understanding gender issues in water and sanitation management Delays in repairs or rehabilitation of water points were encountered in some communities due to both pre and post- election activities. Lessons Learnt The WPMCs need to understand that it is mandatory for local leadership to approve their constitution. Some trained WPMCs had drafted their constitutions and had not taken them to the local leadership for approval. The inclusion of women in WPMCs does not guarantee their participation in decision making because of cultural beliefs. Some WPMCs had an evolving fund which they used to fund operation and repair costs though they had other documents missing. An example cited was Chilimani in Gwanda district. Recommendations There is need to continue encouraging women in decision making in water point management Communities to manage the operation and maintenance of the low cost systems Intensive capacity building to Water Point management committees on management of their water point funds for maintenance and operation. Need for continuous capacity building on conflict management. Way forward Committees agreed on documenting every intervention on each water point and every water point management committee to come up with an evolving fund so as to sustain operations and maintenance. 13 Material Distribution Borehole rehabilitation materials, which were returned to the supplier due to manufacturing defects, were rectified and returned to respective districts. The process of rehabilitation and repairs is progressing well. The received materials were distributed to wards of operation as of in July 2013. Distribution in Gwanda was done as outlined in the table below: Ward 11 14 15 16 17 18 19 20 24 Total Leather Cups 100 100 100 100 100 100 100 100 100 900 Pipes Rods Cylinders 200 200 200 200 200 200 200 200 200 1800 100 100 100 100 100 100 100 100 100 900 8 7 8 8 8 8 7 8 8 70 Bush Pumps 6 5 5 6 5 5 6 5 5 48 Foot Valves 7 6 6 6 6 6 6 6 7 56 In order to get effective feedbacks regarding the rehabilitations and repairs done, monitoring of rehabilitated water points is encouraged after every service. The table below shows the water points that were rehabilitated specifying the parts installed during the process. Rehabilitation and Repairs WARD 14 WATER POINT Esidulini [Paye Village] 14 Switsha [Ntanye Village] 15 Frank [Nkalange Village] 24 PARTS INSTALLED 6 pipes and rods; 1 bush pump 1complete cylinder Bush pump; Complete cylinder 7 pipes and rods 8 pipes and rods; 1 bush pump Complete cylinder 3 pipes and rods; 1 bush pump Complete cylinder So far a total of 53 water points have either been repaired or rehabilitated by the trained pump mechanics. Some of the water points had been down for a number of years and as such the coming of the project with many materials has meant that communities will be able to access the water without challenges. A coordination meeting with representatives of the pump mechanics, local leadership intended to identify and document best practices in rehabilitation as well as the lessons learnt and challenges that the pump mechanics face is in plan. Pump mechanics will be trained on documentation of the water points they would have rehabilitated or repaired. 14 . a) (b) a) District Development Fund (DDF) staff member, Mr. Dube views received Rehabilitation material in Gwanda b) Trainee pump mechanics preparing to go for a practical session during pump mechanic training c) d) c) Community assisting trained pump mechanic (lady in pink head gear) to rehabilitate water point d) Borehole rehabilitation in ward 6 in progress BOREHOLE DRILLING Borehole drilling started in September 2013 and to date 10 boreholes have been drilled of which 8 have a fair yield and 2 were dry holes. Name of the site Date drilled Total Depth Blow yield Remarks Rutenga Growth Point Chagomoka Primary School Gwamarara Primary School Takunda Primary School Mucheni Primary School Mucheni Primary School Bubi Primary School Rinette Primary School Bubi Secondary School 12/09/2014 17/09/2013 14/09/2013 13/09/2013 15/09/2013 16/09/2013 26/09/2013 25/09/2013 20/09/2013 56m 51m 56m 50m 65m 55m 39m 40m 40m 600l/hr 2200l/hr 1000l/hr 400l/hr Nil Nil 1000l/hr 1000l/hr 2000l/hr Fair drilling Fair drilling Fair drilling Fair drilling Dry hole Dry hole Fair drilling Fair drilling Fair drilling 15 Case Study A newly drilled borehole within Magaya Village of ward 17 in Gwanda district was been fenced and the WPMC arranged for a livestock drinking trough to be constructed to cater for supplying livestock with water especially during dry seasons. This shows evidence of a trained committee putting into practice the lessons learnt at training workshops. From the pictures there is anticipation that hygiene will be maintained and a low down time will be accomplished, attributing to an organised committee. Livestock drinking trough within the newly drilled and fenced water source in Magaya Village; Ward 17 Gwanda District: Photography by Tendere Tendai 5 Feb 2014 16