Community activities are being implemented in each village and directly involve men, women, children and chiefs. The main aim of these activities is to improve health related behaviours of parents.

These activities are being implemented in partnership with government outreach workers – called Health Surveillance Assistants (HSAs) – from Nambazo Health Centre. For further details see the Program Document.

Identify and train Village Health Committees

According to the government health strategy, each HSA is supposed to work with the community to identify and train official Village Health Committees in their catchment area. There is usually 10 members per village. Their role is to work with the HSA to improve the health of their village.

Few Village Health Committees were trained or active within Nambazo Health Centre catchment area when our project commenced. Therefore, the first step in the community level activities was to identify and train them. So far 277 Village Health Committee members have been identified and trained by the HSAs and Inter Aide facilitators – a minimum of 3 members from every village in the area.

VHC training

A village health committee is trained by an Inter Aide Community Health Facilitator and a government-employed Health Surveillance Assistant

Chiefs implement and enforce by-laws

The next step is to work with the Traditional Authority in the catchment to develop and implement public health by-laws. These by-laws will require village chiefs to implement and/or promote the following behaviours in their villages:

  1. All households to have latrines
  2. All households to practice hand washing
  3. All households to hang government provided bed nets and sleep under them
  4. Sick children to be taken to the Village Clinic or Health Centre immediately
  5. Couples to be aware of modern family planning methods to prevent unwanted pregnancies
  6. Pregnant women to attend antenatal and postnatal care and deliver at the Health Centre
  7. Husbands to accompany their wives to antenatal care visits

Compliance survey

Once the by-laws have been passed, the Inter Aide Facilitators and HSAs conduct house-by-house visits in each village to determine how many households are already demonstrating the positive health behaviours (e.g. have a latrine, are using modern family planning etc).

Once this survey is complete, a report is produced and provided to the chiefs, Traditional Authority and Area Development Committee showing the baseline compliance level in each village. Chiefs will then be required to improve only those areas of low compliance in their villages. For example, if a village has low latrine coverage they will be required to improve it, but if latrine coverage is already high there is no need for further action.

compliance survey training

Inter Aide Community Health Facilitators are trained in how to conduct the house-by-house compliance survey

Action plans and community triggering

Although the implementation of by-laws through the chief system is a common practice within Malawi, it does have limitations. Even a very committed chief may have difficulty mobilising their community to build latrines or hang bed nets. This may be for a variety of reasons, including lack of awareness, publicity, beliefs in myths and misconceptions, and a preference for income generating activities.

Therefore, after seeing the results of the compliance survey each HSA and facilitator pair will develop their own plan for improving the health of their catchment area. They will put each health issue in priority order and come up with activities that will mobilise the community to take action. The priorities and activities may be different in each area depending on the needs of that area.

Community mobilisation will be achieved through community triggering. This process has been inspired by Community Led Total Sanitation (CLTS) and the Positive Deviance approach (also called the Model Mothers approach). See the Program Document for specific examples of how this approach works in practice.

triggering

Community members map out the location of latrines in their village using seeds during a community triggering activity

House-by-house follow up

The outcome of community triggering is that the community makes their own action plan for improvements. For example, by setting a date by which all households must built a latrine.

House-by-house follow up visits will be conducted in villages where triggering activities have taken place. This will be used to assess whether the village has followed their action plan. For example, by visiting each house on the agreed date to see if they have built a latrine.

The results will be used to give updated information to the chiefs, Traditional Authorities and Area Development Committees on the compliance level within their villages. They can then decide if penalties should be implemented for villages or households that remain non-compliant with the by-laws.

follow up

A community member demonstrates how their hand washing facility works during a house-by-house follow up