Community Health Day Report

EXECUTIVE SUMMARY

Restless Development is a United Kingdom registered Youth-Led international Non-Government Organization; established in 1997 working towards uplifting the status of the youth around the world. In Uganda, the organization is currently running a number of programs and these include; the Big Idea Program, Youth Internship Program, Youth Think Tank Program, My Voice My Rights Program and the International Citizenship Service (ICS) Program among others.

Under Volunteer Service Organization (VSO), ICS is an international volunteer program conducted by a variety of organizations around the world. The program runs around typical volunteerism and operates in three stages; Pre-placement, In-country placement, and Action At Home.

Turning the focus to Action At Home, the stage involves volunteers using some of the knowledge and skills gained while on the program to extend change in their communities of residence explaining why I conducted the Community Health Day in Buikwe District; Najjembe Sub-county.

The Community Health Day had the following objectives.

• To team up with the Out of School Youth and kick-start a platform leading to better sanitation and health practices through the use of tippy taps in the village by 2017.

• To create a spirit of communitarianism among Out of School Youth in the village as they work towards increasing household access to the most basic sanitation facilities.

The Community Health Day started with a tippy tap demonstration where community members learnt how to construct and maintain a tippy tap. Following the demonstration, the event implementers proceeded to pre-selected households; constructing a tippy tap for each.

Still during the Community Health Day, clothes worth UGX 240,000 were distributed to seven community members. The clothes were pooled together through fundraising; a process which was guided by Restless Development.

On top of tippy tap construction and cloth donation, the health day implementers also cleaned around houses of pre- selected elderly persons in the village through pruning of grass and sweeping.

In conclusion, from the Community Health Day, it was observed that majority of the community members in Najjembe Sub- County live under very poor sanitary conditions with very limited access to improved sanitation facilities. Community members also have very limited access to proper knowledge about the sanitation related issues.

Introduction

Restless Development is a United Kingdom registered Youth-Led international Non-Government Organization; established in 1997 working towards uplifting the status of the youth around the world. The organization operates in eight countries around the world and these include Uganda, India, Tanzania, South Africa, Nepal, United Kingdom, Zambia and Ciera Leon. Restless Development operates within three core areas. These include; Youth Civic Participation, Youth Sexual and Reproductive Health and Rights and then Youth Employment and Livelihoods. In Uganda, the organization is currently running a number of programs and these include; the Big Idea Program, Youth Internship Program, Youth Think Tank Program, My Voice My Rights Program and the International Citizenship Service (ICS) Program among others.

Under Volunteer Service Organization (VSO), ICS is an international volunteer program conducted by a variety of organizations around the world. The program runs around typical volunteerism and operates within the objectives of active citizenship, volunteer’s personal development, and development impact. ICS is carried out in three stages; Pre-placement, In-country placement, and Action At Home.

Turning the focus to Action At Home, the stage involves volunteers using some of the knowledge and skills gained while on the program to extend change in their communities of residence. It is against such a background that I conducted a Community Health Day in Buikwe District; Najjembe Sub-county. The initiative aimed at addressing the social and health issues around the Sub-county.

Background

In the 2013 water and sanitation report produced by WaterAid, sanitation was defined as the collection, transportation, treatment and disposal or reuse of human excreta, domestic wastewater and solid waste, and associated hygiene promotion. Basing on the report, it is important to note that almost half of the people living in developing countries do not have access to even a basic toilet presenting a very big risk to public health. Diseases attributable to poor sanitation currently kill more children globally than AIDS, malaria and measles all put together while diarrhea is the single biggest killer of children in Africa. On the other hand, safe sanitation has been widely acknowledged to be the essential foundation for better health, welfare and economic productivity. However, progress in reducing the burden of sanitation related diseases in developing countries still remains slow which has ended up holding back the progress in all other development outcomes.

Access to proper sanitation

Basing on the 2015 World Health Organization (WHO); Joint Monitoring Programme (JMP) Report, Worldwide, 780 million people do not have access to an improved water source, an estimated 2.5 billion people lack access to improved sanitation (more than 35% of the world’s population) with the lowest coverage of "improved" sanitation in the world being recorded in sub-Saharan Africa (31%), Southern Asia (33%) and Eastern Asia (65%).

Disease and health

The 2015 WHO; JMP report estimated that 801,000 children younger than 5 years of age perish from diarrhea each year, majority of the deaths happening in developing countries. This amounts to 11% of the 7.6 million deaths of children under the age of five and means that about 2,200 children are dying every day as a result of diarrheal diseases. Important to note is that unsafe drinking water, inadequate availability of water for hygiene, and lack of access to sanitation all together contribute to about 88% of deaths from the diarrheal diseases.

Worldwide, millions of people are infected with neglected tropical diseases (NTDs), many of which are water and/or hygiene-related, such as Guinea Worm Disease, Buruli Ulcer, Trachoma, and Schistosomiasis. These diseases are most often found in places with unsafe drinking water, poor sanitation, and insufficient hygiene practices

Economic significance of sanitation

From the 2015 WHO; JMP report, one realizes that there is a tremendous impact of sanitation on health results in terms of economic returns on investment in sanitation, for individuals as well as national economies. Evans et al suggests that such returns include direct healthcare savings by both health agencies and individuals, as well as indirect benefits such as productive days gained per year (for persons 15-59 years of age); increased school attendance for children; time savings (working days gained) resulting from more convenient access to services; and a high value of deaths averted (based on future earnings). Evans et al also estimates that with a universal access to even the most basic water and sanitation facilities would reduce the financial burden on health systems in developing countries by about US$1.6 billion annually and US$610 million in the Sub-Saharan Africa; representing about 7% of the region’s health budget.

Financial implication

In 2008, the World Bank’s Water and Sanitation Program (WSP) conducted an economic impact analysis of sanitation in five south East Asian countries: Cambodia, Indonesia, the Lao People’s Democratic Republic, Vietnam, and the Philippines. The research estimated that these countries lose an estimated US$9 billion (2005 dollars) a year; 2% of their combined Gross Domestic Product (GDP) due to poor sanitation. A similar study in Uganda indicated that Uganda loses 389 billion Ugandan Shillings each year, equivalent to US$177 million. The sum is equivalent to US$5.5 per person in Uganda per year or 1.1% of the national GDP. The study also explained that 13.8 million Ugandans use unsanitary or shared latrines, while 3.2 million Ugandans have no latrines at all and defecate in the open.

In Uganda and other developing countries, many initiatives have been undertaken with an aim of overturning the situation and most of these have taken on community-based approaches. The approaches emphasize bottom-up capacity building within communities in order to address the determinants of health, such as safe sanitation. According to the 2011 WaterAid; (the sanitation problem: What can and should the health sector do?) report, community-based approaches are cost-effective and create a strong demand for sanitation and a culture of healthy behaviour. This explains why I took on the community based approach. I did that by teaming up with Out of School Youth and working together for better health and sanitation practices through a Community Health Day in Najjembe Sub-county which was held on 22nd-Oct-2016.

Objectives of the Community Health Day

The Community Health Day had the following objectives.

• To team up with the Out of School Youth and kick-start a platform leading to better sanitation and health practices through the use of tippy taps in the village by 2017.

• To create a spirit of communitarianism among Out of School Youth in the village as they work towards increasing household access to the most basic sanitation facilities.

Target population

The Community Health Day targeted Out Of School Youth and the entire community of Najjembe Sub-county- Buikwe District aged 16 and above.

Sustainability measure

Under the guidance of the Leader of Congregation, the youth hand of Nakyesanja Church of Uganda will occasionally team up with the Out Of School Youth in the area and engage in sanitation and health promotion activities around the village.

Budget

In general, some of the resources which were used during the Community Health Day were provided by the community members since they were readily available. Such materials include hoes, brooms, five litre jerrycans, Y-shaped sticks and sucks which were used in the Community Health Day activities. The structure of the budget is illustrated below.

Activities

Tippy Tap construction

A tippy tap can be understood as a hand washing instrument made up of two Y-shaped sticks, a jerrycan and soap. The instrument has been widely recognized for providing a proper hand washing mechanism for community members. With an aim of ensuring that all households use tippy taps, I teamed up with Out Of School Youth in the area; constructing three tippy taps during the Community Health Day. The process started with a demonstration to the community members about construction and maintainace of a tippy tap. Following the demonstration, the implementers proceeded as a group to pre-selected households; constructing a tippy tap for each household. During this process, demonstrations were also conducted to ensure that the community members understood how to use and also maintain a tippy tap. Under this activity, household members contributed sticks while the organizers provided the other materials like jerrycans and goze wire among others.

Donation of clothes

This was the other activity conducted during the Community Health Day and it involved the distribution of clothes to pre- identified elderly persons at Nakyesanja Village. During the activity, organizers of the event through Nakyesanja C/U and Restless Development pooled together clothes in a process commonly known as fundraising. In the process, the organizers reached out for likeminded individuals and institutions requesting them to donate clothes. The elderly persons who received the clothes were selected by community members during a meeting held at Nakyesanja C/U on 9th-Oct-2016. During the meeting, community members utilized their knowledge about the community generated a list of seven elderly persons who needed the help most. During this activity in the Community Health Day, clothes worth UGX 240,000 were distributed to seven community members. Among these were five males and two females.

Cleaning around houses

On top of constructing tippy taps and donating clothes, the health day implementers also pruned grass and swept around the houses of the pre- selected elderly persons. During the activity, the members of the households provided the necessary materials which were used in the cleaning process. Such materials included brooms, hoes and sucks for collecting garbage among others. During the event, implementers used hand hoes to prune, brooms to sweep around the houses and sucks to collect the pruned garbage basing on the household need for the activity. For this particular activity, one household was cleaned. The household only had one individual; an 86 year old who can no longer clean and stays with no one to help him around the house. By 22nd-Oct-2016, his house was fully covered in grass, garbage and dust but by the end of the event, the house was fully clean.

Community partners and their roles

As a volunteer on the ICS program, I appreciate the role of combined effort, active problem solving, active citizenship and partnership as a path towards real and sustainable development and change in our communities. Despite being passionate about community development, without partnerships; there is little to be achieved. That is why I joined my skills and abilities in community development with the efforts and resources of the community partners in order to have the Community Health Day done. The community partners and their roles are explains in the following lines.

Nakyesanja Church of Uganda

As a partner in the Community Health Day, the church acted as an umbrella which unified the community members for collective action. The roles of the church are explained below.

Roles of the church

[if !supportLists]· [endif]The church premises acted as a convening centre for meetings during the preparation stages of the Community Health Day.

[if !supportLists]· [endif]The church engaged in mobilization of community members towards the event as well as identifying the elderly persons in the village who benefited from the event.

[if !supportLists]· [endif]The church also established an event committee of three members. The committee was led by the Leader of Congregation Nakyesanja C/U and was responsible for directly working with other stakeholders establishing all that was needed to ensure that the event was done.

[if !supportLists]· [endif]The church through the youth hand also pledged responsibility for carrying on the idea of regularly conducting sanitation related activities as well as helping elderly persons around the village.

[if !supportLists]· [endif]The church also engaged in fundraising. Here, different church members contributed clothes as well as asking other community members to raise the clothes which were distributed to the elderly persons during the Community Health Day.

Challenges faced

Weather changes:

Basing on the fact that majority of the youth in the area engage in break laying to earn a living, weather changes significantly affects the activity. A few days before the event was held, Najjembe Sub-county received very high amounts of rain leading to low productivity among the break makers. With the sun shining bright on 22nd October, break laying activities were at the peak; making it very hard for most youth to engage in the event activities.

Tree cutting:

With majority of residents in Najjembe Sub-county engaging in break making, this has left the area with very limited trees. This is due to the great need of wood in the break burning process and has left most households in the area with no trees at all. It is because of this situation that no plate stand was constructed during the event despite the great for the plate stands in the area. Although the community members were informed about the activity days before, they could gather the sticks needed to make plate stands because they simply had no access to trees. This explains why no plate stand was constructed during the event.

Limited local government participation:

In some of the event preparation activities, the organizers of the Community Health Day contacted the local government; inviting local leaders to the event. However, despite the timely invites, none of the local leaders turned up for the event because of different reasons although the event activities proceeded normally.

Conclusion

From the Community Health Day, it was observed that majority of the community members in Najjembe Sub- County live under very poor sanitary conditions with very limited access to improved sanitation facilities. From the five households visited during the event, none of them had a proper latrine. Among the households, one had a mad walled latrine with no door; one had an open pit acting as a latrine while all the remaining three households go to the neigbouring houses and practice open defecation at times. In addition to that, community members also have very limited access to proper knowledge about the sanitation and health related issues.

Recommendations

There is need for the all stake holders to urgently engage in sanitation and health promotion activities in the area. From the event, it was realized that there is limited access to improved sanitation facilities by the locals in the area; making all community members vulnerable to diseases.

There is also need for more local government engagement in community development activities in the area. During the event, local leaders failed to actively turn up for the Community Health Day; a complaint which was also raised by other community members during the event. According to the community members, local government officials missing such community events is a common practice which needs to end if sustainable change is to be achieved.

More effort should be directed towards ensuring that all community members construct latrines in order to avert open defecation in the area. This will help prevent a variety of poor sanitation-related diseases.

There is also need for combined efforts against tree cutting in the area. During the Community Health Day, it was impossible for plate stands to be constructed as a result of lack of trees in the area. Most of the trees have been cut down for agriculture and break laying an act which needs to be urgently addressed.

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