Evaluation of the Control of Water Sanitation and Hygiene Related Disease Through Community Hygiene Club Intervention in Rwanda

Abstract

This article consists of a review article reporting the results of previous evaluations of the control of water, sanitation, and hygiene (WASH) related disease through the Community Hygiene Club (CHC) intervention from 2010 to 2020. CHC constitutes the main intervention for the control of WASH-related disease in Rwanda and is implemented countrywide. The study objective was to evaluate if the CHC intervention significantly reduced the prevalence of WASH-related disease after 10 years of its implementation in Rwanda. The study utilized online existing policy documents, research reports, and experiences on the CHC intervention in Rwanda published between 2010 and 2020. We selected and reviewed 12 published documents, and the evaluation followed the steps proposed by ACHI (2020) Health Impact Assessment (HIA) and related frameworks of effective implementation of community health interventions. The primary outcome measure used was the reduction of WASH-related disease while the secondary outcome measure used was the increase of household WASH practices at less than a 5% level of statistical significance. We also described the structure and the implementation process of the CHC intervention. From the case studies where frameworks of effective implementation of community health interventions were applied, the study results showed the intervention significantly (a) increased households’ WASH practices and (b) reduced WASH-related disease. Due to limited publications in the research area and the lack of association of the WASH-related diseases and practices to the CHC intervention’s evaluation for most of published research reports, we recommend additional field data for an extended conclusion and its generalization in Rwanda. The study highlights the need to use appropriate frameworks in the evaluation of community health interventions to (a) attribute the outcome to the intervention and (b) easily identify the shortcomings in case of failure to get expected outcomes.