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A

guide

for

and community

health workers

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WHO

Library Cataloguing-in-Publication Data

Howard, Guy

Healthy villages : a guide for communities and community health workers / Guy Howard with Glaus

Bogh

... [et al.]

1. Rural health services

handbooks 2. Community health services

handbooks 3. Community

health

aides

• handbooks I. Bogh,

Glaus Il.Title

ISBN 92 4 154553 4 (NLM

Classification: WA

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or in full. Applications

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Organization, Geneva, Switzerland, which will be glad

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for new editions, and reprints and translations already available.

World Health Organization 2002

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TYPESET IN HONG KONG

PRINTED IN MALTA

2001/ Best-set/lnterprint

7500

Contents

Foreword vii

Acknowledgements

ix

Chapter

Introduction 1

What is a

healthy village?

Structure of the

guide

Using

the

guide

and

setting priorities

Chapter

Achieving good

health 7

2.1 Factors that influence health 7

2.1.1 Environment 7

2.1.2 Awareness of health issues

2.1.3 Personal

hygiene

2.1.4 Health care

2.1.5 Faecal-oral diseases

2.1.6 Vector-borne diseases

Identifying

health

problems

and

establishing priorities

2.2.

Assessing community perceptions

about health 12

Identifying

causes of health

problems

Using

the information

Chapters.

Water

Providing community

water

supplies

Types

of water sources

3.2.1 Protected

springs

3.2. Dug

wells

3.2.3 Boreholes

3.2.

Piped

water

supply

3.2.5 Rainwater

harvesting

3.2.

Ponds,

lakes and water treatment

CONTENTS

6.3.1 Communal refuse pit

6.3.2 Communal collection 54

Managing special

solid wastes 55

6.4.1 Health care solid wastes 55

6.4.

Slaughterhouse

solid wastes 56

6.4.3 Industrial solid wastes 56

6.5 Chemical

safety

6.5.

Storage

of toxic chemicals 57

6.5.

Handling

toxic chemicals 58

6.5.3 Chemicals in the home 59

Disposal

of toxic chemicals 60

Chapter

Housing quality

7.1 Ventilation 61

Lighting

7.3 Disease vectors in the home

Overcrowding

in homes

Chapter

Personal,

domestic and

community hygiene

8.1 Personal and domestic

hygiene

8.1.1 Hand

washing

8.1.

Bathing

8.1.

Laundering

Community hygiene

8.2.1 Markets

8.2.2 Animal

rearing

8.3 Food

hygiene

8.3.1 Food

preparation

in the home 70

8.3.

Eating-houses

8.3.3 Street

food-vendors 72

8.3.

Promoting

nutrition

Chapter

Promoting hygiene

Assessing hygiene practices

Planning hygiene promotion projects

Implementing hygiene promotion projects

9.3.

Building community capacity

9.3.

Organizing groups

and

committees 76

9.3.3 Situation analysis

9.3.4 Communication and education 77

Monitoring

and

evaluating hygiene projects

9.4.

Deciding

what information is needed 79

HEALTHY VILLAGES: A GUIDE FOR COMMUNITIES AND COMMUNITY

HEALTH WORKERS

9.4. Selecting project investigators

9.4. Selecting

tools for collecting

information 80

9.4.

Reviewing project

findings

9.4.5 Feedback and dissemination of

findings

Chapter

Providing

health care

Establishing

community

health care

programmes

10.2 Factors that influence the

type

of health care that

people

seek

Encouraging

and

sustaining

the use of health services

Immunization of children 86

10.4.

Overcoming

barriers to immunization 87

Making

immunization safe 89

Groups

with

special

health care needs 90

Pregnant

women and infants 90

10.5.2 The

elderly

Risky

behaviour

Changing risky

behaviour 92

10.6.2 Health education

10.7 Mental health

problems, learning

difficulties and

epilepsy

10.7.1 Mental health

problems

Learning

difficulties

Epilepsy

10.7.4 Social inclusion

Chapter

Establishing

committees

for

implementing

Healthy Villages programmes

11.1 The role of local

community

committees in

Healthy

Villages programmes

11.1.

Composition

of a

Healthy Villages

committee 98

Transparency

and

accountability

11.2 The role of local

government

committees in

Healthy

Villages programmes

11.2.

Funding

and

accountability

11.2.

Technical advice and

support

11.3 The role

of national committees and coordinators in

Healthy Villages programmes

Annex 1.

Organizations supporting Healthy Villages

initiatives 103

Annex 2.

Books and manuals

providing

further advice 106

viii HEALTHY VILLAGES: A

GUIDE FOR COMMUNITIES AND COMMUNITY HEALTH WORKERS

as a communication

strategy

that

develops political

and

popular

health

awareness and

support

for health issues.

Settings

are

major

social structures that

provide ways

of

reaching

defined

populations.

Each

setting

in a village

has a

unique

set of

members,

authori-

ties,

rules and

participating organizations,

each with interests in different

aspects

of the village

life. For

example,

work settings

include

agriculture

and

small-scale industry;

other

settings

include

the

food-market,

the

housing

setting

or the school

setting. Generally,

these structures are

organized

for

pur-

poses

other than health. Interactions are

frequent

and sustained in

these set-

tings

and are characterized

by patterns

of formal and informal

membership

and communication. These

qualities

create efficiencies in time and resources

for health education

programming,

and offer more access and

greater poten-

tial for social influence.

Villages

are often defined in terms of

arbitrary

administrative definitions.

A

village may

be a small

group

of

people

living

in a settlement who

practise

subsistence agriculture,

with no

specialization

or division of labour,

and who

are isolated

from national

development agencies.

A

village may

also be a

large

and

differentiated conurbation where some

people

work in agriculture,

some

work in small-scale

industries and others

provide

education,

health

care,

administration and a

variety

of services. This

guide

is directed towards the

larger

and more differentiated

village.

It is also

recognized

that many villages

do not

operate independently

from

cities,

in that cities require

sustained inter-

action with rural communities for their food and

natural resources

(includ-

ing

land for waste

disposal). Often, too,

the district

agencies

that set policy

and administer the

villages

are located in cities. Under these

circumstances,

a Healthy Villages programme

has a

greater

chance of success if the linked

city

is participating

in a similar

type

of programme

for cities a

Healthy

Cities Programme

1

and if the district-level staff

implement Healthy Villages

as part

of the health

policy

for all the towns and

villages

in the district.

1

Werna E et al.

Healthy city projects in developing countries: an international approach to local

problems. London, Earthscan,

Acknowledgements

The

preparation

of this

guide

was coordinated

by

the

Water,

Sanitation and

Health

programme,

Protection of the Human Environment

Department,

of

the World Health

Organization

in

support

of the

Healthy Villages

Pro-

gramme.

Its

preparation

was initiated and led

by

Annette Priiss.

The authors

gratefully

acknowledge

the contributions of the

participants

in the

following

two

expert

consultations

organized by

WHO's

Regional

Office for the Eastern Mediterranean:

Regional

Consultation on

the

development

of technical

guidelines

and

integrated

environmental

management

norms for

Healthy Villages,

Tabriz,

Islamic

Republic

of

Iran, June

Inter-regional

Consultation on

Healthy Villages,

Damascus,

Syria,

October 1999.

The authors would also like to thank the staff from WHO

Headquarters

and

WHO

Regional

Office for the Eastern Mediterranean for their

comments on

the content and

style

of the

guide.

In particular

thanks

go

to Kumars Khosh-

Chashm for his

support.

Finally,

the authors would like to

acknowledge

the editorial work of Kevin

Farrell.

CHAPTER

1

Introduction

Many

factors determine the health both of individuals and of the commu-

nities in which

they

live. These factors include

income,

social relationships,

access to

and

use

of basic services such as water

supply

and

sanitation, the

quality

of available

health

services,

individual

responsibility

and the

quality

of the environment.

Consequently, public

health interventions

designed

to

reduce the risk of ill-health

and

promote feelings

of

well-being

in a commu-

nity

must consider

many

social

and environmental factors. These factors will

vary

in

importance

between

communities,

because of differences in the

current

services, facilities, priorities

and needs of the

communities,

and

because communities

change

over time.

If health interventions are needed in

several areas,

they may

need to

be

prioritized

before

they

are

implemented.

Several

programmes,

such as

primary

health

care or the Basic

Development

Needs

programme,

1

address the factors that influence the

health and well-

being

of communities. Advice on these

programmes

is available from a

number of sources (see

Annexes 1 and

2).

This

guide

focuses on the different health interventions

that

support

the

development

of

healthy

communities.

Many

of the interventions require

outside

support

to the

communities,

such as from local

and national

governments

and

nongovernmental organizations

(NGOs). However,

the

communities themselves also

play

an

important

role in

identifying problems,

defining

solutions and

setting priorities.

Often,

communities

will also need

to participate directly

in

implementing

solutions

and in

sustaining

the

improvements

made.

Indeed,

many

interventions require

commitments

from individual

community

members

and

households,

in addition to com-

mitments from

the broader

community. Frequently,

the most

important

element in

promoting

health is to ensure that

everyone

has access to

services.

1 Abdullatif AA. Basic development

needs approach

in the Eastern Mediterranean Region.

Mediterranean Health Journal, 1999, 5:168-176.

HEALTHY VILLAGES: A GUIDE FOR

COMMUNITIES AND COMMUNITY HEALTH WORKERS

Characteristics of a

healthy community

The

physical

environment is clean and safe.

The environment meets

everyone's

basic needs.

The environment

promotes

social

harmony

and

actively

involves everyone.

There is an understanding

of the local health and environment issues.

The community

participates

in identifying

local solutions to local problems.

Community

members have access to varied

experiences,

interaction and

communication.

The health services are accessible and

appropriate.

The historical and cultural

heritage

is

promoted

and celebrated.

There is a diverse and innovative

economy.

There is a sustainable use of available resources for all.

The

purposes

of this

guide

are:

To

help community

leaders and

people

who work with rural com-

munities

identify problems

that affect health.

To outline

possible

solutions to these

problems.

To

help

in the setting

of priorities

that will

lead to

a healthier

community.

During

the

development

of the draft version of this

guide

many

workshops

and discussions were held with

public

health

practitioners.

Based on these

discussions, it is

expected

that health

department

officials will find the

guide

a valuable tool for their

community

health

work,

and

may

translate

it into local

languages

or make

adaptations

to suit local circumstances and

conditions. The

guide

is not

exhaustive, however;

it

does not cover

interven-

tions for

every

situation,

nor are the

descriptions

of interventions detailed.

Instead,

it is

designed

to

provide

information to communities that will enable

them to start the

process

of

problem solving.

More information about

imple-

menting programmes

can be obtained from the

organizations

and documents

listed in the annexes at the end of the

guide.

1.1 What is a

healthy village?

It is

impossible

to define precisely

what is

"healthy''

for all

communities,

because this will

depend

on the

perceptions

of

community

members as to

whether their

village

is a

"good" place

to live.

However,

a village

or rural

HEALTHY VILLAGES: A GUIDE FOR COMMUNITIES AND

COMMUNITY HEALTH WORKERS

CHAPTER 1. INTRODUCTION

CHAPTER 2

Achieving good

health

According

to the World Health

Organization

(WHO)

good

health is

not

merely

the absence of

disease;

it is also a reflection of the social and mental

well-being

of

people

in a

community.

Thus,

to achieve the WHO

goal

of

pro-

viding

health for

all,

improvements

in a

community

should aim not

simply

to reduce

disease,

but also to reduce social tensions and mental ill-health to

acceptable

levels.

2.1 Factors that influence health

Many

factors influence health and some

may

have both

good

and bad influ-

ences. For

example,

surface water bodies can be beneficial as

they

can

supply

water for domestic and

agricultural

work,

may

be used for

fishing

and re-

creation,

and can create a

pleasant

environment.

However,

they

can also be

breeding

areas for insects and snails that transmit diseases such as

malaria,

dengue

fever and schistosomiasis. Pollution of water bodies

by

humans also

increases the risks to health. Factors that influence health can be

grouped

as

follows:

The environment.

The awareness of individuals and communities about health.

Personal

hygiene.

Health care.

Disease.

The

linkages

between these factors and health are discussed more

fully

below

(see

also

Figure

2.1).

2.1.1 Environment

The environment includes both the

physical

environment we live in and

the social fabric of the

community,

and both

significantly

influence health.

The

physical

environment

plays

an

important

role in many ways.

A clean

HEALTHY

VILLAGES:

A

GUIDE FOR COMMUNITIES AND COMMUNITY HEALTH

WORKERS

Figure

2. 1

Linkages

between factors that affect health

Health care

environment

helps prevent

the

spread

of disease and

may

reduce

depression.

For

example,

safe and

adequate

water

supplies,

sanitation,

drainage

and solid

waste

disposal

all benefit health

by

removing

disease vectors from human

contact.

Dirty

environments,

by

contrast,

encourage

the

spread

of disease and

may adversely

influence the mental and emotional

well-being

of individuals.