**Acknowledgements**

*Healthcare Access - Regional Overviews*

**7.6 Scaling up the CHC model**

Action Plan;

**8. Conclusion**

CHCs throughout the country;

more cost-effective per beneficiary, that programme has 'come and gone', whereas the national CBEHPP under MoH continues to slowly transform every village in

Schools are an expected resource in every village, but this was not always the case. A few decades ago, education was recognized as a fundamental human right. Despite the huge challenge, Ministries of Education throughout Africa have almost succeeded in providing schools in most villages and as a result literacy is increasing annually. CHCs provide an informal *adult* education system filling in the gaps that remain in community knowledge and ensuring that communities are health conscious and coordinated to manage their health challenges. Scaling up CHCs to every village takes time, but as there is little infrastructure needed, it is comparatively cost-effective relative to the buildings needed by schools. If Rwanda has been able to coordinate community efforts through CHC in a national structure leading from

Is scaling up the CHC model possible in those countries that have already missed their MDG targets and are now being challenged to meet the SDGs as well? We suggest that it is indeed possible through three distinct stages: Advocacy, Policy and Program.

• by Regional bodies such as AMCOW advocating at a high level to replicate successful programs across the continent using such declarations as the Kigali

• by ensuring that the CHC model is adopted into policy, so the Ministry of Health can use its existing structures and resources with very little additional cost to organize the Environmental Health Department to start up and monitor

• by coordinating multiple and diverse efforts by numerous development partners and INGOs into a single national Environmental Health Promotion Program to avoid duplication of efforts and multiplicity of conflicting

The CHC Model 'works'. Community Health Clubs are indeed capable of stimulating public health action cost-effectively. The Model deserves to be replicated in other countries in Africa as soon as possible to alleviate poverty and tackle many preventable diseases in a sustainable, holistic and integrated way. A national Environmental Health program using Community Health Clubs as a vehicle for change in every village, can be reasonably predicted to deliver a wide range of community-led hygiene behavior changes which will ultimately improve family health, social capital and living standards throughout the country. What is badly needed is a clear vision by Governments to adopt the CHC model systematically and invest in building the capacity, not only of the curative wing of Ministry of Health but also the Environmental Health systems which can prevent disease. Countries which adopt the Rwandan approach at national scale are more likely to meet at least

approaches through a myriad of small NGO projects.

Goal 6 of the Sustainable Development Targets by 2030.

Village to the President, this can surely be emulated by other countries.

Rwanda, going from strength to strength on an upward trend.

**52**

Both in Rwanda and Zimbabwe the Ministry of Health's Environmental Health Department was a partner in the implantation of the Programme. In Rusizi District of Rwanda, the intervention and monitoring through Ministry of Health in partnership with Africa AHEAD was funded by Bill & Melinda Gates Foundation. In Mberengwa District, Zimbabwe Action Contre la Faim (ACF) in partnership with Zimbabwe AHEAD, funded by the European Commission. We also recognized the contribution of Community Health Club members, their committees and their facilitators who participated in these interventions.
