*5.1.2 Effectiveness*

*Healthcare Access - Regional Overviews*

**42**

**5. Methods**

**Figure 3.**

**Figure 2.**

*courtesy of J. Waterkeyn.*

**5.1 Data collection**

*improvements. Photographs courtesy of J. Waterkeyn.*

*Popularity* of the CHC can be measured by the ability of the facilitators to attract many members and retain their attendance for the duration of the intervention. The Membership Cards of all members were collected at the end of the training and this was triangulated with project records to ascertain overall number of members in the

*Left: A model CHC kitchen hut in Zimbabwe showing shelving made of clay, individual family utensils and covered drinking water with ladle. Right: In Rwanda, a traditional cooking shelter outside, with no CHC* 

*Left: Subsidized ventilated improved pit latrine (VIP) in a CHC home in Zimbabwe with lined pit, concrete slab and vent pipe - a fly trap which eliminates smell and a hand washing facility. Right: An unsubsidized traditional pit latrine in Rwanda, unlined and open pit, log floor giving open access for flies. Photographs* 

*5.1.1 Popularity*

Effectiveness was demonstrated by the *community response to the training* as measured by the percentage of members adopting each of the recommended practices. The observation check list, known as the *'Household Inventory',* was used to conduct spot surveys which uses proxy indicators of hygiene behavior change which can be empirically observed first-hand by the enumerator. We did not use self-reported data as we are skeptical of the value of this method given the well-known effect of observer bias. For example: although we can observe the presence of handwashing facility (HWF) and whether soap was present, the calculation of regular usage over time is not observable. To overcome this monitoring challenge, all members are required to place a pot plant beneath their HWF. If the pot plant has been regularly receiving water from the HWF, and is alive, we know the HWF is likely to be in use. Similarly, we do not place much credibility on reported behaviour, as householders when asked this question, are likely to answer that they are in compliance with handwashing methods and use soap. To avoid such interviewer bias, we simply ask a child to demonstrate how they wash their hands and we note whether soap is used. Observations in Rwanda were conducted by Environmental Health Officers (EHOs) and trained enumerators drawn from teachers and students for a random selection of CHC member households. In Zimbabwe CHC facilitators, CHC chairpersons and Environmental Health Technicians (EHTs) collected data.
