Health promotion in Darfur, Sudan

Knowing the best way to keep yourself and your family healthy is important. This is especially the case for the people of Darfur in Sudan, who have been displaced from their homes due to fighting and are living in cramped basic conditions in camps or with relatives. Tearfund is working to provide safe water and sanitation in these areas and give appropriate health messages so that people use the resources effectively.

Health clubs

Health clubs have been set up in order to communicate health messages and provide fun activities for women and children affected by the conflict. The clubs on the border with Chad also include nomadic people who have had very little access to any sort of education and are keen to learn about good hygiene. There are women’s clubs for a total of 14,000 women, and children’s clubs for 65,000 children across the Darfur region. In order to fit into the women’s daily routines and allow access for the few children who attend school, the clubs tend to meet in the early evening twice a week.

Each club is run by a group of local facilitators who are volunteers. The children’s clubs also have an ‘encourager’ in each group of about 50 children. The encourager is a child who guides his or her peers and promotes hygiene through example.

The women’s clubs provide an opportunity for social time and discussion about how to ensure they and their families stay healthy. Various methods are used for communicating and discussing health. For example, as it is cultural for one of the local tribes to jump to music, the women enjoy jumping to various songs and rhymes about hygiene.

The children’s clubs involve a range of activities related to health, such as use of puppets, stories, songs, cloth charts, drawings, drama, skipping rhymes and games. One participatory activity is the ‘rating chart’ where children are asked a question such as, ‘how often do you wash your hands?’ Different choices are shown by pictures drawn on the ground with a stick. They use a stone to mark their answer. They then compare their answer with the answers of other children. The answers can be recorded and the activity repeated after a time to see how health-related behaviour is changing.

Men tend to be more difficult to target with hygiene messages than women and children as they already feel quite well informed about hygiene and are not so keen on the methods used in the women’s clubs, such as singing songs. They sometimes receive such messages at community meetings. They also learn through household visits, which is another element of the programme. Some men have volunteered to take part in the programme as facilitators in the children’s clubs.

Household visits

Household visitors visit homes in the area to pass on hygiene messages and assist families to put into practice what they are learning at clubs. They provide vulnerable families with additional support such as identifying malnourished children for the nutrition programme. The household visitors are trained to provide families with psychosocial support where it is needed.

The household visitor checks to see that the latrine is clean and well maintained, and that water and soap or ash is available for washing hands. If the inspection is successful, the household visitor puts up a flag outside the latrine to show the neighbours that it is well looked after. At the next visit, if the inspection is unsuccessful, the household visitor takes the flag away. This simple method has proved to be highly successful in motivating people to look after their latrines, although it works better for latrines that are used by one household than for shared latrines. Tearfund is therefore trying to provide more household latrines. This method is also empowering for the household visitors, because the presence of flags shows the fruit of their own work in educating the households.

Training the volunteers

Each month the club facilitators, encouragers and household visitors receive training. The content of the training is decided by the volunteers themselves. For example, during the mango season they may ask for training about hand-washing and diarrhoea as people are likely to pick up and eat mangoes without washing the fruit or their hands. In winter the volunteers may ask for training about colds.

The volunteers are taught hygiene messages and various methods for communicating those messages. Some of the facilitators cannot read, so pictures are provided to help them to remember the different activities they can share with the community.

Soap distribution

The United Nations has contracted Tearfund to distribute soap to communities in Darfur. This distribution has been incorporated into the health programme. There are three methods of soap distribution:

1. Soap is distributed at the women’s and children’s clubs. Each person is currently given two bars of soap every month.
2. Soap is distributed during household visits. Each household receives four bars of soap each month. This is below the recommended minimum, but children from many of these households attend the clubs where they also receive soap.
3. Each facilitator, encourager and household visitor is given eight bars of soap every month as an incentive to take part in the programme.

This soap distribution has reinforced the messages given out at the clubs and has resulted in an increase in hand-washing. However, there are disadvantages of distributing free soap.

• The money for the soap is running out, so it is not sustainable.
• If the distribution stops, hygiene may suffer as few people can afford to buy their own soap.
• Even though people came to the clubs before the soap distribution started, there is a concern that if the soap distribution stops, people will stop going to the clubs.
• Without the incentive of additional bars of soap for facilitators, encouragers and household visitors, it is possible that they will withdraw from helping with the work.

To address these issues, the following actions are taken.

• The club facilitators and household visitors are trained in promoting alternatives to soap, such as the use of clean ash or sand.
• Small amounts of money are being provided to groups of facilitators for starting income-generation projects. This provides an alternative incentive to participate in the programme when the soap distribution stops. Some of these facilitators have received money and training to make pasta to sell. It is hoped that in the future they will be able to make and sell soap, but it is currently difficult to obtain the ingredients.

Hygiene in schools

Another element of the programme involves hygiene education with school children. In each school there is a committee of children consisting of a child from each class. This committee ensures that the latrines are kept clean and that there is water and soap or ash for washing hands. The children on the committee are given a special uniform to wear when cleaning the latrines to ensure that their school uniform does not get dirty. As an incentive, these children are given a badge to wear and a certificate. There is a prize each month for the class that keeps the latrines the cleanest. Health messages are shared weekly at school assemblies.

Children paint murals on the outside walls of the latrines. This makes them look attractive and encourages the children to look after them. The murals usually contain health messages. Programme staff helped with the painting to start with, as it was a new concept, but now the children are inventing all sorts of creative designs themselves.

Anne McCulloch is Tearfund’s Health Promotion and Children’s Activities Manager in Genina/Beida, North Sudan. To contact her, email: [email protected]

Example of an activity used at children’s clubs: ‘Checking chums’

• Divide the children into pairs. 
• The children should inspect their partner’s hands and decide whether they are good, bad or okay in terms of cleanliness.
• Draw three large faces in the sand – happy, okay and sad. Ask the children whose hands are clean to stand on the happy face, those with unclean hands on the sad face and so on.
• Ask the children to count how many children are standing on each face. Record the results. If there are more children on the happy face than the previous week, give them praise.
• Provide some warm water and soap so that the children standing on the sad face can wash their hands and move to the happy face. Make this fun so it does not embarrass the children.