Strategies used by community health volunteers in attaining open defecation free status in Alego Usonga sub-county, Kenya

Abstract

Community Health Voluntears are people of influence who are ready and willing to champion and promote community initiatives and drive the transformation from Open Defecation to Open Defecation Free community status. ODF is clean environment where everyone within the community do not defecate in the open. Sanitation and hygiene are critical to health, survival, and development. Many countries are challenged in providing adequate sanitation for their entire populations, leaving people at risk for water, sanitation, and hygiene (WASH)-related diseases. Throughout the world, an estimated 2.5 billion people lack basic sanitation. Open defecation is one of the challenges compounding WASH related problems especially in 3rd world countries. In order to address such sanitation challenges, Community Led Total Sanitation (CLTS) was adopted in Kenya. Community Health Volunteers (CHVs) are enthusiastic about CLTS and ever willing to take responsibility for maintaining their localities’ open defication free (ODF) status. With CLTS facilitation in Kenya, their recognition and contribution has not been determined indepth and documented mostly owing to their informal role and responsibility. Alego Usonga Sub-county was the first Sub-County in Siaya County to be declared ODF. The main objective of this study was to determine the current ODF status of Alego Usonga, and the approaches used by CHVs in the attainment of ODF status in Alego Usonga. The specific objectives are; to determine the ODF status, to determine the approaches used by community health volunteers to attain ODF status; to assess the strategies employed by CHVs in sustaining ODF status in Alego Usonga Sub-County. To address these objectives, a descriptive cross sectional study design was adopted to collect information from 350 community health volunteers using a structured questionnaire. The quantitative data collected included number of ODF villages and demographic factors. The study identified four approaches used by the CHVs to promote ODF status. These are door to door visits, use of village committees, use of chief’s barazas, use community dialogues, and use of sanctions. Amongst the post ODF sustainability approaches that were being used by the CHVs, frequent monitoring of sanitation status was the most common strategy (32%), this was closely followed by acting as role model and acting as CLTS Champions at 22% and 19% respectively. However Community health education and social marketing were also noted as additional approaches used to ensure sustainability. Majority of the CHVs reported that as part of their work, they performed frequent monitoring of latrine construction amongst those households that were triggered to ensure that all the CLTS indicators are in place. Working together with the community leaders and the undersigned village committees selected during triggering process, the CHVs were able to monitor and document the progress of latrine construction by households triggered. This work highlights the importance of include CHVs in sanitation programs because of their relatability and familiarity with members of their communities. These findings will be used in informing policy makers and stakeholders on considering CHVs in achieving ODF status in all counties in Kenya and World wide considering their significan impact.