Implementation challenges for Community Health Clubs in Rwanda

This briefing examines the implementation of Community Health Clubs (CHCs) in Rwanda, highlighting that while the model is culturally appropriate, its effectiveness is hampered by fragmented, donor-driven funding and a lack of district-level ownership. Key challenges include the unaffordability of soap, water scarcity in hilly regions, and inconsistent monitoring systems across different NGOs. The report warns that without inclusive strategies, men, the extremely poor, and those with mobility issues may be left behind, and notes that the current focus on households ignores critical sanitation needs in public spaces like markets and workplaces.

• The implementation of Community Health Clubs (CHCs) in Rwanda is characterized by fragmentation and a heavy reliance on donor funding, which undermines sustainability. Because CHCs are predominantly managed by internationally funded NGOs and time-bound projects, activities often slow down once funding ends, and district-level government bodies struggle to take ownership of the clubs.
• While the CHC model is considered culturally appropriate for Rwanda due to its use of positive peer pressure and consensus rather than shame, several practical barriers hinder long-term hygiene behaviour change. These include the high cost and low availability of soap, water shortages in hilly areas, the theft of 'tippy tap' handwashing stations, and a training period of six months that may be insufficient for permanent behaviour shifts.
• Monitoring and evaluation of CHCs are currently inconsistent because different implementing partners use varying tools and reporting systems. Although the CBEHPP Roadmap assigns oversight to district environmental health officers, these officials often lack the financial and technical resources, such as data management systems, to perform effective follow-up.
• There is a significant risk that vulnerable populations may be excluded from the benefits of the CHC programme. Specific risks include the exclusion of men and boys, as attendees are predominantly women; the exclusion of people with mobility issues or those living far from meeting sites; and the inability of the poorest households to afford materials for latrines and soap.
• The CHC approach focuses exclusively on household and community-level health, leaving a gap in sanitation services for public spaces. The document notes a lack of toilets and handwashing facilities in workplaces, farms, and markets, which limits the overall effectiveness of disease prevention.

APA

Ekane, N., Dickin, S., Gabrielsson, S., Ntakarutimana, A., & Rujeni, N. (2019). Implementation challenges for Community Health Clubs in Rwanda. Stockholm Environment Institute. https://www.sei.org/wp-content/uploads/2019/11/sei-brief-rwanda-chcs.pdf

Chicago

Ekane, Nelson, Sarah Dickin, Sara Gabrielsson, Amans Ntakarutimana, and Nadine Rujeni. Implementation challenges for Community Health Clubs in Rwanda. Stockholm Environment Institute, 2019. https://www.sei.org/wp-content/uploads/2019/11/sei-brief-rwanda-chcs.pdf.

Wikipedia

{{cite report |last1=Ekane |first1=Nelson |last2=Dickin |first2=Sarah |last3=Gabrielsson |first3=Sara |last4=Ntakarutimana |first4=Amans |last5=Rujeni |first5=Nadine |title=Implementation challenges for Community Health Clubs in Rwanda |publisher=Stockholm Environment Institute |date=October 2019 |url=https://www.sei.org/wp-content/uploads/2019/11/sei-brief-rwanda-chcs.pdf |access-date=17 August 2026 |via=Climate Insights Directory}}

BibTeX

@techreport{ekane2019implementation, author = {Ekane, Nelson and Dickin, Sarah and Gabrielsson, Sara and Ntakarutimana, Amans and Rujeni, Nadine}, title = {{Implementation challenges for Community Health Clubs in Rwanda}}, institution = {Stockholm Environment Institute}, year = {2019}, month = oct, url = {https://www.sei.org/wp-content/uploads/2019/11/sei-brief-rwanda-chcs.pdf}, urldate = {2026-08-17}, note = {Indexed by Climate Insights Directory} }