Clean water and health: A program for community development in rural Honduras

We describe a project for community development in a remote village community of Honduras conducted between 2004 and 2008. The project serves as pilot for a network of similar projects throughout the region. The project is based on the training and supervision of community health workers, the establishment of a drinking water supply system, the construction of latrines and a program of community organization and education. Phase 1 included a health needs assessment and demographic survey in rural communities as well as the identification of a target community for the intervention according to accessibility for training staff, lack of local health facilities, establishment of a community health committee, and selection of community health workers by the health committee. Next, a community survey was conducted in the target community. The issues of most urgent need included: diarrheal diseases, respiratory infections, malnutrition, poor water quality, and a strong stigma against tuberculosis. Phase 2 included the development of a training curriculum for community health workers, the establishment of a community water board, and a second community survey for the feasibility of a drinking water supply system conducted by an engineering NGO. Phase 3 included the training of 2 community health workers, and the design of a drinking water supply system providing all 136 households of the target community with potable tap water and latrines. Phase 4 included regular evaluation visits for quality assessments, training maintenance and curriculum expansion. Health workers were now trained in community education, focusing on water sanitation, hygiene, oral rehydration, and the destigmatization of tuberculosis. The drinking water supply system with access points and pour-flush latrines for all 136 households was constructed using local engineering and labor. The water board was trained in basic accounting and financing principles allowing them to supervise a maintenance system based on minimal customer fee contributions. Phase 5 begins in 2009. It includes the upscaling of the project to 2 further communities, the extension of the health worker training curriculum to include antenatal care, and the design of a community garden project to enhance community nutrition.