7.3 Role of the Health Development Army

The Health Development Army(HDA) is another key group with a significant role in WASH. You may already be familiar with them as enormous numbers of people are involved. They are organised groups of families who promote healthy activities and behaviour among other families. More than 2.25 million HDA families have been mobilised in Tigray, Amhara, Oromia and SNNP regions (Figure 7.2). Since 2010/11, the Ethiopian government has invested a lot in establishing the HDA who have made a huge contribution to the major achievements made in the health sector, including reduction of the number of deaths in children under five. HDAs are regarded as the key players in the attempts to achieve government targets in the Health Sector Development Programme (HSDP).

Figure 7.2 HDA promotional banner.

The smallest unit of the HDA consists of six households organised together and is referred to as a one-to-five (1–5) network. One of the households is a model family who have mastered and implemented some or all of the WASH packages such as access to an improved latrine, handwashing and solid waste management. Usually it is mostly the women who are involved. The family head of the model household leads the 1–5 network. Five of these networks are organised into a larger team comprising 30 households in the same neighbourhood. The leaders of these teams undergo intensive training over seven to ten days to ensure that they fully understand their tasks. The HEWs, described in Section 7.2, facilitate the establishment of these teams and in collaboration with the health centres, provide training for the team leaders.

The main task of the HDAs is implementing the components of a Health Extension Package in each household. These are first adopted in the model household and then cascaded to the other families in the 1–5 network. To achieve this, the 1–5 networks meet every week to:

• identify the major bottlenecks and gaps in implementing the WASH improvement components of the Health Extension Package
• prioritise gaps and agree on strategies to address them
• review progress.

This process has accelerated achievements in achieving HSDP targets, notably the use of health facilities by mothers with newborn babies. It has also successfully increased knowledge and practice of safe hygiene and sanitation practices among households, including construction of basic or improved latrines at household level, improved personal hygiene, waste management, and safe handling and storage of water.

In summary, HDAs work to change practice in communities through a participatory process of learning and action-oriented meetings, working below HEWs at neighbourhood and family levels. They are the key players in the improved WASH situations that many households enjoy today and will continue to be an important part in future progress towards improved and sustainable WASH services in communities.