COLLEGE OF MEDICINE AND HEALTH SCIENCE

DEPARTMENT OF ENVIRONMENTAL HEALTH

COURSE CBTP – II
INTERVENTION FOR IDENTIFIED PROBLEMS IN CBTP-I IN HABITAT KEBELE
02 KETENA 02

GROUP-3

PREPARED BY: GROUP – II

AUGUST, 2022

KOMBOLCHA, ETHIOPIA
 Acknowledgement

First of all we would like to thanks for God. Next we would like to thank all advisors for their
professional input to prepare this report. We would like to thank Wollo University, CMHS, and
Department of Environmental Health Science for giving as the chance to conduct CBTP in this
area. We would also like to thank the owners of the Householders in kebele 02 of kombolcha
town, kebele 02 Health Centre, health extension workers and kebele administration for
cooperating in this program.

Acronyms and abbreviations

CBE Community Based Education

CBTP Community Based Training Program

HEW Health Extension Workers

SDG Sustainable Development Goal

SRP Student Research Program

TTP Team Training Program

UNICE United Nation Children Fund

WASH Water, Sanitation and Hygiene

WHO World Health Program

HHs- house holders

CMHS- College of medicine and health science
ABSTRACT

During this CBTP phase II some basic problems related to solid and liquid waste management
and practicing unhealthy behaviors of the community are identified during last CBTP (CBTP
phase I) were solved by us to some extent. By taking the problems that are identified during
CBTP phase 1 as a sample and solutions were given by us for some of the problems. Due to
limited time and resources we are unable to give solution for all identified problems and we
didn’t get opportunity to discuss in detail on the solution of many problems. This program has
been finished within only three weeks but it needs prolonged time to resolve all problems. Health
education was given to the society on the way of practicing healthy behavior and management
systems of the household waste.

INTRODUCTION

1.1 Background

.Community based training program is one of the component of the community based education
program. CBTP as one of the strategies is an integrated program which runs in phases along with
an in-built regular follow up.it is one of the community based education program that aimed at
enabling the students to assess, diagnose and intervene prioritized community health problems
depending on the level of competence. It also ensures that both students and the community
derive some benefit from each other. This community based education program has different
phases. Phase I is done to identify problems existing in the community Phase II is to prepare
action plan for prioritized problems and give an intervention for those problem.

CBTP is one of community based education which design to conduct survey and assessment of
community health and health related problem and also it intended to identify, examine and
prioritize health related problem in order to prepare action plan for prioritized problem in study
area.At CBTP phase I the basic problem were identified in In habitat ,02 kebele , ketena 02
community regarding on the problem relating with the management of solid and liquid waste,
awareness of community on health related issue and the activities they perform.

CBTP phase II Comprises problem solving process by taking the problem identified and
prioritized in CBTP phase I as a sample. After the major problem was identified, the solution
was given by discussion with the community and group member. Both community and students
were benefited by knowing how to solve their problem using the available materials. In this
CBTP phase two, our team worked several activities to intervene the problem identified and
prioritized in CBTP 1.  It involves giving and implementation of possible solution for some
identified problem. Intervention is a combination of program elements or strategies designed to
produce behavior changes or improve health status among individuals or an entire population.

 In habitat ,02 kebele , ketena 02 there are several problems that were identified
in CBTP phase I. Among these problems: poor implementation of hand washing
facility around toilet, improper solid waste disposal and absence of liquid waste
management are the core problem identified

1.2 Statement of the Problem

Since health is what we want to have in every individual’s entire life our focus
should be on the community. Community health is the core thing that have been
given a great attention if we want to have country that achieved healthy life style
for her nations and a country with a minimal report of both communicable and
non-communicable health problem. As we have seen from our CBTP 1 report it is
possible to conclude that the society of habitat ,02 kebele , ketena 02 is almost
educated society because there have, clean public toilet, enough amount of
potable drinking water supply, but most peoples are suffered from organized
management of solid and liquid waste, even the community do not receive
training on the way how to improve their health. The community also faced with
bureaucratic problem that means they are asked to pay money monthly for
kombolcha`s municipal to collect the waste but the municipal still now couldn’t
be functional.
After the problems that are associated with environmental health conditions were identified
based on the data collected from CBTP I among 02 ketenas of kebele 02 of Kombolcha town,
intervention plan was designed and implemented to give a solution for the problems that were
prioritized below.

1.3 Significance of CBTP II

It helps the community:

 To have awareness on the transmission of communicable disease

 To have knowledge on how can it be possible to manage waste water at household level
using soak pit.
 How to make and use solid waste burning pit at individual level and being independent of
municipality
 To know how these facilities can be constructed or implemented with a minimum coast
and labor
 To protect themselves from damage of being ill by contagious disease.
 To know the advantage of washing their hand with soap after toilet use without hand
contact of facility.
 To get scientific knowledge from us on the way how to practice healthy life style
It helps the student (us):

 To have a practical knowledge in addition to theoretical knowledge

 To be experienced with finding solutions for communities’ problems
 To know how waste management facilities can be constructed at household level
 To report our work for the department
 It helps us to be a good communicator and to be a good convincer
 To know how community health education could be given.

2.OBJECTIVE

2.1 General objective

• To solve problems related to community health which were identified in CBTP 1 and
prioritized in CBTP 2 in habitat ,02 kebele , ketena 02.

2.2 Specific objective

 To overcome communicable diseases by install hand washing facility near to latrine at
households
 To reduce liquid waste management problem by constructing soak pit at household level.
 To reduce improper solid waste disposal by performing sanitation campaign and construct
dump hole.
 To give health education about health and health related issues in the community level
 To perform sanitation campaign.

All Identified problem in CBTP1

 poor liquid waste management
 poor hand washing facility near the latrine
 improper solid waste disposal
 Lack of chimney (6% kitchens had no chimney)
 Inadequate water supply (78% of residents total consumption is less than 20L)
 Improper food handling materials
 Improper latrine utilization (6% of toilets had no cover & 22% were not clean during
observation)
 Some latrines were not constructed properly
 Poor housing condition
 Poor hygiene and sanitation

Prioritized problems during community diagnosis

As described above, there are several problems that are identified during community diagnosis.
Since it is not possible to deal with all the problems at once, we prioritized the problems based
pre-defined problem prioritization criteria. The criteria's that are used for prioritization of
problems are;

 Magnitude
 Severity
 Feasibility
  Community concern
 Government concern

Since it needs a lot of resources, time and man power to find an intervention for all
identified problems, we couldn't intervene all problems.

So using community resources and our man power are the best option that helps as to
overcome these shortages.

• Priorities are then made on the basis of the depth and severity of the problem, the
feasibility and the degree of community concern and willingness to be involved in the
resource mobilization.

Problem Prioritization Criteria

1. Feasibility: the state of being feasible with regard to resource, time and skill
of manpower
2. Magnitude: it is an extent or size of the problem that occurred in the
community
3. Severity: the condition of being severe to the society
4. Community concern: the concern of the community needs to get a certain
solution regarding problem
5. Government concern: the concern of getting acceptance in the government
office

Based on the above prioritization criteria the problems were evaluated by group members and
given number starting from zero to five for ranking or prioritization
 Table 1: prioritized problems in kombolcha town, kebele02, ketena 02

S/N. Problem Magnitud Severity Gon. Feasibility Con.. Total rank

e concern concern

1 poor liquid
waste
management

2 poor hand
washing
facility near
the latrine

3 Improper
solid waste
disposal

4 Lack of
chimney

5 Inadequate
water supply

6 Improper
food
handling
materials
 7 Improper
latrine
utilization

8 Some
latrines were
not
constructed
properly

9 Poor housing
condition

10 Poor hygiene
and
sanitation

Problems selected for intervention

After we prioritized the problems, the following are selected for intervention;
 Poor liquid waste management At house hold level
 Improper solid waste generation And storage at house hold level
 Hand washing facility near the latrine
 Improper use of latrine at house hold level
 The poor hygiene and sanitation of sarounding residient

Unselected problems for intervention

 Lack of chimney

 Inadequate water supply

  Poor housing condition
 Some latrines were not constructed properly
 Improper food handling materials
These problems are not selected for intervention, due to they are not feasible with regard to our
resource, time and man power. For example the problem of daily water supply was high in
community and government concern, severity and magnitude. But we can’t do an intervention
for it as it requires a lot of resource, time and skilled man power. For those and other reason it
was excluded from problem selected for an intervention. The left others was also excluded due
to they got least rank and needs repeated interventional action to be resolved due to shortage of
time it is not possible.

Activities Required For Prioritized Problem

1 .Health education for all selected problem

1. Construction of soak pit

2. Sanitation campaign at school and some selected household

3. Home visit with Health education

4. Installation of handwashing facility with soap near to the latrine

Action plan
Action plan write up Identify the main health challenges in the community.

Prioritize them using prioritization criterion.

Develop an action plan for each priority health challenges.

Students shall produce an organized action plan document based on the CBE guiding format and
power points for action plan presentation seminar day.

Make sure that the community is getting involved in your action plan developments

Table 2: Total Action plan for prioritized problems in kebele 02 , ketene 02 of kombolcha town,
2022,GC
S/N.. Activity Responsible Available Unit Total Time frame Indicators
body resource plan

1 Construction Group Man power NO. 15 W1 W2 W3 W4 Installation of

of hand members, Jerrican, hand washing
washing HHs rope, nail, 5 5 5 facility
facility soap

2 Construction Group stone, NO. 12 4 4 4 Disposing

on soak pit members, gravel, waste at
HHs bidet, hoe, constructed
pit
sprinkle, nail

3 Home visit Group Skill man session 6 2 2 2 Visited HH

with Health members, power
education HHs &document improved
s

4 Sanitation Group Student, NO. 2 1 1 Collecting

Campaign members, gloves, waste and
HHs match stick, store
storing separately for
material proper
disposal to
Make healthy
community

5 health Group Pen, paper session 2 1 1 Health

education members, education on
HHs ways of
disease
transmission
and
prevention
Strategies to implement activities
Strategy is a systematic or operational method applied to achieve or reach at our objectives. It is
methods or procedure followed during implementation of solution for problem selected for an
intervention. Strategy is a coordinated and comprehensive set of activities aimed at achieving an
objective.

In order to achieve the above mentioned objectives the following strategies were taken.

 Identify households whom we have constructed mini projects/activities by using the data
collected (observation) in the study area and by asking health extension workers to indicate
households that haven’t these sanitation facilities
 Creating awareness in the community together with health extension workers and community
leaders about the purpose of these activities
 Encouraging and motivating health extension worker to initiate community on our program .
 Involving all group member for each and every activity
 Asking health extension workers and community leaders who take responsibility of constructed
models to follow up the well being of the project.
 Initiating and motivating the community to participate in maintenance

Activities implemented
1.Installation of hand washing facility near to latrine

Introduction
Hand washing facility near to latrine is one of the infrastructures of latrine that the user used to
wash their hand after using toilet. It is a container for holding Small amount of water for hand
washing purpose. This container was made from jerican, nail, rope and faucet.

Handwashing is one of the most effective ways to prevent transmission of infectious diseases.
Improving access to handwashing facilities near to latrine will reduce infection and mortality
rates, particularly in maternal and child health .Without handwashing and adherence to good
hygiene practices, the health and socio-economic benefits of improved water supply and
sanitation cannot be fully realized and will impede progress towards many of the SDGs.

We installed handwashing facility near to latrine to overcome communicable diseases in the

way that avoid hand contact with it before and after wash.

It is a container for holding small amount of water for hand washing purpose.
This container was made from Jeri can, nail and rope.

First, we created awareness for the community about handwashing facility and its use.

And we taken nails, jerican and rope from homeowner when the householders were voluntary.

We installed handwashing facility near to latrine to overcome burden of feco-oral diseases in the
way that avoid hand contact with it before and after wash.

Procedure

 First, we created awareness for the community about handwashing facility and its use.
 And we take nails, jerican and rope from homeowner when the householders were
voluntary.
 Then the jerican was drilled using nail three times on it for the purpose of:-
 Tied the jerican with the upright wood on the front.
 Tied the jerican with stake for stamping with leg on the handle of it.
 Allowing for the flow of water on the back.
 Next, the jerican was filled with water and covered with its cap, after that soap was
placed near to it,
 Finally we showed them how it operates
Table 3: plan and achievement of installation of hand washing facility near to latrine

Week Plan Achievement Percentage %

Week 1 5 5 100
Week 2 5 5 100
Week 3 5
Week 4

Stake holders and beneficiaries

Stakeholders
 Kombolcha CBPT – II team-2
 HEW
 Local community
 Beneficiaries
 Households
Figure 1: Installation of hand washing container near to latrine in kebele 02
ketena 02 of kombolcha town, 2022

2 . Construction of Soak pit

A soak pit, also known as a soak away or leach pit is a covered, porous-walled chamber that
allows water to slowly soak into the ground. Pre-settled effluent from a Collection and
Storage/Treatment or (Semi-) Centralized Treatment technology is discharged to the
underground chamber from which it infiltrates into the surrounding soil. As wastewater (grey
water or black water after primary treatment) percolates through the soil from the soak pit, small
particles are filtered out by the soil matrix and organics are digested by microorganisms. Thus,
soak pits are best suited for soil with good absorptive properties; clay, hard packed or rocky soil
is not appropriate.

The soak pit should be between 1.5 and 4 m deep, but as a rule of thumb, never less than 2 m
above the groundwater table. It should be located at a safe distance from a drinking water source
(ideally more than 30 m).

The soak pit should be kept away from high-traffic areas so that the soil above and around it is
not compacted. It can be left empty and lined with a porous material to provide support and
prevent collapse, or left unlined and filled with coarse rocks and gravel. The rocks and gravel
will prevent the walls from collapsing, but will still provide adequate space for the wastewater.
In both cases, a layer of sand and fine gravel should be spread across the bottom to help disperse
the flow. To allow for future access, a removable (preferably concrete) lid should be used to seal
the pit until it needs to be maintained.
All the wastes drained in water ways depends on the winter rains for cleaning.
Although very high wastewater pollution may not be expected in the rural Ethiopia, there are
some household sewage (liquid dung, domestic wastewater, etc.) generated from kitchens,
toilets, barns, and other domestic areas. If household, industrial, or commercial wastes are not
properly disposed, then the disease problems caused by pollution will still remain to be persistent
in the environment. The disease commonly transmitted through water such, as Cholera,
dysentery and typhoid are waste related. If waste was safely deposited, or treated and disposed
most of the water born diseases would have not been a problem.

When we see the kombolcha town kebele 02 dwellers because of lack of awareness and
carelessness they dispose their waste generated in the house on open field this brings problem on
the community. Acute respiratory infection is the first top 10 disease which cause morbidity and
mortality in our catchment area. Poor liquid waste management is one cause for this because it
has bad odor. So we decided to construct soak pit in order to solve this problem as possible.

Justification
A soak pit does not provide adequate treatment for raw wastewater and the pit will quickly clog.
It should be used for discharging pre-settled black water or grey water.
Soak pits are appropriate for rural and peri-urban settlements. They depend on soil with a
sufficient absorptive capacity. They are not appropriate for areas prone to flooding or that have
high groundwater tables.

When we construct the soak pit we have estimate the amount of liquid waste generated from the
HHs. The minimum depth of the soak pits is 1.5 meter. The materials that we have used to
construct soak pit are stone, gravel, sand, screening material. First we marked the ground with
the diameter that depends on soil types and digs the ground up to 1.5 meter then we fill the pit
with large stones at the bottom next to that we add stones that have small size than the large one
after that add gravels then by using the mixture of sand and cement we tied the circumference of
the pit finally we use screening materials to capture the solid waste from entering in to the pit.
Table 4 : plan and achievement of soak pit construction

Week Plan Achievement Percentage %

Week 1 4 4 100%
Week 2 4 4 100%
Week 3 4
Week 4

Advantage
 Can be built and repaired with locally available
materials
 Technique simple to apply for all users
 Small land area required
 Low capital and operating costs

Disadvantage
 Primary treatment is required to prevent clogging
 May negatively affect soil and groundwater properties

Stake holders and beneficiaries

Stakeholders
 Kombolcha CBPT – II team-3
 HEW
 Local community

Beneficiaries
 Households
Figure 2 : soak pit construction in kebele 02 ketena 02 , of kombolcha town,
2022.

Home Visit with Health education

Observation of hygiene and sanitation condition of the home and the compound. Awareness
creation by giving Hygiene sanitation related education repeatedly.us individual Motivating
people to adopt health-promoting behaviors by providing appropriate knowledge and helping to
develop positive attitude.
Helping people to make decisions about their health and acquire the necessary confidence and
skills to put their decisions into practice.
individual Ask any problem they faced regarding health. .

Table 5 : plan and achievement of Home Visit with Health education

Week Plan Achievement Percentage %

Week 1 2 2 100
Week 2 2 2 100
Week 3 2 2 100
Week 4

Sanitation campaign

Introduction
Sanitation refers to the provision of facilities and services for the safe management of solid
wastes that are generated from different areas. Inadequate sanitation is a major cause of
communicable diseases. Sanitation campaign was applied with the cooperation of us and
students to make the school compound free of rubbish and with some householders to create
clean environment by collecting, differentiate waste, and burn the wastes that were disposed by
burning.

In reality sanitation campaign was not a one day activity; it requires continuous performance and
follow- up by responsible body. However for this continuous activity it requires plenty of time
and a lot of resource. Since we have only two weeks for our activity it was not possible for us to
achieve continuous follow up of the activity.

Material used: Glove, Match stick

Our aims in sanitation campaign

 As much as possible to make an environment free of mess waste

 To accelerate sanitation coverage in habitat ,02 kebele , ketena 02 .
 To motivate Community to keep safety of their environment through awareness campaign
and health education.
 To promote hygiene, education and sanitary habits among school students.
 To prevent waste related disease like trachoma, typhoid, cholera and bad odor of the
environment.

Table 5: plan and achievement of sanitation campaign

Week Plan Achievement Percentage %

Week 2 1 1
Week 3 1 1

Stakeholders and beneficiaries

Stakeholders
 HEW
 Community leaders
 Kebele administration
 Kombolcha CBTP team 2
Beneficiaries
 Local community
 [[p

Health education
Health education is a profession of educating people about health.Areas within this profession
encompass environmental health, physical health, social health, emotional health, intellectual
health, and spiritual health, as well as sexual and reproductive health education.

Health education can be defined as the principle by which individuals and groups of people learn
to behave in a manner conducive to the promotion, maintenance, or restoration of health.
However, as there are multiple definitions of health, there are also multiple definitions of health
education. The Joint Committee on Health Education and Promotion Terminology of 2001
defined Health Education as "any combination of planned learning experiences based on sound
theories that provide individuals, groups, and communities the opportunity to acquire
information and the skills needed to make quality health decisions.

The WHO defined Health Education as "comprising of consciously constructed opportunities for
learning involving some form of communication designed to improve health literacy, including
improving knowledge, and developing life skills which are conducive to individual and
community health.

Justification
It is one of the means that helps to people to understand about their own health. Education was
given to the community peoples on the health center about prioritized problem and diseases that
are related to environmental health condition especially regarding to feco-oral diseases we
prepare a figure that shows transmission route, symptoms and prevention method that is easy for
understand rather than oral learning method for peoples.

Within the last week of intervention (in week 8) we are create awareness together with HEW,
environmental health professional and other health center staff workers for peoples about
environmental health determinants like liquid waste, solid waste, housing condition, effect of
open defecation, utilization of latrine and importance of hand washing facility near to latrine.
The main aim of delivered health education by our group is:

 Changing behavior of the community concerning health and health related issue
 Educating participant to practice healthy behavior and to protect their personal hygiene
and environmental sanitation
 Showing and educating them how communicable disease transferred through cross
contamination due to failing of washing hand with soap after latrine use
 Creating awareness for participant about prevention and control mechanism of
communicable disease like scabies, typhoid, cholera, trachoma and etc.
 How could it be possible to use the constructed facility in a proper manner.

Table 6: plan and achievement of health education

Week Plan Achievement Percentage %

Week 2 1
Week 3 1

Stakeholder participations

 Health center staff workers

 Team member
 HEW
Beneficiaries

 Community

 Strength During Solution Implementation

We have a great motivation to give solution for prioritized problem and to be part of the group
that solves major community health problem. We know that the community of kelem meda
kebele was hurt by war so we were psychologically ready to solace the community and to view
any insult from the positively . since our group contain an individuals or health extention worker
who have the experience of working with the community for long time , most of our ideas and
interventional activity was easly accepted by the community exept some householders.
Additionally we built an appreciated team spirit for the achievement of our plan with a
minimum requirement of time, resource and man power. The other strength of our group member
were accepting the idea of each other and giving the chance for the community to raise and solve
their problem in cooperation of us.

 Project Sustainability
For the sustainability of our project we largely focus on changing the behaviour or giving health
education for the community with regard to the appropriate use of installed facility, to practice
the right operational way of those facility and health and health related issue. Since we were try
to implement the correct solution of the community health problem and most of the
householders were believe that it was possible to overcome their problem with those solution, we
belive that the the project was sustainable and hope to look projeects sustainability during
evaluation and monitoring phase of CBTP 3.