Public Health Mission
To empower rural communities to prevent common illnesses through in-home infrastructure development, community leader training, and health education.
In rural Ghanaian, Honduran, Nicaraguan, and Panamanian communities where Public Health Brigades currently operates, there exist common diseases greatly affecting the health of community members which can be alleviated by simply improving home infrastructure and personal hygiene education. Public Health Brigades strives to combat these easily preventable diseases through low cost sustainable infrastructure projects utilizing materials that can be sourced locally and designs that can be taught to empowered local community experts.
Years of Medical Brigade patient records, illustrated the most common diseases on a community level to be high levels of chronic respiratory disease, skin fungal infections, parasites and diarrhea tracked back to a poor in-home infrastructure. The Public Health projects in each country represent the best solutions to these challenging conditions in the home. Along with poor conditions in the home, there also exists an underdeveloped concept of preventative health on a community-wide scale. These observations inspired the creation of the Public Health program, as many of these medical problems could be diminished or prevented through a combination of education within the community and infrastructure improvements within each home.
The Public Health program in Ghana, Honduras, Nicaragua, and Panama each implement a combination of the following projects: clean-burning stoves, cement floors, showers, water storage, and latrines. Public Health team members work with community leaders to prepare communities for projects, inventory materials, and hire local experts. Once the community has been prepared, foreign student volunteers and professionals work alongside community members to construct each public health project during Public Health Brigades.
In addition to the infrastructure projects, Public Health Brigades also works with communities to provide health education to school-age children and adults in the community. The Public Health team collaborates with school teachers and other key community members to develop a curriculum that will directly address the communities’ needs, while volunteers prepare lessons for the children during each brigade.
Before public health projects are implemented in Ghana, Honduras, Nicaragua, or Panama, the Public Health Brigades staff meets with communities to establish project parameters, goals, and funding in order to ensure the future sustainability of projects. Buy-in from selected community partners is crucial as they must commit to work for and maintain the projects in each home.
Throughout the project, student volunteers are also involved in the process of community organizing. This includes, but is not limited to: meeting with community leaders and members of the Basic Sanitation Committee; visiting families and visibly measuring impact of the projects; and taking part in community activities such as the education day in the primary school that can build a relationship between the communities and Public Health Brigades.
In Ghana, prior to committing to a community Public Health notifies the district Environmental Health office to gain assistance from one of their facilitators with a Community Led Total Sanitation (CLTS) triggering. A CLTS triggering focuses on igniting a change in sanitation behavior by helping the community to analyze their own sanitation situation towards stopping poor health practices, specifically open defecation. This triggering is instrumental in determining how committed a community is to creating a clean and healthy environment for everyone. Because the full commitment of the community is necessary for the success of the program, Public Health looks at closer at the attitudes and behaviors within the community by working with community leaders to set up an additional triggering at a later date. Upon a successful triggering, Public Health works with the chief of the community, the nearest school, and local opinion leaders to notify the community of the partnership to assist with sanitation solutions. The strong relationship with the district office ensures continued follow up long after Global Brigades exits the community to monitor their consensus to remain open defecation free by conducting unannounced follow up visits and working with community leadership and the Basic Sanitation Committee. Public Health is also working with the Water team to establish a Basic Sanitation Committee that would ensure the continued education and empowerment of natural leaders in the community.
In Honduras, Public Health Brigades works specifically with four entities to carryout in-home infrastructure projects, improving health and hygiene community wide. Collaboration includes all other Global Brigades program teams, local community members, the local government, and student volunteers. Before formally entering into a community, the Public Health program approaches the local government to notify them of the work that the Public Health program does and also work out ways that the government can aid in the projects. Local authorities typically provide assistance by supplying transportation of materials and providing the sand used for the projects. Through this collaboration, costs of the projects are reduced and the Public Health program fosters a positive relationship with the government. To ensure long-term sustainability and maintenance, the Public Health program team trains and empowers local community leaders in the formation of the Committee of Basic Sanitation (Comite de Saneamiento Basico).
In Nicaragua, communities are selected based on the infrastructural needs determined by our talented in-country team as well as local authorities´ technical assistance. A “Global Brigades Committee” is formed, comprised of talented young adults who manage materials as well as the accounting books for families paying their percentage of the projects. Throughout the duration of the Public Health team´s presence in that community, the GB committee acts as the organizing entity, mobilizing teams of individuals to distribute materials and form task teams. The public health team hopes to mobilize already existing health workers or brigadistas to act as a committee for continuing education in the topics of sanitation and preventative health in the near future.
In Ghana, Honduras, Nicaragua, and Panama, different types of public health infrastructure projects are implemented in order to meet the needs of communities. Below is information regarding which projects are implemented in each country and a detailed description of what each project entails.
In Ghana, volunteers work with communities at both school and household levels to construct Kumasi Ventilated Improved Pit (KVIP) latrines. The KVIP latrine design originates from Ghana, specifically from Kumasi, the capital city of the Ashanti region. The latrine is designed to provide users with a healthier environment by featuring a concrete pit to collect waste and an attached ventilation pipe to reduce odors and eliminate flies. This latrine provides a solution to a community committed to ending open defecation.
In Honduras, volunteers work with communities to construct two crucial infrastructure projects, eco-stoves and latrines, meant to improve the health of the home and surrounding environment. These projects target the largest international threats to human health: acute diarrhea and respiratory diseases.
In Nicaragua, student volunteers and professionals work alongside community members to build sanitary units consisting of a latrine, a shower and a washboard (small pila), eco-ovens and concrete floors. To date, 2 pre-fabricated, low-cost homes have been constructed for families in desperate need of improved living conditions.
Presently, 7-10 million people in Latin America are infected with Chagas disease. This potentially fatal disease is spread by insects that borrow into the ground and bite people while they are sitting or sleeping on mud floors. Children are specifically prone to contracting this disease, as they learn to crawl and walk on the dirt floors, increasing the incidences of parasitic infection, diarrheal disease, and respiratory illness. The concrete floors that Public Health Brigades constructs prevents these insects from borrowing into the floor, thus preventing much of the spread of Chagas disease. Dirt floors are also breeding grounds for fungus and bacteria that can easily infect the people in contact with them. The concrete floors provide a more sanitary living environment for families, who are able to easily sweep and mop this new, impeccable surface
Many families currently cook over open flames in poorly ventilated rooms, which lead to the inhalation of smoke, eye irritation, and other health problems. The majority of rural families use wood-burning stoves (without chimneys) for all their daily cooking. First, the eco-stove design includes a chimney, which filters smoke and other pollutants outside the home and significantly reduces pulmonary illness. Additionally, these stoves reduce the daily wood used, from 30 pieces of wood to eight. This dramatically reduces the time and workload of wood-gathering, and also decreases the community's environmental impact.
The lack of proper sanitary facilities in many rural homes causes the spread of infectious disease and parasites through contamination of water sources. Diarrheal disease, in particular which is often spread through poor sanitary conditions, kills 4.5 million children each year throughout the world. A latrine with an underground septic tank provides the family with a hygienic way to dispose of human waste.
After a community has a working water system with treated water, the next step is storing that water in a sanitary container for constant access. The pila, a partially-covered water storage unit, reduces the time spent bringing water from the local source and ensures that families have the ability to practice good personal hygiene and sanitation, such as washing their dishes, hands, clothes, and bathing children. Additionally, proper water storage prevents a breeding ground of mosquitos, the source of malaria and dengue fever.
One of the main tenets of personal hygiene is to bathe daily, yet most rural homes do not have a private, sanitary place to do this. Without a shower or a pila, people are forced to use the river or other unclean sources of water to bathe themselves - sometimes in full view of the community. The shower structure provides a clean, private space for daily bathing.
Public Health projects are worked on with community members and families through the utilization of student volunteers participating in 7-10 day programs called "Public Health Brigades"
Public Health Brigades are typically made up of about 15 or more university student volunteers and other members of the Global Brigades team. Depending on the duration and country, each volunteer fundraises between $1,400-$2,200 which covers a portion of the construction supplies, airfare for the participants, and the follow-up. Some of the specific costs are: supplies, travel insurance, meals, lodging, interpreters, coordinators, ground transportation, and program staff salaries to make evaluation and improve sustainability.
In Ghana, the average family and school pays 23% and 20% of the total latrine project cost respectively. Implementation of a household latrine is $450 and a 4 stall school latrine is $1370. The amount a family contributes is standardized at $105. The amount a school contributes is based on the number of students in attendance. The standardizing of family contributions is owed to the presence of Microfinance in the community. Interested families, regardless of their income, are encouraged to start a savings account at their local Community Development Fund (CDF) to develop healthy financial practices that contribute to the overall wellbeing of the household. The family contributions are currently reinvested into the Public Health program to assist with the development of the program and future projects in the same community.
In Honduras and Nicaragua, families pay 10-20% of the total project costs depending on their yearly income. Implementation of the projects for each home costs between $800 and $1000 in total depending on the number of floors and floor size in each home. The amount a family pays averages out around $150. Considering that the income of any one family may only be around $1000 a year, and that this income is extremely dependent on different agricultural harvesting seasons, $150 can be a lot for families to pay at once. Therefore, each family has a contract with the ‘caja rural’, or rural bank, to pay for their projects over a period typically lasting around 10 months to one year. The interest rates are kept very low – around 3% in most communities. Public Health works with the Microfinance team to either establish or train existing cajas to give out these micro loans and work with the families on individual repayment plans. Each family can create a unique plan – paying all at once, every three months, every month, etc.
Although the money that these families contribute is based on the cost of their project, the funds are not used to purchase supplies for the projects. Through the program contributions raised by volunteers, enough funds are raised to pay for the material and labor costs for the projects. Instead, the money contributed by families goes to the community bank and is ultimately used on wider community projects that the community members decide on as a whole.
In Ghana, Public Health relies on a list of interested families and prioritizes which families to work based on need. All interested households are surveyed (household baseline survey) and a priority scale is used to consider factors such as family size, family demographics, income, and reported cases of diarrhea. Surveys allow the team to collect information on physical details of the houses that will be considered during planning and construction as well as general qualitative information about a family and individuals within the family. Using this information, family profiles are created to give chapters information about the families they may be working with before they arrive in Ghana, increasing the volunteer to family personal connection during the actual brigade. As brigade dates draw near, the program technicians and coordinators work together to prepare each family or school by selecting their dates, drawing up their contracts to contribute to the projects, and delivering materials to the construction sites. Upon their arrival, volunteers work with local masons and community members to construct KVIP latrines. Post brigade follow-up involves an interview that focuses on: use, maintenance, appearance, family perception and community perception. These areas help to ensure that the project is being used and cared for properly and consistently, that the family is satisfied with different components of the latrine, and that the team is aware of perceptions of the project within the household and the community at large. All these aspects ensure that the project actively considers the needs and priorities of the community when moving forward.
In Honduras and Nicaragua, project implementation begins long before students land in-country. When entering a community, each home is first surveyed to understand the living situation of each community member. Although the Public Health team selects communities based on a general need for all projects, there are almost always a few families in every community that already have a latrine, or one out of three homes may have concrete floors, etc. Thus, the Public Health team surveys each house to determine the needs of each family, including how many floors and size of homes. This process assists the team in choosing the right sized student groups for each home. As student volunteer arrival nears, the program technicians prepare each family by selecting their dates, drawing up their contracts to contribute to the projects, and delivering materials to the homes. Once students arrive in Honduras and Nicaragua respectively, volunteers, local masons, and family members work side-by-side in a number of construction activities: mixing cement, laying concrete blocks and bricks, pouring concrete floors, digging trenches, spackling, assembling wood frames, creating rebar reinforcements, and making cement finish. Post brigade, the program team monitors the projects to make sure that they were implemented correctly and are being cared for and used properly.
In order to successfully implement the use of the public health projects and to ensure that the projects are maintained, education and training are vital.
In Ghana, education stands at the forefront of ensuring that behaviors and attitudes around projects are sustained and that the community as a whole is ultimately committed in those efforts. Volunteers educate at the local school and within households. The headmaster and teachers are interviewed to compile the school demographics, local teaching approaches, and the current sanitation situation the youth encounter at school. By working closely with the school, education topics are developed to reinforce health lessons taught in the classroom and build upon previous brigades to prevent redundancy. The school profile along with an education manual is made available to volunteers to help them better plan their education component. Teachers are active participants by approving lesson plans designed by volunteers and assisting volunteers when they are in-country with classroom control and feedback. Household education provides an intimate platform for families and volunteers to engage in an exchange of positive health practices. This exchange of ideas and suggestions provide Public Health the proper forum to address other health related issues within the household by identifying future projects through direct feedback from community members. Public Health is working with Water to develop a Basic Sanitation Committee that provides community members with solid support and works alongside the Community Health Committee (CHC) and Community Health Workers (CHW) initiatives being developed by the Medical program.
Currently, Water and Public Health share an experienced foreman who oversees the training of masons, some of who live in the same community, and the construction process of all projects. By training community members, Public Health can rely on these individuals for future project repairs and maintenance. These local masons can partner with the BSC to assist with a successful exit.
In Honduras, education sessions for school children and community leaders are provided to empower them with the knowledge to take action and make positive behavioral changes. The Public Health community technicians provide training to the Basic Sanitation Committee on health and hygiene practices, as well as project maintenance, so that they can monitor community practices and maintenance even after the Public Health program officially exits a community. Additionally, volunteers teach health-related topics to the schoolchildren as well as the CSB members to further their health education.
Employing the experience of local individuals the Public Health program hires masons, often from the same communities, to assist in projects and receive mason training while the program is actively working in the community. The community technicians will place experienced masons together in a house with new masons and monitor their progress and training throughout the construction process. In this way, the Public Health team can exit knowing that there are community members who can help with project reparation and maintenance throughout the years.
In Nicaragua, children and adults alike are educated on topics pertinent to personal hygiene and prevention of diseases. With each brigade season, trained educators alongside student volunteers go from home to home to impart a set of topics previously chosen by the program technicians. These topics are determined based on the health trends in the country at the time of the brigade season, including changes of weather and outbreaks that may be priority to the Ministry of Health.
Interested community members as well as already trained masons are involved in the construction process of the first projects in order to amplify their knowledge, and during brigades are hired as “project managers” at each building site. These individuals upon the exit of the public health team will be responsible for maintenance and follow-up of projects.
To enhance the sustainability of community work, the basic sanitation health committee is responsible for carrying out in-home assessments and monitoring the status of the projects. As a program, Public Health carries out periodical visits to monitor the status of the projects and the CSB’s work. Once all projects are implemented, the community is educated and leaders are empowered, the Public Health program gradually decrease our presence, leaving the community equipped with the necessary materials and resources to prevent common illnesses and lead overall healthier lives.
An improved quality of home public health infrastructure is essential to progressing a community’s goals of sustainability in health and economic development, ultimately leading to the exit of Global Brigades programs from a community.
Public Health program staff collaborates closely with Medical, Water and Microfinance program staff throughout project implementation. The Medical program sets the foundation to work in communities by establishing the relationships with community leaders. Water brigades follows by setting up the basic sanitation health committee and Water Council in each community, while ensuring that the necessary systems are constructed and functioning well. Public Health continues those relationships by training committee members in health and hygiene practices. Lastly, the Microfinance brigades help families and community members take out loans to pay for our projects and help them understand how to use their finances to invest in their family and their families’ health for the future. This sequence of programs ensures that the holistic model is implemented and that Global Brigades has long lasting, trusting relationships with each community.
Public Health Projects for Communities without Public Health Brigades
The Public Health program operates on a funding model that has each student directly funding the projects for the houses that they work in. Unfortunately, there are some communities that the Public Health program would like to assist, but that do not fit the traditional model of operation. For example, in the Honduran community of La Concepcion, most houses only need 1 or 2 of the projects. Students cannot have a complete experience by working in this community, so the Public Health program has to work primarily with masons. Therefore, the normal funding that would come from students working in each house must come from elsewhere. One of the largest funding needs is funding for communities where students are not able to work and fund.
Materials and Masons
By the same token, there are houses in almost every community visited that only need a couple of projects. Typically Public Health works in these houses when finishing up a community. Again, since Public Health cannot work in these houses with students, extra funding is needed to purchase materials and to pay masons to work in these houses. This is also an important funding need in order for Public Health to be able to provide needed projects to every community member.