Use of group maturity index to measure growth, performance, and sustainability of community health clubs in urban water, sanitation and hygiene (WASH) program in Zimbabwe

Zimbabwe experienced an unprecedented cholera outbreak in 2008 and 2009. Reduced access to water, sanitation and hygiene, delayed community health education, and limited knowledge on cholera prevention were the major risk factors of this outbreak which were addressed by urban WASH interventions. Health and hygiene promotion through community health clubs (CHCs) is a cost-effective strategy to reduce the risk of cholera. In 2013, UNICEF Zimbabwe launched the Small Towns WASH Program (STWP) and used the CHC approach for hygiene promotion. To monitor the growth, performance, and sustainability of CHCs, STWP employed the Group Maturity Index, which measures the status of CHCs in five domains: objectives, governance, resources, group systems, and impacts. This study described the maturity status of CHCs as measured by GMI as a new monitoring tool and assessed if CHCs’ performances in GMI's output domains are associated with the impact domain. The results suggested that over 75% of CHCs had reached the managed stage or the mature stage by 2018. Three of the GMI's output domains were independently associated with the overall impact domain after controlling for potential confounders. CHCs and club members may experience overall positive impacts by developing their governance, resource, and group system domains.