A Review of the Community Health Club Literature Describing Water, Sanitation, and Hygiene Outcomes.

The Community Health Club (CHC) model is a community-based health promotion program that utilizes water, sanitation, and hygiene (WASH) education as the first stage of a longitudinal development process. Although the CHC model has been implemented in fourteen countries over 20 years, this is the first review of the literature describing the model's outcomes and impact. We conducted a review of the literature that provided quantitative or qualitative evidence of CHC interventions focused on WASH in low- and middle-income countries. We identified 25 articles that met our inclusion criteria. We found six major outcomes: WASH behaviors and knowledge, social capital, collective action, health, and cost or cost-effectiveness. The most consistent evidence was associated with WASH behaviors and knowledge, with significant effects on defecation practices, hand washing behaviors, and WASH knowledge. We also found qualitative evidence of impact on social capital and collective action. CHCs catalyze favorable changes in WASH behaviors and knowledge, yielding outcomes commensurate with other WASH promotion strategies. This review provides insights into the model's theory of change, helping identify areas for further investigation. The CHC model's holistic focus and emphasis on individual and collective change offer promising potential to address multiple health and development determinants.