THE HEALTH CONSEQUENCES OF WATER AND SANITATION PROVISION IN RURAL AREAS

1. THE HEALTH CONSEQUENCES OF WATER AND SANITATION PROVISION IN RURAL AREAS BY ROWAN DUVEL

2. OBJECTIVES • Water supply in South Africa and it’s role in preventing disease • Sanitation problems in Africa and its influence in disease management • Highlighting the differences in water and sanitation between urban, rural and peri-urban areas • Cholera control and prevention • Literature linking water and sanitation to disease

3. Water Sources • Surface water, rivers and dams • Underground water, boreholes and wells • Rain water, seldom used in a dry country

4. Why pay for water? • Cleaning and delivering it to you • Infrastructure costs eg. Lesotho Highlands Inter-basin transfer • Operating costs

5. Water Supply to Households Communal Stand Taps Streams and Rivers Water Networks

6. Water • National policy on 6000 litres free water to each family per month • Water Quality • About 40 different factors are measured to determine whether water is fit for human consumption – SANS 0241 • The most significant are the micro-organisms such as Ecoli and plate counts

7. Fetching Water: Urban

8. Fetching Water: Rural

9. Water Service Providers • In the absence of any subsidies the water service providers need to: • Get people to pay for the water consumed over the 6000 litres per month, or • Restrict families to using only 6000 litres per month

10. Water Restriction Devices Restrictor Communal Standpipe TSHIAME – “tank system” with restricted flow has used an average of < 6kl per month

11. Sanitation • Types of sanitation, VIP’s, septic tanks, conservancy tanks, bucket system, water borne sanitation • Key parameters, COD, suspended solids and nitrates

12. BUCKET SYSTEMS AND SEPTIC TANKS septic tanks and VIP’s in Intabazwe that require weekly emptying

13. Manual Disposal of Excreta • collection of buckets and loading onto trailer

14. Cleaning of the buckets

15. “Home-made” Latrines

16. Ventilated Improved Pit Latrines (VIP)

17. Chemical Toilets

18. Rural: Good Sanitation Practice

19. URBAN SEWERAGE TREATMENT PLANT

20. Community Involvement • Emptying a “urine diversion” VIP in Kwazulu-Natal VIP PSC in Winterveldt VIP PSC in Wheelers Farm

21. Rural vs peri-urban • Spread out • Difficult to service – give water • VIP’s only sanitation answer • Problem is poor sanitation - pollutes the water sources, river and ground water

22. Rural vs peri-urban • Densely populated • Difficult to service – give water, can’t get in-show Winterveldt slides • Proper VIP’s or water borne -only sanitation answer • Problem is poor sanitation – much greater impact • People can’t pay for services

23. LINKAGES TO HEALTH

24. Water supply, sanitation & hygiene development • 2.4b people do not have access to sanitation facilities • 1.1b do not have access to water supply sources • 2m die every year due to diarrhoeal disease, eg,U5IMR • HDI (human development index) uses the U5IMR as an indicator for the overall social, economic & developmental level of a country • Annual UNO indicator

25. Water supply, sanitation & hygiene development (cont) • People mainly affected: poverty stricken • Main reasons: lack of priority, financial resources, sustainability of water supply & sanitation services, poor hygiene, inadequate sanitation in public places

26. Water-related Disease • Water-related diseases include those due to micro-organisms & chemicals in water: • Anaemia, Arsenicosis eg, Arsenic in drinking-water, Ascariasis, Campylobacteriosis, Cholera, Cyanobacterial Toxins, Dengue and Dengue Haemorrhagic Fever, Diarrhoea, Drowning, Fluorosis, Guinea-Worm Disease (Dracunculiasis), Hepatitis, Japanese Encephalitis, Lead Poisoning eg, lead in drinking-water, legionellosis (carried by aerosols), Leptospirosis, Malaria(water-related vectors), Malnutrition, Methaemoglobinemia, Onchocerciasis (River Blindness), Ringworm (Tinea), Scabies, Schistosomiasis(part of life-cycle in water), Spinal Injury, Trachoma, Typhoid and Paratyphoid Enteric Fevers

27. Cholera in Africa • Cholera, together with Malaria, is the most widely known endemic disease of Africa. • Transmitted by ingestion of the Vibrio cholera bacteria from the excreta of an infected person, eg inadequate excreta disposal and sanitation, contamination of water sources, poor personal hygiene, the contamination of foodstuffs, and flies. • NOTE: VACCINATION AND QUARANTINE ARE NOT EFFECTIVE WAYS OF CONTROLLING OR PREVENTING OUTBREAKS OF CHOLERA.

28. Cholera in Africa cont’d • 1997, a total of 118,349 cholera cases and 5,853 deaths were reported in Africa. • Most outbreaks followed heavy rainfalls and flooding. • 27 Countries reported cholera in 1997: Benin, Burundi, Cameroon, CAR, Chad, Congo, DR Congo, Djibouti, Ghana, Guinea-Bissau, Kenya, Liberia, Malawi, Mali, Mauritania, Mozambique, Niger, Nigeria, Rwanda, Senegal, Somalia, Togo, Uganda, Tanzania, Zambia • The countries with the highest number of cases in 1997* • Tanzania (40,249) • Guinea Bissau (20,555) • Kenya (17,200) • Chad (8,801) • Mozambique (8,739)

29. Cholera in South Africa • August 2000, was the most recent outbreak of Cholera in KZN • By April 2001, national reported statistics were 117 147 reported cases with 265 deaths • The epidemic was the largest since the early 1980s when more than 105,400 people were infected and over 340 died in four consecutive outbreaks.

30. Red Cross/ Red Crescent “Cholera remains a global threat and one of the key indicators of social development.  While the disease no longer poses a threat to countries with a minimum standard of healthy living conditions, it remains a challenge to countries where access to safe drinking-water and adequate sanitation cannot be assured.  Almost every developing country is now facing either a cholera outbreak or the threat of an epidemic”.

31. Diarrhoea in South Africa • "People don't realise how dangerous dirty water is," says David Linely, national coordinator of the Mondi Wetlands Project. "For example, Environmentek's Cape Water Programme involved 12 rural communities in the Western Cape and found that 33% of people did not disinfect their drinking water, even though almost two thirds of samples failed the SABS Drinking Water Maximum Allowable Limits." • At least 650 South Africans die of diarrhoea every day. • The Water Research Commission says that short term direct costs, such as hospitalisation and treatment of diarrhoea patients are around R5 billion a year. Total annual costs are estimated at R15 billion.

32. Rands and Sense • Patient day equivalents in NW Province in 2000 • District hospitals: R300 to 400 • Provincial hospitals: R700 • Cost to provide clean water to a family of 6 people • R30 for 6000 litres pm • i.e. It costs only R1.00 per day for clean water for the whole family • Makes you think doesn’t it??

33. Literature • World Health Organisation • www.who.int • Science in Africa Magazine • www.scienceinafrica.co.za • Consumers International • www.consumersinternational.org • Environmental Protection Agency (USA) • www.epa.gov

34. QUESTIONS ??