Water, Sanitation and Hygiene in Sub-Saharan Africa
Z
u-Noogo Noba was born during a spectacular thunderstorm in the early hours of 22 June, 2010. There were few medical supplies and not so much as a lightbulb in the rural dispensary in Burkina Faso where he was delivered. Yet Zu-Noogo’s name means ”good things” and he bears it well. Because he was born in Rapadama where clean water and sanitation are now commonplace, his chances of survival are far greater than they would have been 10 years ago when the world adopted the Millennium Declaration. It is not so for others of West Africa’s bairns, one in six of whom still die before the age of five (169 deaths per 1,000 births). Under-five mortality has dropped in every region of the world since 2000, except sub-Saharan Africa where it hasn’t shifted by a single percentage point. The slow progress is due to high levels of fertility but also to diarrhoea, cholera, typhoid fever, malaria and other diseases linked to poor sanitation and lack of clean water. In sub-Saharan African countries that are battling for cleaner lives for their poorest citizens, 80 per cent of afflictions killing children are linked, not to lacking medication or vaccinations, but directly to deficiencies in sanitation and water. With 47.6 million euros from the European Union (EU), the United Nations Children’s Fund (UNICEF) has in the past three years executed a successful programme of water, sanitation and hygiene initiatives (known as WASH) in needy regions of 16 sub-Saharan countries. They aim to achieve progress towards two key objectives: •• Ending the most dangerous practice for human health, open defecation, which in 2008 was still practised by 34 per cent of Africans (44 per cent urban and 24 per cent rural); •• Moving towards the 85 per cent Millennium Development Goal (MDG) target for access to drinking water, which stood at 65 per cent in 2008 (47 per cent rural and 83 per cent urban), having risen from a 1990 total in sub-Saharan Africa of 49 per cent. The EU-funded initiatives have, in keeping with UNICEF policy, targetted the poorest of the rural poor, partly by using schools as key platforms for disseminating messages about, for example, the virtues of handwashing. The WASH initiatives also incorporate key EU objectives such as strengthening governance and empowering communities. Professionals in the sector are impressed by the can-do spirit they have encountered. ”In the past, agencies would go into an area, build latrines and leave,”
said Guibril Kamssoko, a UNICEF WASH officer in Côte d’Ivoire. ”If you go back to those communities you find people still defecating in the open and using the latrines as nice storage spaces. These days, the villagers build the latrines themselves. These become a matter of pride among neighbours.“ Another UNICEF WASH officer, Kinfe Zeru in Ethiopia, remarked that as part of moves to encourage the use of local materials, communities in Tigray had devised a latrine vent made from a hollowed-out stem of sisal. ”UNICEF is not simply turning up and building shallow wells or latrines. When drilling machinery needs to get through, the community builds the access road,” he said. To the EU’s chargé d’affaires in Nigeria, Pierre Philippe, the WASH initiative – which targets 1,000 communities in six of the country’s 36 states – has been a valuable testing ground for what he sees as a trend to move away from standalone projects towards a sectoral approach. ”Before we finance work such as drilling boreholes, we have to make sure the regulatory environment is right, that necessary sector reforms have been carried out and that there is political commitment to make changes which will have a lasting impact on the population,” he said. Beyond borehole-drilling, the WASH initiative in Kenya is intended to assist a remote and historically-disadvantaged region in implementing decentralization policies that pass responsibility for water – including the upkeep of pumps – to communities. In Kenya, as in other countries, UNICEF partners work with communities, informing them of their rights and helping them to establish water committees. These create a fee structure for the borehole water and use the money to buy fuel for their generator – if they have one – and keep a fund for pump repairs. Contractors can be hired on maintenance contracts. UNICEF WASH official Ally Tifow said the system presented problems. ”Low levels of literacy, high levels of poverty and the population movements of pastoralists are the issues we are dealing with in Samburu district.“ But he said local solutions could often be found. ”Working through partners who know the community, we are able to achieve a great deal. For example, in one area, elders have undertaken to protect their water catchment area, a forest, by invoking a traditional system whereby defaulters are fined for breaching social contracts. Consequently, the forest has become a no-go area for people and livestock.” WASH in Tigray, a drought-prone region of Ethiopia, is intrinsically tied to the devastating impact of climate change and deforestation. Epidemiologist Aynalem Assefo said the link between health and climate became evident to him
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Water, Sanitation and Hygiene in Sub-Saharan Africa
last year. ”Much more of our water is unsafe than it used to be because the rain is lacking,” he said. ”We had a typhoid outbreak in three sub-districts of Edgasehelus, with 161 cases and one death. Those who fell ill lived in three villages where people use unsafe water because the river is much closer to their homes than the closest pump. Areas where water schemes have been deve-loped and sanitation has been improved had no cases of typhoid. In fact, they are healthier in almost all respects. “When you talk to people about water and sanitation, there is a broader beneficial effect. Mothers complete their babies’ vaccinations and become curious about nutrition,” said Assefo who, as a local government employee, is a key player in a process that aims to devolve the responsibility for WASH implementation from UNICEF to national and local government as soon as practicable. Stultified by eight years of political uncertainty, Côte d’Ivoire is finding that WASH initiatives in the north of the country play a role in reviving community cohesiveness. In Assafou, near Bouaké, 56-year-old retired civil servant Dominique Krakoffi emerged as a ”natural leader” when he and the other 300 villagers were introduced to community-led total sanitation (CLTS) through the highly-theatrical ”triggering” process that was pioneered in Bangladesh in 2000. Krakoffi urged fellow villagers to dig pits for latrines and within a month of Assafou undergoing ”triggering”, 23 latrines were in the process of being built. But introducing latrines can be complex in West Africa where some communities believe it is bad luck for women’s excrement to come into contact with men’s. That rule does not apply in Assafou but Krakoffi said some villagers were resistant to giving up open-air defecation. ”Nature provides,” he said. ”In our forests, we have leaves for tea when you have diarrhoea. We also have leaves that are softer than toilet paper, and twigs that serve as toothpicks and even toothbrushes. “People have for generations snuck off into the bush to do their business, braving spirits, snakes and scorpions. Visitors know the code. They say: ‘When you have killed the chicken, where do you go to pluck it?’ and everyone understands that they wish to relieve themselves. For us, culturally, it is a big step to start talking openly about such things as defecation. It is embarrassing,” said Krakoffi who is now a firm believer in CLTS. Even though the EU-funded UNICEF WASH initiatives have changed hundreds of thousands of lives in sub-Saharan Africa, they have not provided an MDG magic bullet for the countries concerned. The reason is that, in keeping
with UNICEF policy, the initiatives have targetted the hardest-to-reach populations – the poorest of the rural poor. In Burkina Faso, UNICEF WASH specialist Jean-Paul Ouédraogo explained; ”The job is huge. We have a good chance of reaching our water MDG as we have already achieved 76 per cent provision. But on sanitation, we started at a much lower point; the MDG is 54 per cent, and we are way off. The EU-UNICEF project is aimed at 75,000 people in three years. That is a good score but it is a drop in the ocean. The rural sanitation rate is currently about 10 per cent and, given the huge number of people that still needs to be reached, we will be lucky to reach 12 per cent by 2015.” Yet reminders are constant of how urgent the need is for clean water and sanitation. In August, both Cameroon and Nigeria were dealing with their worst cholera outbreaks for several years. But there are also moments of triumph that buoy campaigners for water and sanitation. Separate from WASH, a 20 million euro EU-UNICEF initiative in Ghana is close to declaring guinea worm eradicated, only four years after the country was listed as having the second-highest number of cases of the parasite in the world. Chris Cormency, UNICEF’s regional adviser for WASH in Western and Central Africa, said more than 1,000 villages in the region had been declared ”opendefecation free” since the launch in late 2008. But he added that several issues still need to be addressed for water and sanitation efforts to move forward faster and more cohesively. ”Governments need to better coordinate and prioritize both water and sanitation in their national strategies. This has happened in Mali where the government now has viable plans that are interesting other donors to support and press on with WASH programmes. “We also need to support governments to settle on one or two makes of pumps to allow easier spare part managment. More needs to be done to tackle the cost of drilling, in partnership with government and the private sector. In Chad, for example, UNICEF has helped train groups of manual drillers, including some demobilised child soldiers. They have now independently won contracts to drill for the EU,” said Cormency. In Eastern and Southern Africa, the WASH partnership between UNICEF and the EU began in Zambia in 2007. As a result, that country can now boast entire districts that have been declared ”open defecation free”. But WASH regional adviser David Delienne said approaches for ensuring reliable water provision and effective sanitation still need perfecting. ”We know that schools are a very good
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Water, Sanitation and Hygiene in Sub-Saharan Africa
platforms for introducing handwashing but we still need to do more to ensure that we achieve true behaviour change. One idea could be to design latrines that include a handwashing area. “While we have had great success in Zambia, neighbouring Zimbabwe has so many internally displaced people that it remains difficult to work there. In South Africa, four million people are practising open defecation and we believe the government should take on this problem. One of the advantages UNICEF has is that we can talk directly to government.” Delienne also called for more ”reflection” over rural drinking-water provision. ”In countries where we see 30 per cent of pumps out of order, that is actually not good enough. We have gone from systems where governments were responsible for repairing pumps, to the privatization of pump maintenance. Recent experience suggests the pendulum has to swing back somewhat, so that governments have at least a supervisory role.” An open and frank debate is under way among WASH specialists to improve a system that is already hailed as the best yet among efforts to secure reliable sanitation and clean water – thus improved health – for the poorest people in Africa. It is three months since the heavens opened over Rapadama in rural Burkina Faso, and Zu-Noogo Noba came into the world. His mother, Catherine, gave birth at the dispensary, rather than at home, because UNICEF’s WASH partner had explained the advantages of an attended birth. Catherine was then encouraged to defy tradition and give Zu-Noogo her first milk – the immune-building colostrum. Clean hands and water, and washed greens, should become a routine in his life. On condition that a few more good things come to him, he will be five years old in 2015. He will then have vanquished that awful statistic, called ”under-five mortality”, that means Burkina Faso Sudan Somalia the first years of an African life still Nigeria Ethiopia remain the hardest. CAR Uganda
Guinea Conakry Kenya
Côte d’Ivoire
Sub-Saharan Africa Population, 2008
821,6
million
Under 5 mortality rate, 2008
144
per thousand
MDG target
31 per thousand % of population using improved drinking-water sources, 2008
60 % of population using improved sanitation facilities, 2008
31 % of population practising open defecation, 2008
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Benin Ghana Angola EU-UNICEF partnership countries Sub-Saharan countries not part of the programme Non-sub-Saharan countries
Comoros Zimbabwe Mozambique
Sources: http://www.unicef.org/infobycountry/html http://www.wssinfo.org http://www.afro.who.int/en/countries.html http://www.unicef.org/mdg/mortalitymultimedia/ index.html
Scope of the EU-UNICEF WASH partnership
1