THE HEALTH CONSEQUENCES OF WATER AND SANITATION PROVISION IN RURAL AREAS

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THE HEALTH CONSEQUENCES OF WATER AND SANITATION
PROVISION IN RURAL AREAS

• BY
• ROWAN DUVEL

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OBJECTIVES

• Water supply in South Africa and its 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

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Water Sources

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

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Why pay for water?

• Cleaning and delivering it to you
• Infrastructure costs eg. Lesotho Highlands
  Inter-basin transfer
• Operating costs

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

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Fetching Water Urban
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Fetching Water Rural
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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

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Water Restriction Devices
Restrictor
Communal Standpipe
TSHIAME tank system with restricted flow has
used an average of lt 6kl per month
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Sanitation

• Types of sanitation, VIPs, septic tanks,
  conservancy tanks, bucket system, water borne
  sanitation
• Key parameters, COD, suspended solids and
  nitrates

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BUCKET SYSTEMS AND SEPTIC TANKS

• septic tanks and VIPs in Intabazwe that require
  weekly emptying

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Manual Disposal of Excreta

• collection of buckets and loading onto trailer

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Cleaning of the buckets
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Home-made Latrines
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Ventilated Improved Pit Latrines (VIP)
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Chemical Toilets
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Rural Good Sanitation Practice
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URBAN SEWERAGE TREATMENT PLANT
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Community Involvement

• Emptying a urine diversion VIP in Kwazulu-Natal

VIP PSC in Winterveldt
VIP PSC in Wheelers Farm
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Rural vs peri-urban

• Spread out
• Difficult to service give water
• VIPs only sanitation answer
• Problem is poor sanitation - pollutes the water
  sources, river and ground water

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Rural vs peri-urban

• Densely populated
• Difficult to service give water, cant get
  in-show Winterveldt slides
• Proper VIPs or water borne -only sanitation
  answer
• Problem is poor sanitation much greater impact
• People cant pay for services

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LINKAGES TO HEALTH
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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

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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

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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

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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.

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Cholera in Africa contd

• 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)

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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.

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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.

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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.

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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 doesnt it??

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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

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QUESTIONS ??