Special report on the challenge of providing healthy urban environments

Africa's urban poor, often struggling to eke out a living in unplanned and expanding shanty communities, are at the back of the queue for water and sewerage services from underfunded local authorities. But, as recent serious outbreaks of cholera in Mozambique, Zambia and Zimbabwe have demonstrated, the lack of access to safe water and proper sanitation are critical public health issues. Clean water and sanitation are not only universal needs but basic human rights. "They are essential elements of human development and poverty alleviation, and constitute an indispensable component of primary health care... Sustainable health, especially for children, is not possible without effective and adequate water supply and environmental sanitation," said the foreword to the Global Water Supply and Sanitation Assessment 2000 Report, jointly produced by the World Health Organisation (WHO) and UN Children's Fund (UNICEF). Only 62 percent of Africans have access to improved water supplies, and just 60 percent have proper sanitation facilities. Unsurprisingly, malaria and diarrhoea - diseases linked to poor sanitation - are among the principal killers of children aged under five in Africa, while cholera, a highly contagious water-borne bacterial disease, is endemic in a number of countries. To meet a target of halving the number of people without access to safe water and sanitation by 2015, services would have to be provided to 211 million people in urban areas and 194 million in rural areas, the WHO/UNICEF report said. For countries struggling under a burden of accumulated debt that gobbles up precious resources which could be spent on reaching this target, the outlook is grim. According to UN Habitat, an estimated 77 percent of people in the developing world are expected to live in urban areas by the year 2025. In Africa, the majority of that population will reside in informal shanty towns, which many governments treat as illegal settlements and ignore. "Even in those cases where governments attempt to assist the urban poor, their activities are hampered by lack of capital, poor statistics, and, most importantly, inadequate understanding of the needs, perceptions, and coping strategies of these communities. This has been exacerbated by the lack of meaningful links between the poor residents and the sanitation agencies, and has resulted in services provided not meeting the needs of the urban poor," according to a study by the Harare-based Institute of Water and Sanitation Development (IWSD). The IWSD report looked at the needs of poor communities in Zambia, Zimbabwe and South Africa. It found that, with a few exceptions, residents in the informal settlements surveyed used unimproved pit latrines as toilets. Most were in poor condition and respondents complained of bad smells and overflows. Pit emptying facilities were non-existent, the report said, requiring new construction in very crowded conditions. Where there was access to flush toilets, there were problems of "gross overcrowding" at communal facilities. "For example, toilets in Mbare, in central Harare, are overcrowded and most of them do not flush. Up to 1,300 people share one communal toilet with only six squatting holes," noted the IWSD report, "Linking Urban Sanitation Agencies with Poor Community Needs: A Study of Zambia, Zimbabwe and South Africa". "In addition to poor latrines, the urban poor also face solid waste and drainage problems. There is virtually no household refuse collection in any of the study areas in Zambia, Gokwe and Epworth in Zimbabwe, and Phase 1 (Mamelodi) and Jeffsville in Pretoria, South Africa. Residents in these areas use refuse pits or dump waste indiscriminately. Although most of the residents not served by the authorities use refuse pits, these cause problems of mosquito and fly breeding, and foul smells. Worse still, some children defecate in refuse pits," the study noted. Even in areas where local authorities provide solid waste management services, "at times refuse is not collected for two weeks or more. Domestic, industrial and, in some cases, hospital waste is dumped carelessly on the fringes of informal settlements, endangering children and animals." The report concluded: "The major cause of poor sanitation in informal settlements in the three countries is the lack of strong, transparent and effective linkages between sanitation agencies and the urban poor. The institutional and financial arrangements, and the approaches adopted, do not suit the sociocultural context, nor the needs and priorities of the urban poor. As a result, services do not meet the expectations of the urban poor, or are not provided at all." Noma Nyoni, IWSD deputy director, said the approach of local authorities had often been counterproductive - lecturing communities about hygiene, rather than allowing the communities themselves to identify their hygiene needs and priorities. "You may find that they want to improve sanitation from the point of view of dignity and safety - bathing in the open can lead to rape in poor urban communities," she told IRIN. Nyoni pointed out that in the case of Zimbabwe, local by-laws may have set too high a standard. The Urban Councils Act compels all houses to have waterborne sewerage systems, which are expensive. She suggested the issue should be one of access to proper sanitation, in which households are able to share facilities, rather than a focus on sanitation coverage. Across the Southern Africa region, cholera has claimed hundreds of lives in the last few months. ZAMBIA - POVERTY AND DISEASE Last week the Zambian authorities temporarily closed Soweto market, the largest open-air market in the capital, Lusaka, after the cholera death toll climbed to 100. Fresh food was sold in Soweto's highly unsanitary conditions, where storm drains were blocked with garbage, and public toilets overflowing. The government locked out the 2,500 traders - despite a howl of protest - to allow the market to be cleaned. "My job is to save lives and to prevent further contamination ... the marketeers will appreciate this once the place is cleaned up and disease free," health minister Dr Brian Chituwo told IRIN. He also identified Lusaka's crowded shanty compounds as a source of cholera, accusing residents of indiscriminately digging pit latrines close to water sources, and poor standards of personal hygiene. "Therefore, the government will raze down selected structures in the unplanned settlements and put up a proper sanitation system, and sink boreholes where clean water can be obtained in a bid to stop the disease," Chituwo said. "At the end of the day it's a poverty problem," commented Sham Marthur, a UNICEF official in Zambia. "Most of these waterborne disease problems start in the peri-urban areas, where the groundwater is very shallow and the density of the population very high." According to UNICEF, as much as 80 percent of preventable diseases in Zambia are related to poor environmental sanitation. The country's key social indicators are among the worst on the continent. By 1999, conservative estimates indicated that the infant and under-five mortality rates had increased to 112 and 202 per 1,000 live births respectively, from levels of 108 and 191 when the decade began. Access to clean water and sanitation can also have an impact on education. A poor sanitary environment can lead to outbreaks of parasitic infections, keeping children out of school and aggravating malnutrition. "Although the lack of facilities and poor hygiene affects both girls and boys, poor sanitation conditions at schools have a greater negative impact on girls. Due to the lack of adequate, separate, safe and private sanitation facilities, girls can be forced out of school, thereby greatly reducing their chances of attaining a good level of education," a UNICEF report noted. MOZAMBIQUE - CHOLERA CASES CLOSE TO 5,000 In Mozambique last year there was a cumulative total of around 3,500 cholera cases. In the latest outbreak, which began just before Christmas, the number of cases has already reached 4,700. Cholera has affected Maputo City and five of the country's 10 provinces - Maputo, Gaza, Sofala, Zambezia and Nampula. Officially 26 people had died by 26 January. The Ministry of Health, UN organisations and NGOs have been working together for years in an attempt to prevent cholera outbreaks, and to encourage communities to adopt safe hygiene practices. [More details] They have mounted door-to-door hygiene promotional campaigns, street theatre, media campaigns and public debates. UN agencies and NGOs have also supported the provision of clean water, latrine construction and safe garbage disposal. But it is a mammoth challenge in one of the world's poorest countries, where most people still live in dismal conditions. Despite the efforts, official figures show that 74 percent of the rural population do not have access to clean water, and 71 percent are not using an improved latrine. The situation is a bit better in urban areas, but 60 percent of the population still do not have access to clean water, while 64 percent do not have the use of improved latrines. When HIV/AIDS is factored into the equation the issue becomes even more urgent. Through home-based care programmes, people living with AIDS are expected to be cared for by relatives within the community. Patients need sanitary environments, and chronic bouts of diarrhoea, often associated with the disease, require plenty of water. WHO SHOULD PAY? Broke local authorities are expected not only to maintain a water and sanitation system - fixing leaking pipes, buying expensive purification chemicals - but also to extend that service to a growing urban population that is also struggling to make ends meet. In South Africa, a cost-recovery approach means that municipalities subsidise water to the poorest in the community, providing 6,000 litres per month free, and a stepped tariff that compels wealthier consumers to pay more. However, Johannesburg Water - a public company operating under privatised management - has come in for a great deal of criticism for reportedly cutting off poor households who persist in not paying their bills. [More details] According to the IWSD report, water tariffs neither cover the cost of providing the service, nor reflect how much the urban poor are willing to pay. It noted that in Zimbabwe people pay monthly rates the equivalent of US $2.14 to cover road maintenance, sewer repairs, rent and refuse collection, but surveys have revealed households were willing to pay almost double that amount for improved sanitation. "The surveys show that there is demand for improved sanitation, but there are no institutional means through which this demand can be expressed. Much better cost-recovery mechanisms need to be developed in liaison between the authorities and the local communities," the report said. Water demand is expected to nearly double in Southern Africa by 2020. That scenario requires the region to shift from a supply-orientated approach - the building of more dams and reservoirs - to a more sustainable demand-management approach, in which the available resources are better utilised. Brian Boshof, a development planner at Witwatersrand University, said that sustainability of [water resources] means ecological, economic and social trade-offs, in which cost-recovery policies play a part. "It's a very complicated argument, infused with politics," he commented. To view the IWSD report: www.iwsd.co.zw