THE HEALTH THE HEALTH CONSEQUENCES OF CONSEQUENCES OF WATER AND SANITATION WATER AND SANITATION PROVISION IN RURAL PROVISION IN RURAL AREASAREAS

BY BY

ROWAROWAN N DUVELDUVEL

OBJECTIVESOBJECTIVES

Water supply in South Africa and it’s Water supply in South Africa and it’s role in preventing diseaserole in preventing disease

Sanitation problems in Africa and its Sanitation problems in Africa and its influence in disease managementinfluence in disease management

Highlighting the differences in water Highlighting the differences in water and sanitation between urban, rural and sanitation between urban, rural and peri-urban areasand peri-urban areas

Cholera control and preventionCholera control and prevention Literature linking water and sanitation Literature linking water and sanitation

to diseaseto disease

Water SourcesWater Sources

Surface water, Surface water, rivers and damsrivers and dams

Underground Underground water, boreholes water, boreholes and wellsand wells

Rain water, Rain water, seldom used in a seldom used in a dry countrydry country

Why pay for water?Why pay for water?

Cleaning and Cleaning and delivering it to delivering it to youyou

Infrastructure Infrastructure costs eg. Lesotho costs eg. Lesotho Highlands Inter-Highlands Inter-basin transferbasin transfer

Operating costsOperating costs

Water Supply to Water Supply to HouseholdsHouseholds

Communal Stand Taps Streams and Rivers

Water Networks

WaterWater

National policy on National policy on 6000 litres free 6000 litres free water to each family water to each family per monthper month

Water QualityWater Quality– About 40 different About 40 different

factors are measured factors are measured to determine whether to determine whether water is fit for human water is fit for human consumption – SANS consumption – SANS 02410241

– The most significant The most significant are the micro-are the micro-organisms such as organisms such as Ecoli and plate countsEcoli and plate counts

Fetching Water: UrbanFetching Water: Urban

Fetching Water: RuralFetching Water: Rural

Water Service Water Service ProvidersProviders In the absence of any subsidies the water In the absence of any subsidies the water

service providers need to:service providers need to:– Get people to pay for the water consumed over the Get people to pay for the water consumed over the

6000 litres per month, or6000 litres per month, or– Restrict families to using only 6000 litres per monthRestrict families to using only 6000 litres per month

Water Restriction Water Restriction DevicesDevices

TSHIAME – “tank system” with restricted flow

has used an average of < 6kl per month

Communal Standpipe

Restrictor

SanitationSanitation

Types of sanitation, Types of sanitation, VIP’s, septic tanks, VIP’s, septic tanks, conservancy tanks, conservancy tanks, bucket system, bucket system, water borne water borne sanitationsanitation

Key parameters, Key parameters, COD, suspended COD, suspended solids and nitratessolids and nitrates

BUCKET SYSTEMS AND BUCKET SYSTEMS AND SEPTIC TANKSSEPTIC TANKS

septic tanks and VIP’s septic tanks and VIP’s in Intabazwe that in Intabazwe that require weekly require weekly emptyingemptying

Manual Disposal of Manual Disposal of ExcretaExcreta

collection collection of of buckets buckets and and loading loading onto onto trailertrailer

Cleaning of the Cleaning of the bucketsbuckets

““Home-made” LatrinesHome-made” Latrines

Ventilated Improved Ventilated Improved Pit Latrines (VIP)Pit Latrines (VIP)

Chemical Chemical ToiletsToilets

Rural: Good Sanitation Rural: Good Sanitation PracticePractice

URBAN SEWERAGE URBAN SEWERAGE TREATMENT PLANTTREATMENT PLANT

Community Community InvolvementInvolvement

Emptying a “urine Emptying a “urine diversion” VIP in diversion” VIP in Kwazulu-NatalKwazulu-Natal

VIP PSC in WinterveldtVIP PSC in Wheelers Farm

Rural vs peri-urbanRural vs peri-urban

Spread outSpread out Difficult to service – Difficult to service –

give watergive water VIP’s only sanitation VIP’s only sanitation

answeranswer Problem is poor Problem is poor

sanitation - pollutes sanitation - pollutes the water sources, the water sources, river and ground river and ground waterwater

Rural vs peri-urbanRural vs peri-urban Densely populatedDensely populated Difficult to service – give water, can’t get in-show Difficult to service – give water, can’t get in-show

Winterveldt slidesWinterveldt slides Proper VIP’s or water borne -only sanitation answerProper VIP’s or water borne -only sanitation answer Problem is poor sanitation – much greater impactProblem is poor sanitation – much greater impact People can’t pay for servicesPeople can’t pay for services

LINKAGES TO HEALTHLINKAGES TO HEALTH

Water supply, sanitation Water supply, sanitation & hygiene development & hygiene development 2.4b people do not have access to sanitation 2.4b people do not have access to sanitation

facilitiesfacilities 1.1b do not have access to water supply 1.1b do not have access to water supply

sourcessources 2m die every year due to diarrhoeal disease, 2m die every year due to diarrhoeal disease,

eg,U5IMReg,U5IMR HDI (human development index) uses the HDI (human development index) uses the

U5IMR as an indicator for the overall social, U5IMR as an indicator for the overall social, economic & developmental level of a countryeconomic & developmental level of a country

Annual UNO indicator Annual UNO indicator

Water supply, sanitation Water supply, sanitation & hygiene development & hygiene development (cont)(cont) People mainly affected: poverty People mainly affected: poverty

strickenstricken Main reasons: lack of priority, Main reasons: lack of priority,

financial resources, sustainability financial resources, sustainability of water supply & sanitation of water supply & sanitation services, poor hygiene, services, poor hygiene, inadequate sanitation in public inadequate sanitation in public placesplaces

Water-related DiseaseWater-related Disease

Water-related diseases include those due to micro-Water-related diseases include those due to micro-organisms & chemicals in water:organisms & chemicals in water:

AnaemiaAnaemia, , ArsenicosisArsenicosis eg, eg, Arsenic in drinking-waterArsenic in drinking-water, , AscariasisAscariasis, , CampylobacteriosisCampylobacteriosis, , CholeraCholera, , CyanobacterialCyanobacterial Toxins Toxins, , Dengue and Dengue Dengue and Dengue HaemorrhagicHaemorrhagic Fever Fever, , DiarrhoeaDiarrhoea, , DrowningDrowning, , FluorosisFluorosis, , Guinea-Worm Disease (Guinea-Worm Disease (DracunculiasisDracunculiasis)), , Hepatitis, Hepatitis, Japanese EncephalitisJapanese Encephalitis, , Lead PoisoningLead Poisoning eg, eg, lead in drinking-waterlead in drinking-water, legionellosis (carried by , legionellosis (carried by aerosols), aerosols), LeptospirosisLeptospirosis, , Malaria(waterMalaria(water-related vectors), -related vectors), Malnutrition, Malnutrition, MMethaemoglobinemiaethaemoglobinemia, , OnchocerciasisOnchocerciasis (River Blindness) (River Blindness), Ringworm (Tinea), , Ringworm (Tinea), Scabies, Schistosomiasis(part of life-cycle in water), Scabies, Schistosomiasis(part of life-cycle in water), Spinal Injury, Trachoma, Typhoid and Paratyphoid Spinal Injury, Trachoma, Typhoid and Paratyphoid Enteric Fevers Enteric Fevers

Cholera in Africa Cholera in Africa

Cholera, together with Malaria, is the most Cholera, together with Malaria, is the most widely known endemic disease of Africa. widely known endemic disease of Africa.

Transmitted by ingestion of the Vibrio Transmitted by ingestion of the Vibrio cholera bacteria from the excreta of an cholera bacteria from the excreta of an infected person, eg inadequate excreta infected person, eg inadequate excreta disposal and sanitation, contamination of disposal and sanitation, contamination of water sources, poor personal hygiene, the water sources, poor personal hygiene, the contamination of foodstuffs, and flies.contamination of foodstuffs, and flies.

NOTE: VACCINATION AND QUARANTINE ARE NOTE: VACCINATION AND QUARANTINE ARE NOT EFFECTIVE WAYS OF CONTROLLING OR NOT EFFECTIVE WAYS OF CONTROLLING OR PREVENTING OUTBREAKS OF CHOLERA.PREVENTING OUTBREAKS OF CHOLERA.

Cholera in Africa Cholera in Africa cont’d cont’d 1997, a total of 118,349 cholera cases and 5,853 1997, a total of 118,349 cholera cases and 5,853

deaths were reported in Africa.deaths were reported in Africa. Most outbreaks followed heavy rainfalls and flooding. Most outbreaks followed heavy rainfalls and flooding. 27 Countries reported cholera in 1997: Benin, Burundi, 27 Countries reported cholera in 1997: Benin, Burundi,

Cameroon, CAR, Chad, Congo, DR Congo, Djibouti, Cameroon, CAR, Chad, Congo, DR Congo, Djibouti, Ghana, Guinea-Bissau, Kenya, Liberia, Malawi, Mali, Ghana, Guinea-Bissau, Kenya, Liberia, Malawi, Mali, Mauritania, Mozambique, Niger, Nigeria, Rwanda, Mauritania, Mozambique, Niger, Nigeria, Rwanda, Senegal, Somalia, Togo, Uganda, Tanzania, ZambiaSenegal, Somalia, Togo, Uganda, Tanzania, Zambia

The countries with the highest number of cases in The countries with the highest number of cases in 1997* 1997*

Tanzania (40,249) Tanzania (40,249) Guinea Bissau (20,555) Guinea Bissau (20,555) Kenya (17,200)Kenya (17,200) Chad (8,801) Chad (8,801) Mozambique (8,739)Mozambique (8,739)

Cholera in South AfricaCholera in South Africa

August 2000, was the most recent August 2000, was the most recent outbreak of Cholera in KZNoutbreak of Cholera in KZN

By April 2001, national reported By April 2001, national reported statistics were 117 147 reported cases statistics were 117 147 reported cases with 265 deathswith 265 deaths

The epidemic was the largest since the The epidemic was the largest since the early 1980s when more than 105,400 early 1980s when more than 105,400 people were infected and over 340 people were infected and over 340 died in four consecutive outbreaks. died in four consecutive outbreaks.

Red Cross/ Red Red Cross/ Red CrescentCrescent““Cholera remains a global threat and Cholera remains a global threat and

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

Diarrhoea in South Diarrhoea in South Africa Africa

"People don't realise how dangerous dirty water is," says "People don't realise how dangerous dirty water is," says David Linely, national coordinator of the Mondi Wetlands David Linely, national coordinator of the Mondi Wetlands Project. "For example, Environmentek's Cape Water Project. "For example, Environmentek's Cape Water Programme involved 12 rural communities in the Western Programme involved 12 rural communities in the Western Cape and found that 33% of people did not disinfect their Cape and found that 33% of people did not disinfect their drinking water, even though almost two thirds of samples drinking water, even though almost two thirds of samples failed the SABS Drinking Water Maximum Allowable Limits."failed the SABS Drinking Water Maximum Allowable Limits."

At least 650 South Africans die of diarrhoea every day.At least 650 South Africans die of diarrhoea every day.

The Water Research Commission says that short term The Water Research Commission says that short term direct costs, such as hospitalisation and treatment of direct costs, such as hospitalisation and treatment of diarrhoea patients are around R5 billion a year. Total diarrhoea patients are around R5 billion a year. Total annual costs are estimated at R15 billion.annual costs are estimated at R15 billion.

Rands and SenseRands and Sense

Patient day equivalents in NW Province Patient day equivalents in NW Province in 2000in 2000– District hospitals: R300 to 400District hospitals: R300 to 400– Provincial hospitals: R700Provincial hospitals: R700

Cost to provide clean water to a family Cost to provide clean water to a family of 6 peopleof 6 people– R30 for 6000 litres pm R30 for 6000 litres pm – i.e. It costs only R1.00 per day for clean i.e. It costs only R1.00 per day for clean

water for the whole familywater for the whole family Makes you think doesn’t it??Makes you think doesn’t it??

LiteratureLiterature

World Health OrganisationWorld Health Organisation– www.who.intwww.who.int

Science in Africa MagazineScience in Africa Magazine– www.scienceinafrica.co.zawww.scienceinafrica.co.za

Consumers InternationalConsumers International– www.consumersinternational.orgwww.consumersinternational.org

Environmental Protection Agency Environmental Protection Agency (USA)(USA)– www.epa.govwww.epa.gov