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Water, sanitation and hygiene

Water, sanitation and hygiene, (appropriately known as WASH), may be considered more matters of health than agriculture. Yet the productivity of agriculture is dependent on the health of rural communities, and rural communities almost invariably have poor access to safe water and hygienic sanitation. This inevitably results in faecal-oral transfer of infections and constant re-infection. It has been shown by WHO that investment in improved access to safe water and hygienic sanitation in rural areas results in benefits many times greater than the cost. It also results in increased capacity to utilise the full potential of agricultural research, thus increasing the cost-benefit of research in crops and livestock. Even greater benefits can accrue if supplies can provide sufficient water to allow the development of rural-based enterprises such as baking, brewing, laundries and for market gardens. All raise the income generating capacity of rural areas and vegetable production enhances nutrition.

"Maximising the Benefits from Water and Environmental Sanitation" was the theme of an international conference in Kampala, Uganda 31 October-4 November, which was attended by very few from the agricultural sector, yet many of the issues are common to agricultural development and health. Points of View presents some of the comments made at the conference that relate water and rural health to water and rural wealth.

Water and sanitation - the current situation

Rural communities represent 80 percent of the total population of Sri Lanka. It is estimated that only 40 percent of the rural population have access to safe drinking water at present. Lack of access to safe drinking water has been identified as one of the reasons of deepening poverty among rural populations.
R.Upali Alwis, Rural Water Supply Division, Ratmalana, Sri Lanka

In Jigawa State in North-east Nigeria, only about 40 per cent of the rural populace has access to safe water supply while less than 40 per cent practises safe defecation.
Bioye Ogunjobi, UNICEF, Bauchi, Nigeria

Infant and under five mortality rates remain high throughout Nepal with an estimated 15,000 children dying each year due to diarrhoeal diseases caused by poor environmental sanitation and lack of access to quality water supply.
Rebecca Scott, WEDC, Loughborough University, UK

Bangladesh has to spend US$80 million per year to combat water and excreta-borne diseases. In a study village where 90 percent of the people defecate in an unhygienic way, a specially designed promotional approach to sanitation over twelve months, showed that almost 100 percent safe use of latrines is possible and people stopped open defecation.
Dr Md. Mosleh Uddin Sadeque,DPHE-Danida Water Supply and Sanitation Components, Dhaka, Bangladesh

Diarrhoeal disease is of faecal origin and kills 3.3 million children each year. Preventing faecal matter from entering the domestic environment should therefore be of utmost importance. Recent studies provide overwhelming evidence that suggests hand washing can reduce the incidence of diarrhoea by between 27 and 89 percent.
Stephen Harries, Consultant, New Zealand

The challenge and the cost

President Museveni summarised it for us. He stated that 90% of the disease burden of Uganda is preventable, highlighted that domestic personal hygiene and sanitation is a primary cause for the disease burden, and that far more effort needs to be focused on addressing that.
Anthony Waterkeyn, Technical Adviser-Sanitation, Ministry of Health, Uganda

The costs of not implementing WASH (water, health and sanitation) are enormous. Poor people pay up to 20 times as much for water from vendors as for piped water. Only 1-2 % of GDP is spent on this WASH sector.
Piers Cross, World Bank Team Leader, Water and Sanitation Program, Africa

One hundred and fifty eight years after the Hungarian doctor, Ignaz Semmelweiss discovered the benefits of hand-washing, we are still struggling to implement this vital but simple practice in developing countries. Nine studies conducted in developing countries showed that no more than 20% of child carers washed their hands after cleaning a child's bottom or defecating themselves.
Stephen Harries, Consultant, New Zealand

There have been some recent economic studies undertaken by the World Health Organisation, which found that for every $1 spent on water supply or sanitation you are likely to get a benefit of between $5 and $11 in different countries in Africa.
Ian Smout, Director, WEDC, Loughborough University, UK

Water and sanitation - changing behaviour

I think one of the problems that you have had is where sanitation is sold from a negative angle, where you say to people: 'If you do not have sanitation you will get cholera, you will get diarrhoea.' The whole message must be turned around to be more positive: 'These are the benefits of doing this.' And begin to sell it as something that is good for you.
Dr Barbara Kazimbaya-Senkwe, WSP Senior Water and Sanitation Specialist, Zambia

I think a lot of the problems with development in the past, is that it has been on a 'western' appeal to the individual. But it is very difficult for people living in a communal situation to be different from their neighbours: the tendency is not to be different but to be the same. If you appeal to people on an individual basis, very often they are afraid to make changes. Whereas if you lift the whole community up together, you get them to understand the same principles and work as a common unity.
Juliet Waterkeyn, Director, Africa A.E.A.D Foundation

Access to safe water

In addition to basic domestic needs, a strong demand is often expressed by households for water for small-scale production such as garden irrigation, raising small numbers of livestock, post-harvest crop processing, and micro enterprises like small restaurants. These productive uses of water can generate income, helping to meet the costs of water supply, contribute to food security, and help poor people, especially women, strengthen their livelihoods.
Ian Smout, Director, WEDC, UK

Promoting only community-based water supply may mean that we are omitting a major asset which can contribute to MDGs. Most people in sub-Saharan Africa are investing in their own supplies, and appear interested to retain ownership and invest more...Outside of sub-Saharan Africa water supplies are often very largely a household initiative. In Nicaragua, some 25% of rural coverage is now provided by individuals, who have dug their own wells and bought their own rope pumps.
Dr Sally Sutton, SWL Consultants, Shrewsbury, Shropshire, UK

The hand rope pump is based on a very old technology that is 3,000 years old, and it has proved to be a very effective and sustainable technology for family and communal wells. I think, though, that this technology has been considered 'Stone Age' technology by many technicians and policy-makers. Modern technology has made the hand rope pump an efficient and interesting technology, but 90% of the people here don't know of the existence of this technology.
Henk Holtslag, Praktica Foundation, Apeldoorn, Netherlands

Developing sustainable systems

If you have a pump that has been made by local industries, it is mostly a more simple type of pump; they are easier to understand in the way they function and spare parts are available. One thing that we have underestimated is the ability of people to keep their system going. Look at all the 30 or 40 year-old cars plying African roads; they are functioning.
Erich Baumann, Co-ordinator, Rural Water Supply Network, St Gallen, Switzerland

In Zambia, for instance, when there's a main meal, we wash our hands because we use our hands to eat. Traditionally you would have water in a basin, so all would wash hands in one basin. But now, if you go to many Zambian homes, including in the poorer neighbourhoods, people pour water from a container. So you don't wash in dirty water, everybody washes in clean water; now, in almost every home they wash from a jug and not from a basin.
Dr Barbara Kazimbaya-Senkwe, WSP Senior Water and Sanitation Specialist, Zambia

Because of the increase in people coming to get water for themselves and their livestock from the hafir (a man-made depression to collect run-off water) local entrepreneurs have set up grinding mills, which is generating income for them and their families.
Michael Wood, Water and Sanitation Adviser, c/o European Union in Sudan

One area in Makoni district we went back to about 4 years after the intervention had finished and looked at what was being done. And the changes seemed to continue and actually spread out so that more and more people are taking that standard as the norm. One of the most interesting things is the level of pride in the kitchens of health club members, and it has become a sort of fashionable thing to really upgrade kitchens to a point that they are much smarter than kitchens in town. So I call that a 'culture of health'.
Juliet Waterkeyn, Director, Africa A.H.E.A.D on her experience in Zimbabwe

In Zambia, a survey in Kaoma district showed that of 3,000 unlined, privately owned wells, 93% were working; of 500 lined, improved, communal wells only 60% were working.
Dr Sally Sutton, SWL Consultants, Shrewsbury, Shropshire, UK

*The conference was hosted by WEDC, the Water, Engineering and Development Centre, Loughborough University, UK, and the Ministry of Water, Lands and Environment, Uganda. Sponsors included DFID, the UK Department for International Development.

Date published: January 2006


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