Tag Archives: Zimbabwe

Zimbabwe – Community Health Clubs in Urban Areas

Click on title to view/download:

Zimbabwe – Community Health Clubs in Urban Areas, 2009. (pdf, 446KB)

Juliet Waterkeyn & Regis Matimati. Africa AHEAD Association.

Most countries in Africa will fall short of meeting the MDG targets for the provision of water and sanitation due to lack of financial and institutional capacity (WSP-Africa, 2006). Although safe sanitation has been found to be the most effective single intervention in reducing diarrhoea (Esrey, et al.1991), this does not necessarily mean the building of latrines, as these can become a fly breeding ground if they are not sealed properly, and further compound the spread of diarrhoea. The faecal-oral route can be broken much more easily and a lot more cost-effectively through faecal burial and hand washing with soap (Curtis & Cairncross, 2003). After more than a decade of pilot projects in many countries in Africa the Community Health Club (CHC) Approach can reasonably predict behaviour change, and ensure zero open defecation and handwashing with soap. By creating a strong demand for safe sanitation and a ‘Culture of Health’ that insures good hygiene (Waterkeyn & Cairncross, 2005) Community Health Clubs can become a potent mobilisation strategy in emergencies not only in rural areas but, as this case study shows, in urban areas as well. During the cholera outbreak that affected 12,700 people and claimed 420 lives in Zimbabwe, the a high density suburb of Sakubva, in Mutare, only had 4 cases and no deaths. This has been attributed to an environmental clean-up and improved the hygiene behaviour due to the efforts of 5,400 members in 36 Community Health Clubs.

Zimbabwe: building user-friendly toilets for the disabled

THE Disablement Association of Zimbabwe (DAZ) has started building user-friendly Blair Toilets for people with disabilities. It also plans to improve access to ablution facilities in Bulawayo after a realisation that the authorities were taking too long to act. Insiza and Matobo districts in Matabeleland South have been chosen for the programme which is supported by World Vision.

Speaking at the recent launch of the association, DAZ executive director David Zulu said the programme was part of efforts to address health concerns of people with disabilities. He said they tended to be left out of national programmes yet they were equally affected by challenges such as outbreaks of diseases emanating from poor sanitation.

“In the urban centre of Bulawayo we are involved in assessing the accessibility if public ablution facilities on how the current structures can be modified so that people with disabilities have better access to them,” Zulu said.

However, WVZ humanitarian emergency affairs director, Daniel Muchena said the programme had been affected by the negative attitude towards people with disabilities inherent in society. “For example under Protracted Relief Programme 1, in Matobo district some community members are not willing to assist people with disabilities in constructing user friendly Blair toilets and engage in other productive activities.

DAZ was registered as a trust in 2006 after it was formed by trustees Ronald Ncube, Edmore Hute and Davis Mazodze to represent people with disabilities at grassroots level.

For more information on this topic see:
WEDC – Water supply and sanitation for disabled people and other vulnerable groups

Source: Zimbabwe Standard / allAfrica.com, 29 Aug 2009

Zimbabwe – Why sanitation is the forgotten sister

Q&A: Why Sanitation Is the Forgotten Sister

Busani Bafana interviews NOMA NESENI, WSSCC water, sanitation and health coordinator

BULAWAYO, Jun 11 (IPS) – As part of the International Year of Sanitation in 2008, Zimbabwe developed a national strategy for sanitation, launched in February 2008. Just five months later, a cholera outbreak that was to claim over 4,000 lives began.

One of the strategy’s key proposals was to call for expanded resources for sanitation including public-private partnerships to expand access to proper toilets across the country.

The task force included representation from key ministries such as health, water development, and finance, as well as civic organisations like Plan International, World Vision and the Water Supply and Sanitation Collaborative Council (WSSCC), for which Noma Neseni is the water, sanitation and health coordinator in Zimbabwe.

Neseni told IPS why she viewed the task force’s work as less than a disaster. Excerpts of the interview follow.

IPS: With Zimbabwe’s health delivery services in paralysis, what has your council done to improve sanitation in the country?

Noma Neseni: A national sanitation taskforce team developed a strategy that looked at priority areas. These included an increase in sanitation coverage using demand-led approaches, capacity development at all levels and research into low-cost appropriate technologies.

The strategy also agreed on the opening up of technologies instead of just using the expensive type of VIP [Ventilated Improved Pit] latrine. It was recognised that so long as the latrines took into account the specific scientific aspects of the VIP, the superstructure could be made cheaper.

This strategy was later presented to larger stakeholders who endorsed it. We also had a national sanitation seminar that was attended by different permanent secretaries who endorsed a communiqué that called on private public partnership scaling up of sanitation coverage and more resources for sanitation.

IPS: More often than not, when governments invest in water development, sanitation is its forgotten sister, why so?

NN: Water often gets visibility because without water there is no life. Thus in terms of demand, communities often demand for water over sanitation.

Water is also relatively easy to develop or provide whereas sanitation – especially for large communities – is complicated to implement and manage.

Furthermore, sanitation does not yield the same profits as water so utilities, private sector do not want to invest in sanitation.

It is also easy to show quick returns with water as compared to sanitation. At household level, people have alternatives they can use the bush but if there is no water there is no other alternative.

Even at national level, government has been putting more resources for water as compared to sanitation. Sometimes there is also lack of awareness and understanding on the value of sanitation for the different sectors such as education, environment, tourism, economic development.

IPS: Why is sanitation an important issue today more than ever before?

NN: Access to sanitation is an indicator for human development. It is important for girls’ education, for women’s safety and dignity, for improved health, for control of vectors and diseases and for ecosystem balance.

And yet there are so many people that still do not have access, in Zimbabwe we are backsliding from around 60 percent coverage to as low as 25 percent.

In urban areas where as once we had almost 100 percent coverage, access is now limited due to lack of water, urban population without houses, informal settlements.

In other words sanitation is important for control of diseases, for sustaining our environment and for achieving the many development goals such as maternal health, education, control of malaria.

IPS: Would you say women than men are more affected by the lack of toilets?

NN: Women and girls are more affected by lack of sanitation as they face defecating in the open which means loss of dignity. Women face sexual abuse and even rape as they walk alone at night using a predictable route to a predictable defecation site and there is the issue of embarrassment in the disposal of sanitary pads.

Men can easily urinate in the open and women often do not have that privilege especially when newly married as a daughter in law. Women also have to look after the sick i.e. [those] infected with HIV or suffering from diarrhoea: without latrines this task is even more difficult.

IPS: In your opinion would you say there is adequate attention to sanitation issues in this country if not, why not?

NN: There has been inadequate attention to sanitation particularly from the perspective of resource allocation. Sanitation is largely seen as a donor activity and even among NGOs; more money is allocated to water.

In recent years there have been challenges such as access to inputs like cement. There are also challenges with management of systems, Institutional problems moving the management in urban areas between ZINWA and local authorities.

Firstly, we need to just finalise the water and sanitation policy in Zimbabwe and then we need to rationalise these different policies that impact on sanitation e.g., water act, environmental bill, education act, urban councils act, rural councils act. The harmonization should lead to clear institutional roles and responsibilities.

A regulatory framework is also necessary as we see that the polluter pays principles are affected. At the moment the polluter fee is so cheap institutions would rather pollute and pay. We also need incentives so that policies are implemented without having to resort to punitive measures.

Source – IPS News

Zimbabwe: cholera still not under control, repairing sewage systems essential

Despite a decrease of the crude case fatality rate, the cholera epidemic in Zimbabwe is still not under control, says OCHA, the UN Office for the Coordination of Humanitarian Affairs . As of 19 February 2009, there have been 80,250 registered cholera cases and 3,759 deaths. Case attendance to health facilities is improving as a result of social mobilization activities and decentralization of care close to the affected community.

During a field visit on 18 Februray 2009 to Budiriro and Glenview, the worst affected areas in Harare, OCHA staff concluded that “it can be virtually guaranteed that cholera will continue to blight” communities unless “repair of dilapidated sewage systems” is made “a priority by the donor and humanitarian community: now and during the crucial ‘recovery’ months (May-August) before the next rainy season arrives”.

UNICEF WASH staff visiting Binga district noted a dramatic reduction in new cases of cholera, but at the same time an upsurge of malaria cases. Binga has less than 5%a low water and sanitation coverage, while recent national assessments have at times reported much higher access rates.

Recent reports indicate that up to 60% of boreholes are not functioning due to small breaks or malfunctions, which could be easily be repaired.

There is still a shortage of water treatment tablets and non-food items, including buckets, jerry cans and soap, OCHA notes.

Large quantities of IEC materials (over 310,000 flyers and 14,000 posters) have been distributed and Public Health and Hygiene Promotion (PHHP) training delivered to over 250,000 people.

See an example of an IEC poster below – a full set of IEC materials in English, Ndebele, Shona language is available here.

Read the full Zimbabwe – Cholera Update Update Report #14 of  20 February 2009 here.

Cholera alert (English) poster. WHO/UNICEF

Cholera alert (English) poster. WHO/UNICEF

Cholera under-reported, infects millions a year – WHO

Cholera infects millions of people each year, 10 times the number of cases reported by countries who fear losing tourist or trade income by acknowledging the real scale of an outbreak, experts said

Claire-Lise Chaignat, cholera coordinator at the World Health Organisation, said [in the Feb 2009 issue of WHO Bulletin] the diarrhoeal disease that is spreading fast in Zimbabwe is also under-reported because the stigma attached to it means people often fail to seek treatment.

[...] In 2007, governments reported just 178,000 cases of cholera, which is spread mostly through contaminated food and water. According to Chaignat, about 120,000 people most likely died of cholera that year, compared to the 4,031 official toll reported to the WHO.

Angola, Sudan, Ethiopia, Afghanistan, Liberia, South Africa and Madagascar have all had large outbreaks in the past decade, and Iraq had more than 4,000 cases last year.

[...] WHO disease control expert Francesco Checchi said: “Unfortunately, the cholera epidemic [in Zimbabwe] has struck at a time when most Zimbabweans are unable to purchase salt and sugar [needed for oral rehydration solutions (ORS)]“.

[...] Major hotspots for cholera and other diarrhoeal diseases include Bangladesh, China, India, Indonesia, Pakistan, the Philippines, and much of Africa.

Source: Laura MacInnis, Reuters, 02 Feb 2009

Zimbabwe: Worst-case cholera scenario getting worse

Zimbabwe’s worst-case cholera scenario, as predicted by the World Health Organization (WHO), is likely to be surpassed within a few weeks and there are still about two months of the rainy season left.

In December 2008 the WHO said cholera cases could balloon to 60,000 before the rainy season ended in March 2009, but Gregory Härtl, spokesman for the organisation’s Epidemic and Pandemic Alert and Response office in Geneva, told IRIN that as of 25 January, 53,306 cholera cases and 2,872 deaths had been recorded since the outbreak began in August 2008 [by 28 January the death cholera death toll in Zimbabwe had climbed to 3,028] .

Cholera, an easily treatable waterborne disease, thrives in poor sanitary conditions and is expected to remain a feature until Zimbabwe’s rainy season subsides.

The Herald, a state-owned daily newspaper, trumpeted in its 26 January edition that cholera was on the “retreat” in the capital, Harare. [...] However, Härtl said the conditions causing Zimbabwe’s cholera outbreak remained in place. “The systemic underinvestment in water and sanitation infrastructure and the health system … These conditions will not change overnight.”

Source: IRIN, 26 Jan 2009

To make matters worse, a report by SW Radio Africa stated that the International Red Cross has warned it could be forced to suspend its cholera-relief activities in the coming weeks, because of a critical lack of funding.

The US-based International medical rights organisation, Physicians for Human Rights (PHR), have labelled Zimbabwe’s health crisis a ‘crime’ that should be the subject of an investigation by the International Criminal Court. In a report titled ‘Health in Ruins – a man made disaster in Zimbabwe’ – PHR details the spread of the cholera epidemic and outlines the implications the collapse of the healthcare system has on victims of human rights violations. The report’s preface, which is signed by South African Archbishop Desmond Tutu, former UN High Commissioner for Human Rights Mary Robinson and Richard Goldstone, a former chief prosecutor at the International Criminal Tribunal for Rwanda, reads: “These findings add to the growing evidence that Robert Mugabe and his regime may well be guilty of crimes against humanity.”

One overlooked effect of the cholera epidemic, mentioned by Dr Douglas Gwatidzo, chairman of the Zimbabwe Association of Doctors for Human Rights, earlier in December 2008, was that it was diverting attention away from Zimbabwe’s HIV/AIDS crisis which claims the lives of more than 400 adults every day. People living with HIV are also particularly vulnerable to cholera because their immune systems are weakened and they have more difficulty recovering.

Regular updates and background information on the cholera epidemic can be found on the UN OCHA Zimababwe web page.

Zimbabwe: Nigel’s Story – the tragedy of country’s cholera outbreak

[Nigel Chigudu lost] five siblings in five hours to the cholera epidemic that has been sweeping across Zimbabwe. “They started vomiting and had serious diarrhoea,” recalls Nigel, 15. “The youngest, Gamu, was 14 months old, and Lameck was 12 years old. It was in the middle of the night; I could not take them anywhere. I just watched them die. “Two days later, my grandmother also passed away,” he adds.

Nigel lives in Budiriro Township, Harare, the epicentre of Zimbabwe’s latest cholera outbreak. [B]urst sewage pipes have left puddles and a permanent stench while months of uncollected refuse litter the streets. Filthy conditions like these have prompted UNICEF to make an international appeal for help to control the epidemic, which is spread by contaminated water.

[...] UNICEF has provided hundreds of thousands of water treatment tablets with a capacity to treat and purify water in more than 3 million households. It has also distributed thousands of oral rehydration salts, IV fluids and drips to treat diarrhoeal dehydration, as well as washing soap and buckets. In addition, UNICEF is trucking safe drinking water and mounting community-based water tanks in cholera-affected communities. There is also a drive to intensify hygiene education and health promotion.

[...] UNICEF has embarked on a $17 million emergency programme for the next 120 days. This programme will fund medicines for 70 per cent of the population; scale up community-based therapeutic feeding; carry out outreach immunization services, and provide incentives for teachers and nurses to return to work.

Listen to a UNICEF podcast about Nigel Chigudu here.

Source: Tsitsi Singizi, UNICEF, 19 Dec 2008

On 18 December 2008, there were 1123 registered deaths and 20896 suspected cases of cholera in Zimbabwe (OCHA Daily Cholera Report, 2008-12-18). Medecins Sans Frontieres (MSF), predicts that the cholera epidemic in Zimbabwe will last well into 2009. Manuel Lopez, the head of MSF in the country, told the BBC the epidemic was still at a critical level and would not subside until the rains end in March. (BBC, 21 Dec 2008).

The outbreak could surpass 60,000 cases, according to an estimate by the Zimbabwe Health Cluster, which is a group coordinated by World Health Organization (WHO) and comprising health providers, nongovernmental organizations and the Ministry of Health and Child Welfare (MoHCW). The estimate is based on six million people, or half of Zimbabwe’s 12 million population, potentially being at risk of contracting cholera, with an estimated 1% of those at risk of actually suffering from cholera. (WHO, 10 Dec 2008)

Zimbabwe declares national emergency over cholera

Zimbabwe has declared a cholera outbreak that has killed more than 560 people [with the capital Harare the worst affected] a national emergency and appealed for international help to deal with the crisis.

[...] “Our central hospitals are literally not functioning. Our staff is demotivated and we need your support to ensure that they start coming to work and our health system is revived,” Health Minister David Parirenyatwa was quoted as saying in an appeal to donors.

[...] Zimbabwe’s health sector is collapsing with not enough money to pay for essential resources and doctors and nurses often striking over pay. The water system is in disarray, forcing residents to drink from contaminated wells and streams.

[...] Analysts said worsening conditions may force Mugabe’s government to mend relations with donors and other governments.

[...] Zimbabwe’s neighbours, faced with cholera patients fleeing across their borders, moved to help the country, while the World Health Organisation said it was preparing to send a team to help deal with the cholera outbreak.

[...] Deputy minister for water and infrastructural development Walter Mzembi said the ministry had only enough water treatment chemicals to last about 12 weeks, and called for donor support, the Herald reported. “I am appealing for at least 40 million rand ($3.9 million) to purchase chemicals for the next two months and the money is needed between now and next Monday,” the paper quoted him as saying.

Source: MacDonald Dzirutwe, Reuters, 04 Dec 2008

WASH response

The humanitarian community continue to scale up responses to cholera. UNICEF and OXFAM GB [who lead the WASH Clsuter], GAA, and ACF and other humanitarian partners are enhancing hygiene education; and emergency supplies. [T]he Health and the WASH Clusters will be holding weekly joint meetings, [while] UNICEF is working on a database indicating emergency supplies prepositioned by WASH Cluster members for the response.

{…] So far, Matabeleland North remains the only province which has not reported any cases.

The rapid deterioration of the health service delivery system in Zimbabwe, lack of adequate water supply, and lack of capacity to dispose off solid waste and repair sewer blockages in most areas will continue to contribute to the escalation and spread of the outbreak.

For more information contact: Ben Henson at bhenson@unicef.org for WASH

Read more: OCHA, Weekly Situation Report on Cholera in Zimbabwe, 03 Dec 2008

Regular updates and background information can be found on the UN OCHA Zimababwe web page.

See below a report by Sky News on cholera victims who have fled toSouth Africa for treatment

Zimbabwe: Derrick Jimu, “I put the blame for his death squarely on the city officials and the government”

Derrick Jimu, 56, has still not come to terms with the death of his son from cholera in the low-income suburb of Budiriro, in Zimbabwe’s capital, Harare. So far more than 20 lives have been lost in this area, and the epidemic has now spread beyond the city.

“Samson had just graduated with a degree in community medicine from the University of Zimbabwe. I remember the days when he would come back from university and we would discuss a host of disease outbreaks that we faced in this country. He always warned me that our suburb was sitting on a cholera time bomb.

“My son was in the process of obtaining his work permit, after being promised a job in Namibia. A day before he was taken ill, he told me that the job was well-paying and he promised that he would look after the whole family.

“I put the blame for his death squarely on the city officials and the government. They have turned a blind eye to the health hazards in our area for too long, despite repeated pleas from residents.

[...] “Children play in the sewage, and ponds of the contaminated water are attracting armies of flies. Without regular supplies of clean water, it means the food we eat is unhygienic, and most of it is sold in the open”.

Read more: IRIN, 12 Nov 2008

Zimbabwe: Disaster unit deployed in response to cholera outbreak

Zimbabwe has activated its national disaster response agency, the Civil Protection Unit (CPU), to counter the spread of cholera. [...] The CPU is usually deployed in the wake of national disasters, such as floods and droughts. [It had been] mandated to provide clean water [with assistance from UNICEF and WHO], even though this was the responsibility of the state-owned Zimbabwe National Water Authority (ZINWA).

[...] The capital, Harare, including its central business district, has been without piped water for the past four days, while sewer bursts are being left unrepaired. [...] ZINWA confirmed that it has been pumping untreated sewage into Harare’s water supply dam, Lake Chivero.

[S]hallow wells people have dug to get to water when the taps stopped running are being decontaminated; refuse, which has not been collected this year, will now be collected, the CPU said.

Read more: IRIN, 05 Nov 2008