Drinking water is a big problem in Mityana, as it is in most of sub-Saharan Africa. Sub-Saharan Africa is the worst-performing region in the world in this respect, and this is most true in rural areas. The UN estimates that only 1 in 4 rural sub-Saharan Africans has access to clean water. While SE Asia has made many strides to improve water quality in the past 20 years, Africa has made very little progress. The stats on Uganda, in particular, are better than Africa as a whole, but not by much. According to the previously pictured District Community Development Officer, about 44% of the population in the area surrounding Mityana has access to safe water, though I’m not sure how he’s defined it.
The piped water that is now available in Mityana is certainly not potable. But, people often drink it straight from the tap anyway. Most, though, still do not have access to piped water and need to continue fetching it from streams that are exposed to contamination of a variety of sorts. Even after collecting from these streams, some do not boil their water before drinking it. The result is often diarrhea or worse. I have spent time in the last few weeks researching the current flavor of development in this area, and it seems that almost across the board, it is extremely difficult to implement centralized water treatment systems in sub-Saharan Africa. The reasons range from broad corruption to mismanagement to inadequate funding to lack of power to lack of technical training and the list goes on. It makes me appreciate living in the United States – there’s a lot I take for granted.
In reading through the literature from the World Health Organization and UNICEF, the numbers of sick and dying people due to water problems are staggering. Estimates are that at any given time, at least 50% of the hospital beds in the less-developed world are being occupied as a direct result of poor water access, cleanliness, and sanitation (some say it’s 80%). A large proportion of the under-5 child mortality can be attributed to poor sanitation and water quality, and could be prevented. Of course, the next question is always, “at what cost?”
Because of the challenge in implementing large-scale, centralized water treatment systems, the WHO and the UN have both recently shifted to promoting “Household Water Treatment and Safe Storage” (HWTS; see, for example, http://www.who.int/household_water/en/index.html). These systems have often been found to be more effective than central systems because of the risks of recontamination during transport and at the point of use. HWTS has the advantage of educating the end-user of appropriate treatment and storage methods as the systems are installed. According to a recent WHO cost-effectiveness study (available at http://www.who.int/water_sanitation_health/economic/prevent_diarrhoea.pdf), HWTS is roughly twice as effective at preventing diarrhea as are source-based interventions, but the costs are usually much higher on a per-person basis. Of all the methods studied for treatment, household chlorination had the best cost-effectiveness ratio, and household filtration had the best overall effect (a 63% reduction in diarrhea cases), albeit at a higher average cost of prevention. The next post will be about one HWTS system I’ve encountered since being here.