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WEST AFRICA: Cleaner toilets to save slums from cholera

Photo: Anna Jefferys/IRIN

Public toilets in Kroo Bay slum in Freetown, do not entice users

FREETOWN/CONAKRY/ACCRA/DAKAR, 16 August 2012 (IRIN) - Aid agencies are scrambling to treat thousands of cholera patients in Sierra Leones capital, Freetown, where the number of infections is mounting by over 250 per day. Most patients are from the citys various urban slums, where open defecation is rife, toilets are rare, sewage is improperly disposed of, and awareness of cholera is very low. Water and sanitation specialists say unless these problems are addressed, cholera will continue to flourish both in Sierra Leone and throughout West Africa. By 15 August, 19,370 people had contracted cholera in West Africa, the most affected countries being Sierra Leone (9,613 cases), Ghana (5,121 cases), Niger (5,023 cases), and Guinea (802 cases), according to the UN Childrens Fund (UNICEF). There is a massive failure to take cholera seriously in this region, and to publicize it, said a West Africa cholera specialist. Ultimately, if you want to get rid of cholera you need to address the structural issues that cause it. The money is there, it is a question of tapping into it and taking responsibility for your citizens. Take cholera seriously Most West African countries are falling far short of their Millennium Development Goal to double the proportion of citizens with access to proper sanitation facilities - just 37 percent of inhabitants can access a clean toilet, according to the World Health Organization (WHO). As in Freetown, a high proportion of the cholera cases in Conakry, the Guinean capital, and Accra, Ghanas capital, are concentrated in urban slums, where there are few clean toilets and most people openly defecate, often dangerously close to open wells that are the source of water for most residents.

The cholera outbreak now has a caseload of 60 per week in Conakry and Accra and is thought to be past its peak, when there were 90 to 100 cases per day in each city, but Charles Gaudry, head of Mdecins sans Frontires in Guinea, warned that We must still be on our guard. Governments tend to clean up the cholera mess once it is in full swing rather than working on prevention, said an independent water and sanitation (WASH) specialist in West Africa. It is governments responsibility to address the very basic sanitation rights of its citizens. Donors, too, prefer to fund reactively, hence UNICEFs Sword and Shield [response-prevention] strategy is more sword than shield, noted Patrick Laurent, West Africa WASH coordinator at UNICEF. When aid agencies approached the African Development Bank in 2011 for cholera prevention support in the Central African Republic, the response was: When you report a cholera case, well give you the money.
Photo: Anna Jefferys/IRIN

A mother tries to keep her baby clean in Kroo Bay

In Guinea, just one or two aid agencies - Action against Hunger and UNICEF - work on cholera prevention with the government, while one - MSF - is doing the bulk of the treatment and transmission containment. Ghana: prosecution over publicity In Greater Accra, with 77 percent of the countrys cholera cases, at least 20,000 people have no toilet or use bucket latrines (a pot that is periodically dumped outside), according to Accra health department director Simpson Boateng. Those living near the sea simply defecate on the beach. The Ghanaian government banned open defecation and bucket latrines in 2010, and arrests all perpetrators, said Boateng. We need to continue to educate them [people], but more importantly, you will be arrested when caught, he told IRIN. As I speak, over 1,000 landlords have been prosecuted for still using pan latrines in their houses. The city council is establishing a sanitation court to try the culprits. We are simply enforcing the by-laws which frown upon this conduct, he said.

Cholera in Niger
In Niger, the situation is different in terms of topography and humanitarian context. Some 99 percent of the cholera cases are in the Tillaberi Region in the southwest of Niger, on the Niger River. The rest are in refugee camps in Ouallam, in southwestern Tillaberi. Cholera has broken out against a backdrop of high rates of malnutrition and food insecurity, and large numbers of refugees who fled the takeover of northern Mali. The rains and insecurity make it difficult to access some cholera-hit villages, said UNICEFs Patrick Laurent. If you add all of the above conditions, plus the rainy season, floods and poor sanitation, its not surprising to see a cholera outbreak, he noted. The government has a low capacity to respond to cholera but is willing to collaborate with the many relief and aid agencies working to alleviate the emergency there, said Laurent. For me, this is half

Rather than crackdowns, more awareness-raising is needed, suggested Accra residents, including journalists, who had no idea there was a cholera outbreak in their city.

the battle.

Unlike in neighbouring Guinea and Sierra Leone, where the governments are weak and rely on aid agencies to drive the response, the Ghanaian authorities are leading the cholera response but have underplayed it for political purposes, said WASH specialist Laurent. The recent death of President John Atta Mills and the approaching parliamentary elections have drawn the attention of most government officials for weeks. Give them an alternative Arrests may be a temporary deterrent, but people will continue to defecate in the open as long as they have no alternative, say aid agency staff. Just 17 percent of Accras residents, and 8 percent of rural Ghanaians, have access to an adequate toilet, according to the governments 2008 health survey. The key is to get communities all over West Africa to want to use and maintain clean toilets. In Sierra Leone, UNICEF is pushing community-driven total sanitation, in which communities move away from open defecation once they understand its consequences, and go on to build and maintain clean toilets themselves. In this model, UNILEVER, which manufactures cleaning products, has worked with UNICEF and local partners in Gambia, and with Water and Sanitation for the Urban Poor, a non-profit group, in Ghana to form The Clean Team. The process is: trigger a demand for toilets through behaviour change; arrive at a price that works for everyone; and then make clean toilets available. An ongoing project in Kumasi, south-central Ghana, targeted 100 families, most of whom were sharing dirty latrines. Each was given a free chemical toilet with a sealed waste container that was exchanged two to three times per week. A family of five pays about US$15 per month for the service, which is less than it costs to use the public toilet. The waste is processed in the citys septic tank system, but the municipality hopes to use it to produce biofuel in the future. Thus far the scheme has improved hygiene, lowered household costs and reduced the use of plastic bags for defecation, otherwise known as "flying toilets", said Clean Team manager Asantewa Gyamfi. The plan is to expand it to 1,500 families. Keeping toilets clean Transferring such an intensive approach to an urban slum setting in Freetown is a challenge, said UNICEFs Sierra Leone communications specialist, Gaurav Garg. Most of Freetowns flood-prone slums are hemmed in by the ocean and/or mountains, and there is simply no room to build new toilets - public latrines are the only option. An urban WASH consortium - made up of NGOs Oxfam, Action against Hunger, Save the Children, GOAL, and Concern - charged with helping the government improve sanitation in Freetowns slums, has decided that improving and rebuilding public toilets is the only option, but keeping them clean is the real challenge, said Marc Faux, the group coordinator.

Photo: Anna Jefferys/IRIN

Community committees have been set up to run the toilets. Each is given four roles: collect money for their use Upkeep of public latrines is the challenge (usually 100-200 leones per person [2 to 4 US cents] use the money to clean and repair the toilets; communicate the communitys sanitation concerns to political decision-makers; and make sure waste is dumped safely. Health officials say until each of these jobs is done well, use will continue to be low. To date, most of the waste from public latrines has been dumped in nearby rubbish tips or into the sea. The NGO consortium is currently experimenting with a low-technology device that pumps waste into containers that can then be taken to trucks. Another method being tested is a device used to separate urine from faecal matter, which can then be turned into compost over an 18-month period. These and other innovations are an important start to addressing the myriad challenges in unsanitary, densely populated, coastal cities such as Freetown, Conakry and Accra. But they will only make a dent in cholera prevention. The issue must be addressed, not on a project-by-project basis, but holistically, involving education, health systems, water and sanitation infrastructure - the lot, said Mariamme Dem, West Africa head of NGO Wateraid in Senegal. That looks a long way off. For now, NGOs like MSF are hastily setting up treatment centres to care for the cholera victims who come their way - as they have done every few years since the 1980s. aj/js/ic/bb/sda/he

Theme (s): Education, Environment, Governance, Health & Nutrition, Water & Sanitation, [This report does not necessarily reflect the views of the United Nations]

In South Africa's slums, mob justice rules

Thu Jul 12, 2012 2:30pm GMT Print | Single Page [-] Text [+]

By Wendell Roelf KHAYELITSHA, South Africa (Reuters) - Beaten and set alight, Ncedile Gigi's unrecognisable remains have not been buried since March, when a mob fed up with poor policing took the law into their own hands, torching the 26-year-old in a crime-ridden South African township. Accused of theft, Gigi was one of three men who had petrol-laced tyres shoved over their shoulders in Khayelitsha, a shanty town 40 km (25 miles) east of Cape Town. The heat fused his body with that of another and the charred remains were then left on a sandy patch of ground where children normally play soccer - a macabre warning to others and a grim reminder of the social problems that plague Africa's biggest and most developed economy. For South Africans, the violence also evokes the dark days of apartheid when suspected collaborators of the white-minority regime were executed by "necklace" - a car tyre wedged over the torso, followed by a can of petrol, and then a match.

Police removed the bodies a few hours after the attack but, five months later, have yet to release two of them for burial because they do not know which is which. "The way my brother died is very painful. We are waiting for DNA tests," Gigi's older sister, Kholiswa, told Reuters in her home, a tin and wood shack. "Maybe if I was there I could try to stop them - maybe just a beating only and not go so far as to burn him." The death of Gigi and 10 other young men in the township since January reflects an alarming loss of trust in the police in South Africa's slums, where rates of robbery, rape and murder are among the highest in the world. "This is actually a deeply worrying trend for the police and government because citizens do not have faith in formal institutions and are resorting to violence," said Hennie van Vuuren, director of the Cape Town office for the Institute for Security Studies. Continued...
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Case of the week: Multifunctional energy centre in Mozambican slum

UN-HABITAT is collaborating with the municipality of Beira and the BASF Social Foundation to build a Multifunctional Clean Energy Centre (MCEC) in Munhava slum. The MCEC is being designed to use locally available renewable energy resources (human waste, solar energy and wind) for added value. This includes public toilets connected to biogas digesters and solar panels installed on the centres roof for lighting and for charging lanterns for domestic lighting to replace kerosene lamps. A playground, lit by energy produced in the centre, will be annexed.

The project will be mainly managed and operated by self -promoting groups of youth in the slum of Munhava selected with and within the community. At least 200 young people will benefit from professional training and will generate sustainable incomes through service management and selling. The duration expected for the construction of the new infrastructure is 24 months, finalizing at the end of 2013. The total cost of the project is around 200,000 USD. Examples of currently operating MCECs are in Kibera, Kenya (Kibagare Haki Yetu Bio -centre in Kangemi, Stara Biogas Toilets, Nicoteli Youth Club and Katwekera Tosha Bio -centre) and in slums in Dakar, Senegal. More information is in the attached brochure. You can also watch the attached videos about biocentres currently operating in Kibera.

Case of the week: Mapping slums with smartphones Accurate maps of remote rural areas - and the slums of big cities - can be hard to find in Uganda. So smartphones are being used to map some of the poorest and most distant areas of the country. The Mapping Uganda project is the brainchild of NGO Fruits of Thought. With its technology partner Mountbatten Ltd, they go to universities across the country and hold mapping days, where students use two bespoke smartphone apps to gather location information. The results are uploaded to OpenStreetMap. EasyMappr plots the position of businesses, recording details such as opening times. Geo Bucket (a smartphone application) tracks the longitude and latitude of a phone as it moves, allowing roads to be accurately mapped. Both are about to be made publicly available on smartphone platforms. Mountbatten's Ketty Adoch says this will allow mass mapping of businesses, sanitation facilities and other landmarks. "If this information is known it saves [local councils] a lot in planning." Ultimately accurate maps can save lives, according to Mountbatten's developer David Ebukali. Wednesday 5 September 2012 17:50 Comments

Here are some links to the main players involved in the Uganda mapping project. Fruits of Thought: www.fruitsofthought.org/index.html Mapping Day Uganda: www.mappingday.com/ EasyMappr: www.easymappr.com/ Geobucket: www.geobucket.org/ Mountbatten Ltd: http://mountbatten.net/ Feel free to post if you can add some of your own mapping experiences! Tom van Geest (Web team) Wednesday 5 September 2012 17:52

This is an interesting initiative. One of the shortfalls local councils have is the absence of spatial information in informal settlements. That makes planning for the areas a big problem. It would be interesting to see samples of the finished maps. Lets share more of such approaches so that slums stop being black holes data wise.

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