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Fighting a lost cause

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… Harare turned tropical disease hot spot

Erratic water supplies (of questionable quality), poor sanitation and erratic refuse collection have all been blamed for the persistent outbreaks of waterborne diseases like typhoid and cholera.

By Phyllis Mbanje

Garbage lies uncollected for weeks and residents end up dumping it anywhere and everywhere. Pic: Shepherd Tozvireva
Garbage lies uncollected for weeks and residents end up dumping it anywhere and everywhere.

Cholera killed more than 4 000 people between 2008 and 2009 and another 100 0000 were hospitalised by a tropical disease synonymous with the 19th century.

It was Africa’s worst epidemic in decades.

Conditions that allowed the disease to flourish at the time are exactly the same today and a gigantic health time bomb is looming.

But what makes it worse is the initial government response, which is always lukewarm, punctuated with denial, neglect and attempts at a cover-up.

The risk of another cholera outbreak remains high, especially with no concrete, sustainable solutions in sight as well as erratic response mechanisms.

It took two people — a teenager from Mbare and a 33-year-old man — to die of typhoid for the authorities to initiate marathon meetings and inter-ministerial caucuses, which do not exactly give the public the confidence.

The rushed setting-up of the inter-ministerial committee, consisting of the Health, Local Government and Water ministries, could just be a charade designed to hoodwink the public into thinking something is being done.

Their solution — banning vending of food on streets. Really?

“We have agreed to prohibit the vending of food. People are selling food from everywhere. This must stop,” Health minister David Parirenyatwa told a media briefing this week.

But without a proper support structure in place and a poor delivery system, this will take more than just banning food vendors.

With the prevailing economic situation, which has forced many people into vending, putting an end to this will be a near-impossible task and in the absence of proper legislation to clearly tighten the loophole it will remain a mirage.

“The delay in bringing the Public Health Act Amendment Bill to Parliament for debate and adoption is part of the problem. Local authorities continue to take advantage of the loopholes in the current outdated Public Health Act that was enacted way back in 1924,” Itai Rusike, from the Community Working Group on Health, said.

The current Act does not adequately cater and provide for effective handling of new trends of these diseases, Rusike said.

“So Parirenyatwa should be held accountable as the custodian of the Public Health Act.”

But Parirenyatwa has lumped blame squarely on the shoulders of councillors.

“Typhoid is purely caused by poor hygienic practices and, no matter what we do as a ministry, if the issues (erratic water supplies, poor sewer management and infrequent garbage collection) are not addressed we fail,” he said.

The city’s health director, Prosper Chonzi said they were frantically trying to address the typhoid menace, which according, to deliberations by the inter-ministerial committee, would require about $250 000.

He largely accused members of the public of failing to adhere to good hygienic practices.

“Issues of personal hygiene should be emphasised and people should practice things like boiling water before drinking and washing their hands after using the toilet or before consuming food,” Chonzi said.

On council’s actual action, he said teams were on the ground de-blocking sewer pipes and providing public education on typhoid causes and prevention.

Over the past few years, the City of Harare has been unable to provide potable water and, although many houses have the infrastructure for piped water, the supply is inconsistent.

A report compiled by Human Rights Watch (HRW) in 2013 pointed out that their surveys had revealed that people rely on water from boreholes, many of which are contaminated with human excreta.

Old unmaintained pipes and leaks in both water and sewage systems mean tap water that does not flow (like in some parts of Mbare) can be mixed with raw sewage.

Lack of access to proper sanitation facilities has perpetuated open defecation.

Although this is worse in rural areas, because of the illegal settlements in the peri-urban areas, this has creeped into the urban setting as well.

Such poor sanitation practices lead to outbreaks of diseases like typhoid and cholera.

“People should practice hand washing after using the toilet,” Chonzi gave the magic bullet.

But many do not have access to running water and the little they would have sourced from whichever source is preserved for more “important” uses like cooking.

Garbage lies uncollected for weeks and residents end up dumping it anywhere and everywhere.

Of concern, at the moment, is that the health delivery system is in the doldrums.

Most government health facilities are barely coping. They are grappling with repeated drug shortages, dwindling qualified personnel and obsolete equipment for diagnosis and treatment.

“We have enough stocks to manage an outbreak,” Parirenyatwa claimed unconvincingly.

However, if a repeat of 2008-9 plays out, the facilities and their skeleton staff will not cope.

According to the HRW report, corruption and mismanagement should be curbed and resources allocated for critical services be channelled to their rightful uses.

In a populist decision in 2013, a week before the elections, the Local Government ministry announced that all debts residents owed municipal authorities in urban areas would be cancelled.

This is despite that the revenue generated from the bills provides a bigger portion of the operating funds for Harare.

This has worked as a demotivating factor for residents to pay bills and in the process affecting city revenues.

“As long as infrastructure and health crises are not given attention by the government, it is unlikely that the situation will improve,” read part of the HRW report.

The ballooning wage bill, which has seen top management getting huge salaries and perks, has also been a bone of contention.

Elsewhere in the world, services like water provision and sanitation have been privatised.

In Europe, almost all the public toilets are managed by private companies and it seems to work out well, as they have a culture of paying for services.

“Water distribution, sanitation services and refuse collection have been privatised in most advanced countries including South Africa,” Rusike said.

Harare, during the mayor Solomon Tawengwa era from around 1994 to 1996 privatised refuse collection and the Zimbabwe National Water Authority, a parastatal, once took over the distribution of water in all major towns, but with disastrous consequences.

“To some extent, privatisation brings efficiency, but at a prohibitive cost to the majority poor and that may be a barrier to access,” Rusike said.

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