Out of all global health matters, the World Health Organization (WHO) highlights the indisputable importance of water, as it is essential to life. Furthermore, this branch of the United Nations primarily concerned with international public health states that, “the amount of fresh water on earth is limited, and its quality is under constant pressure. Preserving the quality of fresh water is important for the drinking-water supply, food production and recreational water use (WHO, Water).” Quality drinking water, or lack thereof, is a powerful environmental agent that determines health outcomes. The problem in preserving the quality of water is the presence of various external factors, some of which include: infectious agents, toxic chemicals, and radiological and biological hazards. In 2008, a WHO study noted that improving access and eliminating contamination in water can drastically improve the overall health of the population. Based on annual statistics, investing in improving drinking water can prevent: “1.4 million child deaths from diarrhea; 500,000 deaths from malaria; and 860,000 child deaths from malnutrition (WHO, Water, 2008).”
Developing countries are vulnerable to compound challenges that are interconnected, hindering their ability to eradicate poverty. Lack of access to basic resources, such as safe drinking water, is a crisis that contributes to poor quality of life, spread of disease, morbidity, mortality, and lack of environmental sustainability. The effects of climate change and natural disasters increase risks in many sectors of urban and rural life. Flooding or cyclones, for example, can damage inadequate infrastructure, roads used for transport, water storage systems (e.g. a container that protects the water from re-contamination), and, where poor sanitation exists, pipelines can be susceptible to the inundation of waste and toxicities. In addition, in many sub-Saharan African countries it is the job of women and girls to fetch water for the household. The long distances to be traveled, complemented by waiting in lines, limits time available for schooling and lowers social prosperity. Clearly, access to safe, local and accessible drinking water is vitally important.
The pages that follow serve as an informative tool in explaining the causes and consequences resulting from the dire crisis of water insecurity. My argument strives to show that water-borne infectious diseases can be prevented and controlled through proper management, supply, and provision of safe drinking water. I will acknowledge members of government and NGOs who have recognized the importance of alleviating water scarcity. However, I will illustrate why, despite that the action has been taken in various forms of projects, initiatives, and setting goals, many constraints against success remain in poverty ridden and socioeconomic insecure regions, such as Madagascar.
Madagascar, a large island lying off the coast of southeastern Africa in the Indian ocean, is a poor country that suffers from high levels of water contamination, along with many other ills. In 2014, an annual UNDP Human Development Report measured Madagascar in three basic sectors: life expectancy, education attainment, and income: all of which correlate to the quality and standard of living of its population. Madagascar placed 155 out of 187 countries, which signals a country’s low level of development (UNDP, HDR Madagascar, 2014).
Antananarivo, the capital, is a case in point. In 2008, the Infrastructure Consortium for Africa (ICA), stated in a project proposal for piped potable water that the “majority of population in this area is poor and has no access to piped water.” Five years later, the country’s progress in access toward resources has not been impressive. In 2013, the Municipal Office of Hygiene in Antananarivo stated that, “only 24 percent of households in the urban community have a private water connection, while the remainder is dependent upon standpipes, water kiosks, and wells." Such lack of access to clean water is a crisis for the continuing development of Antananarivo.
Water in the Sustainable Development Goals
On July 28, 2010, the UN General Assembly issued a thematic report recognizing and prioritizing the basic human right to water and sanitation. It acknowledged that clean drinking water (and sanitation) is essential to global health, as well as a human right of all individuals, irrespective of where they live. The report resolved to call upon the governments and international organizations to “provide financial resources, help capacity-building and technology transfer to help countries, in particular developing countries, to provide safe, clean, accessible and affordable drinking water and sanitation for all.”
The statistics and linkages between unsafe water and global health presented by WHO were reiterated five months later in December 2010, when the director of the USAID referenced its impact on the education sector. With regard to Madagascar, “more than 3.5 million school days are lost each year because students fall ill from diarrhea and other illnesses due to lack of clean water or adequate sanitation.”
A leading reason why diarrhea is prevalent in developing countries, and takes the life of nearly one in five children, is because of a lack of safe drinking water caused by the region’s unsanitary environments, thus allowing diarrhea-causing pathogens to spread easily. The United Nations Children’s Fund (UNICEF), states that “diarrhea caused by dirty water, poor sanitation and bad hygiene kills more children than malaria, measles and HIV/AIDS combined (Diarrhea, UNICEF, 2009).” Dehydration, malnutrition, and a weakened immune system all increase vulnerability of children in developing regions, illustrating why it is the second largest reason for child mortality.
Rural vs. Urban Antananarivo
Situated inland at the center of the island Antananarivo is the largest city in size and population, and in 2012 it was estimated to be home to around three million people. The population is expected to double to six million by 2030. The cityscape of Antananarivo is unique because the surrounding communes are peri-urban. Considering its landscape, the city progressively spreads out from this central point to cover the hillsides to the flat terrain at the base of the hills. During the rainy season between November and April, these flatlands are susceptible to flooding. The plains are drained via the Ikopa River that borders Antananarivo to the south and west. Dating back to pre-colonial times, the lower classes, including those descended from the slave class and rural migrants, have occupied the flood-prone lower districts bordering the Betsimitatatra rice fields to the west of the city.
The international NGO WaterAid, which actively works in Madagascar, states that the country is "one of the poorest in the world with a population growing faster than its economy," resulting in over 11 million people who lack access to safe drinking water. Similar to other developing cities and states in Africa, the rural areas of Antananarivo are burdened by poverty, pollution, and inadequate infrastructure. In contrast, the urban sectors feature modern restaurants, shops that sell western goods, good healthcare facilities and other social services, universities, and an airport. In general, the availability and quality of health care is better in Antananarivo than elsewhere in Madagascar. Access to quality drinking water is one of the greatest disparities between the rural and urban community: 66% of urban inhabitants have access, while fewer than 15% do in rural areas. WaterAid asserts that this enormous inequality makes the challenge of overcoming poverty virtually impossible for the rural population. Furthermore, a UNDP report published in 2006 states that slum dwellers in developing countries typically pay “5-10 times more per unit of water, than people with access to piped water (UNDP, Water and Sanitation Report, 2006).”
In the peri-urban communities of Antananarivo, as elsewhere in Africa, women and girls face the grim task of collecting dirty water from unsafe sources. The gender inequality inflicted upon them results in other issues aside from serious illness due to poor-quality water. With the long distances required to fetch water, and the intermittent availability of water that results in long lines, women and girls are faced with limited free time for social inclusion, plus poorer health and lowered standards of living. Improving access to clean water helps more than just health.
Challenges in the city
Antananarivo is a home to around 10% of the island’s population. Rural migration into the city propels uncontrolled urban expansion in Antananarivo, and challenges residents because of economic downturns and economic policy shifts. The burden of structural adjustment programs implemented by the World Bank (WB), and the national economic crisis that hit Madagascar in the mid-1970s until the early 1980s, lowered living standards for residents of the city. This, in turn, incited state subsidies, rapid inflation, higher taxes, widespread impoverishment such as poor infrastructure, shortages of clean water, decreased public health, degraded sanitation, and the economic decline of the population. Inadequate management of urban, industrial, and agricultural waste water significantly contributed to dangerously contaminated or chemically polluted drinking water for millions of people. These effects were especially evident in Antananarivo, as was the growing wealth of a rather small political and economic elite in the city.
According to a 2012 UN-Habitat report titled, “Madagascar: National Urban Profile,” in Antananarivo, “running water was installed in fewer than 25% of homes, small restaurants and businesses in 2007, necessitating the collection of water from household wells or neighborhood pumps.” Mandated by UN General Assembly in 1978, UN-Habitat is the UN program that works toward addressing socially and environmentally sustainable human settlements, and assumes a catalytic role in matters of urbanization and development processes. Additionally, the report describes the densely populated residential zones of Antananarivo that contribute to a lack of access to clean drinking water. Exacerbating the problem is inadequate, proper processing and disposal of industrial and residential waste in the city. “Waste-water is often discharged directly into the city's waterways,” according to the report. Although over the last few years the city has set up scattered clean water pumps, they remain inefficient and access is limited, declining even more in the poorest and most populous parts of Antananarivo.
The International Development Association (IDA) is an international financial institution and a member of the World Bank Group that offers concessional loans and grants to the world's poorest developing countries. It became directly involved in addressing the issues of Madagascar by introducing a sector strategy and action plan to the Malagasy (Madagascar) government in the 1990s. Upon approval by the government, the initiative brought clean water and sanitation services to rural residents, as well as lessened the burden of women and girls who have to fetch water over long distances. A two-decade long time frame was assigned to raise the water supply level from 12% to 50%, and the sanitation level from 5% to 30% by 2010. Another mission of the project was to confront the water and sanitation crisis through a balance of institution support, capacity building, and infrastructure development. Through this partnership of the Malagasy government and the IDA, the Rural Water Supply and Sanitation Pilot Project was launched. At that time, only about 12% of the 12.5 million people living in the rural community had access to potable water, hygiene was poor, and community efforts to educate the residents on the importance of improving these standards were weak. Compounding the dire crisis was that the water and sanitation sector of the Malagasy government was “disorganized and uncoordinated, lacked any real policy, legal, regulatory, or operational framework,” according to IDA.
Climate and Environmental Instability
Madagascar is vulnerable to natural disasters including cyclones, droughts, and flooding. The hurricane season is usually between the months of December and March. Recently the World Bank (WB) updated its country profile on Madagascar and estimated that one quarter of the population currently lives in zones at high risk of natural disasters. In addition, dry seasonal periods pose a threat for rural households, since only 26% of rural families have access to water during the dry months.
Within the UN system, the UN Environment Program (UNEP) is authoritative in the realm of sustainable global environmental development. UNEP provides an overview of what is expected by 2050, in a fact sheet titled, “Climate change in Africa- What is at Stake?” With regard to rainfall, the document warns that there will be major changes in terms of annual and seasonal trends and extreme periods of flood and drought. It states that, “rainfall in southern Africa is likely to decrease in much of the winter rainfall region and western margins. There is likely to be an increase in annual mean rainfall in East Africa.” The findings in the document also reveal that by “2020 a population of between 75 and 250 million” will be exposed to increased water stress due to climate change. Furthermore, the effect of climate change is “likely to impose additional pressures on water availability, water accessibility and water demand in Africa.”
The arid and semi-arid seasonal periods intensify water scarcity and water shortages. Combined with population growth in Madagascar that has risen 2.6% in just one year from 2013 to 2014, and lack of economic development, water scarcity is acute in this region. The UN Food and Agriculture Organization (FAO) explains that water scarcity occurs from “imbalances between availability and demand, the degradation of groundwater and surface water quality, inner-sector competition, inter regional and international conflicts, (FAO Water Scarcity and Shortages)” and is a direct consequence of poverty.
In order to tackle water scarcity in Madagascar, education and raising awareness of the crisis are crucial initial steps that are vital in gaining international support, financial donors and partnerships across global health and development sectors. NGOs such as WASH and WaterAid will be able to harness an expert collaboration to confront challenges of capacity building and sustainable infrastructure development. Working with professional and government representatives in the health and environmental sectors could tremendously enlarge the sphere of influence of development projects.
Rural populations in Madagascar, as well as other countries in Africa, disproportionately lack the access to improved water supplies. Sharp geographic, sociocultural and economic inequalities between rural and urban areas must be broken. In addressing the gender-inequality in the water sector, women will be able to have a voice as well, as they won’t be spending hours each and every day hauling water. With that said, my recommendations are not solely focused in digging wells or water pumps. Rather they stress the importance of educating marginalized groups. It can be done through workshops and creative learning methods about legal and human rights to water. When poorer and vulnerable groups are empowered with decision-making skills, they become included in generating projects in local, municipal, and state levels. Taking this bottom-up approach of first educating the lower class of their basic right to water could have a powerful effect. As a result, the government may feel pressured toward making long-term political commitments concerning policies of allocating water resources, and establishing sustainable improvements in tools used for water provision and storage.
Madagascar is prone to natural disasters, which contribute to a recurring state of emergency. I recommend teaming up with Medair, an international humanitarian aid agency that has been responding to emergencies, especially post-cyclone regions, in Madagascar since 2002. Medair’s work needs to expand, as its strategy can be beneficial as the organization recruits and requires community participation. Furthermore, in rural villages, training local business in simple drilling and construction techniques and how to install water pumps will be effective in bringing locals drinking water. When the community participates in improving access to safe drinking water pumps, members feel included, empowered, and learn sustainable skills. Moreover, learning these skills will ensure that the community members will pass down the fundamentals of preserving and sustaining this progress to future generations. Also, new water stations will need to be managed by members of the community. This, too, will give individuals a greater sense of purpose and social inclusion in their communities. In regions that are hardest hit by floods, it is necessary to not only build sustainable water points, but they must be elevated and protected for inevitable disasters.
I support and recommend continuing WaterAid’s work in gravity-fed water systems. The organization argues that this system proved to be a sustainable water supply technology by virtue of its “supply [being] from a small upland river, stream or spring, impounded within a protected catchment.” Another benefit of using this system is that the work involved in hauling water is reduced. By using the force of gravity, water is transported by pipework to tap-stands that can be placed near residential homes. Although this system is more costly than obtaining water from underground sources because of the various operational costs, its reliability is high, and it reduces attendant social ills. Important components of the gravity-fed water system include all sorts of distribution pipelines. With these improvements, the country will see a boost in its overall economic growth, which will also contribute to poverty reduction.
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