ZIMBABWE CHOLERA - USAID/DART WASH ASSESSMENT

UNCLAS SECTION 01 OF 03 HARARE 000086 SIPDIS AIDAC AFR/SA FOR ELOKEN, LDOBBINS, BHIRSCH, JHARMON OFDA/W FOR PMORRIS, ACONVERY, LPOWERS, TDENYSENKO FFP/W FOR JBORNS, ASINK, LPETERSEN PRETORIA FOR HHALE, PDISKIN, SMCNIVEN GENEVA FOR NKYLOH ROME FOR USUN FODAG FOR RNEWBERG BRUSSELS FOR USAID PBROWN NEW YORK FOR DMERCADO NSC FOR CPRATT E.O. 12958: N/A TAGS: EAID TBIO EAGR PREL PHUM ZI SUBJECT: ZIMBABWE CHOLERA - USAID/DART WASH ASSESSMENT -------------- SUMMARY -------------- ¶1. From January 23 to February 7, the USAID Disaster Assistance Response Team (USAID/DART) water, sanitation, and hygiene (WASH) specialist undertook an assessment of the WASH sector response to the present cholera epidemic in Zimbabwe. The water and sewer systems serving urban centers in Zimbabwe are in abysmal condition as a result of financial neglect and the resulting lack of maintenance. Few rural areas have access to clean drinking water or sanitation facilities. The lack of clean water and poor sanitation conditions are major contributing factors in perpetuating the present cholera outbreak. The WASH sector response has been severely hampered by the lack of government WASH partners, as well as logistics issues. ¶2. Despite the obstacles faced by the WASH sector, non-governmental organization (NGO) partners are performing exceptionally well in implementing cholera control interventions that meet professional standards. Unfortunately, the cluster has not fully evaluated the effectiveness of WASH interventions to date. In light of the increasing number of cholera cases, it is critical that the WASH sector conduct a real-time evaluation of the effectiveness of the WASH interventions and make adjustments to the cluster strategy based on the findings of the evaluation. END SUMMARY. -------------- USID/DART WASH SPECIALIST ACTIVITIES -------------- ¶3. While in Zimbabwe, the USAID/DART WASH specialist met with the UN Children's Fund (UNICEF),Oxfam/Great Britain (GB),World Vision, the International Organization for Migration, Concern, Mercy Corps, Norwegian Church Aid and GOAL. The WASH specialist also met with representatives from the European Community Humanitarian Aid Office and the UK Department for International Development (DFID),as well as USAID and U.S. Embassy staff. The WASH specialist conducted assessment visits to the urban areas in Beitbridge, Bulawayo, and Kadoma districts, high-density suburbs including Chitungwiza in the Harare area, and rural areas in Mudzi District. The WASH specialist participated in Joint Health and WASH cluster and stand-alone WASH cluster coordination meetings. -------------- WATER AND SEWER SYSTEMS IN URBAN AREAS -------------- ¶4. Water and sewer systems serving urban centers in Zimbabwe are in very poor condition as a result of financial neglect and the resulting lack of maintenance. Water systems are on the verge of collapse. Water is produced and delivered irregularly in urban areas, while many high-density urban areas have no piped service. Urban water treatment facilities have no chemicals other than those supplied by international organizations, primarily UNICEF. Water treatment chemicals are a critically needed item as many municipal water sources are heavily contaminated, such as the Lake Chivero reservoir serving Harare and the Limpopo River serving Beitbridge. Qreservoir serving Harare and the Limpopo River serving Beitbridge. ¶5. Facility operators are knowledgeable and professionally operate the facilities when chemicals are available, shutting off water supplies when there are no water treatment supplies. Shutting off water supplies disrupts service and allows contaminated ground water to enter empty water pipes. During water disruptions urban residents obtain water from shallow open wells. The wells are in disrepair and easily contaminated with surface water. ¶6. The gravity sewers have overflowed in numerous locations. The sewage runs down streets and pools in low areas creating large marshy areas filled with sewage. Residents have created dirt dams along streets preventing the sewage from entering yards and surrounding homes. During heavy rains the sewage mixes with waters HARARE 00000086 002 OF 003 flooding the communities and flows into the unprotected open wells. NGO partners are working with sewer operators, providing tools and assistance to unclog sewers. Unfortunately, without long-term financial and technical support for the utilities, the sewers will become blocked again and overflowing sewage will place community residents at risk of catching cholera and other fecal-borne illnesses. ¶7. Repair and renovation of urban water and sewer systems will be a massive financial undertaking, but a necessary one if the Government of Zimbabwe wishes to minimize future outbreaks of water-borne and sanitation-related diseases in urban areas. Any U.S. Government long-range strategic planning for the WASH sector must consider support for repair and renovation of urban water and sewer systems. -------------- WATER AND SANITATION IN RURAL AREAS -------------- ¶8. Rural communities use shallow wells or handpumps connected to boreholes for water needs, where available, otherwise resorting to sources such as rivers and streams. Many handpumps are nonfunctional due to a lack of spare parts and technical support for rural communities. Oxfam/GB reported refurbishing a handpump that had been broken for more than six years due to a worn out leather gasket. The leather gasket is inexpensive, simple to replace, and typically wears out in six months. ¶9. The USAID/DART WASH specialist inspected a number of shallow wells during field visits, finding that all such wells were in disrepair and open to contamination. Latrine coverage in rural areas is minimal as many pit latrines are full and not functional. -------------- HUMANITARIAN COORDINATION -------------- ¶10. In partnership with the NGO community, UNICEF is actively resolving coordination problems through the WASH cluster mechanism. The WASH cluster has formed a strategic advisory group that overseas technical issues and has outlined a cholera control strategy that appears to have been adopted by the NGO community. Health and WASH partners implementing social mobilization interventions have formed a working group to guide hygiene promotion interventions and standardize associated printed materials. NGO partners appear to be actively participating in cluster meetings and working groups. ¶11. UNICEF has added a full time information management officer to support WASH cluster efforts to improve coordination. The addition of information management support should dramatically improve WASH sector data collection and dissemination of compiled data. -------------- TECHNICAL CAPACITY -------------- ¶12. UNICEF and NGO WASH staff appear to have the technical capacity to effectively implement cholera control interventions. The emphasis on household water treatment, hygiene promotion and quick cost-effective repairs to sewers, water lines, and hand pumps, if implemented effectively, should mitigate the spread of cholera and Qimplemented effectively, should mitigate the spread of cholera and provide community members with the knowledge and tools to protect themselves during future cholera outbreaks. ¶13. New borehole construction remains a concern. The construction of new boreholes is a costly intervention that is not sustainable without long-term technical support. Instead of new boreholes, the WASH sector should place greater emphasis on household water treatment and the construction and protection of open wells, as well as the construction of rainwater catchments particularly in rural HARARE 00000086 003 OF 003 areas. -------------- EVALUATON AND MONITORING -------------- ¶14. While the implementation of WASH interventions appears to be progressing well, there has been no credible evaluation of the effectiveness of the interventions. The lack of a standard, ongoing, real-time evaluation of WASH interventions is a critical shortcoming. The sector is evaluating success based on materials provided, infrastructure repairs, and cholera prevention instruction. The WASH sector must evaluate the expected outcomes of interventions such as evaluating household water quality and measuring cholera prevention knowledge, attitudes and practices. -------------- RECOMMENDATIONS -------------- ¶15. USAID's Office of U.S. Foreign Disaster Assistance (USAID/OFDA) should continue to focus on the present hygiene promotion and household water treatment interventions. Considering the present situation in Zimbabwe, interventions that strengthen individual household coping mechanisms have the greatest chance of being sustainable in both rural and urban areas. Such emergency interventions will help increase household-level preparedness in the event of a future cholera outbreak, complementing USAID/OFDA's longer-term complex emergency WASH programming. ¶16. It is critical that urban water treatment plants have sufficient chemicals to treat and deliver safe drinking water to urban residents. USAID/OFDA should closely coordinate with other donors to ensure than UNICEF supplies urban water treatment plants with an adequate quantity of water treatment chemicals. ¶17. USAID/OFDA should avoid funding drilling of new boreholes. The present situation in Zimbabwe makes new boreholes unsustainable, as even existing handpumps are often not being properly maintained. The large number of existing non-functioning handpumps provides evidence of the present inability of communities to conduct repairs and the lack of a spare parts supply chain. Rehabilitation of existing handpumps should only be funded if the implementing agency agrees to provide both long-term technical and material support to the community with the rehabilitated handpump. ¶18. For water source development, USAID/OFDA should consider funding the construction and renovation of open wells and the construction of rainwater catchments. Such interventions, in combination with the household water treatment and hygiene promotion interventions have the greatest chance of sustainability and contributing to future disaster risk reduction. ¶19. USAID/OFDA should strongly encourage UNICEF and the WASH sector to conduct a real-time evaluation of the effectiveness of the WASH interventions. MCGEE