Access to Water and Sanitation in the City of Cape Town Informal Settlements: An Environmental Health Perspective

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1 Access to Water and Sanitation in the City of Cape Town Informal Settlements: An Environmental Health Perspective Author: Lena Stofile INTRODUCTION: Cape Town has a population of about 3,6 million people. The continued in-migration against the housing backlog has resulted in the proliferation of informal settlements. The CoCT adopted norms for the provision of basic services (water, toilets and solid waste removal). Environmental Health Practitioners (EHPs) from the 8 health sub districts carry out weekly inspection visits to all informal settlements in the city to monitor health hazards. Failure to meet the adopted norms and problems with access to water and sanitation are documented and reported to the relevant departments. The persistence and nature of the problems encountered; the difficulty in resolving them; and the Institutional Affiliation: City of Cape Town Lena.Stofile@capetown.gov.za contradictory perspectives of the various role-players lead to frequent clashes that are not helpful to get buy-in and cooperation of service departments and communities affected. Khayelitsha, situated 30 kilometres outside Cape Town and with a population close to 500,000, has two thirds of its population living in 46 informal settlements and it is the health sub district most affected by the backlog in access to basic services. This is aggravated by on-going conflict with community groupings who often express their disagreement with the choice of services, availability and its location through vandalism. This leads to further escalation of service backlogs and repairs against a budget that is already stretched. Aim and objectives: To improve access and meet Cape Town adopted water and sanitation norms by: 1. Improving EHPs monitoring and evaluation of access to basic services in their weekly visits to informal settlements. To use the data collected and M&E reports for service departments to develop a more effective service delivery plan to improve access and reduce shortfalls and meet approved city norms. High rate of Sewer blockages due to usage of unsuitable material Blockages Theft, use of non durable parts, slow repair response time frames Strategy: Challenges: EHPs lack of standardized M&E reporting systems. Informal settlement' compliance ratings not uniformly applied across the various sub districts. Lack of qualitative detail on associated health risk. The city's electronic notification system (C3), to register and report internal and external problems to all service units, not consistently used for water and sanitation problems. Fears by departments of health clogging the system and referrals to wrong departments. Fragmented reporting for quantification of complaints received, addressed and service turnaround times. Discrepant service databases with regards to the accuracy of dwellings and infrastructure count for the calculation of current ratios against the adopted norms. Land scarcity and high density settlements, limited the technical ability to install services and reduced the range of possible service choices. Exclusion of Health from initial planning process, resulted in lack of sync between educational 'user know-how' interventions and service installation. Challenges with community consultation, with regards to the 'choice' of sanitation service to be installed. Heightened community' expectations and political instability, leading to widespread rejection of services installed. Service delivery protests with extensive vandalism. Adoption of a single database to track levels of service delivery and infrastructure needs to meet adopted norms. Development of sub district spreadsheet (with name of settlement, no. of dwellings, no. of infrastructure available & shortfall), to produce Quarterly Reports on compliance with adopted norms. (As indicated by Graph 1 & 3 below) Engagement with service departments, for their input on definition of service levels and the development of best reporting format, to eliminate variability and misinterpretation of assessment reports. Adoption of an integrated area management approach (Sub District Urbanization Forum) to identify and address service delivery strategies closer to the ground. Identification of quick wins (low-hanging fruit), for rapid implementation, reduction of non-compliance with norms, and contributing towards gaining community trust. See Graph 2 & 4 below. Increased community involvement through the creation of temporary jobs (EPWP) employing people from affected areas for door-to-door education (hand washing, diarrheal prevention, etc., including water and sanitation problems. Consistent capturing of problems related to basic services directly via C3 electronic system, to quantify problems reported, repairs undertaken and turnaround time frames. Regular updating of dwelling count and services database. Quarterly review of services provided by relevant departments, and progress towards achieving the adopted norms. Khayelitsha Informal settlements Compliance with access to sanitation norms May 2012: ( 1toilet:5 household) Khayelitsha Informal settlements Compliance with access to water norms May 2012: (1tap:25 household) Khayelitsha informal settlements needing <60 taps to meet access to water norms: "Quick Wins" Khayelitsha informal settlements needing <50 taps to meet access to water norms: "Quick Wins" GRAPH 2 GRAPH 1 GRAPH 3 Outcomes: Improved EHPs M&E, and standardization of reporting and information systems. Development of standardized weekly pictorial reports Much improved effectiveness of pictorial reports to get message across (comparing with previous memo's, s, C3 notifications and tick sheets) to substantiate the relevance and severity of the problems reported. Acceptance by service departments of the value of City Health M&E process, as well as recognition of health's role in the service delivery planning phases. Improved interdepartmental communication and gradual reduction in silo operation approach Improved turnaround time in maintenance & repairs of infrastructure Increased communities' awareness around access to services r and roles of different service departments and increased visibility of officials on the ground Establishment of toll-free telephones for reporting faults by community Categorization of informal settlements based on suitability of criteria for provision of infrastructure Piloting of various technologies to suit various density and geographic conditions Piloting of janitorial services and provision of toilet paper Establishment of partnerships with community organizations City Health data upkeep & quarterly service review utilised strategically to channel budget and services to the most needy areas. Reduction of infrastructure backlogs and improved access to basic services in the long run Way Forward: The Sub District Urbanization Forum is the platform for pro-active engagement with city service delivery departments. Not all potential 'quick wins' are possible in reality due to an extensive array of local barriers. The collective identification of service delivery issues and development of integrated implementation plans to address them has a better chance of resolving challenges. City Health will continue to strive towards universal access to basic services in informal settlements within the City of Cape Town. GRAPH 4

2 Informal Settlement Services An environment free of pollution, rodents with access to adequate clean water and sanitation = healthy communities!

3 Waste

4 Water

5 Sanitation Conditions that reduce access to adequate, clean and functioning sanitary facilities Incorrect usage Incomplete structures Poor maintenance and repairs Unhygienic conditions Blocked drains Vandalism / theft Discharge of sewerage causing health risks

6 Grey Water All grey water is unfit for human consumption! Improper disposal of food waste, household waste materials and waste water: block storm water drains pollution of water bodies create unhygienic conditions attract rats and other pests can cause health risks for humans and animals

7 Hand Washing 1. Wet hands with clean water 2. Add soap to palms. 3. Rub hands together to create a lather. 4. Cover all surfaces of the hands and fingers 5. Clean knuckles, back of hands and fingers. 6. Clean the space between the thumb and index finger. 7. Work the finger tips into the palms to clean under the nails. 8. Rinse well under clean water. 9. Dry with a single use towel and then use towel to turn off the tap. Minimum wash time: seconds.