Understanding the Water Health Nexus: Perceived Local Linkages between Water, Environment and Health

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1 Understanding the Water Health Nexus: Perceived Local Linkages between Water, Environment and Health Project Partners Fleming College Kenya Medical Research Institute Lake Victoria Basin Commission McMaster University Rotary (Hamilton) The Canadian Institute of Cultural Affairs (ICA Canada) Uganda Christian University University of Waterloo Local Facilitators and Participants Il Ngwesi Kisumu Department of Environment Kisumu Department of Health Rotary (Kisumu) SANA International Usoma West Kagan Rationale Access to safe water is a key determinant of population and public health, particularly in low income countries. Contamination from industrial, agricultural and primarily human waste continues to threaten both human and ecosystem health in many parts of the world. Further, it is now widely recognized that the primary determinant for addressing the issues of global poverty is the provision of safe water; access to safe water enhances the potential for educational opportunities (particularly for girls) and facilitates participation in local community economic development. Water related diseases associated with contamination are many: diarrhoea, cholera, typhoid, shigella, polio, meningitis, and hepatitis A and E. Children and women are most severely and directly impacted by this contamination. Understanding the relationship between drinking water and good health is vital to population and public health, as access to safe drinking water through source water protection, treatment and sanitation, is a cornerstone of a healthy population. However, sustainable interventions can only be achieved through education, empowerment and ownership. Moreover, without an understanding of the social, political, cultural, historical and economic contexts within which humans live, work and play, sustainable change in human behaviour is not possible. When communities can access to safe water, it results in improved household health and substantial reductions in the amount of time and effort required to collect water and undertake 1

2 sanitation related activities. In turn, these changes facilitate improved food preparation, increased time available for tending to crops and livestock, greater school attendance, and, an opportunity to participate in the local economy; all mechanisms which work toward breaking the cycle of poverty (Schuster Wallace et al., 2008). Indeed, it is no longer disputed that the primary route to solving the problem of poverty in the world is through the provision of safe water. Project Purpose To bring together the experience of partner institutes in Canada, Africa and elsewhere to understand the knowledge, attitudes, practices and perceptions of local communities around water and health; To use this information to develop an educational intervention that will help raise awareness of water health links in local communities, especially in the Lake Victoria basin; To develop community based decision support tools for understanding the physical and socio economic contexts within which a community has to work towards managing their water resources; To identify best practices that facilitate the development of a community vision and action plan for safe water supply; To provide the capacity development and technical expertise necessary for the community to carry out their action plan to achieve access to sustainable safe water; and, To create sustainable development conditions for the people of East Africa by directly addressing water health challenges in an integrated and effective manner. Project Summary This initiative addresses a very difficult question related to understanding human knowledge, attitudes and practices around water and sanitation, with a focus on sustainable behaviour change with respect to health and wellbeing in rural, remote and marginalized communities in East Africa. In so doing, the project brings particular emphasis to the roles of women and girls in society, the burden of water provision in rural, remote and marginalized communities, and the opportunity costs associated with this activity, particularly access to education and time spent caring for the sick. Engagement of local people is essential to finding sustainable solutions and increasing the probability of sustainable change (Schuster Wallace et al., 2008). The involvement of women in particular has been demonstrated to improve the success of project outcomes (Chattopadhyay and Duflo 2004). Further, it is essential when attempting to understand a complex ecosystem to engage a mixed methods approach that blends epistemologies (Waltner Toews and Kay, 2005). The initial phase of the research program implemented a community centred, mixed methods approach to understanding linkages in 2 rural communities in Kenya. The approach included focus groups, semi structured interviews (household and key informant), household surveys, community mapping, photo voice, rapid assessment surveys of water sources, water quality testing and hydrogeological investigations. The methodologies developed, and findings established, will be applied to the second phase of this initiative. In all cases, community members are trained to work with the researchers to undertake data collection, building local capacity as well as allowing for some economic gain on the part of the community. 2

3 The second phase of the project will focus on mobilizing these communities to address challenges related to water and health in an integrated manner that promotes community mobilization and ownership. Focus has shifted slightly, as a result of preliminary findings, to incorporate community and social cohesion into the project, as it became clear during the initial phase that this is essential for project sustainability. By building upon pre existing conditions, using strategies which require community participation, and making everyone part of the leadership of the project, the initiative will create a sense of community ownership as well as improved understanding of water health linkages and the resources available to secure safe water provisioning. As part of the process to understand how decisions are made and what information is required for informed decisionmaking, the project will facilitate community consultations of stakeholders to develop together a community vision. The community and project partners will work together to develop an action plan to implement that vision, which will be used to identify appropriate and sustainable solutions. Ultimately, the lessons learned will be used to develop supporting tools and co ordinated, validated information to scale up and scale out community support to facilitate rural safe water provisioning both in East Africa and globally. Project Stages 1. Community and Site Reconnaissance Meet stakeholders in the community Build local partnerships Conduct preliminary research on perceptions and behaviour around water, environment and health in the community 2. Public Awareness and Education Campaign Facilitate the education of communities on the linkages between water, environment and health 3. Community Visioning Facilitate all stakeholders to participate in a process in which the community develops a vision to address their water needs Using UNU INWEH s Hydrosanitas knowledgebase, communities input their local conditions and needs to find out which technologies would be suitable for them 4. Community Decision and Action Plan Facilitate dialogue among the community regarding the available options The community decides on the appropriate solution and develops an action plan to carry out the initiative Conduct capacity development activities to equip local people with the skills necessary to achieve their vision 5. Project Expansion Conduct training of trainers to build the capacity in local people to expand the project into other communities Project Status Phase one of the project has been initiated in Usoma and Il Ngwesi. The project will expand to other communities in Kenya, Uganda and Tanzania, replicating established methods to understand the issues, contexts and perceptions within each community with respect to water, environment and 3

4 health and continuing to engage communities in developing interventions and evaluating effectiveness and sustainability. Preliminary research by UNU INWEH graduate students has been completed in Usoma and is ongoing in Il Ngwesi. This research is assessing local perceptions and behaviours related to water, environment and health. The resulting data will provide the basis on which to design the subsequent stages of the project which will address safe water provisioning and educating communities about linkages between water, environment and health. Through funding from the Hamilton Rotary Club, UNU INWEH has initiated a small water supply and sanitation intervention in Usoma. Project partners are working with local stakeholders to determine which technology would be most appropriate to address the community s water needs. It is hoped that this initial investment will act as a catalyst for the community to take action to solve their water related issues. Project partners have strong linkages within the targeted communities. The UNU INWEH Near Lakeshore Drinking Water Project, which has now been completed, has created strong local ties in the communities of West Kagan, Kenya; Kiyindi, Uganda; and Mbarika, Tanzania; and has provided preliminary information about local access to drinking water sources and sanitation. ICA Canada has worked with the community of Il Ngwesi to facilitate an HIV/AIDS intervention through the Afya Program. Through this initiative the organization has developed strong local partnerships through facilitating community strategic planning, program development and funding, and focusing on community ownership, participation, and relationship building. Through this process the community has demonstrated their ability to organize themselves to address local issues. Due to ICA s ongoing capacity development activities in Il Ngwesi, there is a group of local leaders able to actively participate in project implementation, mobilize the rest of the community and initiate project expansion in securing water supplies. Next Steps Compiling the information collected from the preliminary research in Il Ngwesi Conducting education and public awareness campaigns in the communities based on findings in Usoma and Il Ngwesi Identifying and applying for funding opportunities to implement the community vision and action plans in these communities Linking graduate students with communities identified for project expansion to conduct preliminary research Funding Opportunities CIDA Partners for Development program (universities; colleges) CIHR Operating Grant Lake Victoria Funding Agency Kenya Water Services Trust Fund African Development Bank 4

5 References Chattopadhyay R and Duflo E. (2004) Women as policy makers: evidence from a randomized policy experiment in India. Econometrica. 72 (5): Schuster Wallace C., Grover V., Adeel Z., Confalonieri U. and Elliott S.J. (2008) Safe Water as the Key to Global Health. Hamilton, Ontario, Canada: United Nations University: International Network on Water, Environment and Health. Waltner Toews D. and Kay J. (2005) Evolution of an ecosystem approach: the diamond schematic and an adaptive methodology for ecosystem sustainability and health. Ecology and Society 10(1):

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