Excerpt from setting up community Health programmes by Ted Lankester
WHY URBAN ENVIRONMENTAL HEALTH IMPROVEMENTS ARE IMPORTANT.
The world health organisation estimates that 4 people out of 10 do not have access to basic sanitation (that is 2.6 billion people of whom 1.5 billion live in china and India). 2 people out of 10 do not have access to clean water
The 7th millennium development goal is to ensure environmental sustainability, and targets include halving the proportion of people living without clean drinking water and the proportion of people without sanitation by 2015. These priorities have put water and sanitation (WATSAN) high on the global agenda.
Many diseases are caused by water that has been contaminated by human faeces. Many environmental health measures are directed towards keeping human and animal waste separated from water used for drinking and washing.
3,900 children per day die as a direct result of unsafe water or absence of basic sanitation. Countless more suffer from diseases that are directly linked.
Diseases associated with poor WATSAN include diarrhoea, dysentery, typhoid, cholera, hepatitis, intestinal worms, trachoma and bilharzia. Quite apart from those who die, many million, especially children, are weakened by repeated infections.
Success, in reaching this MDG target would enable people to lead healthier and more productive lives and would improve the economies of all the poorest nations. To reduce these diseases of poverty, three actions are essential:
• Improving the quality and availability of water.
• Disposing of human waste, especially faeces.
• Improving hygiene – at personal, household, school and community levels.
These three components have been described as the legs of a three-legged stool. Unless all legs are present the stool falls over.
This chapter concentrates on water supplies and waste disposal. Recent research has shown just how vital this is: regular hand-washing with soap can reduce diarrhoea by almost half.
In community based health care we can empower community members to make significant improvements at the household level and to make more widespread improvements through advocating or working with government departments.
It is worth emphasizing that any technology that is not affordable by the community will not be sustainable.
Nearly all government funded or subsidized investments in capital works fail at handover. There are rarely sufficient government funds- or political will- for proper maintenance.
This means that for any government linked programme to be successful there must be full community involvement from the start, both in deciding what improvements should be made, in management, in maintenance and in community financing. The community must have ownership of changes and improvements from the very beginning.
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