Having just returned to New York from Maputo, the capital of Mozambique, I'm reminded how lucky we are in this city to have reliable water and sanitation services. Thanks to investment in water pipes and sewers in the 19th century, diarrheal diseases that ran rife through our city a few generations ago have all but been eliminated, and we take it for granted that safe drinking water is available at the turn of a tap.
As in many other large cities across the developing world, Maputo is facing rapid growth of low income settlements and major challenges in providing the population with access to safe water and sanitation. The latest data (UNICEF/WHO 2012) show that only 77% of Mozambique's urban population has access to improved water sources. The situation is even grimmer when it comes to sanitation, with only 38% of the urban population having access to safe sanitation.
The country has one of the highest infant mortality rates in the world with 86,000 children dying before their first birthdays every year. Diarrhea is one of the leading causes of child deaths and 44% of children under five are undernourished.
Increased investment in providing access to safe water and improved sanitation dramatically impacts child survival. In low-income areas of cities like Maputo, that is often a complex task. High population density, transient populations and, poor quality housing are part of the problem and present challenges to those striving to improve water and sanitation infrastructure.
Often in low-income urban neighborhoods the provision of piped water to homes is simply too expensive for ordinary families to afford. One way of tackling that problem is by helping local residents band together and negotiate affordable payment plans with water service providers with the help of local NGOs.
Last week I visited the community of Costa do Sol on the northern periphery of Maputo and found that a community water users' association (ACODECOS) established with the help of WaterAid and local partner organization ESTAMOS had achieved great success in expanding the number of household water connections over a five year period, with very positive results for the health of the community, particularly children. Data given to us by the Ministry of Health showed that the number of cholera cases had dropped from 371 in 2003/4 to only 21 in 2008/9.
One reason why this was achieved was ACODECOS' successful negotiation of a reduction in the household connection fee to $50 (from Aguas de Mozambique, a private company receiving 75% of its investment from government) that can be paid in installments.
Local resident Francesca Nhantos in the photo above told me that having piped water available in the home had transformed her life. "Before we had the standpipe a water truck came to the village once a week and we had to pay 5-7 meticais (20 cents) for 20 litres of water and we weren't sure how clean it was so we had to boil it."
"Having a tap outside my front door has made a huge difference to my life. The well in my yard only produces salty water so I had to walk to a standpipe far away to collect water and sometimes when I got there there was no water. I have a water meto and my average water bill if $4.00 a month."
In the above photo, Laura Jose' is washing her hands while Arminda Manuel, the local health promoter is looking on.
Laura is washing her hands in the bowl we had installed in our primary school. All the children wash their hands here before school breakfast or school lunch. We have three shifts at the school and over 2,000 students. They are on holiday at the moment for the winter vacation. The students can also drink from this tap. We have worked with the Parent Teachers Association to install boys and girls toilets. Now the girls are not afraid to go to the toilet and are not dropping out of school as they did before. Laura and I both have children in this school."
As Arminda told me, other changes, such as the installation of latrines, hygiene education, the provision of drinking water and toilets in schools and the disposal of solid waste, have also helped to dramatically improve the health of the community.
With the absence of piped sewerage in densely populated low-income urban communities, disposal of fecal sludge from latrines also poses a major challenge. Last week, I visited a pilot project managed by WSUP (Water and Sanitation for the Urban Poor), an organization working closely with WaterAid. This project shows how offering loans to small businesses can help with the development of affordable waste management services.
Paulo Biane Vaiene from the Maputo community of Maxaquene is one such entrepreneur benefiting from financial assistance. His small enterprise UGSM Vaiene started emptying small septic tanks using a small pump and tank called a "gulper" that was pulled by a donkey. With a loan from WSUP he was able to buy a truck that has allowed him to cover more clients and expand his radius of operations. Business is thriving, more households can now take advantage of his services, which cost around $20 and are required twice a year, and public health is safeguarded by the safe disposal of the waste.
Just as Paulino has demonstrated that fecal sludge removal can be a profitable business, there are opportunities to develop small businesses selling a selection of toilet designs to families. A range of viable technologies has been developed, but business models need to be developed with finance plans to ensure that options are affordable to all families regardless of income. We found that all needed construction skills exist in the communities, so the focus needs to be on ensuring these skilled laborers are able to find employment that not only helps their families out of poverty but also helps communities stay healthy and meet their basic needs.
These experiences show how innovative financing models can impact on health in low-income urban communities. When water connection charges are not only reduced but split into installments, poor families can afford to get linked to the municipal piped water system, and the support of small private service providers ensures families have access to effective and affordable fecal sludge removal services until the sewage network can be expanded.
These examples also show the importance of linking larger systems -- such as pipes for the water utility or waste management and sewage systems -- with community and household-based needs and approaches. Reducing poverty and protecting people's health and well-being requires a combination of efforts, from local capacity building and small business development, to larger-scale infrastructure development. I was inspired by the efforts being made by NGOs and community based organizations to build healthy communities. The skills, the demand, and the creativity are there. We have so many opportunities now to make the most of them.