As a son of Homa
Bay, born, bread and schooled within the County up-to Secondary level and a PHO
who has spent most of his professional experience within the county, I think I
understand it better. I wish to share why Cholera again struck Ndhiwa in Homa Bay,
claiming 3 lives and more than 100 cases. I am very sure this will not be the
last Cholera outbreak unless any miraculous public health and sanitation
investment happens in the shortest time, and the issues I wish to express, well
in the public domain, are not given the requisite attention. Any single
confirmed cholera case, in any village is a sign of a very poor water,
sanitation and hygiene situation. Why in this age would people die from a
disease very preventable by mere proper washing of hands, proper cooking of
food or proper environmental sanitation? We may mistake it as a matter of
cultural negligence but I take it as the repercussion of poor public health
governance.
The statistics
on the ground do not lie. From report sources, only 2% of the more than 1.2
million residents of the County have access to clean and safe piped water. An
average of 14% of residents lack basic sanitation and latrine coverage at its
worst. Every day of our lives we live amidst serious danger of water-borne
disease outbreaks. Homa Bay town must be having one of the most serious water
shortages with the water service provider lacking the technical capacity to
supply a growing population and improve its supply chain. The result is a
lowering in the quality of life, reduced urban productivity, and increased
burden of health care and unmitigated environmental pollution. The acute
water shortage can get worse that people drink the raw waters of Lake Victoria.
With a child-rich population with the 0-14 year age bracket accounting to 43%,
there is clear linkage between the high child mortality rates to the ever
present health hazards posed by poor water and sanitation.
In Homa Bay, we
enjoy the largest section of Lake Victoria and boast of four rivers: Awach
Tende, Awach Kibuon, Riana and Kuja. The argument has understandably been that
tapping the Lake Victoria water with the incessant water hyacinth infestation
has been expensive and problematic, and therefore we have just to live with the
lake beside us. But what about the rivers? Why can’t we have a sustainable plan
of connecting communities along the rivers with the available water? A
comprehensive water supply plan from our immense fresh water sources is the way
forward. It is never in drilling boreholes the way the Governor promised last
week over 50 boreholes. South Nyanza ground water has quality issues, too salty
and unsafe for human consumption. There is enough evidence from Pala in
Karachuonyo to Pala in Koguta that the high fluoride levels in the ground water
have serious public health risks.
Plan
International, World Vision and other agencies have done tremendous work in
Community Led Total Sanitation (CLTS) in Homa Bay County. But must NGOs fund
CLTS any longer for our people? Even without CLTS, what energy or funds does it
take to invest in low cost toilets, even for the urban poor? With good
leadership, we can break away and run the County’s WASH like NGOs ourselves. What
can stop us from running a Countywide CLTS Program to ensure all our villages
are Open Defecation Free (ODF)?
The County
Government is frustrating health professionals. Late payments and poor working
conditions have demoralized many health workers to an extent the quality of
their service delivery has been immensely affected. Challenges regarding
transition of public health management and service delivery have immensely
affected community health, with Community Health Extension Workers (CHEWS) and
in extension the Community Health Workers (CHWs). Community disease
surveillance, reporting, documentation and progress have back-tracked. The
frequency of field visits and supervisions have reduced possibly even due to
untimely fueling of their motorbikes; now all the funds are managed by the
County Treasury. Local Health Centers are ill-prepared to handle Ebola cases,
and Rongo Sub-County Hospital was far, and ended up being over-crowded by the
patients. Many will tell you they avoided the Homa Bay County Hospital because
no quality health care is offered there.
The County’s
Ministry of Health must go back to the Homa Bay County Integrated Development
Plan (CIDP) and borrow the insights therein regarding improving health care for
the people of Homa Bay. It must hold full grip of our Public Health Management
System, and get our Disease Surveillance, Community Health Strategy and
Community Led Total Sanitation back to its feet.
The three main
diseases that the government must give equal focus and responsive prevention
strategies are AIDS, Malaria and Water Borne Diseases (Cholera and Typhoid).
The burden of AIDS might have blocked our eyes from other real public health
matters. This outbreak will once again put spotlight on our County and most
like attract more NGOs into the WASH sector but we must offer leadership. I am
hopeful that this will help the County’s Ministry of Health WASH Strategy, and
Community Mobilization must be at the heart of it. Village Committees,
Community Leaders and CHWs must be capacity built, motivated and tooled to
mobilize very village to take personal hygiene and sanitation seriously.
Generally, if
Cholera killed 9 people in two days you can imagine if it were an Ebola
outbreak. In the end you realize that Africa's problem in disease surveillance
and disaster response is uniform and the same from West to East: We are
under-staffed, ill-equipped, unprepared, clueless, hypocritical and poor
learners. The burden of disease is seriously taking tall on us and we
look forward to our County leadership mobilizing every citizen so that we can
be a model WASH County: Let us manage devolved health care properly, invest
heavily in water supply and low cost latrine construction, re-energize
community health workers and revive proactive management of Lake Victoria.
(The writer Chrispory Juma is a Public Health Officer and Community
Mobilization Expert based in South Sudan. Email: chrispory.juma@gmail.com)
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