Search

 

Cablegate: Usaid/Ofda Field Trip Report: Mitigating Cholera In

VZCZCXRO8088
OO RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHSB #0744/01 2601455
ZNR UUUUU ZZH
O 171455Z SEP 09
FM AMEMBASSY HARARE
TO RUEHC/SECSTATE WASHDC IMMEDIATE 4911
RUEHSA/AMEMBASSY PRETORIA IMMEDIATE 5735
INFO RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHGV/USMISSION GENEVA 2322
RUCNDT/USMISSION USUN NEW YORK 2001
RUEHRN/USMISSION UN ROME
RUEHBS/USEU BRUSSELS
RHEHAAA/NSC WASHINGTON DC
RUEKJCS/SECDEF WASHINGTON DC
RHMFISS/JOINT STAFF WASHINGTON DC

UNCLAS SECTION 01 OF 04 HARARE 000744

SIPDIS
AIDAC

AFR/SA FOR LDOBBINS, BHIRSCH, JHARMON
OFDA/W FOR ACONVERY, CCHAN, LPOWERS, TDENYSENKO
FFP/W FOR JBORNS, ASINK, LPETERSEN
PRETORIA FOR HHALE, PDISKIN, SMCNIVEN
GENEVA FOR NKYLOH
ROME FOR USUN FODAG FOR RNEWBERG
BRUSSELS FOR USAID PBROWN
NEW YORK FOR DMERCADO
NSC FOR CPRATT

E.O. 12958: N/A
TAGS: EAID EAGR PREL PHUM ZI
SUBJECT: USAID/OFDA FIELD TRIP REPORT: MITIGATING CHOLERA IN
BULAWAYO THROUGH COMMUNITY WASH PROGRAMS

REF: HARARE 486

HARARE 00000744 001.2 OF 004


-------
SUMMARY
-------

1. SUMMARY: In mid-August, staff from USAID's Office of U.S.
Foreign Disaster Assistance (OFDA) met with implementing partners,
beneficiaries, city officials, and United Nations (UN) personnel in
Bulawayo, Zimbabwe's second-largest city, to assess current water,
sanitation, and hygiene (WASH) conditions and evaluate USAID/OFDA
contributions to Bulawayo's relatively low cholera rates during the
nationwide 2008/2009 outbreak. City officials noted that without
the assistance of USAID/OFDA and other donors, Bulawayo would likely
have suffered much higher cholera rates during the 2008/2009
outbreak. USAID/OFDA staff visited a number of ongoing,
well-implemented, USAID/OFDA-funded projects to provide water
storage and continue support for community mobilization and hygiene
awareness efforts. Although the underlying factors that could
contribute to another cholera outbreak in Bulawayo remain unchanged,
city officials, implementing partners, and UN staff predict lower
cholera rates in the event of a 2009/2010 outbreak due to better
preparation by the city and implementing partners and heightened
cholera and hygiene awareness in communities. USAID/OFDA continues
to support WASH activities in Bulawayo and throughout Zimbabwe
designed to mitigate the risk of cholera and other waterborne
diseases. END SUMMARY.

------------------------------------
CONTEXT AND USAID/OFDA WASH STRATEGY
------------------------------------

2. From August 2008 to July 2009, Africa's largest cholera outbreak
in 15 years struck Zimbabwe, resulting in nearly 4,300 deaths and
nearly 98,600 cases nationwide. Poorly maintained water and
sanitation infrastructure contributed to the scope of the outbreak,
and Zimbabwe's fragile health system was unable to treat patients
adequately. In response, USAID/OFDA committed more than USD 7.3
million in emergency assistance to support the provision of
emergency relief supplies, WASH and health interventions, hygiene
promotion and social mobilization activities, and humanitarian
coordination and information management to improve epidemiological
reporting and analysis.


3. USAID/OFDA has supported WASH activities throughout Zimbabwe
since fiscal year (FY) 2007, as the increasingly irregular provision
of water and sanitation services heightened the potential for the
spread of waterborne diseases such as cholera. The case of Bulawayo
demonstrates the merits of community-based WASH interventions, the
focus of USAID/OFDA's WASH strategy for Zimbabwe. For the past
several years, Bulawayo has suffered inconsistent water supply and
has a sewage system that functions poorly, like those in most
Zimbabwean cities. In 2007, the city suffered a diarrheal disease
outbreak as a result of a severe water shortage that prompted relief
agencies, including USAID/OFDA, to increase WASH intervention
activities. Since 2007, USAID/OFDA-supported programs in Bulawayo
Qactivities. Since 2007, USAID/OFDA-supported programs in Bulawayo
have included: hygiene promotion activities to raise awareness;
social mobilization to increase community reporting of cholera cases
and sewage system breaks; distribution of soap and other hygiene
supplies; provision of water storage tanks and water containers to
schools and houses; and provision of water purification materials
for community and household use.

4. During the 2008/09 cholera outbreak, the metropolitan Bulawayo
area recorded 445 cases and only 18 deaths, rates significantly
lower than other urban centers. By comparison, Harare, the capital,
and Harare's high-density suburbs and dormitory towns recorded
nearly 19,600 cases and more than 650 deaths. Several factors
played a part in keeping Bulawayo's rates comparatively low; among
them were ongoing USAID/OFDA support for WASH activities in the
city.

HARARE 00000744 002.2 OF 004

--------------------------------------------- ---
COOPERATION BETWEEN THE CITY AND RELIEF AGENCIES
--------------------------------------------- ---

5. During meetings with USAID/OFDA staff, city officials noted that
without the assistance of USAID/OFDA, other donors, and relief
agencies, Bulawayo would likely have suffered much higher cholera
rates during the 2008/2009 outbreak. On August 13, 2009, Bulawayo
Mayor Thaba Moyo stated that "our partners came to our rescue. We
managed to keep the figures down -- a big achievement as compared to
other regions." According to the city's Director of Health
Services, Dr. Zanele Hwalina, "a combined effort" helped protect
Bulawayo. City councilor James Sithole, representing Makokoba, a
high-density suburb, noted that "government cannot win the war
against cholera on its own; the war was won because of relief agency
involvement."

6. In general, USAID/OFDA staff noted exceptional cooperation
between USAID/OFDA-funded non-governmental organizations (NGOs) and
the Bulawayo city government -- a notable difference from the
anti-NGO rhetoric and harassment typical of the national government
in 2008. Mayor Moyo stated to USAID/OFDA staff that "the residents
of Bulawayo appreciate your assistance" and noted that the city
government had made office space available to USAID/OFDA partners.
In addition, the Mayor noted that USAID/OFDA partners provided tools
and protective clothing to assist the city in collecting refuse,
thus improving sanitation. Dr. Hwalina expressed the hope for
further cooperation between the city and NGOs, not only in the WASH
sector, but also in the health sector, in which health NGOs
organized and seconded staff to cholera treatment centers and
assisted with epidemiological analysis and reporting. Staff from
Lead Trust, the local partner of USAID/OFDA partner Oxfam-Great
Britain (Oxfam-GB), provided an illustrative example f the city
government's commitment to working with NGOs to improve WASH
conditions: in schools with USAID/OFDA-funded water tanks, the city
provides the water free of charge, not wanting to limit the schools'
ability to store water for students' and faculty members' use.

--------------------------------------------- -
SOCIAL MOBILIZATION TO RAISE HYGIENE AWARENESS
--------------------------------------------- -


7. According to Dr. Hwalina, "the reason we managed to control
cholera was the very high level of awareness." Shadreck Khuphe, the
UN Children's Fund (UNICEF) WASH coordinator in Bulawayo, noted that
social mobilization programs and hygiene awareness programs funded
by USAID/OFDA and other relief agencies in 2007 and 2008 meant that
residents' associations "already had the best network for
distribution of hygiene promotion materials" once cholera struck.
Before and during the cholera outbreak, Oxfam-GB and Lead Trust
reached approximately 127,000 people through social mobilization
trainings, distribution of hygiene promotion materials, and
Qtrainings, distribution of hygiene promotion materials, and
distribution of hygiene supplies and other emergency relief
commodities.

8. In Mzilikazi, one of the oldest high-density suburbs of
Bulawayo, USAID/OFDA staff met with community sanitation committee
members organized by USAID/OFDA partners. The committee discussed
the importance of mobilizing neighborhoods. Committee member
Cynthia Shirto noted that "we visit schools, asking about problems
of burst pipes, which we report to the local councilor, and we
conduct hygiene awareness presentations for students, who in turn
teach parents." Ms. Shirto also noted that once the cholera
outbreak began, "we learned that we must not just sit around, but be
active for the benefit of the whole community." In addition,
community sanitation committees and residents' associations help
distribute soap and other hygiene supplies, including cotton wool,
supplied by USAID/OFDA and implementing partners. According to Ms.
Shirto and others, committee members volunteer up to two hours per
day in service of the community.

HARARE 00000744 003.2 OF 004

--------------------------------------------- -----
ONGOING ACTIVITIES TO PROVIDE BACKUP WATER STORAGE
--------------------------------------------- -----

9. The inconsistent water supply in Bulawayo, due both to general
water shortages in the drought-prone region and to leaks and burst
pipes, necessitates community water storage. USAID/OFDA has
provided ongoing funding for provision of large water tanks to
schools, community centers, and the homes of particularly vulnerable
inhabitants. On days when water flows in the municipal system,
schools and households fill the tanks, providing backup water
storage for days when the city taps run dry.

10. USAID/OFDA staff visited several schools benefiting from
USAID/OFDA-funded water tanks, including Lozikevi Primary School in
Bulawayo's high-density suburb of Nguboyenja. According to
headmistress Letty Mpofu, the availability of backup water means
that children need not bring water to school. Mrs. Mpofu also noted
that the school no longer occasionally cancels the school day for
lack of water. Equally important, having a constant supply of clean
water for hand-washing and drinking lowers the risk of cholera
transmission. USAID/OFDA-funded distribution of hygienic household
water containers, such as 20-liter jerry cans, facilitates the
storage of clean water.

--------------------------------
OTHER FACTORS CONTRIBUTING
TO LOW CHOLERA RATES IN BULAWAYO
--------------------------------

11. During meetings with UNICEF WASH staff, Lead Trust, and city
officials, USAID/OFDA staff learned of other factors that
contributed to Bulawayo's comparatively low caseload during the
cholera outbreak. According to UNICEF, Bulawayo's longstanding
water shortages, dating back decades, led to strong community
awareness of the need to conserve water. Furthermore, during the
2008/2009 cholera outbreak, neighborhoods never ran dry for more
than 24 hours due to conscientious efforts by the city government to
keep treated water flowing through the system. According to Dr.
Hwalina, "the availability of good, quality water, in good
quantities, was contributory" to low cholera rates. In addition,
the topography of the Bulawayo metropolitan area resulted in limited
contamination of the water system by sewage, since sewage emanating
from depleted sanitation infrastructure tends to flow to the north,
in the direction of the watershed, whereas the dams that supply
Bulawayo's water are located to the south of the city. Finally,
both the Mayor and UNICEF WASH staff noted that Bulawayo
successfully resisted attempts by the Zimbabwe National Water
Authority, controlled by the national government, to assume control
of Bulawayo's water system. However, UNICEF, relief agencies, and
city officials all reiterated that despite these additional factors,
WASH activities funded by USAID/OFDA and other donors played a
critical role in mitigating the effects of cholera in Bulawayo. The
Qcritical role in mitigating the effects of cholera in Bulawayo. The
fact that such efforts started as a result of the diarrheal disease
outbreak in 2007, a year before the nationwide cholera outbreak,
played a key role in helping the city and relief agencies develop
cholera preparedness and coordination mechanisms.

-------------
LOOKING AHEAD
-------------

12. UNICEF voiced concerns regarding the potential for a renewed
cholera outbreak during the next rainy season, which is likely to
start in November or December. Bulawayo's sewage system remains in
a state of collapse; of 10 treatment plants, most were operating at
less than half capacity as of August 2009, according to UNICEF. In
addition, much sewage fails even to reach the treatment plants due
to blockages in the system. Since the sewage system is water-based,
lack of water results in lack of pressure, leading to solidifying of
waste. Bursts throughout the water system result in a water loss of

HARARE 00000744 004.2 OF 004


at least 30 percent, and the city has stockpiled water treatment
chemicals sufficient for only three months in the event that ongoing
UNICEF funding for provision of such chemicals comes to an end.
However, UNICEF informed USAID/OFDA that efforts are ongoing to gain
donor support for continued provision of chemicals, and UNICEF
expressed optimism that water treatment needs will continue to be
met for the foreseeable future.

13. Bulawayo's water and sanitation infrastructure thus remains
poorly maintained and in need of large-scale rehabilitation. As the
rainy season -- a period when waterborne disease incidence tends to
increase -- approaches, relief agencies and city officials alike
note that while the underlying risk factors for a renewed cholera
outbreak have not changed, given the city's limited resources to
rehabilitate aging systems, the levels of awareness and preparation
amongst city authorities and humanitarian organizations have
increased greatly. As Mayor Moyo states, "prevention is the best
cure." Hygiene promotion and awareness-raising, social
mobilization, soap and hygiene supply distribution, water tank
provision, and other WASH programs funded by USAID/OFDA and other
donors helped limit Bulawayo's rate of cholera in 2008/2009.
Continued support for the same activities will likely help reduce
the risk of cholera transmission in 2009/2010. In FY 2009 to date,
USAID/OFDA has committed more than USD 8.5 million for WASH
programming throughout Zimbabwe to improve community resilience to
cholera and other waterborne diseases and to help mitigate a
potential recurrence of cholera. The experience of the residents of
Bulawayo bears out the wisdom of community-focused WASH programming
as a means to limit the scope of a potentially devastating disease.


PETTERSON

© Scoop Media

 
 
 
World Headlines

 

OECD: COVID-19 Crisis Puts Migration And Progress On Integration At Risk, Says

Watch the live webcast of the press conference Migration flows have increased over the past decade and some progress has been made to improve the integration of immigrants in the host countries. But some of these gains may be erased by the COVID-19 pandemic ... More>>


Pacific Media Watch: How Pacific Environmental Defenders Are Coping With The Covid Pandemic

SPECIAL REPORT: By Sri Krishnamurthi of Pacific Media Watch Pacific Climate Warriors - creative action to trigger better responses to climate crisis. Image: ... More>>

Reporters Without Borders: Julian Assange’s Extradition Hearing Marred By Barriers To Open Justice

After monitoring four weeks of evidence in the US extradition proceedings against Wikileaks publisher Julian Assange, Reporters Without Borders (RSF) reiterates concern regarding the targeting of Assange for his contributions to journalism, and calls ... More>>

OHCHR: Stranded Migrants Need Safe And Dignified Return – UN Migrant Workers Committee

The UN Committee on Migrant Workers has today called on governments to take immediate action to address the inhumane conditions of migrant workers who are stranded in detention camps and ensure they can have an orderly, safe and dignified return to ... More>>