EDPRS: Integrating Population, Health, and Environment in Rwanda

By Godfrey Ntagungira The last decade in Rwanda’s history has been one of transition and rebirth. 15 years ago, the country has been emerging from effects of 1994 genocide; in 2009, urban and rural areas are energized with the promise of steadily improving Economic, Social and Health conditions. COMMUNITY-LED SANITATION PROJECT WITH PROMISE In the framework of DPRS the Ministry of Healthy encourages communities to work to improve their health and hygiene means in empowering people with the right messages and the means to improve their sanitation systems. The community led sanitation project Community –Based Environment Promotion Programme (CBEHPP) is a revolutionary low-cost approach to rural sanitation where communities are facilitated to assess their own sanitation situation, analyze and take action to stop open defecation and build their own latrines without any subsidy and using locally available materials. Through this programme Rwanda targets by 2012 to reduce Rwanda’s existing disease burden by at least 50 percent and expected to contribute meaningfully to poverty reduction through the EDPRS framework. The programme also seeks to place environmental healthy firmly on Rwanda’s developmental agenda. PROJECT IMPLEMENTATION The project is set to be implemented in three phases with first two lasting six months each, before rolling out to the rest of the country. It’s in plans to provide capacity training of over 45,000 community healthy workers and all will have to undergo close mentoring and supervision by environmental healthy officers who are based at healthy centers across the country. The training will focus on most diseases dealt with by local healthy centers as long as they are preventable and among them include diarrhoea. Acute respiratory infections, skin diseases. Eye diseases, intestinal worms, bilharzias and malaria which comprises the 80 percent of the national burden. Upon the accomplishment of training, the community healthy workers will facilitate the formation of community Hygiene Clubs (CHCs) in every village as a means towards rapidly achieving sustainable and cost effective hygiene behaviour change in every home stead. The project already targets public institutions like schools, clinics and prisons. BETTER HYGIENE, BETTER LIFE When the reporter visited the office of Joseph Katabarwa the Coordinator of Environmental Healthy Desk in the Ministry of Healthy last week he paused from his work and demonstrated how hygiene must be practiced in homes or public places. He said “We empower the communities with the messages on how to improve the state of sanitation in homesteads. He emphasized that to ensure good hygiene in homes of low income earners, a small jerry can is positioned at the door and it is tied to a wooden post, with a rope extending from its mouth to a small peg on the ground. The idea behind this is that one does not have to touch the jerry can, but on stepping on the rope, it automatically tilts the jerry can downwards to enable hand washing. A bar of soap is positioned next to it. Katabarwa said that many Rwandans have enthusiastically embraced the sanitation programs. Katabarwa cited example of Gahini Primary School in Kayonza district which was declared open defecation free. In 2009, a momentous community mobilization initiative was geared towards collective behaviour change to give up open defecation and take up safe hygiene practices, He defines hygiene as to what you do to keep yourself clean, such as washing yourself, your clothing and bedding, and what you apply to your body. And sanitation also refers to what we collectively do to keep toxic environmental waste from forming a heap in which microbes flourish. “After all, hygiene and sanitation are for our own good, and perhaps we should proceed for our own good, not hide under the darkness of ignorance” he intimated. Thus, continued improvement in the quality of life of Rwanda’s citizens depends in large part on finding innovative and integrated solutions to complex population, health, and environment problems. WATER AND SANITATION Safe water drinking can reduce diarrhoea by about 15% improved personal and domestic hygiene practices can reduce diarrhoea by over 65 percent through hand washing with soap at critical times Hygiene behaviour change as proposed under CBEHPP is critical to all water and sanitation initiatives to ensure they meet their enormous potential to improve national healthy standards. Fortunately, the links between population, health, and environment are now largely recognized by policymakers in Rwanda especially through the EDPRS framework. Water and Sanitation Rwanda’s urban population share increased from just 5 percent in 1995 to 17 percent a decade later. The rate of urbanization is accelerating and Rwanda’s urban population is expected to reach 30 percent by 2020. Although 72 percent of the country’s population reported having access to clean water, the current pressing issue is to lead Rwandans meet the acceptable hygiene standards. Though much work remains to be done to improve the health and well-being of Rwandans, the health sector is poised to make significant progress in achieving its health goals. Along with the education sector, the health sector has made the biggest inroads to successfully integrate its programs across sectors in accordance with Health Ministry principles: acceptability and quality of health care, effectiveness and efficiency, intersectional coordination, community participation, decentralization, and integration. Katabarwa reiterated that the health sector policy recognizes that “actions in the health sector will have a more sustainable impact if they are integrated and fundamentally incorporated into the national development programs. COMMUNITY HEALTH CLUBS According Katabarwa, the head of environmental desk at the Ministry of Healthy describes them as voluntary community associations dedicated to promoting a culture of hygiene. He says that the community based organisations (CBOs) will be open to men and women of all ages, income and educational levels, they will be dedicated to members who have joined together in order to upgrade their knowledge on health-related issues and hygiene practices with a view to improving their own family’s health. The clubs have no political or religious affiliations and will be formed specifically for eradicating communicable diseases in their community. Ideally, most households within the community will be represented in these forums. Health Clubs are expected to own their executive committee, a constitution and bank account. They will focus on physical health issues; their activities are expected to spread out into many other areas to improve the quality of life of their members. Health in its broadest sense is expected to improve, including mental and spiritual well being, which will come from empowerment through a sense of purpose, achievement and material security. Typically, the facilitators will use participatory activities to encourage active participation and enable members to find their own solutions to common problems. The members of a health club are expected to be bonded by a common ethos and can identify each other by their practices and beliefs, almost like a church congregation. As dedicated members attend every week, facilitators can build upon their health knowledge which can then be reinforced by additional information, the club members will become experts themselves. Almost all the pollutants from human excreta ultimately end up in the environment. This is a great threat for our environment. Katabarwa urges the public to keep in mind that nature has a limited carrying capacity. If nature receives more pollutants than its capacity then natural sustainability will collapse. He also emphasized that proper wastewater management is very urgent for a better environment and economy. The government is taking proper initiatives to make people aware about the impact of improper sanitation on the environment and should make some emergency programmes to achieve the Millennium Development Sanitation Goal SANITATION DESERVES HIGHEST PRIORITY Katabarwa defines Sanitation as safe management of human excreta, including environmental cleanliness, hand washing, garbage removal and wastewater disposal. Proper sanitation is the basis of a healthy environment. Lack of sanitation facilities forces people to discharge excreta in open places. Without proper sanitation, a sustainable environment is not possible. Target C of the Seventh Millennium Development Goal is to “Halve, by 2015, the proportion of people without sustainable access to safe drinking-water and basic sanitation.” To raise awareness and to accelerate sanitation progress, the UN General Assembly declared the year 2008 the International Year of Sanitation. According to the report of International Year of Sanitation, around the world, 2.6 billion people do not have a clean and safe place to use for performing their bodily functions. Based on 1990-2004 trends, it is projected that in 2015, 692 million urban and 1698 million rural people will still be unserved. The majority of communities are also not in a position to provide or maintain such systems themselves. However, because of the strong link between sanitation services and public health, it is imperative that a programme which encourages an adequate basic level of sanitation, which is also largely affordable, be actively pursued in order to reach the communities who have little or no sanitation facilities. The issue of contamination of groundwater by VIP toilets is addressed in recommendations from the available literature regarding pit depths and safe distances between pit toilets and water sources are summarised, while measures to prevent pollution from taking place are also included. Regular maintenance of VIP toilets is essential if they are to continue functioning as they should remain in an attractive and acceptable condition for use. The research report emphasises cleanliness and prompt attention to matters such as fixing of cracks, termite control, and storm water diversion, fly screen care, treatment of doors and hinges, as well as mosquito control. FOOD SAFETY Food safety is a crucial issue for Rwanda’s development because it has an impact on the health of the population, job creation, investments inflow, fair trade of food, and, globally, on the efficiency and productivity of the nation. In the framework of achieving the country’s targets embedded in the framework of Vision2020 and EDPRS Rwanda Bureau Standards officials inspects food processing factories, super markets, hotels and restaurants across the country. These visits have emphasised on the importance of food safety, food hygiene and personal hygiene. The Bureau has made big leap in consumer protection by enforcing product quality. In line with Economic Development Poverty Strategy (EDPRS), RBS is upgrading products and services with respect to quality assurance to promote export to the international markets. RBS has also developed a Certification Systems with different tiers (Standards Mark-S, Quality Management System-QMS-ISO 9000, Environmental Management System-EMS-ISO 14000 and Food Safety Management Systems-FSMS ISO 22000. All the products are being designed to offer Industry Certification Scheme of their choice. The application of these products will boost competitiveness of locally produced products and services since each is given after training and rigorous audit of the applicant’s productions system and operating procedures. Only products conforming to the stipulated standards requirements get a quality mark. All these services are there to safeguard public safety, health, business promotion and protection of our environment. It’s of great importance for Rwandans to get the best use of them. Ends

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EDPRS: Integrating Population, Health, and Environment in Rwanda