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Infectious Diseases

24 April 2020

OPINION | Access to clean water, proper sanitation crucial in Covid-19 battle

Together with all the regulations and measure that have been put in place, the continued supply of clean water and adequate sanitation will go a long way in helping us overcome this crisis and emerge stronger as a nation, writes Dr Lungiswa Nkonki.

South Africa reported its first case of Covid-19 on 5 March.

At the moment we have 143 570 tests conducted, 3 953 positive identified cases, 1 4733 recoveries and 75 deaths.

Since the first reported case, we have seen decisive, strong leadership from the President, and significant, essential and necessary co-ordination between different ministries including Education, Justice, Health, Trade and Industry, Transport, Public Works and Infrastructure, Finance, Cooperative Governance and Traditional Affairs, and International Relations and Cooperation. This intersectoral action and co-ordination is something we have needed for a long time to address development in the country. 

The threat that Covid-19 presents has resulted in leadership from government and the apparent willingness of all South Africans to play their part. Covid-19 has also highlighted the necessity to address the social determinants of health.

Dire consequences for children

The World Health Organization defines the social determinants of health as “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national, and local levels. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.

For instance, adequate clean water and sanitation are social determinants of health and long-standing problems in South Africa with dire consequence for children who live in households with no clean water and proper sanitation. South Africa's under-five mortality rate had fallen from 75 deaths per 1 000 live births in 2006 to 34 per 1 000 live births in 2016.

According to a 2016 United Nations Statistical Commission Report on Sustainable Development Goal Indicators, the post-2015 Sustainable Development Goals agenda seeks to accelerate the decrease in mortality from diarrhoeal disease so that by 2030 under-five mortality will not exceed 25 per 1 000 live births in any country. This is achievable.

About 88% of diarrhoea-associated deaths are attributed to unsafe water, sanitation, and insufficient hygiene. Among the proven ways to save lives is the provision of safe water, adequate sanitation and human waste disposal, and handwashing with soap. Even though we have known this, as a society, we have not ensured that all households have access to safe water and adequate sanitation.

Despite the disruption caused by the Covid-19 pandemic, this event has been a critical opportunity for the provision of safe water and driving home the important message of handwashing with soap. In a speech on 25 March 2020, Minister of Human Settlements, Water and Sanitation Lindiwe Sisulu announced measures by this department aimed at curbing the spread of Covid-19. The interventions included, among others, identifying high-risk areas that required immediate responses. 

A very unequal society

These were public areas with limited or no access to water and sanitation services, overcrowded settlements, informal settlements, and rural settlements and water-scarce towns. Using these criteria, they identified over 2 000 communities across the country. To date, 1 482, 612, and 262 water tanks have been delivered to Gauteng, Free State, and Limpopo respectively. Also, 47 water tanks were procured in the Eastern Cape. 

The past few weeks have been characterised by leadership, speed, responsiveness, and communication. We have seen regular press briefings where the Minister of Health and other members of the inter-ministerial committee have been providing us with updates on new infections, the total number of infections, and deaths as a result of Covid-19.  Most importantly, there has been an openness to discussing challenges raised during the press briefings by journalists.

Furthermore, we have been provided with a WhatsApp mobile number to access reliable and accurate information on tests conducted, positive cases identified, recoveries, deaths, as well as the new regulations and frequently asked questions. The number can also be used to report fake news and any other criminality related to the Covid-19 pandemic and the national lockdown. 

As we prepare for the next round in the battle against Covid-19, we must sustain the momentum to curb the spread of the virus. We live in a very unequal society where many people don’t have access to proper health care. It is, therefore, of the utmost importance that we prevent a dramatic increase in the number of cases, as this will put our healthcare system under severe strain.

Together with all the regulations and measure that have been put in place, the continued supply of clean water and adequate sanitation will go a long way in helping us overcome this crisis and emerge stronger as a nation.   

*Dr Lungiswa Nkonki is a senior lecturer in the Department of Health Systems and Public Health at Stellenbosch University.

Image credit: Luis Tosta, Unsplash