Environmental Sanitation Program Kabul, Afghanistan 1996 2004 Riccardo Conti Stefan Spang

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Environmental Sanitation Program Kabul,
Afghanistan1996 2004Riccardo Conti -
Stefan Spang
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Historical overview

• Afghanistan (armed conflict since 1979)
• Russian occupation (1979 89)
• power vaccuum (fight for Kabul by war lords)
• Taliban regime 1996 2001
• International Coalition Forces 2001
• Central Government since 2002
• ethnically divided / "regional leaders"
• Kabul
• fighting 1992 95 (40 destr.)
• degrading of WatSan infrastructure
• urbanisation gt 1996
• gt 2002 Int. Organisations / WB

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Environmental Sanitation Program, Kabul (1996
2004)____________________________________

• Why ICRC intervention ?
• Needs in Environmental Health
• WATSAN facilities in Kabul badly damaged
• Streets contaminated with excreta
• Cholera outbreak 1995 (ACF study linking to
  sanitation)
• Deteriorating health of the population (diarrhoea
  rel.)
• Armed conflict gt 1979
• Kabul 1.2 Mio pop. (40 IDP)
• ICRC mandate

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• PROGRAM BRIEF
• Objective To improve Environmental Health
• Target population 75'000 households, Kabul
• Period gt 5-7 years
• Program
• improved latrine (10'000 / year 60 / 18 )
• night soil collection
• safe water supply (wells h.-pumps) (50
  70 / y)
• hygiene promotion
• Strategy
• integrated approach
• participation hh (20 50 of costs)
• co-operation Min. of Public Health
• advocacy ("snow-ball effect")

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before (poor traditional design)
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A) Rehabilitation / construction of latrines

• Improved traditional
• latrine
• separation of urine
• soak pit for urine
• improved chamber
• emptying door
• ventilation (fly trap)

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B) Improved nightsoil collection, treatment
disposal.

• equipment for collectors (gloves, rubber boots,
  donkey carts)
• composting (fertilizer for farmers)
• advocacy to communities (management, incentives)

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C) Improved communal water points

• training of
• water committees
• in O M
• repair shops
• (out-sourcing)

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D) hygiene promotion

• access (gender issue)
• complementary to MoPH (schools)
• house to house / mosques / illiteracy gr.
• radio broadcast / posters / flip charts

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Evaluation by WEDC, Loughborough (July 2003)
Bob Reed Public health Engineer Mimi
Khan Public health consultant
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Programme strengths

• The intervention was appropriate
• Programme well designed
• ICRC was justified in initiating the programme

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Successes

• 49'000 latrines constructed/improved
• 1.7 million invested in local economy
• Measurable improvements in health
• Technology widely copied
• Committed and effective local staff
• Raised profile of ICRC nationally and
  internationally.

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Programme weaknesses

• Minimal programme development.
• ICRC institutional aspects (turnover of staff
  reporting interdepartmental co-ordination
  global strategy)
• Vulnerable members of community excluded.
• Poor involvement of beneficiaries.

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Recommendations

• Urban sanitation in Kabul is still a problem and
  ICRC should remain involved.
• Cease installing communal water points.
• Develop alternatives to nightsoil collection
  system.
• Develop strategies for including vulnerable
  groups.
• Involve beneficiaries more in the programme.

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Health Impact Study (Dr. David Meddings)

• Objective Cost effectiveness of ICRC
  sanitation program on
• diarrhoea-related mortality among children,
  Kabul
• Data collection 1998 - 99
• Case Control Study 5 dispensaries,
  1863 children (625 controls)
• Stratified Cluster Survey 790 households
  interviewed

• Results for 15'000 latrines during 1 year
• (330'000 p., 59 coverage)
• 235 diarrhoeal deaths averted of children under
  5 years
• 2'144.- direct costs ICRC per death averted
• estimated impact for 49'000 hh ?
• (publication accepted for bulletin of WHO)

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Water Habitat Activities in Afghanistan 2001-
03
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END thank you for your attention