DEPARTMENT: WATER AFFAIRS & FORESTRY Cholera Outbreak Response in

Limpopo and Mpumalanga Provinces

Presentation to the Portfolio Committee of Water Affairs and Forestry

Date : 04 February 2009

Presented by: DG Water Affairs & Forestry Ms Pam Yako

CONTENTS OF PRESENTATION

• Background• Status of the outbreak• Cholera Protocol• DWAF Interventions:Zimbabwe,Limpopo and

Mpumalanga and • Mpumalanga and Limpopo Case Studies• Conclusion• Action Plan

BACKGROUND

• In 2003 DWAF’s role moved from that of provider of water and sanitation services to communities to that of a supporter and a regulator

• The role of the Department of Water Affairs and Forestry is to work with local government support municipalities in executing their constitutional mandate

• Due to challenges faced by this sphere of government, Dwaf role has not been confined to the above- in most cases the Department had to be directly hands on in resolving service delivery challenges

• The Department of Health is the lead Department in epidemics like cholera with sector support from other departments

BACKGROUND Cont• Cholera outbreak reported in Zimbabwe in August 2008• First cholera cases reported on 15 November 2008 South Africa

Musina. Has since spread to all provinces.• At that time, three deaths and 132 cases of affected people

were reported and received treatment in hospitals, clinics and temporary centers

• In response to this threat Dwaf regional office intensified monitoring of water quality in rivers and within affected municipalities

• Dwaf also participated in the National Cholera Response Plan which covers (inter alia)– Health interventions– Water & Sanitation– Community Mobilisation

Cholera Protocol : Role of DWAF• Support intergovernmental Coordination structures

– Initiation, representation, functions, strategies

– Internal co-operation and communication• Identification of high risk areas

– Surveying of infrastructure – water quality monitoring (all sources: taps, plants and rivers of affected areas)– Ensuring Operational efficiency of water services infrastructure– Provision of water purification materials to treatment plants

• Support on Water Services Infrastructure– Survey and ensuring compliance– Provision of temporary/Emergency water and sanitation infrastructure at emergency

and strategic points – Influence and Support short and long term rehabilitation of infrastructure

• Control over authorized users by management of compliance and authorization conditions

WHY THE 2008/9 OUTBREAK IN LIMPOPO

• Movement of affected people from Zimbabwe into RSA

• Polluted water resource, i.e. rivers from untreated effluent eg BeitBridge into Limpopo river,Ngoaritsane river in Mpumalanga

• People without access to water and sanitation services drinking unsafe water

• Inadequate awareness on health and hygiene

Institutional Arrangements: National co-ordination

• Dwaf reports on water quality and status of water supply and health and water education and physical interventions National Inter-sectoral Committee hosted by DOH (weekly)

• In the Province DWAF participates in the Mpumalanga and Limpopo Provincial JOCs.

DWAF RESPONSIBILITIES DURING OUTBREAK

• According to the National Cholera Outbreak Response Plan for South Africa:

• Community mobilisation

• Environment: Safe Water supply

• Environment: Sanitation

STATUS REPORTED CHOLERA CASES

• According to the National Department of Health (NDOH) cholera cases have been reported in all nine provinces- a total of 7580 cases and 51deaths indicating a Case fatality ratio (CFR) of 0.67% .

Updated Cumulative Statistics(AS AT 12H00 ON 27JAN 2009, SINCE 15NOV 2008)

Limpopo Gauteng Mpumalanga KwaZuluNatal

NorthWest

East Cape NorthernCape

Western Cape

Free State

Total

Cases 3407 230 3923 2 7 1 1 8 1 7580

Deaths

16 3 31 1 0 0 0 0 0 51

Notes:1. CFR = CASE FATALITY RATIO2. Wolrd Health Organisation (WHO) GUIDELINE IS THAT IT SHOULD BE BELOW 1%

Initiatives at SADC Level• DOH chaired SADC Troika meeting on health and water: 11

December, 2009• Troika officials recommended:

– Establishment of inter-sectoral Task Team which was done– Fact-finding mission to Harare- to be undertaken on 15th

February 2009– Assistance to Zimbabwe on water and sanitation, materials

and infrastructure (Zimbabwe indicated a need for: US$85million requirement, this need will be verified on the fact finding mission

– Mobilisation of resources through Secretariat

Interventions in Zimbabwe

• Through the SADC protocol, Dwaf’s interventions in Zimbabwe around the Beitbrigde and other strategic areas can be summarised as follows:

• Refurbishment of Water Treatment Works- including disinfection of systems

• Water Tankering to affected areas• Refurbishment of Waste Water Treatment plants• Drilling of new boreholes and refurbishment of dilapidated ones-

30 x 10kl tanks and new boreholes• Water Quality monitoring• Repair of Water and Sanitation Distribution Systems• Health and Hygiene awareness including provision of soap, jik

and educative material

DWAF INTERVENTIONS in Limpopo

• DWAF initiated mapping of vulnerable areas using GIS with DOH and SAMHS (SA Military Health Serves)

• Intense Monitoring of raw water and drinking water-normally raw water is monitored once a month and drinking once daily. During the outbreak, raw water was monitored once in 4days and drinking water about 6 times a day or during every shift

• Ensuring compliance by water treatment and sewage works that are run by municipalities- a total of 6 treatment works in the affected areas

• Assistance with operations & maintenance practices where necessary

Interventions : MUSINA

• Estimated Expenditure for Musina / Beitbridge (until May 2009: R12 million)

• Water quality monitoring:– Limpopo River– Water works (raw water, treated water)– End user points (Home Affairs centre at the

showgrounds, civic centre) :Municipality provided temporary ablution facilities and water points

• Health and Hygiene materials distributed at key transit areas

Musina Cont..

• DWAF Community Development Officers (CDOs) deployed

• Health and hygiene materials distributed to communities

• Working with PDOH identify potential outbreak areas using GIS mapping

Interventions: MUSINA-Madimbo• Supply of water tanks (3x10kl, 1x5kl

and 4x2.5kl)• Temporary toilets – 50 No. supplied• Water quality monitoring in local rivers• Drill and equip 5 boreholes• PDOH supply of water buckets• Improvement of operations and

maintenance of local infrastructure

CASE STUDY OF DWAF SUPPORT (VHEMBE)

• Since declaration of cholera in Musina, DWAF has– Attended the municipal and medical JOCs (led by

Musina municipality!)– Supplied personnel to co-ordinate water,

sanitation, and health & hygiene(H&H)– 5 x Community Development Officers for H&H– Artisans and drivers

CASE STUDY OF DWAF SUPPORT(VHEMBE)

• Anti-cholera activities– Water quality testing: water supply (5no.

sites every three days)– Water quality testing: river water (5 no.

samples per day)– Drill new boreholes– Water tanks– Temporary toilets

DWAF SUPPORT(VHEMBE)

• Other ongoing support:– O&M budget– Regional bulk water grant– Refurbishment budgets– ISD: Institutional capacity building– Planning and implementation

CASE STUDY OF DWAF SUPPORT(VHEMBE)

• Dwaf has allocated R49,2m for operation and maintenance and R8,7m. This funding just covers only the schemes transferred by Dwaf, there is no contribution from the municipality to maintain other schemes

– VDM regularly underspends O&M/Refurbishment and Regional Bulk Infrastructure funds

– Minister issued two Directives (Nov & Dec 2008). In response, VDM indicated that they require support from that DLGH

– Ineffective O and M leads to disruption of supply: this increases the likelihood of transmission (due to ingress of contamination, communities reverting to unsafe sources)

Vembe Case Study

• For sanitation R60m has been budgeted in the MIG allocation and to date R36,6m has been spent. There is currently a backlog of 139622 households without sanitation and the current allocation is less than what is required to address the backlog in 2014

• R15m has been allocated for bulk infrastructure and R10,3m has been spent

• For schools and clinics they have been allocated R3,4m

MPUMALANGA: Bushbuckridge Case Study

• Some cases originated from Limpopo

• Lack of access to safe water and sanitation facilities

• Lack of operation and maintenance of water services infrastructure

• Not enough investment in refurbishment and O&M

Interventions : MPUMALANGA• Installation of temporary sanitation facilities in strategic points of

affected communities• Intervened by chlorination of Water in certain areas• Conducted Operations & Maintenance works when necessary• Mapping of affected communities• Daily Testing of borehole and tap water• Enforcement of water quality /sewage discharge standards• Health and hygiene education

The Bushbuckridge Case Study

• BBR LM has a population of 743653 people a figure which is the highest in the Province

• BBR LM has 143839 households, coming second only to Mbombela Local Municipality which has 157465 households

• BBR LM has the highest number of villages in the Province, listed as 143 villages, the second highest is Emalahleni with 84 villages.

• The population water services needs in BBR LM is (water) 534626 and (sanitation) 580564

• The water services project list in BBR for the year 2007/08 and 2008/09 is dominated by water projects.

• The sanitation backlog in BBR LM is 114272 which is the highest in the Province and yet sanitation has not been equally prioritised by the district

Analysis

• There are 18 Water treatment works and 10 waste water works managed by the municipality and yet only R49,8m is being spent on operation and maintenance.- a big proportion of that coming from DWAF through the transfers programmes

Budgetary Information 08/09

• Municipal Infrastructure Grant R 152.7m• Operations & Maintenance R 49.8m• Refurbishment R 22.7m• Bulk Infrastructure Grant R 3.0m

Total R228.5m• BBR LM has spending R1,5M towards the provision of

sanitation for the year 2008 from a budget of R3.338m• Overall MIG expenditure is R73.m out of R152.7m

Support provided Support• Development of specifications and terms of

reference for the installation of a chlorination system

• Assistance in the training of plant operators• R10m funding for sewage works and boreholes,

supplementary to the refurbishment budget • Registration of water works in terms S26 of the

National Water Act• Facilitated process to secure funding through

the Mpumalanga Provincial Cabinet

Corrective Action (notices) issued in response to non-compliance

• Sewage overflow into a public stream: College View 05/10/2006

• Operation of Thulamahashe Sewage Works 31/01/2007

• Operation of Mangwazi Biodisc 04/12/2006• Operation of Dwarsloop Sewage Works 31/01/2007• Operation of Mkhuhlu Sewage Works 13/12/2006• A notice of non-compliance will be issued to BBR

LM by Friday 06 February 2009

Other Corrective Actions In Mpumalanga

• Emalahleni Local Municipality (notice deadline 06/02/2009

• Tubatse Local Municipality (responded within their 7 day notice to take remedial action)

• Mbombela Local Municipality: in process of issuing notice for non compliance in White River

• Delmas Local Municipality : in process of issuing non compliance notice for Delmas sewage works

PROGRESS REPORT: OTHER PROVINCES

• Gauteng/Western Cape, North West, KZN in control in co-operation with Provincial DOHs

• Other provinces: DWAF on alert, but there are no reports of confirmed NEW cases.

• The Department is however continuing with:– Co-operation with Provincial DOHs– Water quality monitoring– Health & Hygiene education

Conclusion

• Strengthening the Regulatory function of DWAF will help manage cholera incidents much more effectively in future

• There is a need for a much proactive- preventative and well resourced strategy to manage disasters of this nature- DWAF is working on the implementation

• The fundamental challenges like the powers and functions will have to be addressed in order to deal with capacity of LG to discharge its mandate

WAY FORWARDShort Term• Intensification of Health and Hygiene Education• Refurbishment of infrastructure in Zimbabwe and in affected

Districts• Availability of health services in Zimbabwe to prevent people

from having to come to RSAMedium Term• Speeding up water and sanitation infrastructure development• Development of a National Intervention Unit for cholera and

other related services in Dwaf to ensure a proactive and speedy response to prevent loss of lives

THANK YOU