An assessment of the causes of malnutrition in Ethiopia: A ...

5.3. The Water and Sanitation Sector and Nutrition
5.3.1. What are the objectives?
A review of information on the status of drinking water and sanitation in relation to
nutrition in Ethiopia indicates that significant achievements in the reduction of communicable
diseases, such as diarrhea, would be made if sanitation components are integrated and
implemented at the grassroots level. In particular, the effort should focus on latrine provision,
making available safe and adequate water supplies, and the promotion of hygienic behavior.
The historical trend of basic environmental health services in Ethiopia has not shown any
marked changes over the last three decades, and is far from attaining a level that can affect the
transmission of prevailing communicable diseases. There are, however, hopes attached to
provisions in the Health Sector Development Program and the Health Extension Package to
support sustained efforts though focused community interventions to bring about positive
changes in hygienic practices.
5.3.2. Current status and trends in provision of healthy environment, water
supply, and sanitation
The access to safe water and excreta disposal facilities is still low at 37.3 percent and
28.9 percent, respectively (MOH 2005a). The management of solid waste is yet to be
institutionalized in most regions of the country. In the MOH structure, the professionals
responsible for environmental health services are sanitarians, also called environmental health
workers. Sanitarians are employed in hospitals and sub-regional offices, relatively far from
local communities. Following the proclamation on public health issued in 2000 GC in which
hygiene and environmental health is covered, only a few regions have prepared regulations
and implementation guidelines. Overcrowded living conditions in urban slums and poor
management of both liquid and solid wastes in these areas increase the prevalence of diarrhea
and acute respiratory tract infections. Recurrent infections and rickets (vitamin-D deficiency)
are the hallmarks of these situations. Soil-borne parasitic infestations are still common in
most rural areas. Marshy areas remain as major breeding sites for mosquitoes in most regions
of the country. Cohabitation with animals is the norm in most rural areas of the country,
resulting in infections and infestations with parasites.
Sanitarians are trained in four universities: Gondar, Alemaya, Jimma, and Debub. The
average annual output of trained sanitarians from these universities increased from 35 in 1994
EC to 56 in 1996 EC. The number of environmental health workers at present is 1169 (80
percent with diploma and baccalaureate degree holders). The main duties of trained
sanitarians are environmental hygiene activities focused on the provision of safe and adequate
drinking water, food hygiene, control of vectors causing human diseases, proper waste
management (human, liquid, and solid wastes), promotion of hygiene education, and
safeguarding the human environment from any pollution that is likely to damage human life
and comfort. Their mandates are clearly spelled out in Public Health Proclamation No
200/2001. Environmental health workers are posted in the MOH, Regional Health Bureaus,
and Woreda Health Offices to run and manage the environmental health activities. They are
also found in health institutions, hospitals, and health centers to manage local sanitation
activities. In addition, health center environmental health workers extend their duties to the
respective woreda that the health center is serving.
Traditionally, small-scale water source development (shallow well and springs)
activities used to be managed by these cadres. At present drinking water development, at
whatever scale the construction might be, is mandated to the Ministry of Water Resources
(MoWR), while other sanitation activities remain the function of MOH. At the operational
level, these two Ministries are to work together in an integrated manner so that the MOH
ensures the quality of drinking water meant for public consumption, while the MoWR deals
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