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

Institutional arrangements are also an important factor in sustaining and scaling up
efforts in the development of water and sanitation services to a level that would have a
significant impact on public health. The Ministry of Health, the Ministry of Water Resources,
and the Environmental Protection Authority (EPA) are key actors in the area of environmental
health. The division of labor for these institutions is clearly indicated in proclamation 41 of
1993. The Ministry of Health is responsible for the safety of environment for health, such as
the quality of drinking water and safe waste management, while the Ministry of Water
Resources is responsible mainly for developing and implementing the engineering aspect of
water supply and liquid waste management. The EPA by law is accountable to ensure the
well-being of and maintenance of the ambient environment. At times, the Ministry of Health
and the Ministry of Water Resources have disputes concerning their respective roles in the
implementation of small-scale water and sanitation projects, in particular for rural areas.
Sanitation activities that involve the construction of low cost latrines for household use are
the mandate of the MOH, while designing and construction improved drinking water sources
is the responsibility of MOWR. In all cases of ensuring the prevention of source
contamination, continued hygiene education during and after construction is monitored and
evaluated by MOH. Further, the sectoral approach for both water and sanitation schemes is to
maximize the benefits given limited resources.
The financial aspect is also an input in the development of improved water and
sanitation services in Ethiopia. The Government, through the MOWR, has continued to
design and implement urban water projects. As a result, the proportion of beneficiaries in
accessing safe drinking water is urban areas is growing far faster than in rural areas. There is
hope that the National Health Extension Package will contribute to reducing this inequity in
the near future. There are funds that are allocated by international and bilateral community to
promote a healthy environment. The World Bank, ADB, UNICEF, and a number of NGOs
are major partners in funding the sanitation and water development sector.
Setting up drinking water supply systems within poor communities can also be part of
Productive Safety Net Program that is now being implemented. The construction and
maintenance of shared latrines in rural communities could be included among the public
works carried out under the program. Such latrines can be positioned within rural population
centers at health posts, extension centers, peasant association offices, demonstration centers,
schools, as well as at food distribution centers. They can also serve as centers of education
communication for changing sanitation and hygiene related behavior.
Access to a safe environment is not only the responsibility of Government, but more
importantly, it requires public and individual involvement. Community involvement and its
mobilization in all aspects of sanitation are necessary to sustain the use and maintenance of
sanitation projects and activities. The activation of community participation in sanitation
thorough the Health Extension Packages Program is anticipated to sustain sanitation services.
Health Extension workers in return give continued support for hygiene education and
technical support to the beneficiaries. The development of culturally and economically
acceptable sanitation facilities, like low cost latrine alternatives and monitoring and
evaluation of their utilization are other aspects to sustain the physical inputs. The Health Posts
in each village (with 1000 households), through the Health Extension Package, is designed to
be a focal point to evaluate the performance and changes in health service delivery at village
level, including in the areas of safe water and sanitation.
5.3.6. Health and sanitation policy issues in Ethiopia.
Many initiatives formulate the national needs of environmental health services in
Ethiopia. The Ethiopian Constitution in Article 44 states that every citizen has the right to live
in a clean and healthy environment. The Ethiopian health policy also makes a number of
statements on the provision of health services and sanitation. It emphasizes PHC as an
approach for the preventive and curative components of health care in Ethiopia to reach the
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