water sources, infrastructure, space and the dynamics of ...

Matthew Biniyam KursahTRITA LWR Master Thesisand the 70+ years to their lists, 4) age inflation or reduction to benefitfrom the free registration, and 5) extremely high hospital bills formembers of the scheme (Box 4). Therefore, the problem of the healthscheme is simply resource constraint and fraud from the public. NHIS isurged to engage in effective health awareness programmes since it willbenefit immensely from good health of the public – less hospital bills.Political and gender issuesDuring the field study, I did not find any concrete water policy in thedistrict. The study revealed that customary laws are more wholistic inmanaging and protecting water resources in the district than governmentor district laws. Customary laws are also widely known and obeyed with41.8% of the respondents believed it was highly effective , 36.1%(medium) and only 22.1% rated it as lowly effective; compared to 6.5%,44% and 49.5% for high, medium and low, respectively, for governmentor district laws (Fig. 5). Also, 15.4% of the respondent said there are nogovernment or district laws protecting water resources in the district asagainst 2.3% for customary laws (Table 8). This is because customarylaws are seen to have come from the people by the people and for the people. Thisanalysis therefore questions, as many have done, the effectiveness of topdownapproach to policy formulation and implementation.The study also discovered that women do not actively participate indecision making and issues concerning the communities. This was clearlyseen during the administration of questionnaires where women referredme to direct the questions to their men counterpart. In most cases(mostly in villages) the women had to first seek permission from men orhusbands before being interviewed – partly why they were underrepresented in the sampling. The study also discovered that women weredisproportionately affected by water related diseases as more than half(54.2%) of the patients diagnosed of water-related disease in SMC werewomen compared to 45.8% for men. Also, more women (54.5%) thanmen (45.5%) reported with RTI. However, a sharp reverse is the case forother diseases, as 54.5% were men and 45.5% being women. Theexplanation is that generally, more men have access to the defencemechanisms against environmental hazards (Fig. 2) due to their controlof resources and power in the family. However, data from WHC showlesser proportion of women (51.5%), but still higher compared to men(48.5%). This may be due to the non-treatment of disease like Typhoidat WHC and physical accessibility (long distances). For other diseases,just like in SMC, a sharp contrast occurred with 57.9% being men and42.1% women. WHC data also shows that Genital and STIspredominantly affects women (60.0%) than men (40.0%).Causes of high prevalence of environmental diseases in Saboba districtThe study identified a number of factors that have predisposed Sabobadistrict to higher rates of water-related (and in general, environmentaldiseases) such as Malaria and Typhoid in Saboba district. Many of thecauses are synergic in character as discussed below;Presence of dugout pits created by the large use of mud or earth (94.2%) asthe main building material and their subsequent fill-up with water duringrainy season has made it possible for mosquito larvae to breed. The useof such pits as a place of toilet (free-range) and sources of water furtherexplains the high occurrence of Typhoid. Closely related to this, is thepresence of stagnant water found in potholes, disposed tin cans, brokencalabashes and other containers.56