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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
Water sources, infrastructure, space and the dynamics of environmental diseases in Saboba District: Using GISConclusionGrowing population and inadequacy of toilet facilities, including uncleanness ofthe few existing public ones have pushed 91.1% of the population to usethe free-range system resulting in increasing rates of Typhoid. This laidcredence to IWMI (2000) view stated above.Inadequacy of clean or treated water and frequent interruption in the flow of pipewater is identified as another causal factor for the high incidences ofwater related diseases in Saboba district. Even with the presence of pipeborne water in the district, majority of the population still drink waterfrom unimproved sources as 50.2% drink water from streams or springsor rivers, 12.7% (dugout pits) and 12.4% from Wells. Only 17.2% ofthe total population in the district drink water from boreholes and 7.4%from pipes (improved sources). The high proportion of unimprovedsources of water is due to 1) lack of access to pipes and boreholes formany communities, 2) frequent interruption in existing pipe watersupply, 3) disconnection of pipes due to non-payment of water bills, and4) many people especially from the periphery will not drink boreholewater because it is too light and does not quench taste or smells badly.The research also discovered lack of waste disposal system as responsible forthe high environmental diseases in the district, as 92% uses unimprovedmethods of waste disposal such as dump elsewhere, burn and buried methods.The indiscriminate and large dumping of used tin-cans, broken calabash andpolythene bags in the district are also found to contain water for a long timeafter rain, serving as reservoir for breeding mosquito larvae. Openedunderground tanks and public toilets also breeds a lot of mosquitoes(Appendix IV f and Fig. 15b)Poverty has also been identified as one other cause of high environmentaldiseases in the district. Poverty accounted for why people cannot paytheir water bills leading to disconnection of pipes. It is also responsiblefor high illiteracy, inability (financially) to acquire a personal toilet facilityand the general lack of defence mechanisms shown in the conceptualframework.Illiteracy and ignorance have it part to blame for the high incidences ofwater related diseases, and environmental diseases in general. Complainsthat borehole water is too light and does not quench thirst were largely seen tobe more perceptual, and a consequent of ignorance than reality.The free-range system of animal rearing, especially pigs, have resulted inanimals dump littered almost every where, while some share the samesource of water with humans. Their faecal matter is easily washed intowater bodies, while some create potholes or drainage blockage thatfacilitates the breeding of mosquitoes (Appendix IV c).The cause of high rates of RTI may be the use of woodfuel for cooking,bushfires, the inappropriate use of mosquito coils or plant matter anddust from the Harmattan. The effect of environmentally unfriendly carsand lorries on RTI in the district does not seem to play an importantrole, due to fewer cars and the rough nature (potholes) of the roads.Generally, the higher rate of environmental diseases in Saboba district islargely a human induced phenomenon; hence natural causes have verylimited impact. The study discovered that the immediate environmentalthreats for the people of Saboba district may not be the long-term effectsof cumulative exposure to carcinogens or/and effects of global warming,or even decade-long desertification but rather the life and deathimmediacy of Malaria, Typhoid and respiratory diseases. These threatsare mainly synergic human factors derived from household57
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