The WHO defines primary healthcare as a concept that considers individuals’ holistic health care needs and their communities. The major components of primary health care are an adequate supply of water, sanitation and health education. These components have never been more critical than now during the COVID-19 pandemic.
Good hand hygiene is an excellent preventive measure to limit the spread of COVID-19. This is a challenging matter when most of the country, especially the Eastern Cape, is experiencing dire water shortages. Health promotion is concerned about highlighting people’s health status to ensure that their health status receives required attention.
This ensures that necessary interventions are done to assist those affected by different health problems to obtain the required assistance.
The WHO estimates that 829000 deaths occur each year to insufficient water, sanitation, and hygiene. These factors contribute up to 15% of the Global Burden of Disease.
Presently, South Africa is battling the COVID-19 pandemic. One of the WHO’s recommendations is that the most effective strategy to prevent the spread and minimise the infections of COVID-19 is effective hand washing.
Therefore, for South Africa to combat the virus, clean water would need to be available in adequate quantities to all communities to ensure that they can wash hands effectively.
The StatsSA General Household Survey (GHS) in 2017 reported that roughly 3.1% of households in the country have inadequate sanitation services, which showed a significant decrease over the years. However, the same survey showed that approximately 17.9% of households in informal areas complained that they do not have sanitation services that meet the required national standards.
The cause of this is related to poor water infrastructure maintenance, minimal investments made to ensure that the infrastructure can meet a growing population’s needs, and to an extent, unplanned land occupation. These problems present a challenge in combatting the COVID-19 pandemic.
Besides, annually thousands of people die from diseases that could have been prevented if they had access to adequate clean water and basic sanitation facilities.
Furthermore, since so many people have an inadequate water supply, they will always be difficulties convincing people to use what they consider a precious resource to wash their hands. This is particularly important in a region such as Nelson Mandela Bay metro where dam levels are currently around 22% and where bucket toilets are still used in more than 132 informal settlements.
The consistent message from the local government is that citizens must save water. Water outages have also become the norm.
The local media outlet, The Herald, ran a front-page indicating that Nelson Mandela Bay Metropolitan municipality water may be contaminated with potentially harmful substance and is unsafe for citizens to drink. This adds fear and uncertainty as citizens become less trusting of the water provided by the municipality.
Simultaneously, as this fear of potentially harmful pathogens in water rages on, people are being told to wash their hands regularly to maintain good hand hygiene. Such messaging is likely to ring hollow for citizens who rely on bucket toilets to relieve themselves.
According to the municipality, there are over 6000 buckets still being used by citizens in the area. This number is staggering and disgraceful. There have also been reported cases where bucket toilets are not collected as per the schedule.
Informing residents living in squalor and in appalling conditions to practice hygiene is not going to be effective. This is especially true in a metro where COVID-19 cases continue to rise daily.
As of 15 November 2020, the NCID estimated that Nelson Mandela Bay COVID-19 cases have increased from 349 to over 6,000 in less than three weeks. This has mainly alluded to public gatherings, which include social meetings, funerals, etc.
To control the virus’s spread, the Nelson Mandela Bay Metro has decided to roll out Health Education to tavern owners. Although this is a noble exercise, its effectiveness may not achieve the intended outcome. This would not be sufficient if health education is not done to assist individuals in assessing their circumstances.
The metro would need to roll out personalised health education, especially in the townships and informal settlements where the COVID-19 pandemic is spreading widely. The health education programme must consider the impact of consistent messaging over the last number of years that people must save water.
It should investigate the strategies that individuals could employ to wash their hands and maintain good personnel hygiene while at the same time saving this precious resource. The focus should be on those communities with limited access to water and use bucket toilets to relieve themselves. While this points to many government failures, public health officials would need to work with resources to limit the spread.
For many South Africans who have not made it a habit to use water and sanitation services to enforce hygiene, there would need to be a heavy roll-out of education programmes to educate them on the importance of keeping their hands clean. The roll-out would need to consider the country’s literacy levels, practical and different learning tools, and other mediums that could be used to send out the message.
Effective health education about the importance of washing hands with soap and water would be the key strategy to combat COVID-19, especially in less-resourced communities.
Public Health Officials should focus specifically on this preventive measure to limit and combat the seemingly uncontrollable spread of COVID-19 people empowered through effective and personalised health education; they will limit public transport, visit churches and other social gatherings.
Health professionals and politicians alike should never underestimate the importance of a well-planned and researched health education to target audiences.
Local government must play a central role in providing safe and drinkable water through investing resources in water infrastructure, skills development of artisans and water treatment technicians, and upskilling Environmental Health Professionals. By law, they should ensure the provision of safe and potable water.
In the future, the government needs to consider incorporating non-health policies such as access to clean water in its health policies to prevent a situation where social determinants of health directly impact health outcomes.
Written by: Mthokozisi Nkosi (CEO of ASC Consultants which specialises in food safety and public health)