WASH, health & Sierra Leone
Sierra Leone is one of the poorest countries in the world, ranking towards the bottom of the Human Development Index (181/188 in 2015); it also has one of the highest child mortality rates, at 161 deaths for every 1,000 children born. More than 14% of these deaths are due to diarrhoea. This is partly as a result of inadequate water, sanitation and hygiene (WASH) services, which was also largely responsible for a series of cholera outbreaks between 2006 and 2012. In 2014, when Ebola hit Sierra Leone, poor WASH infrastructure combined with unsafe hygiene practices exposed health workers,
patients and wider communities to the virus and probably contributed to its spread.
Although it is estimated that 85% of the urban population has access to potable water, this figure hides important disparities between the richest and the poorest neighbourhoods. In Freetown, one of the fastest-growing cities in West Africa, uncontrolled urbanization presents major challenges for the main service provider, Guma Valley Water Company. More than 96% of the water it supplies is from the Guma Dam, which was built in 1960s to serve a maximum of 300,000 people. With the current population estimated at 1.5 million, and high water losses (45-50%) due to the ageing and
badly maintained network system and illegal connections, the centralized water supply system is unable to meet public, commercial and industrial demand. The situation is compounded by leakage of wastewater from a poor sanitation system, encroachment of people in the watershed, and climate variability.
More than one-third of the population (>500,000 people) live in areas that are not fully covered by the Guma Valley Water Company supply network; they are highly dependent on small, decentralized water supply systems that account for less than 4% of the total supply. The functions, ownership, roles and responsibilities of community-based water management groups and formal institutions are still unclear. This has been an impediment to good governance around the decentralized facilities, as demonstrated by lack of regulation, poor management, and poor upkeep of the facilities and the
hygiene around them. There is currently no effective regulation of urban water sector, beside the requirements of the governing board of sector agencies and sector organization.
Only 23% of the urban population have access to improved sanitation. In 2013, the council contracted a private company, MASADA, to manage the city's solid waste collection and disposal, but this has insufficient capacity. This has resulted in indiscriminate dumping which contributed to the blockage of drainage channels in parts of the city, leading to increased flooding, as in September 2015. Of the sludge that is removed from toilets, only 27% is disposed of in Kingtom, the only official sludge-disposal site in Freetown. However, these treatment facilities have not been
maintained, so untreated sludge spills into a series of creeks that run through informal slums and into the sea. Good hygiene practices are not widespread; many families remain unaware of the importance of hand washing, and soap is often unavailable. According to the World Health Organisation, poor WASH environments are responsible for 88% of all cases of diarrhoea. While building WASH infrastructure takes time and financial investment, hygiene promotion can be implemented at a relatively low cost and with good results: it is estimated that hand washing with soap can reduce diarrhoeal
disease prevalence by 35%.
Public duty bearers' capacity to detect, prepare for and respond to emergencies remains weak, as observed during the Ebola outbreak and the 2015 flood response. Ebola claimed more than 3,500 lives, including those of 200 healthcare workers. The impact on the economy has been catastrophic, the healthcare system almost collapsed, and schools closed for almost a year. Concerns about the safety of health facilities led to an estimated 70% drop in clinical admissions, a drop in routine immunizations, and a marked increase in maternal and infant mortality. To put the country's
economy back on track, the government has designed a National Ebola Response strategy, and identified recovery priorities in key sectors including WASH.