UNICEF- Resilience inom Vatten och Sanitet för bättre hälsa  2018-2020 UNICEF- Resilience WASH for Health 2018-2020 - UNICEF Resilience WASH for Health 2018-2020 Den växande befolkningen boende i slumområden, som följd av den snabba urbaniseringstakten av Harare, samt  avsaknaden av statlig vatten-, sanitet- och hygienreglering kombinerat med svaga leverantörer inom sektorn,  ökar befolkningens sårbarhet mot vattenburna sjukdomar och andra miljörelaterade risker. Bristerna inom vatten och sanitet har också en stor negativ inverkan på nutrition, hälsa och utbildning. Dessa specifika utmaningar som drabbar den fattiga befolkningen i urbana slumområden kräver lösningar på individ-, kommunal-, institutionell- och politisk nivå.

I september 2018 utbröt en kolera epidemi i de fattig förorterna Glen View och Budiriro. I FNs senaste situationrapport, daterad den 21 september 2018, informerar Zimbabwes hälsoministerium och WHO att sammanlagt 38 människor avlidit, varav blott två utanför huvudstaden Harare. Enligt rapporten handlar det nu om ca 100 patienter varav 76 fall av kolera bekräftats, av dessa finns 54 i Harare och återstoden i övriga landet. Under perioden har sammanlagt 4600 människor sökt vård för kolerarelaterade symtom, åter med en överväldigande majoritet i huvudstaden och då i förorterna Glen View och Budiriro. Läget är kritiskt och  om situationen blir värre befaras 50 000 eller flera bli smittade. Dessutom har flertalet dött av tyfoid under samma period. 

UNICEF har i egenskap av ledarorganisation for vatten och sanitetsfrågor (WASH) tillsammans med regeringen och civilsamhället redan kunnat komma igång med att förbättra saniteten och installera mobila latriner. Dessutom har de två kontaminerade vattenbrunnarna stängts av för bruk och sanering pågår. Ambassaden bedömer det av vikt att fort förstärka UNICEF:s insats inom WASH. In Zimbabwe, poor women, children and men live in a multi-risk environment, facing both slow and rapid onset emergencies. An erosion of coping mechanisms in an increasingly uncertain and unpredictable socio-economic environment has exacerbated vulnerabilities, coupled with economic uncertainties and high inflation reducing the coping capacity of communities. Floods and drought (exacerbated by climate change), high rates of disease all contribute to increased levels of risk. Beginning in 2000, the country experienced a protracted humanitarian crisis that manifested in frequent outbreaks of water borne diseases such as cholera. The crisis occurred due to a culmination of factors such as a declining economy which affected the provision of basis services such as WASH and Health services in both urban and rural areas.
Despite some progress, humanitarian challenges remain; these include recurrent outbreaks of waterborne diseases (Typhoid and cholera) in both urban and rural areas; sporadic internal displacements due to flash and riverine flooding; and, the existence of a wide range of highly vulnerable groups such as the chronically ill mainly due to a high prevalence of HIV (13.9%) , returning migrants, asylum seekers and child headed households.  Access to safe water supply, sanitation and hygiene in Zimbabwe has been eroded due to the general economic decline, reduced institutional and community capacity and effects of climate change. Decline in WASH service provision has been particularly significant in high-density and unplanned urban areas, which now face continual water shortages and rationing due to lack of investment and maintenance.  UNICEF continues to serve as the co-chair to the government for the Emergency Strategic Advisory Group (ESAG) of the WASH sector for strengthened coordination of the WASH response although challenges exist in coordination between City of Harare and the Ministry of Health.  Outputs of the meetings include plans for a detailed WASH assessment of hot spots, sector immediate response plan and 4W matrix mapping collation.  This proposed intervention will focus on activities that can quickly build community resilience around WASH and improved health.  It is expected to have an immediate impact and that can be quickly replicated among the communities. Approaches that can have longer term implications (such as the water supply by City of Harare availability, solid waste management, sanitation, sewerage systems) are being strongly advocated for through robust technical advice to the Government and local authorities to ensure that those issues are being addressed through proper planning and by-laws and strengthening implementation. Pillar 1. Strengthen coordination and leadership of the response through the existing sectoral and inter-sectoral coordination mechanisms by • Strengthening the WASH technical working group for the duration of the outbreak and strengthen inter-pillar/thematic group coordination to ensure that identified gaps/issues are tackled in a holistic manner.• Advocacy for and participate in bi-monthly joint health and WASH cluster meetings at the national level for the duration of the outbreak.• Implementation of the WASH sector responsibilities matrix, including information management and reporting and monitoring of partner’s cholera response in the field.
Pillar 2. Reduce the spread of the epidemic by:• Develop integrated WASH interventions to prevent the spread of the disease, mainly through the following: access to safe drinking water, through provision of water treatment products; drilling and motorizing 4 boreholes (solar powered) in the affected areas to augment water supply; support to City of Harare on rehabilitation existing piped water and sewers networks as needed; targeted regular water quality testing• Promote the adoption of key hygiene practices, namely through ? safe water chain household water treatment, transportation and safe storage? safe disposal of waste? Handwashing with Soap at critical times during the day (i.e. before touching, preparing and/or eating food, after defecation and after clean excreta of infants.? Training and formation of community health clubs (focusing on those not usually reached, i.e. males and under 15 year olds) that will be leading discussions on health and hygiene issues at community level, in schools, health centers and market places • Supporting the piloting of alternative sanitation options for scaling up• Supporting the elimination of Open Defecation and proper use of latrines through the provision of alternative sanitation mechanisms. The project will explore how to pilot alternative sanitation options like the Ecological sanitation (Ecosan), the Fossa alterna version in consultation with relevant stakeholders and ensure the technical solution chosen is compatible with Government guidance and local community preferences. The Fossa alterna is a simple alternating shallow pit toilet system designed specifically to make humus suitable for agriculture. It is based on a twin pit system - the use of the toilet itself alternating between two permanently sited shallow pits. This has been implemented before in similar set ups in Kuwadzana extension, Dzivarasekwa extension and Caledonia areas. The project will target construction of 150 demonstration units of the chosen technology targeting the most vulnerable areas of Stoneridge and other unserved areas. • Strengthening community engagement through enhancing local networks for social mobilization, including community health clubs: ? Increased engagement with religious and local leaders, schools, health centres and other institutions and key influencers amongst all affected groups including nomadic pastoralists and others.? Intensified messaging through appropriate media (posters, radio, social media, schools and sms-texts).? Integration and harmonization of messages from different sectors (education, health, nutrition, WASH) for maximum impact.? Increased institutional/facility based by hygiene promotion interventions through schools, churches, health centers etc.?Pillar 3. Reduce vulnerability to cholera outbreaks in susceptible areas• Prepositioning of emergency stocks where necessary and conduct contingency planning at all levels and associated capacity building as needed