Water, sanitation and hygiene (WASH)

Despite significant progress over the years, only half of Mozambicans have access to improved water supply and less than a quarter (one in five) use improved sanitation facilities.

Overall, glaring inequities persist in water and sanitation services between people who live in rural and those who live in urban areas. 

Nationally, although the proportion of people without access to improved water sources declined from 65 per cent in 1990 to 49 per cent in 2015, disparities between those without coverage in rural and in urban areas are marked, estimated at 64 per cent and 17 per cent respectively. Moreover, in rural areas, one in five use surface water as their primary drinking water source.

At 36 per cent, Mozambique has one of the highest open defecation rates in sub-Saharan Africa. And as much as 76 per cent of the population do not have or do not use improved sanitation facilities: 88 per cent in rural areas, and 53 per cent in urban and peri-urban areas. 

Although rural areas are most affected by the lack of basic WASH services, even the moderately positive urban WASH indicators mask serious service gaps for the poor in fast-growing cities and towns where lack of systematic maintenance, low investment and unclear institutional mandates have hindered service delivery. 

Geographic disparities also exist, with services generally weaker in northern provinces. For example, in the southern province of Maputo, about 87.1 per cent of the population access safe water and 70.1 per cent access and use improved sanitation compared to the northern province of Zambézia, one of the country’s most populous provinces, where only 30.6 per cent access safe water and 13.0 per cent access and use improved sanitation.  WASH in schools and at health facilities remains unknown. Frequent natural disasters, which are being exacerbated by climate change, are also a huge challenge. They continue to have a devastating impact on millions of Mozambicans. 

Climate change also threatens the availability and quality of the country’s freshwater resources, both surface and ground water. Young children are most at risk from poor WASH conditions. Although Mozambique has seen progress in the reduction of under-five mortality, diarrhoeal diseases remain amongst the leading causes of death among children. Additionally, strong evidence indicates that WASH is an essential intervention to reduce undernutrition; this is particularly pertinent in Mozambique where 43 per cent of children under 5 years of age are severely or moderately stunted.

Women and girls are also particularly affected by poor access to water and sanitation. Besides having a detrimental impact on their health, poor access to WASH for girls threatens their security, well-being, education, and contributes to a loss of dignity and threat of sexual assault due to a lack of toilets, both in times of emergency and stability. Also, children with disabilities are denied access to a school education when accessible WASH facilities are unavailable or inadequate.

Additionally, population growth and rapid urbanization will soon put an even greater pressure on WASH services. The urban population of Mozambique may reach 50 per cent by 2025. Cities and their poorly served peri-urban areas are magnets for rural migrants. Also, growing rural towns of up to 50,000 inhabitants represent roughly 15 per cent of the total urban population and will require much greater investments.

UNICEF’s WASH programme will support the national priorities laid out in the Government’s Five-Year Plan, which are in line with the Sustainable Development Goals (SDG), including SDG 6 to ‘ensure availability and sustainable management of water and sanitation for all’. UNICEF will work in partnership with the government to ensure vulnerable groups have access to safe water supply and sanitation infrastructure in rural, small towns and peri-urban areas. UNICEF’s work on water, sanitation, and hygiene will contribute to its overall mandate to advocate for the protection of children's rights, to help meet their basic needs and to expand opportunities which will allow them to reach their full potential. WASH interventions will make significant contributions to reducing preventable child deaths, reducing undernutrition, helping girls and boys to fulfill their right to education, and to reduce the burden on women and girls to fetch water. 

Fragresse Finiassa, a mother of six, explains how until recently she lacked a toilet and safe water. “We used to suffer a lot from diarrhoea,” she says. “When we had severe diarrhoea, we would have to walk five hours to the health centre for treatment.”

The lack of a toilet meant that “at night, our shoes would often get dirty, because we couldn’t see where we were treading, and my children would also get scared to go out in the bush (to defecate) in the dark,” says Fragresse.

This all changed at the end of 2016 when Fragresse and her community learnt the dangers of open defecation and how to solve the problem. They did this by participating in a Community-led  Total Sanitation triggering exercise, with the help of animators (government contracted behaviour change facilitators). During the exercise, they discovered how flies that land on faeces around their homes contaminate the food they eat. Importantly, they learnt how just one home practising open defecation (OD) could put the whole community’s health at risk. 

Chris Cormency, UNICEF Chief of Water, Sanitation and Hygiene (WASH), explains that UNICEF has provided technical support for this approach, known as Community-Led Total Sanitation (CLTS), “because it is an empowering methodology which encourages communities to completely eliminate open defecation.”

He points out that the approach has an advantage over others, such as subsidizing toilet construction, as CLTS “focuses on collectively identifying the problem associated with open defecation and assisting the community to come together to find their own solutions to collectively change their behaviours. They can adapt the solutions to their local reality and needs, which foster ownership and should in turn lead to sustainability.”

Fragresse lives with just 55 other families in the remote Podogoma community, Milange district, in the central province of Zambézia. She says that following the CLTS exercise, her husband – like other men in the community – agreed to dig a latrine and bought the concrete slab to cover it. He also built a mud and straw structure around the latrine for privacy. 

As well as learning about the importance of toilet construction, the community also learn about good hygiene practices both during the CLTS exercise and during ongoing health promotion activities, including home visits by community health workers.

Fragresse shows how her family have made other improvements around their home. For example, outside the toilet enclosure, hanging on a stand made of twigs, is a large water container and cup, as well as a recycled plastic tub to collect water when they wash their hands, which she can then use to water the plants. 

There is no sign of any litter around her home. Fragresse has swept using a broom, made from leaves on small branches that she has tied together. There is also a deep pit which her husband dug to deposit rubbish.

Fragresse built a rack out of bamboo which she uses to drain her cooking utensils and plates, and below the rack, there is a bamboo shelf with a water jug and a bar of soap. Before, Fragresse says, she used to keep the utensils on the ground to dry, which she was told was unhygienic. 

She points out they often could not get soap due to the distance to the market; it is a three-hour walk. But now, they take it in turns in the community to buy a bulk supply whenever they have cash. “When we don’t manage, we have been told we can use ash,” says Fragresse.

Terencio Fernando Sondique, a water technician at the district government in Milange that covers Fragresse’s community, says that “although there has been some resistance from the communities, most are now convinced that they need to build toilets. 
They know open defecation is not good, but it takes time to change habits.”

Mozambique has one of the highest open defecation rate in sub-Saharan Africa at 36 per cent, according to official figures. Furthermore, as many as 76 per cent of the population do not have or use improved sanitation facilities, with the rate being 88 per cent in rural areas compared to 53 per cent in urban and peri-urban areas.

To address this, CLTS has been adopted by the government with the aim of reducing rates of under-five mortality and undernutrition. Despite the progress, still 97 children die per 1,000 live births, and diarrhoeal diseases remain one of the leading causes of death. Moreover, some 43 per cent of children under 5 are severely or moderately stunted in Mozambique.

Fortunately, the community in Podojoma will soon be classified as Open Defecation Free (ODF). The leader of the community, Ernesto Hussein, says, “This project has made the community aware of the importance of toilets. It has made a huge difference. We no longer have so much diarrhoea in the community.”

Source: JMP, 2017