Primary health care: why has water been neglected?

Abstract

Selective primary health care (SPHC) discourages water supply and sanitation (WS&S) projects because of their supposed cost ineffectiveness in reducing morbidity and mortality. What SPHC fails to recognize is that WS&S projects using appropriate and effective simple technologies are just as or more effective than the SPHC technologies e.g immunization for all children. Not only do WS&S projects reduce the incidence of diarrhea and child deaths but with a community participating in such projects the communitys involvement in immunizations is 5-10% higher than communities with no WS&S. Further mothers have more time to spend on time intensive child survival activities e.g. preparing oral rehydration solution when potable water and improved sanitation are present in the community. Despite all the evidence most international agencies still contend that WS&S interventions should wait until a community is at an advance stage in the development process. In Nigeria researchers conducted a short term study to observe the dynamics of guinea worm (transmitted via unsafe drinking water) disability and its linkages to child survival policies and maternal well being. Average prevalence in Idere Town stood at 30% and in Kwara 60%. Due to their disability mothers could not tend to their personal or childrens needs. For example afflicted mothers often changed the 406 month olds diet to a low nutritional content corn meal gruel because they could no longer earn an income to buy more nutritious foods or they could no longer tend to their gardens. The study stresses the need to invest in potable water supplies and sanitation facilities because without them immunizations are missed diseases are not treated properly breast feeding and good nutrition are neglected.