Salud Pública

Las Historias Detalladas (Basados en visitas de campo y entrevistas extensas)

Las Historias Cápsulas

  • MozambiqueSaneamiento Ecológico – La utilización de música para promover el “saneamiento ecológico”, un proceso para transformar desechos humanos en un fertilizante agrícola rico en nutrientes, de bajo costo y ecológicamente sustentable.
  • UgandaControl de SIDA – Un enfoque holístico hace un ejemplo de los esfuerzos para controlar el SIDA en Uganda.

Mozambique – Saneamiento Ecológico

by Amanda Suutari

Using music to spread the message of ecological sanitation to the most remote corners of Mozambique, Feliciano dos Santos is empowering villagers to participate in sustainable development and rise up from poverty. In Niassa province, many villages lack even basic sanitation infrastructure. Without reliable access to clean water and waste management systems, the population is highly susceptible to disease. Santos, who grew up in the region, today heads an innovative program that is bringing new hope to Niassa. With his internationally-recognized band, Massukos, Santos uses music to promote the importance of water and sanitation in Mozambique. His program is now serving as a model for other sustainable development programs around the world.

Sanitation and Poverty

Throughout much of Africa, the lack of proper sanitation poses significant challenges to development. When drinking water is compromised, disease often follows. The World Health Organization estimates that 80 percent of all sickness in the world is attributable to unsafe water and sanitation. More children under five die from water-borne illnesses than AIDS. Recognizing both the environmental and societal risks associated with poor sanitation, the United Nations has declared 2008 the “Year of Sanitation” in order to bring further attention to the issue worldwide.

In Mozambique, more than half the population lives in extreme poverty without access to basic sanitation. The northernmost province of Niassa is one of the poorest and most isolated regions of the country. Most of its nearly one million inhabitants live in small villages dispersed throughout the province, which is as large as New England, yet has only 170 kilometers of paved road.

Waste Fuels Sustainable Development

Sanitation continues to be a taboo subject throughout the world, though it remains one of the most pressing problems in poverty-stricken regions. Santos has successfully found ways to discuss human waste management techniques with villagers through both grassroots outreach and music. He grew up in Niassa with no clean water or proper sanitation and is disabled from polio. As an adult, he has focused on improving living conditions in the region. Santos understands that environmental and health problems are interrelated in regions dealing with poverty issues like Niassa. As the director of Estamos, he works directly with villagers to provide community sanitation, promote sustainable agriculture, lead reforestation projects and support innovative HIV/AIDS initiatives. Santos believes that sanitation and water supply issues must be solved in order for other development projects to take root.

Santos and Estamos promote low cost, environmentally sustainable “ecological sanitation,” a process that uses composting toilets, called EcoSans, to transform human waste into nutrient-rich agricultural fertilizer. Typically, a family will use an EcoSan for a number of months, adding soil and ash after each use. The pit is then buried and left for eight months, and the family moves on to another pit. During the eight months all the harmful pathogens die off, leaving a rich fertilizer that can be dug up and used in the fields. The compost not only provides natural fertilizer, but also enhances the soil’s water-retention capacity. Families using ecological sanitation report markedly fewer diseases, a 100 percent improvement in crop production, and improved soil retention. Before ecological sanitation, many villages used costly artificial fertilizers on their crops, and often were barely able to feed their families. By using the compost instead of artificial fertilizer, many are able to produce more food than they need and can generate a small income by selling some of their harvest.

Santos and Estamos believe that no sanitation system or behavior change should be imposed on villagers by an external NGO. As an insider, Santos and his team lead participatory workshops in which villagers come to understand their sanitation options, and, if they like, choose the option they prefer and build it themselves.

Since Santos and Estamos began their work in Niassa in 2000, they have helped thousands of people in hundreds of villages gain access to clean water and ecological sanitation. This is a considerable achievement considering the lack of infrastructure in Niassa’s remote villages. Estamos continues to grow and is now working in three districts in northern Mozambique. In one remote area, a local chief working with Estamos is leading a group of 70 villages to achieve 100 percent sanitation coverage. This achievement would be the first of this magnitude in Mozambique.

Empowerment through Music

Santos’s band, Massukos, incorporates the sanitation message into music, performing in villages across Niassa and at times around Mozambique and abroad. Since Santos began his music-based outreach, people throughout Niassa and Mozambique have begun to focus more on the country’s rural sanitation problems. By connecting with Mozambique’s rich performance traditions, Santos and Estamos connect to villagers in a culturally appropriate way through music and theater. When Santos and the band arrive in a Niassa village, the entire local population often appears to hear them and their message. But the music is not the only reason for Estamos’s success. In July 2007, Massukos traveled to the UK where they released their album “Bumping” and performed at the World of Music, Arts and Dance (WOMAD) festival.

Feliciano dos Santos is a recipient of the Goldman Environmental Prize. For more information see the Goldman Prize website.

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Uganda – Control de SIDA

by Amanda Suutari

As one of the first African countries to experience the HIV/AIDS epidemic and one of the first to show declines in infection rates in 1996, Uganda has become a model of how a nation with limited resources and health care services can manage and control an epidemic of unprecedented scale. When the first cases of HIV/AIDS began to appear in 1982, some 50% of the country had access to health care and less than 30% had access to safe water. The disease was initially limited to people who traveled frequently such as long-distance truck-drivers or prostitutes, and was clouded by mystery, rumor and superstitions such as witchcraft.

HIV/AIDS went from being a disease to an epidemic, and in 1986 Uganda’s health minister publicly announced the situation during a World Health Organization conference in Geneva. This marked the beginning of political frankness which created conditions for the mass public education campaigns that followed. (This could be contrasted with the Chinese government’s handling both of SARS in 2003 and its own AIDS epidemic, where existence of both diseases has been denied or downplayed, allowing them to spread in a culture of ignorance and misinformation.)

Uganda took a multi-pronged, pan-sectoral approach which was both centralized and decentralized where appropriate. It mobilized all levels of legal, political, administrative, health, non-profit, for-profit, research institutions, international donors, and international institutions (WHO etc):

  1. It launched massive education campaigns, aimed at de-stigmatizing the disease, targeting different age groups about issues related to their age or situation, including delaying sexual relations, use of condoms, avoidance of casual sex, and fidelity. This was coordinated through mass media but also decentralized through folk media, religious organizations, educational institutions, community groups and non-governmental organizations. Initially the strategy was to instill fear in the public, but it became clear that this had only limited, short-term success and authorities learned that the approach had to be made more hopeful and positive.
  2. Health authorities were given support by government and international donors to screen blood banks, and to improve services related to detection, testing, counseling, and make them widely available, especially to the poor, who might be doubly stigmatized and less likely to seek help. Drugs for opportunistic infections were also made available to patients free of charge.
  3. Understanding AIDS/HIV was a gender issue with womens’ participation as its basis; improvements were made to the public education system to make it more available to all, especially girls. At the legal level, female lawyers banded together to change laws and punishments related to rape and statuatory rape. Credit facilities targeted towards women were established, enabling women to start small businesses.

In 1992 the Uganda AIDS Commission was established to coordinate and harmonize efforts from all corners. While the epidemic is far from over and will continue to incur high, long-term costs, Uganda is seen as an international leader in controlling HIV/AIDS. Reasons for its success are linked to these factors:

  • coordination
  • decentralization
  • a holistic, integrated approach
  • a clear understanding that HIV/AIDS was much more than a public health issue
  • flexibility which allowed for creativity and innovation while improving institutional conservation
  • openness
  • active participation of women

For more information visit the World Health Organization and the Uganda AIDS Commission.

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