SEAP - Human Settlements, Urbanisation and Environmental Health Working Group

CONTENTS | INTRODUCTION | GOALS | ISSUES | SUGGESTED POLICIES | STRATEGIES | MONITORING | INSTITUTIONAL AND LEGAL FRAMEWORK | CONCLUSION | REFERENCES | ANNEXURES

3.0 THE ISSUES/PRIORITIES

3.1 Settlement Patterns, Land Use and Housing

As it has been mentioned before, Swaziland experiences problems and challenges attributed to the high rate of urbanization and the explosive population growth. This has resulted in a significant deterioration of the environment and the resource base.

Further, the worsening of the economic climate has led to the inability of the country (especially at the level of the public sector) to cope with the pressure of urbanization and population growth against the demand for services or improvement thereof.

It is apparent that there is need to devise new and innovative ways to cope with the challenges of human settlements .

Coupled with the problems as highlighted above, there is the lack of appropriate information. Up to date information is needed in implementing activities related to the management of human settlements.

3.2 Environmental Health

3.2.1 General Overview

Most killer diseases in Swaziland are due to poor environmental sanitation and are diarrhoeal in nature e.g Typhoid, Hepatitis, Cholera, Tuberculosis etc. Swaziland has an unacceptably high rate of ninety eight (98) children out of every thousand (1000) live births dying before their first birthday, while the mortality rate for the first years of life is one hundred and forty one (141) children per one thousand (1000) live births. About 80% of all the sicknesses and diseases in Swaziland can be traced to unsafe water that either infects people directly, serves as breeding ground for diseases and insects that lead to poor personal hygiene, poor housing, poor household sanitation practices and lack of understanding of the relationship of these factors to diseases.

Leading causes of inpatient deaths. 1989, 1994

1989

1994

Disease subgroup

% of total deaths

Disease subgroup

% of total deaths

Environment related

Bacterial

Non-vaccine prevent

Cardiovascular

Malnutrition

Nonvehicular trauma

Nervous/ mental

Oral/ Gastrointestinal

Complications of delivery

16.02%

13.81%

9.94%

8.84%

7.73%

5.52%

5.52%

3.87%

3.31%

Environment related

Bacterial

Non-vaccine prevent

Cardiovascular

Oral/ Gastrointestinal

Nervous/ mental

Endocrine/Mental Balance

Complications of delivery

Non-vehicular trauma

18.01%

13.36%

10.85%

8.75%

5.96%

5.25%

4.85%

3.34%

3.16%

In an analysis of the leading causes of total inpatient deaths for the two sentinel years (see table above), the data shows a remarkable consistency -particularly among the top four leading causes of inpatient deaths (environmentally related, bacterial, non-vaccine preventable and cardiovascular). Of particular significance is the 12% increase in environmentally related deaths between the two sentinel years. Similarly, deaths from the oral/gastrointestinal group show a dramatic increase of 54 percent - from 3.87% to 5.96%. Non-vaccine preventable diseases also show an increase- from 9.94% to 10.85%. Bacterial related deaths remained relatively stable as has the nervous/ mental group. Declines are shown in deaths from malnutrition, and non-vehicular/trauma.

Patient administration patterns

Leading causes of inpatient admissions, 1985, 1989 and 1994

1985

1989

1994

Disease Subgroup

% of total admissions

Disease subgroup

% of total admissions

Disease subgroup

% of total admissions

Normal deliveries

Environment related

Non-vehicular trauma

Bacterial

Non-vaccine preventable

31.7%

9.63%


9.01%


7.70%

5.56%

Normal deliveries

Environment related

Non-vehicular trauma

Bacterial

Non vaccine preventable

39.48%

11.04%


8.48%


8.59%

4.46%

Normal deliveries

Environment related

Non-vehicular trauma

Bacterial

Non-vaccine preventable

30.17%

14.96%


8.66%


6.86%

5.67%

Examination of the leading causes of total inpatient admission for three sentinel years (above- table) show considerable consistency. For each year it is the same five causes of admission; normal deliveries, environmentally related diseases, non-vehicular trauma, bacterial diseases and non-vaccine preventable diseases. Of particular significancy is the increase in environmentally related diseases (food poisoning, gastrointestinal, malaria etc) between the sentinel years.

In general the data consistently support the assertion that admissions could be reduced considerably with more effective health education and primary care programmes, and a more sanitary environment.

Gender Related Health And Environmental Issues

The purpose of looking into health-related gender and environmental issues is to highlight a number a number of norms and practices which lead to inequalities in access to health outcomes, and also lead to over exploitation of natural resources. Such norms and practices also impede the attempts to achieve universal health for the entire Swazi population and a sustainable use of our resources. In Swaziland the most serious gender issues affecting the health sector are concentrated in the reproductive domain and are revealed through health indicators of maternal and infant mortality.

The first gender based issue is the social and economic status of women in Swaziland as influenced by both modern and customary laws. Customary and modern law regard women as minors in regard to the law, and as a result , decisions about their lives (which include seeking obstretic care and family planning) are often made for them by men - husbands or boyfriends. Under Swazi customary law, decisions about child bearing rest mainly with the men and the in-laws of a woman. A woman gains full respect from her in-laws and the community at large through child bearing. For example, a woman is expected to produce male heirs for her in-laws which means that she has to continue bearing children until she gets a boy. Furthermore, not being able to bear children is often punished by social stigma or by having the husband take another wife (Gule, 1993). These practices contribute to population explosion which burdens the natural resources in terms of land for housing, food production and energy supply.

The poor economic status of women also puts them in a position whereby they rely on men for the most vital means of survival, such as land. For example, women on Swazi National Land obtain usufructuary rights through marriage or male children. Modern law also requires men’s signatures for their wives to obtain loans. Women also tend to lack employment opportunities, and are concentrated mainly in lower paying jobs compared to their male counterparts. This forces them to rely on men for economic support, and hence the pressure to engage in sexual relationships and having unplanned pregnancies. This factor also results to poverty, which is a central environmental concern. The population of women who are outside the job market also rely on the natural resources for survival: for example, some engage in poor farming methods, causing degradation of the environment. They also over exploit the natural forests for energy supply (this mostly affects rural women). The poor economic and social status also affect teenage girls, who often drop out of school earlier than boys due to pregnancy, and hence end up with no skills for entering the job market. These practices further put teenagers at a greater risk of contracting sexually transmitted diseases, and in particular becoming infected with the HIV virus. According to FLAS, 1996 report more teenage girls in Swaziland have been identified as having the HIV virus than teenage boys.

The second gender issue has to do with the unequal division of responsibilities between men and women. Women in Swaziland shoulder an enormous burden of responsibility in terms of production, reproduction, child care and rearing, home management and maintenance which in most cases they do without the security of marriage or even a cohabitating partner (Oppong,1995). On the other hand, men are not socialized into helping with domestic duties, and the laws are weak in forcing them to maintain their families. The heavy work load on women affects their health, and that of their children in the sense that the women energy levels (both physically and emotionally) are drained and can lead to chronic illnesses. Mothers are forced to return to wage employment or do not have maternity leave, thereby exposing their children to additional health risks. As a result of poor health and poverty women would rather projects with direct profits than projects such as environmental management and protection.

3.2.2. The Existing Strategies

The Environmental Health Programme comprises a number of interventions which may broadly be classified under the following eight (8) components:

  • Water supply and sanitation
  • Environmental protection (air , water, land pollution control, solid waste management)
  • Food safety and meat hygiene
  • Housing
  • Port health
  • Control of communicable diseases
  • Insects and rodent/vermin control
  • Law and Administration
Water supply and sanitation

As the data above have demonstrated, diseases such as diarrhoea, bilharzia, malaria and infectious diseases have been, and continue to be, among the leading causes of mortality and morbidity in Swaziland. Such diseases are caused primarily by unsafe water and inadequate environmental sanitation. The data below shows progress that has been made in the provision of safe water supplies and environmental sanitary means of excreta disposal, two key interventions required to reduce the morbidity and mortality burden.

Water and sanitation coverage

Indicator

Rural

Urban

Total

Access to safe water

1986

1992

 

33%1

45%

 

80%1

80%1

 

39%1

53%1

Access to safe sanitary excreta disposal

1986

1992

 

40% (1991)2

 

69% (1991,peri-urban)2

 

35%1

60%1

Sources:
1. UNICEF, Summary situation analysis, Children and women in Swaziland, April 1994
2. National Programme of Action, 1993-2000

As the data show in the table above , approximately 53% of the total population in 1992 has access to safe water supplies, while approximately 60% of the total population had access to sanitary excreta disposal. When broken down by rural urban areas, the urban areas had a higher percentage, with access to both safe water (80%) and sanitary excreta disposal (69%). Approximately 55% of the rural population did not have access to safe water while approximately 60% were without access to sanitary excreta disposal. What is not known, however, is the actual usage rate of such amenities.

Pollution

There are three main (interconnected) areas in which pollution can be identified in Swaziland, which may be classified as:

  1. Water pollution
  2. Air pollution
  3. Soil / land pollution.

The main forms of pollution and their effects are described on the annexed chart.

1. Water Pollution

As mentioned in the section above, water pollution provides some of the most direct affects upon mortality and morbidity: bilharzia and diarrhoeal infections such as cholera, for example, are from inadequate sewage facilities in human settlements.

Other causes of water pollution include major industrial expansion. For example, the rivers are increasingly susceptible to accidental release of chemical pollutants. One effect of this can be nutrient enrichment in water supplies as a consequence of effluent from agro-industry, which in turn causes eutrophication.

Another of the chief pollutants affecting the rivers of the country is the increased sediment loading resulting from erosion due to poor land use.

2. Air Pollution

The effects of air pollution on environmental and public health can be just as profound as those of water pollution in the long term. The fact that it is monitored less in Swaziland does not alter its effects on health; it only alters our understanding of what such affects may be. Pollution from fuel-burning, in particular vehicular fuel-burning, has been demonstrated internationally to have harmful results not confined to respiratory problems. Moreover, dissipation of poisons into the air from whatever source - fuel-burning, industry, organic waste - does not necessarily mean that the poisons disappear: they may simply become more widespread, and accumulate through time to dangerous levels in organisms, including humans, and on land.

AIR POLLUTANTS: WHAT THEY ARE, WHERE THEY COME FROM, AND THEIR POTENTIAL EFFECTS

For six pollutants - ozone, carbon monoxide, nitrogen dioxide, and lead - the EPA of the United States has established air quality standards designed to protect the health and welfare of people, plants and animals, as well as buildings, monuments, water resources, etc. These standards are based on currently available scientific data and health studies. Levels of concern vary from pollutant to pollutant.

POLLUTANT

SOURCES

EFFECTS

Ozone: A colourless gas that is the major constituent of photochemical smog at the earth's surface. In the upper atmosphere (stratosphere), ozone is beneficial, protecting us from the sun's harmful rays.

Ozone is formed in the lower atmosphere as a result of chemical reactions between oxygen, volatile organic compounds and nitrogen oxides in the presence of sunlight, especially during hot weather. Sources of such harmful pollutants include vehicles, factories, landfills, industrial solvents and numerous small sources such as gas stations, farm and lawn equipment, etc.

Ozone causes significant health and environmental problems at the earth's surface, where we live. It can irritate the respiratory tract, produce impaired lung function such as inability to take a deep breath, and cause throat irritation, chest pain, cough, lung inflammation and possible susceptibility to lung infection. Smog components may aggravate existing respiratory conditions like asthma. It can also reduce yield of agricultural crops and injure forests and other vegetation. Ozone is the most injurious pollutant to plant life.

Carbon Monoxide: Odourless and colourless gas emitted in the exhaust of motor vehicles and other kinds of engines where there is incomplete fossil fuel combustion.

Automobiles, buses, trucks, small engines, and some industrial processes. High concentrations can be found in confined spaces like parking garages, poorly ventilated tunnels, or along roadsides during periods of heavy traffic.

Reduces the ability of blood to deliver oxygen to vital tissues, affecting primarily the cardiovascular and nervous systems. Lower concentrations have been shown to adversely affect individuals with heart disease (e.g., angina), and to decrease maximal exercise performance in young, healthy men. Higher concentrations can cause symptoms such as dizziness, headaches, and fatigue.

Nitrogen Dioxide: Light brown gas at lower concentrations; in higher concentrations becomes an important component of unpleasant-looking brown urban haze.

Result of burning fuels in utilities, industrial boilers, cars and trucks.

One of the major pollutants that causes smog and acid rain. Can harm humans and vegetation when concentrations are sufficiently high. In children, may cause increased respiratory illness such as chest colds and coughing with phlegm. For asthmatics, can cause increased breathing difficulty.

Particulate Matter: Solid matter of liquid droplets from smoke, dust, fly ash and condensing vapours that can be suspended in the air for long periods of time.

Industrial processes, smelters, automobiles, burning industrial fuels, wood smoke, dust from paved and unpaved roads, construction and agricultural ground breaking.

These microscopic particles can effect breathing and respiratory symptoms, causing increased respiratory disease and lung damage and possibly premature death. Children, the elderly, and people suffering from heart or lung disease (like asthma) are especially at risk. Also damages paint, soils clothing, and reduces visibility.

Sulfur Dioxide: Colourless gas, odourless at low concentrations but pungent at very high concentrations.

Emitted largely from industrial, institutional, utility and apartment-house furnaces and boilers, as well as petroleum refineries, smelters, paper mills and chemical plants.

One of the major pollutants that causes smog. Can also, at high concentrations, affect human health, especially among asthmatics (who are particularly sensitive to respiratory tract problems and breathing difficulties that SO2 can induce). Can also harm vegetation and metals. The pollutants it produces can impair visibility and acidify lakes and streams.

Lead: Lead and lead compounds can adversely affect human health through either ingestion of lead-contaminated soil, dust, paint, etc., or direct inhalation. This is particularly a risk for young children, whose normal hand-to-mouth activities can result in greater ingestion of lead-contaminated soils and dusts.

Transportation sources using lead in their fuels, coal combustion, smelters, car battery plants and combustion of garbage containing lead products.

Elevated lead levels can adversely affect mental development and performance, kidney function, and blood chemistry. Young children are particularly at risk due to their greater chance of ingesting lead and the increased sensitivity of young tissues and organs to lead.

Toxic Air Pollutants: Includes pollutants such as arsenic, asbestos and benzene.

Chemical plants, industrial processes, motor vehicle emissions and fuels and building materials.

Known or suspected to cause cancer, respiratory effects, birth defects, and the reproductive and other serious health effects. Some can cause death or serious injury if accidentally released in large amounts.

Stratosphere Ozone Depleters: Chemicals such as chlorofluorocarbons (CFCs), halons, carbon tetrachloride and methyl chloroform that are used in refrigerants and other industrial processes. These chemicals last a long time in the air, rising to the upper atmosphere where they destroy the protective ozone layer that screens out harmful ultraviolet (UV) radiation before it reaches the earth's surface.

Industrial household refrigeration, cooling and cleaning processes, car and home air conditioners, some fire extinguishers and plastic foam products.

Increased exposure to UV radiation could potentially cause an increase in skin cancer, increased cataract cases, suppression of the human immune response system, and environmental damage.

Greenhouse Gases: Gases that build up in the atmosphere that may induce global climate change - or the "greenhouse effect". they include carbon dioxide, methane and nitrous oxide.

The main man-made source of carbon dioxide emissions is fossil fuel combustion for energy-use and transportation. Methane comes from landfills, cud-chewing livestock, coal mines and rice paddies. Nitrous oxide results from industrial processes, such nylon fabrication.

The extent of the effects of climate change on human health and the environment is still uncertain, but could include increased global temperature, increased severity and frequency of storms and other "weather extremes", melting of the polar ice cap, and sea-level rise.
3. Soil / land Pollution

Sources of contamination of land are widespread; the most dangerous to health include several types of pesticide, and heavy metals such as lead, mercury and arsenic (the heavy metal arsenic was also used as a pesticide at one time). In most of the developed world, the problem is considered so serious that legislation has been introduced resulting in clean-up costs averaging about one thousand US dollars per person in the country concerned: that is, in a country of sixty million, the clean-up costs would be very roughly sixty thousand million US dollars. The more that can be done now to limit such pollution in Swaziland, the less such environmental, health and economic costs are likely to be. Lack of accounting does not mean lack of loss.

  • Insects and rodents/ vermin control

The Environmental Health department of both The Ministry of Health and the City Councils run insect and rodent control programmes for entrepreneurs, addressing the control of such vermin as cockroaches, rats and mice and mosquitoes. This is because private companies have emerged claiming to be specializing in pest control. These companies at times operate in complete disregard of the health and safety rules dealing with the insecticides. Under these authorities, there is still the use of banned chemicals within the country like DDT which is used for mosquito control .

  • Food contamination

Access to nutritionally adequate and safe food is every individuals right. Yet, many people suffer from diseases caused by contaminated food. Food borne pathogens such as bacteria, viruses and parasites, contribute heavily to diarrhoeal diseases. Chemical contamination of food, from agrochemicals or soils and pastures polluted by toxic metals is also a serious public health problem. Contamination of all kinds can occur at any stage of the handling and preparation.

  • Housing/shelter

Unmet housing needs affect the health of people. Primary causes include insecure residential tenure or inadequate, overcrowded shelter that lack basic sanitation, ventilation and other basic health protection. Direct health-threats come from exposure to disease pathogens and pollutants. Residents of low-income settlements are also at high risk of suffering from drug abuse, violence and accidents, and the mental strain of overcrowding, noise and lack of privacy lead to increased psychological and social stress.

  • Development hazards

Economic development contributes to improved health, but ill-considered development can also add to health risks. Examples include the creation of breeding grounds for schistosomiasis and malaria vectors in reservoirs or irrigation schemes, injudicious siting of industries with toxic effluents near population centres or strategic water resources, and transport schemes which increase traffic density and consequent air pollution and accidents.

  • Refuse/solid waste disposal

This is one of the problematic areas which affects health in Swaziland. Refuse disposal by the major towns is crude dumping, and where burial is practised it is very minimal and does not serve the intended purpose. Site selection is usually based on a minimal understanding of the potential effects on surface and ground water resources. Some dumping affects both water quality, and the health of the people and domestic animals. Much of the rural population still depend on surface streams for drinking water. Rural, urban and peri-urban areas are at risk where uncontrolled dumping occurs because scavengers commonly scavenge for food, or other items useful to them. The possible presence of chemical, expired drugs or spoiled food poses a greater risk.

3.3 Solid Waste Management

As already stated in the introduction, the key feature of human settlements in Swaziland is the high rate of urbanization. This presents great challenges to the citizenry in terms of urban management. Almost half of housing in these urban areas is the informal group, exhibiting unplanned settlements with high densities, lack of water supply, sanitation and other services such as solid waste management. The need or urgency to deal with solid waste seems to be most evident in areas of high levels of agglomerations such as urban or peri-urban areas.

The lack of such services is a cause of ill health.

Insufficient control, monitoring and maintenance of many urban areas have had a detrimental effect on the natural environment. Problems of pollution, loss of habitat and visual amenity are evident.

In addition, the high rate of population growth poses even greater challenges in the mobilisation and utilization of natural resources. This is true for all the categories of settlements in urban, peri-urban and rural areas. With the projection that more than 50% of the population will be living in urban areas by 2005, the urban population will place increasing demands on existing infrastructure for solid waste management. Further, the migratory component creates an unfulfilled demand for new services in the peri-urban areas.

3.4 Pollution

Pollution in Swaziland is becoming an issue of growing concern which, for a number of reasons, is unfortunately unmonitored. Current developments in the manufacturing, transportation, energy supply and urbanization fields have brought a number of pollutants to natural resources and environment. There is presently a great need to monitor and control the pollution of resources like water, soil and the atmosphere, through both the strengthening of anti-pollution policies and education of people on pollution control.

Notable effects of pollution include ill-health to human beings, contamination of air, water resources and soil, and the depletion of the protective ozone layer. These effects may have permanent negative implications to human health and development potential , many of which are not obvious in the short term and are thus inadequately addressed (for example, as in the case of lead poisoning). For this reason, polluting activities have to be aggressively discouraged.

Pollution in Swaziland is becoming an issue of growing concern which is unfortunately inadequately monitored. Current developments in the manufacturing, transportation, energy supply and urbanization fields have brought about a number of pollutants to natural resources and environment. There is presently a great need to step up monitoring and pollution control measures of resources like water, soil and the atmosphere through both the strengthening of anti-pollution policies and education of people on pollution control.

Notable effects of pollution result in ill-health to human beings, contamination of water resources and soil and the depletion of the protective ozone layer. These effects may have permanent negative implications to human health as is the case with lead poisoning and it is for this reason that polluting activities have to be discouraged at all costs where possible.

3.4.1 Main causes

Pollution occurs as a result of a wide range of activities many of which are man made. These activities include the following:-

  1. Heavy Traffic Congestion.
  2. Industrial Emissions.
  3. Crude dumping of solid waste and improper landfills.
  4. Septic and fuel tank/ sewer leakages and water effluents.
  5. Agricultural activities
Traffic Congestion

Emissions from vehicles contain pollutants like nitrous and sulphur oxides and carbon monoxide which cause respiratory problems, and can even be fatal. The presence of lead in petrol exposes people to lead poisoning which has very serious effects to human life. Exposures are expected to be to be greatly reduced with the introduction of unleaded petrol in Swaziland.

Heavy traffic is also a major source of noise pollution especially in cities, highways and industrial centres. Although this seems not to be a great problem presently careful monitoring has to be undertaken.

Industrial Emissions

Developments in industrial production along the Oshoek - Manzini corridor are increasingly impacting adversely on the environment due to the nature of activities and types of wastes dispersed into the public domain. Added to these are the sugar-milling and the timber-growing companies, which burn cane fields before cutting and use saw dust for thermal power production respectively. The fact that an increase in industrial activity usually means increased energy consumption warrants the institutions of research studies to ascertain damages resulting from pollutants produced by such activities. It is through these studies that authorities will determine the most suitable methods for solid wastes disposal and pollution control measures.

Solid Wastes Disposal

Solid wastes production has been noted to be on the increase with the introduction of manufacturing and packaging companies in the country. A lot of packaging material is of no use to end users and thus ends up at the abovementioned solid waste disposal sites. Waste accumulation burdens have been noted in major growth areas and industrial sites, forcing authorities to look for the cheapest means to dump solid wastes. Presently, Swaziland does not have in use even a single proper landfill which is able to handle solid wastes. This disposes the country to soil and water pollution problems. Worse results are caused by improper disposal of radioactive wastes- and medical wastes.

Waste Water Disposal Systems

Pollution from waste effluents coming from leaking or faulty drainage systems endanger human and animal life as it exposes them to contamination with pathogenic organisms. The same applies to waste water effluents flowing into surface water resources used for domestic purposes resulting to outbreaks of communicable diseases. As the country fights to control rural-urban migration there is also a need to establish rural development policies which enhance the quality of life in rural areas. This then means that rural areas should be enabled to have proper wastes disposal systems and carefully planned housing and human settlement schemes.

Agriculture And Land Use

The use of fertilisers and pesticides in modern farming practices does not only yield better harvests but exposes the environment to pollution with these chemicals especially in areas where their use is not carefully planned. However, while the benefits are normally adequately accounted for, the costs usually are not. For example, using fertilizers and pesticides containing ammonium products and nitrates alters the quality of ground and surface water, as some of these chemicals are dangerous to both plant and animal life which greatly affects the food chain and ecosystem. The fact that accounting practices are currently incompetent in tracing such costs does not mean that the costs do not accrue to the nation.