My thoughts reflected in this post were stimulated recently while driving past both formal and informal housing areas occupied by the less affluent communities in towns and feeling aggrieved by heaps of refuse piled against fences and in gullies in close proximity to homes both formal and informal. As a health professional my immediate thought was of the health risk that this posed to the residents with the rodents and vermin that are likely to flourish in this environment. On a human level, however, I reflected on how unpleasant it must be to live alongside these unsightly and I am sure malodorous piles of rubbish. It was unclear to me whether these piles of refuse accumulate due to the failure of local government to fulfil its mandate to undertake refuse removal or possibly the failure of communities to cooperate with local government to ensure that refuse is removed in an orderly manner. It is notable how often during service delivery protests refuse is strewn across roads by residents to express their dissatisfaction with the state of their communities.
As my thoughts developed on this issue I reflected that a consequence of the COVID-19 pandemic has been a greater awareness of the need for increased personal hygiene. The messages related to hand washing, use of hand sanitisers, the wearing of masks and social distancing have been relentless since the onset of the pandemic over a year ago. While this has become a necessity to combat the spread and of a novel virus, the importance of personal hygiene and sterilisation has been known from the time of Joseph Lister. Lister is known as the father of antiseptic surgery that led to a drastic reduction of deaths after surgical procedures.
Beyond the field of surgery an act as simple as washing your hands after using the toilet has its basis in the work of Lister in the mid 1800’s. Certainly since the onset of the pandemic hands have been washed and sanitised with greater vigour and dedication by most, which has had benefits extending beyond the imperatives imposed by the COVID-19 pandemic.
Casting the net wider with regard to hygiene, news reports have highlighted towns where the sewerage disposal plants are either non-functional or unable to process the increased volumes of sewerage that are required to be processed due to increases in populations in the towns concerned. In addition, failure to maintain sewerage bulk infrastructure has resulted in raw sewerage flowing down streets and even into the homes of some residents. In other towns the supply of water has either not been constant or of the required standard which although not as apparent to an outside observer nevertheless is an important factor. Similarly, in many areas people live under conditions where piped municipal water is not available in their homes but rather sourced from communal taps. Under these conditions even the simple act of washing of hands becomes a challenge that is often not appreciated by those in a more advantaged environment. That these, as with the accumulations of refuse, are health risks are self-evident and speaks to the role of government to ensure a healthy environment for the population.
While in the minds of many, health is an issue for health departments but this misses the wider aspects of public health that extend far beyond the the responsibilities of health departments. The rapid movement of people has created major challenges for local government to provide not only housing but also the bulk infrastructure and services that are required to ensure a healthy environment. However, this is an important challenge that must be met just as the challenges posed by the COVID-19 pandemic must be met. In the various occasions that the President has addressed the nation with regard to the COVID-19 pandemic, I do not recall a single occasion when the failure of government to provide clean water or sewerage and refuse removal in many disadvantaged communities was identified as a priority. However, without access to these basic services not to mention adequate housing the risk of the spread of infections, including that of COVID-19, is increased.
Effective service delivery by local government which has been woefully absent in many areas of this country must be restored to ensure a safe and healthy environment for many communities. This would be predicated on effective water purification plants, sewerage treatment plants, adequately maintained bulk infrastructure and well managed landfill sites to accept household and industrial refuse, which in South Africa is a local government function.
As with COVID-19 the role of communities and community advocacy will be an essential component if these challenges to public health and well being are to be successfully met that communities are engaged in ensuring that reticulated purified water is responsibly utilised, that sewerage systems are respected and do not become the receptacle of inappropriate items and that there is no indiscriminate dumping of refuse. In my recent experience at a community level, albeit limited, it has been concerning to see leaking communal taps resulting in streams of purified water being wasted and even in hospitals to see taps and toilets failing to seal effectively again resulting in a wastage of a precious resource. Similarly, even in the most affluent communities it is concerning how many people leave refuse behind in communal areas thus the piles of refuse that I referred to earlier may also to an extent be the result of a lack of community involvement.
It is possible that with minimal incentives communities could become more engaged in the collection and disposal of the household refuse that litter many areas in South Africa. However, when leaking taps or overflowing sewerage are reported and no remedial actions are taken by local government it is a disincentive to communities to become involved. Therefore to meaningfully engage communities, it will be important that local government fulfils its mandate to provide basic services at an acceptable standard.
Returning to the issue of refuse and showing my age I recall a campaign in the 1980’s which used the catchy slogan “Zap it in a Zibi” coupled to a ostrich-like cartoon character to encourage people not to litter but rather place refuse in designated “Zibi bins”. The degree to which this was effective then I cannot say, but the concept remains, in my mind, useful as it speaks to the need for individuals and communities assuming ownership of the problem. Could the piles of rubbish to which I referred earlier be removed by communities themselves and what would motivate them to do so? What would make people in these communicates and elsewhere indeed “Zap” refuse into a “Zibi-like bin” of the 1980’s campaign? Certainly at the very least the “Zibi bin” would have to be emptied regularly to incentivise people to participate. If not, those responsible in local government to provide this service to communities should be held accountable and subject to consequence management. Another option could be to incentivise people to collect refuse and deliver it to designated points for a nominal payment. This may be particularly effective in communities where there are high levels of unemployment and the cost involved could possibly be offset by the value of collected recycled refuse.
I am sure that there are many strategies that can be considered to improve the public health challenges resulting from the environment in which people live and work. As a manager of people I do know that people need to be motivated if not compelled to do the right thing. Conversely people must accept that there is a consequence to their actions be it the irresponsible dumping of refuse, to use the services provided responsibly or failing to undertake their responsibilities as government employees and understand that there will be a consequence of failing to do so. A concerted action is required to address the problems of the magnitude that face communities across this country particularly from a public health perspective. However, with the focused actions of a cohort of honest and dedicated people anything is possible. Starting with refuse removal the end result could be a healthy environment that promotes healthier and happier lives.
