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THE RURAL CHALLENGE

Against a backdrop of climate change and insufficient economic growth to accommodate the 400,000 new babies that are born every year, Burkina Faso will fall well short of its Millennium Development Goals (MDGs). While the under-5 mortality rate had in 2007 fallen to 191 per thousand, against 206 per thousand in 1990, the MDG target is a far-off 69. Water provision has long been a government priority in the Sahelian country and Burkina Faso’s goal of clean water access for 76 per cent of rural and urban households by 2015 is close to being achieved. Previous attempts to introduce latrines have failed – mainly because these were provided without sufficient community involvement and hygiene training. There are examples from the past of latrines being built for communities and later being found being used as storage spaces, while open-air defecation continued. Given past failures, the ambition of bringing latrines to within everyday use of 54 per cent of the Burkinabé population will not be achieved, with most experts believing that a current figure of about 10 per cent is realistic, due to lack of progress in rural areas.

Sanitation for all is still a distant dream in this Sahelian country, but a self-help project supported by political and traditional leaders has

achieved memorable results

Women Lead the Way

Nurse Roland Nikiéma need only reach for a pile of dog-eared ledgers to produce evidence that his un-der-equipped rural dispensary is contributing towards achieving the Millennium Development Goals.

“If I compare, say, January 2009 and January 2010, the evidence is clear,” says the 26-year-old as he fumbles for the records in the half-light of the three-room clinic at Rapadama where he is

single-handedly expected to serve the health needs of 10,000 of Burkina Faso’s poorest people.The odds are against this landlocked Sahelian country of 15.23 million people, recently described as

“ground zero” for climate change. Wedged between the Sahara desert and Cote d’Ivoire, a southern neigh-bour emerging from civil war, Burkina Faso is currently suffering the knock-on effects – especially price increases – of a food crisis in Niger, to the east.

Despite feeling tired after delivering three babies overnight, Nikiéma’s optimism grows as he peruses his ledgers. “When it comes to children with diarrhoea, I recorded 14 cases in January 2009 and only seven in the same month this year. Let’s try intestinal parasites. Here we are: We had eight of those in January 2009 and three in January 2010.”

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Dispensary nurse Roland Nikiéma is responsible for the wellbeing of 10,000 people in the area. At the age of 26, this is his first posting since completing his training. He delivers two or three babies each night and must diagnose and treat life-threatening conditions in adults and children.

In the past 10 years the EU has provided more than 110 million euros for water and sanitation projects in Burkina Faso as well as co-

financing numerous NGOs in the sector

It may be microscopic in scale but Nikiéma’s data provides tangible evidence that children in this vil-lage of Ganzourgou province, 150 kilometres from the capital Ouagadougou, are becoming healthier. Credit, says Nikiéma, goes to two grassroots organizations, CREPA (Centre Régional pour l’Eau Potable et l’Assainissement) and Chant de Femme. Since 2007, the two organizations have worked with UNICEF and 1.7 million euros’ funding from the European Union to change the sanitary habits of 75,000 people in the provinces of Ganzourgou, in the centre of the country, and Gnagna in the east, and bring safe water to within 500 metres of their homes.

Nikiéma has seen incredible changes in the short two years he has spent at Rapadama. “When I arrived in 2008, CREPA and Chant de Femme were getting down to work. CREPA was helping people build latrines and Chant de Femme was informing the women about how to improve sanitary practices.

“Now, apart from seeing fewer cases of vomiting and diarrhoea in children, I am noticing that the moth-ers have changed their behaviour. They come to the dispensary to have their babies, rather than giving birth at home. They now mostly complete their babies’ vaccinations and they talk to their husbands about family planning. The women have started monthly information groups and I am regularly called to answer questions about contraception and female circumcision. What has happened is tremendous. It should be expanded to all villages.”

A PILOT PROJECT WITH NATIONAL POTENTIAL

In Burkina Faso, the European Union provided 1.77 million euros of the 2.53 million total cost over three years. The pilot project was deployed in rural areas of the Provinces of Gnagna and Ganzourgou, about 150 kilometres from the capital Ouagadougou. The provinces are largely rural and inhabited by settled subsistence farmers whose survival has become more precarious due to population increases and changing rainfall patterns.

KEY PLAYERS: LOCAL GOVERNMENT

AND THE COMMUNITY

In three years, the project aimed to reach 75,000 people by means of linking the improvement of water access to hygiene training, through the work of local NGOs such as Chant de Femme and the regional body CREPA (Centre Régional pour l’Eau Potable et l’Assainissement). In line with Burkinabé government decentralization policies, mayors, local councillors and customary chiefs have been brought in as key players. This strategy not only respects traditional hierarchies but benefits the growth of democracy by giving cash-strapped locally-elected officials an opportunity to be seen to be directly involved in efforts to improve the lives of their constituents.

NOTHING FOR FREE

Villagers have dug their own latrine pits and selected members of the community have been trained in latrine-building and water management so as to allow them to take charge of their new facilities and maintain them for many years to come. Bricklayers have been trained and are called on to build latrines once households have gathered sufficient materials. Among the newly trained bricklayers are women who, as a result of the project, have gained a new skill and therefore a means of supplementing household income.

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Sociologist Ida Ouandaogo coordinates the sanitation programme in Ganzourgou for CREPA, a body that works in 17 West and Central African countries. In the past three years CREPA has made it possible for 8,000 homes in the pilot area to build latrines – 5,000 more than the project had envisaged. She says the success of the EU-UNICEF pilot programme lies in the fact that it has broad support. “It is very important to gain the moral backing of customary chiefs, of the mayors and councillors. And the crucial element holding everything together is the mobilization of women. It is they, after all, who not only fetch water and prepare food but who look after the children.”

Assèta Ilboudo, a 46-year-old mother of four children from Salogo village, does all of the above. She is also among more than 680 latrine-builders trained in bricklaying by CREPA in Ganzourgou and Gnagna. Most of the bricklayers are men but Salogo village – which has a woman mayor – was amenable enough to Ilboudo taking on the traditionally male job. “It is mostly the other women who say mixing cement and laying bricks is no job for a woman. But I just get on with it,” she says.

Ilboudo became a bricklayer by chance. “We had received a visit from CREPA at which they explained the advantages of latrines. They told us that our food was being poisoned by the children defecating in the fields outside the compound where we gather greens. My husband and I were immediately convinced and

BEYOND EXPECTATIONS

In 36 months, 72 boreholes have been sunk and 178 pumps repaired. Two thousand water carts (pousse-pousses) have been donated to allow several jerrycans to be transported at once.

As a result of the initiative, 75,000 people including the pupils of 80 primary schools and the users of 20 clinics have gained regular access to drinking water.

The most resounding success has come through the work of CREPA and Chant de Femme – grassroots organizations that have addressed community concerns head-on and engaged local politicians and customary chiefs in the process.

Villagers have received support to build their own latrines. While the project’s target was to inspire 3,000 households to build latrines, 8,000 had been constructed by June 2010.

“I combine my job as a bricklayer with my old activity of selling rice dishes in the

market. Latrine-building only keeps you busy half the year because you cannot build

in the rainy season”Assèta Ilboudo, bricklayer trained by CREPA

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Female bricklayer, Assèta Ilboudo, was trained by CREPA and played her part in building more than 75,000 latrines in rural Burkina Faso. The training gave her an extra skill and a new source of income.

• 75,000 people were targeted in Ganzourgou and Gnagna Provinces, including 250 water management committees.

• The aim was to build 3,000 household latrines. 8,000 have so far been built across the two provinces.

• The target was to build latrines in 80 primary schools. By August 2009, latrines had been completed in 57 schools.

• Since 2008, 72 wells have been drilled in Ganzourgou Province.

• 180 pumps have been supplied by UNICEF.

• 178 pumps have been repaired in both provinces.

• In the period, more than 2,000 pousse-pousses (carts to transport water) have been provided.

• 400 bricklayers have been trained in Ganzourgou.

• 286 bricklayers have been trained in Gnagna.

“The crucial element holding everything together is the mobilization of women. It is they, after all, who not only fetch water and prepare

food but who look after the children”Ida Ouédraogo, CREPA coordinator of sanitation in Ganzourgou

decided to dig a pit right away. CREPA came back on a visit with someone from UNICEF and they were so delighted that we had already dug our own pit that they asked whether I would like to learn to become a bricklayer,” said Ilboudo who lives with her farmer husband, his two other wives and a total of nine children.

CREPA’s rule is that in order to obtain the services of a trained bricklayer such as Ilboudo – whom the organization pays 50,000 CFA francs (80 euros) for each latrine she completes – residents must themselves dig their pit and purchase or collect the sand, gravel and bricks needed to build the small edifice.

Her latest clients, Mouni and Aminata Kaboré, say they became anxious to own a latrine after their sons, Adama, 12, and Oumarou, 14, explained the benefits of handwashing, hygiene and the privacy they enjoyed thanks to three new latrines that had been built at their school. The EU-UNICEF pilot project included building 80 latrines at primary schools in the area.

UNICEF water and sanitation officer Jean-Paul Ouédraogo cautioned that the Ganzourgou-Gnagna project was one small success story in a country beset with a “deeply worrying sanitary situation, high infant mortal-ity, high childbirth and severe health challenges linked to sanitation and water”.

Burkina Faso set itself the goal of sanitation for 54 per cent of the population and clean water for 76 per cent of households by 2015. “We are close to achieving the goal for water access but on sanitation we are

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way behind. Fifty four per cent was an ambitious target given that, when we set out, the rural sanita-

tion figure was about one per cent. We have made strides as a country but I doubt whether, taking into account both rural and

urban sanitation, we have even reached 10 per cent access,” he said.Ouédraogo warns that the work in Ganzourgou-Gnagna is not over. “Sensitising people implies respon-

sibility. If you tell people the advantages of latrines, you have to be certain these will continue to be built and maintained for years to come. Similarly if you tell women to go to the clinic with their babies, then the vaccines have to be available and the health facilities functioning.”

Rapadama dispensary has no electricity. Wounds are dressed with bandages that are cut so as to avoid wasting a single centimetre. The young nurse and de-facto midwife, Roland Nikiéma, hardly ever gets a full night’s sleep be-tween deliveries. Yet fuelled by optimism and the encouraging figures in his ledgers, he stoically ploughs on, dealing with a stream of malaria and pneumonia cases that would defeat some qualified doctors twice his age. Why? “It is obvious to see,” he says. “Things are getting better and better. It is exciting to be involved.”

Population, 2008

15.23 million

Primary cause of death among under 5s

1 Pneumonia2 Malaria

3 Diarrhoea

Under 5 mortality rate, 2008

201 per thousand

MDG target

69 per thousand

% of population using improved drinking-water sources, 2008

76% of population using improved sanitation facilities, 2008

11% of population practising open defecation, 2008

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Burkina Faso

Ouagadougou

Ganzourgou

Gnagna

Sources:http://www.unicef.org/infobycountry/burkinafaso_statistics.htmlhttp://www.wssinfo.orghttp://www.afro.who.int/en/countries.htmlhttp://www.unicef.org/mdg/mortalitymultimedia/index.html

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“Each time one has the opportunity to meet one’s people, one makes it known that cleanliness is priceless. When the rains come but even in the dry season, such filth is disgusting. When a stranger come to visit it is shameful to ask them to relieve

themselves in the open”The Naba Saaga of Meguet, Ganzourgou Province

MEGUET

The Naba Saaga (chief) of Meguet, with a servant. The chief is a fervent supporter of efforts to build latrines, provide drinking water for all and end female circumcision. His spotless compound (right) stands as an example to the community of good hygiene practices.

Greens collected around the compound (centre picture) are rich in vitamins and essential minerals. However, they can prove to be a sanitary hazard in households where children in a hurry defecate or urinate only metres from home.

Fetching water is a woman’s job and girls take on this responsibility from a young age. UNICEF supports efforts to supply handcarts to lighten the burden.

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RAPADAMA VILLAGE 4

After hundreds of people went blind here in the 1960s from river blindness, the area was considered cursed and was abandoned. In the 1970s, after the government declared the zone free from the disease, many inhabitants returned. UNICEF works in close partnership with Chant de Femme, a grassroots NGO that supports women’s groups in Ganzourgou Province. The groups meet monthly so that women can exchange useful hygiene and health information. As part of its work, Chant de Femme provides recipes for nutritious porridge made with local ingredients. Chant de Femme coordinator Valentine Bakyono (centre picture) heads a team that ensures the entire community is informed about hygiene issues. Chant de Femme carries out workshops in villages that have yet to give up open-air defecation. Known as “triggering” the hands-on workshops graphically describe the dangers to health of faeces left out in the open. Inhabitants of successfully “triggered” villages tend, very rapidly, to start digging pits for latrines.

Bricklayer Moumini Soudré built 101 latrines in 2009 and 98 in 2010. He says it takes 12 days on average to complete a latrine – from digging the pit to completing the walls.

“Defecating in the open was unpleasant and dangerous. You had to clap your hands to make sure no one disturbed you. There were snakes. Some of us thought diarrhoea was a curse. Now we know it is carried by flies and by children who do not

wash their hands”Urcile Ouédraogo, mother of four children and member of women’s group

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“Women should look after water. It is they who collect the water, it is they who cook for the family and it is they who take care of sick children”

Fatimata Kafando, mayor of Salogo

SALOGO

Communities gather to attend training sessions on safe hygiene and sanitation practices (above).

Hygiene education starts early in this pre-school (above right).

The mayor, Fatimata Kafando (centre right), heads a council that is made up of 50 per cent women. Her husband is the local chief. Here she is shown on a visit to outlying communities.

UNICEF provides “taxis” (below) that are hand-drawn by teachers and parents to help get tiny tots to school.

Q: What do you learn at

school?

ADAMA: We learn to read and

write so that we can become

the men of to-morrow.

Q: And?

OUMAROU: We learn that

when you go to the toilet you

must wash your hands very

well and clean the toilet.

Beneficiaries Adama Kaboré, 12, and his brother Oumarou, 14

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ZORGHO

Koulweogo Primary School (above and top right).

Community members gather to watch a play portraying the dangers of unsafe hygiene practices (centre).

In a local eatery (below), dishes are washed with soap made from shea nut butter. Restaurateurs are a key target audience for hygiene education.

“Like us, UNICEF have been present in Burkina Faso for decades. To us, the sustainability of projects is of prime concern. We know by now that UNICEF is a reliable partner”

Amos Tincani, EU head of delegation

http://www.unicef.org/ec http://ec.europa.eu/europeaid 9