VZCZCXRO6332
OO RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHSB #0486/01 1621218
ZNR UUUUU ZZH
O 111218Z JUN 09
FM AMEMBASSY HARARE
TO RUEHC/SECSTATE WASHDC IMMEDIATE 4592
RUEHSA/AMEMBASSY PRETORIA IMMEDIATE 5698
INFO RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHGV/USMISSION GENEVA 2175
RUCNDT/USMISSION USUN NEW YORK 1993
RUEHRN/USMISSION UN ROME
RUEHBS/USEU BRUSSELS
RHEHAAA/NSC WASHDC
RUEKJCS/SECDEF WASHDC
RHMFISS/JOINT STAFF WASHDC

UNCLAS SECTION 01 OF 04 HARARE 000486 
 
SIPDIS 
AIDAC 
 
AFR/SA FOR ELOKEN, LDOBBINS, BHIRSCH, JHARMON 
OFDA/W FOR ACONVERY, CCHAN, LPOWERS, KMARTIN 
FFP/W FOR JBORNS, ASINK, LPETERSEN 
PRETORIA FOR HHALE, PDISKIN, SMCNIVEN 
GENEVA FOR NKYLOH 
ROME FOR USUN FODAG FOR RNEWBERG 
BRUSSELS FOR USAID PBROWN 
NEW YORK FOR DMERCADO 
NSC FOR CPRATT 
AF/S FOR BWALCH 
 
E.O.  12958: N/A 
TAGS: EAID EAGR PREL PHUM ZI
SUBJECT:  WASH Assessment trip, April 20 - May 1, 2009 
 
HARARE 00000486  001.2 OF 004 
 
 
------- 
SUMMARY 
------- 
 
¶1. From April 20 to May 1, 2009, the water, sanitation, and hygiene 
(WASH) specialist undertook an assessment of the WASH sector 
response to the present cholera epidemic in Zimbabwe.  The water and 
sewer systems serving urban centers in Zimbabwe are in a state of 
severe disrepair as a result of financial neglect and the resulting 
lack of maintenance.  Approximately 80 percent of boreholes in rural 
areas are broken.  Cholera control interventions by NGOs and local 
government involve distribution of hygiene kits, hygiene promotion 
and minor repair of water and sewer infrastructure. 
 
¶2.  WASH sector, non-governmental organizations (NGOs) in 
partnership with local governments are performing exceptionally well 
in implementing cholera control interventions that meet professional 
standards.  Individual NGOs are performing independent evaluations 
of their WASH programs and a month-long sector-wide evaluation will 
conclude in mid-June.  While the overall number of cases of cholera 
has decreased dramatically over the last month it is critical that 
the sector be prepared for isolated outbreaks and possible second 
major cholera outbreak this fall by continuing hygiene promotion 
activities. 
 
 
--------------------- 
USAID/DART WASH 
SPECIALIST ACTIVITIES 
--------------------- 
 
¶3.  While in Zimbabwe, the USAID/DART WASH specialist met with the 
UN Children's Fund (UNICEF), Oxfam/Great Britain (GB), World Vision, 
International Relief and Development (IRD), Population Services 
International (PSI), Lead Trust, Practical Action, Concern, Medecins 
sans Frontieres Holland, and GOAL.  The WASH specialist conducted 
assessment visits to the urban areas in Bulawayo, Chegutu and Kadoma 
districts, high-density suburbs of Harare area, and rural areas in 
Mount Darwin district.  During these visits the WASH Specialist met 
with local leaders, sanitation committees, and Government of 
Zimbabwe (GOZ) public health and utility employees.  The WASH 
specialist participated in the WASH cluster and WASH Strategic 
Action Group (SAG) meetings. 
 
----------------------------- 
WATER AND SEWER SYSTEMS IN 
URBAN AREAS AND GROWTH POINTS 
----------------------------- 
 
 
¶4.  Water and sewer systems serving urban centers in Zimbabwe are in 
very poor condition as a result of financial neglect and the 
resulting lack of maintenance.  Water leaks are evident throughout 
urban areas.  Water is produced and delivered irregularly in urban 
areas and growth points, while many high-density urban areas have no 
piped service.  Urban water and growth point water treatment 
facilities have an extremely limited supply of chemicals. 
 
¶5.  Water facility operators are knowledgeable and professionally 
operate the facilities when chemicals are available.  Operators 
cease producing water when there are no water treatment chemicals. 
Shutting off water supplies disrupts service and allows contaminated 
ground water to enter empty water pipes.  During water disruptions 
residents obtain water from contaminated shallow open wells. The 
Qresidents obtain water from contaminated shallow open wells. The 
WASH sector has been actively repairing urban hand pumps to provide 
an alternate source of water when the piped water is unavailable. 
 
 
 
¶6.  The gravity sewers have overflowed in numerous locations.  The 
sewage runs down streets and pools in low areas creating large 
marshy areas filled with sewage.  The overflowing sewage is not a 
 
HARARE 00000486  002.2 OF 004 
 
 
recent occurrence, but has been going on for years.  Residents have 
created ditches along streets directing the sewage to open land next 
to communities.  NGO partners are working with sewer operators, 
providing tools and assistance to unclog sewers and making minor 
repairs.  Unfortunately, due to limited water service the sewers 
become blocked regularly, sometimes every 2-3 days. 
 
¶7.  Repair and renovation of urban water and sewer systems will be a 
massive long-term financial undertaking, but a necessary one if the 
Government of Zimbabwe wishes to minimize future outbreaks of 
water-borne and sanitation-related diseases in urban areas.  Any 
U.S. Government long-range strategic planning for the WASH sector 
must consider support for repair and renovation of urban water and 
sewer systems. 
 
 
----------------------------------- 
WATER AND SANITATION IN RURAL AREAS 
----------------------------------- 
 
¶8.  Rural residents use shallow wells or handpumps connected to 
boreholes for water needs.  Where these water sources are 
unavailable or broken, residents obtain water from shallow wells, 
rivers and streams.  UNICEF estimates approximately 80 percent of 
rural hand pumps are not functioning.  The WASH sector is repairing 
rural hand pumps in high risk locations. 
 
¶9.  Latrine coverage in rural areas is minimal as many pit latrines 
are full and not functional.  WASH sector interventions have focused 
on repair of school latrines and household latrine construction in 
densely populated areas. 
 
------------------------- 
HUMANITARIAN COORDINATION 
------------------------- 
 
¶10.  In partnership with the NGO community, the WASH cluster 
co-leads, UNICEF and Oxfam GB, are successfully coordinating 
interventions through the WASH cluster mechanism.  The WASH cluster 
has formed a highly effective strategic advisory group that overseas 
technical issues and has outlined a cholera control strategy that 
has been adopted by the NGO community.  Health and WASH partners 
implementing social mobilization interventions have formed a working 
group to guide hygiene promotion interventions and standardize 
associated printed materials.  NGO partners appear to be actively 
participating in cluster meetings and working groups. 
 
¶11.  UNICEF has a full time information management officer to 
support WASH cluster efforts to improve coordination.  The 
information management support has dramatically improved WASH sector 
data collection and dissemination of compiled data. 
 
----------------------------- 
CHOLERA CONTROL INTERVENTIONS 
----------------------------- 
 
¶12.  UNICEF and NGO WASH staff appear to have the technical capacity 
to effectively implement cholera control interventions.  The present 
cholera outbreak appears to have been mitigated by the WASH sector's 
focus on household water treatment, hygiene promotion and minor 
repairs to sewers, water lines, and hand pumps. Since sewage still 
flows in the streets and water supplies are intermittent, one must 
credit the distribution of soap, household water disinfectants and 
Qcredit the distribution of soap, household water disinfectants and 
hygiene promotion with the decrease in cholera cases.  The WASH 
sector continues to implement an aggressive hygiene promotion 
program that they hope will provide community members with the 
knowledge and tools to prevent the spread of cholera this fall, when 
an increase in choleras cases is expected.  The hygiene promotion 
program utilizes Community Health Volunteers to conduct hygiene 
promotion activities and instruction on household water treatment. 
These workers have been instrumental in minimizing the spread of 
cholera. 
 
HARARE 00000486  003.2 OF 004 
 
 
 
¶13.  New borehole construction by UNICEF remains a concern.  The 
construction of new boreholes is a costly intervention that is not 
sustainable without long-term technical support.  Repairing existing 
boreholes appears to be a more effective intervention.  The WASH 
sector should focus its efforts on hygiene promotion, household 
water treatment and the continued use of Community Health 
Volunteers. 
 
¶14.  The distribution of NFIs through UNICEF has been effective, but 
NGOs have stated that distribution of material was at times slow and 
water containers purchased were substandard.  Of particular concern 
was the instance of UNICEF's logistics officers steering program 
direction by procuring open-topped buckets versus more 
technically-sound closed-lid jerrycans, with the justification of 
"not wanting to ship air."  OFDA's WASH specialist highlights the 
risk of secondary contamination due to improper use of buckets, and 
NGO partners are now purchasing approved jerry cans in lieu of 
distributing the UNICEF buckets.  NGOs stated that allowing them to 
purchase NFIs will allow them greater flexibility in distribution, 
to respond faster and purchase of approved jerry cans. 
 
------------------------- 
EVALUATION AND MONITORING 
------------------------- 
 
¶15.  The implementation of WASH interventions appears to be 
progressing well.  NGO partners have been conducting real time 
evaluations of their WASH programs and making adjustments to their 
program activities based on evaluation results.  The WASH sector is 
planning to conduct an in-depth evaluation of the sector activities 
from mid-May to mid-June.  The results of the evaluation will be 
used by the cluster to develop the strategy for the expected cholera 
season this fall. 
 
--------------- 
RECOMMENDATIONS 
--------------- 
 
¶16. USAID's Office of U.S. Foreign Disaster Assistance (USAID/OFDA) 
should support the ongoing highly effective hygiene promotion and 
household water treatment interventions.  While it appears that the 
present cholera epidemic is ending, the disease has a high 
probability of resurfacing this fall.  It is imperative that 
existing hygiene promotion and household water treatment 
interventions continue.  These interventions will help prepare 
communities for the next outbreak and will be instrumental in the 
prevention of the spread on new cases of cholera this fall. 
 
¶17. The present efforts by NGOs to strengthen preexisting community 
based public health programs, such as Community Health Volunteers, 
should be strongly supported, and, if possible, expnded.  Community 
based public health programs have been shown to be very effective in 
the prevention of cholera. Community Health Volunteers, supported by 
NGOs, implementing effective hygiene promotion and household water 
treatment programs, would be instrumental in preventing a 
reoccurrence of a massive a cholera epidemic this fall and 
preventing other hygiene-related diseases in the future. 
 
¶18. It is critical that urban water treatment plants, in both major 
Q18. It is critical that urban water treatment plants, in both major 
cities and growth points, have sufficient chemicals to treat and 
deliver safe drinking water to residents.  If treatment plants run 
short of chemicals one can expect to see numerous, very large, point 
source outbreaks of cholera attributable to contaminated water 
systems.  USAID/OFDA should closely coordinate with other donors to 
ensure the WASH cluster monitors urban and growth point water 
treatment plants to ensure the facilities have an adequate quantity 
of water treatment chemicals. 
 
¶19. OFDA should fund NGO partners to acquire and distribute NFIs, 
including soap, jerrycans, and household water treatment 
methodologies.  Being able to procure NFIs with OFDA funds (as 
 
HARARE 00000486  004.2 OF 004 
 
 
opposed to relying on UNICEF) would allow NGOs greater flexibility 
and dramatically increase their rapid response time, a critical 
issue when preventing cholera outbreaks.  NGOs could also develop 
local markets by purchasing NFIs locally and find vendors for 
approved water storage containers.  OFDA supported PSI for the 
distribution and social marketing of water treatment tablets 
("Aquatabs") during the current outbreak, and should consider 
supporting their diversification into other options, such as the 
chlorine liquid "Waterguard" (which has more versatility in 
treatment options than Aquatabs). 
 
¶20. USAID/OFDA should avoid funding drilling of new boreholes.  The 
present situation in Zimbabwe makes new boreholes unsustainable, as 
even most existing hand pumps are often not being properly 
maintained.  In addition, USAID/OFDA should avoid funding the 
construction of latrines, as this is not a critical cholera 
prevention strategy. 
 
¶21. USAID/OFDA should avoid funding any repair or renovation of the 
existing water and sewage treatment infrastructure.  One WASH 
specialist advised that some NGOs are attempting to repair 
sub-standard sewage systems installed in peri-urban areas by 
contractors years ago as the population of Harare grew.  It is 
likely that these sub-standard sewage lines will need to be removed 
when and if a major renovation of the water/sewage system in Harare 
is undertaken.  As other donors and international finance 
institutions consider wider infrastructure repairs, OFDA's WASH 
specialist highlights that these have little effect on immediate 
cholera transmission or occurrence, and re-emphasizes the 
above-outlined recommendations of hygiene promotion, household water 
treatment, and distribution of necessary NFIs in preparation for the 
upcoming cholera season. 
 
MCGEE