Earth Summit 2002   Limpopo Basin

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Eradication of Diarrhoeal Disease in the Limpopo Basin through Health Related Catchment Development



Diarrhoeal disease accounts for a high proportion of the preventable deaths and illness in the Limpopo basin.  The social impact translates to diarrhoea diseases causing the death of 20,000 people p.a. in the region.  It also affects morbidity rates, loss of work, training etc.  The economic impact translates to direct health cost SA Rand 3bn/ yr while indirect health as well as opportunity costs amount to SA Rand 20bn/yr.

Children are particularly vulnerable to the combined effects of substandard water quality, insufficient sanitation and poor hygiene.  Reduced diarrhoeal disease will lead to reduced morbidity, less loss of work, training, direct and indirect health cost reductions.  Cleaning up faecal and other waste pollution of water in the river basin will improve water quality and create a virtuous spiral of improved health.


Action Plan Goals

·          Develop and implement health‑related interventions to eradicate diarrhoeal disease for the entire target river basin to such an extent that the reduced levels should at least be those of developed‑world incidence.

·         This target will be achieved over a 15‑year period.

·         The project will be initiated at the lowest catchment scale i.e. quaternary catchments of the Limpopo and will be based on community‑level participation principles.

·         The process will then be multiplied up through the tertiary and secondary to the primary catchment, expanding to all‑inclusive stakeholder participation to ensure sustainability.



To enhance existing regional, national and community level catchment development activities, we propose to use a vehicle we refer to as health‑related catchment development.  This implies that the health‑focus of Diarrhoea Disease Eradication (DDE) is infused to enhance existing water resource (catchment) management processes and structures (e.g. water quality and sanitation improvement initiatives etc.), and where these do not exist, to stimulate such initiatives through DDE.

Initial participatory forums will be set up at the primary level (entire basin, 9 million. inhabitants) to identify quaternary catchments to pilot DDE initiatives as case studies.  Following this approach, participatory development actions, aimed at DDE, will be initiated at the family / household level and sustained by active CBO involvement.

Based on the successes achieved a model will be developed that can be applied to all communities in the Limpopo basin. The processes in the model will be multiplied upwards through the catchment scales creating a South-to-South exchange through development and sustaining of a regional civil society forum.

While involvement of stakeholders at each level is a crucial aspect of this Action Plan, the activities at the quaternary level will be largely CBO driven, based on community sized related to the scale of the catchment (i.e. 10,000 people at the quaternary catchment unit).


Project outline (Table 1 provides details)

Collaboration between South Africa, Botswana, Mozambique and Zimbabwe governments to co‑ordinate the regional approach.

The SADC Water Sector is the co‑ordinating unit.

At the primary level the Limpopo Basin Permanent Technical Committee (LBPTC) is set up to deal with issues common to all participating countries.

To practice trans‑boundary co‑operation, a multi‑party stakeholder forum at primary level will identify country‑specific, as well as shared quaternary catchments in which case studies will be conducted.

Successful outcomes, based on best practices will be multiplied up the catchment scales to eventually include the entire Limpopo basin.


Monitoring, Evaluation and Reporting

Systems and proposal to be developed.


Knowledge Management

Before: Group for Environmental Monitoring (GEM) does background surveys

After: share information regionally and globally



1st 0bjective: £300,000 GEMS over 3 years

2nd Objective: Multiply by 5 for total project

Possible funding sources: European Union (unit on Water & Sanitation): £300,000 over 3 years ‑ multiply by 5 for total project Source from Global Fund for AIDS, TB and Malaria, and at local level: sanitation subsidies in SA.


Table 1:           Action Plan

1.          Background

Relevant sustainable development agreement(s)

Dublin Principles ‑ Catchment Management Principles

Millennium 2000 Plan ‑ Health targets

ASDC Shared Water Course Protocol

Relevant components of the (draft)

Johannesburg agreements

Bali document ‑ Water and Sanitation targets


2.           Content


To eradicate Diarrhoeal Disease in then Limpopo Basin.

Measurable endpoint

Reduction of the level of diarrhoeal disease incidence to developed‑country levels within 15 years (by 2015 to 2020)






Case studies in quaternary catchments 2003 – 2005

(1‑3 yrs)

Phase 1:

Inter‑country action

·   Set up participatory forums.

·   Identify target catchments through a process of situation analyses ‑ focus on area where there would be most chance of success

·   Population size at the quaternary level approximately 10,000 people translating to 5 ‑ 10 CBOs with approx. 15 ‑ 20 families per community unit.

Primary level:

SADC Water Sector

Depts of water and health in each country

Task Teams:

NGOs, Environment sector, Private sector

Regional level:

NAWISA (+ 3 NGO’s)




Medical Research Council SA


Academic Institutions



Phase 2: In the study catchments

·    Develop knowledge bases (KB's)




·    Set up CBOs as integrated process with KB development


·    Develop toolkit as integrated process with KB development and CBO establishment

Develop baseline databases for:

·   Social status

·   Health status

·   Environmental status

·   Conduct audit of full range of existing programmes, share experience of success and failure

·    Action‑orientated groups, defined by willingness to participate and their development potential to contribute to processes of DDE (e.g. hygiene promotion).

·    Participatory techniques for community involvement e. g. Participatory Health and Sanitation Transformation (PHAST):

-         Hygiene education

-         Domestic water management

-         Sanitation infrastructure and utilisation

-         Waste management

·     Create demand through e.g.:

-         Hygiene education

-         Community radio

-         Road shows

-         Media: NGOs using videos on hygiene promotion

-         Develop plays, translated and filmed on sanitation, water supply and hygiene

-         Specific engagements with mothers of young children (DfID sponsored project in place).

20 NGOs at primary level (5 in each country).

Lead organisations:


Zimbabwe ‑ ZERO

Mozambique - LIVINGO

Botswana – Kalahari Conservation Society

+16 more

Multiplication process plan

To be developed








Partners for the Action Plan:

Environmental Monitoring Group (EMG), Group for Environmental Monitoring (GEM), Mvula Trust, Umgeni Water, University of Bloemfontein, University of Pretoria


Potential Partners:

SADC Water Sector, Department of Water and Health in each country at primary catchment level; NAWISA.

Partners in second phase include 20 NGOs at primary level (lead organisations: South Africa: Group for Environmental Monitoring; Zimbabwe: ZERO; Mozambique: Liviningo; Botswana: Kalahari Conservation Society).

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