Memo #2_DM

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New York University *

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Dec 6, 2023

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Date: 10/22/2023 To: Abdoulaye Saydou Sow, Minister of Urban Planning, Housing and Public Hygiene From: Dania Mohammad, Advisor to the Minister of UPHPH Re: Diarrheal Diseases in Tambacounda, Senegal Children It is imperative that the Department of Urban Planning, Housing and Public Hygiene prioritize the integration and stability of waste and sanitation systems within Tambacounda, Senegal to improve the health of households and thus increase financial stability of the country. Lack of stability and awareness on best practices robs our children of a peaceful childhood and parents and family members of a healthy household. According to the UNIGME, in 2021 34 Senegalese children per 1000 live births died before the age of 5 with a large portion of them due to diarrheal diseases 1 . High rates of diarrheal disease allow for more communicable diseases such as typhoid and malaria to infect and ultimately kill the Senegalese children, especially in Tambacounda as compared to surrounding provinces such as Darker or Kaffrine. IHME shows that although U5M has declined rapidly in the past 20 years, there are still large improvements needed to be made especially in poorer regions 2 . We have seen significant decreases in U5MR in Darker, an urban epicenter, almost 50% within the last 10 years but this progress has yet to be replicated in the poorer southeast areas 2 . We must focus our efforts in these often-forgotten areas and continue the remarkable progress done so far throughout the country, beginning with Tambacounda. There are multiple ways to tackle the issue, but one that has been proven thus far is building a stronger waste management infrastructure. I would like to propose a coordinated effort in collaboration with other stakeholders such as roadway and waste management companies who are looking for employment opportunities to implement a series of measures aimed at improving waste management and promoting better monitoring practices across the country. These measures will not only reduce the incidence of diarrheal diseases but also contribute to a cleaner and more sustainable environment. This includes a dual-pronged approach: 1. Establishing Proper Government Waste Management Services a. Promotion of Safe Disposal b. Collection and Transportation c. Landfill and Treatment Facilities Enhancing Waste management includes developing a system of how waste can be commercially disposed of. Since there are no facilities to transfer waste to a secure location in Tambacounda, Senegalese leave waste in open containers or on the ground without following proper manual disposal practices. Currently, due to climate change and political unrest, it has been difficult to finance and support extensive building projects for waste management. Previous practice has been to simply provide a private waste management service where customers paid a fee to have their waste picked up and deposited in minimal 1. IGME. (2023). UN Inter-agency Group for Child Mortality Estimation [Data Set]. United Nations. https://childmortality.org/data/Senegal 2. Exemplars in Global Health. (2019). Why is Senegal an Examplar? https://www.exemplars.health/topics/under-five-mortality/senegal/why-is-senegal-an- exemplar#:~:text=The%20Institute%20for%20Health%20Metrics,Metrics%20and%20Evaluation %20(IHME)

areas, often far away. However, this is not within reach for the poor which continues to exacerbate the issue. The Department of UPHPH must step up and advocate for a government sponsored or mainstream waste management system with a focus on impoverished communities who cannot afford other expensive services. This may increase the budget for urban planning objectives, taking away from the other action items being considered by the Senegal president, but waste management is a human right and must be given utmost importance. 2. Monitoring and Evaluation: a. Surveillance and Data Collection b. Research and Innovation In order to even begin implementing waste management services into Tambacounda we must have accurate data and monitoring processes set up to have a high efficacy. We have made significant strides in reducing mortality and morbidity rates and it would be beneficial for us to stay ahead of the curve and begin monitoring other potential areas of improvement to continue this momentum. Monitoring allows us to not only see what great improvements we have made, but where further improvements must be made as well. This can promote research and data analysis on whether our implementations are effective and encourage innovation. By expanding our efforts in these two directions – infrastructure building and monitoring- it is possible to continue to see significant improvements. These two vital objects must work concurrently to ensure that both are effective in reducing diarrheal disease in children under 5. It is the hope of our department that by providing greater access to waste management we are able to fulfil our SDG goals and work towards a healthier future. 1. IGME. (2023). UN Inter-agency Group for Child Mortality Estimation [Data Set]. United Nations. https://childmortality.org/data/Senegal 2. Exemplars in Global Health. (2019). Why is Senegal an Examplar? https://www.exemplars.health/topics/under-five-mortality/senegal/why-is-senegal-an- exemplar#:~:text=The%20Institute%20for%20Health%20Metrics,Metrics%20and%20Evaluation %20(IHME)

Figure 1: IGME. (2023). UN Inter-agency Group for Child Mortality Estimation – Tambacounda in 2021 [Data Set]. United Nations. https://childmortality.org/data/Senegal Figure 2: Exemplars in Global Health. (2019). Why is Senegal an Examplar? – Senegal has outperformed neighboring countries and Countdown to 2030 peers in both U5m and NMR. https://www.exemplars.health/topics/under-five-mortality/senegal/why-is-senegal-an-exemplar#:~:text=The %20Institute%20for%20Health%20Metrics,Metrics%20and%20Evaluation%20(IHME) 1. IGME. (2023). UN Inter-agency Group for Child Mortality Estimation [Data Set]. United Nations. https://childmortality.org/data/Senegal 2. Exemplars in Global Health. (2019). Why is Senegal an Examplar? https://www.exemplars.health/topics/under-five-mortality/senegal/why-is-senegal-an- exemplar#:~:text=The%20Institute%20for%20Health%20Metrics,Metrics%20and%20Evaluation %20(IHME)

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