memo3

Date: 11/12/2023 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 reduce diarrheal disease rates throughout the region and improve the health of the household. Lack of stability and awareness on best practices robs our children of a peaceful childhood and parents and family members of a healthy future. 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. The most critical implementation bottlenecks in Senegal are primarily rooted in the lack of latrines and flush toilets in every household, inadequate infrastructure for transportation and roadways to properly transport waste from pits to waste dumps, and lack of education on how to properly dispose of waste in the absence of latrines. We plan to overcome these challenges through strategic partnerships with the government and private waste management companies to understand feasibility of implementing waste collection and transportation programs. Currently, the Senegal government provides waste collection and transportation services to major capitals which is take to uncontrolled dump sites. It is imperative that we expand these efforts to include Tambacounda and surrounding rural areas that do not have these services. Expansion includes building safe roadways, trucks to collect and dispose waste, fuel for the trucks, and funding for personnel funding. This would require us to increase funding from the Islamic Development Bank which had provided financial support first in 2004, as well as from the World Bank and the European Union. A similar system is also in place funded by the Bill and Melinda’s Foundation which provides waste collection services to select houses in Darkar. However, they charge a fee for these services with limited subsidies for the poor. Therefore, this service is uncommon especially in rural areas such as Tambacounda. The DCP3 report on Water Supply, Sanitation, and Hygiene recommends that one of the four main ways of compensating for the financing deficit is to increase government and donor investments from the private sector into the poor population 3 . A government funded system would allow for more investment and employment opportunities, as improved sanitation creates jobs and generates wealth. Concurrently, it is important that we 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. We suggest that each state and county keep a map of roadways and households with latrines and flush pits in their house or nearby. These maps should also include information about frequency of latrine use 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) 3. Hutton, G., Chase, C. , . “Water Supply, Sanitation, and Hygiene” . In: Disease Control Priorities (third edition): Volume 7, Injury Prevention and Environmental Health , edited by C. N. Mock, R. Nugent, O. Kobusingye, K. Smith. Washington, DC: World Bank. 4. Backer, M., Keles, D., & Bergaentzlé, C. (2023). Success factors in off-grid energy auctions: A comparative analysis of selected cases from low- and middle-income countries. Renewable & Sustainable Energy Reviews , 183 , 113350. https://doi.org/10.1016/j.rser.2023.113350

and access to waste collection and management services. All this information should be in a secure file with multiple copies stored elsewhere for protection. It must be updated every year to account for new wells built. There should also be a sub file that accounts for schools that have access to WASH and those that do not along with population sizes in the area. The format of these files must be electronic so that they can be updated regularly. However, areas like Tambacounda that have between 2-10% of electricity access 4 may find maintaining this difficult. Therefore, funding for a town database center with electricity access must be allocated for this program. This two-pronged approach distinguishes itself from previous efforts by focusing on a more holistic approach that not only treats the disease but also aims to prevent it by addressing the underlying factors contributing to its prevalence. The urgency of action is underscored by the immediate need to reduce diarrheal disease prevalence and ensure the future health of children in Senegal. With Senegal under relatively peaceful presidential transitions, it is time for the National Health departments to shift their focus to prevention and infrastructure building. It is also important to ensure that these initiatives are independent from the political climate and receives funding that is not impacted by it. It is imperative to act promptly to curb this crisis. Delaying action will exacerbate the situation, leading to more preventable deaths and further strain on the already burdened healthcare system. 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) 3. Hutton, G., Chase, C. , . “Water Supply, Sanitation, and Hygiene” . In: Disease Control Priorities (third edition): Volume 7, Injury Prevention and Environmental Health , edited by C. N. Mock, R. Nugent, O. Kobusingye, K. Smith. Washington, DC: World Bank. 4. Backer, M., Keles, D., & Bergaentzlé, C. (2023). Success factors in off-grid energy auctions: A comparative analysis of selected cases from low- and middle-income countries. Renewable & Sustainable Energy Reviews , 183 , 113350. https://doi.org/10.1016/j.rser.2023.113350