Thulani Shezi proudly lifts the lids of the flush toilets to show how clean he keeps the ablution block in his informal settlement.

Shezi’s New Germany Road settlement is one of about 500 shacklands in the eThekwini metro, and it only had a few portable toilets and a distant tap before the ablution block was built two years ago.

A lack of clean water and sanitation have a direct impact on health, and the diarrhoea rate among children in eThekwini that is double that of any other metro.

Some 270 out of every 1000 child under five in eThekwini had diarrhoea in 2004, mostly because their families didn’t have access to clean water or proper toilets.

It is thus unsurprising that a militant movement aimed at pressuring the eThekwini council to provide them with land and services, Abahlali base Mjondolo, has sprung up out of these informal settlements over the past few months.

While the pace of change may seem slow to those living in shacks, Dr Umi Sankar, eThekwini’s head of health, says there are both long and short’€‘term plans.

“The council has a 10’€‘year plan to upgrade informal settlements, but we know that people can’t wait that long. So we have been building ablution blocks in the informal areas comprising of toilets, showers and sinks,” says Sankar.

This approach is unique to eThekwini, and so far 32 ablution blocks have been built with a further 20 planned for the current financial year.

The ablution blocks are only built in communities that accept responsibility for maintaining them.

In New Germany Road, Shezi reports to a local committee. His salary for maintaining the ablution block is paid from the R5 monthly contribution made by each of the almost 200 households in the area. In return, the health department provides all cleaning materials and trains people in health and hygiene.

Although the toilets are a drop in the ocean of need, residents gathered round the tap doing their washing were enthusiastic about the ablution block.

“Everything is working fine. It is much better and easier to do the washing now,” says Zandile Mzoto, who has lived in the settlement for the past five years.

With massive urban shacklands, one of the highest HIV rates in the country and a tropical climate, eThekwini’s health department faces many challenges in keeping residents healthy.

Sankar heads a staff of 881 people, excluding senior management, and is in charge of about 60% of the metro’s primary health clinics (the rest fall under the province) and the environmental health service.

Almost two million patients were treated by the 56 metro clinics and 11 mobile units between July 2004 and June 2005.

The busiest clinic by far was the Prince Cyril Zulu Communicable Diseases Centre in Durban’s Warwick Triangle which saw almost 145 000 patients ‘€“ some 12 000 a month!

Pinetown, Cato Manor, Red Hill and Clare Estate were also very busy.

In the past 18 months, 35 health posts have been set up, mostly in the more rural areas of eThekwini that were originally outside the metro’s borders. These offer part’€‘time health and welfare services but, in time, may become full clinics.

All municipal clinics now offer treatment for common HIV’€‘related opportunistic infections, while almost all offer HIV tests.

Between July 2004 and June last year, almost 11 000 pregnant women ‘€‘ 90% of

those attending antenatal services ‘€‘’€‘ were tested at the various clinics, and 6 785 (39%) were HIV positive.

Over 80% of babies born to HIV positive mothers during this period were given the medication, nevirapine, which helps to prevent HIV from being transmitted from mothers to their babies.

Tuberculosis ‘€“ often attacking people with HIV ‘€“ is a huge problem in eThekwini, and clinics diagnosed some 12 700 cases in 2004.

The provincial cure rate for the disease is a mere 30%, but that of the metro clinics is significantly higher and did not drop below 43% in 2004.

In the past, people suspected of having TB had to be referred to four clinics in the metro, but now all clinics are now able to diagnose and treat pulmonary (lung) TB.

Chronic “lifestyle” illnesses such as diabetes and hypertension are also on the rise in Durban, and Sankar is piloting tai chi and yoga instruction as part of the Vuka South Africa (‘€œMove for Health’€) campaign.

“Tai chi and yoga offer holistic health benefits, not just physical exercise. They promote overall well’€‘being,” says Sankar.

“Fifty young people will be trained in basic tai chi movements over the next year and will then expand the current ‘keep fit’ classes being run at some community halls. We will also be commencing a three’€‘month pilot project with yoga instructors offering free sessions at public parks, gardens and beaches.”

Air pollution, particularly in the south of Durban and the growing problem of substance abuse at schools are other urgent health challenges.

While staff shortages are a general problem in health, the metro pays higher salaries than the province, so eThekwini does not struggle to find nurses to fill positions. However, the professional nurses at the clinics see between 50 and 80 patients a day, way higher than the recommended 35.

But the division of control over eThekwini’s clinics between the council and the province is awkward and there are few forums where officials from both the metro and the province meet to plan together.

According to the National Health Act, recently signed into law, provinces are supposed to either assume control for all clinics or to sign service agreements with councils empowering ‘€‘ and paying ‘€‘ them to do so.

So far, this has not yet happened in eThekwini, and is another challenge for the metro.


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