The cost of dirt

Women caretakers in Ambohimijery take responsibility for looking after their water point to ensure it lasts in to the future.

Credit: Brent Stirton

Madagascar, the world's fourth largest island, sits in the Indian Ocean. Geographically closer to Africa than Asia, but with a complex history of migration, it has a diverse population of 17 million.

Courtesy, tolerance and mutual respect are prized. But while it is known mostly for its arresting beauty and wealth of unique wildlife, it is one of the poorest countries in the world. It can be so picturesque that it is hard to see the poverty, and there are few international non governmental organisations present. But of every 1000 children born, 136 will die before their fifth birthday.

WaterAid has been working in Madagascar since 1999 to improve the situation, with partner organisations including SAF and Caritas. Here, Essi Lindstedt reports on the projects she visited in September 2003.

In Ilaza, a village in the centre of Madagascar, men and women had asked SAF to help them with a safe water project because they had sick children, little money with which to care for them, and less money for their future.

The season of sickness is from January to March, when the rivers rise and the rains sweep rubbish and excrement into traditional water sources. The harvest is not until April.

The need to pay for medical care hits families just as they are most likely to be at the end of their slim resources. Families had to make heart-rending choices - selling the crops and livestock they needed to farm and survive in the next year, just to get through the immediate crisis.

Ill health and poverty are inseparable, murderous twins. The big killers before the WaterAid projects were plague, malaria and diarrhoea. Diarrhoea was the child-killer.

A harsh choice. In the fields on the outskirts of Antananarivo’s slums families dig up the earth from their precious rice fields to make bricks.

Credit: Brent Stirton

For malaria, villagers would save money to buy aspirin, for plague, they had to find money to pay for care at a clinic. Now, they have safe water, diarrhoea has virtually disappeared, and having less stagnant water and a more hygienic domestic environment gives mosquitoes and fleas, the carriers of malaria and plague, less chance to thrive. In Vohimalaza, the men said, "We tell men from other villages about the cost of dirt, the cost of an unsafe environment."

Better health and improved incomes coincide in other ways. In Ilaza they use the run off water for watering fruit trees and vegetable gardens, and for fish ponds. One man, Alexandre, told us he got MGF 250000 (around £25) from the sale of fish, a huge addition to the household income.

He also eats fish with his family to improve their diet. Women told us that for the first time, they want to plan their families. Now that they know their children have a better chance of survival, they are interested in spacing their births so that babies can receive better care and so that the mothers will be stronger too.

Madagascar remains largely reliant on external aid to provide essential services. The country is so poor that even basics like immunisation are paid for by donor countries.

At the local level, communities are largely reliant on non governmental organisation assistance for development projects, but the exciting thing about WaterAid projects is that having reduced vulnerability to disease, they create environments where broader change can happen.

There was a discussion in Vohimalaza about what comes next. One of the men said they wanted a clinic. "No," answered Alphonsine, one of the animatrices (women selected by the village for their leadership qualities to promote good hygiene practises).

"Better hygiene and sanitation have improved our health so much, we have much less need for a clinic. What we need is electricity. It will reduce our lack of security, and we can have a machine for animal feed, and a fridge to keep our food in."

The headman told us, "We have made efforts but this is not enough. We have to set up new challenges. We promise that when you come back you will see many changes."

Planning ahead requires taking care of what you have. The seriousness and intensity of SAF and WaterAid's work in sanitation and hygiene promotion means that people regard having latrines and better hygiene as the key to preventing sickness from recurring.

In Ambohimijery, we heard how important the care and cleaning of their water source is to prolong its life span. And in Marosahale, the school children told us "If you don't take care of what you have, it's the same as having nothing."

Choices are limited when you are poor. Bad health and poverty eat time and make it harder for communities to work together. Where women are spending large parts of their day bringing water home, or bringing their child through yet another bout of debilitating sickness, it is hard to find time to look past the immediate threat. WaterAid projects give people time to make choices.

In the fields that skirt the slums in Antananarivo, people do not wish to exhaust their rice fields of nutrients, but they need to dig up that earth to make bricks to sell for things that rice cannot buy, like medical care.

The huge gift of clean water is that it gives people the time, and the physical and emotional strength, to make choices, and get on with their lives. For most of the time those choices will not be easy but thanks to your support people have a stronger ground on which to make them.

Essi Lindstedt is WaterAid's Project Funding Manager.

WaterAid in Madagascar

Examples of our work in Madagascar