Lack of drinking water (inadequate storage)

Team leader: Abdul Majeed

Provide health awareness of this issue to all households

Ensure that all households in the island have access to safe drinking water (through a community- organized approach to buying water storage tanks)

Major changes in water availability observed. Community uses rain water for drinking.  They have purchased the tanks through aegis of two Ministries; one promoted by the Healthy Ministry and other by the southern atolls program of the Ministry of Atolls Administration. The roof run-off collection system has been improved at the household level by having an appropriate mechanism for having the first rain roof-wash runoff separated from the clean water that is collected.  The roof-to-tank connection is detachable when there is no rain. The necessary valves are being connected. 47 houses have fixed up this type of connections that can be detached.

Over the past year, this task force/team has visited three times to each household in the island to advise and facilitate. The volume of water stored has increased about 75 percent from the base line (1.9 pcd in 2002 to 3.3 liters pcd in 2003). The community groups feel there has been very good progress. They would give this effort an 8 out of 10 score for this progress

Procurement issues: The roof to tank connection valves are not easy to get from the island.  Sometimes the connections and the tanks arrive separately. Having these to arrive together would help. Delays in the work experienced because of delays in procurement process.

Water demand by visitors: There is still more water being used by those visiting the island also. Fishermen and also the visitors to the island are given this collected water free of cost. 

2004/5 target could be:

--To have this kind of safe water for cooking also - not just for drinking. To cook garudiya (fish soup), prepare tea, etc also so that these will taste better.

--To have better constructed roofs to collect water could be a target for next phase.

Personal Hygiene.

Team leader: Mohamed Saeed

Educate island community on the importance of personal hygiene (having soap for hand-washing after toileting practiced in households and in schools)

Solicit support from concerned island authorities and other stakeholders on improving the sanitation on the island.

The task force/team visited all households and gave health education using pamphlets prepared on personal hygiene. Together with health staff from the island health center and hospital, the team discussed with household members the need for better sanitation, and solicited community support for a better sanitation system. Through this process, the more wealthy (shop owners and Keyolhus (fisherman leaders / boat owner) each agreed to host the laying of  a sewer line along the length of their road to the sea, and agreed to entertain individual house connections for a charge/fee of MRf 1500 by each household. The pipeline owner would thus be

responsible for managing the system. This way a community approach has been devised. The sewer lines have been laid during the last year and at least 75 percent of households have now connected to this shallow line sewer.

This is proof they feel that much can be done without external financial input but with the existing resources of the community.

Soap to wash hands after toileting is now consciously practiced. Households have soap for this purpose (the community groups interviewed attest to this), and the school toilets have soap available now (it was not available at the time of starting this HealthyIsland program in 2002).

Information on preventing diarrhea, malaria, and aspects of mothers’ health given to many households. How to prepare oral salt solution from sugar and salt at the household and breastfeeding (exclusive for six months) information provided.

The community groups gave a score of 9 out of 10 for this achievement.

Loss of fresh ground water to the sea:

All the flush water goes to the sea. The future problem of salinity intrusion into the island’s fresh water aquifer needs to be addressed seriously and urgently. Serious repercussions on availability of fresh water for island vegetation and home gardening for the future if this continues.

Pollution of the sea with sewage:

Major issue precipitated by the sewer line is the pollution of the south eastern side of the island by the sewer outfall.

These two major issues need to be address most urgently.

A waste-water reuse/recycling and ground water charging system needs to be devised urgently. 

Target for all households to be connected by 2004/5 - perhaps about 350 households altogether in the island.

Nutrition concerns

(The problem is looked at from the view that nutrition issues arise from lack of food, and competition for food  is because of family size and the price of fruits and vegetables on the island. So in order to address nutrition issues practically, these proximate aspects were those targeted by the community)

Team leader: Jihada Ali

Demonstrate growing fruits and vegetables in the island school garden, and also promote home gardening

Encourage and sustain the reduction of family size through greater advocacy to parents on family management and family planning methods.

Increase awareness

Promote island community information on healthy foods and eating habits

Health education given to all the island homes. The house visits of the task force/team covered about 350 mothers who had young children (this was the target group for promoting health education in this area). Messages on better feeding practices and family planning were delivered during these contacts.

Conducted four workshops for teenagers also. Monthly antenatal clinic conducted at the health center, and information on family planning and child care provided.

Almost every household has a vegetable or fruit growing. Previously, there was very little of this in households. Now it appears that more fruits and vegetables are being consumed also – by children especially. More fruits available for sale in the shops and less expensive than before. 

All families have nutrition education. Now haemoglobin higher and no blood transfusion needed to be given to a mother in delivery in the past year. No low birth-weight baby was born the past year.

– the least recorded this year was 2.9 kg.

No malnourished seen– as noted from the growth-charts maintained by the health center – ie below 2SD. De-worming regularly done.

Family planning advice given to households; shows increased use of contraceptives. Pills/condoms/tube-ligation up by 47 couples (about a 60 percent increase). All done in the island – health center and hospital.

The community group gives a score of 9 out of 10 for this achievement.

Tree disease is a problem. Ministry of agriculture needs to give more advise and other support – this issue cannot be addressed by the community efficiently without advise.

No school garden yet.

Lack of knowledge of composting --so home gardens not quite well managed and well mulched, although the awareness and process of action has begun.

Ministry of Agriculture needs to provide support to this.

Perhaps to have a school garden up an operational by end of  2004

Perhaps can give IMCI flip charts to the household visit health education (by WHO)

Ministry of Agriculture needs to be involved in providing know how and demonstrating preparation and use of composting for home gardening.

Solid waste disposal

Team leader: Mohamed Hassan

Build three waste disposal sites in the island

Provide island community information on safe management of solid waste

The taskforce/team visited all households in the island at least twice during the past year to make people aware of need for safe management of waste.

Two ends of the island selected as dumpsites made at the edge of the island. The habit of taking the waste to the site is increasingly observed. Earlier there was indiscriminate waste disposal. Now these two sites are being used – the habit has begun. However, the garbage is not well managed. It gets washed away by the tide which is not the best way to get rid of it.  The community built the Kuni Koshi (waste dump site) in a make shift way and so is not quite permanent.  However, even so almost all households now take the solid waste to the site and will not throw away indiscriminately.  The plan is to make a more permanently designed disposal site/s in the next phase.

No funds. about 8000 rupees spent by the community and made a koshi, but Ministry of Environment is still awaited to give a response / advise on where to locate the sites.

Collection of waste is cumbersome process if each individual has to go to the sites at end of the island. 

The way to do this better, they say, is to have a vehicle to carry the solid waste from four ward collection points. Need a vehicle for this. 

Target for this year.

To build a better dump site with a wall to contain the waste rather than a wire mesh. Also to provide better lighting at the site so that people will go there to dump even in the night time.

To devise a system of collection from a few collection points (one in each ward) in the island - even if a charge per household is to be levied. This will help pay for the service provided and make it easier to collect rather than each individual carrying to the end of the island.

Some sort of separation of plastics and organic material to be done at the household level before taking to disposal site (this would help in composting the organic – ie not having to sort at site which would be a messy task).

Ministry of Agriculture to teach composting. 

Will work on having kashi kundi (fish meal or fish-based compost for plant food) for the future

Mosquito breeding

Team leader: Shaheeda Ismail

The island population will have information, education regarding the safe management of rainwater tanks, and septic tanks (proper sealing of vents and openings from which mosquitoes can get in for breeding)

Ensure that all unused wells in the island will be protected or eliminated (filled up/destroyed

Find a way to control breeding at the marshy areas in the island.

The team members had several meetings with the island administration to find a way to tackle the marshy area mosquito breeding issue. No solution could be found as this was too large a water body. They would be asking MOH or WHO for help in this.

Team members also had several visits to households to advice on mosquito control. 170 households have been given advice by visits to homes. Included information on how mosquitoes breed, and what diseases they cause and how to control.

Of the five unused water wells in the island, one was destroyed and others were protected by cleaning the wells.

There appears to be less density of mosquitoes this time than earlier in 2002. The swarming is less observable at dusk unlike before, and night time nuisance appears less. This may have been through other actions being undertaken by the healthy island program at this time.   Some contributing factors may be that there is better solid waste disposal, no littered receptacles that can retain/collect water and promote mosquito breeding ; elimination/closure of septic tanks  (now being connected to the sewer), and also the elimination of soakage pits for bath water that used to be a good breeding site at households when the soak pits (chaka-valhugandu) got clogged-up and stagnant water remained leading to mosquito breeding.  

Grade of 6 

The kuli  (marshy mangrove area) is being preserved on grounds of environmental protection (bio-diversity concerns and the kuli being the natural storm drain for the island; heavy rains could flood the island if this natural drainage system is destroyed).  No permit by the Environment Ministry to reclaim it on account of these.

To use Bacillus Thuringensis  to control mosquito breeding in the mangrove pools. (WHO to assist in this through MOH)

 A mosquito breeding places survey could be conducted in the island to actually locate potential sites and then prepare a strategic plan more systematic control in future. MOH could help in this.

Fly breeding

(this is indirectly an issue related to diarrheal disease, worm infestation, and food safety)

Team leader: Ibrahim Hashim

Ensure that all fish wastes are disposed in the fish waste site that is to be constructed and placed in the lagoon or at the edge of the island reef facing the sea.

Provide island community information on better management of solid wastes generated on the island.

Provide families information on preparation of organic fertilizer utilizing organic and fish wastes

The teams have advised households and fishermen groups to not throw the entrails on the beach. Gave knowledge of how flies breed on rotting fish entrails like on all rotting organic matter. Also advised to use fish waste as plant food. Women’s committee is helping this by advising on burying the stuff. Also there is the idea of making compost with fish waste too.

The island community planned and cost-estimated the construction of a koshi and other items needed for implementing the fish waste disposal process.  The island development committee and the women’s committee have donated around MRf  8,000 for this purpose. The koshi has been made and the decision on the site to locate it is pending advice from the Ministry of Environment. This has still not come to pass.

So the fishermen are now throwing the entrails into the sea directly without doing the gutting on the beach. This way, only a few of the fish for home consumption is gutted on the island. There appears to be less washed-ashore entrails lining the beach and thus less fly breeding observed. Even visibly there appears to be less flies buzzing around than was observed at the initiation of this program in 2002. There were perceptions that this reduction of flies at the moment could be because this was a low fishing season. But the explanation was that even if it were, the local dry fish processing industry in the island brings in several tons of fish each day (from the adjoining fish stock island nearby) which have to be gutted and cleaned before cooking and processing. So obviously, they are exercising good preventive behavior in not throwing entrails around to rot and breed flies. 

Administrative constraint:

Atoll office not adequately responsive - have asked atoll office permission to put-up the koshi, but still no response from atoll office. The advisers from the Ministry of Environment do not agree to the planned location of the koshi on the reef, but has still not suggested an alternative on what else to do.

Cost constraint:

Construction of koshi and the gangway to move the stuff to the koshi may cost around 60,000 Rupees.

To have a koshi constructed  and placed on the reef, or any other operational approach to deal with disposal of entrails so that it will not be washed ashore.

Ministry of agriculture and fisheries to help with the fish silage composting of fish waste to be used as fertilizer for home gardening.

Smoking cessation

Team leader:

Adnan Rashaad

Install anti-smoking posters in all households

Install anti-smoking posters in public places.

No-smoking households will be selected and special certificates will be given to the houses that have given up smoking in their premises.

Posters put up. Most of the houses have anti-smoking posters put up for cessation advocacy. Posters put on fishing boats too. 

Previously, baseline showed, 282 households out of a total of 350 to be smoker resident households. Fourteen households have stopped at the time of this review. (a 5 percent reduction). Ministry of Health would be giving certificates of recognition to the non-smoking households.

The community groups give this performance a grade of 7 on a scale of 10.  Very good progress has been made. One person said that he took the challenge to stop smoking.

New to promote school children and then reduce the numbers. 25 percent reduction

ARI and common cold

Team leader:

Ali Shameem

Develop leaflets on preventive measures of common colds and distribute to all households

Increase awareness and conduct a survey to find homes, where there is no proper ventilation, ensure that all households in the island have proper ventilation

The information given to mothers of children under three. Leaflets have been distributed. Included knowledge on how to take care of children when they get ARI and how to prevent.

Ventilation in households assessed. First baseline showed inadequate ventilation in 47 households; at the time of this review (one year later), this is reduced to 28 households (a 40 percent reduction).

Next target. Have the rest of the houses improve the ventilation. All new houses to have minimum standard design for ventilation.

School health education to include knowledge of ARI and prevention.

Mothers to receive such advice at mother/baby clinic at hospital.

Women and Child health

Team leader: Shageela Jaufar

Provide all pregnant women in the island information /awareness regarding safe motherhood (risks of pregnancy

Ensure that all pregnant women in the island get regular ante-natal check-ups from the clinic.

Weekly clinic and all pregnant women checked (this year 64 pregnant mothers) regularly as scheduled. Health education given through home visits and at the hospital. Provided leaflets.

Legal age of marriage is now 18 so very few teenage pregnancies. 

Facilities of c-section also available in the atoll hospital that is on this island.

Community groups give a score of 10 on a scale of 10. Very well done.

Future;

Keep up the full contact with mothers and the regular visits to the antenatal clinic to eliminate high risk pregnancies.

Continuously provide health education to mothers to ensure no low birth weight babies

To have mothers do exclusive breast feeding for six months.