Impact of health, water and sanitation services on improving the quality of life of poor communities

Manona, Wellman Wela (2004-12)

Thesis (PhD)--Stellenbosch University, 2004.

Thesis

ENGLISH ABSTRACT: Good health is a major imperative for social, economic and personal development, thus an important dimension of quality of life. Quality of life, in turn, is significantly influenced by access to the goods and services provided by the State. Access to infrastructure and services such as water and sanitation, has direct effects on health. Thus, the delivery of health, water and sanitation services should ensure improved access to basic needs, enhance the health profile of poor communities and their access to employment opportunities. Safe clean water supplies and adequate sanitation services therefore are among the major determinants of health. Health-related services such as water and sanitation should ensure a certain average life expectancy and eliminate mass disease and ill health. Mindful of the fact that there are many factors that determine the quality of life, the aim of the study was to investigate the impact of health, water and sanitation services in improving the quality of life among poor communities. To do this, this study adopted a comparative qualitative analysis approach between poorly serviced and adequately serviced areas. Subsequent to the findings, this study espouses constructive suggestions and recommendations that could act as guidance to community development agencies' strategies in amelioration of the quality of life among poverty-stricken communities. The research was based on a narrow model of services (health, water and sanitation services) that have impact on improving the quality of life among poor communities. The empirical findings of this study indicate these services to be insufficient to draw conclusive findings in other aspects of the survey. The research was conducted in a sample of 573 households in 6 communities in the Eastern Cape and Western Cape Provinces in South Africa. The sample comprised 3 communities in the category classified as poorly serviced with health, water and sanitation services, and 3 communities that were regarded as adequately provided with these services. The data was gathered by means of structured questionnaires, administered by the researcher with the assistance of a trained field worker. Additional, the data was gathered by means of a semi-structured, open-ended interview with a Sister-in-Charge of a clinic in the rural villages. The interaction between variables on the improvement of the quality of life were explored by means of basic statistics, which made it possible to assess the effects of independent and dependent variables. The results of data analysis provided support for the proposition contained in the premise of the study that although the provision of health, safe clean water and adequate sanitation services lead to improvement in the standard of living, their impact alone does not incorporate all the attributes that enhance quality of life as suggested by mainstream schools of thought in the health sector. Poverty-related factors also have to be taken into account. As such, the findings of this study have shown that poverty, combined with poor public health conditions, inadequate nutrition, overcrowded poor quality housing, lack of accessible drinking water and sanitation, renders communities vulnerable to ill health. Given the poor socio-economic conditions prevalent in the communities under investigation, it was not surprising that tuberculosis was most prevalent in all areas. In line with the premise of this study, there were instances that povertyrelated factors such as income, housing and nutrition had significant influences with regard to improvement in the quality of life. It became evident therefore that in certain instances, health, water, and sanitation services alone are not sufficient to make conclusive findings. Thus, the impact of povertyrelated factors such as income, housing and nutrition necessitate expansion of factors that impact on the quality of life to include their influence.

AFRIKAANSE OPSOMMING: Goeie gesondheid is 'n belangrike vereiste vir sosiale, ekonomiese en persoonlike ontwikkeling, en dus ook 'n wesenlike aspek van 'n goeie lewensgehalte. Toegang tot goedere en dienste wat deur die staat voorsien word, het ook 'n beduidende invloed op lewensgehalte. Boonop het die toegang tot infrastruktuur en dienste soos water en sanitasie 'n direkte invloed op gesondheid. Die lewering van gesondheids, water- en sanitasiedienste verseker dus die bevrediging van basiese behoeftes, onderwyl arm gemeenskappe se gesondheidsprofiel en daarmee saam hul toegang tot werksgeleenthede verbeter word. Toegang tot veilige en skoon waterbronne en voldoende sanitasiedienste is gevolglik van die belangrikste gesondheidsbepalers. Gesondheidsverwante dienste soos water en sanitasie verseker 'n sekere gemiddelde lewensverwagting, en verminder die moontlikheid van wydverspreide siektetoestande. Met inagneming van die feit dat lewensgehalte deur talle faktore beïnvloed kan word, was die doel van hierdie studie om ondersoek in te stel na die invloed van gesondheids, water- en sanitasiedienste op die verbetering van lewensgehalte in arm gemeenskappe. Gevolglik is 'n vergelykende analise tussen areas met swak dienslewering en areas met bevredigende dienslewering uitgevoer. Op grond van die bevindinge word sekere voorstelle en aanbevelings gemaak wat kan dien as riglyne vir ontwikkelingsagentskappe ter bevordering van die lewensgehalte in arm gemeenskappe. Die navorsing was gegrond op 'n beperkte model van dienste (gesondheids, water- en sanitasiedienste) wat die verbetering van lewensgehalte in arm gemeenskappe beïnvloed. Die empiriese bevindinge van die studie toon aan dat hierdie dienste onvoldoende is om as basis te dien vir beslissende uitsprake oor ander aspekte van die opname. Die studie het 'n steekproef van 573 huishoudings in 6 gemeenskappe in die provinsies van die Oos-Kaap en Wes-Kaap in Suid-Afrika ingesluit. Die steekproef het bestaan uit 3 gemeenskappe met swak gesondheids, water en sanitasiedienste, en 3 gemeenskappe waar sulke dienste op 'n bevredigende vlak voorsien word. 'n Gestruktureerde vraelys is gebruik om die navorsingsinligting in te samel, wat deur die navorser en 'n opgeleide veldwerker toegedien is. Bykomende inligting is bekom deur 'n semigestruktureerde onderhoud met die verpleeghoof van 'n kliniek in 'n landelike gemeenskap. Die invloed van die verskillende veranderlikes op lewensgehalte is deur middel van basiese statistiese analise geëvalueer. Die resultate van die data-analise verleen 'n mate van steun vir die premis van die studie dat hoewel die voorsiening van gesondheid, veilige, skoon water en voldoende sanitasie tot 'n beter lewenstandaard kan lei, die uitwerking daarvan as sodanig nie alle vereistes insluit vir 'n beter lewenstaard nie, soos voorgestaan deur hoofstroom denkskole in die gesondheidsektor. Faktore wat met armoede verband hou moet ook in ag geneem word. Die studie se bevindinge dui dus daarop dat armoede, tesame met swak openbare gesondheidstoestande, onvoldoende voeding, gebrekkige behuising en swak water- en sanitasiegeriewe gemeenskappe meer kwesbaar maak. Weens die swak sosio-ekonomiese toestande in die gemeenskappe in die steekproef, is gevind dat tuberkulose wydverspreid voorkom. Alhoewel die studie se hipotese met betrekking tot verskeie aspekte bevestig is, was daar ook gevalle waar armoede-verwante faktore soos inkomste, behuising en voeding 'n beduidende rol gespeel het. Dit het dus geblyk dat gesondheids, water- en sanitasiedienste nie in alle gevalle voldoende is om swak lewensgehalte te verklaar nie. Dus sal die faktore wat op lewens kwaliteit 'n impak maak, uitgebrei moet word om vir die invloed van armoede-verwante faktore soos inkomste, behuising en voeding voorsiening te maak.

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