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Securing financial support for a peri-urban primary healthcare clinic borehole

At The AMECA Trust we are at the point of construction of a primary healthcare clinic in the hills surrounding Blantyre, which will serve an approximate per-urban population of 22,000 in 11 catchment villages.

In summary, Chilaweni Village has a working bore hole at the primary school, but this is remote from the clinic site and would not really assist the clinical requirements of the clinic. A second bore hole in a nearer location is no longer functional. A mains pipe belonging to Blantyre Water is accessible, but the supply from the water board is currently sealed off, as the villagers could not afford the bills. Although this can be re-instated, the water supply is at best, unreliable and furthermore this would only result in the same outcome, over the long term.

Any assistance that you may be able to provide in terms of grant funding for a bore hole at the primary healthcare clinic site would be gratefully received.

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Hi Ruthie, since the location is peri-urban, I would encourage connecting the clinic to the Blantyre Water Board mains and make arrangements that Ministry of Health pays for the water bills as it does with other government health centres in Blantyre City. This will be on the understanding that the water connection will strictly be for the clinic and its clients.

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The issue is not so much connection with Blantyre Water Board, which is indeed possible. The issue is that borehole water is very pure, free of pathogens if of correct depth and a borehole frees up the site from continuing bills from the Water Board. It is our intention to have a small agricultural area, which of course will require continuous watering in the dry season. The production of maize and other crops will make a positive contribution to the immediate environs and clinic and we are trying to think a little more holistically over the long term.

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While I can understand your reasoning here, particularly with respect to the link between the borehole and the garden, the stark reality is that you will find the maintenance costs of the borehole equally difficult to maintain and the system may well work for a couple of years with minimal maintenance and then face a large failure that requires a large amount of cash to repair. For me the best option is as Mercy describes given that the Ministry must hold this responsibility, assuming this clinic will fall under their management. In addition to making a connection, I would suggest putting in a raised storage tank to provide some backup supply for those intermittent supply periods. The Blantyre Water supply should meet standards but that would be an important aspect to verify.

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I concur that ongoing maintenance costs for a bore hole are a consideration; however, it is our experience that most of the maintenance problems of bore holes are caused by poor installation, build quality and insufficient depth of the borehole in the first place. I also concur with the need for a storage tank. You are correct in stating that The Blantyre District Health Office will bear the cost of utility bills, but they would be unwilling to incur huge bills for irrigation of crops and surrounding foliage. The installation of a well-constructed solar borehole is huge cost saving over the long run, together with the fact that the water is totally pure and free from disease causing pathogens, which in our experience; simply create a circular problem of intestinal disorders and poor health. A study of water supplies undertaken by a professor from Strathclyde University has revealed quite a concern over the delivery of safe water to rural hospitals and healthcare clinics.

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Agree on the point of the fact that the District would not want to fund the water for the garden as well as the hospital. Actually at some point in the future a dual supply might be the answer.

However – on the water quality issue – just to say that there is no guarantee that the groundwater in the area will be safe, particularly if the area is peri-urban and a lot will depend on the likely local contamination sources and the local geology. Equally, I agree that a well designed and installed solar system has huge advantages, it is just my core plea to not underestimate the maintenance costs of these systems – they may appear low at first, but when something fails or gets stolen the cost is high and often catches a small institution with limited resources (and by this I mean the clinic or for that matter the District Health office) off guard.

Any technology creates a whole host of financial, capacity and technical dependencies. This assessment should also specifically look at the reliability of supply and quality of supply of the utility network. This will allow you to reach to most appropriate decision. You may have seen this already, but you might find this a good read on the overall issues with respect to WASH in Health Care Facilities: http://www.who.int/water_sanitation_h...

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I would indeed concur that a dual supply would be a long term solution and interestingly, I had this is mind all along, if funding permits. Again, I concur with your thoughts in respect of solar boreholes re possible long term costs; in my humble opinion, many of the problems over the long term are due to poor installation and insufficient depth of the borehole. We are fortunate in the quality of our builder in Malawi and in the training of his staff. We would also be consulting experts in this field before any decisions are made.

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You could try approaching donors based Malawi to determine if they are operating national health programmes (I should think UNICEF, USAID, UNDP and DFID are likely candidates as each have priorities around MCH and reducing child mortality). However I think you may be fighting an up hill struggle as most donors will be concerned about sustainability issues. The fact that there are other boreholes in the area that are not working would significantly count against the proposed project, as would the fact that the villagers have been unable or unwilling to pay the bills associated with the Water Authority’s supply. Frustratingly for your scheme donors are going to examine your proposal at the macro rather than the micro scale. In essence you are proposing to set up a parallel supply scheme using technologies that have failed in the area in the past, rather than directing funds towards the maintenance and improvement of the existing system. In addition to the capital investment and direct running costs, there will be a need to factor in the overhead costs of maintaining two O&M systems in the area, one at the water authority level and one at the village level. For anything other than a handpump system this will be an extremely difficult sell. However, nothing ventured, nothing gained, and there is the possibility that your project objectives will intersect with local policies or priorities.

In light of the other discussions in the thread, it may be useful for you to calculate the hydraulic workload (HW) of the proposed system. This is the product of the volume of the required demand per day (D) [m3] and the Total Dynamic Head (TDH) [m]. If HW=DxTDH<1,500 m4, then PV is likely to be feasibile. If HW>2,000 m4, then internal combustion engines or wind is power are likely to be more economically feasible energy sources.

Best of luck with your project.

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