Social History

In former centuries, the mostly nomadic Kyrgyz population kept their herds of horses and sheep on the meadows of the Tien Shan mountain range. Kyrgyz culture includes epic oral narratives, songs and poetry about their hero “Manas” who unified the clan groups into one nation to defeat Chinese invaders.

Recent social history includes villagisation during the 65 years of soviet authority and the transition to independence again since 1991. Re-emergence has had its problems. Communal farms and industry have collapsed and essential services no longer have the financial support they need and are breaking down. For example, Government health care budget per capita has reduced from $130 to only $6 within 9 years (2000). Adjusting to the decline is difficult for the highly educated Kyrgyz population. Depression with associated alcoholism and suicide is high.

WELL were invited by DFID's Central Asia Division to identify opportunities for British Government support to Kyrgyzstan in the hygiene and sanitation sector to "add value" to water sector initiatives of Kyrgyzstan Government and its other development partners. Field visits were carried out in December 1999, April and June 2000. These trips were mostly spent meeting and listening to a range of people talk about water supply, sanitation and hygiene issues.

These meetings included:

- Men, women and children in villages
- Government officials at village, oblast and republic level
- Staff members of profit and non-profit organisations established in Kyrgyzstan

A latrine in Talas

Field study methods

The WELL team used the following field study methods:

- Interviews relating to hygiene, sanitation, water quality surveillance and protection with villagers, raiyon and oblast level professional staff, Ministry level professionals, and NGO and international ESA experts.
- Field observation of conditions in government laboratories and health promotion centres at oblast level, schools and hospitals, individual households (including latrines), waterworks, bath-houses, and one sewage works.
- Collaborative discussion about hygiene, sanitation and water quality to establish common threads, approaches and lessons from their meetings and field observations.
- Debriefing and discussions around preliminary ideas with oblast level, central level and DFID staff.

Latrines can be difficult to clean and dangerous for children to use.

WELL's findings

Hygiene

- Hygiene practices are reasonable but declining
- Diarrhoea problems are endemic and worsening (currently diarrhoea is responsible for 8% of all child deaths)
- Water systems are breaking down and soap is expensive
- Effectiveness of current hygiene promotion methods is doubtful

Sanitation

- All households have their own toilet or latrine facility
- Most latrines are made out of local materials and are difficult to keep clean

Water quality

- Laboratory standards for former Soviet Union are different from WHO international standards
- Many laboratories are under-utilised, badly equipped and in a poor state of repair
- Existing water testing regime is not helping to control contaminated water sources

The proposal

WELL identified two sister water projects which together would provide rehabilitation or construction of water supply systems in 25% of the villages, countrywide. These projects were designed with only nominal hygiene and sanitation components. A health sector review has identified the need for revitalising health (and hygiene) promotion. WELL proposed a hygiene, sanitation and water surveillance project to compliment these two national initiatives (see diagram below). The main focus of the proposed programme would be to exposure of people responsible for health (and hygiene) promotion to new methods and approaches that could be used later to address wider health promotion issues.

Water collection beside a broken pump in Yssyk-Kul

A woman collects water in Naryn

Formative research to identify target hygiene practices and effective techniques,channels, messages to influence them
Capacity-building for national and oblast health centres (training, technical and material support, innovation) so that the centres are better able to promote improved personal hygiene and other health seeking behaviours Training of felchars (nurses) in hygiene promotion skills in order that diarrhoea is reduced
Training of artisans (masons, carpenters) in the technical and business skills required to promote village level sanitation facilities
Rehabilitation of school and health centre toilets
Promoting a reduced number of laboratory facilities and improving the quality of water-related tests
Promotion of strategic approach to surveillance and sanitary surveys in order to reduce dependence upon laboratories

Girls collecting water in Yssyk-Kul

The information in this poster was presented as part of WELL Task 432, Design of Hygiene, Sanitation, and Water Quality Project for Kyrgyzstan. The team comprised Pete Kolsky, Val Curtis, Joy Morgan (who prepared the poster) and Ian Wilson. Joy Morgan and Ian Wilson spent time in Talas, Issy-Kul and Naryn oblasts, as well as Bishkek.