1. Ram Pump Irrigation in KwaZulu-Natal, South Africa Tuesday, April 8, 2008 Valley Trust Community Health Clinic Zakhe Agricultural School JHU Whiting School of Engineering JHSPH Maura Dwyer, MPH DrPH student, EHS Sharon Nappier, PhD Environmental Health Engineering

2. Population Population: 10 M Languages Languages: Zulu: 71% English: 35% Afrikaans: 2% Unemployment: 31% Education: 22% of people >age 20 no formal education (http://www.info.gov.za/aboutsa) KwaZulu- Natal

3. KZN Health Statistics HIV and Tb –HIV Prevalence ~40% –1/3 AIDS deaths attributable to Tb Significant micronutrient deficiencies –Adequate dietary intake essential to receiving full benefits of anti- retroviral therapies (www.ukzn.ac.za) Between 1995-2005, over 1.1 million children lost one or both parents to AIDS (World Health Organization 2005. South Africa: Summary Country Profile for HIV/AIDS Treatment Scale-Up)

4. KZN Communal Gardens Rely heavily on subsistence agriculture Available to all persons in community Gogos manage the communal gardens Water must be transported uphill manually to gardens

5. The Ram Pump Improve irrigation and expand existing communal gardens to increase food security Renewable energy source (gravity) Cheap and local materials, local design Simple and reliable parts Little environmental impact Automatic, continuously operates

6. Communities Inchanga (2006)Maphaphateni (2006) Phateni (2007)Siwmenzomeni (2007)

7. Objectives and Methods Conduct a pilot study to evaluate the effects of the ram pump on the gardening communities Evaluate gardening households in terms of garden water usage, food security, vegetable variety and production, and health status Household Surveys and Key Informant Interviews –Survey Instrument –Gardening households Maphaphateni: –baseline (n=21) and follow-up (n=24) Inchanga: baseline (n=10) Phateni: baseline (n=22) *Received IRB exception status 1 *Survey questions derived from validated assessments from WHO and JHSPH-International Health Department

8. Survey Findings in Maphaphateni Demographic: Household size: 10 people, 5 ≤ age 18 Orphans: 37.5% of households Garden: Water Usage in Garden: 300 L/garden plot/day Time Spent Collecting Water: –10% ≤1 hour in 2006 vs. 55% ≤1 hour in 2007 (p=0.006) Injuries Associated with Collecting Water: –20% of respondents reported injuries prior to the pump Vegetable Production: –significant increase in # rows per gardener (5.75 vs. 14.48, p=0.0006)

9. Gardener Perceptions All gardeners reported that pump has “helped life a lot” 89% of Maphaphateni gardeners report having “more time for other activities since the pump” Greatest benefit is ability to plant more vegetables and access food all year round –Food now going to waste and gardeners desire the means to sell excess vegetables at a market Three new gardeners in Map cited the pump and its benefits as one of the reasons they joined

10. Limitations Small sample size Missing data Reporting errors Strained time and resources for data collection Inadequate a priori understanding of target communities No site selection criteria or methods Limited interpreter training

11. Public Health Implications Enhance the capacity of community to provide for themselves Free gardeners from laborious weight bearing jobs, allowing for more productive uses of their time Boost crop yields Potential to increase income Reduce injuries associated with water collection Decrease gardeners’ exposure to fecally contaminated water Allow new members to join and benefit from the garden, enabling the community to support the growing number of orphans in the area

12. Future Research 1.Assessment of a community’s need, capacity and readiness for ram pump installation as part of site selection 2.Assessment of factors influencing project feasibility and sustainability to enable scale-up 3.Community gardens as micro- enterprise 4.Irrigation system comparison studies

13. Thank you! Funding: –Johns Hopkins University –Engineers without Borders –Center for a Livable Future –Rotary International –Global Health Experience Fund –Mondialogo Engineering Award Garden Communities: –Inchanga –Maphaphateni –Phateni –Siwmenzomeni Local Contacts and Translators: –David Alcock –Nonhlanhla Majozi –Sebenzile Gumede –Lillies Nkolongwane –Nomkhosy Mabaso –Slie Ngcongo