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Tajik water project targets disease, dilapidation

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A struggle to keep the system working

Dr Abdusalom Umarov

The water's potable but causes kidney disease

Kidney disease hits children hardest

At a municipal water pumping station in Khujand city in northern Tajikistan, a burly, barefoot man wielding a huge wrench splashes in ankle-deep water as he jogs from one pipe spewing water to another, tightening and tapping here, loosening there.

His valiant battle against an oversized enemy – the well-advanced deterioration of the city water system – has been given a boost, thanks to donor funds (including $3 million from the Swiss government) and a $1.2 million EBRD loan.

“Since the collapse of the Soviet Union, the situation of the water company has become worse and worse,” says Ilkhom Akilov, director of the municipal water company Vodokanal. “Most of the equipment is too old and many pumps have stopped working. One third of the city population lives in high rises but often the water cannot reach the upper floors of those buildings. Often water is completely shut off to entire sections of the city.”

Kidney disease rife

Across town at the city’s main pediatric hospital, chief medical officer Dr Abdusalom Umarov sees a more tragic result from Tajikistan’s struggle to maintain a safe, reliable water supply. The mountainous central Asian country is the poorest member of the Commonwealth of Independent States (CIS), is highly indebted and spent much of the 1990s engulfed in civil war.

“Among CIS countries we have one of the highest rates of kidney stones which result from a high level of minerals, especially salts, in the groundwater. There may also be a lot of heavy metals in the water exacerbating the problem,” says Dr Umarov. “The CIS average is about 2.5 cases per thousand people while in Tajikistan it’s 4.8 and in Khujand it’s 5.2 to 5.8. I wouldn’t wish a kidney stone on my worst enemy. They are excruciatingly painful. The high level of salts in our drinking water also means people retain water and are more prone to kidney and other infections. All these problems can lead to kidney failure.”

The doctor points out two moon-faced children whose faces and bodies have been bloated by extreme water retention. Both have kidney stones, and not for the first time.

“People, including children, die from these problems,” says Dr Umarov. ”We don’t have a lithotripter (a machine using ultrasound to pulverise kidney stones) or kidney dialysis anywhere in our country. The best solution would be to improve water treatment.”

Water a Swiss priority

“Water is a priority for us as donors in Tajikistan because water is related to poverty alleviation and health issues,” said Hans Peter Reiser, deputy country director of the Swiss Cooperation Office.

In trying to maintain vital public services, whether in transport, water or district heating, municipalities across the EBRD region have been caught in a vicious circle since the collapse of the Soviet system:

• under socialism residents were not expected to pay much for those services – water and heat consumption was not metered at the household level
• without adequate funding from consumers, those services deteriorated along with the end of subsidies from the Soviet Union
• as services and the overall economy worsened, customers were even less likely to pay their bills – so services deteriorated further.

Collecting utility payments from an impoverished population is difficult. In Khujand, nearly 70 per cent of the average $20 monthly household income is spent on food, leaving very little for public services. But the EBRD is unable to lend to projects unless they can be sustained after the Bank and donors have left the scene, and that means consumers must pay for services received.

Improving service, collection

Vodokanal has been chipping away at its arrears while also improving service, cutting its bad debts by 20 per cent as of mid-2004 and expecting to achieve a 45 per cent reduction in the next year or two. It has raised charges from a symbolic $4.50/year per household to about $3.30 per month.

“People will pay because they are tired of poor supply,” says Mr Akilov. “Within the next two years every household will have a water meter to track usage and control their own costs. None of this is easy but we will be helped by our new local water user committees. They will help sensitise society to the need for these changes and provide us with feedback, particularly whether extreme hardship is being imposed on the most vulnerable citizens in terms of water payments.”

“Sustainability is the goal,” says Mr Reiser of the Swiss Cooperation Office. “A lot of projects are well designed technically but fall down at the social level; the local water committees in Khujand will help explain the reality to people and help ease the changes necessary for sustainability.”

In addition to the Swiss donor support, the Governments of the Walloon and Flanders Regions of Belgium funded project preparation. The Government of Norway is funding improvements to the water company's governance and managerial practices. It is doing so by financing experts from the water company of Tallinn, Estonia to advise Vodokanal. A decade ago, when Estonia was in the early stages of its transition from a centrally planned economy, Tallinn’s water utility went through similar changes while implementing an EBRD financed project; it has since been privatised and is owned and operated by United Utilities.

18 February 2005