Taworeda Clinic Borehole Project – Togo

Taworeda Clinic Borehole Project – Togo

This project is made possible through the partnership of WATER CHARITY and the NATIONAL PEACE CORPS ASSOCIATION.NPCA and WC logos

This project has been completed.  To read about the conclusion, scroll down the page.

Taworeda Clinic Borehole Project - TogoLocation
Taworeda, Central Region, Togo

Community Description
Taworeda is located approximately 30 km southeast of Sokede, the regional capital of the Centrale Region. The population is around 3,800 inhabitants and comprised of several different ethnic groups: Kotokoli, Kabyé, Losso, Moba and Lamba though predominantly Kotokoli and Kabyé, the dominant groups in the Centrale region. History has it the first inhabitants were hunters from the north, arriving at this relatively verdant forested tropical savannah.

The religious make-up is similar to most of the villages in this region, predominantly Muslim with several smaller Christian congregations of various denominations. The people of Taworeda are primarily subsistence farmers cultivating manioc, some rice, yams, soy and maize during the one rainy season a year.

Annual food security is at about 50 %, indicating half of the population lacks sufficient post-harvest storage of essential staple grains; 80 % of the local diet. Households with a scarcity of food stores rely on the generosity of family and neighbors. Animal husbandry exists, although not on a developed scale. Most households have free-range chickens and perhaps a few sheep or goats, the latter consumed almost exclusively during religious holidays.

A large community of nomadic Fulani herders settles annually near low-lying shallows during the dry season or for the duration water is present, prior to migrating with their herds southward. Conflicts between pastoralists and sedentary farmers has abated over the years as the Fulani are no longer free-ranging their cattle during the growing season, which would otherwise result in damaged crops.

While there are several shallow wells scattered throughout the village, most run dry by April. There are two perennial borehole wells that serve as the main source of water for all 3,800 inhabitants during this period of water scarcity. One is at a communal site managed by a water committee which requires a nominal payment. The other is in the Chief’s compound, and access is free of charge, although limited.

Description of the ClinicTaworeda Clinic Borehole Project - Togo
The health clinic in Taworeda serves a larger population of 4,450 people from the neighboring villages. An international NGO built the 6-room cement block clinic in 2009, and equipped the center with indoor plumbing. However, the sole water source was of both poor water quality and of insufficient supply, as water was depleted typically by late November – earlier than most of the village wells.

There is no electric power in Taworeda and only recently has the clinic had access to power for lights and a refrigerator, through a 2017 UNICEF solar panel project. The clinic pays for power with funds from the sale of medicines.

The clinic is staff by a head nurse, a licensed midwife, and a pharmacist. The most common illnesses treated at the health clinic include malaria, gastro-intestinal diseases, a variety of infections from surface cuts to respiratory complications, and births, which average 9 per month. Though most of the women attending the clinic for maternity services cannot pay the clinic fees, pregnant women still receive care and are encouraged to attend the family planning and child-maternal nutrition classes offered at the clinic.

Problem Addressed
The water supply infrastructure presently at the Taworeda clinic consists of a 9 m deep, closed well equipped with a manual hand pump, a 4.5 m metal water tower, and a 1 m3 polyethylene tank. According to the clinic staff, the well and pump ceased functioning effectively several years ago and today what little is pumped is used by the neighboring households, as the water quality is considered too poor for clinic use.

The Red Cross evaluated the well in 2015 and decided the system could not be rehabilitated – requiring the relatives of patients to haul water, particularly onerous for those patients giving birth, as water needs must also be provided post-birth for cleaning of the maternity room, utensils, and birthing cloth.

Water brought to the clinic from neighboring wells is poor and requires the addition of bleach. Potable water for staff and patients is brought to the clinic in plastic containers from the borehole well 0.5 km away and subsequently sanitized with bleach.

Project Description
This project is to build a borehole well for the clinic.

Under the guidance of the Department of Hydraulics and Sanitation’s regional office in Sokode and with support from the Ministry of Health regional director, who identified clinics with the most critical need, and a local drilling company, this project proposes to drill a 60- to 100-meter borehole well at the clinic, equipped with the following:Taworeda Clinic Borehole Project - Togo

• An electric submersible pump,
• a 4-meter high cement block water tower,
• a 2 meter**3 polyethylene tank, and
• indoor plumbing (water basin and faucet) to the one room with a subsurface drain (mentioned above).

The submersible pump will be run using a gas-powered generator as there is currently no electric power in the community. The local drilling company selected, Plomberie Génerale de Réalisation de Forage, in operation since 1998 and based in Tchamba, has extensive experience drilling deep borehole wells throughout Togo and regionally in Burkina Faso, Benin, and Nigeria.

Project Impact
4,450 people will benefit from the project.

Project Administration
This project will be managed by Anne Jeton, hydrologist and Returned Peace Corps Volunteer (RPCV), Burkina Faso (’82-’85) and Returned Peace Corps Response Volunteer (RPCRV), Togo (’16 -’17).

Anne was sent to Togo on behalf of Water Charity to develop and administer new projects, and to coordinate with Peace Corps.

Monitoring and MaintenanceTaworeda Clinic Borehole Project - Togo
Along with staff from the Department of Hydraulics and Sanitation who will monitor the well “indefinitely” (the well data becomes part of the official borehole well database, and as such is included in periodic field monitoring by technicians based in each Prefecture ), the contract for well drilling states a one-year guarantee provided by the drilling company. Problems with pump and borehole functioning are typically resolved in the first month of use.

Proper screening of the borehole and submersible pump placement relative to the static water table often mitigate the most common problems. However, any mechanical problems surfacing in the first year will be the responsibility of the drilling company.

The clinic staff will be responsible for maintaining a well repair account which will be funded from the sale of medicines. The clinic will decide a nominal fee for water use should the water account be insufficient, or the community will be asked to contribute directly to the costs.

The PCV near the site will monitor construction and do periodic evaluations.

Project Funding
This project has been funded by an anonymous donor.

Conclusion of Taworeda Clinic Borehole Project
The project finishedThe percentage of the total population in the Tchaoudjo District with access to potable water is estimated to be 35 percent. In the Centrale region, only 41% of the population is estimated to have potable water hence the need is immense. The current Togo water assistance program in Togo choose to focus on village-level health care clinics with the intention of addressing both a health care need and to provide potable water to the surrounding neighborhoods during months of water scarcity.

The maternity delivery room was equipped with a sink, faucet and running, potable water, and through additional outside funding; a floor drain and a discharge chamber, both plumbed to a dedicated subsurface cement-lined and ventilated septic tank. Delivery room waste (blood and tissue) can now be dispensed with directly in the maternity room in a safe and hygienic manner, rather than hand-carried by the midwives to an outdoor pit or in many cases poured into the latrines.

The Togolese Ministry of Health’s regional office compiled a list of community health clinics in critical need of water for each of the four districts within the Central Region. These community health clinics are run by the Ministry of Health and are the first rung of health care services designed for rural communities, known locally as a Unité Soins Périphérique or “USP” (hereafter refers to as “ health clinic”) typically staffed with a salaried licensed nurse and midwife. Other personnel at the clinic often include a midwife assistant, a “pharmacist” i.e. someone who dispenses medicines with the supervision of the head nurse, and a community member trained in basic accounting skills to manage the clinic account. Lifting the storage tank.The clinic typically cares for a range of illnesses, most prominently malaria, gastro-intestinal and respiratory ailments, and surficial infections. However, providing women with maternity care, pre and post-birth, was the primary reason for their establishment several decades ago and has since been the main emphasis of these rural clinics.

The scope of the current Water Charity assistance program managed by the in-country coordinator, is to meet this water scarcity by installing deep borehole wells and a water distribution system to provide yearlong, potable water to both the clinic and the surrounding community. By maintaining appropriate hygiene in the clinic facilitated by indoor plumbing and uncontaminated water, the presence of pathogens should be reduced. Indoor plumbing will also alleviate the burden on both the clinic staff in general and in particular the mid-wives who typically operate under severe and very unhygienic conditions.

Additionally, the added burden imposed on the female relatives of expectant mothers to fetch water from the open, unpotable clinic well (during the rainy season) or further to distant sources during the dry season will be eliminated. The health clinic borehole well program uses the term “borehole” to refer to the mechanical insertion of a vertical pipe ( or casing) with a modern, mechanized drilling rig, to depths typically between 60 and 100 meters to reach water-filled fractures, and not a hand-drilled borehole used in some countries with shallower depth to the water table.

Initial site assessment of a designated health clinic (including Taworeda) was carried out by the Department of Hydraulics hydrologist and the Water Charity coordinator where the following information was collected to determine the feasibility of a borehole well distribution system, in consultation with both clinic staff and community leaders:
A meeting of community leaders.

–          Date of construction of clinic and by whom.
–          Assessment of the water system currently at the site, date of installation and by whom, maintenance history if any, and subsequent
modifications to the original system.
–          Current power source (solar, electricity, generator).
–          Staff positions and numbers funded by the community.
–          Assessment of clinic infrastructure (building, indoor/outdoor plumbing, septic, presence and or condition of latrines)
–          Frequency of patients and type of illnesses treated, number of births per month, community training (for example family
planning, STD, HIV, maternal-child nutrition)
–          Community oversight by leaders – community development organization, village heads and religious leaders (Imams).
–          Financial soundness of the clinic insofar as the ability to provide maintenance and upkeep and to pay for fuel to run the generator
for those clinics without power, or for the later, to make a regular payment to prevent disruptions of service.

Village children watching construction.All of the health clinics visited were in critical need of water however given the limitations in funding, final determination of a project site were based on several factors including; the motivation of the clinic staff to responsibly managed the borehole well water system to ensure future repairs, the community leaders to contribute building material and labor during well implementation, the presence of an established water committee to manage community access to the well during months of water scarcity, viability of the clinic itself i.e. frequency of clinic visits, and financial means (and willingness) to create a separate well repair account.

The health clinic staff, the community leaders, including the head Imam and members of the community development committee were very motivated and actively participated in all meetings, and engaged in the discussion on maintenance and upkeep, and the establishment of a water committee.  The clinic staff repaired the requisite indoor plumbing in record time. Taworeda met the project criteria discussed above, particularly given the water shortages in the neighborhoods surrounding the health clinic.  The purpose of the borehole well project at the Taworeda health clinic was to address both a shortage of year-round water and unpotable water at the clinic, to provide running water to the clinic, and to make available to the community on an as specified basis, water during times of scarcity.

The scope of the borehole project entailed drilling a 92-meter borehole well, properly “developed” using modern technology and equipment; equipping the borehole with an electric submersible pump, constructing a 4.5-meter high cement block water tower topped with a 2,000-liter polyethylene water tank, installing a gas-powered generator as no electric power is available in village, outdoor water access points (faucets next to the clinic), a water access point on the water tower for community members, and the servicing of the well to the indoor plumbing.

WORK ACCOMPLISHED (progression of work through each stage)
1) Site assessment of the existing water system.A village worker perched atop the tank. Community meetings with village leaders, community development members, and the health clinic staff to discuss the feasibility of project relative to the community contribution (labor, housing for drill crew and building material for the cement water tower. In addition, the financial strength of the clinic budget was assessed and motivation of the clinic staff to maintain the well system in constant working order. Discussed the ability of the clinic staff to repair/replace indoor plumbing necessary as the project limits its scope to borehole well, water tower, power source and plumbing for both outside and indoor access. The clinic was notified of its responsibility to repair or replace plumbing and hardware as needed as the center was plumbed originally for running water.

2) A geophysical field study lead by a Togolese firm (overseen by the drilling contractor) was implemented to determine borehole drill placement using the electric resistivity method to locate deep-seated water-filled fractures (or fissures). Knowledge of prior hydrogeological investigations Borehole placement was identified based on geophysical indicators of a fracture-filled water aquifer (defined as a “saturated permeable geologic unit that can transmit significant quantities of water under ordinary hydraulic gradients” [Freeze and Cherry, 1979. Groundwater p.47].

3) A local Togolese drilling company based in Tchamba with extensive experience was hired to oversee the borehole well water system for the Taworeda health clinic. The Department of Hydraulics Director prepared a contract stipulating the conditions, responsibilities, and timelines for the project. A borehole drilling machine was brought to the clinic and the borehole site prepared for drilling. The community provided a secure building for equipment storage and housing for the drill crew. A borehole well was drilled using an industry-standard rotary drilling machine attached to a flatbed truck that accomplishes two tasks; using rotation, a drill bit cuts away at the bedrock while PCV drill pipes are lowered progressively into the drilled or vertical “borehole”, in this case using compressed air. The well was drilled to a depth of 60 meters, through the lateritic overburden into the crystalline bedrock. Material brought to the surface during drilling was identified to assist the driller and hydrogeologist in classifying the geologic formations within the borehole (figure 1). The geophysical study also helped to identity shallower, less desirable groundwater intrusions which were sealed from entering the borehole. The aquifer tapped by the borehole water is a confined aquifer ( where there an impermeable layer above the aquifer thereby allowing groundwater in a borehole well to rise above the aquifer). The static water table (the water table before pumping) was at 6 meters, while the dynamic water table ( the water table during pumping at the desired yield) was at 21 meters. The well was screened between 40 and 43 meters and again between 84 and 87 (thus allowing groundwater to enter the borehole).Village children.

4) An electric submersible pump was inserted at 36 meters and a pump test initiated to determine the well’s productivity. Essentially the pump is run for several hours at a rate similar to actual pumpage use, the declining water table is measured at regular intervals and the return flow to the initially measured water table provides information on the transmissivity of groundwater through the subsurface material i.e. how rapidly the well recovers from pumping. Once a well is free of any accumulated fines, it can be properly evaluated for the amount of water it will yield. The Taworeda borehole was drilled to a depth of 92 meters has a yield of 3,200 liters/hour which is more than adequate to supply not only the clinic and the surrounding households. The pump test also indicates a rapid filling of the borehole after pump use. Simply put, the hydraulic conditions of the well are favorable to ensure sustainable water supply.

5) A water sample from the borehole well was taken and sent to the Regional laboratory in Sokodé, the regional capital for a complete microbial and an inorganic compound analyses. The results of this analysis indicates zero presence of any of the disease-causing bacteria tested (E Coli, Salmonella, Fecal Streptococci, Enterococci and a general category of thermotolerant coliforms). Of the inorganic elements tested (elements found in the bedrock, and nitrate, a product of fertilizer use and septic/sewage contamination) were all within acceptable levels. The water quality from deep borehole wells is potable, bacteria-free water with no discernible color, taste or odor. The results from shallow wells tested in the region indicate bacteria counts exceeding 100 counts/ml (the international standard is 0/ ml) thus attesting to the non-potability of the most common form of water access, whether open wells or sealed with a hand pump. Lateral subsurface movement of water from contaminated sources outside the immediate well area occur even if hygiene practices around the well are respected, due to polluted streams, septics and latrines,  and surface infiltration of contaminants from animal processing and open defecation.

A young family with newborn baby.6) Construction of 4.5-meter high cement block water tower equipped with a 2,000 liters polyethylene water tank. The community contributed sand, gravel, and labor in manufacturing the cement bricks needed for constructing the water tower.

7) Piping installed from the borehole well to the water tank and from the tank to both the outdoor faucets and the intake valve to the building allows for a gravity-fed routing of water powered by a gas generator as there is no electricity at the clinic. Additional water spigots were installed at head height on the water tower to allow the community members (women) to fill their basins directly without having to lift heavy basins of water as is the case with hand pumps. The clinic staff replaced worn faucets and indoor plumbing as needed prior to the opening.

8) Numerous visits were made during the well installation by the Coordinator and the government hydrologist to ensure the clinic and community leaders understood the responsibilities associated with maintaining and ensuring a sustainable water supply. A final visit by the Regional Director of hydraulics insured the borehole well and the associated delivery system met all of the driller’s contract requirements and functionality.

9) An official technical opening concluded the project with a presentation by driller on the borehole well components, brief discourses by the Department of Hydraulic Regional Director, village leaders, clinic staff and representatives from the regional ministry of health.The villagers and chief.  Taworeda was well represented by the religious leaders of the predominantly Muslim community, male and female elders, children, community development members and some members of the general population. As the representative for Water Charity and its donor(s), the Coordinator reinforced previously discussed themes of maintenance and upkeep through the active participation of a community water committee and a clinic repair account, the management of public access to the well in a non-disruptive manner to the clinic staff and patients, and most importantly to take ownership of this valuable, perhaps once in a lifetime resource.

Monitoring
The Department of Hydraulics will assume monitoring of the borehole well from a maintenance perspective for an indefinite period. The Department has on its staff personnel trained to work with community water committees and clinic staff. The contract states a one-year guarantee for the submersible well. Any technical problems that arise with the initial use will be addressed by the drilling company. The clinic staff does not foresee a need for the community to access the well water until later in the year when the local wells begin to dry up. While there has been much discussion around the issue of how the clinic will manage community access to the well, it remains to be seen how this will play out. The well is primarily for the clinic however, in water-scarce communities, water sources are shared.
The finished project.Given the well is powered by a gas generator that the clinic is responsible for running and maintaining in constant working order, the clinic will collect a nominal fee from the users to be deposited in a separate account. The Taworeda clinic serves a population of approximately 3,800 people, including the neighboring villages hence all attending the clinic will benefit directly. While the number of people using the clinic well for personal consumption is not known at this time, as there is still water in the community wells, several hundred people live in close proximity to the clinic. However, there could be as many as several hundred people or more accessing the well during the dry months (from February on) as there no other deep borehole wells in the village. The clinic anticipates seeing a rise in births at the clinic now that there is running water and female relatives are no longer obliged to fetch water for the patient – not to mention the overall hygiene. The clinic will use access to potable water to encourage better overall hygiene given most of the disease-causing bacteria in the community water sources are due to fecal transmission by both animals and humans.

Conclusion
The Regional Director of the Department of Hydraulics stated in his technical report ( information provided in this report on borehole characteristics and figure 1) the following: “ The political view of the government of Togo states shallow wells on the order of 7 to 25 meters are considered unhygienic and unpotable. The subsurface zone at this depth receives only infiltrated water directly from the surface of water that flows laterally into this zone from contaminated sources (other wells, wastewater, septics, streams). Deep borehole wells reaching uncontaminated water is the only acceptable water for our population”. In this light, the Taworeda health clinic borehole well water system has fully succeeded in meeting both the local and national objectives for potable water. The community of Taworeda offers its sincere thanks and gratitude to the donor(s) for this valuable water resource. As they here “ l’eau est la vie”. Water is life, and the cleaner the water the longer and more satisfying than life will be! Un grand merci!