Intervention Summary
Title: Cholera Risk Reduction in Zimbabwe through Support for Essential Water Treatment
Chemicals
What support will the UK provide?
The UK will provide £600,000 for the period July 2011 to 31 March 2012
Why is UK support required?
The cholera outbreak of 2008/9 in Zimbabwe was the worst outbreak of cholera in the history of the country; around 100,000 cases and over 4,000 deaths were documented (WHO and Ministry of Health
Cholera Updates, 2008-2011). It is estimated that the international community spent over £90 million responding to the cholera outbreak during that period. The outbreak was predominately urban, at least in the initial stages, and due largely to the breakdown of the urban water and sanitation infrastructure and the population using untreated water, either from remaining municipal sources or shallow wells. At the height of the cholera crisis in early 2009, UNICEF took over the procurement and distribution of water treatment chemicals for the 20 major urban centres and Zimbabwe National Water Authority
(ZINWA). The support for water treatment has contributed to a marked reduction in cholera which is now endemic in Zimbabwe; in the 2009/10 rainy season there were less than 1,000 cholera cases and around 20 deaths- a 99 percent reduction in disease burden from the previous year (WHO and Ministry of Health Cholera Updates, 2008-2011).
It was planned that the urban councils and ZINWA would take over procurement of essential water treatment chemicals from July 2011, inline with a phase-out/cost-recovery strategy being developed with UNICEF, and would be able to provide safe water to over 4 million people who are increasingly at risk of cholera and other water and sanitation related diseases. However, this has not been possible because of a number of factors including ongoing impacts of Zimbabwe's complex emergency; prevailing economic situation; and increased operational costs of water utilities - which have resulted in the councils being unable to meet the cost recovery targets and hence the costs of water treatment chemicals.
UNICEF has secured (or obtained commitment for) approximately $5 million for procurement of water treatment chemicals for provision of water treatment chemicals for a period of 9 months on the basis of the town-specific phase-out/exit strategy. Additional funding ( £600,000), however, is required to ensure the procurement of water treatment chemicals is possible in all urban at-risk populations (20 urban councils). This support will ensure that a major cholera outbreak is averted in Zimbabwe.
What are the expected results?
The UK funding will support provision of safe water in 20 urban councils and ZINWA’s growth points.
The total effort (including the $3 million from CERF, $0.7 million from AusAid and $1.3 million committed by ECHO and our £600,000 contribution) will provide safe drinking water to an estimated 4 million people (approx. 2,080,000 female, 1,920,000 male including 560,000 children under-5), who in the absence of water treatment chemicals will be forced to drink water from unsafe and contaminated sources. DFID attributable beneficiaries will be approximately 680,000 individuals.
A major cholera outbreak could occur in Zimbabwe if timely support for water treatment chemicals is

not provided. This could have disastrous effects in terms of loss of life and may cost the international community over £90 million. Given its ability to quickly provide funds to such life threatening situations,
DFID is, therefore, being requested to provide support to mitigate immediate public health threats to the vulnerable population.
Business Case for :
Strategic Case
A. Context and need for DFID intervention
Urban councils and the Zimbabwe National Water Authority (ZINWA) are currently not able to procure essential water treatment chemicals due to low cost recovery, prevailing economic situation and increased operational costs. As such Zimbabwe is facing the threat of dramatically increased cholera transmission rates in high population urban centres, with ‘red flag’ cholera cases already emerging. Consequently, over 4 million people face the risk of consuming contaminated water due to an acute shortage of water treatment chemicals putting the population at critical risk of severe cholera outbreak which could result in loss of lives and cost the international community over £90 million in response (on the basis of 2008/09 cholera response). As such, urgent humanitarian action is required to mitigate public health threats to the population. Given the ability to quickly provide funds to such life threatening situations, DFID is, therefore, being requested to provide support to mitigate immediate public health threats to the vulnerable population.
Following the unprecedented hyper-inflation which reached its peak in 2008 and the political instability, an Inclusive Government was formed in Zimbabwe in February 2009 to address these challenges, and those resulting from successive years of poor agricultural production and massive degradation of basic social services. At its height in 2008, these disruptions led to about 5 million people requiring emergency food assistance. In 2008 and 2009, the country experienced a nationwide cholera epidemic that began in Chitungwiza, the urban epicentre of Zimbabwe and which, by the mid June 2009, had led around 100,000 cholera cases and over 4,000 dead (WHO and
Ministry of Health Cholera Updates, 2008-2011).
The underlying cause of the unprecedented cholera in Zimbabwe during 2008/2008 was recognised as the inability of vulnerable populations to access and use safe water and sanitation services leading to compromised safe hygiene practices. Zimbabwe has experienced a decline in access to safe water supply and basic sanitation services. Water treatment plants are dysfunctional or lack chemicals and most distribution systems are in need of repair. The poor state of WASH services is also a financial drain on families and on the national economy. It compromises gains made in education, and it impedes progress towards the goal of gender equality. At the same time, gains in the WASH sector are threatened by climate change, by rapid urbanization, by emergencies and by the continuing economic crisis that is eroding Zimbabwe's ability to maintain and invest in new WASH services.
At the height of the cholera epidemic in late 2008, it became clear that urban councils and the
Zimbabwe National Water Authority (ZINWA) were facing difficulties in procuring essential water treatment chemicals and the lack of these chemicals was resulting in untreated water being supplied to the residents, and water cuts, thereby forcing residents to drink contaminated water or seek other unsafe sources. UNICEF commissioned a comprehensive chemical need assessment for all major urban councils which formed the basis of initial procurement of Aluminium Sulphate, High-test hypochlorite (HTH) and chlorine gas in February 2009. Since then, UNICEF, with support from donors, has provided these water treatment chemicals to 20 urban centres and for ZINWA that ensured production of safe water to approximately 4 million people and contributed to a marked reduction in cholera cases in urban areas.
Sufficient funding, however, is not available with UNICEF to fully support the procurement of water treatment chemicals for a period of 9 months beyond June 2011. Given the Government of

Zimbabwe is not in position to support procurement of chemicals, an estimated 4 million people face the risk of consuming contaminated water due to an acute shortage of water treatment chemicals putting the population at critical risk to further public health risks (including re-current severe cholera outbreak, typhoid and other outbreaks of water-borne disease) if support for chemicals is not obtained.
DFID intervention is, therefore, requested to act early and respond to the time-critical need for adequate coverage of water treatment chemicals.
UNICEF is currently implementing one of the largest water and sanitation sector programmes in
Zimbabwe. UNICEF is the only development partner which has been involved in the procurement and country-wide distribution of water treatment chemicals in Zimbabwe since early 2009. Given its strategic position, competencies, particularly in procurement and water and sanitation sector, and strong relationships with partners including central government, urban and rural local authorities,
NGOs and private sector individuals and companies, UNICEF will ensure effective and efficient delivery of stipulated results for this project.
B. Impact and Outcome
Impact : The project will reduce morbidity and mortality in Zimbabwe due to cholera and other WASH related diseases. The support for water treatment contributed to a marked reduction in cholera which is now endemic in Zimbabwe; in the 2009/10 rainy season there were less than 1,000 cholera cases and around 20 deaths- a 99 percent reduction in disease burden from the previous year (WHO and
Ministry of Health Cholera Updates, 2008-2011).
Outcome : DFID contribution to the project will provide safe water to an estimated 680,000 at-risk people through provision of water treatment chemicals. The project, in addition to reducing death and illness due to cholera and other water and sanitation related diseases, especially in the children, would also result in economic benefits to households and individuals. Access to safe water would mean increased productivity and reduced medical costs due to water and sanitation related illnesses.
Moreover, the considerable amount of time women and children spend for fetching water from alternate sources could be spent more effectively on other tasks, improving their economic productivity, a key component in poverty alleviation efforts. The project will also contribute to improving the gender equality by reducing the drudgery of fetching water from alternate or unsafe water sources as well as increased girls school attendance.

Appraisal Case
A. Determining Critical Success Criteria (CSC)
Each CSC is weighted 1 to 5, where 1 is least important and 5 is most important based on the relative importance of each criterion to the success of the intervention.
CSC Description
1 Water treatment chemicals are procured and provided to the local authorities in time and used appropriately for treatment
Weighting (1-5)
5
2 Phase-out/exit strategy for water treatment chemicals to enable the local authorities and ZINWA to take over the provision of water treatment chemicals is developed and agreed to
B. Feasible options
4
The feasible options for achievement of impact and outcome for this project include the following:
1. Implementation through UNICEF
2. Implementation through several partners including national and international NGOs
3. Do nothing
Option-1: Implementation through UNICEF
Evidence of impacts :

UNICEF, over the last two years has successfully managed procurement and timely delivery of water treatment chemicals across Zimbabwe. The support for these water treatment chemicals ensured safeguarding of the quality of water supplied to approximately 4 million people and contributed to marked reduction in cholera cases in the country - 1022 cholera cases and 22 deaths were reported during 2010 compared to 66,773 cases and 2700 deaths during 2009 (WHO and Ministry of Health Cholera Updates, 2008-2011).

DFID Multilateral Aid Review, inter-alia, notes that (i) UNICEF provides critical support and coordination in humanitarian and emergency situations and the scale of its operations cannot be delivered by other MOs, (ii) There is good country level evidence for value for money.

UNICEF has already secured funds for procurement of bulk of the chemicals and is already in the process of tendering. This option, would, therefore, result in cost saving through economies of scale and ensure coordinated coverage and response.
Climate change and environment : This option would result in improved water supply and quality to the communities. Given the fact that adequate arrangements will be made for safe storage, handling and application of chemicals, no adverse impact on climate change and the environment is anticipated.
How the intervention will work :
UNICEF, on the basis of its experience of successful procurement and timely delivery of water treatment chemicals across Zimbabwe over the last two years, will procure these chemicals on the basis of competitive process in close coordination with the local authorities, ZINWA and WASH cluster partners. UNICEF, with funding available under Emergency Rehabilitation and Risk
Reduction Programme, which is also funded by DFID, is in the process of engaging a consulting firm for development of the town-specific exit strategy for water treatment chemicals. The key elements of the proposed exit strategy include the following:

• collection of information on the target water treatment systems including water production, chemical requirements
• review of the existing budgets of the urban councils/ZINWA
• establishment of revenue collection and chemical purchasing capacity of the urban councils/ZINWA
• formulation of recommendations along with timeframes for each council and ZINWA to take on responsibility for procurement of water treatment chemicals
• provision of technical support to urban councils and ZINWA for enhanced cost recovery and sustainability of WASH services
• WASH sector tariff study
• support to the national capacity for procurement of water treatment chemicals
• mobilization of the government commitment at highest levels to taking over the procurement of chemicals
UNICEF is currently implementing one of the largest water and sanitation sector programme in
Zimbabwe. The programme aims at increasing access to, utilisation of, sustainable and equitable safe water supply and adequate sanitation and promotion of safe hygiene practices in Zimbabwe.
•
•
•
•
•
The key components of the WASH programme include:
• Strengthening of WASH sector policy and institutional framework
Community water supply and sanitation and hygiene promotion
Urban water supply and sanitation (including Water Treatment Chemicals)
Emergency risk reduction, preparedness and response
Sector capacity development
Sector coordination
In Zimbabwe, UNICEF works at all levels; local, district, province and national with all stakeholders such as government, communities, local and international NGOs and the private sector. Given
UNICEF’s strategic position, competencies, particularly in procurement and water and sanitation sector, and strong relationships with partners including central government, urban and rural local authorities, NGOs and private sector individuals and companies, this option will ensure effective and efficient delivery of stipulated results.
Option-2: Implementation through several partners
Evidence of impacts : Though several partners, including national and international NGOs, are working in urban water and sanitation in Zimbabwe, none of these has any experience of large scale procurement and distribution of water treatment chemicals. This option could, therefore, cause delays in delivery, and increased cost of achievement, of the stipulated results.
Climate change and environment : This option would result in improved water supply and quality to the communities. Higher risk relatively of less rigorous safe storage, handling and application of chemicals since implementers not as experienced as UNICEF, but still not a major risk overall.
How the intervention will work :
International NGOs working in water and sanitation sector, particularly in urban areas, would be engaged by DFID to support provision of water treatment chemicals. This option would require engaging more than one partner and hence would no offer best value for money.
Option 3: Do nothing .
Evidence of impact: This option, by reducing the availability of chemicals, will increase the risk of cholera and other water and sanitation related diseases.
Climate change and the environment: Likely reduced water quality for human consumption and

other productive use
How it would work: Communities are likely to be forced to drink untreated water or resort to drinking water from unsafe sources.
In the table below:

the quality of evidence for each option as is rated either Strong, Medium or Limited,

the likely impact on climate change and environment is categorised as A, high potential risk / opportunity; B, medium / manageable potential risk / opportunity; C, low / no risk / opportunity; or D, core contribution to a multilateral organisation.
Option Evidence rating
1
2
3
Strong
Limited
Strong
Climate change and environment category (A, B, C, D)
C
C
C
C. Appraisal of options
Costs
Option-1, implementation through UNICEF, will cost £600,000 including the UNICEF HQ direct recovery cost, operational support, staffing and monitoring costs.
Option-2 cost would be considerably higher due to multiple contracts involved and additional overhead/administrative costs.
Option-3 costs should factor in potential humanitarian response to a major outbreak of cholera in
Zimbabwe thus placing over 4 million people at risk. This response to the cholera outbreak may cost the international community over £90 million (on the basis of experience of 2008/2009 cholera response).
Benefits
Given the fact that UNICEF has already secured funding (or funding commitment) for about US$5 million, Option 1 will contribute to provision of safe water to about 4 million people who are at risk of cholera and other water and sanitation related diseases. Reduced burden of water and sanitation related diseases would result in increased productivity and decreased absenteeism among members of the work force and reduced time and energy burden on the household leading to more time for child care and income-generating activities, as well as more regular school attendance. As the total
DFID funding will be co-mingled with funding from other donors, about 17% of the results will be attributable to the DFID contribution.
For Option-2, the total number of beneficiaries will be only about 700,000 (as partners have not secured funding for the total cost of the action required).
For Option-3, no benefits would accrue to people at risk of, or affected by, cholera. This option, would, therefore, have the negative impact on the target communities by exposing them to risk of cholera.
Risks

The significant risk attached to Options-1 is that the urban councils and ZINWA may continue to unduly rely on UNICEF to provide water treatment chemicals without taking on this responsibility. To address this risk, UNICEF is developing an exit strategy in coordination with the government and partners.
Option-2 carries the risk of delay in delivery of services due to capacity issues.
Option -3 will put the life of over 4 million people at risk by exposing them to the risk of cholera and other water and sanitation related diseases.
D. Comparison of options
The same weighting is used as for CSC above. The score ranges from 1-5, where 1 is low contribution and 5 is high contribution, based on the relative contribution to the success of the intervention.
Analysis of options against Critical Success Criteria (CSC)
Option 1 Option 2 Option 3
CSC
1
2
Totals
4
Weight
(1-5)
5
Score
(1-5)
5
5
Weighted
Score
25
20
45
Score Weighted
2
2
Score
10
8
18
Score
1
1
Weighted
Score
5
4
9
E. Measures to be used or developed to assess value for money
UNICEF has been procuring water treatment chemicals for 20 urban councils and ZINWA since early
2009. UNICEF, on the basis of international competitive bidding process over the last two years, has been able to establish the estimated average unit costs for aluminium sulphate, chlorine and HTH.
These rates, to be revised subsequently on the basis of competitive tendering process will provide requisite information for assessment of the value for money.
DFID funding (£600,000) will ensure that about 680,000 people would not drink unsafe water and hence will be protected from the risk of cholera and other water and sanitation related diseases. The unit cost per beneficiary would be £0.88.

Commercial Case
Indirect procurement
A. Why is the proposed funding mechanism/form of arrangement the right one for this intervention, with this development partner?
DFID and UNICEF will sign an MOU for implementation of this project.
UNICEF is the only development partner which has been involved in procurement and country-wide distribution of water treatment chemicals in Zimbabwe since early 2009. Given this and the reasons mentioned under “Appraisal Case’, UNICEF is the only partner that can implement while ensuring best value for money.
B. Value for money through procurement
UNICEF Zimbabwe Country Office has a dedicated “Supply and Logistics Section” which is responsible for procurement and distribution (where applicable) for supplies worth about
£30 million annually. As is the case for all procurements, UNICEF will follow a competitive tendering process for procurements under this project in line with UNICEF supply guidelines and involving local and international suppliers. This will ensure procurement of chemicals on competitive/cheaper prices.
Additional cost savings will also be effected through economies of scale.

Financial Case
A. How much it will cost
£600,000 for the period July 2011 to 31 March 2012, including UNICEF HQ direct recovery cost, operational support, staffing and monitoring costs.
B. How it will be funded: capital/programme/admin
Programme funds
C. How funds will be paid out
In line with MOU to be signed between UNICEF and DFID.
D. How expenditure will be monitored, reported, and accounted for
The project will be monitored by UNICEF in line with UNICEF’s guidelines. The specific means to be adopted for monitoring of the project to ensure that supplies provided are used for intended purposes are as follows:
• Regular review meetings will be held with the line local authorities and partners;
• Regular field visits would be undertaken by UNICEF staff to monitor utilization of
• chemicals; and
UNICEF progress/final report and financial report in line with agreement between
UNICEF and DFID.
DFID will engage with UNICEF on regular basis to discuss the progress of the programme.
If any funds remain un-utilized, UNICEF will return the same to DFID in line with the Global
Agreement between UNICEF and DFID.

Management Case
A. Oversight
This project will be overseen by UNICEF Zimbabwe Country Office and DFID in line with the global agreement between UNICEF and DFID.
Under this project, 20 urban councils, all members of the Urban Councils Association of Zimbabwe
(UCAZ), who are operating and managing water treatment and distribution in their respective areas, will be assisted. In addition, ZINWA, which is managing water treatment and distribution in several urban centres and over 500 growth points, will also be supported. UNICEF will procure chemicals
(Aluminium sulphate, HTH and Chlorine gas) centrally and distribute to the urban councils and ZINWA.
UNICEF, in coordination with the WASH Cluster partners will continue monitoring water supply and chemical situation of the urban towns and cities to ensure that urban populations have access to safe water supply and that the needs of the poorest and most vulnerable communities are met. UNICEF will also work with the local authorities and partners on development of an exit strategy for phased take over of the water treatment chemicals by the local authorities and ZINWA.
B. Management
This contribution will be managed by DFID Zimbabwe and UNICEF Zimbabwe Country Office.
C. Conditionality
Not applicable
D. Monitoring and Evaluation
The project will be monitored by UNICEF in line with UNICEF’s guidelines. The specific means to be adopted for monitoring of the project to ensure that supplies provided are used for intended purposes are as follows:
• Regular review meetings will be held with the line local authorities and partners;
• Regular field visits would be undertaken by UNICEF staff to monitor chemical utilization;
• and
UNICEF progress/final reports and financial report in line with agreement between
UNICEF and DFID.
DFID will engage with UNICEF on regular basis to discuss the progress of the programme. Due to this project being under the threshold of £1 million and the rigorous reporting planned by UNICEF we do not plan to undertake a Project Completion Report. However, we wi ll ensure UNICEF’s reporting provides DFID Zimbabwe with the data we require and will support any independent evaluation completed.
E. Risk Assessment
The key risks that could threaten the successful delivery of the intervention along with the corresponding mitigating actions to minimise these risks are summarized as follows:
Risk assumption Mitigation strategy
1. Political and economic situation does not worsen to civil conflict or general paralysis of service
UNICEF is working closely with government Ministries responsible for social service sectors to ensure good relations and delivery. UNICEF was able to support the

sectors
2. Re-establishment of exchange rate system that would negatively affect the cost of programming
3. Overall costs of procurement of goods and services do not escalate beyond reasonable levels provision of services through various mechanisms over the past years and does not anticipate this changing in the near future. The UN system has coping strategies to continue support even should security phase increase.
Consultations would be held with donors, UNICEF financial managers and other key players to develop strategies to mitigate the effects of this and ensure a level of implementation continues.
UNICEF has a comprehensive procurement process which aims at supplying the best services or goods at the best cost and can access global markets to ensure economies of scale where necessary. Nevertheless there is a principal in process to try to develop the local economy wherever possible – but not at the risk of compromising implementation.
The programme has a strong training and capacity development component which will be further developed during 2011.
4. Capacity of urban councils to manage their water and waste water treatment does not further deteriorate.
5. Major breakdowns and load shedding by ZESA can seriously affect water treatment and distribution.
6. Councils continue to unduly rely on UNICEF to provide water treatment chemicals without taking on this responsibility.
UNICEF is closely working with Zimbabwe Electricity Supply
Authority (ZESA) at project level to seek agreement of agreed time schedule of loading shedding in towns, dedicated lines and alternative electric power solutions – transformers where possible.
UNICEF, in close coordination with the local authorities and line ministries, is in the process of developing an exit strategy for water treatment chemicals that will enable the local authorities/ZINWA to take over the procurement of chemicals in a phased manner.
7. Systems and processes are in place to ensure that there is no risk of fraud in management of the project
UNICEF has a globally agreed financial system with robust financial accounting and monitoring system.
F. Results and Benefits Management
The project will contribute to reduced morbidity and mortality in Zimbabwe due to cholera and other
WASH related diseases. The immediate provision of safe water through water treatment chemicals will contribute to reduced disease impact on 4 million vulnerable people living in 20 urban centres and
ZINWA’s growth points/service stations. The log-frame for the project is attached.