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22 April 2025 | Story André Damons | Photo Supplied
Dr Tafadzwa Maramura
Dr Tafadzwa Clementine Maramura is a Senior Lecturer and NRF-Rated Researcher in the Department of Public Administration and Management at the UFS.

With roughly half the world’s population experiencing severe water scarcity for at least part of the year, according to the UN World Water Development Report 2024, a researcher from the University of the Free State (UFS) seeks to understand how South Africa and the rest of the African continent can ensure that every person has access to water.

Besides Dr Tafadzwa Clementine Maramura, Senior Lecturer and NRF-Rated Researcher in the Department of Public Administration and Management at the UFS, research focusing on service delivery, especially delivery of water to the most vulnerable and poorest households, her work also focuses on the water-health nexus. In February she was appointed the Secretary for the Institutional Governance and Regulations Framework – a sub-specialist group for the International Water Association (IWA), becoming the first black African female to be appointed to this position.

According to statistics quoted by Greenpeace, 5.52 billion people out of a population of 7.78 billion in 186 countries face water insecurity, of which, 1.34 billion are Africans, accounting for more than 90% of the continent’s population. The United Nations World Water Development Report 2024: water for prosperity and peace; facts, figures, and action examples state that as of 2022, 2.2 billion people were without access to safely managed drinking water.

 

Research focus

With this, and with the Sustainable Development Goals (SDGs) – especially Goal 6 (clean water and sanitation) – in mind, Dr Maramura seeks to understand how South Africa and the rest of Africa can ensure that everyone gets access to this particular resource. “My research focuses on water governance and sustainable service delivery, public policies, and the green economy in the African, as well as the South African, context. What I found is interesting and really saddening at the same time. When you break it down, you realise that one in every three people in Africa don’t have access to potable water.

“Water is a basic human right, you can survive without electricity and other luxuries, but not without water. Each time you brush your teeth or flush your toilet with at least 15 litres of clean water or you are watering your garden with clean water, there are people that actually don’t have access to basic drinking water,” says Dr Maramura.

She is also investigating what the government is doing to ensure it delivers on this service it is mandated to, as South Africa has all the policies in place, and the best constitution in the world, but still the poor and most vulnerable communities do not have water.

“Access to clean water is not just a basic need; it is a matter of dignity, equality, and survival. As a young African woman, through my research, I see first-hand how the burden of water scarcity falls disproportionately on women and girls, robbing us as women, of education, economic opportunities, and health.

“But we are not just victims – we are leaders in this fight. By empowering women and investing in sustainable water solutions, we can transform our communities and break the cycle of poverty. The time for action is now because water is life, and every African deserves it.”

 

The water-health nexus

Dr Maramura has book chapters coming out in June this year that focus on the water-health nexus in failed states, thereby merging SDG 3 and 6 on health and water respectively. Water plays an indispensable role in the world as it is important for accomplishing several other SDGs, such as zero hunger, poverty eradication, good health and well-being, and affordable and clean energy. It all depends on the achievement of goal 6.

Says Dr Maramura: “You cannot solve problems in isolation; you cannot look at the water problem in isolation. If you have a water problem, you have a health and education problem because kids can’t go to school if there is no water. Hospitals can’t function when there is no water.

“SDG 3 speaks to health and SDG 6 speaks to water and that is where the nexus is, nexus meaning connection between water and health. How can we ensure that we merge the two together and ensure researchers working on health and water can find common ground to address any challenges arising from the lack of water so that we don’t have these health issues?”

South Africa is an upper-middle-income country but still struggles to deliver potable water to everyone and many communities in the country still rely on ventilated pit latrines due to limited access to modern sanitation facilities. With the deadline for achieving the 17 SDGs only five years away, South Africa is at risk of failing to achieve the SDGs.

 

Solving the water problems

According to Dr Maramura, there is no magic wand that can be used to solve all the country's water problems, but a collaborative and comprehensive effort is needed. “There is work that needs to be done. The government, private sector, the communities, as well as other role players need to work together. South Africa is a water-stressed country with rainfall below the global average. We realised that we have scarce groundwater resources.

“The community needs to understand, participate, and be aware of how much damage we can do by just drilling boreholes and digging wells. The private sector needs to know what it is that they can do to ensure that they also play a part through their corporate social responsibility and philanthropic dimensions in assisting the community.”

From the government side, she says, the policies are there so the government needs to consult with the communities, the private sector, and all other relevant stakeholders. They need to involve affected communities and after consultations, they need to engage these communities because they understand their problem best.

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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