Two years from now South Africa’s regulated drinking water supplies will be fluoridated to an optimum level of 0,7mg per litre of water in accordance with regulations promulgated by the Department of Health on September 8 this year.
“The cost of this programme is estimated at R30-million a year,” says the chairperson of The South African Association of Water Utilities (Saawu), Phiroshaw Camay.
“The fluoridation legislation is viewed as premature because the institutions operating in the water services industry face many challenges in trying to improve the quality of life of all South Africans by ensuring the extension and improvement of water services and sanitation. Massive backlogs for these services exist. About seven million people do not have piped water and 20-million do not have basic sanitation services. The estimated costs for infrastructure provision to meet these backlogs runs into many billions of rands.”
Meanwhile, according to recent press reports 75% of the money allocated for water and sanitation throughout the country has not been spent because of lack of capacity at local government level.
“Municipalities, who have a constitutional obligation to supply services, face serious financial and capacity constraints that are compounded in many instances by non-payment for services delivered,” says Camay.
“Should we not be directing all efforts at rectifying this situation before stretching both municipalities, and ultimately the consumer, with additional implementation and service costs for fluoridation?”
In addition to this municipalities are grappling with the substantial challenges of implementing the recent basic free water policy in a manner that ensures full cost recovery and ultimately sustainability and viability within the sector.
Camay says the real issues are whether the water sector can, or should try, to do all these things simultaneously. “Will the people who need these services the most actually benefit? What are the priorities and where should the limited resources be focused in the first instance?
“Is the provision/improvement of basic sanitation in particular (given cholera and related outbreaks) and water services not more important from a basic health perspective than fluoridation at this time? Have other methods of fluoridation been sufficiently explored such as fluoridating salt (sodium chloride), bread, maize meal or milk?” asks Camay.
Of course the question remains: Who will carry the cost? As usual it will probably be the consumer.
Camay asks what conclusive research was conducted that indicates that potable water is the best delivery option in terms of total implementation, ongoing operational and maintenance costs, targeted delivery and so forth.
Saawu supports the principle of augmenting dietary fluorides in view of the poor dental health situation in the country as indicated by the Department of Health.
“The association believes that there is no conclusive evidence that water fluoridation, if correctly implemented, will pose a threat to its consumers and encourages Saawu members to comply with the legislation, the first phase of which came into effect this September,” says John Connolly, chief executive of Saawu.
A key concern is that water providers may be held liable for certain health and environmental impacts that may result from the fluoridation of water supplies. Latest correspondence from the director general of the health department stipulates that such claims will be made against the Minister of Health Manto Tshabalala-Msimang as the minister issued the regulations.
A query which to date has not been satisfactorily addressed is the extent of access to future fluoridated water supplies. The intended major beneficiaries of the fluoridation policy are people in the rural areas and those who do not have the benefit of being able to augment their dietary fluoride intake in some other way such as taking fluoride tablets and/or using fluoridated toothpaste.
An estimated seven million of the country’s 43-million inhabitants do not at present have access to a regulated water supply. They draw their water from boreholes, dams or streams and basic water treatment systems and the ability to fluoridate these supplies is questioned.
Once information on the registration of water suppliers becomes available it is expected a more accurate figure will emerge and the figure will be substantially higher. In addition many small water service providers may not be able to accurately and safely apply water fluoridation due to the toxic and aggressive nature of the products that will be used in the fluoridation process.
It is estimated that less than 1% of the water supplied by service providers is used for drinking purposes. As an example only 0,65% of the water produced by Rand Water is used for drinking purposes. This equates to 19 000m3 of the 3 000 000m3 sold daily, which means that effectively 99,3% or R25 500 of the direct costs (chemical costs per day) is not effectively utilised for the intended purpose.
It is estimated that of 1 500kg of fluoride introduced into Rand Water’s water a day approximately 1 000kg a day will find its way back into the environment. Fluoride- concentration levels in South African streams vary considerably and fluctuations would have to be continuously monitored. In order to ensure compliance with the regulations water service providers will have to invest in infrastructure that will enable them to fluoridate water.
Fluoride compounds that can be added to water are available in either solid or liquid form and the dosing plants will be designed and built to handle one of the forms. In addition legislation requires that qualified technicians administer and monitor the dose, operate the dosing sites, oversee the offloading, storage and distribution of the product and run the dosing plant. Additional staff have to be trained to deal with possible emergencies after spillages or contamination. These technicians are not readily available, especially in rural areas. The alternative is to automate, but at a high capital cost. The consumer will ultimately pay for the process, infrastructure, operation and maintenance. Maintenance costs of fluoridation plants are high because of the highly dangerous and corrosive nature of the product.
“The high water tariff has already placed a burden on consumers,” says Noeline Basson of Scientific Services of Sedibeng Water. “The cost of fluoridation will reflect an added cost. The cost implications for smaller, or rural water treatment plants will be serious.”
Roelf Strydom, area manager of Magalies Water, says: “Although we will comply with the relevant regulations on fluoridation (registration, application for exemption) we believe that all alternatives to fluoridation of water supplies have not been properly investigated. Furthermore, the practical implications of fluoridation of water supplies have also not been considered fully.
“Fluoridation should be approached from a catchment perspective. We are reliant on recycled water as a source and the effect of fluoridation in the upper reaches of the catchment area on downstream use have not been determined. Not much attention has been given to the possible need to defluoridate, its costs and its possible effects.”
The Bloemfontein Water Authority is against the fluoridation of water because, it says, it is extremely difficult to control and it increases salinity in effluent. “Besides,” says Louis van Oudtshoorn, acting CEO, “only 1% of potable water is actually consumed by people thus there is a large waste element. If dental health is indeed a concern then we support the idea of fluoridation via other means, such as adding the substance to selected foodstuffs which the consumer can choose from. And indeed can choose whether or not he or she wishes to take fluoride at all.”