INTRODUCTION

•  Context of the intervention

Cameroon
Cameroon (Fig. 1) counts more than 16 million inhabitants, distributed on a total area of 475.442 km, with a high demographic density in the southern and south-western regions of the country. The administrative capital is Yaoundé, with few more than 1 million inhabitants, while Douala , the greatest city of Cameroon (1,5 million inhabitants), further than being the economic capital, is also the principal industrial center. Ex French and British colony, Cameroon contains about 200 ethnic groups who speak 24 major languages. About 25 percent of the population adheres to traditional religions, 22 percent of the population is Muslim; the remaining majority is Christian. Muslims predominate in the north and Christians in the south. Away from the modern cities in expansion as Yaoundé or Douala , the tropical forests extend in the northern part beginning from the Atlantic ocean , while even more to the north, the climate favors the presence of savannas and mid-desert zones. From the geographical point of view, Cameroon is one of the most variegated countries in Africa and includes three principal environmental zones: the north savanna, the tropical forests to south and to east, the region of the northwestern plateaus toward Nigeria . To the western part, the fertile grounds of volcanic origin near Bafoussam and Bamenda, have allowed a greater density of rural population than in the other zones of the country. In the western regions, where lives almost 25% of the population, prevail the cultivations of coffee and cocoa. The differences in the precipitations between a region and another are notable: in some zones of the extreme north the rain is hardly enough to allow the agricultural cultivations, while in the southwest, around Mount Cameroon , it overcomes the 5000 mm annually. On the north region, the rain season extends from June to September; on south, the light rains of March and April are followed by real downpours among May and November, that make the asphalted roads almost impassable.

In Cameroon there is a multi-partitical political system in force, guided by the president Paul Biya from more than 20 years. The last elections, happened in October 2004, confirmed once more the President. From the administrative point of view, the country is separated in ten provinces: Littoral (capital: Douala ), South-West (Buea), North-West (Bamenda), West (Bafoussam), Central (Yaoundé), Adamawa (N'Gaoundéré), North (Garoua), Extreme North (Maroua), East (Bertoua), South (Ebolowa).

After a period of rapid expansion a phase of economic recession, cultural conflicts and increase of the crime took over, particularly in the great cities and also in the most remote areas like the extreme northern regions. Agricultural activities are the main occupation of about 80 percent of the population of Cameroon ; the principal commercial crops in Cameroon are cacao, coffee, tobacco, cotton, and bananas.

SOCIAL - ECONOMIC AND SANITARY CONDITIONS (Tab. 1)

Esteemed in 560 USD, the Cameroon boasts a per-capita annual income among the higher of western Africa , despite, according to the estimates, the 33% of the population keeps on living with less than 1 USD a day. Cameroon has achieved one of the highest rates of school attendance in Africa , although the literacy rate is still just 54 percent. Mission schools play an important role in education and are partly subsidized by the government.

The analysis of numerous demographic and social-sanitary indicators set Cameroon abreast of the averages of the Countries of Sub-Saharan Africa. One of the most known indicators used for appraising the human development of a Country (1), the under 5 years mortality rate (MIS5), sets Cameroon to the 23rd place in the Countries classification in base to infant mortality rate ( Italy : 164°). Such data, further than pointing out the results of the process of development, is the result of a wide range of factors (nutritional state and sanitary knowledge of the mothers, level of vaccination, availability of food, of hygienic services and drinkable water) and it is less sensitive, for instance in comparison to the PIL per capita, to the discards from the average.

Cameroon appears to be a highly complex country, in which the sanitary system and the state of health vary considerably from region to region and, above all, from the urban areas to the rural areas (2). Since 1992, the Minister of Public Health has promoted a national health policy of decentralization designed to maximize available resources at district levels. Every administrative province is divided into Sanitary Districts and each of these Sanitary Districts is divided into different Areas. The total sanitary expense of the country is run partly by the government. However there are other non-governmental sectors which support financially the expenses of the country's sanitary system. In fact, besides the governmental sanitary provisions, the No-profit private sector develops a meaningful role in the Cameroon 's health system, offering a wide network of services throughout the Country that would require, nevertheless, a greater coordination in the offer of services. The private sector For-profit is quite diffused in the urban areas, placing side by side the omnipresent traditional medicine. In 1998, the WHO and the Demographic and Health Survey in Cameroon identified as principal sanitary problems of the Country: HIV/AIDS, Malaria, Tuberculosis, Schistosomiasis, Trypanosomiasis, Leishmaniosis, Cholera, Amebiasis, Typhoid fever, Leprosy, Onchocerchiasis, Lymphatic Filariosis, Paragonomiasis, Meningitis (2). Numerous are the government programs and the no government ones, aimed at the prevention and treatment of such pathologies. There is, nevertheless, always a great disparity in the access to such programs between the rural and urban population.

Kumba.

Kumba (about 350.000 inhabitants), situated in the South-western province, it is one of the greatest cities in the English-speaking zone (Fig 2). It constitutes an important road knot and it is the center of one of the most important markets of Cameroon . The city entirely rises in a clearing that opens inside the tropical forest, characteristic of this zone of the Country. The city is characterized by a vivacious aspect and the infrastructures, although not always very well preserved, are discreetly present. Numerous are the sanitary, public and private, religious and secular structures, that assure a good sanitary coverage of the urban territory. Nevertheless, the inhabitants of the numerous villages located to the outskirts of the city, often not attainable because of the bad conditions of the roads (especially during the rainiest periods), have scarce access to the sanitary provisions and the Primary Health Care Centers disposed on the territory are not able to face the necessities of the population. Besides, in the rural zones the access to safe sources of water or to suitable hygienic services is insufficient: this converges in a high incidence of infections and infestations through the oral-faecal routes of transmission and to a high incidence of malaria (3). As specified by WHO and UN (4), access to safe drinkable water and basic sanitation is one of the fundamental target of primary health care. In some regions, it's been demonstrated that interventions aimed to improve access to safe water can be one of the best strategies for the acceleration of social and economic development at national, regional and local levels.

•  The SISM

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