Complex Problems May Have Simple Solutions


By Ranjit Mulleriyawa

Chronic Kidney Disease of Uncertain Origin (CKDu) has now become the most serious health problem afflicting farming communities in many ‘dry zone’ areas in Sri Lanka. It has already been diagnosed in six out of the nine provinces in the country.

Despite over a decade of research, involving scientists (both local and foreign), the exact cause of CKDu is still not known. However, available evidence seems to indicate that the disease is probably multifactorial, involving one or more environmental factors (contaminated drinking water, nephrotoxic substances in the food chain) and strongly linked to the life style of dry zone farmers. Long hours of work in the hot climate of the dry zone, and failing to drink enough water, may result in serious dehydration leading to kidney damage, which is further aggravated by nephrotoxins present in inorganic fertilizers and some pesticides. Indiscriminate use and careless application of pesticides - a common feature among paddy (rice) farmers in the dry zone; regular consumption of illicit liquor (Kassippu); cigarette smoking (including beedi); frequent intake of highly potent painkillers for body aches and pains – are believed to be some life style – related factors possibly contributing to the development of CKDu.

Although the exact cause of the disease is still unknown, there seems to be widespread consensus among scientists that improving quality of drinking water, preventing excessive use of fertilizers and pesticides, as well as careless handling, and health education of people living in CKDu endemic areas may help substantially in preventing, or delaying the onset of the disease. How best to do this appears to be now the question.

Multi – pronged action needed

1. Considering the complexity, magnitude and gravity of the CKDu problem, investigations and action programs must not only be multidisciplinary, but also multisectoral involving Government Departments/Agencies, Non Governmental Organizations (NGO), Private sector and Civil Society groups. The role that NGOs could play should not be underestimated (since they have proven experience in working with underprivileged rural communities in areas such as health education, water supply and sanitation projects, rural extension, etc). As such, active participation of NGOs and CBOs must be an integral part of future programmes, designed to address the CKDu problem.


Proposed interventions must consider the specific context of CKDu affected communities – widely scattered rural households in the dry zone; essentially poor farmers having limited access to public services (health education, water supply and sanitation, agricultural extension ); dilapidated roads, relatively low educational level, etc. Interventions that are easy to understand and easy to implement, also have the best chances of being widely adopted.

Improving Water Quality

Several organizations (Water Supply and Drainage Board, bilateral assistance programs, and Nongovernmental organizations) have already attempted to provide improved water quality to residents in some areas, through use of water filters (Electro-chemical coagulation units, Reverse Osmosis systems) and rainwater harvesting and storage structures. Despite these laudable efforts, community response, with respect to utilization of these facilities is believed to be poor. It is thus apparent that the reasons for lack of community interest in these interventions be ascertained before prescribing the same facilities, for adoption in other areas of the country. The urgency of undertaking such study becomes more apparent in the light of the President’s recent Budget speech allocating a substantial sum of money (900 million SLR ?) for provision of water purification facilities to dry zone villagers.

Evaluate existing water purification facilities

An investigation of this nature will provide a sound, rational basis for installing appropriate water purification facilities.

This evaluation needs to focus on the following issues:

(i) Determine the technical effectiveness of installed water purification facilities at village level.

(ii) Determine ability of installed facilities to meet community and household water requirements.

(iii) Determine community and householders’ response/attitudes to drinking rainwater and filtered water.

(iv) Identify weaknesses/bottlenecks in operating the facilities at community level.

Recommend the most viable, cost effective, and sustainable water purification method acceptable to a wide spectrum of communities in CKDu endemic areas.

Fertilizers and Pesticides

Indiscriminate/excessive use and careless handling of inorganic fertilizers and pesticides by farmers has contributed to many environmental pollution problems (contamination of ground water, eutrophication (nutrient enrichment) of reservoirs leading to algal blooms) in recent years. This unhealthy situation is due to several factors: (i). Ineffectiveness and impotency of the Agriculture Department’s extension services (II) Aggressive advertising of pesticides by chemical companies and their local agents. (III) Inadequate safeguards and regulatory measures pertaining to the import of highly toxic chemicals into the country and (IV). Huge fertilizer subsidy (amounting to over 90% at one stage) enabling farmers to resort to excessive application of cheap fertilizers.

Effective action has already been initiated by the Department of Agriculture to curb advertisements pertaining to pesticides as well as banning the import of some pesticides (Carbaryl, Chloropyrifos, Propanil and Carbofuran), in addition to strengthening regulatory mechanisms applicable to pesticide imports. Fertilizer prices have been increased by the government recently in an effort to curb excessive fertilizer application. However, there is no likelihood of any significant improvement in public sector extension services in the foreseeable future. This void needs to be filled by NGOs and CBOs.

Break Down in Agricultural Extension Services

Cosmetic and ill conceived changes to this country’s agricultural extension services over the past two decades have resulted in this vital service being rendered completely impotent. Devolving extension functions to Provincial Councils, in 1987, has further compounded the issue.

Severe Indictment

A recent (2009) investigation into the extension services rendered to B-Onion farmers in Matale District, by a researcher (Chathura Jayampathi De Silva) attached to the Agrarian Research and Training Institute (ARTI), found that 90% of farmers were dissatisfied with the extension services. A staggering 80% of these farmers had never received extension support.

Considering the above revelations, expecting any meaningful improvement in public sector extension in the foreseeable future would appear to be mere wishful thinking.

Resolving Extension Problems

Any realistic effort to solve weaknesses in the extension services would require a Government – NGO partnership, and training and deploying farmers as community based farmer extensionists. This does NOT mean the creation of another cadre of public servant, but enlisting the services of farmers on a voluntary basis, for a specific purpose/s (awareness raising and educating fellow farmers on rational application of pesticides and fertilizer). These farmer extensionists (‘Praja Sevaka’) may be provided a modest incentive allowance for their services). Such innovative steps ("out of the box thinking") are urgently required, at least in CKDu endemic areas, in preventing excessive use and indiscriminate application of pesticides by farmers.

Health education

An effective community health education programme designed to inform rural households on the importance of drinking adequate quantities of water (at least 3- 4 liters/adult/day); refraining from smoking, intake of illicit brews (Kassippu), avoiding self medication by rushing to the nearest pharmacy or village Kade to purchase strong analgesics (pain killers) for relief of common body aches and pains, and overall improved nutrition is a vital need for residents in CKDU endemic areas. Educating school children on the above issues may help in getting the message across to their parents.

Volunteer community based health workers may be enlisted to assist Government health personnel in health education activities.

Priority Action

Well organized and effective community mobilization programmes need to be carried out in CKDU endemic villages before disbursing any benefits (like water purification facilities) to the community. Trained community mobilizers deployed by suitable NGOs/CBOs will use participatory rural appraisal tools such as social mapping, seasonal charts, transect walks, key informant interviews and focus group discussions in accomplishing this task.

Main purpose of this exercise is twofold: (i) Encourage villagers to reflect on, discuss and analyze their situation and activities, life style, food habits, drinking water sources (water quality) ,health related problems – incidence of disease (CKDu) and others, health education, health care and medication; farming systems (with special emphasis on fertilizer and pesticide use), availability of extension services, content of extension messages etc. and (ii) Enable ‘outsiders’ ( Researchers, Administrative officers and NGO personnel) to obtain a thorough understanding of the specific village situation.

*The author is a member of the CKDu Research Group, Kandy. He holds a Masters’ degree in Agriculture from the University of the Philippines, and has over 30 years experience in tropical agriculture and rural development in South and South-East Asia (Sri Lanka, Maldives, Philippines and Laos.)He has also been a farmer himself operating a 2 ha farm in the dry zone for ten years. He is currently based in Kandy, Sri Lanka, and functions as a free lance consultant in sustainable agriculture and rural development.

He may be contacted at the following e-mail address:

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