White teeth and healthy skeletons for all: The path to universal fluoride-free drinking water in Tanzania

Fluorosis has been prevalent in the great East African Rift Valley (EARV) since before this region was given a name. In the Tanganyika days, Germans reported elevated fluoride concentrations in natural waters. In the 1930s, the clear relationship between high fluoride level and mottling of teeth was established. Since then, the global research community has engaged in the battle to provide fluoride-free drinking water, and the battle is not yet won for low-income communities. An applicable concept for fluoride-free drinking water in the EARV was recently presented, using the Kilimanjaro as a rainwater harvesting park. The Kilimanjaro concept implies that rainwater is harvested, stored on the Kilimanjaro mountains, gravity-transported to the point of use, eventually blended with natural water and treated for distribution. This article provides a roadmap for the implementation of the Kilimanjaro concept in Tanzania. Specifically, the current paper addresses the following: (i) presents updated nationwide information on fluoride contaminated areas, (ii) discusses the quality and quantity of rainwater, and current rainwater harvesting practices in Tanzania, (iii) highlights how low-cost water filters based on Fe ⁰ /biochar can be integrating into rainwater harvesting (RWH) systems to provide clean drinking water, and (iv) discusses the need for strict regulation of RWH practices to optimize water collection and storage, while simplifying the water treatment chain, and recommends strict analytical monitoring of water quality and public education to sustain public health in the EARV. In summary, it is demonstrated that, by combining rainwater harvesting and low-cots water treatment methods, the Kilimanjaro concept has the potential to provide clean drinking water, and overcome fluorosis on a long-term basis. However, a detailed design process is requiredto determine: (i) institutional roles, and community contributions and participation, (ii) optimal location and sizing of conveyance and storage facilities to avoid excessive pumping costs, and (iii) project funding mechanisms, including prospects for government subsidy. By drawing attention to the Kilimanjaro concept, the article calls for African engineers and scientists to take the lead in translating this concept into reality for the benefit of public health, while simultaneously increasing their self-confidence to address other developmental challenges pervasive in Africa.