Household and small community water safety

1. Household and small community water safety Kuching 2 November 2010 • Bruce GordonWater, Sanitation, Hygiene and Health

2. Guidelines for Drinking-water Quality (GDWQ) • Flagship normative publications of WHO. • Demand for the document is among the highest and most sustained of all WHO publications.

3. WHO Guidelines for Drinking Water Quality, Framework for Safe Drinking Water: • Considers overall public health context and contribution of drinking-water to disease burden • Eventually need to be expressed as Water Quality, Performance, or Technology Targets Health-based targets(National regulatory body) • Risk management plan • Implementation of step-wise improvements • Continuous monitoring • Documentation and supporting programmes Water Safety Plan(Water utility) Independent surveillance(Surveillance agency) • External audit of WSP • Verification monitoring

4. Water Safety Plan (simplified) What are the risks? Continuous cycle How do I control the risks? Monitoring Source: Netti et al. 2005

5. Implementing a WSP?

6. WSP steps Water Safety Plans Risk Assessment Control measures System mapping Improvements (e.g. investment planning) Monitoring + verification

7. WSPs: Sanitary survey reborn?

8. Paradigm shift (from reactive to preventive) • But common sense ("sanitary survey +")

9. Benefits of WSP approach • Reduce disease • Risk-based approach • Enhance good practice • Evidence-based investments • Save money in the long-term

10. Small Community Water Supplies – the need for a WSP approach Undertrained operators Varying and inconsistent perception of risks Unclear roles and responsibilities; Limited resources More frequently associated with waterborne disease in both developed & developing countries

11. The case for HWTS • Dramatically improves microbial water quality • Significantly reduces diarrhoea • Among the most effective of water, sanitation, and hygiene interventions • Can be rapidly deployed and taken up by vulnerable populations

12. WHO Guidelines for Drinking-water Quality • "HWTS has been shown to significantly improve water quality and reduce waterborne infectious disease risks"

13. Effectiveness ranges of HWTS technologies for the reduction of microbes in water Courtesy of Mark Sobsey, University of North Carolina

14. The Need for a Network • Looking Back: the situation in 2003 • lack of awareness of effectiveness, and cost effectiveness • lack of supportive policies • limited cooperation: fragmented advocacy, research and implementation efforts • limited tools available to support implementation • major gaps in implementation research • Response: Establishment of an International Network

15. Limitations of HWTS • Does not improve access to water (quantity) • Does not provide the health and economic benefits associated with a regular, piped-into home, water supply • Places the burden of water quality management on consumers • Demands a lot from householders, requiring: • Consistent and sustained behaviour change • Time investments to manage water • Financial investments

16. Current Evidence (simplified) Sustainable impact

17. Challenges • Has not achieved sustained pubic health impact • Government have not developed comprehensive policies or regulations addressing (non-boiling) HWTS options as part of their overall water safety efforts • Largely a small-scale intervention undertaken by NGOs in isolation from central government-formulated drinking-water supply programmes

18. Give up?

19. NO! • For many vulnerable populations, HWTS remains the only viable approach to rapidly improving water safety • Immense potential health and other benefits associated with ultimately succeeding in scaling-up HWTS • Challenges are significant, but are not dissimilar to those that had been faced previously by successful current interventions • (e.g. bednets to protect against malaria).

20. UNICEF and WHO: 7 point plan to control diarrhoea: