Oliver Schmoll Federal Environment Agency Bad Elster, Germany

1. Water Safety in Small Scale Water Supplies in the European Region: Common Challenges and Needs Oliver Schmoll Federal Environment Agency Bad Elster, Germany EU TWINNING PROJECT PL-06-IB-EN-01 Warsaw, 18 June 2009

2. Water supply … are you talking 19th century?

3. “Sanitary revolution” won the “Oscar”

4. Big utility’s perspectives 1/2

5. Big utility’s perspectives 2/2

6. Why to focus on small scale water supplies? • They are plenty! • In the European Union, 1 in 10 citizens (= 50 of 500 Mio) receive drinking water from small scale water supplies • In Germany: • One third of the population receives water from more than 3,600 public supplies serving less than 5,000 people • One million people use water from ca. 200,000 private or hamlet wells

7. Why to focus on small scale water supplies? • Backbone of drinking-water supply in the rural areas in all parts of the European Region: • Permanent residents mainly in rural, often not densely populated areas • Transient users (tourists, holiday makers etc.)‏ • Need for decentralised solutions: • Economic reasons • Hygienic reasons

8. Why to focus on small scale water supplies? • EU Drinking Water Directive revision process: • More focus on small supplies (see data collection by EC)‏ • Water Safety Plan approach • International momentum: • Protocol on Water and Health • WHO Guidelines for Drinking-water Quality:

9. “Small scale water supplies” • Babylonian language jumble … • … small supplies, very small supplies, small scale supplies, small community supplies, small public supplies, private supplies … • Size of the supply or number of people connected: • Widely varying classification schemes • Often derived from regulatory definitions • Organisational set-up: • Community managed • Publicly or municipality managed • Regional water board associations • Privately owned and operated

10. Different shapes … Kyrgyzstan Tajikistan Denmark Lithuania Germany

11. Different shapes … Germany Germany

12. … similar characteristics and challenges 1/4 • Differently regulated or non-regulated • Less “political” attention than large supplies • Lack of awareness and in sense of responsibility • Inaccurate perception of water-related health risks

13. … similar characteristics and challenges 2/4 • Administration and management differs from organised utilities • Limited technical, personnel and financial resources • Less effective or inadequate source protection in the local context • Relatively greater capital costs

14. … similar characteristics and challenges 3/4 • Typical staffing profiles: • Involvement of ordinary or untrained staff • Staff is working part-time or have other jobs to do • Labour may be voluntary or unpaid • Lack of “support networks”: • Widely dispersed over large areas • Limited access to information and technical support • Little degree of networking in scientific and professional communities • Difficult recruitment of trained operators

15. … similar characteristics and challenges 4/4 • Regulatory approach: “undivided” health protection • Need for intelligent surveillance strategies: • Plenty of supplies in widespread areas • Limited manpower to advise, inspect and control • One sample per year at best • Enforcement of compliance-based approaches debatable • Advice-based approaches • Risk-based approaches

16. Private supplies inGermany Germany Germany

17. What do we know? • Compliance with microbiological standards remains a challenge in many small scale supplies : • Little readily available “hard data” from routine monitoringand sanitary inspection • Data are often informal or “hidden” • High degree of anecdotal evidence • Chemical contamination is of less priority but can be locally relevant (e.g. natural constituents)‏

18. Microbial contamination • Analysis of database from by 150 local authorities in England: • 34,904 microbial water quality results from • 11,233 private water supply sites • 1996 to 2003 • E. coli was detected in 6,588 (19 %) of samples • At least one positive sample being detected from 3,638 (32 %) water supply sites Hunter et al 2008

19. Source Groundwater 1.000 9.09E-12 Surface water 2.347 Spring 2.342 Treatment Treatment 1.000 3.77E-07 No treatment 1.781 Rain on day prior to sample/mm 0  1.000 0.0016 1-9 1.325 10-99 1.364 100-999 1.707 1000-9999 2.066 Probable failure rate Hunter et al 2008

20. What do we know? • Most detected outbreaks of water-borne disease are associated with “small scale water supplies” and single household supplies • Data on waterborne disease is difficult to collect systematically • Anecdotal evidence suggests comparatively higher disease burden • Ongoing literature review by ISS (Italy)‏

21. Country,year Cases Description Causative agents Water quality (cause)‏ Reference Slovenia, 1997-2007 5-181 cases/ outbreaks Between 1997 and 2007, 20 waterborne outbreaks notified . In 12 outbreaks , more causative agents Often contamination of drinking water from water supply systems Kopilović et al., 2008 Slovenia, 2008 408 cases In June and July 2008, outbreak of acute gastro-enteritis in the town of Piran (17,400 inhabitants)‏ Several causative agents were isolated water samples with faecal contamination on the basis of bacterial indicators Kopilović et al., 2008 Albania, 2000 2,722 children Tirana Hospital (also outside the town); main age group : 0-5 years Rotavirus in 26/28 faecal samples, but also astrovirus, adenovirus and calicivirus Environmental contamination Divizia et al., 2004 Gastroenteritis outbreaks in small communities Funari et al 2008

22. Country,year Cases Description Causative agents Water quality (cause)‏ Reference England and Wales, 1992-2003 89 outbreaks of waterborne infectious intestinal diseases, 4321 people From 2000 consistent decline of the number of outbreaks of WRDs Crypt. (69%) Camp. (14% )‏ E. coli 0157 (3%)‏ Giardia (2%)‏ Private water supplies: 28% outbreaks Smith et al., 2006 England and Wales, 1970-2000 25 outbreaks 16 outbreaks reported after the introduction of enhanced surveillance. Campylobacter was the main pathogen, implicated in 13 (52%) outbreaks Private water supplies Said et al., 2003 Austria, 2006 160 cases August Unknown aetiology, rural village Contaminated drinking water Heavy rains before the outbreak 2007 Gastroenteritis outbreaks in small communities Funari et al 2008

23. Country,year Cases Description Causative agents Water quality (cause)‏ Reference Italy, 2006 2,806 patients admitted or seen by hospitals (District of Taranto)‏ Acute diarrhoea Rotavirus and Norovirus in 48 % and 40% of cases No faecal indicators found in tap waters. Martinelli et al., 2007 Bulgaria, 2007 977 cases of acute gastroenteritis 34.6% children 3-36 months old Norovirus (also rotavirus) as probable cause of the outbreak No faecal indicators were found in drinking water Kamenov et al., 2007 France, 2000 202 cases and 62 probable cases population 709 in stool sample analysed: Rotavirus 71% E. coli 31% Norovirus 21% Groundwater probably contaminated by agricultural runoff Gallay et al., 2006 Gastroenteritis outbreaks in small communities Funari et al 2008

24. Is it worth to improve? • “Undivided” health protection? • Cost-benefit studies: • Costs of legislation and interventions • Proportion of illnesses likely to be prevented by interventions • Direct cost of illness (health care)‏ • Indirect cost of illness (loss of work, loss of schooling)‏

25. Region Cost-Benefit-Ratio Mean L95%CI U95%CI Eur-A 2.52 0.78 5.88 Eur-B 21.34 6.64 49.89 Eur-C 3.91 1.22 9.14 Cost-Benefit-Ratio for water interventionsaiming at reducing acute diarrhoeal illness Hunter et al 2008

26. Bad Elster conclusions 1/5 • Small scale systems are vital to water supply of significant parts of the population • Need for strengthening epidemiological evidence base on health impacts of small systems • There is a positive cost/benefit ratio for investment in improving small scale systems

27. Bad Elster conclusions 2/5 • Development and dissemination of advocacy material aiming at increasing the awareness of decision-makers on the importance of small systems: • Need for political will • Need for dedicated “piece of thinking” for developing effective management and surveillance strategies

28. Bad Elster conclusions 3/5 • There is a lack of consistent and coherent application of internationally recognised good practices and standards • WSP are seen as a viable approach for small scale supplies, including private wells • Experience from Switzerland, Scotland, Finland

29. Bad Elster conclusions 4/5 • Need for enabling environment: • Provision of external expertise • Promotion of partnerships and twinning arrangements between major water services and small scale water suppliers • Preparation and distribution of easy to understand guidance (useful WSP manuals available)‏ • Development of specialised training programs targeting owners and operators of small systems • Increasing competence for the application of WSP approaches

30. Bad Elster conclusions 5/5 • Challenges to the health system: • Lack of awareness of health risks by users of small scale systems • Underreporting of water related disease • Need to revise and strengthen outbreak detection and response mechanisms • The need for international networking was recognised, including within • Protocol on Water and Health as platform for information sharing within the European Region • WHO Network on Community Supply

31. International Small Community Water Supply Network • To promote the achievement of improvements to the safety of small water supplies • Networking idea: • Advocate for political support • Sharing of good practices, experiences and information • Fostering Research • Development of internationally-recognized guidance and tools for the management of small water supplies • Face-to-face meetings and information on “virtual forum” in the internet

32. Tools to assist • Access to over 500 training tools • Access to over 300 examples of risk communication tools • Access to over 50 examples of risk assessment tools • Online searchable database of terms (Lexicon)‏

35. International Small Community Water Supply Network • Open to anyone working on the topic of small water supplies: • Government and non-government organizations, universities • There are over 40 countries currently represented in the Network • For more information, please email to scwsm@who.int