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1 The International Network to Promote Household Water Treatment and Safe Storage The Network N e t w o r k B u l l e t i n IN THIS ISSUE: Introduction Page 1 Secretariat News Page 2 New appointment Update Evaluation Communication / Advocacy Page 2-6 Ghana Indonesia Tanzania Atlanta Key HWTS Events Page 7 Network Items Due Page 7 Key HWTS Knowledge Gaps Page 7-8 Implementation Highlights Page 9-11 Eawag PSI CAWST Procter & Gamble UNICEF SWI I N T R O D U C T I O N This 3 rd edition of the Network Bulletin marks the beginning of the Network's second phase ( ) as well as the end of its first phase ( ). The focus of this second phase is to promote the "scaling up" of HWTS adoption worldwide. Key priorities for phase two are outlined on pages 7 and 8 Also included are summaries of major events and achievements since the 4 th Meeting of the Network in Accra, Ghana (June 2008). The last 5 years have seen increased recognition of the potential contribution of HWTS to provide a significant reduction in diarrhoeal and waterborne disease. With support of the Network, a number of countries have begun to incorporate HWTS into national WASH strategies as a complementary means to improving health and access to safe drinking water. Yet the global situation remains dire: approximately 1 billion people in urban and rural areas still lack access to an improved drinking water source. This contributes to the 2.2 million deaths around the world due to diarrhoeal disease. An active Network is needed more than ever. There has been an increasing interest in the Network, and in HWTS worldwide. This has been demonstrated by the numbers of new members asking to join the Network, as well as governments and organizations wanting to engage with HWTS and the Network. HWTS continues to be strongly promoted by the World Health Organization and UNICEF, both of whom are taking a leading role in supporting governments with their WASH activities. An example of this can be seen in the Network-led HWTS and cholera-prevention conference in Tanzania (see page 4), co-organized by WHO and UNICEF. The increased recognition of HWTS has also been accompanied by questions raised by some about whether the evidence base is strong enough to advocate scaling-up interventions. The Network serves as a good mechanism to respond to these concerns, and some participants have done so. A crucial step for scaling-up is close cooperation among all stakeholder groups, particularly the Network and governments. This will enable the Network to provide information and support to inform national policies wherever they are most needed. Such activities can already be seen in some of the recent conferences that have taken place this year (e.g Tanzania), as well as projected conferences in the near future. 1

2 S E C R E T A R I A T N E W S New Appointment: Ameer Shaheed has recently joined WHO and has been taking on the responsibilities of managing the Secretariat since January. His background is in Biochemistry and Environmental Engineering, (University of Warwick and Imperial College London respectively). He has worked in Nepal on natural water disinfection, and with Aga Khan University in Karachi, Pakistan in Community Health Sciences. There are now 331 users subscribed to the Network listserve, 59 new participants over the last year (the highest annual count since 2006). The number of organizations listed as Network participants on the WHO website has now reached 125. Update: The Secretariat will target sending out at least 2 Network bulletins per year, reporting major news pertaining to events, working group activities, and HWTS highlights. Furthermore, listserve messages will be sent out on a monthly basis with the latest links to research and general HWTS news being sent in to the Secretariat. Evaluation: In preparation for the Network's second phase, an external evaluation is taking place over the next few months. It is being conducted by Dr. Zoe Wilson (Pollution Research Group, University of KwaZulu-Natal, South Africa). The goals of this evaluation are to reflect on the impact of Network activities over Phase I, and recommend strategic directions to guide Network operations for Phase II. The evaluation aims to assess the The WHO HWTS website ( is also currently under revision and undergoing updates. In this regard, please feel free to make any suggestions to hhwater@who.int. value of its current priorities; identify opportunities and constraints which could impact the effectiveness of its activities; and make strategic recommendations for the next 5 year period. Dr. Wilson has been contacting a number of Network participants for interviews over the following weeks. Any queries to Dr.Wilson can be directed to jzoewilson@gmail.com C O M M U N I C A T I O N S / A D V O C A C Y 4 th Meeting of the International Network to Promote HWTS; Accra, Ghana (June 2008) The conference was divided into three key activities: a technical symposium; a Network meeting; and a consultation with the Government of Ghana. The overriding theme was on methods of scaling up HWTS interventions at the national level. 2

3 More detailed information on the proceedings of the various conferences discussed will be added to the Network website in due course, under "Communic ations and Advocacy". nt/househol d_water/ad vocacy/en During the Network consultation, the working groups summed up their key accomplishments over the first 5 years of the Network ( ), and gave recommendations for the future, summarized as follows: Advocacy/communications: this included greater involvement of donors; emergency advocacy; further national-level meetings; and a revitalization of the working groups and their heads. Further areas for research included: cost-benefit analyses; educational, behavioural, cultural and social drivers; and forming linkages to broader WASH groups. Implementation: formation of 3 sub-groups (Scale-up; Behaviour Change; Monitoring/evaluation and Guidelines). National Household Water Treatment and Safe Storage Conference- Jakarta, Indonesia (August ) During the government consultation, the Network committed itself to: supporting the Government of Ghana with their technical expertise, guidelines, key partners, materials, and tools. The Government suggested the need for a policy analysis on water and environmental sanitation. To this end, the National Environmental Health and Sanitation Policy Council (NESPOC) was chosen to discuss future HWTS initiatives. Two immediate goals were identified: 1) Terms of Reference for assessing HWTS in Ghana and 2) the design of a country road map for HWTS. WHO and UNICEF country offices expressed their support to NESPOC and the Ghanaian Government in this endeavour. (Information provided by Bonifacio Magtibay, freelance consultant for Water Supply and Sanitation, Philippines.) Household Water Treatment and Safe Storage (HWTS) has firmly been established as one of the Indonesian Ministry of Health s pillars for their Total Sanitation program aimed at reducing diarrheal disease. Just two years ago, boiling water was the only accepted technology that was endorsed by the Ministry of Health to get safe drinking water. Today four categories of technologies are now accepted: chlorination, filtration, SODIS, and boiling. Indonesia is one of the first countries to establish a HWTS policy and to develop an overall integrated hygiene strategy that includes HWTS, stopping open 3

4 Introducing the link between choleraprevention and HWTS is a promising area for collaboration. This will be further developed this July in the Democratic Republic of Congo, in a choleraprevention workshop organized by the Ministry of Public Health, aiming to revise a National Action Plan. To this end a technical fair will be organized, and Network members with connections to the DRC invited to participate. The workshop is being coorganized by UNICEF and WHO. defecation, hand washing with soap, household waste water management, and household solid waste management. Dr. Siti Fadilah Supari, Sp.JP(K), Minister of Health successfully launched the PAM RT (HWTS) policy and the 10,000 Villages STBM (Community Based Total Sanitation) program at the Conference. Supported with the help of USAID s Aman Tirta Safe Water Program, the conference brought more than 450 people from local governments all over Indonesia, NGOs, Donors, Central government and the private sector. Presentation topics included the impact International Conference to Promote HWTS and Choleraprevention; Bagamoyo, Tanzania (4-6 February 2009) This conference was a follower to the Ghana symposium. Both the Ministry of Health and Social Welfare as well as the Ministry of Water and Participants identified key implementation barriers, knowledge gaps, and suggested possible solutions to address these issues. Key suggestions included: Developing partnerships: a synergistic approach is essential to achieving of HWTS on health and water quality; the Ministry s accelerated program on HWTS; and the use of Air RahMat in emergencies. The (Indonesian) National HWTS Network was also launched by Dr. I Noman Kandun, MPH, Director General PP & PL. This network will serve to bring the private sector, academics, NGOs, public sector together in support of HWTS, and will be used to disseminate information, provide assistance, and promote the benefits of HWTS nationally. Information provided by Robert Ainslie (John's Hopkins University) Irrigation (MoWI) were represented, with the attendance of Permanent Secretaries from both Zanzibar and mainland Tanzania. The international component of the meeting included private companies; international organizations; academic institutions; NGOs; non-profit organizations (PSI); and small-scale implementers. The focus was on capacity-building at the national level, with the provision of support and guidance from international stakeholders and experts. It formed an excellent framework for future national-level conferences with Ministry participation. reduced waterborne disease prevalence and higher access to safe water Clear, coordinated, and specific roles should be laid out for the GoT and NGOs for greater efficiency (with the MoHSW as a leader) 4

5 "The importance of achieving uptake and sustained use of HWTS must not be underestim ated because a day without safe water is a day of risk of waterborn disease" Mark Sobsey Monitoring, mapping, and information-sharing needs to be significantly scaled-up Clear guidelines for HWTS technology and performance should be finalized by WHO to support the GoT and other governments to develop policies and approve technologies HWTS products should be deemed as "health products" and have taxes removed and/or be subsidized by donors/governments Sustainable local supplychains should be created Greater focus is needed at the community-level, using existing social structures Increased participation of donor agencies should be sought Ministry of Education should be involved in future HWTS endeavours Disinfection - HWT track; Atlanta, USA (28 Feb-3 March 09) This conference aimed to bring the various fields within the household water treatment community together. The HWT track of the conference began with a day - long ceramic filter workshop, followed by a series of presentations to not only share experiences, current research, and future ideas, but to also plan future POU conferences and meetings. A wide range of experts were present. Thirteen countries were represented, including: Cambodia, India, Myanmar, Thailand, Ghana, Kenya, Guatemala, Nicaragua, UK, USA, Switzerland, and the Netherlands. The presentations were divided into the following topics: A national plan for HWTS in emergency response situations should be developed Greater use of available communication tools should be promoted (e.g cell phones and radio) to facilitate promoting awareness, implementation, and emergency-response. Three major outcomes of the meeting were 1) strong commitment from the Government of Tanzania; 2) development of a Tanzanian National Action Plan to Promote HWTS and cholera-prevention; 3) formation of a good framework for future Networklinked country-level capacity building HWTS conferences. Information provided by Ameer Shaheed (World Health Organization) Critical evaluation of HWTS programs in different regions. Major challenges addressed included: cost, sustainability, creating supply and demand, building capacity of the private sector, and willingness to pay. Emerging and new options. These included: the use of bone char to remove arsenic and fluoride, the Opuntia plant as a coagulant; antibacterial and antiviral metal ions; and UV-LED light to remove a range of pathogens. Determinants of adoption. Areas of discussion included: disparities in use and awareness in national scale programs; challenges to scaling-up; and reasons for adopting cetain products in rural areas. Challenges discussed included rural coverage; cost; and the lack of a developed commercial sector in certain areas. 5

6 Designs for implementation A key point was the importance of assessing the knowledge, behaviours, and attitudes of a population alongside the local water quality and diarrheal incidence before program implementation. Another essential component of designing programs that was discussed was of determining the availability and quality of local products and the capacity of local producers. Examples of programs from implementers POU options discussed included BioSand filters, alternative chlorine solid, chlorine, SODIS, and ceramic filters. Important points for successful implementation were: including HWTS within the broader context of hygiene and sanitation interventions; providing populations with multiple POU choices; making full use of community health workers; and giving tailored messages to target populations. 5 th World Water Forum; Istanbul, Turkey (16-22 March 09): The main theme of the Forum was bridging divides for water. This was explored through more than 100 thematic sessions, seven regional sessions, and a series of political processes involving local authorities, parliamentarians, ministers and heads of state. More than 25,000 participants attended, representing governments, UN agencies, intergovernmental organizations, non-governmental organizations, academia, business and industry, indigenous groups, youth and the media. Its main outputs included a Ministerial Declaration and the Istanbul Water Consensus, agreed to by local authorities. The WHO Network and its members contributed to several events, including a CAWST organized session at the learning center on How to Promote Household Water Treatment (HWT) Programs on March 17. Approximately 30 people attended this participatory workshop which featured 9 presentations explaining the rationale for HWT; introducing HWT technologies and processes; talking about how to generate demand from consumers and governments, how to develop a supply chain, and, how to support implementing organizations. The discussions resulted in several organizations identifying specific future actions and directions. More information on this can be found at

7 K E Y H W T S E V E N T S I N N E T W O R K I T E M S D U E International Conference to Promote HWTS and cholera-prevention (Bagamoyo, 4-6 Feb 2009) Disinfection 2009 (Atlanta, Feb 28- March ) World Water Forum (Istanbul, March 2009) World Water Day (Dublin, 21 March 2009) 34 th WEDC Conferece: Water, Sanitation and Hygiene, Sustainable Development and Multisectoral Approaches. (Addis Ababa, May 2009) World Water Week (Stockholm, August 2009) HWTS Technical Symposium (Dublin, September 2009) IWA 2009 ( Mexico City, 6-9 September 2009) Water Technologies for Emerging Regions (WaTER) conference (Oklahoma, October 2009) APHA Annual Meeting (Philadelphia, 7-11 November 2009) International Conference to Promote HWTS and cholera-prevention (Bagamoyo, 4-6 Feb 2009) Disinfection 2009 (Atlanta, Feb 28- March ) World Water Forum (Istanbul, March 2009) World Water Day (Dublin, 21 March 2009) 34 th WEDC Conferece: Water, Sanitation and Hygiene, Sustainable Development and Multisectoral Approaches. (Addis Ababa, May 2009) World Water Week (Stockholm, August 2009) HWTS Technical Symposium (Dublin, September 2009) IWA 2009 ( Mexico City, 6-9 September 2009) Water Technologies for Emerging Regions (WaTER) conference (Oklahoma, October 2009) APHA Annual Meeting (Philadelphia, 7-11 November 2009) KEY HWTS KNOWLEDGE GAPS: AN AGENDA FOR ACTION 2009 A brief summary of major directions to be taken in 2009 for the Network and HWTS. By Network Working Group chairs Dr.Marc Sobsey (University of North Carolina) and Dr.Susan Murcott (M.I.T) The WHO Network and its membership needs to continue expanding in size, scope and coverage. Greater involvement of experts in social sciences and human behaviour and in marketing and commercial enterprise is much needed for HWTS to become mainstream and effectively scale up. There continues to be a growing need of research, demonstration and practice activities for: (1) Development and evaluation of new, improved (and existing but poorly studied) HWT technologies, including mechanistic and design research intended to improve our understanding of how these technologies work and to identify ways to improve their performance. (2) Establishing and putting into practice appropriate criteria and guidance for evaluating the performance of HWT technologies to produce safe water and encouraging the development and implementation of international, regional and national policies and 7

8 regulations that make it possible to identify effective HWT products. (3) Efforts to address the continued problem of microbial recontamination and re-growth in household stored water, including: improved water storage containers or systems, containers having antimicrobial properties (such as copper), and passive systems that make posttreatment disinfection automatic or practical and easy for consumers. (4) Identifying, testing and assessing the effectiveness of marketing methods that improve supply, increase demand, and achieve scaled-up and sustained coverage with HWTS products and services. Such research and practice is being directed at understanding consumer behavior, perceptions and preference, willingness-topay and market segments, with the goal of identifying those HWTS products and services to which consumers aspire and which they will continue to use on a daily basis. (5) Understanding the extent to which effective and continuous "inferred correct" and sustained use is achieved by different HWTS products and systems. These can be either durable goods, such as household filters and multitreatment devices (filterdisinfectant devices) or fast moving consumable goods (such as chlorine liquid and tablets, coagulant-flocculantdisinfectant sachets and tablets and other water treatment additives). HWTS technologies and their implementation and marketing systems must strive to achieve continuous consumer protection based on the kind of technology, its availability and convenience, the effectiveness of its marketing and its desirability to be used by consumers, and its encouragement at all levels by all stakeholders. (6) Developing and making available simple, accessible and affordable ways to test water for microbial quality on a routine basis. Most of the water people consume globally is of unknown microbial quality and therefore of unknown safety or waterborne disease risk. Several efforts are underway to develop microbial water tests. However, there is a need for broader and more inclusive creative thinking and research on what such tests should measure, how they should measure the target contaminant(s), what the technological basis and format of the test should be, to whom the test results should be communicated and what actions should be taken in response to test results that indicate unsafe water. (7) Linking HWTS technologies, programs and policies to related water, sanitation and hygiene activities and initiatives, including improving access to adequate and safe water sources, such as rainwater harvesting, improving access to and promotion of handwashing at critical times through better and more accessible handwashing stations that consumers will be inclined to use, and initiatives for increasing access to improved sanitation. (8) Making HWTS an integral component of all child and adult education programs and systems. If HWTS is to become mainstream, it needs to be incorporated into all education and consumer outreach systems and services as well as become institutionalized into international regional and national policies related to health, hygiene, water resources and water supply, environmental protection and agriculture. (9) Expand Web-based tools that assist HWTS implementers access the resources and expertise of HWTS members and other players. Expand the dataset on the global status of HWTS and publish on a Google Earth platform. 8

9 I M P L E M E N T A T I O N H I G H L I G H T S EAWAG - SODIS Since 2006 the promotion of SODIS in Developing Countries has experienced a gradual shift from an exclusive collaboration with NGOs, experienced in health education as partners for SODIS implementation, towards an increased collaboration with government institutions. Activities worldwide: 1.5 Mio people presently use SODIS in Asia. Promotional projects are ongoing in Indonesia, India, Pakistan, Nepal, Vietnam and the Philippines. In Pakistan for example, 1000 Lady Health Workers are being trained in SODIS, HWTS and improved hygiene practices, in an effort that is expected to reach more than 800'000 people. teacher-training; radio spots and radio novels for children; and visual promotion. The broader promotion of SODIS in 14 countries in Africa has only been taken up since At present, about 1.1 Mio USD are committed for 26 projects in the above countries with the goal to train 1.5 Mio people until mid of In Sierra Leone the promotion of SODIS has been offered as a solution for water treatment after conducting general awareness exercises in the community using CLTS, resulting in an uptake of SODIS practice by about 70% of the households trained. In Latin America, household water treatment, including SODIS and hygiene promotion are being promoted in 7 countries in Central America and the Andean region. Recent implementations include: house-to-house promotion; Population Services International: As of February 2009, PSI profess to have empowered enough people in the world to treat 50 billion litres of water. A notable success story of the year involved point-ofuse water disinfection bottles used in Vietnam. The program was targeted towards people living with HIV/AIDS (PLWHAs), orphans and vulnerable children (OVCs) and their families. From August to December 2008, PSI distributed 12,500 bottles to over 8,650 PHLWAs, OVCs, and family members, far exceeding their targets. Furthermore, PSI partnered with Society for Family Health (SFH) in the distribution of 2.9 million bottles of a chlorine-based solution in Zambia in 2008, making it the largest point-of-use water treatment programme in the world. 9

10 CAWST: In 2008 CAWST carried out a comprehensive household water treatment survey of their various HWTS implementation programs. According to their survey, 1.6 million people were impacted by HWT programs with CAWST involvement (1 million of which were provided with BSFs) by June Biosand filters (BSF) accounted for 60% of all their HWT technologies chosen by CAWST clients, followed by water pasteurizers, ceramic filters, chlorination and SODIS(at around 10%). Coagulation and settling methods followed with around 3%, and the rest were comprised of arsenic filters, boiling and other methods. In terms of use, coagulation & settling; boiling; biosand filters ; and arsenic filters all had over 90% retention by users. Procter and Gamble: President Uribe of Colombia helped provide 2.5 million packets of a coagulantdisinfectant powder following the floods in February 2009 that affected 60,000 people. Procter and Gamble volunteers helped the local relief agencies implement the usage of the packets, which were flown in for free with the Presidents support. In collaboration with World Vision, Procter & Gamble have donated $200,000 USD for cholera-prevention activities in Zimbabwe using coagulant-disinfectant packets; an estimated 2.5 million packets will be distributed, which would be able to benefit approximately 10,000 households. UNICEF: UNICEF were recently awarded a substantial inaugural grant: the "American Express Members Project Grant". The money was for projects in Guinea, Angola, Democratic Republic of Congo, and Tanzania. According to the American Express report, no cholera cases were reported in 2008 after the initiation of a 10

11 UNICEF and PSI collaboration in areas which had reported a staggering 5875 cases and 190 deaths in the previous year. One of the most successful models for country-level efforts is based on the Tanzania project. This involved the integration of hygienic practices and HWTS with broader community-based maternal care, immunization, malaria prevention, and household child-care practices. Key members of this initiative were PSI, UNICEF, Ministry of Water and Irrigation, Ministry of Health and Social Welfare, and sub-national and community-level leaders. Safe Water International: to best scale-up their work, a combined approach called the Village Strategy has been developed by SWI; the full approach will be put into action in late May in Malawi, and then followed up in central Mexico. This strategy, relying on village participation, offers a low-cost system of water management. It begins with the improvement of the existing water source, and follows through with rainwater collection and household level filtration. "The WHO Guidelines for Drinking-water Quality emphasize the need for continuous access to safe water because lapses in such access cause welldocumented waterborne disease outbreaks and cases of illness" Mark Sobsey, University North Carolina 11 M E M B E R S H I P I N F O R M A T I O N Membership in the Network is open to all interested stakeholders that agree with the Network mission and guiding principles and who are willing to commit themselves to working towards achieving the objectives of the Network. Contact: Ameer Shaheed Secretariat of the International Network to Promote Household Water Treatment and Safe Storage World Health Organization hhwater@who.int