Effective use as an indicator for HWTS success in emergencies

Transcription

1 Effective use as an indicator for HWTS success in emergencies Daniele Lantagne, PE London School of Hygiene and Tropical Medicine

2 HWTS and Emergencies PoUWT has been shown in development context to: Improve microbiological quality of water Reduce diarrheal disease Increasingly, PoUWT is recommended for emergencies Natural disasters, outbreaks, complex emergencies However, it is not known if PoUWT is as effective Differences in risks, funding, implementation, timing Most effective in high-diarrhea disease risk Flooding, displacement, outbreaks

3 LSHTM Research Project Supported by UNICEF and Oxfam to answer: 1. What role, if any, should HWTS play in emergency response? 2. What are the factors associated with feasible, and potentially sustained, implementation of HWTS in response to emergencies? 3.

4 Deployment Criteria 1. Acute emergency Study complete within 8 weeks of onset 2. High diarrhea risk emergency Flood, outbreak, displacement 3. Multiple PoUWT options used 4. Water supply options used 5. Populations have various levels of exposure/training 6. Logistically feasible

5 Tool Kit (Research Plan) 1. Spatial analysis 2. Random household survey ~400 in each location 3. Water quality testing FCR, turbidity, MF micro 4. Qualitative interviews 5. Costs/logistics analysis

6 Reported targeted Reported received Use Evaluation Metrics Reported use Ever use / use regularly / currently use Confirmed use Can you give me a cup of your drinking water? Is this water current treated? Stored safely? Chlorination: Free chlorine residual Filters: Is the filter wet/assembled? Effective use Addresses whether the household needed the intervention

7 Effective use % of surveyed households who report current treated water today with the particular HWTS option multiplied by % of households who had 1* E. coli CFU/100 ml in untreated stored drinking water from the same source as treated water with <1* E. coli CFU/100 ml in stored drinking water *: Also can be calculated with 10 and <10 Can multiple this percentage by number recipients targeted to calculate number of households effectively reached, and using program cost can calculate cost / household effectively reached.

8 Responses Evaluated Jajarkot, Nepal Cholera, August 2009 Pariaman, Indonesia Earthquake, October 2009 Turkana, Kenya Flood/cholera, Jan-Feb 2010 Haiti Earthquake, Feb-Mar 2010

9 Summary Data Table Reported Use Confirmed Effective Nepal Aquatabs 8% 87% 7% Piyush 16% 51% 8% WaterGuard 6% 56% 3% Indonesia AirRahmat 3% Tabs 1% Boiling 88% 31% 27% Turkana Aquatabs 13% 42% 5% PuR 6% 39% 2% Haiti Aquatabs 24, 75-92% 62, 75% 15, 54-66% Ceramic 72% 27% 20% Biosand 53% 20% 8%

10 Treated-Untreated Water Pairs: DSI Aquatabs Treated Water E. coli

11 Treated-untreated Water Pairs: Ceramic

12 Treated-untreated Water Pairs - BioSand Suboptimal Use

13 Unsafe Water Effective Use Effective Option User demand / use

14 Costs Nepal: Indonesia: Kenya: Haiti: 16,886 USD (2 VDCs) 4,331 USD (all NFI kits) 37,750 USD (4 communities) Unknown

15 Costs Nepal: Indonesia: Kenya: Haiti: USD/HH with FCR None - boiling USD/HH with EU Not enough data

16 Conclusions The emergency has high waterborne disease risk. The recipient population is correctly targeted. The water quality in the targeted population is contaminated. The target population is aware of HWTS before the emergency. The target population has the appropriate safe storage container for the HWTS option (and all the materials). Pre-preparedness has been completed. An appropriate HWTS option is selected for the emergency. Adequate trainings are conducted in the appropriate language. Behavior change is considered. An appropriate chlorine dosage is used.

17 Recommendations to implementing organizations Prepare. Strategize. Select. Provide. Train. Be realistic. Evaluate.

18 Summary Data Table - Sustained Use Effective Reported Use 9 months Sustained Effective Turkana Aquatabs 5% PuR 2% Haiti Aquatabs 54-66% 80% 46%, 41% Ceramic 20% 55% 0%, 19% Biosand 8% 57% 28%, 18%

19 Acknowledgments The survey teams. Namaste. Ma kasi. Asante sana. Meci anpil. The funders and designers: UNICEF: Richard Luff, Andrew Parker Oxfam: Miriam Aschkenasy, Andy Bastable The local support: Nepal: UNICEF (Madhav Parahi, Anirudra Sharma) DEPROSC, NEWAH, PSI Indonesia: UNICEF (Claire Quillet), Oxfam, CARE, ACF Kenya: Haiti: KRC DSI, CWH, HRC, FilterPure, Klorfasil, GoW Filiarisis Guest House Rick Rheinghans, Eric Mintz, and advisor Thomas Clasen.

20 Thank you. The notion that being humanitarian and doing good are somehow inevitably the same is a hard one to shake off (Slim, 1997) daniele.lantagne@lshtm.ac.uk