1. 1 Integrating HWTS and Nutrition WHO/UNICEF International Network on HWTS Meeting Vientiane, Lao PDR November 2014 Mai Lethituyetmai P&G VietNam

2. P&G Purifier of Water for HWTS (formerly PUR) Reverse engineered current municipal water treatment process Small packet to treat 10 liters of water using coagulation, flocculation and disinfection Uses same ingredients as in municipal systems -Calcium Hypochlorite as Disinfectant -Ferric Sulfate as Coagulant

3. US EPA approved as microbiological water purifier Meets WHO criteria for ‘protective’ POU  7 log bacteria  4 log viruses  3 log chlorine-resistant parasites Reduces heavy metals  98% arsenic  Randomized controlled trials show average of 50% reduction in diarrhea Laboratory and Field Testing

4. Sustainable Provision of P&G Packets P&G provides packets at subsidized cost as part of not-for-profit Children’s Safe Drinking Water Program Provide for emergency relief and sustained distribution New plant in Singapore opened – capacity to provide more than 200 million packets per year

5. Program Footprint

6. Integration with HIV/AIDS Efforts P&G packets remove chlorine resistant parasites that can be fatal to PLWHA UNC-Malawi demonstrated 99% use of hygiene package in PMTCT, low rates of diarrhea in mothers and babies, and increased retention in program CHAI/CDC found HWTS incentive for testing and clinic attendance Many NGOs incorporating HWTS into HIV/AIDS programs and reporting high acceptance

7. Importance for Malnourished Children Public health authorities estimate up to 50% of malnutrition linked to diarrhea Diarrhea increases GI transit time and reduces absorption of nutrition from food Malnourished children are susceptible to opportunistic infections Shortening time to recover can be life-saving in severely malnourished children

8. Integration with Nutrition Programs CARE Ethiopia incorporated P&G packets into program for malnourished children and found less diarrhea and trend for reduced time on therapy HOPE NGO studied 3000 HHs in Sindh province (7019 children) o Treatment HHs received P&G packets, training, supplies o Nutrition screening/monitoring and diarrhea surveillance, water cooler checks for 4 months

9. HWTS Helps Malnourished Children HOPE reported reductions in diarrheal incidence in HH using P&G packets vs. control group – 45% less (6 mos to 1 year) – 51% less (children under 5) Time to recover for MAM children reduced by 20 days – With clean water = 3.5 months – Control group = 4.15 months. *Agboatwalla, M, Ahmed, R., Reza, A (2013) ENN - Nutrition Exchange Publication

10. WASH Integration RCT in DR Congo ACF/Action Against Hunger randomized study in 207 HHs in Bandundu province National IMAM 30-day protocol for treatment of severely malnourished children under 5 Comparing RUTF + P&G packets vs. RUTF alone Study results* showed trend in reduction of length of stay & higher weight gain per day *results submitted for publication

11. Integrating HWTS into HIV/AIDS, Nutrition & School WASH Programs Clinically Effective Absorption of ARTs and improved nutritional status Incentive to go to clinic Improved overall outcomes Increased school attendance and adoption of hygiene/ sanitation practices Cost-Effective & Scalable 40-50x less expensive than ARTs or nutrition therapy Easily integrated and large scale programs underway in several countries

12. Thank You! For further information: Allison Tummon Kamphuis CSDW Program Leader tummon.ad@pg.com www.csdw.org facebook/pg_csdw @PG_CSDW