1. Water Safety Plans | November 2010 Household and small community water safety Kuching 2 November 2010 Bruce Gordon Water, Sanitation, Hygiene and Health

2. Water Safety Plans | November 2010 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. Water Safety Plans | November 2010 WHO Guidelines for Drinking Water Quality, Framework for Safe Drinking Water: Health-based targets (National regulatory body) Independent surveillance (Surveillance agency) Water Safety Plan (Water utility) External audit of WSP Verification monitoring Risk management plan Implementation of step-wise improvements Continuous monitoring Documentation and supporting programmes 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

4. Water Safety Plans | November 2010 Water Safety Plan (simplified) Continuous cycle What are the risks? How do I control the risks? Monitoring Source: Netti et al. 2005

5. Water Safety Plans | November 2010 Implementing a WSP?

6. Water Safety Plans | November 2010 Water Safety Plans System mapping Risk Assessment Control measures Monitoring + verification Improvements (e.g. investment planning) WSP steps

7. Water Safety Plans | November 2010 WSPs: Sanitary survey reborn?

8. Water Safety Plans | November 2010 Paradigm shift (from reactive to preventive) But common sense ("sanitary survey +")

9. Water Safety Plans | November 2010 Benefits of WSP approach Reduce disease Risk-based approach Enhance good practice Evidence-based investments Save money in the long-term

10. Water Safety Plans | November 2010 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. Water Safety Plans | November 2010 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. Water Safety Plans | November 2010 WHO Guidelines for Drinking-water Quality "HWTS has been shown to significantly improve water quality and reduce waterborne infectious disease risks"

13. Water Safety Plans | November 2010 Effectiveness ranges of HWTS technologies for the reduction of microbes in water Courtesy of Mark Sobsey, University of North Carolina

14. Water Safety Plans | November 2010 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. Water Safety Plans | November 2010 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. Water Safety Plans | November 2010 Current Evidence (simplified) ReferenceReduction (percent) Effect size on diarrhoea morbidity Intervention Waddington et al. 2009 1 44%0.56Water quality, under 12 months Waddington et al. 2009 1 19%0.81Water quality, after 12 months or more Sustainable impact

17. Water Safety Plans | November 2010 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. Water Safety Plans | November 2010 Give up?

19. Water Safety Plans | November 2010 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. Water Safety Plans | November 2010 UNICEF and WHO: 7 point plan to control diarrhoea: