1. WHO International Scheme to Evaluate Household Water Treatment Technologies UNICEF International Network on Household Water Treatment and Safe Storage 10-13 November 2014 Vientiane, Lao

2. Basis for Scheme Household Water Treatment –Implementable, cost-effective approach to improved water quality –May play an important role in protecting public health where existing water sources are untreated, not treated properly, or become contaminated during distribution or storage. Important interim solution for: –~ 780 million without access to improved drinking-water supplies (http://www.unicef.org/media/files/JMPreport2012.pdf).http://www.unicef.org/media/files/JMPreport2012.pdf) –Billions without access to safe and reliable drinking-water Requires optimal choice, consistent and correct use!!!

3. How to make an optimal choice? Technologies: Physical removal (filtration, adsorption, sedimentation) Chemical (chlorine, iodine, silver) Disinfection by heat (boiling, pasteurization) Ultraviolet (UV) radiation Solar disinfection Combination Emerging technologies Options! Options! Options!

4. How to choose: basis for Scheme Locally relevant performance specifications needed for decision-making for selection of technologies or approaches –Information is not always available To realize health gains associated with HWT –HWT technologies must sufficiently reduce pathogens to result in significant health gains –Technologies must reach and be consistently and correctly used by the populations most at risk for waterborne disease. Until recently: No international specifications to evaluate performance claims of HWT product against a health-based performance benchmark existed.

5. WHO Recommendations (WHO, 2011) WHO established an international evaluation scheme for HWT to fill the need for rigorous health-based assessments of HWT technologies (December 2012) First document that sets forth global criteria to evaluate microbiological performance of HWT (June 2011) WHO Scheme to Evaluate Household Water Treatment (HWT) Technologies “The Scheme”

6. WHO Recommendations and the Scheme Objectives: Promote and coordinate independent and consistent testing for the evaluation of household water treatment products based on WHO criteria Support national governments building technical capacity of research and laboratory institutions; especially in applying WHO Guidelines on Drinking-water Quality. Aim: Guide WHO Member States and procuring UN agencies in the selection of technologies and support national governments in evaluation related functions.

7. Why a WHO International Scheme? Many countries do not have the capacity to evaluate HWT based on WHO recommendations Ensures criteria are appropriately adopted Effective mechanism to build national capacity WHO, global authority on public health Precedence: WHO Pesticide Evaluation Scheme, WHO Evaluation of Rapid Malaria Diagnostic Tests

8. Scheme Scope Products included in the Scheme Household water treatment technology (definition) Products used in households or similar settings to remove microbiological water contaminants that may pose health risks. Priority for testing: Low-cost Appropriate for developing country settings Generally “free standing” products Serve a limited number of individuals each day.

9. Scheme Components Laboratory Testing Evaluation based on laboratory testing Based on harmonized test protocol http://www.who.int/household_water/scheme/HarmonizedTestProtocol.pdf?ua=1 Microbiological reduction/inactivation performance specifications (not chemical) Tiered approach: series of health-based performance targets Subsidized testing – funding secured for Scheme Subsidy subject to availability of funds Criteria: size and capital resources of manufacturer; origin/location of manufacturer; local need; cost/liter treated

10. Scheme Components Designated Testing Laboratories Selection criteria: Institution with formal WHO relations Not-for-profit, ISO certified Stable income of core activities Strictly adhere to harmonized test protocols/plans Agree to WHO ownership of test results http://www.who.int/household_water/scheme/laboratories/en/ Currently designated: N SF International (USA); KWR (Netherlands) Aim to designate labs in different geographic regions

11. Scheme Components Independent Advisory Committee (IAC) Advisory body to WHO on the Evaluation Scheme. Experts with demonstrated commitment to advancing public health Goal: attain an adequate technical distribution of expertise in drinking water quality, microbiology, water treatment technology and/or regulation, geographical and gender balance. http://www.who.int/household_water/scheme/IAC/en/

12. Scheme Components Performance - Tiered approach WHO HWT: Series of health-based performance targets which allows for incremental improvements Highly protective:10 -6 DALY/person/year Protective: 10 -4 DALY/person/year Limited protection: Meets “protective” for two classes of pathogens Based on Disability-Adjusted Life year (DALY) Target pathogens: viruses, bacteria and protozoa

13. Rating Log 10 reduction: bacteria Log 10 reduction: viruses Log 10 reduction protozoa Highly protective ( 10 -6 DALYs/ P/yr) ≥ 4 99.99% ≥ 5 99.999% ≥ 4 99.99% Protective (10 -4 DALYs/ P/yr) ≥ 2 99% ≥ 3 99.9% ≥ 2 99% Limited protection Achieves “protective” target for two classes of pathogens Basis for assessing performance

14. Scheme Procedure Invitation for expression of interest Manufacturers to submit detailed information on product WHO screening of dossiers WHO will review with input from the Independent Advisory Committee and determine which products are eligible for testing Testing (or evaluation of exiting data) Products and payment for testing sent to laboratories Specific test plans, based on harmonized test protocol, developed by laboratories in consultation with manufacturers

15. Scheme Procedure, contin Testing Results and Reporting Laboratory will report results to WHO WHO with advice from IAC will determine level of performance Summary of ALL results posted on WHO website Use of Information Manufacturers can discretely list performance level achieved in technical material addressed to water and health professionals May not use WHO name or logo in any manner Maintenance Manufacturers update WHO on changes in product/manufacturing

16. Challenges and Conclusion Starting simple; 2 laboratories and technically advanced protocols Future work on simplifying protocols and building national laboratory capacity Linking evaluation to new and innovative products Optimizing performance in tandem with achieving consistent and correct use HWT only has health impact if used consistently and correctly by at-risk populations! WHO/ M Montgomery

17. More information Visit Scheme Webpage: http://who.int/entity/household_water/scheme/en/ http://who.int/entity/household_water/scheme/en/ Contact: Nikki Beetsch Water, Sanitation, Hygiene and Health World Health Organization beetschn@who.intbeetschn@who.int or hhwater@who.inthhwater@who.int