1. Burden of Water Quality on Public Health in Developing Countries

2. Global Effort to Provide Safe Drinking Water to All

3. Drinking Water Technology Options in Developing Countries

4. The Way Forward

Polluted Water

Cost Effectivness of prevention

Preventative Expenditures

Replacement/Relocation

Health Effects

Sickness

Loss of Earnings

Medical costs

Death

Loss of Capital

CLASSIFICATION OF DRINKING WATER SOURCES

PIPED WATER ON PREMESIS

OTHER IMPROVED UNIMPROVED

Piped household water connection located inside the home, plot or yard

Public taps or standpipes Tube wells or boreholes Protected dug wells Protected springs Rainwater harvesting

Unprotected dug wells Unprotect springs Cart with small tank/drum Surface water (river, dam,

lake, pond, stream and canal

rainwater harvesting

1 2 3

(Adapted from WHO/UNICEF, 2010a)

Today contaminated water kills more people than cancer, AIDS, wars or accidents. Diarrhoea and dysentery claimed the lives of approximately 2 million people in 2005 (WHO). 75% percent of all diseases in developing countries arise from polluted drinking water

The vast majority being children under the age of five in developing countries.

Child deaths due to inadequate water and sanitation is a particular problem in Africa

Source: Bern et al., 1992

In 2004, > 80% of child deaths due to diarrhoea occur in Africa and South Asia

Proportion distribution of deaths due to diarrhoeal diseases among children under five years age by region Source: WHO(2004)

SADC Countries Mortality due to diarrhoeal diseases in children <5 years (%) (WHO, 2010)

Number of reported cases of cholera

(WHO, 2009) Angola 25 10511 Botswana 7 8 Democratic, Republic of Congo

19 30150

Lesotho 10 - Madagascar 22 - Malawi 11 831 Mauritius 2 - Mozambique 12 9087 Namibia 6 3496 South Africa 9 3907 Swaziland 8 1 Tanzania 12 2911 Zambia 15 2061 Zimbabwe 9 60055

The impact of deficient water and sanitation services falls primarily on the poor.

Women and children are the main victims. Burdened by the need to carry water containers long distances every day, they must also endure the indignity, shame, and sickness that result from a lack of hygienic sanitation.

In 2000, the UN, as part of its Millennium Development Goals (MDGs), has set a target of halving the proportion of people without access to safe drinking water and basic sanitation by 2015.

The WHO has declared 2005–2015 the decade of water, with the goal of establishing the framework to eventually provide full access to water supply and sanitation for all people.

In 2003, the WHO also established the Household Water Treatment and Safe Storage Network, a consortium of nearly 100 organizations working throughout developing nations.

The aims of the network include fostering collaboration, generating research, and exploring measures to scale up pilot projects.

In another major initiative, WaterAid has helped foster citizen-action groups to improve services as part of a global grassroots movement in water and sanitation.

Source WHO/UNICEF, 2010,2012

With the exception of Sub-Saharan Africa, most countries are on track to meet the MDG target 7c.

Sub-Saharan Africa still faces the greatest challenge in increasing the use of improved drinking-water.

It's now estimated that Africa has a population of 1.033 billion people in 2013.

Africa 348 000 000

World >780 000 000

Number of people without access to an improved source of drinking water (Source WHO/UNICEF 2011/2012)

Current Figures With its population of 1.033 billion, only 66 % of African people have access to improved source of drinking water.

Estimate Figures by 2015: Worldwide, 605 million people without access to an improved drinking water source.

China and India represent 46% of the developing world’s population. Both countries alone have recorded almost half of world’s progress, with increases of 457 million and 522 million, respectively since 1990. Of note are the impressive gains in Eastern Asia, which added 23% points, and the small decline in coverage in the Caucasus, Central Asia and in Oceania.

Though they are on track to reach the target, China and India combined are still home to 216 million people without access to improved water supplies. This represents 28% of the global population that remains un-served.

Access of Safe drinking Water in China and India

Urban Areas Rural Areas

Use of improved drinking-water sources in urban areas is almost double the use in rural areas of Sub-Saharan Africa

Access to safe water varies both among and within nations

For example, 77% of city and town dwellers in the Congo have access to safe drinking water but only 17 percent of rural inhabitants do.

In the Lao Peoples’ Democratic Republic, the situation is reversed: Virtually all rural Laotians have access to safe drinking water but only 60 percent of the residents in the capital city of Vientiane do. (Source: Third World Academy of Sciences2002).

DRC

Technological options fall into two broad categories – Centralised systems: used by municipal authorities at centralized points from where water is then distributed. Decentralised systems: can be practiced in individual homes.

Given that > 80 % of the world’s population lives in developing countries, technologies for making drinking water safe must be accessible, affordable, environmentally sound, and tailored to a nation’s cultural norms.

ECMA - Establishment of Catchment Management Agencies IWRM - Implementation of Integrated Water Resource Management DS - Distribution System

Ensuring that the water that consumers receive is safe to drink from a microbial point of view involves four steps: i. Protecting the source water from contamination e.g. from pollution from

human and animal faeces, rubbish and litter, sludge and inadequately treated effluent from municipal wastewater treatment plants and from industry.

ii. Adequate purification and disinfection of the water in the water treatment plant.

iii. Maintaining the integrity of the distribution system and ensuring an adequate disinfectant residual throughout the system.

iv. Safe handling and storage of water by consumers.

1. Shortage of trained and skilled people

The implementation of centralized systems requires highly skilled personnel for continuous maintenance and management. Lack of technical skills in water sector has been highlighted as one of the major challenges to sustain quality water provision through centralized systems.

Potential areas for capacity development include :

Technical, managerial, marketing and public relations. This challenge underscores the need for upgrading and training of personnel.

Case-study in South Africa : Skill levels in small water treatment plants

Source : Momba et al,. 2008

Constraints (cntd

Shortage of human resource capacity in over 70% of SWTPs visited in the designated provinces. Lack of knowledge for flow rate measurement, chemical dosing. Lack of a clear framework clarifying roles and responsibilities. Lack of in-service training. Lack of communication between operating staff and management

Level of compliance with SANS 241

Source: Momba et al., 2008

High prices per unit of water supplied, poor water quality and difficulty in regulating the providers are important issues that challenge progress in safe water provision.

Higher-income households with connections to utilities derive the greatest gains from water sold at prices far below the level needed to cover operations and maintenance costs.

E.g. In Kenya people living in the slums pay five to ten times more for water per unit than those in high-income areas, and more than consumers pay in London or New York.

2. Large Financial Inputs

3. Lack of access, regulation and public utilities Throughout Africa, there are areas where Water services are more easily accessible than others.

This can be due to geography, climate and the economic and

political history of the countries. In poor and conflict-prone areas, water services are meagre and most areas have no infrastructure at all. Rapidly growing and unplanned peri-urban areas

Constraints (cntd)

i. Centralised systems could take decades to be established, especially in impoverished rural communities of developing countries, where populations are dispersed and the proportion served is less than half that in urban areas.

i. Rapidly growing, unplanned, peri-urban areas are also not effectively served by

centralized systems.

ii. Moreover centralized approaches are often plagued by high capital costs, lack of proper operation, and an overreliance on treatment technologies that cannot be afforded or maintained in developing countries due to lack of skilled human resources.

Overall Challenges for Implementation of Central Systems

in Rural/peri-urban Areas

If only one barrier is possible, it has to be disinfection unless evidence exists that chemical contaminants are more harmful than the risk from ingestion of microbial pathogens

Decentralized or point-of-use water collection and treatment systems are the short- to medium- term solutions to ensure rapid implementation and improvement of the quality of life in scattered rural areas.

1. Household water treatment systems (HWTS) contribute to the reduction of microbial contaminants that are of public health concern. They provide a short–term solution to meeting the basic need of safe drinking water in rural communities.

2. HWTS are cost – effective, easy to construct and operate, do not

require highly skills. 3. Materials for the construction of HWTS are locally available. 4.Members of rural communities can be trained in terms of construction,

operation and maintenance of the promising household devices.

Common Household Drinking Water Technologies

Technology Availability and

Practicality

Technical

Difficulty

Annual Cost per

Household

Microbial

Efficacy Advantages Disadvantages

Boiling or heating

with Fuels

Varies depending

on heating

method and fuel

availability

Low-moderate Low-high

depending on

method ad cost of

fuel

> 2 log reduction Simple, effective in

destroying all classes of

waterborne pathogens

Not usually a cost-effective or

sustainable long term solution for

underdeveloped areas unless there is

an affordable supply of suitable fuel

which does not result in environmental

damage (e.g. deforestation for

firewood)

Solar disinfection High Low-

moderate

Low (< US$ 10) 1-2 log reduction Heat and UV radiation effective against bacteria; low cost and skill

High levels of turbidity interfere with sunlight penetration

Filtration

(membrane,

ceramic, granular

media such as bio-

sand, fabric etc)

Various

depending on

technology

Low-moderate Various depending

on technology

Various depending

properties of filter

medium. High (>

2 log) for some

Reduction of bacteria and

protozoa efficiently; long

lasting

lacks residual protection with low

flow rates of 1 - 2 L/h; Water with

high values for turbidity and TSS

requires pre- treatment before

filtration.

Chlorination High to

moderate

Low to

moderate

US$10 – 100 > 2 log removal Residual; effective against most bacteria including viruses

Potential production of disinfection by-products; Quality of the water influence microbial inactivation, need of skilled people to calculate chlorine dose.

i. Filtration with ceramic filters ii. Chlorination with storage in an improved vessel, iii. Solar disinfection in clear bottles by the combined action of UV

radiation and heat, iv. Thermal disinfection (pasteurization) in opaque vessels heated

in solar cookers v. Combination systems employing chemical coagulation-

flocculation, sedimentation, filtration and chlorination. All of these systems have been demonstrated to substantially

improve the microbiological quality of water.

Most Promising and Accessible Decentralised Technologies

Results of our survey in2009

(Wright et al., 2004)

Effective methods at the family and community level can bring a rich supply of substantially clean water with little effort and at a reasonable cost.

Many countries have

devised successful practices based on decentralised systems.

Locations of Studies of Household Drinking Water Treatment/Storage Interventions in

Developing countries

Common Problems or Knowledge Gaps 1. People do not know why they need to disinfect water 2. People do not know how long they have to boil water 3. People do not know what dose of Jik to use or what the contact time is 4. People assume clear water is safe to drink 5. People assume piped water is always safe 6. People are not aware of the association between dirt particles and pathogens 7. People are not aware of the need to pre-treat water to remove sediment 8. People are not ware that treated water is re-contaminated by dirty cups, scoops and hands inserted into the containers. 9. People are not aware that water for drinking is not stored differently than water for other purposes 10. People are not aware that treated water should not be stored for long periods of time 11. People are aware that using the same untreated source for a long period of time may become immune to the pathogens and therefore assume the water is safe. 12. People see diarrhoea as a water problem but not necessarily as a health and hygiene problem 13. People are not aware that containers contaminated with chemical residues such as chlorine pose a hazard if used for other purposes

Chlorine compounds for water treatment including bleach deteriorate if stored improperly or f l

Disinfection Challenges for Decentralised Systems: Results of our Survey in 2009

1. Knowledge about water, and health should be translated into action through community projects and research. Community-based research includes gaining a better understanding of the key factors driving long-term use of interventions, establishing hygiene behavior-change initiatives within existing community structures, and creating consumer demand for interventions through marketing efforts. 2. Improved methodology and indicators should be developed for quantifying the health impacts of interventions for water, and hygiene. These indicators should be easy for local communities to monitor and will enable projects to base claims of “improving health” on quantifiable evidence, rather than on selected personal narratives. 3. Last, additional, randomized, controlled studies could assist researchers in understanding health outcomes from different interventions, especially among key subgroups, such as children or immunocompromised individuals

Selection Criteria of Devices

Selection criteria – choice of devices evaluated in the laboratory/field.

Evaluation criteria – characteristics tested during laboratory/field work.

1. Can members of rural communities afford obtaining the unit? Construction and operation cost must not exceed earnings

1. Cost (capital/running)

2. Effective removal of microorganisms 2. Final water quality must comply with SANS 241 drinking water guidelines ( 0 cfu/100 mL E.coli)

3. Effective reduction of turbidity 3.Turbidity of treated water must comply with SANS 241, <1NTU

4. Ease of construction and operation 4. Extensive knowledge not required by user in rural community

5. Power requirement does not exceed equitable share

5. Little or no energy /fuel (power or fire) required for operation

6. Robustness – durability of filter 6. Robustness (test) 7. Produce minimum required volume of 25 L/p/d

for basic human activity , including 1.8 L/p/d for drinking,

7. Acceptable flow rate

8. Does not negatively affect lifestyle of consumer, social implication

8. Social acceptance

A number of criteria for the selection and evaluation of the water devices were identified (Momba et al,2012)

If the community is not properly informed and made aware of the advantages of the new household water treatment systems, they may not accept the units and will therefore not use them. The community members should be thoroughly informed via community meetings so that all may understand, or at least have an idea, of how the treatment systems work.

Prof Momba with Mrs Christina Skosana addressing the Makwane community Prof Rugimbana sitting with some of the members of the community as they listen.

Prof Momba and Christina explaining the operation of the filter

Setting up of the clay pot filter and zeolite filter in one of the homes

Various household water treatment systems and devices have been extensively reported in the literature.

Little is known about the way to assist local communities in making their

choices on a particular system or unit that can be appropriate to their situation.

A better understanding of the disinfection process, sustainable drinking water technologies, appropriate training and understanding of the selection criteria can assist communities to make the right choice of the technologies that can produce safe drinking water and eradicate preventable waterborne diseases prevalent in developing countries.

African leaders must focus not only on centralized water supply systems, but also on decentralized systems such as cost-effective HWTSs to provide access to safe drinking water to all.

UNESCO –IHE for supporting my travel cost for the purpose of this symposium

TUT and all our Sponsors

All the TUT Water Research Group