inter-regional workshop on: strengthening evaluation ... workshop on: strengthening evaluation,...
TRANSCRIPT
Inter-regional workshop on:
Strengthening evaluation, regulation and
implementation of household water treatment and
safe storage
Workshop report
Addis Ababa, Ethiopia
3-5 May, 2016
ii
Contents
Summary and key outcomes ...................................................................................................... 1
Background ................................................................................................................................ 2
Workshop proceedings............................................................................................................... 4
Session 1: The big picture: Water and health .................................................................... 4
Session 2: Status of HWTS strategies and policies ........................................................... 5
Session 3: Promoting HWTS: approaches and knowledge dissemination ........................ 6
Session 4: Accelerating access to HWTS: distribution options ........................................ 8
Session 5a: Strengthening evaluation and regulation of HWT performance .................. 8
Session 5b: Strengthening evaluation and regulation of HWT performance .................. 9
Session 5c: Strengthening evaluation and regulation of HWT performance ................ 11
Session 5d: Visit to Ethiopian Public Health Institute (EPHI) laboratory ..................... 11
Session 6: Monitoring and evaluating HWTS use .......................................................... 12
Session 7: HWTS as part of broader water, sanitation and hygiene (WASH) response in
emergencies ........................................................................................................................ 13
Session 8: Way forward: key challenges and solutions ................................................... 13
Appendices
Appendix 1: Workshop agenda ............................................................................................ 16
Appendix 2: List of participants .......................................................................................... 20
Appendix 3: Summary of group discussion on regulation................................................... 23
iii
Abbreviations
EFMHACA Ethiopian Food, Medicine & Health Care Administration & Control Authority
EPHI Ethiopian Public Health Institute
FDA Food & Drugs Authority
GSA Ghana Standards Authority
HWT household water treatment
HWTS household water treatment and safe storage
M&E monitoring and evaluation
NGO non-governmental organization
SDGs Sustainable Development Goals
UNICEF United Nations’ International Children’s Fund
WASH water, sanitation and hygiene
WHO World Health Organization
WSP water safety plan
1
Summary and key outcomes
A workshop on strengthening evaluation, regulation and implementation of household water
treatment and safe storage (HWTS) was convened by the International Network on
Household Water Treatment and Safe Storage (“the Network”) on 3-5 May 2016 in Addis
Ababa, Ethiopia. The Network is co-hosted by the World Health Organization (WHO) and
United Nations’ Children’s Fund (UNICEF). The purpose of the workshop was to review
progress made on implementing national strategies and policies on HWTS, and discuss key
needs to strengthen implementation efforts, as well as national evaluation and regulation of
household water treatment (HWT) products. This report summarizes key discussions points
from the workshop, as well as next steps.
Key discussion issues
HWTS is an important component of the framework for safe drinking-water. Under
the Sustainable Development Goal, monitoring will include indicators on water safety.
HWTS is a component of the drinking-water safety framework, and is an important public
health intervention for improving the safety of water and protecting health among
vulnerable populations.
Implementation of HWTS needs to be strengthened
In general, policies / strategies on HWTS exist, but resource mobilization, improved
coordination particularly at sub-national level and integration with other health
intervention are required to strengthen efforts.
Strong national working groups on HWTS are essential for catalysing progress.
Working groups should serve as a platform through which national stakeholders can meet
and strategize on key issues related to HWTS, and serve as the advocacy and catalysing
agent for:
The development of national standards on performance of HWTS products;
The establishment of regulatory frameworks for HWTS, including strengthening
certification frameworks to include comprehensive criteria on microbiological
effectiveness; and
The engagement of the private sector in policy formulation and programme
implementation.
2
Promotion of HWTS should be balanced with behaviour change.
HWTS implementation strategies should be strengthened to focus on sustained behaviour
change, not ‘pushing’ HWTS products to households.
Tangible approaches for engaging the private sector are needed. Beyond inviting the
private sector to discussion fora, practical incentives such as tax waivers are needed to
encourage manufacturers and distributors to reach wider markets. In addition, customs
authorities are encouraged to recognize HWTS products as health products and apply
similar procedures as other supplies or goods imported for public health purposes.
Commitments and next steps
WHO to continue to work towards strengthening national capacity in evaluation and
regulation of HWTS products, and liaise with countries on prioritization of activities and
next steps
Governments, NGOs, private sector and academia to work together in strengthening
national working groups on HWTS, and work to:
o Adopt WHO performance recommendations for HWT in the development of their
national standards;
o Support countries in undertaking performance evaluation of locally-manufactured
HWTS products;
o Classify of HWT products as ‘health products’ and facilitate waiving of import taxes;
and
o Facilitate accurate coding of HWT devices by the customs agencies, to support the tax
waiving noted above, and prevent products found to not meet performance
requirements from being allowed into countries.
Participating organizations of the Network to support countries in wider implementation
efforts, including knowledge exchange fora, supply chain management and consumer
financing.
Background
Household water treatment and safe storage (HWTS) is an important public health
intervention to improve the quality of drinking-water and prevent water-borne disease. When
effective methods are used correctly and consistently, HWTS can reduce diarrhoeal disease
3
by as much as 45 %1. In order to comprehensively assess effectiveness, WHO in 2014
established the International Scheme to Evaluate Household Water Treatment Technologies
(the Scheme) to independently and consistently evaluate HWT products based on WHO
criteria2. Concurrently, the Scheme also aims to strengthen the capacity of countries to
regulate and evaluate HWT products and seeks to ensure that results of the evaluation are
considered and used by procurement and regulatory authorities.
In addition to effectiveness, achieving tangible health gains from HWTS also depends on
other factors, including the existence of national enabling environments and effective policies
that recognize HWTS amongst other public health interventions, supply chains, affordability,
user preferences, etc. In order to facilitate progress on these fronts, the WHO and UNICEF-
hosted International Network on Household Water Treatment and Safe Storage (“the
Network”) brings together over 140 participating organizations, including representatives of
governments, academic institutions, implementing agencies and the private sector, around the
common goal of reducing water-borne disease through safe water.
All three countries at the workshop (Ethiopia, Kenya and Ghana) have participated in
previous workshops convened by the Network aimed at developing policy frameworks and
national strategies on HWTS in the regions of East Africa3 and West Africa
4. Further, in all
three countries diarrhoeal disease is a significant cause of morbidity and mortality, and
HWTS serves as an important intervention for safety of drinking-water, and have participated
in discussions aimed at identifying how HWTS evaluation and regulation can be
strengthened5,6.
1 WHO (2014). Preventing diarrhoea through better water, sanitation and hygiene: Exposures and impacts in
low- and middle-income countries. Geneva: World Health Organization;
(http://www.who.int/water_sanitation_health/gbd_poor_water/en/). 2 WHO (2011). Evaluating household water treatment options: health-based targets and microbiological
performance specifications. Geneva: World Health Organization
(http://www.who.int/water_sanitation_health/publications/2011/household_water/en/). 3 WHO, UNICEF and UNC (2011). National Household Water Treatment and Safe Storage Strategies and
Integrated Household Environmental Health Interventions: Report of a Workshop for selected countries in East
Africa. Available from: 4 http://www.who.int/household_water/resources/EastAfricaPolicyIntegrationWorkshop2011.pdf?ua=1
WHO, UNICEF and UNC (2013). Household Water Treatment and Safe Storage in West Africa: Report of a
May 2013 Regional Workshop on Household Water Treatment and Safe Storage and Integrated Household-
based Environmental Health Interventions. Available from:
http://www.who.int/household_water/resources/2013AccraReport_Final_forposting.pdf?ua=1 5 WHO, UNICEF and PSI (2013). Evaluating Household Water Treatment Performance and Scaling up Safe-
Drinking Water Solutions: National workshop, Ethiopia. Available from:
http://www.who.int/household_water/resources/EthiopiaHWTWorkshopReport_Feb2013_Final_2.pdf?ua=1 6 WHO (2015). Strategic Meeting of the WHO International Scheme to Evaluate Household Water Treatment
Technologies.
Available from: http://www.who.int/household_water/scheme/schemestrategicmeetingreport-2015.pdf?ua=1
4
The current workshop was therefore to follow up on these efforts, and specifically:
Review status and implementation of national strategies and polices on HWTS,
including existing approaches to addressing HWTS in emergencies;
Share lessons learned in policy formulation and implementation; and
Discuss key needs and solutions in improving HWTS implementation, including:
product performance evaluation and regulation, monitoring and evaluation of use, and
utilizing lessons learned to improve implementation approaches.
The workshop took place over three days, and included over 50 participants from Ethiopia,
Kenya and Ghana, representing national and regional governments, non-governmental
organizations, academics, implementing organizations and manufacturers of HWTS products.
Themes covered on Day 1 of the workshop included: recent evidence on water and health,
and HWTS in the global development agenda; status of national strategies and policies on
HWTS; and HWTS promotion and financing options. Day 2 covered WHO performance
recommendations for HWT and results from Round I of the Scheme, existing approaches to
HWT evaluation and regulation in countries. Day 3 was focused on field monitoring and
evaluation of HWTS, as well as discussions on key needs to strengthen implementation,
regulation and evaluation of HWTS in countries. The workshop agenda is attached in
Appendix 1, and the list of participants and group photograph in Appendix 2.
Workshop proceedings
Opening remarks at the workshop were given by Dr Paul Mainuka (Officer in Charge, WHO
Ethiopia); Dr Samuel Godfrey (Chief of WASH, UNICEF Ethiopia) and Dr Taye Balcha
(Head Office of State Minster, Federal Ministry of Health). Mr Dangew Tadessa (Ministry of
Health, Ethiopia) welcomed participants and led the round of introductions, and Dr Batsi
Majuru (WHO headquarters laid out the objectives of the workshop. The workshop was
divided into sessions, which are summarized below.
Session 1: The big picture: Water and health
The objectives of the session were to provide an overview of recent evidence on water quality
and health, and linkages between HWTS and broader efforts on water safety in the
Sustainable Development Goals (SDGs).
Anna Murray, Tufts University
Ms Murray presented an overview of recent evidence on water quality and health, including
5
the most recent estimates on the burden of disease attributable to inadequate drinking water,
and systematic reviews of the impact of water quality interventions on health. Key points
highlighted were that although global diarrheal disease has been reduced and access to
improved water sources has increased, there is still high disease burden, particularly among
children under 5. New drinking-water targets under the SDGs will consider drinking-water
safety, not just water access, current evidence demonstrates that HWTS can reduce diarrheal
disease among users.
Batsi Majuru, WHO headquarters
Dr Majuru presented on the water safety framework presented in the WHO Guidelines for
Drinking-water Quality7, highlighting concepts relating to water safety management, and the
role of HWTS. Key concepts highlighted were health-based targets and how they relate to the
WHO performance recommendations for HWT technologies8, water treatment methods and
that HWTS is analogous to conventional water treatment; and the consequent need to ensure
that such treatment is effective, and done correctly and consistently by users. Discussions
following the presentation highlighted the importance of safe storage after treatment and
verification of material safety as a part of HWT evaluation.
Session 2: Status of HWTS strategies and policies
The objectives of the session were to: provide overview of existing policies and strategies on
HWTS; update on progress on implementation, including challenges encountered; and
discuss potential solutions to challenges to shared.
Dangew Tadesse, Ministry of Health, Ethiopia
Ethiopia does not currently have a consolidated strategy that comprehensively addresses key
aspects relating to HWTS, but it is included in various public health policies and strategies.
The Health Transformation Plan of Ethiopia(2016-2020) has a target to increase HWTS use
from the current 10 % to 35%, by 20209. The National Water Quality Monitoring and
Surveillance Guideline (in draft), includes indicators on HWTS use, and the Health Extension
Program has been on promoting safe storage. In general, comprehensive water safety
7 WHO (2011). Guidelines for drinking-water quality. Fourth edition. . Geneva; World Health Organization.
Available from: http://www.who.int/water_sanitation_health/publications/dwq-guidelines-4/en/ 8 WHO (2011). Evaluating household water treatment options: Heath-based targets and microbiological
performance specifications. Geneva; World Health Organization. Available from:
http://apps.who.int/iris/bitstream/10665/44693/1/9789241548229_eng.pdf 9 The Federal Democratic Republic of Ethiopia Ministry of Health (2015).Health Sector Transformation Plan,
2016-2020. Available from:
http://www.moh.gov.et/documents/26765/0/Health+Sector+Transformation+Plan/5542a23a-9bc7-46a2-8c1f-
8b32c2603208?version=1.0
6
management including HWTS is not strong, and the key challenges noted are high turnover
of trained professionals, and weak monitoring: health management information systems do
not include HWTS.
Adam Mohammed Ali, Ministry of Health, Kenya
HWTS is addressed as a component of the Environmental Sanitation and Hygiene Strategy of
2007, which has been revised and is due to be launched in late May 2016. The main
components of the strategy are HWTS promotion and M&E. To date, progress has been made
in HWTS promotion as part of wider WASH in schools efforts, and on M&E, where water
safety indicators have been integrated into the health management information system of the
Ministry of Health. Among the key successes are that the national working group on HWTS
remains active and provides input on product selection, and an HWTS training manual has
been developed, though not yet available in print form. Challenges noted are as follows:
Lack of prioritization of HWTS at policy level;
HWTS is viewed only as an emergency intervention, and there is therefore no sustained
financing or clear budgetary allocation from government and development partners; and
Weak integration of HWTS into wider disease prevention strategies.
Kweku Quansah, Ministry of Local Government and Rural Development
Mr Quansah shared an overview of the national strategy for HWTS in Ghana, which
comprises the overall strategy itself, a private sector participation framework, and a scale-up
model. The strategy has seven components: policy and institutional development; technology;
consumer engagement; emergency response; research and knowledge management; financing
and partnerships; and monitoring and evaluation. To date, progress has been made on: policy
and institutional development through development of a drinking-water quality management
framework; consumer engagement, through implementation of a behaviour change
programme; and emergency response, through training of over 200 health officers and
engineers in HWTS, and WSP in 24 districts. While the strategy includes a private sector
participation framework which outlines the sector’s roles, to date there has been little
progress. It was noted that although representatives actively participated in the development
of the national strategy, there has been little engagement with them since.
Session 3: Promoting HWTS: approaches and knowledge dissemination
The purpose of this session was to highlight challenges and lessons learned in HWTS
promotion.
7
Alemayehu Tegegne, Population Services International (PSI) Ethiopia
Mr Tegegne shared an overview of PSI’s promotional strategy for HWTS products. PSI
Ethiopia currently produces and distributes a chlorine disinfectant WaterGuard, under the
brand name WuhaAgar, and distributes the flocculant-disinfectant P&G Purifier of Water.
Distribution is to all nine regions in the country, and promotional methods used include
advertisements, community-wide events, door-to-door promotions, etc. Among the
challenges noted are:
HWTS is largely perceived as an emergency intervention, with little long-term use; and
there is little interest from vendors to stock HWTS products
Long registration process with the regulatory authority, EFMHACA;
Limited access to foreign currency, which hampers imports; and
Presence of contraband products.
Kweku Quansah (Ministry of Local Government and Rural Development)
Mr Quansah shared an overview of a behaviour change programme aimed at promoting
HWTS in communities that is being implemented in Ghana and lessons learned. The
programme is currently being implemented in the five priority regions of the country where
the burden of disease related to WASH is highest. The programme is being implemented as a
component of a broader programme on community-led total sanitation and hygiene, and to
date, over 1, 000 key extension staff have been trained in 5 regions for community level
HWTS promotional activities. With regards to the monitoring, the BASIS (MIS System for
Basic Sanitation) is being used to capture HWTS activities. Key lessons learned are outlined
below:
“Behaviour first” approach has the potential to promote sustained use of HWTS products;
Using other behaviour change communication vehicles to promote HWTS has been
effective and mainstreaming is key for sustained, long term social change; and
Completion and use of harmonized sector management information system and M&E
systems would enhance coordination and regulation and rally relevant partners for scale up.
Paul Earwaker, Centre for Affordable Water and Sanitation Technologies (CAWST)
Mr Earwaker presented an overview of the HWTS Knowledge Base; an online tool which
aggregates information on HWTS developed by CAWST. The tool contains information on a
range of topics related to HWTS, including: technology and product efficacy; monitoring and
8
evaluation; existing projects on HWTS; and implementation approaches. Contributors can
upload information to the Knowledge base can be accessed from www.hwts.info.
Session 4: Accelerating access to HWTS: distribution options
The aim of the session was to jointly develop ideas on private sector engagement, financing
solutions and supply chains to achieve national targets on HWTS.
Hester Foppen (Aqua for All) and Lemessa Mekonta (IRC Wash Ethiopia)
Mrs Foppen introduced a project that is under development that aims to pilot new pathways
for the distribution of HWTS products. The proposed distribution pathways are: health
centres; sanitation business centres; and drinking-water utilities. Lemessa then led the
discussion, in which workshop participants shared their input on the proposed distribution
pathways and the opportunities and challenges each of them present, possible incentives for
their involvement in HWTS distribution, and overall feasibility. The presentation and
discussion generated a lot of interest and debate, with discussions highlighting the pros and
cons of each distribution pathway. Discussion points highlighted that while public facilities
such as health centres may have a wide reach, their experience is in providing public services,
and they may have little experience in the retail service that would ensue from selling HWTS
products. Sanitation marketing business were highlighted as being retail oriented, but may not
have the capacity to provide after-sales support / maintenance.
Session 5a: Strengthening evaluation and regulation of HWT performance
The purpose of this session was to give an overview of the WHO performance
recommendations for HWT and share examples of national regulation of HWT.
Batsi Majuru, WHO headquarters
Dr Majuru shared an overview of the WHO performance recommendations for HWT, the
summary of Round I results from the WHO International Scheme to Evaluate Household
Water Treatment Technologies (“the Scheme”), and capacity building activities. Health gains
from HWT and safe storage can only be achieved when treatment products are effective in
removing pathogens from drinking-water, and are accessible to, and used correctly and
consistently by vulnerable populations. A variety of HWT products – with performance
ranging from little to considerable pathogen removal – are available. The Scheme was
established in 2014 to independently and consistently evaluate the performance of HWT
9
products according to WHO performance recommendations10
. In Round I of the Scheme, ten
HWT technologies, including solar, chemical, filtration and ultraviolet (UV) were evaluated,
and a rapid market assessment of HWT products was conducted. The Round I summary
report 11
details that there are both high performing and poor performing products and that
more needs to be done to strengthen national regulation and evaluation of HWT alongside
effective implementation. Evaluation under the Scheme does not constitute a certification, as
WHO is not a certifying body; this is the prerogative of national regulatory authorities.
Performance evaluation is a component of the product certification process, and through the
Scheme, WHO carries out this service on behalf of countries that would otherwise not have
the resources nor the capacity to rigorously evaluate HWT products. As such, the results of
the Scheme evaluation form the basis on which national regulatory authorities can then
certify or authorize products for sale or distribution within their countries. WHO is working
with national governments to fast track the authorization of products that have been evaluated
the Scheme and to strengthen evaluation, regulation and overall implementation of HWTS.
Anna Murray, Tufts University
Ms Murray shared an example of national regulation of HWT products in Haiti, where Tufts
University and the Centres for Disease Control and Prevention (CDC) have been supporting
the development a certification framework for HWT products12
. The certification framework
developed includes: reviews of product dossiers, verification of existing certifications, review
of efficacy data; verification of product composition (where applicable), and review of
product packaging. The presentation highlighted the importance of strengthening the capacity
of regulatory authorities in conducting similar reviews, and how regulations can be applied to
a wider range on HWT technologies, other than chemical disinfectants.
Session 5b: Strengthening evaluation and regulation of HWT performance
The purpose of this session was for countries to share overviews of their frameworks for
HWT evaluation and regulation.
10
WHO (2011). Evaluating household water treatment options: Heath-based targets and microbiological
performance specifications. Available from:
http://apps.who.int/iris/bitstream/10665/44693/1/9789241548229_eng.pdf 11
WHO (2016). Results of Round I of the WHO International Scheme to Evaluate Household Water Treatment
Technologies. Geneva: World Health Organization. Available from:
http://www.who.int/household_water/scheme/household-water-treatment-report-round-1/en/ 12
Murray A, Pierre‐Louis J, Joseph F, Sylvain G, Patrick M, Lantagne D. 2015. Need for certification of
household water treatment products: examples from Haiti. Tropical Medicine & International Health. 20(4):462-
70.
10
Seyom Wolde, Ethiopian Food, Medicine and Health Care Administration and Control
Authority (EFMHACA); and Almaz Gonfa, Ethiopian Public Health Institute (EPHI)
EFHMACA is mandated to regulate food (including water) and medicine with respect to
products, professionals, premises and practices. EPHI’s food microbiology and food safety
conducts analyses of food and water-related products. There are currently no national
standards for HWT products in Ethiopia. HWT products are required to be registered with
FMHACA before being marketed or used. To date, only chlorine disinfectants and flocculant-
disinfectants have been certified. Currently, the requirements for registration of HWT
products are a dossier evaluation and laboratory testing to verify the safety and material
composition of the product. Among the existing challenges noted are weak supply chains for
laboratory materials required to conduct performance evaluation and absence of certified
laboratories. However, as part of the capacity building activities of the Scheme, WHO is
working with FMHACA and EPHI to expand the scope of the evaluation and registration to
include devices, as well as microbiological performance against bacteria, viruses and
protozoa, and develop national standards for HWT.
Benjamin Murkomen, Ministry of Health Kenya
There are currently no national standards for HWT in Kenya. Products are tested by the
Kenyan Bureau of Standards against faecal coliform and the government chemist for material
safety and verification of product composition. Products are licensed by both the national and
county governments. Following testing by these institutions, the results are then shared with
the technical working group on HWTS for review. Upon approval by the technical working
group, the product is then registered with the Kenyan Regulatory Authority and licensed by
government agencies. Challenges noted are: no harmonized testing protocols amongst labs;
lengthy procedures for licencing of products; and weak field M&E on ongoing performance.
Genevieve Baah, Ghana Standards Authority (GSA)
There are currently no national standards for HWT in Ghana. Products are required to be
certified by GSA, and be registered with the Food & Drugs Authority (FDA). Current
certification requirements are: inspection of facility and premises; dossier review, laboratory
test results; and appropriate labelling. The timeline for product registration is 3 months. As
part of the capacity building activities of the Scheme, WHO is working with FDA and GSA
to expand the scope of the evaluation and registration to include microbiological performance
against bacteria, viruses and protozoa, and develop national standards for HWT.
11
Session 5c: Strengthening evaluation and regulation of HWT performance
The purpose of this session was to identify key needs and potential solutions with regards to
HWT regulation and evaluation. Participants broke up into country groups to discuss the
following questions:
1. What are the benefits to having country-level regulation of HWTS products?
2. What are the difficulties/drawbacks to having country-level regulation of HWTS products?
3. Who should be involved in developing a regulation framework?
4. What are some barriers to creating and implementing a regulation framework?
5. What components, beyond laboratory efficacy testing, would be useful to evaluate for
HWTS products?
The main issues highlighted from the discussion were: weak coordination amongst
stakeholders, lack of capacity to develop or enforce regulations, even if they were to be
established; and the perception that regulations may discourage manufacturers or distributors.
It was also noted that the devolved governmental structures in countries such as Ethiopia and
Kenya where national and regional / county regulatory structures may exist could be difficult
to coordinate. A detailed summary of the discussion points is attached in Appendix 3.
Session 5d: Visit to Ethiopian Public Health Institute (EPHI) laboratory
At the conclusion of Day 2 participants visited the Food & Water Microbiology and
Environmental laboratories at EPHI. The purpose of the visit was to better understand the
existing services provided by the lab and key needs for strengthening capacity in relation to
HWT performance testing. The laboratory faces logistical and infrastructural challenges,
summarized below:
Low output of laboratory grade water, little or no access to materials of test water
preparation and equipment for evaluation of water constituents;
Long material procurement process that spans 6-12 months in order to secure laboratory
materials and equipment, and not all supplies they submit purchase orders for are
guaranteed; and
Frequent electrical power outages that impede work and may compromise stock
microorganisms.
12
Session 6: Monitoring and evaluating HWTS use
The purpose of this session was to provide an overview of current M&E approaches for water
safety and share lessons learned.
Alex Doyen, Vestergaard
Mr Doyen presented on the use of remote sensors to assess the effectiveness of filter use,
based on a study that was conducted in Rwanda13
. The sensors measure how much water is
put in into the filters, how much is filtered put, and frequency of cleaning of the filter.
Anna Murray, Tufts University
Ms Murray gave a presentation on lessons learned from field M&E of HWTS, including key
challenges encountered. The presentation highlighted the need to maintain clarity on the
M&E questions to be addressed, selection appropriate indicators, and structural and
organizational arrangements. Discussions ensuing from the presentation highlighted that
M&E of HWTS is often fragmented, and conducted by the implementing organization with
little or no linkage of the data with government entities responsible for HWTS.
Balew Yibel, Ministry of Water, Irrigation and Energy
Mr Yibel gave a presentation on the status of water quality monitoring and management in
Ethiopia. Currently, four of the nine regions in the country are conducting water quality
monitoring. Ethiopia is also implementing Climate Resilient Water Safety Plans (CR-WSPs),
which also include HWTS as a component. The work is currently being implemented in 12
areas (nine urban and three rural) that serve more than 600,000 people in total. Improvement
actions include both soft components and infrastructure improvements. A number of
challenges were noted, which are outlined below:
Human resources
o Lack of water quality specialists
o Limited capacity to interpret water quality data and recommend necessary corrective
action
Institutions
o Although national standards for water quality are in place, regulatory capacity is weak
and operational staff are unclear on roles and responsibilities of regulatory authority
and service providers
o Lack of accredited reference laboratory for water quality testing
13
Thomas et al. (2013). Use of remotely reporting electronic sensors for assessing use of water filters and
cookstoves in Rwanda. Environmental Science & Technology 47(23).
13
Implementation
o Although the CR-WSP strategy includes HWTS as a component, there is no practical
guidance on how HWTS and WSPs can be integrated
o HWTS is primarily regarded as an emergency intervention
o Low community involvement in risk factor identification and mitigation
Session 7: HWTS as part of broader water, sanitation and hygiene (WASH)
response in emergencies
In this session participants broke into groups to discuss key challenges and potential solutions
in emergency response with regards to HWTS and broader WASH, and discussions were
structured within three broad phases of emergencies: preparedness; response; and recovery.
The main discussion points highlighted were:
Preparedness
o Regular communication and coordination amongst stakeholders outside of emergency
contexts is weak, and there is therefore little opportunity for joint learning and
improvement
o Awareness of HWTS products beyond popular brands chlorine disinfectants and
flocculant-disinfectants is low, and product selection is limited to these technologies
only
Response
o Much of the existing guidance on HWTS in emergencies is very generic, and is difficult
to apply in a more localized context
o Coordination at district or other localized is weak
Recovery
o Limited capacity to follow up and reinforce HWTS use on a more sustained basis
o Post-distribution monitoring is weak
o Public-private sector engagement is weak; little opportunity for reviewing lessons
learned.
Session 8: Way forward: key challenges and solutions
Participants broke into country groups to review lessons learned from the workshop,
challenges faced with regards to HWTS and strategize on follow-up actions. In all three
countries HWTS is addressed either as a standalone strategy (Ghana) or included in other
health strategies / policies (Ethiopia and Kenya). Common challenges shared amongst all
14
three countries are: low resource mobilization; weak coordination at sub-national level; weak
field monitoring and evaluation systems; and weak engagement of the private sector.
Common priority action points from the three countries were to:
Strengthen national working groups on HWTS (e.g. more regular meetings, clear terms of
reference and expected deliverables, and periodically meet with wider stakeholders in
WASH to present on progress made and exchange knowledge);
Develop national standards for HWT;
Develop more comprehensive certification framework for HWTS products, taking into
account microbiological performance; and
Advocate for reduced import taxes / tax waivers for HWTS products.
A fourth group comprising manufacturers and distributors of HWTS products also discussed
challenges faced within the sector and potential solutions. From this group there was
discussion on what ‘engaging the private sector’ means at a practical level. Key challenges
highlighted were that the private sector is largely seen as seeking solely to make profit and is
excluded from decision-making and discussion fora, and this consequently has an impact on
implementation of HWTS, including:
Technology choice and accessibility: An example shared was that chlorine disinfectants
and flocculant-disinfectants are considered as public health products and as such, import
tax waivers for these HWT technologies can be obtained. However, these waivers are not
applicable to other HWT technologies such as filters. Importers of these technologies have
no platform through which they can engage with relevant government officials to obtain
similar waivers, and consequently pay import taxes of between 25-39 %. This ultimately
results in a limited range of HWT technologies being available.
Monitoring and evaluation of field use: data collected by manufacturers or their
implementers is not shared with governments as there are limited platforms / channels of
communication.
The group recommended the following: the private sector should be included in discussion
and decision making fora on HWTS; HWTS is a preventive health intervention, and as such,
HWTS products should be categorized as health products and that national standards for
HWT performance be established.
15
Conclusion
Specific recommendations and commitments are summarized at the beginning of the report.
In closing, Dr Batsi Majuru and Mr Waltaji Kutane thanked participants for their
contributions to the workshop, and highlighted that follow up will be made on the
commitments from the various countries, and shared with the Network. Mr Dangew Tadesse
closed the workshop.
16
Appendix 1: Workshop agenda
WHO/UNICEF International Network on Household Water Treatment and Safe
Storage
Inter-regional workshop on: Strengthening evaluation, regulation and implementation of
Household Water Treatment and Safe Storage
Agenda
Jupiter International Hotel, Addis Ababa, Ethiopia
3-5 May 2016
Workshop objectives
Review status and implementation of national strategies and polices on HWTS, including existing
approaches to addressing HWTS in emergencies;
Share lessons learned in policy formulation and implementation; and
Discuss key needs and solutions in improving HWTS implementation, including: product
performance evaluation and regulation, monitoring and evaluation of use, and utilizing lessons
learned to improve implementation approaches.
Day 1: Tuesday 3 May
08:30-09:00 Registration
09:00-10:00 Opening ceremony and workshop overview
09:00-09:20 Opening remarks Dr Paul Mainuka,
Officer in Charge,
WHO Ethiopia
Dr Samuel Godfrey,
Chief of WASH,
UNICEF Ethiopia
Dr Taye Balcha,
Head Office of State Minster,
Federal Ministry of Health
09:20-09:40 Introduction of participants Dangew Tadessa,
Ministry of Health Ethiopia
09:40-09:55 Workshop objectives and overview Batsi Majuru,
WHO
09:55-10:00 Group photo All
10:00-10:30 Coffee break
17
10:30-11:30 Session 1: The big picture: water quality and
health
Moderator:
Kebede Eticha
10:30-10:45 Water quality and health: A look at the evidence Anna Murray,
Tufts University
10:45-11:00 An overview of the drinking-water safety
framework
Batsi Majuru,
WHO
11:00-11:30 Discussion
11:30-13:00 Session 2: Status of HWTS strategies and policies Moderator:
Akosua Kwakye
11:30-11:45 HWTS implementation in Ethiopia: status and key
challenges
Dangew Tadessa,
Ministry of Health
11:45-12:00 HWTS implementation in Ghana: status and key
challenges
Kweku Quansah,
Ministry of Local
Government and Rural
Development
12:00-12:15 HWTS implementation in Kenya: status and key
challenges
Benjamin Murkomen,
Ministry of Health
12:15-13:00 Discussion
13:00-14:00 Lunch
14:00-15:15 Session 3: Promoting HWTS: approaches and
knowledge dissemination
Moderator:
Batsi Majuru
14:00-14:15 Promoting HWTS in Ethiopia: Experiences and
lessons
Alemayehu Tegegn,
PSI
14:15-14:30 The HWTS knowledge base Paul Earwaker,
CAWST
14:30-15:15 Roundtable: Successful approaches to behavior change communication
15:15-15:45 Coffee break
15:45-17:00 Session 4: Accelerating access to HWTS:
distribution options
Moderator:
Solomon Nzioka
15:45-16:00 Pathways for distribution of HWTS Hester Foppen / Lemessa
Mekonta,
Aqua for All and IRC
16:00-16:45 Discussion: Engaging utilities in distribution of HWTS
16:45-17:00 Wrap up
18
Day 2: Wednesday 4 May
09:00-09:15 Recap Day 1
09:15-10:30 Session 5a: Strengthening evaluation and
regulation of HWT performance
Moderator:
Kebede Eticha
09:15-09:45 WHO performance recommendations for HWT and
the Scheme
Batsi Majuru,
WHO
09:45-10:00 Strengthening HWT certification: Example from
Haiti
Anna Murray,
Tufts University
10:00-10:30 Discussion
10:30-11:00 Coffee break
11:00-12:30 Session 5b: Strengthening evaluation and
regulation of HWT performance
Moderator:
Waltaji Kutane
11:00-11:15 Evaluating and regulating HWT in Ethiopia:
Experiences and challenges
Seyom Wolde,
FMHACA
Almaz Gonfa,
EPHI and
11:15-11:30 HWT evaluation and regulation in Ghana:
Experiences and challenges
Genevieve Baah,
Ghana Standards Authority
11:30-11:45 HWT evaluation and regulation in Kenya:
Experiences and challenges
Benjamin Murkomen,
Ministry of Health
11:45-12:30 Discussion
12:30-13:30 Lunch and exhibition of HWT products
13:30-15:00 Session 5c: Strengthening evaluation and
regulation of HWT performance
Moderator:
Anna Murray
13:30-14:30 Country group discussion: key needs and challenges
for strengthening HWT evaluation and regulation
All
14:30-15:00 Presentation and discussion of key needs and challenges
15:00-16:30 Learning visit to EPHI laboratory
19
Day 3: Thursday 5 May
09:00-09:15 Recap Day 2
09:15-10:30 Session 6: Monitoring and evaluating HWTS use Moderator:
Benjamin Murkomen
09:15-09:30 Monitoring and evaluation of HWTS and using data
to inform improved implementation
Alex Doyen,
LifeStraw
09:30-09:45 Monitoring HWTS use: Lessons from selected
countries
Anna Murray
Tufts University
09:45-10:00 Water quality monitoring in Ethiopia Balew Yebel,
Ministry of Water, Irrigation
& Energy
10:00-10:30 Discussion
10:30-11:00 Coffee break
10:30-12:30 Session 7: HWTS as part of broader WASH
response in emergencies
Moderator:
Kebede Eticha
10:30-11:30 Roundtable discussion: Key needs for strengthening HWTS in emergencies
11:30-12:30 Session 8: Way forward: key challenges and
solutions
Moderator:
Batsi Majuru
11:30-12:30 World café: country group sessions All
12:30-13:30 Lunch
13:30-16:00 Session 8 continued: Way forward: key
challenges and solutions
Moderator:
Waltaji Kutane
13:30-14:30 The shopping bag: Country group reflections on
‘take home’ messages
All
14:30-15:15 Presentation of shopping bags (over coffee) All
15:15-15:45 Workshop evaluation All
15:45-16:00 Closing remarks Dangew Tadessa
17:00-19:00 Closing cocktail at Jupiter International Hotel
20
Appendix 2: List of participants
Name Organization Country
Suzzy Abaidoo Ministry of Water Resources, Works and
Housing
Ghana
Genevieve Baah Ghana Standards Authority Ghana
Emmanuel Dzotsi Ministry of Health Ghana
Akosua Kwakye World Health Organization Ghana
Kweku Quansah Ministry of Local Government and Rural
Development
Ghana
Adam Mohammed Ali Ministry of Health Kenya
Doyle Birika Ministry of Health Kenya
Benjamin Murkomen Ministry of Health Kenya
Samuel Wairia Ministry of Health Kenya
Solomon Nzioka World Health Organization Kenya
Alexandar Doyen Vestergaard Kenya
Paul Earwaker Centre for Affordable Water and Sanitation
Technologies
Kenya
Abiy Girma Ministry of Water, Irrigation and Energy Ethiopia
Ashagire Cherinet Regional Health Bureau Ethiopia
Desalegn Gullo SNNR Regional Health Bureau Ethiopia
Umata Negassa Oromia Regional Health Bureau Ethiopia
Dawit Siraw Addis Ababa Regional Health Bureau Ethiopia
Seyoum Wolde Ethiopian Food, Medicine and Health Care
Administration and Control Authority
Ethiopia
Almaz Gonfa Ethiopian Public Health Institute Ethiopia
Kirubel Tesfaye Ethiopian Public Health Institute Ethiopia
Zufan Abera Damtew Federal Ministry of Health, Ethiopia Ethiopia
Goitem Medhien Federal Ministry of Health, Ethiopia Ethiopia
Dagnew Tadesse Federal Ministry of Health, Ethiopia Ethiopia
Solomon Yimer Federal Ministry of Health Ethiopia
Wondeossen Assefa SETEMA Plc Ethiopia
Mesefin Saheles FMOH/GSF Ethiopia
Tadesse Wordofa AAFM&HC Ethiopia
Kebede Eticha World Health Organization Ethiopia
Waltaji Kutane World Health Organization Ethiopia
Kulule Mekonnen World Health Organization Ethiopia
Osman Yiha World Health Organization Ethiopia
21
Name Organization Country
Tewolde Birhanu Save the Children International Ethiopia
Bekele Damte Aqua for All Ethiopia
Gashaw Kebede Plan International Ethiopia
Biyazen Lake Bishan Gari PLC Ethiopia
Andrew Smith Desert Rose PLC Ethiopia
Arto Suominean COWASH Ethiopia
Alemayehu Tegegne Population Services International Ethiopia
Admasu Tesfaye Soyar Filter Ethiopia
Demelahi Woylen Tulip Filters Ethiopia
Raju Gondar University Ethiopia
Yirga Ambaw USAID Ethiopia
Melese Bekele World Vision Ethiopia
Yohannes Hagos Day One Response Ethiopia
Gashaw Kebede Plan International Ethiopia
Menassie Kifle Citrus International Trading PLC /Aquatabs Ethiopia
Lemessa Mekonta IRC-WASH Ethiopia
Shibabaw Tadesse Save the Children Ethiopia
Samel Gonfafay United Nations’ Children’s Fund Ethiopia
Tamene Gossa United Nations’ Children’s Fund Ethiopia
Happy Rugogwe Helioz GMBH Austria
Hester Foppen Aqua for All Netherlands
Anna Murray Tufts University United States of America
Batsirai Majuru World Health Organization Switzerland
23
Appendix 3: Summary of group discussion on regulation
1. What are the potential benefits of having national regulation of HWTS products?
Ghana Kenya Ethiopia (1) Ethiopia (2)
Quality control of
products on the market
Protection of public
health
Make post-market
surveillance easier
Improved knowledge
of HWTS technologies
Reduction in
counterfeits products
Increase product
efficacy
Compliance enhanced
Level ground for
investors
Consumer protection
Improved health /
livelihood
Value for money
Safety of the products
Important for safety,
quality, and efficacy of
products
Creates competition for
supply
Sustainable supply and
distribution
Regulatory agency
should differentiate
between products
which work and don’t
work
Ensures the quality,
safety, and efficacy of
the products
2. What are potential difficulties/drawbacks to having national regulation of HWTS products?
Ghana Kenya Ethiopia (1) Ethiopia (2)
Inadequate human/
material resources
Lack of standards
Lack of political will
Time and money /
Weak enforcement
Capacity (human,
materials, equipment)
Weak coordination
Might discourage
some stakeholders
Regulation doesn’t
solve any problem
3. Who should be involved in developing a regulation framework?
Ghana Kenya Ethiopia (1) Ethiopia (2)
Ministry of Local
Government and
Rural Development
(lead ministry
responsible for
HWTS)
Ministry of Water
Ghana Standards
Authority
Ministry of Health,
Food & Drugs
Authority, Ghana
Health Service
Government
Consumer
Manufacturer
Distributers
GSO
NGOs
Donor groups
Political institutions
Ethiopian Food,
Medicine and Health
Care Administration
and Control Authority
Federal Ministry of
Health
Ethiopian Public
Health Institute
Standards Authority
Ministry of Finance
Ministry of Water,
Irrigation and Energy
Private sector
(manufacturers,
distributers,
importers)
NGOs
UN
Public sector
Private sector
NGOs
24
4. What are potential barriers to creating and implementing a regulation framework?
Ghana Kenya Ethiopia (1) Ethiopia (2)
Long procedures in
enacting laws
Lack of control at
unauthorized routes
(borders)
Low knowledge on
HWTS products
Inadequate human
resource capacity
Interferences
(traditional authorities,
politicians)
Low political will
Conflicting interests
with the players
Lack of champion of
HWTS regulation
Expertise / capacity to
implement
Global market
dynamics
Lack of national
standards for HWT
performance, and
comprehensive
regulation
Limited access to
accredited
laboratories
There is no clear
mandate on regulation
of HWTS –
particularly filters
There is no capacity
to perform
performance
evaluation tests
Getting enough
budget to perform the
tests
Tax exemption
5. What components, beyond laboratory efficacy testing, would be useful to evaluate for HWTS
products?
Ghana Kenya Ethiopia (1) Ethiopia (2)
User-friendly
instructions
Field evaluation data
Submission of dossier
from manufacturers
(i.e. composition of
chemical products,
quality control
information)
Instructions / labelling
Clarity / simplicity of
use
Lot number/expiry
date (for chemical
products)
Materials safety
Independent reviews
with clear guidelines
provided to the
Technical Working
Group
Dossier on system
(product information)
User-friendliness
(cultural, beneficiary
perception, ease of
use)
Availability of the
product
Safe storage should be
considered
Robustness of the
product to the local
water (including
durability)
Simplicity of
operation