sanitary survey of public drinking water sources in slums of bhubaneswar, odisha (1)

A Study Conducted in Slums of Bhubaneswar, Odisha

Sanitary Survey of Public Drinking Water Sources

H e a l t H o f t H e U r b a n P o o r P r o g r a m

Prepared byHealth of the Urban Poor (HUP) ProgramPopulation Foundation of IndiaB-28, Qutub Institutional Area,New Delhi – 110016

AuthorBiraja Kabi SatapathyNiladri Chakraborti

Special InputsShipra SaxenaMerajuddin AhmadDr. Sainath Banerjee

PhotographsHUP

Published January 2015

Copyright: The contents of this publication may be used freely for not-for-profit purposes, provided the users duly acknowledge the Publishers. However, anyone intending to use the contents for commercial purposes must obtain prior permission from the publishers.

Sanitary Survey of

Public Drinking Water Sources

A Study Conducted in Slums of Bhubaneswar, Odisha

2

The study gives details of the survey

undertaken, its findings, and suggestions

for ensuring drinking water quality in the

slums of Bhubaneswar.

3Sanitary Survey of Public Drinking Water SourceS

Summary

The sanitary survey of drinking water sources was done in Bhubaneswar slums where PFI is running the Health of the Urban Poor Program. The purpose was to understand the risk to public drinking water sources based on onsite inspection and water testing of the source with field test for pipe water supply and H2S bacteriological contamination test for all the sources. The study report gives details of the survey undertaken, its findings, and suggestions for ensuring drinking water quality in the slums of Odisha. The report tried to capture the result of the indicator-wise sanitary inspection and its relation with other indicators. We hope the study will be useful for the government for making some policy level corrections. We also hope that Government, Non Government and civil society organisations will adopt the sanitary survey as a tool for identifying factors that affect drinking water sources, which is essential for drinking water safety

acknowledgements

We are grateful to field level staff of PFI-HUP for

conducting the onsite inspection of public drinking

water sources in 168 slums of Bhubaneswar. They

diligently tested all public drinking water sources with

the H2S bacteriological contamination test kit, and

the public pipe water supply through stand posts for

residual chlorine test.

We are thankful to community representatives,

Anganwadi workers, Accredited Social Health Activists,

councillors of respective wards of Bhubaneswar

Municipal Corporation, local community leaders,

youth and women of the slum for participating in the

onsite sanitary inspection of drinking water sources in

their respective slums. Our special thanks go to the

members of Mahila Arogya Samiti (women’s group) for

their enthusiasm in helping the HUP workforce.

The study report has been shared in three round table

consultations in Odisha in the cities of Cuttack, Rourkela

and Bhubaneswar during March 2014.Officials from the

departments of Health and Family Welfare, Housing

and Urban development, Public Health Engineering

Organisation, Odisha Water Supply and Sewerage

Board, urban local bodies, civil society organisations,

and representatives of development partners like

UNICEF, World Bank, Practical Action, One Drop took

part. A similar round table was organised in New Delhi

in June 2014 at Population Foundation of India where

WASH experts from various leading development and

UN organisations like the World Bank, UNICEF, Water

Aid, Water for People, AKVO, CURE and FORCE, and

corporate houses like Coca Cola and FICCI participated.

We acknowledge and value the suggestions by all the

participants at these four round table consultations.

5

ContentsSummary 3

acknowledgements 4

Chapter 1: Introduction 6

1.1 Sanitary Completion and Health 6

1.2 The Nature of Risk to Water Sources 7

1.3 Sanitary Survey for Sanitary Completion 8

1.4 Rationale for Undertaking the Current Study 10

1.5. Objective of the Study 11

Chapter 2: Sanitary Survey methodologies 12

2.1. Type of Drinking Water Sources Surveyed 12

2.2. Study Area 14

2.3. Risk Assessment of Drinking Water Sources 15

2.4. Precautions Taken During Drinking Water Sample Collection 18

2.5. Survey, Ratification and Validation of Data 18

2.6. Software Used for Data Analysis 18

2.7. Expected Outcome of this Study 18

2.8. Limitation of this Study 19

Chapter 3: findings of the Study 20

3.1 General Findings 20

3.2 Source wise Findings 27

Chapter 4: Suggestions 43

4.1 For Surveillance of Sources and Action 43

4.2. For Prioritisation of Area and WASH Intervention 46

4.3. For Community Participation 46

4.4. Advocacy with the Government 48

annexure I : Ward Wise Water Source Distribution 50

annexure II: Code of Slums Where Survey was Conducted 51

annexure III: repeat residual Chlorine test regime 56

annexure IV: Sanitary Survey formats 57

annexure V: Source Wise risk factors Segregation matrix 64

references 65

acronyms 68

6 Sanitary Survey of Public Drinking Water SourceS

1.1 Sanitary Completion and HealthSanitary completion impacts the microbial quality of water. It is essential to prevent the direct contamination of groundwater or surface water supplied through pipelines at the point of abstraction or point of collection, from the rapid recharge pathways close to the source. Sanitary completion includes underground and over ground construction of the abstraction facility, as well as the immediate area surrounding the abstraction point (Howards et al, 2006). Poor sanitary completion allows ingress of contaminated water close to the point of abstraction, and therefore, may short-circuit protection measures designed to limit risks from pathogens.

The direct contamination of drinking water sources caused by poor sanitary completion has been linked to both endemic and epidemic diseases. Outbreaks linked with poor sanitary completion have been noted in many countries. For instance, Olsen et al (2002) related an outbreaks of E. coli in Alpine, Wyoming, including cases of hemolytic uremic syndrome, to a poorly protected spring. Sanitary survey further identified the spring at risk from contamination by surface water. Poor sanitary completion measures also appeared to have played a role in the Walkerton outbreak in Canada (O’Connor, 2002). In developing countries the use of poorly protected groundwater sources have been linked to acute diarrheal diseases (Trivedi et al, 1971, Nasinyama et.al 2000). In November 2003, Odisha witnessed an outbreak of cholera at Parbatia, which was found associated with an unprotected well (Das et al, 2009).

The effectiveness of sanitary completion in reducing risk of all pathogen is profound as it provides barriers to direct contamination of sources. (Robertson & Edberg, 1997). However multiple interventions are required to act as barriers.

Chapter 1: Introduction


1.2 The Nature of Risk to Water SourcesFor sanitary completion measures, it is important to understand the multiple factors leading to contamination of drinking water sources. There are ranges of factors that may compromise quality close to water sources. These can be broadly categorised into hazard, pathway and indirect factors (Howard A. G., 2002).

• Hazard factors: These are sources of fecal material located in the environment which contaminates the water. An example is a pit latrine overlying an aquifer and close to an abstraction point.

• Pathway Factors: These are the potential routes by which contamination may enter into the water supply. Pathway factors include cracks in the lining of borehole, improperly sealed apron, etc. Pathway risk factors often result from poor operation and maintenance.

• Indirect factors: These represent a lack of control measures to prevent contamination (and therefore, increase the likelihood of a hazard or pathway developing) but do not themselves represent either a hazard or pathway. An example is a fence around water source. Absence of fence will not lead directly to contamination but may allow animals or humans to gain access to the source and create either a hazard (by defecating) or a pathway (by causing damage to the source or its immediate surroundings).

The source-pathway-receptor model of contamination is also relevant to sanitary completion of water sources. In this model, the source is the source of hazards, the receptor is the water supply and the pathway is the means by which the hazard can leave the ‘source’ and reach the receptor (Godfrey & Howard, Water Safety Plans (WSP) for Urban Piped Water Supply in Developing Countries, 2004).

The model recognises that the presence of hazards in the environment is insufficient on its own to represent a risk. A feasible pathway must exist that allows hazards to travel from source to the water supply.

BOx 2: Salient featUreS of

Sanitary SUrvey

• It’sacheapprocess.

• Ittellsuswhatneedtobedoneto

improve and protect a water source.

• Itreducesrisksofoutbreaksof

waterborne diseases.

• Ithelpstoprotectpublichealth.

• Oftensanitarysurveyispreferred

over water quality analysis alone, as

the latter can’t identify the sources of

contamination.

BOx 1: SoUrce – PatHway- receP-tor relationSHiP

Pathway

Receptor

Vulnerability of the water supply

Receiving water infrastructure

Source

Hazard event/environment


1.3 Sanitary Survey for Sanitary CompletionSanitary survey provides an easy but effective way of monitoring sanitary completion, particularly when this employs a standardised and quantifiable approach (Lloyd and Bartram, 1991; Lloyd and Helmer, 1991). Sanitary survey involves two principal activities, one is sanitary inspection and other is water-quality analysis. Sanitary inspection is done on-site to identify actual and potential sources of contamination of a water supply that pose potential danger to the health and well being of the consumers. The first attempt of the expert called into pronounce upon the character of potable water should be made through sanitary inspection (Prescott and Winslow, 1904). When sanitary inspection of drinking water sources is made in conjunction with water quality testing, it is called a sanitary survey. Sanitary inspection identifies potential hazard, while water-quality analysis indicates whether contamination is occurring and, if so, its intensity.

According to World Health Organization (WHO, 1997), Sanitary inspection is an on-site inspection and evaluation by qualified individuals of all conditions, devices and practices in the water-supply system that pose an actual or potential danger. In the preamble to the “Interim Enhanced Surface Water Treatment Rule (IESWTR)”,1 United States Environment Protection Agency defines a sanitary survey is defined as: “An onsite review of the water source (identifying the source of contamination using results of source water assessment where available), facilities, equipment, operation, maintenance, and monitoring compliance of a public water system to evaluate the adequacy of the system, its sources and operations and the distribution of safe drinking water”.

There is a need to conduct sanitary surveys on a routine basis to prevent contamination of drinking water supply and eventually reduce public health hazard. The information is used to take appropriate remedial action to improve or protect the water supply. Sanitary surveys are an opportunity to work and communicate with the water system in a preventive mode (USEPA, 1999). A sanitary survey should also be considered in the following cases:

1 United States Environment Protection Agency (EPA), The Interim Surface Water Treatment Rule, June 2001: In 1989, EPA issued two important National Primary Drinking Water Regulations (NRDWR): The Total Coliform Rule (TCR) and The Surface Water Treatment Rule (SWTR). The IESWTR builds on the TCR by requiring sanitary surveys for public water systems using surface water and ground water under the direct influence of surface water.

Sanitary inspection is

done on-site to identify

actual and potential

sources of contamination

of a water supply that

pose potential danger to

the health and well being

of the consumers.


• When contamination is suspected, to identify the likely cause

• During an epidemic of water borne diseases like cholera, to identify potential sources or risks

• To interpret results from water-quality analysis, to establish how the water became contaminated

The limitation of sanitary inspection is that it can determine the most obvious source of contamination, but may not reveal all sources of contamination. Therefore, water sources that show low or intermediate risk for contamination should still be tested for bacteriological contamination to confirm the result. The assessment criteria in many standard sanitary inspection forms are scored on a two-way ‘yes or no’ answer. The possibility of variations between the set out criteria in the forms and the observed sanitary faults are not provided for within the two-way answer system, thereby making the assessment rigid. The scores, therefore, may not represent the correct sanitary problem, as they may either exaggerate or underplay particular risk factors (Oluwasanya, Smith, & Carter, 2011).

Odisha is one of the top five states with

23.1% of its urban households

located in slums.

377 slums out of which only 99 slums are

authorised

1,63,983 people reside in slums across

the BMC


1.4 Rationale for Undertaking the Current Study According to Census 2011, Odisha is one of the top five states with 23.1% of its urban households located in slums. A total of 1,63,983 people reside in slums across the Bhubaneswar Municipal Corporation (BMC) area and its outgrowth (Census 2011). The city has a total of 377 slums out of which only 99 slums are authorised (BMC, 2009). Most of the slums have sprung up on unutilised government land, and railway lands which were lying temporarily vacant. Low income group people reside in those areas in poor living condition devoid of basic services and amenities (Mohanty & Mohanty, 2005). With the proliferation of slums, the city started getting its share of challenges in terms of complex disease etiologies and risk factors.

As per a study, Urbanisation and its Implications for Child Health, three major type of pathologies are emerging in the urban slums of Third World countries. One of these is infectious and gastro-intestinal diseases, often termed as ‘diseases of poverty’. Though these have largely disappeared from the developed nations, they are a major source of mortality and morbidity among children and women in developing countries (WHO & UNEP, 1988). Slums in Bhubaneswar are not an exception. Often this type of pathology is found in direct correlation to the poor infrastructure for drinking water and sanitation. The access to safe water supply in slums gets compromised as inadequate sanitation, drainage and poor solid waste disposal invoke ‘hazard factors’ for water sources. Further, poor operation and maintenance leads to ‘pathway factors’. As most of the slums are un-notified, provisioning of water supply, maintenance and management of drinking water sources gets limited attention (Sajjad, 2014 & Subbaraman, et al., 2013). In slums, there are numerous ‘indirect factors’ as well which pose a risk to drinking water sources. With these arrays of risk factors, slum dwellers are entangled in a vicious cycle of morbidity caused by waterborne


diseases. This cycle can only be broken once the predominant risk factors are indentified and corrective measures taken. Adopting such measures demands ownership and collective action. The current study is relevant especially in the slum context.

HUP-PFI Odisha, under its city demonstration program, conducted a sanitary survey of 742 water sources spreading across 168 intervening slums in 25 wards of Bhubaneswar Municipal Corporation

from May 3 to August 14, 2013. Out of 168 slums, only 30 slums are notified and rest 138 slums are non-notified. All the public drinking water sources used by slum dwellers in the study area were considered for the survey.

1.5. Objective of the StudyThe study survey aimed to do an onsite review of the public drinking water sources, facilities, equipments, operation and maintenance of water supply system in HUP- PFI intervening urban slum areas for calculating the risk factors and taking the necessary remedial measures in coordination with concerned government departments and urban local bodies. The following were the objectives of the study:

• Identify potential sources of contamination risk associated with water supply

• Quantify the hazard attributed to the sources and supply

• Clearly explain the hazards to the user and provide guidance for the remedial action required to protect and improve the supply

• Generate primary data for research to be used in systematic, strategic planning for improvement in quality water supply and minimising risk

• Analyse gaps in the water supply system and suggest ways to bridge them.

The access to safe water supply

in slums gets compromised as

inadequate sanitation, drainage

and poor solid waste disposal

invoke ‘hazard factors’ for water

sources.


Chapter 2: Sanitary Survey methodologies

2.1. Type of Drinking Water Sources SurveyedThe sample strategy was based on capturing all types of water sources like unprotected dug well, protected dug well, tube well (majority India Mark II), bore well fitted with mechanical pump and pipe water supply through stand posts commonly used by the community in Bhubaneswar slums. A couple of protected dug wells were also found and inspected. Table 1 below describes each type of drinking water source surveyed in the study.

According to WHO and UNICEF (2010), the first four types of drinking water sources mentioned in Table 1, i.e. the stand post, tube well fitted with hand pump, bore well fitted with mechanical pump and protected dug well are categorised as improved water sources and the remaining type, that is the unprotected dug well, is an unimproved water source.

Out of total 742 public drinking water sources surveyed, pipe water supply through stand posts stood at 293 (around 40% of the sample size), bore wells fitted with mechanical pump were at 108 (15%), tube wells with hand pump were at 177, (almost 24%), while unprotected dug wells were 162 (22%) and protected wells were just two in number. Hence, in the study area, the stand post was found the major water source, followed by the tube well fitted with hand pump, the unprotected dug well and bore well fitted with mechanical pump. The table 2 depicts the distribution of inspected water sources:


TABLE 1: tyPeS of drinking water SoUrceS SUrveyed witH illUStration

Water Source Type Description

Stand post Piped water supply through a stand post consists of a water-lifting mechanism from source, a distribution network through pipe lines and individual delivery points such as public stand posts. Treated water is generally supplied through piped network.

Tube well fitted with hand pump

Ground water could be extracted through a tube well with a hand pump. This consists of a borehole, a platform with a drainage and soak away pit which protects from surface water infiltration and contamination, and a hand pump – the water lifting device.

Bore well fitted with mechanical pump

Mechanical pumps are generally used to draw water from much greater depth through drilling a borehole to reach deep aquifers. Water from deep bore holes is less likely to be affected by pollutants originating from land or surface waters.

Protected Dug well

A dug well is covered from the top with a concrete slab and the hole at the centre draws water through a hand pump or a mechanical pump to minimise the likelihood of contamination. Ideally the top cover stands about a foot above the ground.

Unprotected dug well Unprotected dug wells are uncovered from top. Open or poorly covered well heads pose the commonest risk to well-water quality. The water may be contaminated by the use of inappropriate water-lifting devices by consumers.

Source: Preparation of pictorial illustrations on access to water supply and sanitation facilities for use in national household surveys , prepared for JMP, by UNICEF & WHO)


TABLE 2: diStribUtion of inSPected drinking water SoUrceS

Types of source Frequency Percent

Stand post 293 39.5

Bore well with mechanical pump

108 14.6

Tube well with hand pump 177 23.9

Protected dug well 2 0.3

Unprotected dug well 162 21.8

total 742 100.0

2.2. Study AreaThe current study was conducted in 25 out of 60 municipal wards2 of Bhubaneswar Municipal Corporation (BMC). The study area covers 168 slums out of 3773 where Health of The Urban Poor Program has its presence. Out of total 168 slums 138 are notified or authorised and 30 are non-notified or unauthorised slums4. Figure 1 depicts the study area -

FIGURE 1: maP SHowing SUrveyed wardS in bHUbaneSwar

2 During the study period, the number of wards in Bhubaneswar was 60, but as per the Government of Odisha, Housing and Urban Development Department notification No. Ele 165/2013/26459 dated 24.08.2013, the area of the Municipal Corporation is divided into 67 wards.

3 As per Bhubaneswar slum profile, Bhubaneswar Municipal Corporation, 2009, there are 99 authorised slums and the rest 278 are unauthorised slums.

4 Authorised slums are with dwellers having land rights. Unauthorised slums are with dwellers not having land rights and staying on Central/state government lands.

293

177

108

162

2

Stand post Tube wellBore well with fitted with mechanical pumpsUnprotected dugwellProtected dug well


2.3 Risk Assessment of Drinking Water Sources

2.3.1 Risk Assessment by Onsite Sanitary Inspection

The sanitary inspection report forms are designed so that every fault that may reduce the quality of the supply is listed and checked during sanitary inspection. Each fault represents a sanitary hazard. (WHO, 1997)

The sanitary inspection form prescribed by WHO was customised to the urban context and translated into the local language (Oriya). The standardised survey formats consist of a set of 10-12 diagnostics questions which capture dichotomous response either “yes” or “no” for on-site inspection of various categories of sources. The questions are structured in a way, so that the ‘’yes’’ answer indicates that there is a risk of

contamination, and the ‘’no” answer indicates that the particular risk is absent. Each “yes” answer scores “1” and “no” answer scores “0” attributing same value to each risk factor (usually 1/10-12) based on statistical correlation between the importance of microbiological/chemical contamination as determined by laboratory analysis and different diagnostic information identified through sanitary survey (Ferretti, et al 2010). At the end of the inspection, all the affirmative responses (yes) collectively decide the risk of contamination of each source. Based on the score, the risk of contamination is classified as low [0-2]; intermediate [3-5]; high [6-8] and very high [9 and above].

2.3.2 Water Quality Testing along with Sanitary Inspection

Sanitary inspection identifies the potential hazards of drinking water sources, while water quality analysis indicates the actual quality of water and the intensity of contamination. Two tests were done under the current study along with the inspection. One was the presence – absence test of E.Coli5 (Fecal Indicative Organism) in water samples which indicates the fecal contamination. It is not feasible to test every type of human pathogen that may be present in an aquatic environment. This is due to their great diversity spanning the phylogenetic spectrum from virus and bacteria to protozoa and worms, and because detection methods are often difficult and costly (WHO, 1999). Therefore FIO is used as proxy-indicator of increased probability of pathogens’ presence (EPA, 1986; WHO, 1999;WHO, 2003). This test was

5 Escherichia Coli –a thermo tolerant (TTC) bacteria- is a member of fecal coliform group and is more specific indicator for fecal pollution than other (Odonkers et al, 2013)

Sanitary inspection identifies the potential

hazards of drinking water sources, while

water quality analysis indicates the actual

quality of water and the intensity of

contamination


conducted for all the sources surveyed. The second test was to find trace of residual chlorine in piped water supply and bore well fitted with mechanical pump.

2.3.2.1 Water Testing by H2S Bacteriological Kit

In order to test for faecal contamination, the sample water was collected in H2S vials from each drinking water source that was inspected. The Hydrogen Sulphide (H2S) vial is a useful tool for screening water sources and drinking water for faecal contamination.6 The H2S strip is easy to use and readily available.

The method of testing by the H2S kit:

• Dry and sterile media are provided in thescrew-capped bottles, which are ready for use. Fill the water to be tested in bottle up to the mark and cap it.

• Shakethebottlegentlyafterfiveminutestodissolve the contents completely.

• Keepitatroomtemperaturepreferablyat25-35 degree Celsius for 24 to 48 hours (WHO, 2002).

• Observeforblackeningofthecontents.

• If thewater turnsbrownorblack, it is likelythat it is not fit for drinking.

H2S test uses a medium with thiosulphate as a sulphur source and ferric ammonium citrate as indicator. During incubation, hydrogen sulphide is produced by some enteric bacteria — E. coli by reducing thiosulpahte. Hydrogen sulphide then reacts with ferric ammonium citrate producing a black insoluble precipitate and indicating the presence of the bacteria (Mosley & Sharp, 2005).

6 The results for bacteriological contamination using H2S strip technique are at best indicative and in case of contaminant detection, one must go for further testing to a water quality laboratory.

FIGURE 2: fecal contamination PreSent-abSent teSt witH H2S vial

FIGURE 3: reSidUal cHlorine teSt witH dPd-faS kit


2.3. 2. 2 Water Testing by Chlorine Field Test Kit

The presence of chlorine residual in drinking water indicates that:

• Asufficientamountofchlorinewasaddedinitiallytothewater to inactivate the bacteria and some viruses that cause diarrheal disease; and

• The water is protected from recontamination duringtransportation and storage. The presence of free residual chlorine in drinking water is correlated with the absence of disease-causing organisms, and thus is a measure of the portability of water.

When chlorine is added to drinking water, it proceeds through a series of reactions. Some of the chlorine reacts first with organic materials and metals in the water and is not available for disinfection (this is called the chlorine demand of the water). The remaining chlorine concentration after the chlorine demand is accounted for is called total chlorine. Total chlorine is further divided into: 1) the amount of chlorine that has reacted with nitrates and is unavailable for disinfection which is called combined chlorine and, 2) the free chlorine, which is the chlorine available to inactivate disease-causing organisms, and thus a measure to determine the potability of water (CDC, 1990).

In current sanitary survey water samples from all inspected stand post and bore wells fitted with mechanical pump were collected and tested for residual chlorine with a DPD (N, N-diethyl-p-phenylenediamine – FAS (Ferrous Ammonium Sulphate) reaction based filed test kit.7

The method of testing by the chlorine field test kit:

According to the method described with the field test kit,, a buffered DPD indicator powder is added to a water sample which reacts with chlorine to produce the pink color characteristic of the standard DPD test. Ferrous Ammonium Sulfate (FAS) solution of appropriate strength is then added drop by drop until the pink color completely and permanently disappears, signaling the endpoint of the reaction. To get the reading, the number of drops used to cause this color change is multiplied by the factor (as it was given 0.1 in this test method along with the test kit) for the concentration of free chlorine in the water sample.

7 DPD (N, N-diethyl-p-phenylenediamine), is the most common method for measuring free chlorine. At near neutral pH chlorine oxidizes the DPD to form a pink colored compound. Utilizing this, the quantitative technique suitable to measure free chlorine at site has been developed. A reducing agent, Ferrous Ammonium Sulphate (FAS) is used as a titrant which reacts and changes the pink colored solution to a colorless solution, the end point. (Harp, 2002)


2.4. Precautions Taken During Drinking Water Sample CollectionEvery sample collected in an H2S vial was marked with unique code8 along with the date and time of collection of water sample. To make sure that sample collected from a tube well represents ground water, only after sufficient pumping, it was collected in the vial. To minimise the reporting of false positivity due to the presence of bacteria in the spout of tube well and the tap of the stand post, a sample was collected only after disinfecting the spout and taps by burning with match sticks or a lighter. Precaution was also taken while handling the H2S vial. Directly touching the rim and filling water to the brim was avoided to ensure that bacteria gets enough space to thrive.

2.5. Survey, Ratification and Validation of DataThe survey was carried out by the front line workers of Health of the Urban Poor (HUP) Program. The surveyors were trained on using the simple and standard survey format. They were sensitised on the importance of safe water for health and factors that affect the water quality at source and at point of use. They were also trained on how to use H2S bacteriological testing kit and residual chlorine testing kit while conducting the survey in the field. Each surveyor was given a kit, containing an H2S vial, a sticker for putting the code on the vial, a marker, a small bucket with a rope for collecting water from a dug well, a match box, and a measuring tape. The community was represented in the field at the time of the survey through the slum secretary, president, Mahila Arogya Samiti (MAS – women’s group) members, and the Anganwadi worker. After the respective format for each source was filled, it was duly signed by the community representatives to ratify the information. In many cases, members from MAS actively participated in collecting the water sample from the sources. The entire process of data collection was monitored and validated by the HUP state and city teams during and after the sanitary survey activity.

2.6. Software Used for Data Analysis Software like MS Excel 2010, SPSS v16 were used for data warehousing and subsequent analysis. Other than calculating simple frequency and percentage, some bi-variate and multivariate correlation, regression was done to find the association between contamination and several risk factors as per the standard protocol. Considering the cross sectional nature of the study, the odds ratio was calculated in 95% confidence interval and the chi-square test was done to explore if there is any significant association between risk factors and contamination. The software Aarch View 3.2 was used for mapping.

2.7. Expected Outcome of this StudyThe sanitary inspection survey of all types of public drinking water sources located in the intervention slums of Bhubaneswar will help in:

• Raising awareness on factors that affect the drinking water source and draw attention on operation and maintenance of sources

• Developing models of water safety plan in vulnerable slums followed by specific WASH intervention

8 Program code/Slum code/Source code/Location of the source code


• Provide an opportunity to enhance knowledge for operation and maintenance of water sources

• Developing WASH sector specific BCC and capacity building strategies making drinking water as a focal point

• Identifying vulnerable slums for intervention on priority under NUHM, RAY, JnNURM etc.

• Advocating with respective state agencies and ULBs for strengthening WASH service provision

2.8. Limitation of this StudyIn this study, samples from all public drinking water sources used by the slum dwellers were taken, and individual drinking water sources were excluded. Further, as the sanitary survey exercise was done once, from May to August 2013, the comparison of pre and post monsoon analysis could not be done. The test to trace bacteriological contamination and the presence of residual chlorine in the collected water samples was done by the field test kit only. Samples from water sources that were found with bacteriological contamination could not be confirmed by a lab test.

• Individualdrinking

water sources were

not taken

• Preandpost

monsoon analysis not

done

• Testingofwaterdone

by field test kit only


3.1 General Findings

3.1.1 Contamination Risk of Various Drinking Water Sources

Irrespective of the type of source, the current survey reveals that 19 % of the total sources come under low category of risk, whereas 43% belong to intermediate, 35% to high and 2% come under the very high category of risk.

TABLE 3: riSk Pattern for water SoUrceS

Category of risk Frequency Percent

Low 144 19

Intermediate 320 43

High 260 35

Very high 18 2

total 742 100.0

It is evident from Table 3 that majority of the water sources either come under the intermediate or high risk category.

Chapter 3: findings of the Study


TABLE 4: Percentage of SoUrceS aS Per riSk category

Category of risk Type of sources (in percentage)

Stand post Tube well

with hand

Pump

Bore well with

mechanical Pump

Protected

dug well

Unprotected

dug well

Low (n=144) 55.6 18.1 9.7 0.7 16.0

Intermediate(n=320) 41.2 22.2 17.5 0.3 18.8

High(n=260) 31.2 30.0 13.5 0.0 25.4

Very High (n=18) 0 11.1 16.7 0.0 72.2

Source wise further exploration (Table 4) shows that stand post tops the list of low risk category sources (55.6%, n= 144), while unprotected dug well occupies the top slot of very high risk category of sources(72.2%, n=18).

The spread of contamination risk scores are presented in Figure 4 where the upper and lower points represent maximum and minimum. Boxes indicate 25th and 75th percentile boundaries. The intersecting line in each box represents the median value. The median risk score of stand post was found 4 with Inter Quartile Range 2,6 which is also the median risk score for the bore well fitted with mechanical pump with different IQR[3,6], median risk score for both tube well fitted with hand pump and unprotected dug well is 5 with same IQR[3,7]. So on an average, the stand post and the bore well fitted with mechanical pumps

STAND POST

Cont

amin

atio

n ri

sk s

core

BORE WEL WITH MECHANICAL

PUMP

TUBEWEL WITH HAND

PUMP

PROTECTEDDUG WEL

UNPROTECTED DUG WEL

12

10

8

6

4

2

0

FIGURE 4: median riSk Score of water SoUrceS


emerged as better performing water sources in the slum context in comparison to the tube-well and unprotected dug well. The median risk score for the protected dug well was even lesser than the stand-post. However, the sample size of the protected dug well was not representative enough to conclude anything.

3.1.2. Bacteriological Contamination of Various Sources

Water sample from each inspected source was collected in an H2S vial and was allowed to incubate for the prescribed time i.e. 24 to 48 hours. Based on the change of the colour of the sample (black or deep brown) the sample was considered positive, i.e. trace of fecal contamination was confirmed. Table 5 represents the result of the test for all water sources.

Twenty three percent of the sources were found with fecal contamination, while 77% of the sources were found to be free from it during the survey. In other words, almost one in every four water sources was found to be contaminated with the bacteria.

3.1.3 Source Wise Bacteriological Contamination

As expected, the maximum proportion of unprotected dug wells, which are an unimproved source, were found with the contamination (52%, n=162), followed by tube wells fitted with hand pump (29%, n=177). Table 5 shows the percentage of different sources found positive during water source inspection.

TABLE 5: diStribUtion of contaminated SoUrceS

Type of drinking water sources % reported with contamination

Stand Post (n=293) 10

Bore well with mechanical pump(n=108) 8

Tube well with hand pump(n=177) 29

Protected dug well(n=2) 0

Unprotected dug well(n=162) 52

Traces of fecal bacteria were also detected in around 10% of the stand posts. In slums, both dug wells and tube wells cater to large chunks of population alongside piped water supply. The vulnerability of both the sources for bacteriological contamination reveals the magnitude of the population at risk of several water borne diseases.

3.1.4. Correlation between Bacteriological Contamination and Risk Categories of Water Sources

The current study tries to establish the connection between the bacteriological contamination of drinking water sources along with their risk results obtained from onsite sanitary inspection. A cross tabulation shows that majority of the contaminated sources belong to either the intermediate or high risk category. A greater risk of contamination is associated with a higher grade of contamination. In the present case, a Chi-square test establishes significant association between bacteriological test positivity and higher contamination risk score with χ2 = 9.15, p(0.027)<0.05. However, a high sanitary risk score with a low


level of contamination or no contamination still requires urgent action, as water quality in such sources gets compromised following rainfall (Howard et al, 2003; Godfrey et al, 2006). This indicates the outburst of contamination any time and the need for preventive action.

TABLE 6: contamination and riSk category croSS tabUlation

Sources Category of risks

low (%) Intermediate (%) High (%) Very high (%)

total

Contaminated 17 40 39 5 N1=173

Not Contaminated 20 44 34 2 N2= 569

N=742

A bivariate correlation test (Pearson Correlation)9 further establishes significant positive correlation between the bacteriological contamination of a source and its corresponding risk score or category of risk.

9 Pearson’s correlation coefficient is a statistical measure of the strength of a linear relationship between a paired data. In a sample it is denoted by r and is by design constrained as -1≤r≤1. Positive value denotes positive correlation and negative value denotes negative correlation. The closer the value is to 1 or -1, the stronger the correlation.

FIGURE 5: ward wiSe diStribUtion of contaminated SoUrceS

Water sample from each inspected

source was collected in an H2S vial

and was allowed to incubate for the

prescribed time i.e. 24 to 48 hours.


TABLE 7: PearSon correlation PreSentation

Correlations

Water safe or not Category of Risk

Water safe or not Pearson Correlation 1 .081*

Sig. (2-tailed) .028

N 742 742

Category of Risk Pearson Correlation .081* 1

Sig. (2-tailed) .028

N 742 742

* Correlation is significant at the 0.05 level (2-tailed).

3.1.5 Identification of Vulnerable Wards in terms of Contaminated Water Sources

The color coded map of Bhubaneswar (Figure 5) is to show the spread of vulnerable wards in terms of percentage of contaminated sources identified against total sources surveyed in those respective wards.

3.1.6 Distribution of Water Sources across Municipal Wards According to their Risk Category

The current study has categorised all the water sources located in the study area based on responses to the diagnostic questions. Figure 6 presents the percentage of water sources identified under each risk category out of the total number of water sources surveyed within each slum. Extrapolation of this graphical interpretation may help in categorising and prioritising while taking remedial measures.

12 26 45 56 47 27 31 11 2 9 16 53 57 15 32 52 58 54 1 33 7 30 34 8 460

10

20

30

40

50

60

70

Low

FIGURE 6: ward wiSe Percentage diStribUtion of tHe water SoUrceS witH low riSk category


Figure 6 represents the distribution of low risk category water sources across the surveyed wards. Slums located in Wards 12, 26, 45 and 56 were not identified with any sources belonging to the low risk category. Ward 46 was identified with having maximum percentage of low risk sources. According to the Figure 5, this ward belongs to the green zone, where 0-5 % of the total sources were found contaminated with fecal bacteria. Ward number 12 was also found in green zone though no low risk sources were identified in the slums of this municipal ward.

Figure 7 shows that other than Ward 12, all wards have a considerable proportion of water sources belonging to the intermediate risk category. Bacteriological contamination wise however, those wards come under the entire range of green to red category (Figure 5).

12 2 27 1 33 26 7 32 30 46 34 8 57 54 11 53 31 16 15 58 9 47 45 56 520

10

20

30

40

50

60

70

80

90

FIGURE 7: ward wiSe Percentage diStribUtion of water SoUrceS witH intermediate riSk category


FIGURE 9: ward wiSe Percentage diStribUtion of water SoUrceS witH HigH riSk category

Figure 9 presents the predominance of very high risk category of water sources in seven wards. According to bacteriological contamination vulnerability spectrum presented in Figure 5, none of these wards comes under the green category and are closer to the red category. In terms of taking remedial measures these wards demand top most attention.

52 46 8 34 30 15 58 16 56 45 9 47 54 7 53 11 31 57 33 32 1 2 27 26 120

20

40

60

80

100

120

FIGURE 8: ward wiSe Percentage diStribUtion of water SoUrceS witH HigH riSk category

1 11 12 26 31 32 33 45 46 47 52 53 54 56 57 58 8 9 7 15 30 34 16 2 270

2

4

6

8

10

12

14

The above chart represents the distribution of water sources belonging to the high risk category across the surveyed wards. The critical observation here is that though Ward 12 was in green type in terms of bacteriological contamination of water sources (Figure 5), yet it was detect with 100% high risk sources. As we know water quality varies seasonally (Godfrey et al, 2006), water quality in such sources mostly get affected post a rain event (Howard et al, 2003). Eventually a single measure may often present such ambiguous findings, which otherwise can be ruled out by more frequent assessments (Luby, et al., 2008).


3.2 Source Wise Findings

3.2.1 The Stand Post

3.2.1.1 Proportion of Stand Posts Belonging to Different Contamination Risk Categories

In present study, a total of 293 stand posts were inspected out of which 27% were found belonging to the ‘low risk’ category, 45% were in the ‘intermediate risk’ category and 28% were in the high risk category. No stand post was found in the ‘very high risk category’. It is evident from the data that in a slum context even the safety of pipe water supply, which is considered as one of the development indicators, gets compromised. Though only 10% of the total inspected stand posts (n=293) were found with bacteriological contamination, risk score wise 11% of the intermediate stand post (n=132) and 15% of high risk stand post(n=81) were found contaminated yet the potential hazards outburst from the stand post cannot be ruled out. The following table shows the situation of all the inspected stand posts against the prescribed risk factors.

Surrounding area insanitary (hazard factors), stagnant water surrounding the stand post, plinth cracked and eroded (pathway factors), and animals having access to the source (indirect factors), emerged as the predominant risk factors associated with pipe water supply alias stand post in Bhubaneswar slums.

Stand post, n=293

TABLE 8: exiSting SitUation of Stand PoStS in bHUbaneSwar SlUmS

risk factors %

Leakage in tap 21

Surrounding area insanitary 72

Stagnant water surrounding stand post 46

Discontinuity of water supply for last 10 days 6

Leakage in distribution pipe 21

Stand post below ground level 38

User reported pipe breaks last week 9

Plinth cracked and eroded 45

Animals have access to stand post 83

Cracks and leakage in adjacent tank 8

The sanitary inspection and water quality for stand posts is presented in Table 9:


TABle 9: diStribUtion of contaminated SoUrceS againSt eacH riSk factor

risk factors % reported with H2S test positive

Leakage in tap (n=62) 13

Surrounding area insanitary (n=210) 12

Stagnant water surrounding stand post(n=135) 17

Discontinuity of water supply for last 10 days(n=16) 19

Leakage in distribution pipe(n=61) 20

Stand post below ground level (n=110) 9

User reported pipe breaks last week(n=27) 11

Plinth cracked and eroded (n=132) 10

Animal has access to stand post(n=244) 10

3.2.1.2 Estimation of the Strength of Association Between Risk Factors and Contamination

Stand posts with leakage in the distribution pipe, where the water supply had been discontinued for the last 10 days, and those surrounded by stagnant water, were the ones that were found to be more contaminated. To test whether this contamination happened by chance or there is statistically a significant association between each or multiple risk factors and bacteriological contamination, the odds ratio (OR)10 was calculated along with the Chi-square test11 for each risk factor in the 2 X 2 contingency table.

10 Odds are the probability of an event occurring divided by the probability of not occurring. An odds ratio is the odds of the event (here bacteriological contamination) in one group. For example, those stand posts exposed to certain risk factor divided by odds in another groups - stand posts not exposed to certain risk factor (David et al. 2008). Odds ratio above 1 indicates a positive relationship between the risk factors and water contamination. Confidence interval and p-value gives an indication of the statistical significance of the odds ratio and eventually about the relationship of the risk factor and water quality compromisation (Howard et al, 2006).

11 Chi-square is a statistical test commonly used to compare observed data with data we would expect to obtain according to a specific hypothesis.


The findings are placed in the following contingency table for stand posts. In the following table, only two risk factors that is ‘surrounding area insanitary’ and ‘leakage distribution pipe line’ have been found to have significant association with water contamination at p value 0.024<0.05 and .004<0.05.

TABLE 10: contingency table for Stand PoStS

risk factors Water sample detected with bacteriological contamination

or 95% CI p-value

Leakage in tap 1.481 .622 ,4.032 0.372

Surrounding area insanitary 3.77 1.108,12.820 .024

Stagnant water surrounding stand post 1.753 .805,3.815 0.083

Discontinuity of water supply for last 10 days 2.227 .595,8.333 .223

Leakage in distribution pipe 3.095 1.388,6.896 .004

Stand post below ground level 1.159 0.518,2.592 0.72

User reported pipe breaks last week 1.154 0.325,4.095 0.825

Plinth cracked and eroded 1.010 0.467,2.183 .98

Animals have access to stand post 1.042 0.377,2.878 .937

Cracks and leakage in adjacent tank 1.167 .259,5.249 .841

The round odds ratio in both the cases is greater than 1 and 95% confidence interval, which provides information about precision excludes 1 (Odds ratio =1 signify no association between exposure and outcome), and thus signifying positive association.

Multivariate Logistic regression models12 were developed using SPSS to further investigate the causes of exceeding water quality targets (Howard et al, 2003). While doing the regression however only those covariates where Odds ratio showed relationship significant at least to 95% confidence interval level. ‘Surrounding area of stand post insanitary’ and ‘Leakage in distribution pipeline’ are two such covariates [Table: 10].

The result of binary logistic regression model is shown below.

TABLE 11: logiStic regreSSion for Stand PoStS in bHUbaneSwar SlUmS

Model -2ll Variables log estimate

(B)

S.e. df Sig. exp (B)

95.0% C.I. for eXP(B)

lower Upper

Source found contaminated [H2S test positive]

177.468 Constant -3.467 .599 1 .000 .031

Area insanitary 1.189 .630 1 .059** 3.285 .956 11.292

Leakage in distribution pipe line

1.011 .414 1 .015** 2.747 1.221 6.183

**p<.05

12 Such a model is used to explore the association between one outcome variable (dichotomous, contamination=1, no contamination=0) and two or more exposure variables. In the present study, all the risk factors are exposure variables. This model helps in isolating the relationship between the exposure variable and outcome variable from the effect of one or more other variables called covariates or more precisely confounder.


The model explains that leakage in the pipeline distribution is 2.747 times more likely to have contamination in the water supplied through piped connection. Similarly, stand posts surrounded by insanitary areas are 3.285 times more likely to have contamination. Such findings are in agreement with other similar studies. Infiltration of contaminated surface or sub surface water occurs when there is reduced pressure within the

supply pipeline and simultaneously there is an existence of a physical route i.e. leakage caused either by corrosion, cracks or outright breaks (Robertson, Standfield, Howard, & Bartram, 2003). Leakage rates are typically found high with even well operated system experiencing rates of 10-20 % (LeChevallier et al, 1999; WHO & UNICEF, 2000). Several epidemiological studies through environmental investigation identified pipe line leakage and its cross connection with sewerage, open-drain, stagnant storm water pool etc. as a causal factor associated with the outbreak of various waterborne diseases (Bhunia, et al., 2009; Bhunia, Ramkrishnan, Hutin, & Gupte, 2009; Haque, et al., 2013 Sailaja, et al., 2009)

3.2.1.3. Presence of Residual Chlorine in Pipe Water Supply through Stand Post

Residual chlorine13 in water samples from all stand posts was tested with the field test kit. Samples from total 293 stand posts were found with a minimum 0.0 ppm to 5.50 ppm residual chlorine with a mean of 0.47 ppm and a standard deviation of .479. The slight higher standard deviation indicates that there is wide variation of the presence of residual chlorine in different samples and presence of an outlier as well. The excessive high amount of residual chlorine determined on a few sources is the evidence against the existence of such outliers.

With reference to permissible limit of residual chlorine in drinking water (0.2-0.5 ppm), the entire stand posts were further classified into four categories. The results are presented in Table 12:

TABLE 12: PreSence of reSidUal cHlorine in water from Stand PoSt

residual chlorine frequency Percent (%)

Absent 3 1.0

Below permissible limit 45 15.4

Within permissible limit 180 61.4

Above permissible limit 65 22.2

total 293 100.0

13 The World Health Organization recommends that the residual chlorine in treated drinking water should be within the range of 0.2 to 0.5 ppm (mg/l) for preventing further growth of bacteria during transportation of water through pipe line and in the course of storage.


In majority of the samples collected (61.4%, n=293) from the stand posts, residual chlorine was found within permissible limit (0.2-0.5 ppm). However, a significant percent of samples i.e. 22.2%, were detected with chlorine above permissible limit. One third (n=22) of such sources were further tested and in 32% cases the second time test also resulted with above permissible limit (Annexure III). In surveyed stand posts, chlorine was absent in just 1.0% samples (n=293) and 15.4 % water samples from the stand posts were found with chlorine below permissible level.

There was disparity in the amount of chlorine present during morning and evening supplies. In some stand posts, the morning supply had excessive chlorine, where as the evening supply was within permissible limits. The quality control of chlorine dosing at the water treatment point, or the proximity of the stand post from water treatment plant, flow rate of water in the pipeline, all attribute to the presence of residual chlorine below or above permissible levels in the supplied drinking water. As both conditions have significant public health implications, it demands further study and exploration with water sample testing in the Public Health Engineering Organisation (PHEO) authorised laboratory.

A logistic regression considering the presence of contamination as dichotomous dependent variable and presence of residual chlorine within permissible limit or not as categorical exposure variable were undertaken. The results are depicted in Table 13:

TABLE 13: logiStic regreSSion of PermiSSible cHlorine in water and bacteriological contamination

model -2ll Variables log estimate

(b)

S.e. df Sig. exp (b) 95.0% C.I. for eXP(b)

lower Upper

Source found contaminated [H2S test positive]

99.679 Constant -3.555 .454 1 .000 .029

Chlorine within permissible limit

2.457 .563 1 .000** 11.667 .3.871 35.161

**p<.001

The quality control of chlorine dosing at

the water treatment point, or the proximity

of the stand post from water treatment

plant, flow rate of water in the pipeline,

all attribute to the presence of residual

chlorine below or above permissible levels

in the supplied drinking water.


The model reveals that stand posts carrying water with residual chlorine are 11.6 times less likely to be contaminated.

It is to be noted that both the absence of residual chlorine and excessive residual chlorine can attribute to the risk regime. Though WHO(1993) promotes, “the risk of death from pathogen is at least 100 to 1000 times greater than the risk of cancer from disinfection by products (DBP)14”, the same document quotes, “because of the formation of the by-product the chemical risk increases with increasing level of chlorine”(Morris, 1978). Morris also cited, that with raised chlorine levels and exceeding test and odor thresholds, consumers may switch to unsafe sources.

3.2.2 Tube Well Fitted with Hand Pump

3.2.2.1 Proportion of Tube Wells Fitted with Hand Pumps Belonging to Different Contamination Risk Categories

Tube well fitted with hand pump (India mark II)15 comprises the second largest proportion of all water sources surveyed under the study. A total of 177 tube wells were surveyed, of which 15% were found in the low risk category, 40% in the intermediate risk category, 44% in the high risk category, and 1% in the very high risk category. This shows the extent of risk associated with the tube well – one of the major sources of drinking water in slums – and the potential it has to be a public health threat. Out of the 177 tube wells, 29% i.e. almost 1/3 of the sample inspected were found with traces of fecal contamination. Table 14 represents the contamination pattern in different risk categories of tube wells.

TABLE 14: riSk category vS contamination croSS tabUlation for tUbe wellS


low (n=26) Intermediate (n=71) High (n=78) Very high (n=2)

Contaminated (%) 42 27 26 50

Often contamination is associated with high risk, but in the present study, 42% of the inspected tube wells, which were found to be under the ‘low risk category’ were identified with fecal contamination. This finding is consistent with the poor correlation noted between sanitary inspection scores of shallow tube wells and water quality in Indonesia (Lloyd & Bartram, 1991). Table 15 depicts the situation of the tube wells in Bhubaneswar’s slums.

14 DBP are produced by the reaction of residual chlorine and organic substances present in water. Chloroform, trihalomethanes are the most predominant DBP.

15 India Mark II is a hand pump designed to lift water from 50 m or less. The pump was designed jointly by Government of India, UNICEF and WHO in 1970. It can lift 12 litres of water in every 40 stroke(WaterAid).


TABLE 15: exiSting SitUation of tUbe well in bHUbaneSwar SlUmS

risk factors %

Latrine within 10 m of the tube well 40

Nearest latrine on a higher ground than the tube well 20

Any other source of pollution (e.g. animal excreta, rubbish) within 10 m 81

Poor drainage, causing stagnant water within 2 m of the tube well 66

Faulty drainage channel (broken, permitting ponding) 50

Concrete floor less than 1 m wide around the tube well 63

Installation require fencing 81

Ponding on the concrete floor around the hand pump 36

Cracks in the concrete floor around the hand pump permitting water to enter tube well 45

Hand pump loose at the point of contact 36

Table 15 shows that all types of risk factors are associated with the tube well located in urban slums. Identification of 40% of the total inspected sources (n=177) in close proximity of toilet, and 81% of the total inspected sources in close proximity of other polluting materials -- excreta of animal and rubbish -- clearly gives us an idea about magnitude of ‘hazard factors’ associated.

Whole gamut of ‘pathway factors’ are also found as the study reveals. Sixty six per cent the inspected tube wells (n=177) had poor drainage causing stagnant water nearby, 50% of them had a faulty drainage channel, 63% of the hand pumps were with concrete floor less than 1m diameter and 45% (n=177) had cracks in the apron surrounding hand pump.

In current risk scenario, ‘indirect factors’ also have a profound presence as 81% of the tube wells are actually in need of fencing. While the above table showcases the magnitude of each risk factor, around 85% of the total sources belonging to the intermediate, high or very high categories get the status by having three or more of the above mentioned risk factors.

Sanitary inspection and water quality for tube well is presented in table below

TABLE 16: diStribUtion of contaminated SoUrceS againSt eacH riSk factor

risk factors % of source found

contaminated

Latrine within 10m of the tube well (n=70) 34

Nearest latrine on higher ground than the tube well (n=35) 29

Any other source of pollution ( e.g. animal excreta, rubbish) within 10 m (n=144) 29

Poor drainage, causing stagnant water within 2m of the tube well (n=117) 29

Faulty drainage channel( broken, permitting ponding)(n=89) 30

Concrete floor less than 1m wide around the tube well (n=112) 22

Installation require fencing (n=144) 28

Ponding on the concrete floor around hand pump (n=64) 33

Cracks in the concrete floor around the hand pump permitting water to enter tube well (n=79) 24

Hand pump loose at the point of contact (n=63) 27


Sources in proximity of toilet, with faulty drainage channel, with ponding on concrete floor surrounding hand pump, show slight increased trend for fecal contamination when risk and contamination data are cross tabulated. However to know the significance of the association with each risk factors and contamination odds ratio were calculated corresponding to each risk factors. In the following contingency table, the odds ratio is presented with p-value and 95% CI.


TABLE 17: contingency table for tUbe wellS

risk factors Water sample found with bacteriological

contamination

or 95% CI p-value

Latrine within 10m of the tube well 1.546 .8,2.985 0.194

Nearest latrine on higher ground than the tube well 1.015 .448,2.300 0.972

Any other source of pollution (e.g. animal excreta, rubbish) within

10 m

1.098 .471,2.559 0.828

Poor drainage, causing stagnant water within 2 m of the tube well 1.036 .520,2.063 0.92

Faulty drainage channel (broken, permitting ponding) 1.161 .605,2.227 0.653

Concrete floor less than 1 m wide around the tube well 2.32 1.191,4.524 0.012

Installation require fencing 1.300 .578,2.924 0.525

Ponding on the concrete floor around the hand pump 1.351 .693,2.636 0.377

Cracks in the concrete floor around the hand pump permitting

water to enter the tube well

1.531 .786,2.982 0.209

Hand pump loose at the point of contact 1.150 .579,2.283 0.69

Table 17 shows the significant positive association between fecal contamination and the size of the concrete floor. The above table shows that pumps with concrete floor less than 1 metre of width are 2.32 times more likely (p=.012<.05) to be contaminated by fecal contamination. It is an important ‘pathway factor’ that is contributing to the contamination of tube wells in Bhubaneswar.

Data was further analysed through logistic regression16. The model developed is shown in following table. After adjusting the confounding factors, the model reveals two more risk factors i.e. ‘ponding on concrete floor’ and ‘cracks in apron’ has also contribution towards contamination of the water of tube well.. Sources with ponding on concrete floor are 2.493 more likely to be contaminated (p=.05) and sources having cracks on the concrete floor (pathway factor) are 2.556 times more likely to be contaminated (p=.045<.05).

16 Logic regression is a (generalized) regression methodology that is primarily applied when most of the covariates in the data to be analyzed are binary. The goal of logic regression is to find predictors that are Boolean (logical) combinations of the original predictors.

The regression model includes all co-variates where the odds ratios showed relationship significance at least to 95% level. Although not significant at least to the 95% but other covariats were also incorporated in model seeing the increased number of sources reported with those risk categories.


TABLE 18: logiStic regreSSion for tUbe well in bHUbaneSwar SlUmS

B S.e. Wald df Sig. exp

(B)

95.0% C.I.for eXP

(B)

lower Upper

Concrete floor <1m .945 .389 5.892 1 .015** 2.574 1.200 5.522

Latrine within 10m(1) -.558 .380 2.155 1 .142 .572 .272 1.206

Pollution source within 10m(1) -.452 .527 .738 1 .390 .636 .227 1.786

Poor drainage causing water 2m(1) .034 .445 .006 1 .939 1.035 .433 2.475

Faulty_drainage_channel(1) -.035 .463 .006 1 .939 .965 .390 2.392

Fencing_HP_installation_inadequate_

damaged(1)

.366 .518 .500 1 .479 1.443 .523 3.982

Ponding_concrete_around_HP(1) -.914 .475 3.696 1 .055** .401 .158 1.018

Cracks_concrete_around_HP(1) .938 .468 4.015 1 .045** 2.556 1.021 6.400

HP_loose_point_attachemnt(1) -.520 .476 1.194 1 .275 .595 .234 1.511

Constant -.585 .458 1.627 1 .202 .557

**p<.05

3.2.3 Unprotected Dug Well

3.2.3.1 Proportion of Unprotected Dug Wells Belonging to Different Contamination Risk Categories

The unprotected dug well was the third largest type of water sources inspected for the study. A total 162 unprotected dug wells were surveyed, of which 14% were found to be in the low risk category, 37% were in the intermediate category, a whopping 41% in the high risk category, and 8% in the very high risk category. Fifty two per cent of all unprotected dug wells inspected were detected with fecal contamination, making them the most unsafe drinking water sources. Table 19 shows the contamination pattern across various risk categories of unprotected dug wells.

TABLE 19: bacterial contamination againSt riSk category


low (n=23) Intermediate (n=60) High (n=66) Very high (n=13)


The data clearly reveals that even dug wells that scored low in the risk category have traces of fecal contamination. A study Tube well water quality and predictors of contamination in three flood-prone areas of Bangladesh cited similar incidence, but in case of tube wells where predictor scores were less yet tube well were detected with bacteriological contamination (Luby et al, 2008). The situation of dug wells located in the slums of Bhubaneswar is shown in Table 20.


TABle 20: exiSting SitUation of UnProtected dUg wellS in bHUbaneSwar SlUmS

risk factor %

Latrine within 10 m of the well 50

Nearest latrine on higher ground than the well 30


Poor drainage, causing stagnant water within 2m of the well 37

Faulty drainage channel (broken, permitting ponding) 26

Wall (parapet) around the well inadequate, allowing surface water 35

Concrete floor less than 1m wide around the well 57

Walls of the well inadequately sealed at any point for 3 m below the ground 56

Any cracks in the concrete floor around the well permitting water to enter the well 49

Rope and bucket left in such a position that they may become contaminated? 46

Installation require fencing 79

Fifty per cent of the total dug wells inspected were found within 10 metres proximity of a toilet (n=162), in case of ‘other source of contamination’ the proportion is 62%. This gives an idea about the propensity of hazard factors associated with a dug well. Pathway factors like ‘concrete floor less than 1m width’, ‘inadequately sealed wall’, ‘and cracks in apron’ or ‘rope bucket contamination route’ counted positive ranging from 57% to 46% of the inspected dug well (n=162). Indirect factors like requirement of fencing was identified in 79% dug wells (n=162). This table gives an idea about the magnitude of individual risk factors. But like other sources, here too, 86% of the sources, which were detected within intermediate to


very high category, earned their score for being associated with three to 11 risk factors simultaneously. Such a complex association of risk factors even makes sources more vulnerable towards compromised drinking water quality.

Sanitary inspection and water quality for unprotected dug wells is presented in Table 21.

Against each risk factor, a whopping 45% to 59% dug wells were found contaminated. For an example, almost half of those dug wells located in proximity of a toilet were found contaminated. In case of proximity to other pollution sources (n=100), 48% sources were found contaminated. Such figures apparently show propensity of ‘hazard factors’ towards contamination. But when 57% of the total dug wells detected with faulty drainage channel (n=42) and 59% of the total dug well with poorly sealed wall (n=90) are found contaminated, the influence of ‘pathway factors’ cannot be ruled out. When 53% of total dug well with inadequate fencing (n=128) are found with fecal contamination one cannot exclude the potential indirect factors and their contribution towards water quality degradation.

TABLE 21: Percentage of SoUrceS detected contaminated againSt eacH riSk factorS

risk factor % of sources

found

contaminated

Latrine within 10m of the well (n=81) 49

Nearest latrine on higher ground than the well (n=49) 45

Any other source of pollution (e.g. animal excreta, rubbish) within 10 m (n=100) 48

Poor drainage, causing stagnant water within 2m of the well (n=59) 49

Faulty drainage channel( broken, permitting ponding) (n=42) 57

Wall (parapet) around the well inadequate, allowing surface water (n=56) 48

Concrete floor less than 1m wide around the well (n=93) 41

Walls of the well inadequately sealed at any point for 3m below the ground (n=90) 59

Any cracks in the concrete floor around the well permitting water to enter well(n=79) 51

Rope and bucket left in such a position that they may become contaminated (n=74) 49

Installation requires fencing (n=128) 53


To test whether the contamination has association with the listed risk factors or just happened by chance, the risk estimation was done by calculating the odds ratio for each of the risk factors. The corresponding contingency is presented in Table 22. From the contingency table factors like ‘concrete floor less than 1m width surrounding dug well’ and ‘wall inadequately sealed 3m below ground level’ show positive and statistical significance towards contamination of unprotected dug wells. It can be concluded in the present context that these are the risk factor which are primarily responsible for contamination at p<.05 level. The


significance of association of different risk factors with water quality outcome may vary with each season as well (Alam & Rahaman, 2011). Though the samples were collected in the wet season, seasonality was not considered as one of the confounding factors.

TABLE 22: contingency table for UnProtected dUg wellS

risk factors Water sample found with bacteriological

contamination

or 95% CI p-value

Latrine within 10 m of the well 1.219 .658, 2.259 0.529

Nearest latrine on higher ground than the well 1.492 .760,2.927 0.243

Any other source of pollution (e.g. animal excreta, rubbish)

within 10 m

1.499 .792,2.841 0.213

Poor drainage, causing stagnant water within 2m of the well 1.184 .625,2.247 0.603

Faulty drainage channel (broken, permitting ponding) 1.333 .653,2.710 0.425

Wall (parapet) around the well inadequate, allowing surface

water

1.25 .653,2.392 0.501

Concrete floor less than 1m wide around the well 2.895 1.512,5.541 0.001

Walls of the well inadequately sealed at any point for 3 m below

the ground

1.894 1.011,3.546 0.045

Any cracks in the concrete floor around the well permitting water

to enter well

1.1 .594,2.038 0.762

Rope and bucket left in such a position that they may become

contaminated

1.267 .682,2.354 0.454

Absence of fencing 1.276 .598, 2.717 0.529


A logistic regression model was developed to further investigate the causes of exceeding the water quality target. All co-vitiates where odds ratio showed relationship significant to the 95% confidence interval level (p≤.05) and above, were included in the analysis. Although the odds ratios for proximity of toilet and other sources, garbage within 10m were not found significant at 95% CI, yet they were incorporated in the model. This was as they were deemed to be a plausible route of contamination, specially in the slum context and when even low risk dug wells were also identified with fecal contamination.

TABLE 23: logiStic regreSSion for UnProtected dUg wellS in bHUbaneSwar SlUmS

b S.e. Wald df Sig. exp(b) 95.0% C.I.for eXP(b)

lower Upper

Latrine_10_m(1) -.292 .340 .738 1 .390 .747 .384 1.453

Pollution_source_10m(1) -.627 .359 3.054 1 .081 .534 .265 1.079

Concrete_floor_1m(1) -1.407 .371 14.374 1 .000** .245 .118 .507

Wall_inadequately_sealed_3m_GL(1)

1.145 .374 9.400 1 .002* 3.144 1.512 6.538

Constant .796 .399 3.976 1 .046 2.216

*p≤.05 ; **p≤ .001

The model depicts that even after adjusting confounding factors, proximity of a toilet or other sources doesn’t exhibit any significant association with contamination of dug well. But dug wells with concrete floor less than 1 metre around are found 1/.245 or 4.08 times more likely to be contaminated (p=.000<.001), where as wells with an inadequately sealed up wall to three metres below ground level are 3.144 time more likely to be contaminated. Association of contamination with improper sealing can be attributed to subsurface leaching. Further scope for exploration was not included in the study design.

3.2.4 Bore Wells Fitted with Mechanical Pump

3.2.4.1 The Proportion of Bore Wells Fitted with Mechanical Pump Belonging to Different Contamination Risk Categories

Bore wells fitted with mechanical pump are one of the major sources of drinking water in the slums located in nine [Ward number 1, 2, 7, 9, 11, 15, 16, 47 & 54] out of 25 wards where the current study was undertaken. In wards number 15 and 16 this type of source was found predominant [Annexure: I]. In this type of water source, the mechanical pump (a submersible pump found in study area) gets fitted with the bore well to extract ground water and lift it up to an over head tank. Water from the over head tank then reaches to the door step of the consumers through pipeline connection. These installations were found to be either by NGOs or as community initiatives. In many cases, the community had converted the pre-existing tube well into this advanced version. Often these sources were found to cater to a group of families, who take care of its maintenance and management, and pay the electricity bill by collective subscription. In ward 47 the local Corporator (ULB representative) had utilised the untied fund to install a similar bore well for slum dwellers. In the present study, a total of 108 bore wells were surveyed, out


of which 8% (n=108) were found to have fecal contamination, which is less than all other types of water sources surveyed (excluding protected dug wells as the sample size was not considerable). Majority of the bore wells were diagnosed under the intermediate risk category (52%, n=108), followed by high (32%), low (15%) and very high (3%) category. Table 24 shows the contamination pattern across various risk categories for the bore well.

TABLE 24: contamination and riSk category


low (n=14) Intermediate (n=56)

High (n=35) Very high (n=3)


The situation of the bore wells located in Bhubaneswar slums is shown in Table 25.

Bore wells fitted with mechanical pump (n=108)

TABLE 25: exiSting SitUation of bore wellS in bHUbaneSwar SlUmS

risk factors %

Latrine within 15-20m of the well 62

Nearest latrine is pit /unsewered 22


Uncapped well within 10-15 m 14

Faulty drainage around pump house 19

Fencing inadequate/damaged 43

Floor of pump house permeable to water 31

Well seal insanitary 30

Chlorination is not functioning 100

Chlorine absent 100

Like all other sources surveyed for the study, ‘hazard factors’ are also associated with bore wells as 62% (n=108) are in proximity of a toilet, where as 59% of the total sources were found closer to other sources of pollution — animal feces or garbage. ‘Pathway factors’ show a lesser tendency to be associated with this type of water source. Interestingly, as none of the sources had any inbuilt mechanism of chlorination, residual chlorine was not found in any of the sample. Interaction with the community reveals that the over head tank is not used for storing water. It is used to make lifted water gravity fed. So the need of regular chlorination was not felt. Bleaching powder is used for cleaning the tank. However, a clear conclusion regarding the frequency of cleaning the over head tank could not be drawn as it was not an integral component of the current study design. But no chlorination and minimum presence of fecal contamination this literary ambiguous condition demands an in depth study exclusively for this type of source.

Sanitary inspection and water quality for bore wells is presented in Table 26.


TABLE 26: Percentage diStribUtion of contaminated SoUrceS againSt eacH riSk category

risk factors % of sources found contaminated

Latrine within 15-20 m of the well (n=67) 10

Nearest latrine is pit /unsewered (n=24) 13

Any other source of pollution (e.g. animal excreta, rubbish) within 10 m(n=64) 6

Uncapped well within 10-15 m (n=15) 7

Faulty drainage around pump house (n=21) 5

Fencing inadequate/ damaged (n=46) 7

Floor of pump house permeable to water (n=33) 9

Well seal insanitary (n=33) 9

Chlorination is not functioning (n=108) 8

Chlorine absent (n=108) 8

From Table 26 it is evident that none of the risk factors are associated with increased contamination. Still to explore the statistical significance of the strength of association with contamination, the odds ratio was calculated like for other sources.

3.2.4.2 Estimation of Strength of Association Between Risk Factors and Contamination

TABLE 27: contingency table for bore wellS fitted witH mecHanical PUmP

Variables Water sample found with bacteriological

contamination

OR 95%CI p-value

Latrine within 15-20 m of the well 2.273 .449,11.494 0.309

Nearest latrine is pit /un-sewered 1.857 .428,8.055 0.402

Any other source of pollution (e.g. animal excreta, rubbish)

within 10 m

1.923 .486,7.634 0.345

Uncapped well within 10-15 m 1.318 .153,11.364 0.801

Faulty drainage around pump house 2.025 .239,17.145 0.509

Fencing inadequate/damaged 1.536 .363,6.949 0.557

Floor of pump house permeable to water 1.150 .270,4.906 0.85

Well seal insanitary 1.206 .283,5.155 0.799

Chlorination is not functioning NA NA NA

Chlorine absent NA NA NA

None of the risk factors shows a significant association with the contamination of the water supplied by the bore wells. Data was further analysed in logistic regression model [Table 28] and even after adjusting confounding factors no risk factor shows a significant association with contamination of the source.


The collective maintenance management, in some places NGO intervention, or construction design could be responsible for the source to emerge as a comparatively safer source of water in densely populated slums. But it requires further full length exploration.

TABLE 28: logiStic regreSSion for bore wellS in bHUbaneSwar SlUmS

b S.e. Wald df Sig. exp (b)

Pollution_source_10 m (1) .847 .842 1.012 1 .315 2.332

Fencing_HP_installation_inadequate_damaged

(1)

.364 .883 .170 1 .680 1.440

Latrine_15_20 m_pump_house (1) -.860 .932 .852 1 .356 .423

Latrine_unsewered (1) -.534 .866 .380 1 .537 .586

Uncapped_well_within_15_20 m (1) .006 1.183 .000 1 .996 1.006

Faulty_drainage_around_pump_house (1) .995 1.344 .548 1 .459 2.704

Floor_pump_house_permeable_water (1) -.502 .899 .312 1 .576 .605

Well_seal_unsanitary (1) -.682 .922 .548 1 .459 .505

Constant -2.402 1.386 3.005 1 .083 .091


One important objective of the study was to identify gaps in the water supply system and find solutions. This section of the report has been prepared based on the findings of the study, an extensive desk review, individual interactions with Government officials, urban health and WASH professionals, functionaries of civil society organisations and slum dwellers, and various consultations. The roundtable consultations were organised in three major cities — Bhubaneswar (March 14, 14), Cuttack (March 4, 14) and Rourkela (March 11, 14) of Odisha, one in the national capital, New Delhi (June 6, 14) and the other at the WASH Summit in Jaipur, Rajasthan (June 27, 14). The current chapter suggests ways to improve the quality of the water supply system and its surveillance.

SUGGESTIONS

4.1 For Surveillance of Sources and Action

4.1.1 Routine Inspection and Survey of Water Sources

Sanitary inspection of drinking water sources should be undertaken on a regular basis. Two minimum annual inspections along with microbial water quality monitoring may be done by the surveillance agency.17 As per WHO, the minimum annual frequency of sanitary inspection for dug wells, dug wells with hand pump is six times, and shallow and deep tube wells with hand pump is four times, which can be done by the community with the support of the water supply and surveillance agency.18

17 Capacity building/skill development of staff at all levels on water safety and management may be taken up in a coordinated manner. Refresher courses at regular intervals are required for different stakeholders responsible for water supply and its surveillance. PHEO officials may be given special training on environmental engineering. As suggested in the Round table consultation on safe water on March 4, 2014 in Cuttack.

18 Periodic monitoring of drinking water supply and its quality need to be done by a third party so that timely remedial steps may

Chapter 4: Suggestions


4.1.2 Placement of a Regular Water-Testing Quality Control Mechanism which includes Inspection, Testing and Treatment for Ensuring Safe Drinking Water

Out of total 742 drinking water sources surveyed, the trace of fecal bacteria was detected in all type of sources. Fifty two per cent of unprotected dug wells, 29 per cent of tube wells fitted with a hand pump, and 10 per cent of stand posts were found to be with fecal contamination. Drinking water sources with bacteriological contamination pose a high risk of several water borne diseases. There is the need to place a regular quality control mechanism for ensuring the safety of drinking water. Proper sanitary inspection needs to be followed by regular bacteriological assessment and regular disinfection of all drinking water sources. All these activities need to be planned and conducted on a regular basis. For this, there is a need for cooperation and strong convergent action between the agency responsible for drinking water supply in urban areas under housing and the urban development department, and the public health directorate under the health and family welfare department.

4.1.3 Establishment of Water Quality Labs in Urban Areas

It is difficult to find a water testing labs in cities and towns. Almost all water testing labs are owned by public health engineering organisations, and there are very few labs with the health department which monitors food quality. The capacity of these labs to cater to the need of the general public is meager. Establishment of such labs by the government and other agencies will allow consumers to find out the quality of water they consume.19

be undertaken in ensuring effective water supply. Integrated sewerage system needs to be developed for proper waste disposal leading water safety. As suggested in the Round table consultation on safe water in Cuttack.

19 Specific efforts need to be made for establishing water testing labs at least at district levels on a pilot basis to periodically check the quality of water quality before it reaches the people. As suggested in the Round table consultation on safe water on March 14, 2014 in Bhubaneswar, Odisha


4.1.4 Maintenance and Supervision of Drinking Water Sources to Control Various Hazard, Pathway and Indirect Risk Factors that may Compromise Drinking Water Quality

Maintenance and supervision of drinking water sources is vital for ensuring drinking water quality. Out of 293 public stand posts of pipe water supply surveyed, 10 % found to have bacteriological contamination. The major possible risk factors associated with the pipe water supply found from this study are leakage in the distribution pipe, where the water supply has been discontinued for the last 10 days, and stagnant water. Similarly, all type of risk factors are associated in case of the tube wells fitted with hand pumps. These risk factors can be taken care of by the constant supervision and maintenance.20

4.1.5 Maintaining the Standard on Concrete Floor Around the Source Recommended by WHO

As per the recommendation of WHO, the concrete floor around the well, tube well should be one metre as mentioned in the sanitary inspection format. The study shows the concrete floor is less than one metre in

63% of tube wells. Similarly, 57% of un-protected dug wells had less than one metre of the concrete floor. The study found a significant positive association between fecal contamination and the size of concrete floor. Those tube wells with less than one metre wide concrete flooring are 2.32 times more likely to have fecal contamination. The government could make it mandatory for any agency providing drinking water facility — PHEO, ULBs, NGOs, CBOs-- 21 to follow the standard of concrete floor for various drinking water sources.

20 The guidelines on management of water sources are required to be strictly adhered to and may be a part of the community monitoring process. As suggested in the Round table consultation on safe water on March 11, 2014 in Rourkela, Odisha

21 A structural framework or protocol may be developed to bring role clarity among different stakeholders associated with drinking water supply in the state, cities and towns. As suggestion in the Round table consultation on safe water in Bhubaneswar, Odisha

As per the recommendation of WHO, the

concrete floor around the well, tube well

should be one metre as mentioned in

the sanitary inspection format. The study

shows the concrete floor is less than one

metre in 63% of tube wells. Similarly, 57%

of un-protected dug wells had less than

one metre of the concrete floor.


4.2. For Prioritisation of Area and WASH Intervention

4.2.1 Use of Sanitary Survey as a Tool for Identifying Vulnerable Slums or Wards for Prioritising WASH Interventions

The sanitary survey could be used as a tool to identify the vulnerable slums and pockets in a city for water supply, sanitation and health intervention.22 Apart from the department responsible for provisioning water supply and ULBs, the sanitary survey tool may also be adopted by various civil society organisations working in slums and those that have specific water, sanitation, health and hygiene interventions.

4.2.2 Water Safety Plan and its Execution

Safe water and its supply are always aimed at public health protection and disease prevention. So water safety plans need to be planned and implemented taking a ward or a slum as a unit. The plan involves the assessment of the drinking water supply system to determine the quality of water supply at the delivery point, constant monitoring of the steps in the supply chain that are of particular importance in securing safe drinking water, a systematic independent surveillance to verify and cross check that the system is operating properly. It is worth mentioning that for water safety plan and its execution, local community leaders, ULB representatives, front line workers, women groups, youth clubs, community groups of specific slums and other community based organisations need to be involved.

4.3 For Community Participation

4.3.1 Sharing of the Report and Involvement of the Community in Sanitary Survey

Involvement of community members is crucial for maintenance of community drinking water supplies. As per Uniform Drinking Water Quality Monitoring Protocol of the Government of India, Ministry of Drinking Water and Sanitation, 2013, “The result of the sanitary inspection and the remedial action that needs to be taken to improve conditions should be discussed with the community. In small water supply schemes, it is often possible for community members to carry out most of the inspections themselves using a standard form.” As a first step to disseminate the message and involve the community in the sanitary survey of drinking water sources, front line workers of various departments at the grass root level and functionaries of ULBs can be trained on sanitary inspection and water quality testing with field test kit. They may carry out the same under the guidance of public health engineering functionaries in their respective community.23 They may also be provided with a water quality field test kit and the H2S strip for survey of drinking water quality in a prescribed duration of time. It is important to involve the ward councilor/ corporator of the concerned ward in the survey.24

22 It was suggested at the Round table consultation in New Delhi on June 6, 2014 that the sanitary survey format may be modified considering the local environmental situation.

23 Numbering of tube wells may be done so that in case of need, the community may have a dialogue with the concerned authority for its repair and management. The Mahila Arogya Samiti (MAS) may be used in mapping water sources in their respective slums and the status report may be generated and shared in Ward Kalyana Samiti (WKS)/Ward Coordination Committee (WCC) meeting for its smooth management under NUHM initiatives. As suggested in the - Round table consultation on safe water in Bhubaneswar, Odisha and Round table consultation on safe water on June 6, 2014 in New Delhi.

24 A sound participatory monitoring mechanism to assess the water sources at regular intervals, especially in slum areas is of inescapable necessity. There is need of basic information and its dissemination at all levels about the owners of water sources,


4.3.2 Inclusion of Water Quality in the Communication Plan of Allied Departments and Awareness Generation Among the Community

Any water source, which has serious risks as suggested by sanitary survey report, should be brought to the notice of the concerned authority. The community needs to be made aware for not using the water from the contaminated source. Immediate action should be taken to treat the water and for other necessary action as suggested by the sanitary survey. At the same time, a specific strategy in the communication plan may be developed for awareness on various factors that compromise water quality along with the importance of safe water, linkage of drinking water with health and well being, sanitary inspection of water sources, safe handling of water, safe storage and home-based water treatment methods (Point of Use). By demonstrating the use of H2S strip and field test kit in the community, and the test results, awareness can be created on safe water.25

4.3.3 Precaution for Proximity of Toilet to Drinking Water Sources

There is a direct relation of the presence of a latrine near the water sources with risk of contamination. As per WHO’s sanitary inspection format, the minimum distance of the latrine from the drinking water source needs to be 10 metres from the tube well, and 15 to 20 metres for a bore well with a mechanical pump. The present study reveals that 40% of the tube wells and 50% of the unprotected dug wells surveyed had a latrine within 10 metres. Similarly, 62% of bore wells fitted with a mechanical pump have the latrine within

so that at the time of need, the community may help the owners in successful and quality management and maintenance of the water sources. As suggested in the Round table consultation on safe water in Bhubaneswar, Odisha

25 People residing closer to the pumping station often get water with higher residual chlorine. They should be told to leave the water standing for a minimum for half an hour prior to consumption As suggested in the Round table consultation on safe water in Rourkela, Odisha

The result of the sanitary

inspection and the remedial

action that needs to be taken to

improve conditions should be

discussed with the community.

In small water supply schemes,

it is often possible for community

members to carry out most of the

inspections themselves using a

standard form.


15-20 metres. Since slums are characterised by lack of space and density of population, extra caution needs to be taken to follow the standard. Our experience in interacting with the community in slums shows a lack of knowledge among various stake holders on this basic technical aspect of the distance from the latrine to the drinking water source to restrict contamination. Special focus is required for disseminating this message by the government, urban local bodies and NGOs among the people.

4.4. Advocacy with the Government

4.4.1 Easy Access of Sanitary Survey Report for Public Use

There is a need to maintain a standardised format for sanitary survey report which can be maintained by the concerned water supply and surveillance agency for use. Such reports may also be linked with the general HMIS system for public use. It will help in generating awareness and many agencies working in health, nutrition, water supply and sanitation, and the community governance sector can use such valuable information for research, specific project intervention and awareness generation among the people.

4.4.2 Establishment of a Public Grievance System for Complaints on Water Quality

A public grievance mechanism needs to be developed for lodging complaints of drinking water quality in urban areas so that immediate corrective action can be taken by the water supply agency. A time duration may be kept for rendering the service. If it is not possible to treat or improve the water in the concerned area, an alternative arrangement for providing potable water should be made.


4.4.3 Designing of Messages on Safe Water in Communication Plan

The list of questions in the sanitary inspection assess the risk to water sources. The messages in the communication plan of various departments need to focus on the dos and don’ts for safe water. For example, people must know the safe distance of the drinking water source from a latrine, why it is necessary to keep the platform of the well and tube well clean and unbroken, what is the need for fencing around a hand pump, and why it is important to have drainage channels for disposal of waste water etc.

4.4.4 Preparing the Community for Conducting a Sanitary Survey

In the current HUP sanitary survey study, MAS members and front line workers of HUP and various government departments working at the community level were involved in conducting an onsite inspection and survey. The Mahila Arogya Samiti members (women’s group) involved in sanitary inspection and water testing exercise by the H2S strip showed enthusiasm. To empower the community to assess the risk factor and understand the factors affecting the contamination of water sources, the women’s group in urban areas (MAS) under NUHM, the neighbourhood committee under SJSRY, frontline workers of various departments like ANMs, Anganwadi workers and supervisors, ASHAs, sanitary inspectors and community organisers may be trained on conducting the sanitary survey in support of water supply agencies in respective cities and towns.

4.4.5 Promotion of Household Level Water Treatment and Safe Storage

Health can be compromised when harmful bacteria, viruses, and parasites contaminate drinking water either at the source, through seepage of contaminated run-off water, or within the piped distribution system. At the same time unhygienic handling of water during transport or within the home (at Point of Use) can contaminate safe water. For these reasons, many of those who have access to improved water supply through piped connections, protected wells or other improved sources may be exposed to contaminated water. Therefore, household level water treatment and safe storage need to be promoted through various water, sanitation, health, hygiene and nutrition programmes under various allied departments and urban local bodies, especially in slum locations. 26

26 The knowledge on Point of Use water treatment of water may be percolated down to the community with involvement of NGOs, CBOs and MAS under NUHM. Suggestion: Round table consultation in New Delhi, June 6, 2014

People must know the safe distance of the

drinking water source from a latrine, why

it is necessary to keep the platform of the

well and tube well clean and unbroken,

what is the need for fencing around a hand

pump, and why it is important to have

drainage channels for disposal of waste

water etc.


ann

exur

e I :

War

d W

ise

Wat

er S

our

ce D

istr

ibut

ion

1 11 12 15 16 2 26 27 30 31 32 33 34 45 46 47 52 53 54 56 57 58 7 8 9 Tota

l

0 0 0 9 2 1 9 21 4 47 19 18 9 16 40 9 6 4 2 22 0 1 15 18 21 293

9 6 0 43 32 2 0 0 0 0 0 0 0 0 0 10 0 0 2 0 0 0 4 0 1

108

23 1 3 12 17 5 3 5 20 12 6 3 3 5 6 9 0 5 8 1 8 5 16 1 0

177

0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 2

7 5 0 27 6 3 0 8 19 9 0 0 4 1 3 8 0 9 15 0 16 6 15 1 0

162

WA

RD N

OST

AN

D P

OST

BORE

WEL

WIT

HM

ECH

AN

ICA

L PU

MP

TUBE

WEL

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H H

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annexure II: Code of Slums Where Survey was Conducted

Sl. no. name of the slum Code ngo

1 ABHIRAM NAGAR BASTI 1 GJS

2 ADIBASI GAON 2 MY HEART

3 AKHANDALMANI BASTI 3 BC

4 AKHANDALMANI BASTI, UNIT-1 4 GJS

5 AMBEDKAR SAHI 5 FPAI

6 ANANDA NAGAR PALLAS PALLI 6 GJS

7 ANANTA BASTI 7 OVHA

8 AUROBINDA BASTI 8 OVHA

9 BABA TRINATH ADIVASI HARIJAN BASTI 9 BC

10 BADHIHUDA 10 GJS

11 BAJPAYEE NAGAR 11 OVHA

12 BALITOTA SAHI 12 BC

13 BAPUJINAGAR RLY. BASTI 13 GJS

14 BASTI VIKASH PARISHAD 14 FPAI

15 BHAGABATI BASTI 15 BC

16 BHAGABATI BASTI 16 GJS

17 BHAKTAMADHU NAGAR 17 GJS

18 BHARATI MATHA BHOI SAHI* 18 GJS

19 BHIMATANGI PEOPLES BASTI 19 GJS

20 BHIMPUR BHOI SAHI 20 GJS

21 BIRSA NAGAR 21 FPAI

22 BISHNUNAGAR BASTI 22 GJS

23 BRAHMESWARPATANA BHOI SAHI* 23 GJS

24 CHILIPOKHARI 24 GJS

25 CHIRGOLATOLA BASTI (PRASANT VIHAR) 25 OVHA

26 CHUNUKULI BASTI 26 OVHA

27 CS PUR MANDAP SAHI 27 OVHA

28 CS PUR MUNDA SAHI 28 OVHA

29 DAMANA BASTI 29 OVHA

30 DURGA MANDAP BASTI 30 BC

31 EKAMRA NAGAR 31 MY HEART



32 FARM GATE OUAT BASTI 32 BC

33 FARM PADA 33 BC

34 FIRE STATION BASTI UNIT 8 34 BC

35 G TYPE BASTI 35 BC

36 GADAKANA SABAR SAHI* 36 OVHA

37 GANGA NAGAR 37 BC

38 GANGA NAGAR HOSTEL SIDE 38 BC

39 GANGA NAGAR PALLI A 39 BC

40 GANGA NAGAR PALLI B 40 BC

41 GANGANAGAR BHIMPUR BASTI 41 GJS

42 GOKHIBABA LEPROSY COLONY 42 GJS

43 GOPABANDU NAGAR UNIT 8 43 BC

44 GOURINAGAR BASTI 44 GJS

45 GYANA NAGAR HUDA BHOI SAHI* 45 GJS

46 H K NAGAR* 46 OVHA

47 HARIJAN BASTI, UNIT-1 47 GJS

48 HATIASUNI 48 MY HEART

49 ISANESWAR BASTI 49 OVHA

50 JADI SAHI 50 BC

51 JAGANNATH AMBA TOTA 51 OVHA

52 JAGANNATH BIHAR 52 MY HEART

53 JAGARNATH BASTI, UNIT-1 53 GJS

54 JALESWAR COLONY PAIKA BASTI 54 BC

55 JALI MUNDA SAHI PATIA 55 OVHA

56 JANATA NAGAR 56 MY HEART

57 JAY DURGA BASTI UNIT 8 57 BC

58 JAYADEV NAGAR BHOI SAHI* 58 GJS

59 JHARANA TALA SAHI 59 GJS

60 JHARANA UPPER SAHI 60 GJS

61 JOGESWARPATAN NAIK SAHI 61 GJS

62 JOGESWARPATAN BEHERA SAHI 62 GJS

63 JOGI SAHI 63 BC

64 K K NAGAR 64 BC

65 KABARI (SABAR) SAHI* 65 OVHA

66 KALIMANDIR BASTI 66 BC



67 KALINGA BASTI, UNIT-1 67 GJS

68 KANCHA BHOI SAH* 68 GJS

69 KANDHA SAHI SIRIPUR 69 BC

70 KAPILPRASAD BASTI* 70 GJS

71 KAPILPRASAD BHATTA BHOI SAHI* 71 GJS

72 KAPILESWAR BHOI SAHI* 72 GJS

73 KAPILESWAR TANGI BHOI SAHI 73 GJS

74 KARGIL BASTI 74 GJS

75 KASTURBA NARIMAHAL BASTI, UNIT-1 75 GJS

76 KEDARPALLI BASTI 76 GJS

77 KELASAHI 77 GJS

78 KHANDUAL BASTI 78 GJS

79 KRUSHI BIHAR BASTI 79 BC

80 LAXMI NAGAR 80 FPAI

81 LAXMINARAYAN PRAGATI BASTI, UNIT-1 81 GJS

82 LINGARAJ LEPROSY COLONY 82 GJS

83 M DHIRUKUTI SAHI 83 OVHA

84 M MUNDASAHI 84 OVHA

85 MA MANGALA BASTI 85 OVHA

86 MA MANGALA BASTI (UNIT 7) 86 BC

87 MAA MANGAL BASTI, UNIT-1 87 GJS

88 MAA TARINI BASTI, UNIT-3 88 GJS

89 MAHAVEER BASTI 89 GJS

90 MAHAVEER NAGAR 90 FPAI

91 MAITRI NAGAR 91 MY HEART

92 MANGALA NAGAR 92 OVHA

93 MANGALA SAHI PATIA* 93 OVHA

94 MARUTI VIHAR 94 MY HEART

95 MATISAHI* 95 GJS

96 MAY FAIR NAGAR 96 OVHA

97 MUNDA SAHI (NILAKANTH NAGAR) 97 BC

98 NALAMUHAN & DHOBA SAHI* 98 GJS

99 NALCO BEHERA BASTI 99 OVHA

100 NARAYANI BASTI BACHELOR BARRACK 100 BC

101 NAYAGARH SAHI 101 FPAI



102 NEHRU BASTI 102 BC

103 NILACHAKRA NAGAR 103 OVHA

104 MUNDA SAHI 104 BC

105 NILAMADHAB BASTI 105 OVHA

106 NILAPADIA BASTI 106 OVHA

107 NILAPANI TANKI BASTI 107 BC

108 NIRANKARI NAGAR 108 MY HEART

109 NOLIASAHI MUSLIM BASTI 109 GJS

110 NUAGOAN JENA SAHI* 110 GJS

111 NUAGOAN KHAUDA SAHI* 111 GJS

112 NUAGOAN UPPER SAHI* 112 GJS

113 OCC BASTI 113 BC

114 OMFED BASTI* 114 OVHA

115 PANDA PARK* 115 OVHA

116 PANITANKI SAHI 116 OVHA

117 PATIA BHOI SAHI* 117 OVHA

118 PATIA TALA UPAR BHOI SAHI* 118 OVHA

119 PATRA SAHI 119 OVHA

120 PATTEL HALL BASTI 120 GJS

121 POKHARIPUT BHOI SAHI* 121 GJS

122 POWER HOUSE BASTI 122 BC

123 PRADHAN SAHI I 123 FPAI

124 PRADHAN SAHI II 124 FPAI

125 PUNAMAGATE BHOI SAHI 125 GJS

126 RADHAKRISHNA BASTI 126 OVHA

127 RADHAKRUSHNA TALASAHI-B, UNIT-6 127 GJS

128 RADHAKRUSHNA UPPER SAHI-A, UNIT-6 128 GJS

129 RAMAMANDIR BASTI 129 GJS

130 RAMESWARPATANA 130 GJS

131 RANGAMATIA TALA SAHI* 131 OVHA

132 RANGAMATIA UPAR SAHI* 132 OVHA

133 SHIKHAR CHANDI - II 133 OVHA

134 REDDY SAHI 134 MY HEART

135 RICKSHAW COLONY* 135 OVHA

136 SABAR SAHI 136 BC



137 SADAK SAHI 137 BC

138 SAMANTARAPUR BASTI 138 GJS

139 SAMANTARAPUR TELENGA SAHI 139 GJS

140 SANTALA BASTI 140 FPAI

141 SANTOSHI NAGAR 141 FPAI

142 SARALA NAGAR 142 OVHA

143 SARANAPALLI 143 FPAI

144 SASTRI NAGAR BASTI UPAR SAHI 144 BC

145 SATYANARAYAN NAGAR 145 FPAI

146 SCIENCE PARK MAHAVVER BASTI 146 OVHA

147 SHAKTI VIHAR 147 FPAI

148 SIKHARACHANDI III 148 OVHA

149 SIKHARCHANDI - I 149 OVHA

150 SIMILI BASTI 150 BC

151 SINDURPADA BHAT BHOI SAHI 151 GJS

152 SION SRAMIKA BASTI 152 OVHA

153 SIRIPUR SABAR SAHI* 153 BC

154 SITANATH NAGAR 154 OVHA

155 SITAPUR BASTI 155 BC

156 SLUM INDIRA MAIDAN 156 BC

157 SRIKRISHNA NAGAR 157 MY HEART

158 SRIRAM NAGAR 158 FPAI

159 SWADHIN NAGAR 159 MY HEART

160 SWEEPER COLONY, UNIT-6 160 GJS

161 TARINI BASTI,UNIT-6 161 GJS

162 TARINI NAGAR Basti 162 OVHA

163 TARINI NAGAR 163 FPAI

164 TARINIBASTI, GANDAMUNDA 164 GJS

165 TATIBASTI (NEAR ADIVASI GROUND) 165 GJS

166 TRINATH BASTI (CBI OFFICE) 166 BC

167 TULASI BASTI 167 BC

168 VENKATESWAR BASTI 168 BC


annexure III: repeat residual Chlorine test regimeRepeat residual chlorine testing regime for stand post

Slum Code

Ward No.

Sample Code Ist round IInd Round IIIrd Round

Chlorine Quantity

(ppm)

Chlorine Quantity

(ppm)

Date Chlorine Quantity

(ppm)

Date

161 46 HUP/161/1/A 0.60 0.4 21.10.2013

127 46 HUP/127/1/A 0.60 0.3 21.10.2013

127 46 HUP/127/1/C 0.60 0.4 21.10.2013

138 56 HUP/138/1/A 1.50 1 09.10.2013

138 56 HUP/138/1/B 1.50 1.1 09.10.2013

67 46 HUP/67/1/B 1.00 0.3 21.10.2013

165 46 HUP/165/1/A 3.00 0.6 04.10.2013 (4 PM)

0.3 9.10.2013 (9.30am)

165 46 HUP/165/1/B 1.00 0.6 04.10.2013 (4 PM)

0.3 9.10.2013 (9.30am)

165 46 HUP/165/1/C 3.00 0.6 04.10.2013 (4 PM)

0.3 9.10.2013 (9.30am)

165 46 HUP/165/1/D 2.20 0 0.4 9.10.2013 (9.30am)

165 46 HUP/165/1/E 1.60 0.4 04.10.2013 (4 PM)

0.3 9.10.2013 (9.30am)

165 46 HUP/165/1/F 2.50 0 0.4 9.10.2013 (9.30am)

45 53 HUP/45/1/B 1.10 0.7 10.10.2013 (9.30am)

98 52 HUP/98/1/C 1.50 0.3 10.10.2013 (9.30am)

98 52 HUP/98/1/A 2.20 0.6 10.10.2013 (9.30am)

98 52 HUP/98/1/B 5.50 0.4 10.10.2013 (9.30am)

60 47 HUP/60/1/F 0.80 0.1 9.10.2013 (10.30am)

4 46 HUP/4/1/A 0.60 0.4 21.10.2013

4 46 HUP/4/1/B 0.70 0.4 21.10.2013

160 46 HUP/160/1/F 0.70 0.4 21.10.2013

160 46 HUP/160/1/B 0.90 0.5 21.10.2013

160 46 HUP/160/1/E 0.80 0.4 21.10.2013


annexure IV: Sanitary Survey formats

I. Type of facility: OPEN DUG WELL

1. General information:

i. City/Town __________________________________________________________________

ii. District __________________________________________________________________

iii. Health centre __________________________________________________________________

iv. Slum name __________________________________________________________________

v. Ward No __________________________________________________________________

2. Code no _________________ Address/ land mark of water facility __________________________

3. Water authority / community representative signature ____________________________________

4. Date of visit ________________________________________________________________________

5. Water sample collected? ____________ if yes, Sample no _________________________________

6. Whether water is safe and useable?

(If the colour of the water sample taken in a H2S vial does not change to black in 24-48 hours it is safe and useable)

II. Specific diagnostic information for assessment Risk

Please mark ‘yes’ or ‘no’ as answers to the following questions to assess risk

1. Is there a latrine within 10 m of the well? Y N

2. Is the nearest latrine on a higher ground than the well? Y N

3. Is there any other source of pollution (e.g. animal excreta, rubbish) Y N within 10 m of the well?

4. Is the drainage poor, causing stagnant water within 2 m of the well? Y N

5. Is there a faulty drainage channel? Is it broken, permitting ponding? Y N

6. Is the wall (parapet) around the well inadequate, allowing surface water Y N to enter the well?

7. Is the concrete floor less than 1 m wide around the well? Y N

8. Are the walls of the well inadequately sealed at any point for 3m below the ground? Y N

9. Are there any cracks in the concrete floor around the well which could Y N permit water to enter the well?

10. Are the rope and bucket left in such a position that they may become contaminated? Y N


11. Does the installation require fencing? Y N

Total score of risks ____________________ /11

To calculate the risk at water source, please count all the responses marked ‘yes’ in response to the above questions.

Contamination risk score: 9-11 very high 6-8 high 3-5 intermediate 0-2 low

III. Results and recommendations

Suggestions regarding prevention and precautions were given to the community members or their authorised representative after the assessment of the risk from 1-11.

Signature of those surveying team: ____________________

I Type of facility: covered dUg well witH Hand-PUmP


i. City/Town __________________________________________________________________

ii. District __________________________________________________________________


iv. Slum name __________________________________________________________________

v. Ward No __________________________________________________________________

2. Code no_____________________ Address/ land mark of water facility ______________________


4. Date of visit __________________________________________________________________

5. Water sample collected? ________________________ if yes, Sample No _____________________


(If the colour of the water sample taken in a H2S vial does not change to black in 24-48 hours, it is safe and useable)


II Specific diagnostic information for assessment Risk


1. Is there a latrine within 10 m of the well and hand-pump? Y N

2. Is the nearest latrine on higher ground than the hand-pump? Y N

3. Is there any other source of pollution (e.g. animal excreta, rubbish) Y N

within 10 m of the hand-pump?

4. Is the drainage poor, causing stagnant water within 2 m of the cement floor Y N

of the hand-pump?

5. Is there a faulty drainage channel? Is it broken, permitting ponding? Y N

6. Is the wall (parapet) around the hand-pump inadequate, allowing animals in? Y N

7. Is the concrete floor less than 1 m wide around the hand-pump? Y N

8. Is there any ponding on the concrete floor around the hand-pump? Y N

9. Are there any cracks in the concrete floor around the hand-pump Y N which could permit water to enter the hand-pump?

10. Is the hand-pump loose at the point of attachment to the base so that Y N water could enter the casing?

11. Is the cover of the well unsanitary? Y N

12. Are the walls of the well inadequately sealed at any point for 3 m Y N below ground level?

Total score of risks___________________________/12

To calculate the risk at water source, please count all the “yes” marked in response to the above questions

Contamination risk score: 9-12 very high, 6-8 high, 3-5 intermediate, 0-2 low

Results and recommendations


Signature of those surveying team: ____________________


I Type of facility: TUBEWELL WITH HAND-PUMP


i. City/Town __________________________________________________________________

ii. District __________________________________________________________________


iv. Slum name __________________________________________________________________

v. Ward No __________________________________________________________________

2. Code no _________________ Address/ land mark of water facility __________________________


4. Date of visit __________________________________________________________________

5. Water sample collected? _____________________ if yes, Sample No _______________________




Please mark ‘yes’ or ‘no’ as answers of the following questions to assess risk

1. Is there a latrine within 10 m of the hand-pump? Y N

2. Is the nearest latrine on higher ground than the hand-pump? Y N

3. Is there any other source of pollution ( e.g. animal excreta, rubbish, Y N surface water)within 10 m of the hand-pump?

4. Is the drainage poor, causing stagnant water within 2 m of the hand-pump? Y N

5. Is the hand-pump drainage channel faulty? Is it broken, permitting ponding? Y N Does it need cleaning?

6. Is the fencing around the hand-pump inadequate, allowing animals in? Y N

7. Is the concrete floor less than 1 m wide all around the hand-pump? Y N

8. Is there any ponding on the concrete floor around the hand-pump? Y N

9. Are there any cracks in the concrete floor around the hand-pump which Y N could permit water to enter the well ?

10. Is the hand-pump loose at the point of attachment to the base so that Y N water could enter the casing?

Total score of risks _________________________/10

To calculate the risk at water source, please count all the “yes” marked in response to the above questions



III Results and recommendations


Signature of the surveying team: __________________________

I Type of facility: DEEP BOREHOLE WITH MECHANICAL PUMP


i. City/Town __________________________________________________________________

ii. District __________________________________________________________________


iv. Slum name __________________________________________________________________

v. Ward No __________________________________________________________________

2. Code no. _________________ Address/ land mark of water facility __________________________


4. Date of visit __________________________________________________________________

5. Water sample collected? ________________________ if yes, Sample no _____________________

6. Whether water is safe and can be useable?



Please mark ‘yes’ or ‘no’ as answers to the following questions to assess the risk

1. Is there a latrine or sewer within 15-20 m of the pump house? Y N

2. Is the nearest latrine a pit latrine that percolates to soil, i.e. unsewered? Y N

3. Is there any other source of pollution (e.g. animal excreta, rubbish, Y N surface water) within 10 m of the borehole?

4. Is there an uncapped well within 15-20 m of the borehole? Y N

5. Is the drainage area around the pump house faulty? Y N

6. Is it broken, permitting ponding and /or leakage to ground? Y N


7. Is the fencing around the installation damaged in any way which would Y N permit any unauthorised entry or allow animals access?

8. Is the floor of the pumphouse permeable to water? Y N

9. Is the well seal unsanitary? Y N

10. Is the chlorination working poorly? Y N

11. Is chlorine absent at the sampling tap? Y N

Total score of risks _______________________./10

To calculate the risk at water source, please count all the ‘yes’ marked in the response to the above mentioned questions


III Results and recommendations


Signature of surveying team: ____________________________________

1 Type of facility: STAND POST (Pipe water supply) General information:

vi. City/Town __________________________________________________________________

vii. District __________________________________________________________________

viii. Health centre __________________________________________________________________

ix. Slum name __________________________________________________________________

x. Ward No __________________________________________________________________

7. Code no___________________ Address/ land mark of water facility _________________________


9. Date of visit __________________________________________________________________

10. Water sample collected? _____________________ if yes, Sample No. _______________________

11. Whether water is safe and can be useable?



12. Presence of chlorine in ppm in the sample ______________________________________________

IV. Specific diagnostic information for assessment Risk


1. Is there a leakage in the pipes or tap(s) of stand post? Y N

2. Is the area around stand post insanitary (e.g. presence of animal excreta, rubbish) Y N

3. Is there stagnant water surrounding the stand post? Y N

4. Is there a latrine or sewerage within 10 m of the stand post? Y N

5. Has there been discontinuity of water supply in the last 10 days? Y N

6. Are there any leaks in the distribution pipes of the stand post? Y N

7. Is the stand post below ground level? Y N

8. Have users reported pipe breaks in the last week? Y N

9. Is the plinth of the stand post cracked or eroded? Y N

10. Do animals have access to the area around the stand post? Y N

11. Are there any cracks or leakage on the attached tank (if any) Y N

Total score of risks _________________/11

To calculate the risk at water source, please count all the ‘yes’ marked in the response to the above questions


V. Results and recommendations

Suggestions regarding prevention and precautions were given to the community members or their authorised representative after the assessment of risk from 1-11.

Signature of the surveying team: _____________________________


annexure V: Source Wise risk factors Segregation matrix

type of risk factors

Stand-post tube Well with hand pump

bore well fitted with mechanical pump

open dug well

Hazard factors Q2;Q3 Q1;Q3;Q4;84 Q1-Q5; Q1;Q3Q4;

Path Way Factors Q1;Q4-8;Q10 Q2;Q5-Q7;Q9;Q10

Q6;Q8-Q11 Q2;Q5;Q7-Q11

Indirect factors Q9 Q6 Q7 Q6

Q# is the number of diagnostic question from sanitary survey formats of various sources.


references

Alam, A., & Rahaman, M. (2011, February). Assessment of Dugwell as an Alternative Water Supply Options in Arsenic Affected Areas of Bangladesh. International Journal of Civil & Environmental Engineering, 11(1)

Bhunia, R., Hutin, Y., Ramakrishnan, R., Pal, N., Sen, T., & Murhekar, M. (2009, April 27). A Typhoid fever outbreak in a slum of South Dum Dum municipality, West Bengal, 2007: Evidence for food-borne and water-borne transmission. BMC Public Health, 9, 115. doi:10.1186/1471-2458-9-115

Bhunia, R., Ramkrishnan, R., Hutin, Y., & Gupte, M. D. (2009, March-April). Cholera outbreak secondary to contaminated pipe water in an urban area, Wets Bengal, India, 2006. (S. J. Bahtia, & B. S. Ramkrishna, Eds.) Indian Journal of Gastroenterology, 28(2), 62-64. Retrieved August 2014, from http://www.indianjgastro.com/index.php

CDC. (1990). Chlorine Residual Testing FactSheet. Center For Disease Control- SWS Project. Retrieved from http://www.cdc.gov/safewater/chlorine-residual-testing.html

Das, A., Manickam, P., Hutin, Y., Pal, B. B., Chhotray, G. p., Kar, S. K., & Gupte, M. D. (2009, October). An Outbreak of Cholera Assocaited with an Unprotected Well in Parbatia, Orissa, Eastern India. Journal of Health, Population and Nutrition, 27(5), 646-51. Retrieved February 2014, from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2928086&tool=pmcentrez&rendertype=abstract

EPA, U. (1986). Ambient Water Quality Criteria for Bacteria. Washington D.C: United States Environmental Protection Agency

Ferretti, E., Bonadonna, L., Lucentini, L., & Libera, S. (2010). A Case Study of Sanitary Survey on Community Drinking Water Supplies after severe(post-Tsunami) Flooding event. Ann Ist Super Sanita, 46(3), 236-241. doi:DOI: 10.4415/ANN_10_03_03

Godfrey, S., & Howard, G. (2004). Water Safety Plans(WSP) for Urban Piped Water Supply in Developing Countries. Leicestershire, UK: Water, Engineering and Development Centre . Retrieved August 2014, from http:www.lboro.ac.uk/wedc/projects/iram/index.htm

Godfrey, S., Timo, F., & Smith, M. (2006, September ). Microbial risk assessment and managemnet of shallow ground water sources in Lichinga,Mozambique. Water and Environment, 20(3), 194-202

Haque, F., Hossain, M. J., Kundu, S. K., Naser, A. M., Rahman, M., & Luby, S. P. (2013). Cholera Outbreaks In Urban Bangladesh In 2011. Epidemiology:Open Access, 3(2). doi:10.4172/2161-1165.1000126

Harp, D. L. (2002). Current Technology of Chlorine Analysis for water and wastewater. USA: Hach Company. Retrieved February 2014

Howard, A. G. (2002). Water Supply Survelliance: A Referance Manual (1st ed.). Loughborough, Leicestershire, UK: WEDC, Loughborough University, UK. Retrieved February 2014, from http://www.lboro.ac.uk/wedc/publications/wss-rm.htm

Howard, G., Pedley, S., Barrett, M., Nalubega, M., & Johal, K. (2003, December). Risk factors contributing to microbiological contamination of shallow groundwater in Kampala, Uganda. Water Research, 37(20), 3421-3429. doi:DOI: 10.1016/S0043-1354(03)00235-5


Howards, G., Godfrey, S., & Boonyakarnkul, T. (2006). Sanitary Completion of Protection Works around Groundwater Sources. In O. Schmoll, G. Howard, J. Chilton, & I. Chorus (Eds.), Protecting Groundwater for Health (1st ed., pp. 493-513). London, UK: IWA Publishing. Retrieved February 2014

LeChevallier, M. W., Gullick, R. W., & Karim, M. (1999). The Potential for Health Risks from Intrusion of Contaminants into the Distribution System from Pressure transients. Pennsylvania: U.S. Environmental Protection Agency.

Lloyd, B. J., & Bartram, J. K. (1991). Surveillance solutions to microbiological problems in water quality control in developing countries . Water Science Technology, 24(2), 61-75. Retrieved July 2014, from http://www.iwaponline.com

Lloyd, B., & Helmer, R. (1991). Surveillance of Drinking Water Quality in Rural Areas. London: Longman.

Luby, S. P., Gupta, S. K., Sheikh, M. A., Johnston, R. B., Ram, P. K., & Islam, M. S. (2008). Tubewell water quality and predictors of contamination in three flood-prone areas in Bangladesh. Journal of Applied Microbilogy, 105(4), 1002-1008. Retrieved February 2014

Mohanty, L. N., & Mohanty, S. (2005). Slum in India (1st ed.). Delhi, India: S.B Nagia, APH Publishing Corporation. Retrieved August 2014, from http://books.google.co.in/books?

Morris, J. C. (1978). Modern Chemical Methods in Water and Waste Water Treatment . Delft: The Neatherland: International Institute for Hydrualic and Environmental Engineering.

Mosley, L. M., & Sharp, D. S. (2005). The Hydrogen-sulphide(H2S) paper-strip test for monitoring drinking water quality in the Pacific Island. SOPAC. SOPAC. Retrieved February 2014

Nasinyama, G. W., McEwen, S. A., Wilson, J. B., Waltner-Toews, D., Gyles, C. L., & Opuda-Asibo, J. (2000, September). RISK FACTORS FOR ACUTE Diarrhoea among inhabitants of kampala Distrcits, Ugnada. South African Medical Journal, 90(9), 891-898. Retrieved from http://archive.samj.org.za

O’Connor, R. (2002). Report of the Walkerton Enquiry , Part One: The Events of May 2000 and Related issues(A Summary). Ontario Minsitry of the Attorney General , Ontario. Retrieved Febryary 2014, from http://www.attorneygeneral.jus.gov.on.ca/english/about/pubs/walkerton/part1/WI_Summary.pdf

Odonkers, T., & Ampofo, K. (2013). Escherichia Coli as an Indicato of Bactriological Quality of Water : an overview. Microbiology Research, 4(2)

Olsen, S. J., Miller, G., Breuer, T., Kennedy, M., Higgins, C., Walford, J., . . . Mead, P. (2002, April). A Waterborne Outbreak of Escherichia Coli O157:H7 Infections and Hemolytic Uremic Syndrome: Implecations for Rural Water Systems. Emerging Infectious Diseases, 8(4), 370-375. Retrieved February 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730238/pdf/00-0218_FinalR.pdf

Oluwasanya, G., Smith, J., & Carter, R. (2011). Towards appropriate sanitary inspection tools for self supply systems in developing countries. THE FUTURE OF WATER , SANITATION AND HYGIENE : INNOVATION , ADAPTATION AND ENGAGEMENT IN A CHANGING WORLD . Loughborough: WEDC,Loughborough University . Retrieved August 2014

Prescott, S. C., & Winslow, C. E. (1904). Elements of Water Bacteriology, with Special Referance to Sanitary Water Analysis . New York: John Wiley & Sonos

Robertson, J. B., & Edberg, S. C. (1997, January). Natural Protection of Spring and Well Drinking Water


against Surface Microbial Contamination.I hydrogeological parameters. . Critical Review in Microbiology, 23(2), 143-178. Retrieved February 2014

Robertson, W., Standfield, G., Howard, G., & Bartram, J. (2003). Monitoring the Qulity of Drinking Water during Storage and Distribution. In Assessing Microbial Safety of Drinking Water (pp. 179-204). London, UK: IWA Publishing . Retrieved July 2014

Sailaja, B., MURHEKAR, M. V., Hutin, Y. J., Kuruva, S., Murthy, S. P., Jowaher Reddy, K. S., . . . Gupte, M. D. (2009, February). Outbreak of waterborne hepatitis E in Hyderabad, India. Epidemiology and Infection, 137(2), 234-240. doi:10.1017/S0950268808000952

Sajjad, H. (2014, March 20). Living standards and health problems of lesser fortunate slum dwellers:Evidence from an Indian city. International Journal of Environmental Protection and Policy, 2(2), 54-63. doi: 10.11648/j.ijepp.20140202.13

Subbaraman, R., Shitole, S., Shitole, T., Sawant, K., O’Brien, J., Bloom, D. E., & Deshmukh, A. P. (2013). The social ecology of water in Mumbai slum: failures in water quality,quantity and reliability. BMC Public Health(173). doi:doi:10.1186/1471-2458-13-173

Trevidei, B. K., Gandhi, H. S., & Shukla, M. K. (1971, November). Bacterilogicla Water Quality and Incidence of Waterborne Diseases in Rural Population . Indian Journal of Medical Science, 25(11), 795-801. Retrieved February 2014

WHO. (1993). Guideline for Drinking Water Quality (2nd ed., Vol. 1). Geneva: World Health Orgnization. Retrieved February 2014, from http://www.who.int/water_sanitation_health/dwq/2edvol1i.pdf?ua=1

WHO. (1997). Guidelines for drinking-water quality (2 ed., Vol. 3). Geneva, Switzerland: World Health Organization. Retrieved February 2104, from http://www.who.int/water_sanitation_health/dwq/gdwqvol32ed.pdf

WHO. (1999). Health based monitoring of recreational waters: the feasibility of new approach (the Annapolis Protocal). Sustainable Development and Healthy Enviroenmnet. Geneva: World Health Organization

WHO. (2002). Evaluation of H2S Method for Detection of Fecal Contamination of Drinking Water. Geneva: Water Sanitation and Health Department of Protection and the Human Environemnt , WHO

WHO. (2003). Guidelines for safe recreatioanl water enviornments.Vol1. Coastal and Fresh Water. Geneva: World Health Organization

WHO, & UNEP. (1988). Urbanization and its implications for Child Health: potential for action. Geneva: World Health Organization. Retrieved February 2014, from http://www.who.int/iris/handle/10665/39385#sthash.STuQXWk7.dpuf

WHO, & UNICEF. (2000). Global Water Supply and Sanitation Assessment. USA: WHO/UNICEF.

WHO, & UNICEF. (2010). Progress On Sanitation And Drinking Water 2010 Update. Geneva, Switzerland: World Health Organization. Retrieved February 2014, from http://www.wssinfo.org/fileadmin/user_upload/resources/1278061137-JMP_report_2010_en.pdf


acronyms

AWW Anganwadi Worker

ASHA Accredited Social Health Activist

BCC Behavioural Change Communication

BMC Bhubaneswar Municipal Corporation

FAS Ferrous Ammonium Sulfate

FIO Fecal Indicative Organism

GOI Government of India

HUP Health of the Urban Poor

HMIS Health Management Information System

IESWTR Interim Enhanced Surface Water Treatment Rule

H2S Hydrogen Sulphide

MAS Mahila Arogya Samiti

NUHM National Urban Health Mission

PFI Population Foundation of India

PHEO Public Health Engineering Organisation

POU Point of Use

PPM Parts Per Million

SJSRY Swarna Jayanti Sahari Rojgar Yojana

SPSS Statistical Package for Social Sciences

ULB Urban Local Bodies

USEPA United States Environment Protection Agency

WASH Water Sanitation and Hygiene

WHO World Health Organization

HealtH of tHe Urban Poor ProgramPopulation Foundation of India

B-28, Qutab Institutional Area, New Delh110016Tel: +91-11-43894100, Fax: +91-11-43894199

Email: [email protected]

www.populationfoundation.in

This document is made possible by the support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of the Population Foundation of India and do not necessarily reflect the veiws of USAID or the United States Government.

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P/W

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2015

sanitary survey of public drinking water sources in slums of bhubaneswar, odisha (1)

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