The Acceptance & Adoption of Household Based Treatment And Safe Storage Of Drinking Water (HWTS)

Bongi Moyo-MaposaWater & Asset Management GroupCSIR Built Environment

The evidence & learning from field application in the developing world

Presentation Outline

• Introduction– The safe water challenge & The case for HWTS

• Scaling up HWTS– A review of the field evidence (literature and field

examples)

• Conclusions: – Implications for practice, advocacy and policy– Limitations of the evidence base & further work

The Safe Water and Health Challenge

Globally, approx 3% of deaths, 4% of DALYs due to unsafe water, sanitation and hygiene

Diarrhoeal illness in Africa, Asia and Latin America 90% due to environmental sanitation

Diarrhoea still a public health issue of concern in South Africa

The Case for HWTS

• Focus on personal & domestic hygiene in diarrhoeal disease control

• The rise of HWTS:– Early reviews of the efficacy of interventions

(Water Quantity & availability> sanitation>water quality)

– Shift in the paradigm (quality more important): post –collection contamination &HWTS

– Prospects for universal access to safe

water and sanitation

The Case for HWTS

A cost effective strategy:

Relative risk estimates for diarrhoea Water quality(0.69), sanitation (0.68) and hygiene (0.63) Source water quality (0.89) compared to point of use (0.65)

Independence of HWTS

$1 investment = $60 in reduced DALYs

WHO endorsement- HWTS Network

Scaling-Up HWTS

What are the factors that have influenced the acceptance and adoption of household based water treatment and safe storage in the target contexts?

Scaling up strategies

Areas for further work

Review of the field evidence

Querying the evidence

Review of the literature

Inclusion & Exclusion criteria

Data sources

Thematic analysis

1: Compatibility with existing social and cultural norms

Intervention might interfere

and cause disease

Using disinfectant might

interfere with the cooling

of water in clay pots

Water is culturally

associated with purity

2: Convenience

Convenient method to use

Easy to use/ ease of use

Preferred bleach to the flocculant disinfectant because the process was simpler

3: Time

Women already have a heavy workload

Treating water took too much time

Bleach vs flocculant disinfectant

4:Taste & appeal of the treated water

Volume of treated water

- almost always to little

Taste and smell of

‘WaterGuard’

Visible effects of using

flocculant disinfectant

5: Cost or Affordability

SODIS economical but

bottles were a problem,

cheaper than boiling

No money to buy

disinfectant etc

6: Need for water treatment

Source water contaminated

Aware of importance of

treating water

Aware of the link between

water and disease

Water traditionally

associated with purity,

already clean

7: Self Efficacy & Knowledge

Aware of the link

between water and

disease

Know how to prevent

diarrhoea

Have access to the treatment

technology

8: Motivation

Cues to action

initiate behaviour change

Trusted and competent

information sources

(social marketing

& motivational interviewing)

Prestige

9: Access to the technology/ intervention

Intervention not

readily available in

the home

Cheaper locally available

alternatives

10: Perceived efficacy of the intervention

Know about the

germicidal effects

of the sun and chlorine

Previous experience

Acceptance

Convenience

Taste & Visual Appeal

Compatibility

Time

Knowledge/Self

Efficacy

Motivation

Perceived Efficacy of

Intervention

Accessibility Affordability

Need for water

treatment

Adoption

Review of the field evidence(1)

In a community survey of communities around De Hoop Dam (2009)95% of the households interviewed stored drinking water after collecting it

75% storage containers reportedly covered

62% reported treatment

>80% used JIK (a household disinfectant) and soda

Soda only, chlorine and boiling

Review of the field evidence(2)

Review of the field evidence(2)

In a community survey of 35 randomly selected households in Tsambonkhulu, Mpumalanga (2012):

Community relies on 3 unprotected wells although there a number of boreholes and a piped water scheme

All collection and storage containers were made of plastic

Most of the collection containers had narrow mouths and were not covered

Review of the field evidence(2)

Appears most household do some kind of treatment

Only a quarter (23%) did not report treating their drinking water

Range of treatment methods reportedly used

Review of the field evidence(3)

Potter for Peace Ceramic Water Purifiers were distributed to communities in the E. Cape as part of the ASWSD I project (2010) Community trained in the use of the filters at

distribution

Acceptability to users: Happy to have the filter but dissatisfied with its performance (too little water, too slow, clogs within a few days)

Learnings: Understanding of context is key To deployment of appropriate intervention, Shed light on the relevant elements of context

Review of the field evidence(3)

Review of the field evidence (3)

Review of the field evidence (3)

Review of the field evidence (3)

Review of the field evidence (3)

Review of the field evidence (4)

The AmDrum in the E.Cape (2009)A 50L flocculant- disinfectant system designed by the CSIR, piloted in 2009 and subsequently redesigned

Issues with the original design: Technical problems – loose parts, leaking taps, taps

breaking, smelly sand column

Unavailability of spares and chemical refills

Review of the field evidence (4)

Review of the field evidence (5)

The rise and rise of HWTS in urban Harare (2007-2008)

Breakdown in the municipal water supply services

Cholera and diarrhoea outbreak

Boiling previously common, chlorination became the method of choice

Chlorination preferred over SODIS in an informal settlement in peri-urban Harare

A deep well

Meanwhile....

Review of the field evidence (5)

To treat …motivation, resources, knowledge, health concerns, taste and acceptability of treated water,

trust placed in authorities, availability & accuracy of information

Or not to treat….concerns about time, labour constraints, unwillingness to take up the responsibility, religious beliefs, and conviction about the necessity of treatment

Review of the field evidence (5)

TREAT

MotivationHealth concerns

Knowledge

Taste and acceptability of treated water

Resources

Conclusion

HWTS is an option to secure access to safe water for households

Available field evidence can provide a framework to understand HWTS implementation:

Implications for practice

Direction of future research

Policy and advocacy

Conclusion

Limitations and gaps in knowledgeLimitations

Wide geographical coverage Short term nature of the studies

More work on acceptability and adoption Issue addressed as a secondary objective Settings Technologies

chlorination & solar disinfection

The role of the researcher