Operational Models for Chlorine Dispensers at Communal Water Sources: Lessons from Government Partnerships in Kenya. Source: Proceedings of the Water Environment Federation, Volume 2011, Number 3, 2011 , pp. 412-415(4)

Authors: Ahmed, Aleem; Ahuja, Amrita; Berens, Jeff; Kouskalis, Eric; Pantone, Theodore

The chlorine dispenser system, an innovative point-of-collection approach to water treatment, offers the potential to significantly increase adoption of water treatment at low cost. This session will present some early learnings on operations and on working with governments that are emerging from pilot dispensers programs implemented in partnership with government institutions in Kenya.

Sustainability of Long-Term Take-Up at Point-of-Collection Chlorine Dispensers Provided Free of Charge in Rural Western Kenya. Proceedings of the Water Environment Federation, Volume 2011, Number 3, 2011 , pp. 249-250(2).

Kremer, Michael; Miguel, Edward; Null, Clair; Zwane, Alix Peterson

As part of a prior study, in September 2007 35 springs in rural communities in Western Kenya were randomly assigned to either a comparison group (15 springs) or a point-of-collection chlorination program (20 springs) involving installation of a chlorine dispenser near the spring and training of a community-elected chlorine promoter.

The chlorine dispenser was designed to reduce the costs of chlorination by switching from individually packaged bottles for each household to a common refill jug for the community. It also provides easier and more standardized dosing than the commercially-available bottled dilute sodium hypochlorite, facilitates social learning by making the treatment decision public, and serves as a visible reminder to treat water at the most salient moment.

Take-up was shown to be high (61% of randomly selected households tested positive for at least 0.2 mg/L of total chlorine residual on an unannounced visit) within the first six months of the program when promoters were paid a small incentive (equivalent to US0.29) for every household that tested positive.

Chlorine Dispensers: An Innovative Solution – Innovations for Poverty Action

The Chlorine Dispenser System 

In 2007, a new approach to delivering chlorine at the community level was developed through a collaboration between Innovations for Poverty Action (IPA) and researchers at Harvard University and the University of California, Berkeley. This innovative technology – the chlorine dispenser system – provides a water treatment solution for use in poor areas where people do not have access to safe water from a piped system. This program aims to radically increase the percentage of households that treat their drinking water by providing chlorine treatment at water sources through easy-to-use dispensers.

By using inexpensive bulk chlorine refills and simple long-lasting hardware, chlorine treatment can be provided through dispensers for as low as $0.30 US (24Ksh) per person per year. The low cost and large health impact make this program as cost-effective as the most successful public health programs, such as childhood vaccination.

The dispenser hardware is installed at communal water sources such as springs and wells and consists of a stand, a chlorine tank, and a high durability valve calibrated to release a 3ml dose of 1.25% sodium hypochlorite – enough to treat 20 liters of clear water. A community member is selected to take a leadership role in maintaining and managing each dispenser. This person, known as a ‘promoter’, is responsible for refilling the chlorine tank once a month, conducting community education about the dispenser, and reporting any problems to the organization implementing the chlorine dispenser system. Bulk chlorine refills can be distributed to chlorine dispenser sites through retail outlets, institutions such as schools or clinics, or people who contract with the implementing organization to deliver chlorine via motorbike directly to the promoter.

Treating water with a dispenser is quick and easy. Users dose a 20 liter container by turning the dispenser valve once to add chlorine to their container. The chlorine mixes with the water when the container is filled and transported home.

Furthermore, the public nature of the dispenser helps to encourage adoption. Given the strong social ties of rural communities when one community member sees another community member using the dispenser it leads to powerful social norm formation around water treatment and encourages peer education about safe water practices.

Chlorine Dispensers for Safe Water – Poverty Action Lab, 2012.

Research by J-PAL affiliates Michael Kremer, Edward Miguel, and Sendhil Mullainathan, along with Clair Null, Jessica Leino, and Alix Zwane, has shown that a point-of-collection water chlorination system, in combination with encouragement from community promoters, can dramatically increase access to safe water compared to marketing bottled chlorine through retail outlets. Evidence from their studies has contributed to the scale-up of the Chlorine Dispenser System (CDS), reaching over 400,000 people in Kenya and 20,000 people in Haiti, with plans to expand the program to at least two additional countries by 2014.

Evaluations

From 2003 to 2010, J-PAL affiliates Michael Kremer, Edward Miguel, and Sendhil Mullainathan, along with Clair Null, Jessica Leino and Alix Zwane, conducted a suite of randomized evaluations to investigate ways to improve water quality in rural Kenya. In their first study, researchers and partner NGOs sought to find a cost-effective way to reduce diarrheal disease by improving water quality at the source. Under the “Spring Cleaning” program, community springs were encased in concrete, forcing water to flow through a pipe rather than seeping from the ground, thus preventing contamination from groundwater. This simple infrastructure investment reduced fecal contamination at the source by 66 percent. However, much of this improvement was lost in users’ home water supply due to recontamination during transport and storage. For more about this project, see the related evaluation page.
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Although droughts are often recognized for their impact on crops and food prices, the human effect caused by these natural disasters can be serious and long-lasting. Today’s post by Charlotte Kellogg, a writer and researcher at http://www.publichealthdegree.com/, delves into the ways that droughts can lead to severe, but often preventable, public health crises. Included in these crises is the contamination of water, an issue that can be addressed with innovative and site-appropriate tools, as noted in the WASHplus blog earlier this year.

The Problem Drought Presents to Public Health

Photo source: USAID

All natural disasters pose health risks to survivors, but perhaps none as profoundly as droughts. The worst droughts last for months if not longer, and the toll on humans and animals both is often drawn out and painful. Starvation, malnutrition, and chronic dehydration take a long time to set in, and even longer to reverse. Illnesses transmitted during these periods are sometimes quick to take lives, but more often are latent, causing problems years down the road. Improved infrastructure and planning technologies have allowed government entities and aid organizations to better their responses to droughts. More improvements are on the horizon, with the hope that the suffering caused by suffering may not always be the urgent health crisis it has been in the past.

Simply speaking, a drought is an environmental condition where there is a serious shortage of water. This is often caused by lack of rainfall, but poor irrigation and overuse of streambeds and lakes can also contribute. Many of the most severe droughts happen in the desert climates of Africa, where water is scarce to start with and many communities do not have adequate means of capturing and storing rainfall when they do come. It’s important to remember that severely dry conditions can happen in almost any region, however. The Midwestern United States, a prime corn growing region, has seen serious drought conditions this year, which has weakened the corn yield—and with it, many aspects of the local economy.

Contaminated Water
One of the biggest public health risks of any drought is contaminated water. When the ground becomes dry and parched, wells and springs often dry up, which can severely limit the availability of clean drinking water. In industrialized societies, the biggest problem is often with sewage backup or plumbing failures. “Pressure fluctuations and water outages create ideal conditions for contamination through a phenomenon known as backflow,” the University of Washington School of Public Health and Community Medicine said in a 2001 article examining the effects of drought on communities in Washington State. “Backflow” is a condition where untreated water filters back into pipes that normally carry clean or purified water into homes.

In less-developed communities, the risks of water contamination are much more acute. Very dry conditions often accelerate the rate at which raw sewage enters into the water supply, and wells dug improperly often tap water that is unfit for consumption. Any pools of water that exist also become breeding grounds for insects and other disease-carrying pests.

Communicable Diseases
Hand-in-hand with water contamination is the risk of communicable disease. “Lack of water supply and sanitation services, malnutrition, displacement and higher vulnerability of the population all increase the risk of infectious diseases such as cholera, typhoid fever, diarrhea, acute respiratory infections and measles,” the World Health Organization says. Many of these diseases are exacerbated by dehydration and overheating, two conditions common during droughts.

Starvation and Malnutrition
When water dries up, crops tend to die and livestock loses vitality. This often has profound impacts on the health and well-being of affected populations, particularly children. Young people who do not get enough protein or essential nutrients like vitamin complexes early in life often suffer debilitating consequences later on, regardless of future access to food and water. Weak bones, chronic pain, and stunted growth are only some of the concerns associated with starvation and malnutrition.

It is all but impossible to prevent droughts, as they are usually caused by weather patterns that are out of human control. A lot can be done to mitigate negative health effects, however, including reliance on advanced prediction technologies and the use of cellphones and mobile applications to more effectively bring aid to affected regions. In many cases, simple pre-planning and government readiness with an eye toward understanding the risks is all it takes to help populations weather drought conditions unscathed.

Building effective Drinking Water management policies in rural Africa: Lessons from Northern Uganda, 2012.

Christopher Opio. The Centre for International Governance Innovation.

This discussion paper describes a water quality study undertaken in Northern Uganda, to test the potability and potential contamination of water taken from wells, open water sources and households. Key lessons from the study include the fact that clean well water can be contaminated during transportation to, and storage in, homes. Building on the data from the water quality tests, this paper explores the policy implications for national governments, non-governmental organizations (NGOs) and individuals at the household level. In the absence of more specific, country-by-country studies, the results from this study are applicable across the region due to similarities in water sources and storage practices in rural Africa.

Journal of Water, Sanitation and Hygiene for Development Vol 2 No 4 pp 250–253 2012

Microbiological quality of chlorinated water after storage in ceramic pots

Clair Null and Daniele Lantagne

Rollins School of Public Health, Emory University, 1518 Clifton Road Northeast, Atlanta, GA 30329, USA
E-mail: clair.null@emory.edu
Sustainability Science Program, Kennedy School of Government, Harvard University, 79 JFK Street, Cambridge, MA 02138, USA

Household water treatment with sodium hypochlorite has been shown to reduce self-reported diarrheal disease in developing countries. Reported hypochlorite use, time since treatment, total chlorine residual (TCR), and E. coli concentration results from 589 household surveys in rural Kenya were analyzed to quantify the effect of exceeding recommended 24 hour post-treatment water storage time in ceramic pots.

Exceeding storage time recommendations impacted treatment efficacy, as 87% of reported treaters with TCR ≥ 0.2 mg/L storing their water ≤ 24 hours met World Health Organization (WHO) E. coli guideline values, compared to 77% of reported treaters with TCR ≥ 0.2 mg/L storing water >24 hours (p = 0.024) and 7% of reported non-treaters. Implementing organizations face the trade-off between promoting treating water every 24 hours and accepting slightly compromised efficacy.

Journal of Water, Sanitation and Hygiene for Development Vol 2 No 4 pp 241–249 2012

Rainwater harvesting in rural Trinidad; a cross sectional, observational study

Jonathan M. E. Dean, Fredericka Deare, Keizel Kydd, Jennie Ward-Robinson and Paul R. Hunter

The Norwich School of Medicine, University of East Anglia, Norwich NR4 7TJ, UK.
E-mail: Paul.Hunter@uea.ac.uk
Women Gender and Water Network, Institute of Gender and Development Studies, The University of the West Indies
Institute for Public Health and Water Research, Chicago, Illinois, USA

Rainwater harvesting is a well-established practice in many parts of the world. In the right environment it can provide a convenient, inexpensive and sustainable source of potable water. This study explored rainwater collecting system use within rural Trinidadian communities. Data regarding participants’ demographic details, water practices, health- and water-related beliefs were collected from six separate regions late in 2009 using a purpose designed questionnaire. The findings, obtained from the 1,523 study participants resident in 292 households were analysed. Almost half (130) of the participating households utilised rainwater as their main supply although some found it necessary to switch to alternative sources during dry periods.

The majority of participants (478) who harvested rainwater were very satisfied with the quality of their water and relatively few (212) were concerned that it may pose a risk to their health. Rainwater harvesting systems are well established in Trinidad and are well accepted by those who use them. Further research is needed to establish why more households do not adopt this technology as alternative sources remain inconsistent and inadequate in many respects. These findings will assist individuals and government agencies in making informed decisions when planning and managing water sources on the island.

Journal of Water, Sanitation and Hygiene for Development Vol 2 No 4 pp 223–240 2012

Sachet drinking water in Ghana’s Accra-Tema metropolitan area: past, present, and future

Justin Stoler, John R. Weeks and Günther Fink

Department of Geography and Regional Studies, University of Miami,1000 Memorial Drive, Coral Gables, FL 33124, USA.  E-mail: stoler@miami.edu
Department of Geography, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA

Population growth in West Africa has outpaced local efforts to expand potable water services, and private sector sale of packaged drinking water has filled an important gap in household water security. Consumption of drinking water packaged in plastic sachets has soared in West Africa over the last decade, but the long-term implications of these changing consumption patterns remain unclear and unstudied.

This paper reviews recent shifts in drinking water, drawing upon data from the 2003 and 2008 Demographic and Health Surveys, and provides an overview of the history, economics, quality, and regulation of sachet water in Ghana’s Accra-Tema Metropolitan Area. Given the pros and cons of sachet water, we suggest that a more holistic understanding of the drinking water landscape is necessary for municipal planning and sustainable drinking water provision.

Arch Pediatr Adolesc Med. September 17, 2012

Association Between Intensive Handwashing Promotion and Child Development in Karachi, Pakistan: A Cluster Randomized Controlled Trial

Anna Bowen, MD; Mubina Agboatwalla, MBBS; Stephen Luby, MD; Timothy Tobery, PhD; Tracy Ayers, MS; R. M. Hoekstra, PhD

Objective – To evaluate associations between handwashing promotion and child growth and development.

Design – Cluster randomized controlled trial.

Setting – Informal settlements in Karachi, Pakistan.

Participants  - A total of 461 children who were enrolled in a trial of household-level handwashing promotion in 2003 and were younger than 8 years at reassessment in 2009.

Interventions – In 2003, neighborhoods were randomized to control (n = 9), handwashing promotion (n = 9), or handwashing promotion and drinking water treatment (n = 10); intervention households received free soap and weekly handwashing promotion for 9 months.

Main Outcome Measures  - Anthropometrics and developmental quotients measured with the Battelle Developmental Inventory II at 5 to 7 years of age.

Results – Overall, 24.9% (95% CI, 20.0%-30.6%) and 22.1% (95% CI, 18.0%-26.8%) of children had z scores that were more than 2 SDs below the expected z scores for height and body mass index for age, respectively; anthropometrics did not differ significantly across study groups. Global developmental quotients averaged 104.4 (95% CI, 101.9-107.0) among intervention children and 98.3 (95% CI, 93.1-103.4) among control children (P = .04). Differences of similar magnitude were measured across adaptive, personal-social, communication, cognitive, and motor domains.

Conclusions  - Although growth was similar across groups, children randomized to the handwashing promotion during their first 30 months of age attained global developmental quotients 0.4 SDs greater than those of control children at 5 to 7 years of age. These gains are comparable to those of at-risk children enrolled in publicly funded preschools in the United States and suggest that handwashing promotion could improve child well-being and societal productivity.