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Household Water Treatment and Safe Storage (HWTS)
2014 Annual Meeting of the International HWTS Network
October 2014
Created for the World Health Organization
and United Nations Children’s Fund
This document was prepared by The Water Institute at the University of North Carolina (UNC) as part of the communications support project for the International Network on Household Water Treatment and Safe Storage funded by Procter & Gamble.
The Water Institute at UNC Gillings School of Global Public Health The University of North Carolina at Chapel Hill Rosenau Hall, CB #7431 135 Dauer Drive, Chapel Hill, NC 27599‐7431 Phone +1‐919‐966‐7302 http://www.waterinstitute.unc.edu Author: Jennifer Bogle
Reviewers and Editors: Ryan Rowe and Katie Hall – The Water Institute at UNC Batsi Majuru – World Health Organization (WHO) Angie Saleh – United Nations Children’s Fund (UNICEF)
This document can be downloaded from the HWTS Network communications website: hwts.web.unc.edu.
Please use the following reference when quoting this document:
Jennifer Bogle. 2014 Annual Meeting of the International Network on Household Water Treatment and Safe Storage. 2014. The Water Institute at UNC, Chapel Hill, NC, USA.
© University of North Carolina at Chapel Hill
Disclaimer: The findings, suggestions, and conclusions presented in this publication are entirely those of the authors and should not be attributed in any manner to The University of North Carolina at Chapel Hill.
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About The Water Institute The Water Institute at UNC provides international academic leadership at the nexus of water, health,
and development.
Through research, we tackle knowledge gaps that impede effective action on important WaSH and
health issues. We respond to the information needs of our partners, act early on emerging issues,
and proactively identify knowledge gaps. By developing local initiatives and international teaching
and learning partnerships, we deliver innovative, relevant and highly‐accessible training programs
that will strengthen the next generation’s capacity with the knowledge and experience to solve
water and sanitation challenges. By identifying or developing, synthesizing and distributing relevant
and up‐to‐date information on WaSH, we support effective policy making and decision‐taking that
protects health and improves human development worldwide, as well as predicting and helping to
prevent emerging risks. Through networking and developing partnerships, we bring together
individuals and institutions from diverse disciplines and sectors, enabling them to work together to
solve the most critical global issues in water and health.
We support WaSH sector organizations to significantly enhance the impact, sustainability, and
scalability of their programs.
The vision of The Water Institute at UNC is to bring together individuals and institutions from diverse
disciplines and sectors and empower them to work together to solve the most critical global issues in
water, sanitation, hygiene, and health.
About the Author Jennifer Bogle
Jennifer Bogle is a Knowledge Management Associate at The Water Institute at UNC.
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Acknowledgements The Annual Meeting of the International Network on Household Water Treatment (the HWTS
Network) was made possible in large part due to the contributions of HWTS Network participants in
planning, presenting, and offering insightful comments and questions in response to the meeting
presentations and discussions. Meeting presenters included Nikki Beetsch of the World Health
Organization (WHO), Thomas Clasen of Emory University, Ryan Cronk of The Water Institute at UNC,
Alexandre Doyen of Vestergaard‐Frandsen, Megan Grzybowski of Trip Quest, Rick Johnston of WHO,
Daniele Lantagne of Tufts University, Batsi Majuru of WHO, Edema Ojomo of The Water Institute at
UNC, Rob Quick of the Centers for Disease Control and Prevention (CDC), Michael Ritter of Deep
Springs International, Ryan Rowe of The Water Institute at UNC, and Angie Saleh of the United
Nations Children’s Fund (UNICEF).
The Water Institute at the University of North Carolina, Chapel Hill kindly offered facilities and
logistical support for the meeting as well as for the meeting of the Network Advisory Group and
Public Private Partnership Group. A special thanks to Marissa Streyle of The Water Institute for
planning support.
The meeting was organized jointly by WHO, UNICEF, and The Water Institute at UNC and facilitated
by Batsi Majuru of WHO. Angie Saleh of UNICEF and Ryan Rowe and Jen Bogle of UNC provided
communications and other organizational support.
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Table of Contents 1. Abbreviations, Acronyms and Names vi
2. Executive Summary 7
3. Introduction 8
4. Overview and Objectives 8
5. Sessions and Presentations 8
5.2 Session 1 – Global Access to Safe Drinking Water: Looking Close 8
5.2 Session 2 – Experiences of Network Participants 9
5.3 Session 3 – HWTS: Strengthening Approaches 9
5.3 Session 4 – Getting to the Three Cs: Correct, Consistent, and Continued Use 10
5.4 Session 5 – Learning Opportunities for Network Participants 11
5.5 Session 6 – Integrating HWTS with Other Sectors 11
5.6 Session 7 – Closing Remarks and Next Steps 12
6. References 13
7. Appendix A. Network Meeting Agenda 14
8. Appendix B. List of Network Meeting Presentations 16
9. Appendix C. List of Network Meeting Participants 17
10.Appendix D. Advisory and Public Groups Meeting Proceedings 19
10.1 Attendees 19
10.2 Overview 19
10.3 Network Update 19
10.4 Network Assessment 21
10.5 Conclusions and Next Steps 23
Lists of Tables Table 1. Network Meeting Participants 17
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1. Abbreviations, Acronyms and Names
CDC – Centers for Disease Control and Prevention (USA)
HWTS – Household Water Treatment and Safe Storage
MOOC – Massive Open Online Course
MDG – Millennium Development Goal
M&E Toolkit – Toolkit for Monitoring and Evaluating HWTS Programmes
NGO – Nongovernmental Organization
The Scheme – International Scheme to Evaluate Household Water Treatment Technologies
UNC – University of North Carolina at Chapel Hill
UNICEF – United Nations Children’s Fund
WaSH – Water, Sanitation, and Hygiene
WHO – World Health Organization
WSP – Water Safety Plan
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2. Executive Summary
On 13 October 2014, the Household Water Treatment and Safe Storage Network (the HWTS
Network) held its Annual Meeting in conjunction with the Water and Health Conference hosted
by The Water Institute at the University of North Carolina at Chapel Hill (UNC). The Annual
Meeting was followed by a joint meeting on 14 October 2014 between the Network Advisory
Group, Public‐Private Partnership Group, and the Network Secretariat, which is co‐led by WHO
and UNICEF, with communications support from The Water Institute at UNC. The following
summary reflects a synthesis of key points from these two events.
Network Activities: Network activities in the past year focused on disseminating the Toolkit for
Monitoring and Evaluating Household Water Treatment and Safe Storage Programmes (the M&E
Toolkit), implementing the International Scheme to Evaluate Household Water Treatment
Technologies (the Scheme), and communications activities to support knowledge exchange.
Although HWTS Network members are generally aware of the M&E Toolkit, uptake seems to be
limited. The Scheme is currently undergoing its first round of technology evaluations, the results
of which will be announced in the first quarter of 2015.
Updates on HWTS Scale‐up and Research: With the exception of boiling, household water
treatment technologies have not yet achieved scale. Evidence presented at the Annual Meeting
suggests that household water treatment technologies are effective, but the impact of a
particular technology is context‐specific and tied to high levels of compliance and sustained use.
There is opportunity for further research to evaluate factors that motivate behaviour change
toward correct, consistent, and continued use.
National Action Plans: Cambodia, India, and Bhutan were selected to receive seed funding for
national action plans following the November 2013 Network Annual Meeting. Each country is
now in varying stages of implementation.
Opportunities for HWTS Integration: Integrating HWTS with other sectors was a focal point of
Network discussions. Specifically, this included other public health interventions, such as
antenatal care, HIV programs, child nutrition programs, air quality interventions, and health
facilities, as well as the broader water, sanitation, and hygiene (WaSH) sector, including water
safety planning.
2015 Network Work Plan: The Secretariat recommended four main priority areas for the coming
year. They are: promoting participation in the WHO Scheme, particularly among manufacturers in
low income countries, integrating HWTS with key public health interventions, linking HWTS and
water safety and planning, and disseminating and mapping use of the M&E Toolkit.
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3. Introduction
The intent of the HWTS Network is “to contribute to a significant reduction in water‐borne and
water‐related vector‐borne diseases, especially among vulnerable populations, by promoting
household water treatment and safe storage as a key component of community‐targeted
environmental health programmes” (WHO and UNICEF 2011).
WHO established the HWTS Network in 2003 and was joined by UNICEF in 2011 as a co‐hosting
agency. The HWTS Network comprises over 140 organizations, including intergovernmental
bodies, national governments, non‐governmental organizations (NGOs), private sector
companies, and academic institutions.
Currently, the four main areas of HWTS Network activity are policy and advocacy, research and
learning, implementation and scale‐up, and monitoring and evaluation, supported by HWTS
Network Secretariat communications that crosscut each of these focus areas. Network activities
are guided by expertise and strategic input from the HWTS Network Advisory Group and Public‐
Private Partnership Group.
This report details the proceedings of the 2014 HWTS Network Annual Meeting held on 13
October 2014 in conjunction with the Water and Health Conference hosted by The Water
Institute at UNC. The Annual Meeting agenda is included in Appendix A. Full lists of meeting
presentations and attendees are included in Appendices B and C.
The Annual Meeting was followed by a joint meeting on 14 October 2014 between the HWTS
Network Advisory Group, Public‐Private Partnership Group, and the Secretariat. A summary of
this meeting is in Appendix D.
4. Overview and Objectives
Batsi Majuru of WHO initiated the Annual Meeting with a progress update on HWTS Network
activities and an overview of topics for discussion in the 2014 Annual Meeting.
In 2014, the Network focused on supporting the implementation of action plans developed
following the 2013 Annual Meeting in India, disseminating the M&E Toolkit, identifying barriers to
its use, and evaluating the first round of technologies submitted as part of the WHO International
Scheme to Evaluate Household Water Treatment Technologies (the Scheme).
The objectives of the 2014 Annual Meeting were to present and discuss Network activities carried
out in 2013‐2014, recent research findings, key challenges confronting HWTS, approaches for
achieving correct, consistent, and continued use of household treatment technologies, national
action planning, and the proposed 2015 HWTS Network work plan.
5. Sessions and Presentations
5.2 Session 1 – Global Access to Safe Drinking Water: Looking Close
This session covered the latest research on global drinking water quality and the effectiveness of
household water treatment as a water quality intervention. The session began with an update on
global drinking water targets by Ryan Rowe of The Water Institute, followed by a presentation on
fecal contamination in global drinking water by Ryan Cronk of The Water Institute and a review the
evidence on the effectiveness of water quality interventions by Thomas Clasen of Emory University.
9
Data from the Joint Monitoring Programme (JMP) shows that the sector met its 2015 target to
halve the proportion of the population without sustainable access to safe drinking water.
However, there are still 748 million people without access to an improved source, a figure which
may be overestimated by billions of individuals (Bain et al. 2014). Beyond this, an improved
source does not necessarily mean that water is safe, and there are substantial disparities in
access: one of the most notable gaps is between rural and urban areas, with access in rural areas
progressing more slowly than in urban areas.
A recent systematic literature review and meta‐analysis (Bain et al. 2014) highlighted that
improved water sources are safer than unimproved sources, but are not necessarily free of
contamination, as more than one‐quarter of improved sources have fecal contamination.
Furthermore, source types and settings influence water quality. For example, nearly all protected
dug wells have contamination, even though it is considered an improved source. There is also
evidence that compliance in household water treatment is important for achieving improved
health outcomes where water quality is poor (Brown and Clasen 2012). Short term studies
indicate that household treatment has a high health impact, whereas longer term studies show
that health benefits decline over time, which suggests the importance of correct, continued, and
consistent use. To date, few studies have evaluated the quality of stored water, sanitary risks, or
the efficacy of boiling.
The presentations concluded with a discussion of implications for the HWTS Network. While
household water treatment technologies are effective, the impact a particular technology is
context‐specific and tied to high levels of compliance and sustained use. It is therefore necessary
to further evaluate factors that motivate behaviour change.
5.2 Session 2 – Experiences of Network Participants
This session featured a presentation by Alexandre Doyen of Vestergaard Fransen on the role of
microcredit in improving the accessibility household treatment technologies.
Overall, microfinance institutions are not conversant in WaSH issues and do not see it as a
potential market. They perceive a high credit risk because WaSH interventions do not generate
income. In many countries, there is also minimal engagement between the WaSH sector and
microfinance institutions. This suggests potential opportunities for HWTS suppliers and
microfinance institutions to develop tools to help entrepreneurs with profit maximization.
Responses to the presentation suggested interest among Network members in learning more
about the role of microcredit in stimulating access to HWTS. One existing resource is Water
Credit and WaSH microfinance resources available through Water.org.
5.3 Session 3 – HWTS: Strengthening Approaches
This session included presentations from Nikki Beetsch of WHO, Edema Ojomo of The Water
Institute, Daniele Latagne of Tufts University, and Ryan Rowe of The Water Institute focusing on
technological efficacy as well as contextual factors that contribute to successful uptake and
scalability. The presenters covered specific approaches for evaluating household treatment
technologies, barriers and drivers to achieving scale, as well as issues and strategies to consider
when implementing HWTS policies and programs.
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WHO launched the International Scheme to Evaluate Household Water Treatment Technologies
to promote and coordinate independent and consistent evaluation of household water
treatment products. The Scheme focuses on microbiological contamination and sets
performance targets based on incremental improvements to water quality according to tiered
performance targets. The results from round 1 of technology evaluations are due for release in
the first quarter of 2015.
Presentations also highlighted the importance of considering not only technological efficacy but
also the specific context as part of overall HWTS effectiveness. This involves identifying the
potential barriers to scalability and considering the technology from a user standpoint. There are
a number of factors that contribute to scalability in the field, including quality control,
manufacturing consistency, standards and regulations, user preferences, integration with other
public health interventions, coordination with existing institutions and social structures, resource
availability, user training, and monitoring and evaluation.
Haiti was presented an example where the government is working toward a national strategy on
HWTS. The national water and sanitation authority will need to address issues such as setting
parameters for free versus commercial distribution, identifying vulnerable groups, increasing
willingness to pay among households, and strengthening stakeholder coordination and
knowledge sharing.
Discussions relating to the presentations highlighted the need to consider both scientific rigor
and practicality in designing products and evaluating them through the Scheme. Although there
are no indicators for effective product design, it was suggested that developing a list could help
ensure products are acceptable to users before they go through randomized control trials. With
respect to the Scheme, there were concerns that the costs of rigorous testing may preclude
small manufacturers in low income countries from participating, creating an imbalance in
representation among technologies. WHO conveyed that there are subsidies available intended
primarily for manufacturers in low income countries.
5.3 Session 4 – Getting to the Three Cs: Correct, Consistent, and Continued Use
Rob Quick of the US CDC, Ryan Rowe of The Water Institute, and Michael Ritter of Deep Springs
International presented strategies for achieving correct, consistent, and continued use. The session
began with a review of evidence for behaviour change in HWTS, followed by presentations on the
M&E Toolkit and an example of incorporating behaviour change theory into chlorine distribution
programmes in Haiti.
To achieve partial cost recovery of HWTS programmes, beneficiaries need to have disposable
income, demand, and motivation to adopt a new behaviour in face of other challenges. However,
literature reviews of behaviour change highlight the need for additional research that enables
others to replicate the study and interpret results.
A systematic review of literature by Parker Fiebelkorn et al. 2012 has shown that many studies
report insufficient information on models used for behaviour change interventions. Other studies
are too short to examine factors contributing to sustained use over the long term (Hunter 2009;
Arnold and Colford 2007; Waddington et al. 2009). Parker Fiebelkorn et al. suggest that objective
outcome measures, such as free chlorine residual, and longitudinal data are necessary for
improving knowledge of behaviour change models for HWTS.
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Tools such as the M&E Toolkit provide approaches and standard indicators for monitoring and
evaluating correct and consistent use of HWTS. The Toolkit helps practitioners go beyond asking
whether people treat their water by including objectives measures such as observation of HWTS
practices or confirmatory water quality testing.
Deep Springs International has used behaviour change theories to inform the distribution of
liquid chlorine in Haiti. They have found that different determinants for behaviour change are
linked to distinct stages of the behaviour change process. For example, convincing first‐time
users to purchase a chlorine system was related to user knowledge and attitudes, which became
less important in later stages. Their experience suggests that achieving correct, consistent, and
continued use is a lengthy and iterative process.
Following the presentations, Network members raised a number of questions regarding how to
effectively increase demand. The unifying message was that users vary substantially in their
preferences, which shift among individuals and cultures. For instance, some users may dislike the
taste of chlorine, whereas others interpret chlorine as an indicator of water safety. Ultimately,
there may be value in providing a menu of options and paying careful attention to user
responses.
5.4 Session 5 – Learning Opportunities for Network Participants
Network webinars on the M&E Toolkit as well as a recent online course were featured through
presentations by Megan Grzybowski of Triple Quest and Rick Johnston of WHO.
Triple Quest has held two webinars focusing on the M&E Toolkit. The initiative began with a
survey about Toolkit questions and use, and Triple Quest has since arranged for guest experts to
address questions raised in previous webinars.
Rick Johnston, in collaboration with Eawag, recently taught a free massive open online course
(MOOC), focusing on HWTS.
5.5 Session 6 – Integrating HWTS with Other Sectors
The HWTS Network is looking for opportunities to integrate with other sectors, but has not yet
developed specific guidance or tools to support integration. Small group discussions focused on
challenges and opportunities with respect to integrating with health and nutrition, education, and
the broader WaSH sector, including water safety planning. Three groups discussed themes
independently and presented key points and Network recommendations at the end of the session.
The health and nutrition group identified antenatal care, HIV programs, child feeding programs,
air quality interventions, and health facilities as key points of entry for HWTS. The WaSH group
focused on integration with water safety planning, while the education group spoke more
generally about the challenges of ensuring that school children bring the HWTS message home
to their families.
Several groups identified intersectoral collaboration as an important step in the integration
process. While HWTS actors have made progress in removing silos in HWTS, the Network faces
challenges in effectively integrating with other sectors. For example, there are often challenges
in connecting national ministries that are separately responsible for water and health.
Furthermore, although integration programs are well received and have a good base of evidence,
12
few are willing to pay for scaling up. Going forward, it will be important to identify information
that needs to be shared among sectors to make a stronger case for joint programs. One group
emphasized that HWTS actors should make a more concerted effort to engage with existing
networks. This might include connecting with national WaSH coordinators in government, NGO
Networks, and multi‐stakeholder WaSH networks. The education group noted that it is important
to contact key stakeholders before entering a school to promote HWTS.
The groups provided a number of ideas as to how the Network can support integration, which
included identifying existing networks for promoting HWTS, communicating with leaders in other
sectors, summarizing evidence and build a case for integration, developing briefing notes and
case studies for integrating HWTS and water safety planning, supporting Network members in
presentations at conferences and events outside HWTS, promoting information from the UNICEF
WaSH in schools programme, and providing guidance on community needs assessments. It could
also be useful for HWTS Network members to have information sheets to be ambassadors when
HWTS Network members present at other conferences.
5.6 Session 7 – Closing Remarks and Next Steps
The HWTS Network Secretariat recommended four main priority areas for the coming year. This
includes promoting participation in the WHO Scheme, particularly among manufacturers in low
income countries, integrating HWTS with key public health interventions and water safety
planning, and disseminating and mapping use of the M&E Toolkit.
Feedback and discussion among Network members suggested that the priorities seem feasible
given that the Scheme and Toolkit dissemination are already underway. However,
operationalizing integration is challenging. If one solid product could come out of each area
integration, then that could have value to the Network. Ideas put forward included using the
website as a clearinghouse or preparing briefing notes. If briefings were developed, it would be
important to determine how to convey the information and identify the audience and to show
existing knowledge, gaps, and practical examples. The Secretariat suggested that existing
reviews can be reworked or refreshed into formats that are more accessible to practitioners.
Attendees also suggested that the HWTS Network can make an effort to communicate how
WHO is addressing products that fail in the Scheme and the overall results.
Finally, participants recommended that the HWTS Network strive to provide a more effective
platform for facilitating linkages among its members.
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6. References
Arnold, Benjamin F., and John M. Colford. “Treating Water with Chlorine at Point‐of‐Use to
Improve Water Quality and Reduce Child Diarrhea in Developing Countries: A Systematic
Review and Meta‐Analysis.” The American Journal of Tropical Medicine & Hygiene 76
(2007): 354‐364.
Bain, Robert, Ryan Cronk, Jim Wright, Hong Yang, Tom Slaymaker, and Jamie Bartram. “Fecal
Contamination of Drinking‐Water in Low‐ and Middle‐Income Countries: A Systematic
Review and Meta‐Analysis.” PLOS Medicine 11 (2014): 1‐23.
Brown, Joe, and Thomas Clasen. “High Adherence Is Necessary to Realize Health Gains from
Water Quality Interventions.” PLoS ONE 7 (2012): 1‐9.
Hunter, Paul B. “Household Water Treatment in Developing Countries: Comparing Different
Intervention Types Using Meta‐Regression.” Environmental Science & Technology 43
(2009): 8991‐8997.
Parker Fiebelkorn, Amy, Bobbie Person, Robert E. Quick, Stephen M. Vindigni, Michael Jhung,
Anna Bowel, and Patricia L. Riley. “Systematic Review of Behaviour Change Research on
Point‐of‐Use Water Treatment Interventions in Countries Categorized as Low‐ to Medium‐
Development on the Human Development Index.” Social Science and Medicine 74 (2012):
622‐633.
Waddington, Hugh, Birte Snilstveit, Howard White, and Lorna Fewtrell. “Water, Sanitation, and
Hygiene Interventions to Combat Childhood Diarrhea in Developing Countries.” Available
at http://www.3ieimpact.org/media/filer_public/2012/05/07/17.pdf.
WHO and UNICEF. International Network on Household Water Treatment and Safe Storage:
Strategy and Funding Proposal, Revised March 2011. (Geneva and New York: World WHO
and UNICEF). Available from
http://www.who.int/household_water/resources/NetworkStrategyMar2011.pdf.
14
7. Appendix A. Network Meeting Agenda
International Network on Household Water Treatment and Safe Storage
Annual Meeting Agenda Monday, 13 October 2014, 8:30am‐5:00pm
University of North Carolina at Chapel Hill, USA
Meeting Objectives
Provide an update on selected activities during 2013‐2014.
Share the Network strategy for 2014‐2015.
Share research findings on improved water and present key challenges confronting HWTS.
Focus discussion on correct, consistent, and continued use and national action plans.
Sign‐in starting at 08h00, meeting will start at 08h30
8h30‐8h45 Opening remarks, meeting overview, and recent network activities
Welcome and meeting overview and objectives B Majuru, WHO
8h45‐9h45 Global access to safe drinking‐water: looking closer
Drinking‐water update from the JMP * R Rowe, The Water Institute
Fecal contamination in drinking water R Cronk, The Water Institute
Effectiveness of water quality interventions to T Clasen, Emory University Prevent diarrheal diseases
9h45‐10h00 Experiences of network participants
Micro‐entrepreneurial sales of Lifestraw in Nairobi A Doyen, Vestergaard‐Frandsen
Coffee break, 10h00‐10h30
10h30‐12h15 HWTS: Strengthening approaches
Enabling environment: Barriers/enablers of HWTS E Ojomo, The Water Institute
International Scheme to Evaluate HWT N Beetsch, WHO
Implementing HWTS: issues to consider D Lantagne, Tufts University
Developing a national strategy in Haiti R Rowe, The Water Institute
Lunch, 12h15‐13h15
13h15‐14h30 Getting to the “three Cs”: Correct, consistent and continued use
15
Evidence for HWTS behaviour change R Quick, US CDC
M&E toolkit: Resource for getting to the three Cs R Rowe, The Water Institute
Implementation example from Haiti M Ritter, Deep Springs International
14h30‐15h00 Learning opportunities for network participants
Regular discussions on HWTS M&E M Grzybowski, Triple Quest
Massive online open course on HWTS R Johnston, WHO
Coffee break, 15h00‐15h30
15h30‐16h50 Integrating HWTS into core public health interventions
Current integration efforts and Network involvement Group discussion
16h50‐17h00 Wrap‐up and next steps
Network strategy for 2014‐2015 A Saleh, UNICEF
* Q&A to immediately follow each presentation.
Happy Hour in downtown Chapel Hill, 18h30‐20h30
Top of the Hill Restaurant and Brewery All are welcome for networking and fun! 100 East Franklin Street 3rd Floor, Chapel Hill. +1 919 929 8676
16
8. Appendix B. List of Network Meeting Presentations
Global Access to Safe Drinking Water: Looking Closer
1. Progress on Drinking Water: 2014 Update from the JMP by Ryan Rowe, The Water Institute 2. Fecal Contamination of Drinking Water in Low‐ and Middle‐Income Countries: A Systematic Review
and Meta‐Analysis by Ryan Cronk, The Water Institute and Robert Bain, UNICEF 3. Update on Evidence of the Effectiveness of HWTS to Prevent Diarrhoeal Diseases by Thomas Clasen,
Emory University
Experiences of Network Participants
4. Microcredit and HWTS: A Case Study of Income Generation with the LifeStraw Community Filter by Alexandre Doyen, Vestergaard
HWTS: Strengthening Approaches
5. Implementing Household Water Treatment Interventions: Factors and Actors for Success by Edema Ojomo, The Water Institute at UNC
6. WHO International Scheme to Evaluate Household Water Treatment Technologies by Nikki Beetsch, WHO
7. Implementing HWTS: Issues to Consider by Daniel Lantagne, Tufts University 8. Developing a National Strategy on HWTS in Haiti by Ryan Rowe, The Water Institute
Getting to the Three Cs: Correct, Consistent, and Continued Use
9. Behaviour Change and HWTS by Rob Quick, CDC 10. The Three Cs of Household Water Treatment and Safe Storage by Ryan Rowe, The Water Institute 11. Getting to the 3Cs by Michael Ritter, Deep Springs International
Learning Opportunities for Network Participants
12. HWTS Network / Triple Quest WebEx Initiative by Megan Grzybowski, Triple Quest 13. MOOCing About: An Online HWTS Course by Rick Johnston, WHO
Wrap‐up and Next Steps
HWTS Network Proposed Work Plan: 2015 by Angie Saleh, UNICEF
17
9. Appendix C. List of Network Meeting Participants
Table 1. Network Meeting Participants
Name Affiliation
1 Vivian Akinyi Safe Water Kenya
2 Don Arnold Safe Water Kenya
3 Nikki Beetsch WHO
4 Joshua Briemberg WaterAid
5 Jen Bogle UNC
6 Thomas Clasen Emory University
7 Ryan Cronk UNC
8 Alexandre Doyen LifeStraw S.A.
9 Carolyn Crowley Meub Pure Water
10 Melinda Foran CAWST
11 Katie Friedman UNC
12 Roshini George Sera Global Health
13 John Gilles UNC
14 Bruce Gordon WHO
15 Megan Grzybowski Triple Quest
16 Rodney Herrington Aqua Research
17 Frank Husson Solar Solutions
18 Maria Inestroza Pure Water for the World
19 Rick Johnston WHO
20 Daniele Latagne Tufts University
21 Jonathan Lilje Eawag
22 Laura MacDonald Johns Hopkins University
23 Batsirai Majuru WHO
24 Laura Moehling Gift of Water
25 Hans Mosler Eawag
26 Anna Murray Tufts University
18
Name Affiliation
27 Kevin O’Callaghan Medentech
28 Edema Ojomo UNC
29 Rob Quick US CDC
30 Justine Rayner Tufts University
31 Rochelle Rainey USAID
32 Mark Reimers Waterlines
33 Diane Reimers Waterlines
34 Michael Ritter Deep Springs International
35 Ryan Rowe UNC
36 Angie Saleh UNICEF
37 Mark Sobsey UNC
38 Andrea Stocker Eawag
39 Claudio Valsangiacomo SUPSI / SDC Switzerland
40 Theresa Vonderhaar University of Illinois
41 Kaira Wagoner Potters for Peace
42 Candice Young‐Rojanschi CAWST
43 Claude Zukowski P&G
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10. Appendix D. Advisory and Public Groups Meeting Proceedings
Thirteen members of the Secretariat and Network Advisory and Public‐Private Partnership Groups
convened on 14 October 2014, the day following the 2014 Annual Network Meeting at Water and
Health Conference in Chapel Hill.
10.1 Attendees
Meeting attendees included:
Nikki Beetsch, WHO
Alexandre Doyen, VF
Bruce Gordon, WHO
Rick Johnston, WHO
Kevin O’Callaghan, Mendentech
Rob Quick, CDC
Rochelle Rainey, USAID
Allison Tummon, P&G – by phone
Daniel Maeusezahl, Unibas – by phone
Batsi Majuru of WHO, Angie Saleh of UNICEF, and Ryan Rowe and Jen Bogle of UNC represented the
Secretariat. Batsi has stepped in for Maggie Montgomery who is dedicating her time to Ebola
response at WHO. Angie is supporting Michael Forson who has been deployed to West Africa for the
Ebola response. Jen Bogle is transitioning into the Network communications and knowledge
management role while Ryan continues his work in Haiti.
10.2 Overview
The objective of the meeting was to review Network progress and discuss proposed 2015 Network
priorities. The meeting began with a recap of 2014 milestones, which fed into a discussion regarding
Network strengths, weaknesses, and opportunities in the coming year.
10.3 Network Update
Although the HWTS Network has not accomplished all tasks laid out in the 2014 work plan, there was
substantial progress in advancing the M&E Toolkit and WHO Scheme. Several Secretariat leadership
changes since the 2013 Annual Meeting may have slowed HWTS Network momentum.
Coordination
Planned coordination activities for 2013 were to seek input from the Advisory and Public‐Partnership
Groups and to continue supporting national and regional efforts to scale up HTWS.
Accomplishments included seeking input through the 2014 meeting and continuing to support
national action plans developed as part of the 2013 Network Annual Meeting.
20
The 2013 meeting was held on 14‐16 November 2013 in India in conjunction with HWTS and water
safety planning workshops. The discussion focused on integrating HWTS with water safety planning,
strengthening national capacity, and using the Scheme to advance national regulatory frameworks.
Following the workshop, some countries submitted plans that focused on either water safety
planning or HWTS, while others aimed to integrate the two. Cambodia, India, and Bhutan were
selected to receive seed funding among the six proposals submitted to WHO.
Cambodia faced challenges in implementation after losing the WaSH specialist assigned to support
their project. This individual has been replaced and Batsi is working with Cambodia to progress their
plan. The initiative is combined with a project on water and sanitation for children and HWTS in
schools, using the seed funds for support. Cambodia has received a portion of the seed funding and
is now looking at ways to allocate the remaining amount.
The National Environmental Engineering Research Institute in India is running HWTS behaviour
change projects in two villages using their own funds and have asked to receive WHO seed funding
toward the end of the initiative. They have completed a baseline community survey and are
implementing a communications strategy to facilitate behaviour change.
WHO is currently working with Bhutan to determine how the Network and WSP initiatives at WHO
can support them in refining their proposal. For instance, they were lacking a partner agency to
sustain the project.
Communications
Planned communication activities in 2013 were to hold webinars, strengthen information exchange
and learning platforms such as the HWTS Network newsletter, and attend at least two workshops to
promote HWTS.
Accomplishments included three webinars on the Scheme, two webinars focusing on the M&E
Toolkit, and Secretariat presentations at two international conferences.
Scheme webinars will inform a list of frequently asked questions to be posted on the Scheme
webpage.
Discussions during the M&E Toolkit webinars have suggested that many people are aware of the
Toolkit but fewer have used it. It may be too academic, and it is unclear which components are used.
Efforts focusing on the Toolkit will continue into 2015.
Advocacy and Policy
Planned advocacy and policy activities included the Southeast Asia regional workshop.
Accomplishments will be fully realized in November at the workshop in Lao PDR, which focuses on
integrating HWTS into water safety planning.
Guidance and Tools
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Planned activities were to launch the Scheme and focus on how to integrate WaSH and HWTS into
nutrition programmes.
Accomplishments included launching the Scheme and the first round of testing. The goal is to distill
key components of the Scheme to develop a briefing sheet. Integration efforts are ongoing.
10.4 Network Assessment
Following the review of Network progress against the 2013 work plan, the conversation shifted
toward a review of the HWTS Network Strategy, momentum, and priorities.
The points captured below reflect the opinions of individual attendees and do not necessarily reflect the
position or consensus of the group as a whole.
HWTS Network Strategy and Momentum
HWTS Network meeting attendance was low compared to prior years, but interest and momentum
in HWTS seem to remain strong, particularly with the shift in focus toward water quality as an
essential component of water service provision in post‐2015.
The group suggested a number of factors that may have contributed to the low attendance,
including HWTS Network communications and advocacy efforts, as well as scheduling conflicts with
other Water and Health Conference events such as climate change and health and the JMP review
session.
Despite low participation, the discussion highlighted areas where HWTS still has traction. Some
observed that HWTS is maturing, as more companies are developing water treatment technologies
and researchers are working actively in the field. The shift in focus toward water quality also
provides a window of opportunity for HWTS. There is evidence that water quality is an increasing
concern. Governments were previously focused on providing water, regardless of quality, which
rendered HWTS to be less relevant to their priorities.
Nonetheless, it was generally agreed that the Network Strategy may need to be reviewed and
revised to reflect available financial and human resources and shifts in HWTS Network priorities. The
HWTS Network seems to be moving away scaling up toward strategies for sustained and effective
interventions in areas of need. The HWTS Network is also showing a strong interest in integrating
with other public health interventions and broader WaSH sector.
Recommended strategies for allocating HWTS Network resources were to focus on addressing
priority areas in a particular country. Workshops could be more targeted toward specific countries
and include preparatory meetings with ministries of health, finance, and water.
The discussion on integration with public health interventions suggested that the HWTS Network
focus its resources on a specific topic or location. Malawi was discussed as a potential location to
target integration with both HIV and antenatal care. HWTS advocacy in Malawi is advancing, and
there are opportunities to continue the momentum. There are existing HWTS Networks in Malawi
that focus on integration as well as potential opportunities to measure health impacts, which is a
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challenge with smaller pilots. It was also suggested that nutrition integration could capitalize on
linkages between nutrition and WaSH interventions recognized by Feed the Future.
The group discussed that the international focus on water quality provides a strategic opportunity
for HWTS. HWTS integration in water safety planning is important entry point for HWTS, although
the relationship between them has not been clearly articulated. Nonetheless, some observed
emerging consensus among national officials at a WHO Asian and Southeast Asian conference that
household treatment is an essential and neglected part of the water safety planning framework.
WHO is convening a support group for this initiative, and there is opportunity for HWTS to integrate
into that effort as well as other existing communities.
Several integration outputs were discussed, including briefing sheets, implementation activities, as
well as concrete action points and operationalizing tools. Another suggestion was to have a Network
member stationed in Africa or possibly South Asia to ensure there is policy dialogue with
governments.
As part of targeting HWTS in areas of need, the discussion also covered different mechanisms for
reaching vulnerable groups. Although there are active debates on free distribution, subsidies, and
commercial markets, it was suggested that the discussion seems to now recognize that distribution
mechanisms are necessarily context‐specific. With respect to vulnerable groups, it was suggested
that a separate approach from the rest of the population may be appropriate, although there is still
concern about the potential for free or subsidized HWTS to erode commercial markets. However,
some attendees observed that the private sector and donors are looking primarily at market‐based
models, incorporating elements of cost‐sharing to support with long term and sustainable
distribution.
Guidance and Tools
The M&E Toolkit and WHO Scheme have recently been the focal point of Network resources and
discussions. Overall, the M&E Toolkit is well broadcast but seems not to be meeting the needs of its
intended users.
The Scheme is undergoing its first round of testing and has recently dominated the discussion. It was
suggested that the value of the Scheme at the national level could be more clearly articulated, and
the process could be more clearly link to specific health challenges such as high HIV rates or
Cryptosporidium.
Furthermore, it was suggested that Network tools should be reformulated to be more practical for
field staff. The criteria that field staff use may also be entirely different, based on their particular
objectives and constraints.
Network Communications
Network communications may need to be reinvigorated, particularly to address the fact that there is
minimal interaction among HWTS Network members or reporting from the field.
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It was also noted that there should also be more reports from the field, as Network members are
unaware of the activities and successes on the ground.
The HWTS Network could also better integrate with WaSHplus as a strong information clearinghouse
and draw ideas from WaSHplus communications, which focus on a given topic each week.
10.5 Conclusions and Next Steps
The HWTS Network should consider how to disseminate Scheme results and convey the implications
of passing evaluation along with how countries may interpret the results. Next steps include
reaching out to manufacturers in low income countries.
The HWTS Network will continue webinars on the M&E Toolkit, while consider specific elements that
may need to become more practical to field staff.
Outputs for integration with other public health interventions needs to be refined. Selected activities
should focus on a specific topic or location, matching clearly defined goals to available resources.
There seems to be general support for integration work in Malawi that leverages existing networks.
The key objective for linking HWTS with water safety planning may be to articulate the nuts and bolts
of how to integrate the two through a briefing sheet that condenses existing knowledge.
