Kay Mattson, MSW, MPHEngineers Without Borders

OHSU – Center for Evidence-based Policy

Grace Weatherford, MS, EITEngineers Without Borders

PBS Engineering + Environment

Overview

World water situation and basic issues - Millennium Development Goals (MDGs)

Link between water-sanitation-hygiene , health and poverty in development -Water Related Disease -Diarrhea -Gender/Children burden

Drinking water development and sustainability

Haiti EWB case example

Questions for Consideration

Are drinking water and sanitation a basic right or a need?

Why are water and sanitation global health issues?

What are some of the developing country sustainability challenges in wat-san and how can they be addressed?

How to bring about change in wat-san in the developing world?

Is Water a Basic Right?

“the human right to water entitles everyone to sufficient, safe, acceptable and affordable water for personal & domestic uses”

United NationsCommittee on Economic, Social & Cultural Rights

November 26, 2002

Is Water a Basic Right?Water was determined to be a “Need”

World Water Forum in 2000

Consequence –“Water is subjected to the supply and

demand forces of the global marketplace, where the distribution of resources is determined on the basis of the ability to pay.”

Maude Barlow and Tony Clark Blue Gold

Millennium Development Goals (MDGs)

Established by world leaders convened by the UN in 2000

Eight goals to address the overarching goal of reducing poverty by 50% by 2015

Goal 7 Ensure Environmental Stability- Wat-San Targets - to cut by half the portion of people without sustainable access to safe drinking water and basic sanitation

1.1 Billion People in the World 1.1 Billion People in the World Lack Access to Improved Sources Lack Access to Improved Sources

of Waterof Water

1 in 5

people in

the

developing

world

Drinking Water and 2005 MDG’s and Case Study ConditionsDrinking Water and 2005 MDG’s and Case Study Conditions

Les Anglais, Haiti

Piped water into dwelling Piped water to yard/plot Public tap/standpipe Tube well/borehole Protected dug well Bottled water (only when there is a secondary source of improved water for other uses such as personal hygiene) Protected spring Rainwater collection

Improved Water Sources Unimproved Water Sources

Unprotected spring Unprotected dug well Cart with small tank/drum Tanker Truck Surface water (river, dam, lake, pond, stream, canal, irrigation channels)Other (specify)

What is Improved Drinking Water Access

Improved or unimproved?

Improved or unimproved?

Improved or unimproved?

Improved or unimproved?

2.6 Billion People in the World Lack Access to Improved Sanitation

50% of the

developing

world

Sanitation and 2002 MDG’s and Case Study Sanitation and 2002 MDG’s and Case Study Conditions Conditions

Les Anglais, Haiti

Flush/pour flush toPiped sewer systemSeptic tankPit latrine Unknown place/not known where

VIP latrinePit latrine w/ slabComposting Toilet

Improved Sanitation Unimproved Sanitation

Flush/pour flush to:Elsewhere

Pit latrine without slab/open pitBucketHanging toilet/hanging latrineNo facilities, bush or field

What is Improved Sanitation

Improved or unimproved?

Improved or unimproved?

Improved or Unimproved?

Improved or Unimproved?

Necessity and Disease Burden • Water is a basic element required by all

human beings for survival, without water we will die in a matter of days. -20 liters (abt 5.28 gallons) a day for basic

water needs (washing/drinking) -The average European uses 200 liters of

water every day. North Americans use 400 liters.

-The average person in the developing world uses 10 liters a day for drinking, washing and cooking

• Without adequate and safe water and sanitation, transmission of water related disease mortality and morbidity increases.

• Of the 37 major disease in developing countries, 21 are water and sanitation related. Water borne disease (Diarrhea, Cholera,

Arsenicosis) Water washed (Diarrhea, Trachoma) Water based/vector borne diseases

(Schistosomiasis, Dengue, Malaria)

http://www.abc.net.au/science/news/img/arsenicosis.jpg ArsencosArsencosisis

1000wells.com/why.html

TrachomaTrachoma

Malaria & Malaria & DengueDengue

CholerCholeraahttp://geotourweb.com/32-cholera.jpg

Water borne diseaseWater borne disease

Water Based & Water Based & Vector Vector

BorneBorne

Water Water WashedWashed

www.abdn.ac.uk/.../integrative/vector.shtml SchistosomiasisSchistosomiasis

Diarrhea Disease Burden 4 billion cases of diarrhea annually, 88% attributable to unsafe water.

1.8 million deaths each year, an estimated 6,000 people every day, almost twice the number of the estimated persons who die from malaria and approximately equal to the number of AIDS death each year.

90% of the deaths are children under the age of five; 3,900 children under the age of five every day.

The integrated approach of providing sanitation, water and

hygiene reduces the number of deaths caused by diarrheal

disease by 65%. (WHO)

The simple act of washing hands with soap and water can

reduce diarrheal diseases by over 40%. (British Medical J)

Gender Inequality in wat-san Women and children,

particularly girls, carry the primary burden.

Water collection can take up two-three hours a day, physically demanding.

Limits women’s available time for other activities (child care, productive time, rest).

Impacts children, especially girls, ability to attend school.

Places women at risk of violence and increased health risks as often have to defecate after dark, placing them at risk of harassment and assault, liver disease and acute constipation

Dignity & Gender InequalityDignity & Gender Inequality

Improved Drinking Water Impact on Health in the Developing World

What would it cost to achieve wat-san What would it cost to achieve wat-san MDG’s by 2015?MDG’s by 2015?

Halve by 2015 the proportion of urban/rural people without sustainable access to safe drinking water;

Halve by 2015 the proportion of urban/rural people without access to basic sanitation;

World Bank Estimates - Universal Coverage $30 USD Billion a yearBasic Coverage $9 USD Billion a year

US 2009 Stimulus Package$787 Billion

Breakdown Of Global Aid For Water Breakdown Of Global Aid For Water (2002-2004) $ Million Average(2002-2004) $ Million Average

12%

2%

40%

15%

5%

1%3%

11%

11%

Water resources policy/admin. mgmt Water resources protection

Water supply & sanit. - large syst. Basic drinking water supply and basic sanitation

River development Educ./trng:water supply & sanitation

Waste management/disposal Agricultural water resources

Water transport

(All)

Water Aid Areas

2002-2004 $ million average

Water supply & san –large systems 4983.5

Basic drinking water supply and basic san.* 1887.8

Agricultural water resources 1420.9

Water transport 1398.2

Water resources policy/admin. mgmt 1331.4

River development 677.5

Waste management/disposal 337.9

Water resources protection 200.2

Education/training: water supply & san* 65.7

Grand Total 12303.3Source: Organisation for Economic Co-operation and Development (Retrieved on 9/8/06)

EWB Portland Haiti Drinking Water Project Professional chapter comprised of engineers and public health

professionals in partnership with Our Savior Lutheran Church (OSLC), which has been assisting the community of Les Anglais since 1988 and Tu.

OSLC free medical clinics identified low grade fevers, diarrhea and dehydration among clinic patients, particularly in children.

The community piped water distribution system is comprised of two concrete reservoirs each fed by a spring. When operable these reservoirs served approximately 15,000 people 20,000 people . During the winter of 2008 hurricanes destroyed a main water line across the river Les Anglais and other lines cutting ½ the community off of a water supply.

EWB initial site visit in 2008 tested drinking water spring sources and 15/18 tests were found to have high coliform counts (indicating presence of e-coli). 

The only water treatment currently in use is a small dose of chlorine per reservoir every few months.

Two wells were constructed in the Spring of 2008. Majority y of HH surveyed in February 2009 get their drinking water

from the river and an irrigation canal.

Les Anglais, Haiti

Population •Les Anglais District est 27,000+, Town 20,000

Main Drinking Water Sources

•Surface Water (Les Anglais River, Irrigation Canal)•Two Public Wells, One Private Well (both installed w/in last year)•Spring water from two reservoirs w/ gravity fed pipes to community taps (one system inoperable)

Projects tested for e-coli/coliforms

At Spring Box (2008 and 2009)

Results 16 /19 tests were positive

Water Treatment Some households report treating water w/ bleach and lemon, but few had bleach in the home when surveyed

Latrines Scattered Pit Latrines throughout area, majority use fields or ocean

Drinking Water Source and Quality

Determinants of Disease and Health – Three Potential EWB Approaches to Les Anglais

Microbial Model

(Infectious Agent)

Behavioral Model(Host)

Ecological Model

(Environment)

Increase access to soap and handwashing

behaviors, improved “well behavior “ and

“well knowledge”Increased water treatment

Increased/improved water access & protection of water sources

February 2009 Household SurveysFebruary 2009 Household Surveys50 HHFive “neighborhoods”Water (where, who,

how much, storage, whether or not they treat)

Sanitation (what/where)

Hygiene (access to soap/critical times behavior)

Under five malnutrition

Les Anglais, Engineering Les Anglais, Engineering ChallengesChallenges

Engineering Solutions/ChallengesIncreased/Improved Water Access and Protection of Water Sources Increased Water Treatment

System map/inventorySystem repairsAccess to tools and

supplies to make repairsAccess to/improved skills

to make repairsInventory/Check-out

systemsEducation (e.g. plumbing

skills and water shed protection)

Central vs. Point-of-Use Chlorination

Management of Treatment

Cost of Treatment/Implementation

Potential Treatment SolutionsClean Water For Haiti

Conclusions Implementing new infrastructure that improves water and

sanitation conditions is the relatively easy part.

Changing behaviors and maintaining the infrastructure is difficult and takes sustained interventions that are supported by the community.

Improved health is not always the motivation for change; diarrhea is not always considered an illness or related to water purity or poor hygiene.

Importance of a multi-pronged approach - In highly fecal contaminated settings improved water quality may affect morbidity only when other variables related to fecal-oral agent transmission are ameliorated at the same time (kirchhoff et. all 1985).

Measuring impact is a challenge – controlling for other variables is difficult, if not impossible, to determine cause-effect, but its essential.

What works in one community will not necessarily work in another!

We shall not finally defeat AIDS, tuberculosis, malaria, or any of the other infectious diseases that plague the

developing world until we have also won the battle for safe drinking water, sanitation and basic health care.

Kofi Annan

Be the Change…Be the Change…Learn More

MDG’s - http://www.un.org/millenniumgoals/Water Supply and Sanitation Collaboration Council

http://www.wsscc.org/ Cost of Wat-San MDG’s

http://www.financingwaterforall.org/index.php?id=1099 Water Aid http://www.wateraidamerica.org/ Oxfam http://www.oxfam.org/ Global Citizen Corps - http://www.globalcitizencorps.org/ WHO Statistics - http://www.who.int/whosis/en/

Get InvolvedMarch 22 World Water Day http://worldwaterday09.info/World Toilet Day November 19 http://www.worldtoilet.orgEngineers Without Borders - http://www.ewb-usa.org/ Mercy Corps http://www.mercycorps.org/getinvolved/events