Facilitating behaviour change for the adoption of non treatment options for the implementation of the 2006 who wastewater use guidelines

Water for a food-secure world

Facilitating behaviour change for the adoption of ‘non-treatment’ options for the implementation of the 2006 WHO

wastewater use guidelines

Pay Drechsel, Hanna Karg and Eline Boelee

Presented at the IWA session “Hygienic Risks of Sanitation Systems” at the networking weekend of “Water and Health: Where Science Meets Policy,”

The University of North Carolina at Chapel Hill, USA.October 23-24, 2010

Water for a food-secure worldWater for a food-secure world

Content

• Risk situation & options to mitigate risk• Cost-effectiveness of these mitigation options• Ways to support their adoption on farm and in

street food restaurants

• Example:

Ghana

Water for a food-secure world

Wastewater Irrigated Area

China: est. 4 million ha; out of proportion

Untreated wastewater

Treated wastewater

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200

GermanyS.Arabia

Libya#France

Oman#Kuwait#

TunisiaSyria*

Turkey*Jordan

USAUAE#

AustraliaArgentina

Italy*Cyprus

Egypt*Israel#

MexicoChile

Bolivia*Nepal#

TunisiaSudan

Kuwait*Egypt#

MoroccoTurkey

PeruVietnam

Ghana*SA*

ArgentinaColombia

PakistanSyria*

Chile#*India

Mexico China*

Area ( '000 ha)

Main driver: Water Pollution

Main driver: Water Scarcity

Source: Jiménez and Asano, 2008; Scott et al., 2010.

• 10% of global irrigated area• Food for 10% of global population

Water for a food-secure worldSource: www.who.int/en/


Wastewater generation

Farmer/ Producer

Traders/Retailers

Street food kitchens

Consumer

Wastewater treatment

Safe IrrigationPractices

HygienicHandlingPractices

Safe food washing and preparation

Awareness creation to create

demand for safe produce

Facilitating behaviour change via education, financial & non-financial incentives, and regular inspections

Multi-barrier approach low-income countries

Source: Ilic, S.; Drechsel, P.; Amoah, P.; LeJeune, J. 2010


0

5

10

15

20

25

30

35

Business (e.g., hotel, airport)

Hospital

Military

School

Municipal/Township

Community-level

Region

Num

ber o

f Tre

atm

ent P

lant

sWastewater and faecal sludge treatment

plants in Ghana

Source: Murray & Drechsel, 2011


0

5

10

15

20

25

30

35

Business (e.g., hotel, airport)

Hospital

Military

School

Municipal/Township

Community-level

Region

Num

ber o

f Tre

atm

ent P

lant

s

Wastewater and faecal sludge treatment plants in Ghana

treat in urban areas < 10% of ww

13% operating +/- as designed 30% have some rest capacity 57% (un)officially broken down

How many of them work ?

Source: Murray & Drechsel, 2011

Water for a food-secure worldWater for a food-secure worldPhoto Credit: IWMI


Photo Credit: IWMI


Source: IWMI, 2009

Are at risk every day in Ghana’s 5 biggest cities:

2,500- 3,000 farmers and traders of exotic vegetables 20,000-26,000 staff of street food restaurants,

610,000- 860,000 street food consumers

ca. 12,000 lost DALYs* annually (without family members)

*DALYs: Disability Adjusted Life Years


Wastewater generation

Farmer/ Producer

Traders/Retailers

Street food kitchens

Consumer

Wastewater treatment

Safe IrrigationPractices

HygienicHandlingPractices

Safe food washing and preparation

Awareness creation to create

demand for safe produce

Facilitating behaviour change via education, financial & non-financial incentives, and regular inspections

Applied, participatory action research

Source: Ilic, S.; Drechsel, P.; Amoah, P.; LeJeune, J. 2010


PHILIP AMOAH

Control measurePathogen reduction (log units)

Notes

A. Wastewater treatment up to 6−7 Pathogen reduction depends on type and degree of treatment selected.

B. On-farm options

Crop restriction (i.e., no food crops eaten uncooked)

6−7 Depends on (a) effectiveness of local enforcement of crop restriction, and (b) comparative profit margin of the alternative crop(s).

On-farm treatment:

(a) Three-tank system 1−2 Very effective for helminth egg sedimentation.

(b) Simple sedimentation 0.5−1 If ca. 18 hours; more effective for helminth eggs

(c) Simple filtration 1−3 Value depends on filtration system used

Safer wastewater application:

(a) Furrow irrigation 1−2 Crop density and yield may be reduced.

(b) Low-cost drip irrigation 2−4 2-log unit reduction for low-growing crops, and4-log unit reduction for high-growing crops.

(c) Reduction of splashing 1−2 Farmers trained to reduce splashing when watering cans used (splashing adds contaminated soil particles on to crop surfaces which can be minimized).

Pathogen die-off (cessation) 0.5−2per day

Die-off between last irrigation and harvest (value depends on climate, crop type, etc.).


Control measurePathogenreduction (log units)

Notes

C. Post-harvest options at local markets

Overnight storage in baskets 0.5−1 Selling produce after overnight storage in baskets (rather than overnight storage in sacks or selling fresh produce without overnight storage).

Produce preparation prior to sale 1−2 (a) Washing salad crops, vegetables and fruit with clean water.

2−3 (b) Washing salad crops, vegetables and fruit with running tap water.

1−3 (c) Removing the outer leaves on cabbages, lettuces, etc.

D. In-kitchen produce-preparation options

Produce disinfection/washing 2−3 Washing salad crops, vegetables and fruit with an appropriate disinfectant solution and rinsing with clean water.

Produce peeling 2 Fruits, root crops.

Produce cooking 5−6 Option depends on local diet and preference for cooked food.

Low-cost interventions at one or more entry points could avert up to 90% of DALYs*

DALYs: Disability Adjusted Life Years Source: Amoah et.al. 2011, forthcoming publication


video.google.com

Source: IWMI, WHO


• Costing the promotion & implementation of interventions– Costs to farmers (e.g. to buy and repair a drip kit)– Cost to kitchen staff (e.g. to buy chlorine tablets)– Costs to society (e.g. to train and monitor farmers)

• QMRA* with and without different interventions• Cost-effectiveness analysis (US$ per DALY* averted)

How much would it cost to avert the DALYs?

*QMRA: Quantitative Microbial Risk Assessment *DALYs: Disability Adjusted Life Years


Adoption rate US$/DALY* avertedOn-farm Off-farm75% + 75% $ 8775% + 25% $ 9425% + 75% $ 9525% + 25% $ 394

One new small WWTP*/city ca. $ 4000 (5 cities)

Cost-effectiveness of interventions (Price of gaining 1 healthy life year)

*DALYs: Disability Adjusted Life Years *WWTP: Waste Water Treatment Plant Source: Seidu and Drechsel, 2010


Hazard comparison for Accra, Ghana, via different exposure pathways

Flooding of main river passing city

Swimming at Accra's beaches

94 $/DALY

>500 $/DALYChildren exposed to open drains

Failure of WWTP

Faecal sludge disposal exposure

Workers exposed at WWTPs

Contaminated drinking water pipes

Wastewater irrigated vegetables

*DALYs: Disability Adjusted Life Years , *WWTP: Waste Water Treatment Plant Sources: Labite et al., 2010; IWMI, 2009


Success of

• treatment options depend on appropriate technologies, and incentives supporting responsive maintenance systems

• non-treatment options depend on incentives for individual behavior change ( lasting adoption)


Why should farmers/traders/consumers change their behavior?

• Existing risk awareness/social responsibility/self-protection

• Investments in education & awareness creation • Enforced regulations (control & punitive fees)• Market demand for safer crops supported by a higher

consumer willingness-to-pay• Financial incentives (subsidies on farm inputs, credit

access, payments for environmental services, …)• Non-financial trigger and incentives (prestige, fear, etc.)


What could trigger behavior change?

1. Consumers• Visual neatness of food, trust in trader, and (low) price.

Risk awareness is marginal + too many other risk factors!

Disgust could be an effective trigger to change habits ( Ghana’s hand-wash campaign)


2. Farmers• Significant financial motivation to remain in business

(high cash crop income; market proximity)

• High competition for plots near streams

• No land tenure security (public land), farmers could be expelled at any time

Strong incentive: Tenure security in exchange for safer irrigation practices

Positive image, safety awards (<-> media pressure)

Financial incentives: Market-access, credit


3. Food vendors (street restaurants)

• Higher awareness of microbial risk than farmers

• High willingness to avoid complaining customers

Customer satisfaction Prestige (certification, awards) good for business


Supporting componentsAdoption stages

Association

Acquisition

Application

Is health risk awareness given?

Can the practice be maintained?

Is it easy to integrate it in daily life?

Are effective methods known?

Does the practice bring any benefit to life? (personally, business, tangible, intangible)

Awareness

Yes

Yes

Yes

No

No

No

Yes

No

No

Awareness creation & training à Workshops / Field schools / Roadshow à Options for risk reduction à Providing training material

Social Marketing à Formative Research: Identification of - Barriers for behavior change - Motivators (drivers, triggers, peers) - Communication channels & media à Defining message à Identifying partners for effective promotion (e.g. Public - private partnerships)

Enforcement

à Inquiry about vegetable handling in inspection forms à Controls à Punitive fees à Closure

Incentives , e.g. à Awards and certificates à Good media publicity à New marketing channels à Loans, tenure security, subsidies, training, ... à Becoming more competitive

Adoption stagesBehavior change supporting components

Source: Figure 16.2,Karg et al. 2010


Food Vendors

Whom to listen to

Extension staffMedical doctorPeer colleagueColleague who learnt in catering schoolOther

Farmers

Source: IWMI, unpub.

Whom would you listen to?


Visualizing messages

Imported vs. local symbols

Source: www.fightbac.org


To make the invisible risks visible

Source: clipart, office.microsoft.com Source: www. pdclipart.org

These two symbols were not understood by the target group, but tests with GlitterBug lotion were promising (www.glitterbug.com).


• Financial and social incentives valid in the local context

• Social marketing to promote non-treatment options

• Triggers for behavior change

More research needed on

Many opportunities to learn from the WASH sector!

Source: www.wsscc.org

Source: www.who.int/en


Wastewater Irrigation and HealthAssessing and Mitigating Risk in Low-income Countries

Earthscan2010 • 400 pages

Reference

Free online:www.idrc.ca/openebooks/475-8/ or www.iwmi.org/Publications/Books/index.aspx


Other related publications

• Labite, H.; Lunani. I.; van der Steen, P.; Vairavamoorthy, K.; Drechsel, P.; Lens, P. 2010. Quantitative microbial risk analysis to evaluate health effects of interventions in the urban water system of Accra, Ghana. Journal of Water and Health, 8(3):417-430.

• Murray, A. and P. Drechsel. (in press). Positive deviance in the sanitation sector in Ghana: Why do some wastewater treatment facilities work when the majority fails? Waterlines Vol. 30

• Amoah, P.; Keraita,B.; Akple.M; Drechsel,P.; Abaidoo, R.C.; Konradsen,F. 2011. Low cost options for health risk reduction where crops are irrigated with polluted water in West Africa. IWMI Research Report 141, Colombo (forthcoming)

For more information, please visit www.iwmi.org

Technology

Facilitating behaviour change for the adoption of non treatment options for the implementation of the 2006 who wastewater use guidelines