Presentation by Mary Renwick of Winrock International on MUS and Winrock.
A mix of secondary and primary research was conducted to examine the hypothesis that access to an at-house water supply will deliver significantly greater health, social and economic benefits than those derived from a shared public water supply. The research was carried out by a team from the University of Leeds, University of North Carolina, University of East Anglia, the London School of Hygiene and Tropical Medicine and University College London, and was based on a mix of literature review and field-base case studies. Fieldwork was carried out in three countries; Ghana, South Africa and Vietnam and used a mix of data collection methods, specifically a three-part household questionnaire, which included anthropometric measures and the measurement of water collection journeys, natural group discussions, and contextual checklists.
The headline conclusion from the research is that at-home water supply has significant, measurable benefits when compared with shared water supply outside the home provided that the service provided is reliable enough to ensure access to adequate quantities of water when required. Reliable at-home water supply results in higher volumes of water consumed, greater practice of key hygiene behaviours, a reduction in musculo-skeletal impacts associated with carrying water from outside the home, and improved water quality. This suggests a logical policy shift towards the promotion of reliable household access as the international benchmark for water supply.
Report by B. Evans, J. Bartram, P. Hunter, A.R. Williams, J.A. Geere, B. Majuru, L. Bates, M. Fisher, A. Overbo, W.P. Schmidt available on DFID's Research for Development site.
Divisions between communities, disciplinary and practice, impede understanding of how complex interventions in health and other sectors actually work and slow the development and spread of more effective ones. We test this hypothesis by re-reviewing a Cochrane-standard systematic review (SR) of water, sanitation and hygiene (WASH) interventions’ impact on child diarrhoea morbidity: can greater understanding of impacts and how they are achieved be gained when the same papers are reviewed jointly from health and development perspectives?
Using realist review methods, researchers examined the 27 papers for evidence of other impact pathways operating than assumed in the papers and SR. Evidence relating to four questions was judged on a scale of likelihood. At the ‘more than possible’ or ‘likely’ level, 22% of interventions were judged to involve substantially more actions than the SR’s label indicated; 37% resulted in substantial additional impacts, beyond reduced diarrhoea morbidity; and unforeseen actions by individuals, households or communities substantially contributed to the impacts in 48% of studies. In 44%, it was judged that these additional impacts and actions would have substantially affected the intervention’s effect on diarrhoea morbidity. The prevalence of these impacts and actions might well be found greater in studies not so narrowly selected. We identify six impact pathways suggested by these studies that were not considered by the SR: these are tentative, given the limitations of the literature we reviewed, but may help stimulate wider review and primary evaluation efforts.
This re-review offers a fuller understanding of the impacts of these interventions and how they are produced, pointing to several ways in which investments might enhance health and wellbeing. It suggests that some conclusions of the SR and earlier reviews should be reconsidered. Moreover, it contributes important experience to the continuing debate on appropriate methods to evaluate and synthesize evidence on complex interventions.
Open access article by Michael Loevinsohn, Lyla Mehta, Katie Cuming, Alan Nicol, Oliver Cumming and Jeroen H. J. Ensink published in the Oxford journal Health and Policy Planning.
This process document reports on the integrated water resource management (IWRM) and food security project in Kafue Basin in Zambia. The project was aimed at demonstrating the food security, health, poverty reduction and ecological benefits of applying IWRM principles and practices. The scope of work included the following:
- Provision of improved technology for water abstraction, storage and supply for both domestic and productive use.
- Improvement of water resources management for enhanced availability of water.
- Rehabilitation of water facility infrastructure (boreholes, wells, dams/dykes for enhanced water accessibility and availability).
- Provision of market linkages and capacity building in water resources governance/management, conservation farming rain/food water harvesting.
In this note Hutton focusses on the conceptualization of Multiple-Use water Services (MUS) from the (health) economic perspective
This presentation looks at cost benefit analysis from a health economic perspective. When upgrading a system to multiple use different health issues - including sanitation- related to water quantity and quality need to be taken into account.
Giardia lamblia, Cryptosporidium parvum and Entamoeba histolytica/dispar are ubiquitous protozoan parasites that affect humans, domestic animals and wildlife throughout the world and have been highlighted as significant waterborne parasitic pathogens. The present study was conducted to assess the prevalence of the three parasitic infections among children using protected and unprotected water sources in three rural sites (Legedini, Adada and Legebira) in Dire-Dawa, Eastern Ethiopia from November 2005 May 2006. Single stool specimens were collected from a total of 1894 children under14 years of age and processed for C. parvum using Modified Ziehl-Neelsen staining method. Giardia, amoeba and other intestinal parasites were detected using formalin-ether concentration and by direct wet mount methods. Out of 1894 children examined, 225 (11.9%), 719 (38%) and 639 (33.7%) were infected with Cryptosporidium parvum, Giardia lamblia and Entamoeba histolytica/dispar, respectively. The prevalence of giardiasis, cryptosporidiosis and amoebiasis during wet season sampling was significantly higher than the dry season in all study sites. On the other hand, no difference was observed in the prevalence of cryptosporidiosis, giardiasis and amoebiasis between children drinking water from protected and unprotected sources in Legedini and Legebira while in Adada significantly high prevalence was observed for the unprotected. The insignificant difference in prevalence between children using the two water sources indicates the presence of contamination of the drinking water at some point before consumption and also indicates the poor personal hygiene and environmental sanitation of the community. The prevalence of giardiasis, cryptosporidiosis and amoebiasis in relation to sex group showed no statistically significant difference. On the other hand, lower age groups had a higher prevalence of infection with giardiasis and amoebiasis, and infections with cryptosporidiosis was not related with age. Co-infections were also detected in 25.4% of the study subjects. In addition, other non-pathogenic intestinal parasites such as Iodoamoeba butschilii, Entamoeba coli, Chilomasix mesnelli and Endolimax nana were also detected in the study, which is an indication of fecal contamination of the drinking water source. Providing high quality drinking water may not significantly reduce the incidence of intestinal parasites other factors such as unhygienic and unsanitary situations overwhelm the beneficial effects of protected water sources. In addition untreated protected drinking water sources are not free of the waterborne parasitic pathogens. Therefore, health education in related to personal hygiene and environmental sanitation and cost effective water purification mechanisms such as boiling and chlorination and others will help in enhancing the health and well-being of the community particularly that of children.
A power point presentation giving an overview of water quality and multiple uses in the Peasant Assocation of Legedini and Dire Dawa.
Working Title: Two containers a day- the search for proper water sources in Eastern Ethiopia. Water Quality and Sanitation in the Lege Dini Watershed Area, Ethiopia
Abstract: In this research the possibilities of MUS are explored in a case-study watershed; the watershed of Legedini. The health situation in this area was poor. Many people suffered from diseases like diarrhea, vomiting and less frequently malaria. Clean drinking water was available in five out of eleven villages and inhabitants without access to tap water were forced to drink water from contaminated well and ponds. The quantity of water was also not sufficient for all domestic and agricultural uses. This made it impossible for the area to become self-sufficient. Although many NGO’s and other development agencies were active in the area, the aid-service was poor coordinated. The result of this was that although the operating organizations invented good and effective solutions for the water and health problems in Legedini, these were unfortunately not widely adopted. Only the participants of an education program were often willing to change their habits. An annual assembly of development organizations, in which the plans and projects for the coming year would be discussed, would eliminate the communication and coordination problems.
By investigating the water sources, two turned out to be suitable for drinking water. The discharge of these two sources was also sufficient for the whole population of Legedini. Other sources were suitable for livestock and irrigation. The EC-level is rather high for irrigation, but since there is no other source available, irrigators should select tolerant species like tomatoes to grow on their plots. Most farmers mention that they see irrigation and selling cash crops on the market as one of the opportunities towards self-sustainability.
The MUS-approach seems to have positive effects on the health situation in Legedini and contributes to the goal of self-reliability. A healthy environment is the basis for fewer diseases and therewith more manpower for farming and other income generating activities. A threshold for implementing MUS worldwide will be the distance between village and source in the case of ‘multiple sources for multiple uses’. The walking distances for remote villages in order to obtain clean drinking water will be too large. A threshold for ‘multiple uses in one system’ will be the cooperation between ministries of health and ministries of agriculture, which is difficult to establish in a bureaucratic setting.
E. Boelee: Addressing health through multiple use water services
Multiple use water services can bring more health benefits than separate water supplies for domestic and productive uses – if health is explicitly and properly addressed. That means that in the planning phase due attention has to be given to adequate water allocation for various purposes as well as to providing safe sanitation and offering complementary health and hygiene education. These elements can also be useful in step-wise upgrading single purpose systems to multiple use water services. Sufficient water of good quality is needed for drinking water and hygiene. If the system cannot supply adequate water quality, then additional facilities such as home water treatment can be a good solution, provided the users understand and can operate the treatment themselves. The (re-) use of water for home gardens with a variety of vegetables and fruits is important for balanced nutrition. Proper design, construction, operation and maintenance of water systems can avoid the creation of breeding sites for vectors of diseases such as malaria mosquitoes and schistosomiasis snails. Environmental sanitation, including construction and safe use of latrines, but also protection of water resources from pollution by runoff and animals, reduces the demand for water treatment as well as risks of water use (exposure to pathogens and toxic chemicals) for productive and domestic purposes. Upgrading of water services often reduces water collection efforts for women and children, leading to a whole range of additional socio-economic benefits that in turn may bring health benefits, while poverty reduction in itself also leads to improved health. [authors abstract]