Transcript PowerPoint--15MB file

Kay Mattson, MSW, MPH
Engineers Without Borders
OHSU – Center for Evidence-based Policy
Grace Weatherford, MS, EIT
Engineers 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 Nations
Committee 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 Lack Access
to Improved Sources of Water
Drinking Water and 2005 MDG’s and Case Study Conditions
Les Anglais, Haiti
What is Improved Drinking Water Access
Improved Water Sources
 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
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)
Improved or unimproved?
Improved or unimproved?
Improved or unimproved?
Improved or unimproved?
Could you do it?
2.6 Billion People in the World Lack Access to
Improved Sanitation
Sanitation and 2002 MDG’s and Case Study Conditions
Les Anglais, Haiti
What is Improved Sanitation
Improved Sanitation
Unimproved Sanitation
 Flush/pour flush to
Piped sewer system
Septic tank
Pit latrine
Unknown place/not known
where
VIP latrine
Pit latrine w/ slab
Composting Toilet
 Flush/pour flush to:
Elsewhere
Pit latrine without slab/open
pit
Bucket
Hanging toilet/hanging latrine
No facilities, bush or field
Improved or unimproved?
Improved or unimproved?
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)
Water Washed
Water Based &
Vector Borne
Malaria & Dengue
1000wells.com/why.html
Schistosomiasis
Trachoma
www.abdn.ac.uk/.../integrative/vector.shtml
Water borne disease
Cholera
http://geotourweb.com/32-cholera.jpg
Arsencosis
http://www.abc.net.au/science/news/img/arsenicosis.jpg
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)
Dignity & Gender Inequality
Gender Inequality in wat-san
 Women and children, particularly
girls, carry the primary burden.
 Water collection can take up twothree 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
Improved Drinking Water Impact on Health in the
Developing World
What would it cost to achieve wat-san
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 year
 Basic Coverage $9 USD Billion a year
US 2009 Stimulus Package
 $787 Billion
Breakdown Of Global Aid For Water
(2002-2004) $ Million Average
Water Aid Areas
12%
11%
2%
11%
3%
1%
20022004 $
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
(All)
5%
40%
15%
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
Education/training:
water supply & san*
Grand Total
Source: Organisation for Economic Co-operation and Development (Retrieved on 9/8/06)
65.7
12303.3
Small Scale Community Solutions
Haiti – EWB Case Study
Haiti Water & Sanitation MDGs (2006)
80%
70%
70%
60%
50%
58%
51%
40%
30%
29%
20%
19%
10%
12%
0%
Rural
Urban
Total
Sustainable access to improved water
Sustainable access to improved sanitation
Health and Poverty Indicators (2006)
70%
60%
50%
40%
Infant Mortality Rate per
1000 live births
30%
Deaths under age five due to
diarrheal disease
Population living on < 1USD
Day per person
20%
10%
0%
Haiti
US
Canada
Mexico Nicaragua
Mortality Rate (under age five) and Life Expectancy
90
80
70
60
Probability of dying by
age five - per 1000 live
births
50
40
Life Expectancy at birth
30
20
10
0
Haiti
US
Canada
Mexico
Nicaragua
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 ecoli).
 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.
Drinking Water Source and Quality
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 ecoli/coliforms
Results
At Spring Box (2008 and 2009)
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
Determinants of Disease and Health – Three
Potential EWB Approaches to Les Anglais
Increased/improved water access
& protection of water sources
Ecological Model
(Environment)
Increase access to soap and
handwashing behaviors,
improved “well behavior “
and “well knowledge”
Increased water treatment
Microbial Model
(Infectious
Agent)
Behavioral Model
(Host)
February 2009 Household Surveys
 50 HH
 Five “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 Challenges
Engineering Solutions/Challenges
Increased/Improved Water Access
and Protection of Water Sources
Increased Water Treatment
 System map/inventory
 Central vs. Point-of-Use
 System repairs
Chlorination
 Management of Treatment
 Cost of
Treatment/Implementation
 Access to tools and supplies
to make repairs
 Access to/improved skills to
make repairs
 Inventory/Check-out systems
 Education (e.g. plumbing
skills and water shed
protection)
Potential Treatment Solutions
 Clean 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…
 Learn More
 MDG’s - http://www.un.org/millenniumgoals/
 Water Supply and Sanitation Collaboration Council
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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 Involved
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March 22 World Water Day http://worldwaterday09.info/
World Toilet Day November 19 http://www.worldtoilet.org
Engineers Without Borders - http://www.ewb-usa.org/
Mercy Corps http://www.mercycorps.org/getinvolved/events