Scaling Up Household Water Treatment Among Low-Income Populations
Prepared by:
Thomas F. Clasen, JD, PhD
London School of Hygiene & Tropical Medicine
Public Health and Environment
Water, Sanitation, Hygiene and Health
World Health Organization
Geneva 2009
This report examines the evidence to date regarding the scalability of HWTS. It seeks to consolidate existing knowledge and experience and distill the lessons learnt. Its primary aims are to 1) review the development and evolution of leading household water treatment technologies in their efforts to achieve scale, 2) identify the main constraints that they have encountered and 3) recommend ways forward.
Contents
LIST OF ACRONYMS .............................................................................................................vii
SUMMARY ...............................................................................................................................viii
1. INTRODUCTION................................................................................................................... 1
1.1 Background.............................................................................................................................1
1.2 Definition of scaling up...........................................................................................................2
1.3 Does the evidence support scaling up? ...................................................................................2
1.4 Objective and methods............................................................................................................5
2. SCALING UP OTHER HOUSEHOLD-BASED HEALTH INTERVENTIONS................... 6
2.1 Household sanitation...............................................................................................................6
2.2 Oral rehydration salts...............................................................................................7
2.3 Guinea worm filters ................................................................................................8
2.4 Insecticide-treated nets.............................................................................................9
2.5 Summary.................................................................................................................12
3. CASE-STUDIES IN SCALING UP HWTS METHODS ...................................... 14
3.1 Boiling....................................................................................................................15
3.2 Safe water system (SWS)........................................................................................18
3.2.1 Product origins, development and testing ...........................................................18
3.2.2 Scaling up—PSI and social marketing.................................................................17
3.2.3 For-profit sodium hypochlorite products ..................................................................23
3.2.4 Community-based programmes ................................................................................23
3.2.5 Uptake of SWS..........................................................................................................24
3.3 Sodium dichloroisocyanurate (NaDCC) tablets...........................................................25
3.3.1 Product origins and testing........................................................................................25
3.3.2 Scaling up NaDCC tablets ........................................................................................25
3.3.3 Uptake of NaDCC tablets..........................................................................................27
3.4 Solar disinfection .........................................................................................................28
3.4.1 Product origins, development and testing .............................................................28
3.4.2 Scaling up solar disinfection .....................................................................................28
3.4.3 Uptake of solar disinfection ......................................................................................31
3.5 Ceramic filters...............................................................................................................32
3.5.1 Product origins, development and testing .................................................................32
3.5.2 Scaling up ceramic filters..........................................................................................33
3.5.3 Uptake of ceramic filters...........................................................................................35
3.6 Biosand filters .............................................................................................................37
3.6.1 Product origins, development and testing ...............................................................37
3.6.2 Scaling up biosand filters..........................................................................................38
3.6.3 Uptake of biosand filters ...........................................................................................40
3.7 Middle-market commercial filters ...............................................................................41
3.8 Flocculation/disinfection products................................................................................43
3.8.1 Product origins, development and testing .................................................................43
3.8.2 Scaling up flocculation/disinfection products...........................................................44
3.8.3 Uptake of flocculation/disinfection products............ Error! Bookmark not defined.
4. COMBINED SCALE OF HWTS ................................................................................ 49
4.1 The challenge of measuring coverage........................................................................49
4.2 Combined estimates of coverage and growth ..............................................................50
5. SPECIAL CONSTRAINTS TO SCALING UP HWTS ............................................... 54
5.1 Belief that diarrhoea is not a disease.............................................................................54
vi
5.2 Scepticism about the effectiveness of water quality interventions ...............................54
5.3 Special challenges associated with uptake......................................................................54
5.4 Public health suspicion of commercial agenda and lack of standards governing HWTS
products ................................................................................................................................55
5.5 Orphan status of HWTS at public sector level.................................................................56
5.6 Minimal public sector participation ...............................................................................56
5.7 Lack of focused international effort and commitment.....................................................57
5.8 Perceived policy conflict with efforts to promote piped-in water supplies.....................57
6. CONCLUSION AND RECOMMENDATIONS ........................................................... 59
ACKNOWLEDGEMENTS ............................................................................................... 64
REFERENCES...................................................................................................................... 65
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