WHO HWTS Performance Recommendation

WHO International Scheme to Evaluate

HWT

WHO/UNICEF International Network on
HWTS



More information and links
Introduction to HWTS| 14
Effective and consistent use
Introduction to Household Water Treatment and Safe Storage, Module 5.2
Dr. Richard Johnston



Introduction

Introduction to HWTS| 2
Unsafe
water
Consistent
Use
Effective
Option
768 million people used unimproved
drinking-water sources in 2011

Many improved drinking-water
sources yield microbially
contaminated water
Resource contamination
Collection and storage

Estimates of 1.8 billion people using
water that is faecally contaminated
Unsafe water
Introduction to HWTS| 3

Effective options
Introduction to HWTS| 4
Efficacy: How well it works under
controlled conditions
Effectiveness: How well it works in
the real world
Household chlorination in Ecuador
2009: No significant difference in LRV seen
between households with and without
chlorination
2014: Faecal indicators in around 50% of
households practicing chlorination
Turbidity, raw water contamination levels, post-
treatment contamination
Effective use
Sources: (McLaughlin, 2009), (Levy, 2014)
Introduction to HWTS| 5
Effective use, objective indicators
Residual chlorine
LRV

Consistent use, longitudinal studies
Need repeat visits

Long-term use
One to five years after intervention

Consistent use, compliance,
adherence




Effective and consistent use
Introduction to HWTS| 6
Effective use, objective indicators
Residual chlorine
LRV

Consistent use, longitudinal studies
Need repeat visits

Long-term use
One to five years after intervention

Consistent use, compliance,
adherence


Effective and consistent use
Introduction to HWTS| 7
Source: Brown J, Clasen T. High Adherence Is Necessary to Realize
Health Gains from Water Quality Interventions. PLoS One. 2012.

Efficacy and compliance
Source: Enger KS, Nelson KL, Rose JB, Eisenberg JN. The joint effects of efficacy and compliance: a study of household
water treatment effectiveness against childhood diarrhea. Water Research. 2013;47(3):1181-90.
Introduction to HWTS| 8
Biosand filters in Cambodia
88% of households still using, 6 months-8 years
Self-reported + inspection of BSF

LifeStraw Family in Zambia
96% consistent users, 95% exclusive users
Filter observed, reservoir contained water, +
self-report

LifeStraw Family in Congo
68% consistent users after 8 months
Nearly all reported drinking untreated water


Examples of high compliance
Introduction to HWTS| 9
SODIS in Zimbabwe
Self-reported, calculated, observed
65+% confirmed use after 26 months
If received household visits


Chlorine in Haiti
56% practicing, up to 8 years after intervention
Free chlorine residual

Biosand filters in Cambodia
88% of households still using, 6 months-8 years
Self-reported + inspection of BSF

LifeStraw Family in Zambia
96% consistent users, 95% exclusive users
Filter observed, reservoir contained water, +
self-report

LifeStraw Family in Congo
68% consistent users after 8 months
Nearly all reported drinking untreated water


Examples of high compliance
Introduction to HWTS| 10
Ceramic water filters in Cambodia
31% in regular daily use (interview + inspection)
Highly dependent on time since intervention

LifeStraw Personal in Ethiopia
34% reported use in last week, 13% consistent

SODIS in Bolivia
32% compliance
Self-reported confirmed by observation


Examples of low compliance
Introduction to HWTS| 11
Combined treatment in Guatemala
6 months after intervention, 5% had purchased
sachets

Ultraviolet radiation in Mexico
40% exclusive use of Mesita Azul

Thermal disinfection in Bangladesh
21/101 reported use of chulli
17 reported inconsistent or wrong use




Ceramic water filters in Cambodia
31% in regular daily use (interview + inspection)
Highly dependent on time since intervention

LifeStraw Personal in Ethiopia
34% reported use in last week, 13% consistent

SODIS in Bolivia
32% compliance
Self-reported confirmed by observation


Examples of low compliance
Introduction to HWTS| 12
Personal factors
Behavior change

External factors
Supply chains
Supportive policy environment
Etc

Different for different settings,
sub-populations
Factors impacting compliance
Introduction to HWTS| 13
Five stages of innovation process


Five attributes of innovation


Diffusion of Innovations
Knowledge
Persuasion
Decision
Implementation
Confirmation
Uptake
Relative
advantage
Compatibility
Complexity
Trialability
Observability
Introduction to HWTS| 14
Source: Rogers, 2003
Risks
Perceived
Vulnerability
Perceived Severity
Factual Knowledge
Attitudes
Instrumental beliefs
Affective beliefs
Norms
Descriptive
Injunctive
Personal
Abilities
Action knowledge
Self-efficacy
Self-regulation
Action
control/planning
Coping planning
Remembering
Commitment

RANAS psychological model
Source: Mosler, 2012
Introduction to HWTS| 15
Three classes of factors
Contextual
Psychosocial
Technology

Five levels
Societal/Structural
Community
Interpersonal/Household
Individual
Habitual
IBM-WASH
Source: Dreibelbis, 2013
Introduction to HWTS| 16

Behavior Change Reviews
Introduction to HWTS| 17

Monitoring and Evaluation Toolkit
Introduction to HWTS| 18
Knowledge of correct use
Demonstration of correct use
Demonstration of safe water
extraction
Frequency of non-use by
most vulnerable
Consistently treating drinking
water with HWTS
Use of improved drinking-
water source
Correct,
consistent
use and
storage
Monitoring and Evaluation Toolkit Indicators
Reported and
observed use
Correct, consistent
use and storage
Knowledge and
behavior
Other
environmental
health interventions
Water quality
Introduction to HWTS| 19
Households effectively
using HWTS method
to improve quality of
household drinking-
water (effective use)
Households with free
chlorine residual in
drinking-water
Water
quality
Monitoring and Evaluation Toolkit Indicators
Reported and
observed use
Correct, consistent
use and storage
Knowledge and
behavior
Other
environmental
health interventions
Water quality
Introduction to HWTS| 20
Boisson, S. et al. (2009). "Randomized Controlled Trial in Rural Ethiopia to Assess a
Portable Water Treatment Device." Environmental Science & Technology 43(15): 5934-
5939.
Boisson, S., et al. (2010). "Field Assessment of a Novel Household-Based Water
Filtration Device: A Randomised, Placebo-Controlled Trial in the Democratic Republic of
Congo." PloS One 5(9): e12613.
Brown J, Clasen T. High Adherence Is Necessary to Realize Health Gains from Water
Quality Interventions. PLoS One. 2012.
Enger, K.et al. (2013). "The joint effects of efficacy and compliance: a study of household
water treatment effectiveness against childhood diarrhea." Water Res 47(3): 1181-1190.
Gruber, J. et al. (2013). "A Stepped Wedge, Cluster-Randomized Trial of a Household
UV-Disinfection and Safe Storage Drinking Water Intervention in Rural Baja California
Sur, Mexico." Am J Trop Med Hyg 89(2): 238-245
Gupta, S. et al. (2008). "The chulli water purifier: acceptability and effectiveness of an
innovative strategy for household water treatment in Bangladesh." American Journal of
Tropical Medicine and Hygiene 78(6): 979-984.
Harshfield, E., et al. (2012). "Evaluating the sustained health impact of household
chlorination of drinking water in rural Haiti." Am J Trop Med Hyg 87(5): 786-795.

Levy K, et al. Household effectiveness vs. laboratory efficacy of point-of-use chlorination.
Water research. 2014;54:69-77.
Luby, S. et al. (2008). "Difficulties in bringing point-of-use water treatment to scale in rural
Guatemala." American Journal of Tropical Medicine and Hygiene 78(3): 382-387.
Musezahl, D. et al. (2009). "Solar Drinking Water Disinfection (SODIS) to Reduce
Childhood Diarrhoea in Rural Bolivia: A Cluster-Randomized, Controlled Trial." PLOS
Medicine 6(8): e1000125.
McGuigan, K. et al. (2011). "High Compliance Randomized Controlled Field Trial of Solar
Disinfection of Drinking Water and Its Impact on Childhood Diarrhea in Rural Cambodia."
Environmental Science & Technology 45(18): 7862-7867.
McLaughlin L et al. An observational study on the effectiveness of point-of-use
chlorination. Journal of Environmental Health. 2009;71(8):48-53.
Mosler, H.-J., et al. (2013). "Achieving long-term use of solar water disinfection in
Zimbabwe." Public health 127(1): 92-98.
WSP (2010) Use of BioSand Filters in Cambodia.
WSP/UNICEF (2007). Use of Ceramic Water Filters in Cambodia.

Additional Resources: Compliance
Introduction to HWTS| 21
Dreibelbis R et al. The Integrated Behavioural Model for Water, Sanitation, and
Hygiene: a systematic review of behavioural models and a framework for
designing and evaluating behaviour change interventions in infrastructure-
restricted settings. BMC public health. 2013;13:1015.

Figueroa ME, Kinkaid DL. Social, Cultural and Behavioral Correlates of
Household Water Treatment and Storage. Baltimore: Johns Hopkins Bloomberg
School of Public Health, Center for Communication Programs, 2010.

Mosler, H.-J., et al. (2013). A guideline for behavior change. Eawag.

Mosler H-J. A systematic approach to behavior change interventions for the
water and sanitation sector in developing countries: a conceptual model, a
review, and a guideline. International Journal of Environmental Health Research.
2012;22(5):431-49.

Rogers E. The Diffusion of Innovations. 5th ed. New York: The Free Press; 2003.




Additional Resources: Behavior change
Introduction to HWTS| 22
Health gains require effective and
consistent use (and unsafe water)
Perceptions
Effective use can be measured
Consistent use is harder

Frameworks
Behavioural change
Other factors

Promote and monitor actual use
Conclusion
Introduction to HWTS| 23
Health impact
Introduction to Household Water Treatment and Safe Storage, Module 5.3
Dr. Sophie Boisson, London School of Hygiene & Tropical Medicine
Unsafe
water
Consistent
Use
Effective
Option
Introduction

Introduction to HWTS | 2
Transmission for fecal-oral
pathogens is complex

HWTS addresses only one
pathway

How much diarrhoea can be
prevented by improving water
quality alone?

Transmission of faecal-oral pathogens
Source: WEDC, Adapted from Wagner & Lanoix (1958)
Introduction to HWTS | 3
Systematic reviews on health impact
0 20 40 60 80 100
Flocculation/disinfection
Solar disinfection
Filtration
Chlorination
Household
Source
Water supply
Water quality
% Reduction in diarrhea
Fewtrell 2005
Clasen 2006
Waddington 2009
Introduction to HWTS | 4
Intervention studies
Randomised control trials
Unit of randomisation can be
household or village
Outcome can be blinded

Observational studies
Before/ After
Case control studies
Ecological studies

Modelling studies
Measuring impact: evaluation designs
Introduction to HWTS | 5
Function of stool consistency and
frequency
WHO definition: passase of 3 or more loose
stools within 24-h period

Potential issues
Reporting bias
Placebo effect
Hawthorne effect
Respondent fatigue
Measuring impact: outcome is diarrhoea
Boisson et al (2013)
Introduction to HWTS | 6
Different magnitude of effect
Open trials report diarrhea reductions in the
range of 30-40%
Blinded trial report no effect

Lack of blinding of subjective
outcomes risk exaggerating
magnitude of impact by 25% (Wood
2008)

Adjusting for bias (Hunter 2009)
Went from 44% to 15% reduction after
adjustment




Blinded versus non-blinded trials
Clasen et al (2006)
Introduction to HWTS | 7
Setting with different transmission dynamics
Transmission routes
Pathogens
Treatment methods not effective against all class
of pathogens
Different levels of compliance
Impact on diarrhea diminishes over time (Arnold 2006, Hunter
2009)
Efficacy versus effectiveness trials
Evaluation of 3-year HWT and HWWS in Guatemala Residual
chlorine 9% intervention vs 3% in control (Arnold 2009)
CRT of SODIS among 22 rural communities in Bolivia 32%
(Mausezhal 2009)






Potential explanation for variability
Introduction to HWTS | 8
Blinded RCTs
Challenges to blind effectively
Potentially unethical

Alternative health outcomes
Nutritional indicators
Weight-for-age (malnutrition, diarrhoea)
Height-for-age (stunting)
Environmental enteropathy
Pathogen identification

Alternatives to improve measurement?
Schmidt et al (2010)
Introduction to HWTS | 9
Significant health gains, 30-40%
reductions in diarrhoea but may be
an overestimation

Measuring impact on health is
possible but can be complicated and
expensive

Routine monitoring and evaluation
should focus on use before
attempting to measure health impact



Conclusion
Introduction to HWTS | 10
Systematic reviews

Arnold, B. F. & J. M. Colford, Jr. (2007) Treating water with chlorine at point-of-
use to improve water quality and reduce child diarrhea in developing countries:
a systematic review and meta-analysis. Am J Trop Med Hyg, 76, 354-64.

Clasen, T., I. Roberts, T. Rabie, W. Schmidt & S. Cairncross (2006)
Interventions to improve water quality for preventing diarrhoea. Cochrane
Database Syst Rev, 3, CD004794.

Esrey, S. A., R. G. Feachem & J. M. Hughes (1985) Interventions for the control
of diarrhoeal diseases among young children: improving water supplies and
excreta disposal facilities. Bulletin of the World Health Organization, 63, 757-72.

Fewtrell, L., R. B. Kaufmann, D. Kay, W. Enanoria, L. Haller & J. M. Colford, Jr.
(2005) Water, sanitation, and hygiene interventions to reduce diarrhoea in less
developed countries: a systematic review and meta-analysis. Lancet Infect Dis,
5, 42-52.

Waddington, H. S., B. White, H. Fewtrell, L. 2009. Water, Sanitation and
Hygiene Interventions to Combat Childhood Diarrhoea in Developing Countries.
International Initiative for Impact Evaluation (3ie).




Further discussions about evidence
for health impact of HWTS

Clasen T, Bartram J, Colford J, Luby S, Quick R, et al. (2009) Comment
on Household water treatment in poor populations: is there enough
evidence for scaling up now?. Environ Sci Technol 43: 55425544;
author reply 55455546. doi: 10.1021/es9008147

Hunter, P. R. (2009) Household Water Treatment in Developing Countries:
Comparing Different Intervention Types Using Meta-Regression. Environ
Sci Technol. 43(23):8991-7

Schmidt, W. P. & S. Cairncross (2009) Household water treatment in poor
populations: is there enough evidence for scaling up now? Environ Sci
Technol, 43, 986-92.
Additional ressources: Reviews
Introduction to HWTS | 11

Arnold, B., B. Arana, D. Mausezahl, A. Hubbard & J. M. Colford, Jr. (2009) Evaluation of a pre-existing, 3-year
household water treatment and handwashing intervention in rural Guatemala. Int J Epidemiol.

Boisson S, Stevenson M, Shapiro L, Kumar V, Singh LP, et al. (2013) Effect of Household-Based Drinking Water
Chlorination on Diarrhoea among Children under Five in Orissa, India: A Double-Blind Randomised Placebo-
Controlled Trial. PLoS Med 10(8): e1001497. doi:10.1371/journal.pmed.1001497

Boisson S, Kiyombo M, Sthreshley L, Tumba S, Makambo J, et al. (2010) Field assessment of a novel
household-based water filtration device: a randomised, placebo-controlled trial in the Democratic Republic of
Congo. PLoS One 5: e12613 doi:10.1371/journal.pone.0012613

Mausezahl, D., A. Christen, G. D. Pacheco, F. A. Tellez, M. Iriarte, M. E. Zapata, M. Cevallos, J. Hattendorf, M.
D. Cattaneo, B. Arnold, T. A. Smith & J. M. Colford, Jr. (2009) Solar drinking water disinfection (SODIS) to
reduce childhood diarrhoea in rural Bolivia: a cluster-randomized, controlled trial. PLoS Med, 6, e1000125.

Schmidt, W. P., S. Boisson, B. Genser, M. L. Barreto, K. Baisley, S. Filteau & S. Cairncross (2010) Weight-for-
age z-score as a proxy marker for diarrhoea in epidemiological studies. J Epidemiol Community Health, 64,
1074-9.

Schmidt, W. P., B. F. Arnold, S. Boisson, B. Genser, S. P. Luby, M. L. Barreto, T. Clasen & S. Cairncross (2011)
Epidemiological methods in diarrhoea studies--an update. Int J Epidemiol, 40, 1678-92.


.








Additional ressources: studies cited
Introduction to HWTS | 12
Economic analysis of HWTS
Introduction to Household Water Treatment and Safe Storage, Module 5.4
Dr. Richard Johnston
Cost benefit analysis
Money for money

Cost effectiveness analysis
Money for DALYs

Willingness to Pay
Money for HWTS


5.4 Cost-effectiveness
Introduction to HWTS| 2
Five interventions
Meeting the Water MDG Target
Meeting the Water and Sanitation MDG Targets
Universal access to basic water and sanitation
Universal basic access + HWTS
Regulated piped water and sewer connections

Benefits
Reduced diarrheal disease
Reduced costs of managing diarrheal disease
Increased productivity from improved health
Time savings


Cost-benefit analysis
Introduction to HWTS| 3

Cost-benefit analysis results
0
5
10
15
20
25
30
35
40
45
50
AMR-B EMR-B EUR-B SEAR-BWPR-B EUR-C EMR-DAMR-DSEAR-D AFR-D AFR-E
B
e
n
e
f
i
t
-
C
o
s
t

r
a
t
i
o

Water and Sanitation MDGs
Universal basic
Universal basic + HWTS
Water MDG
Regulated
Hutton, Haller, & Bartram, 2007. Global cost-benefit analysis of water supply and sanitation interventions. Journal of Water and Health.
Introduction to HWTS| 4
The intervention which is
consistently the most cost-effective
across regions and would be
classified as very cost-effective in all
areas where it was evaluated was
the provision of disinfection capacity
at point of use. On purely cost-
effectiveness grounds it would be
the first choice where resources are
scarce.
Cost-effectiveness analysis
Source: World Health Report 2002, page 128
Introduction to HWTS| 5
Chlorine, SODIS lowest cost
Filters, flocculation/disinfection more
expensive than source
improvements



Another cost-effectiveness analysis
Source: (Clasen et al. 2007)
Introduction to HWTS| 6
Chlorine, SODIS lowest cost
Filters, flocculation/disinfection more
expensive than source
improvements

Cost per DALY averted quite low
<< GDP per capita



Another cost-effectiveness analysis
Source: (Clasen et al. 2007),.
472
1117
142
336
123
143
61
144
53
125
0
200
400
600
800
1000
1200
AFR-E SEAR-D
G
r
o
s
s

A
n
n
u
a
l

C
o
s
t

(
$
)

p
e
r

D
A
L
Y

a
v
e
r
t
e
d

Coagulation/flocculation
Filtration
Source
SODIS
Chlorination
Introduction to HWTS| 7
Bangladesh study
Luoto et al. 2012
2-month free trials of four HWTS
options in rotation
WaterGuard liquid chlorine
Aquatabs chlorine tablets
PuR flocculant disinfectant
Crystal Pur ceramic candle filter

Bidding auction methodology

Very low willingness to pay
Willingness to pay
Introduction to HWTS| 8
Cost benefit analysis

Cost effectiveness analysis

Willingness to Pay
Conclusion
Introduction to HWTS| 9
HWTS Selection
Introduction to Household Water Treatment and Safe Storage, Module 5.5
Dr. Richard Johnston
Decision-making at different levels

Establish context

Define objectives

Assess options against objectives
5.5 HWTS Selection
Introduction to HWTS| 2
Water to be treated
Quality (turbidity, level of contamination)
Quantity, level of access

Wealth, education of target population

Access to markets, information

Policy environment

Nature of supporting organization



Context
Introduction to HWTS| 3
WHO WPRO Training Manual
Prof. Mark Sobsey et al.
Netherlands Water Partnership
PATH
Water Resource Quality
Define objectives
Introduction to HWTS| 4
WHO WPRO Training Manual
How well does the technology perform?
Effectiveness
How well does the technology fit into peoples daily lives?
Appropriateness
What will people think of the technology?
Acceptability
What are the costs for the household?
Cost
What is required to get the technology into peoples
homes?
Implementation

Introduction to HWTS| 5
Sobsey: criteria for sustainable HWTS
Able to consistently produce sufficient quantities of microbiologically safe
water to meet daily household needs.
Quantity
Effective for treating many different water sources and quality levels
including turbid and high organic content waters.
Quality
Requires relatively small user time to treat water, thereby not significantly
contributing to already substantial household labor time burdens.
Ease of use
Relatively insensitive to income fluctuations, not causing households to
stop treating water because they cannot afford to purchase the technology
or continuously replace it.
Low cost
Have a reliable, accessible and affordable supply chain for needed
replacement units or parts for which consumers are willing and able to pay.
Supply chains

Introduction to HWTS| 6
Netherlands Water Partnership
Continuity of water quality and quantity
Adaptability to part time operations
High potential of local production
Robustness
User safety during operation
Possibility of water quality checking by user
Amount of experience in technology application
Performance
Operated and maintained at local level
Accessible spare parts
Social benefits to user
Acceptable intensity and frequency of operation and maintenance
People
Low dependency on fuels and chemicals
Isolation or reuse of the waste product
Planet

www.aquaforall.nl/documents/aqua4all/downloads/
smart_disinfection_solutions.pdf
Introduction to HWTS| 7
Water Resource Quality
Capital costs
Capital maintenance costs
Operation and minor maintenance costs
Total costs
Affordability
Cultural acceptance
Water aesthetics
Drinking water standards
Waste management
Acceptability
Simplicity of operation
Requirement of electricity
Frequency of major interventions
Local availability of materials and spare parts
Reliability

www.wrq.eawag.ch

www.sciencedirect.com/science/article/pii/S0048969713012163
Introduction to HWTS| 8
PATH Safe Water Project
Ease of operation
Time to treat
Taste & odor
Clarity
Ease of maintenance
Cost of operation and maintenance
Acceptability
Availability
Affordability
Safe Water Project
HWTS Design Guidelines

Perspectives magazine
http://sites.path.org/water/

Stephen Himley MPH
Development of a Tool To Evaluate
Household Water Treatment and Safe
Storage Technologies Via the Analytic
Hierarchy Process and Expert Elicitation
Based on Factors Influencing Acquisition
and Continued Use

Introduction to HWTS| 9

Landscaping

Formal optimization


Decision trees
What to do with multiple criteria?
Introduction to HWTS| 10

Landscaping
PATH Technology Assessment and Ranking Tool (TART)

18 dimensions
15 systems

Introduction to HWTS| 11
5. Weighting
6. Calculate totals
7. Examine results
8. Sensitivity analysis
Formal: Multi-Criteria Decision Analysis
1. Establish decision
context
2. Identify options
3. Identify objectives,
criteria
4. Scoring
Source: Osterwalder et al. 2014
Introduction to HWTS| 12
Lowest Criterion Element Poor Score Fair Score Good Score Excellent Score
Time to treat
(Acceptability), [t]
t >20 minutes 10 < t < 20 minutes 5 < t < 10 minutes t < 5 minutes
Increase score one level if time to treat > 6 liters is same as for 2 liters
Taste & odor
(Acceptability),
[h = free chlorine or total
bromine]
h > 2.0mg/L 1.0 < h < 2.0 mg/L 0.3 < h < 1.0 mg/L h < 0.3 mg/L
Clarity (Acceptability),
[turbidity, T]
T > 10 NTU 5 < T < 10 NTU 1 < T < 5 NTU T <1NTU
Ease of Operation
(Acceptability),
[involvement time, I]
From Excellent Score:
Decrease score 1 level each if 30 seconds < I < 5 minutes OR poor ergonomics OR 3 to 4 steps.
Decrease score 2 levels each if 5 < I < 20 minutes OR requires 5 or more steps
Decrease score 3 levels if I > 20 minutes
I < 30 seconds, good
ergonomics, & 1 or 2 easy
steps
Ease of Maintenance
(Acceptability),
[f = frequency of
maintenance]
f < weekly & burdensome (> 5
min.)
weekly < f < monthly &
burdensome (> 10 min.)
f > monthly & burdensome
(> 20 min.) - or -
f < weekly & not
burdensome (< 5 min.)
weekly < f < monthly & not
burdensome(< 10 min.) - or -
f > monthly & not
burdensome (< 20 min.)
Cost of Operating and
Maintenance
(Acceptability)
Lower Segment
> $18.25/yr
Low Segment
> $73.00/yr
Interpolate
Lower Segment
< $3.65/yr
Low Segment
< $14.60/yr
Affordability
Lower Segment
> $18.25/yr
Low Segment
> $73.00/yr
Interpolate
Lower Segment
< $3.65/yr
Low Segment
< $14.60/yr
Availability N = 0 or V = 0 L
Interpolate
(N = number of durables; V = volume of liters treated by
FMCG)
N > 72 or V > 72,000 L
Scoring example (Himley MPH)
Introduction to HWTS| 13

Weighting example (Himley MPH)
0%
20%
40%
60%
80%
100%
E
a
s
e

o
f

O
p
e
r
a
t
i
o
n
T
i
m
e

t
o

T
r
e
a
t
T
a
s
t
e

&

O
d
o
r
C
l
a
r
i
t
y
E
a
s
e

o
f

M
a
i
n
t
C
o
s
t

o
f

O
p
s

&

M
a
i
n
t
W
e
i
g
h
t
Rural Lower Rural Low
Urban Lower Urban Low
0%
20%
40%
60%
80%
100%
Acceptability Availability Affordability
W
e
i
g
h
t
Rural Lower Rural Low
Urban Lower Urban Low
Introduction to HWTS| 14

Total score example (Himley MPH)
0% 20% 40% 60% 80% 100%
Filt_Cer
Filt+Br
Filt+Cl
Cl_Tab
Cl_Liq
Floc+Cl
Rural Lower: Ideal
Filt_Cer
Filt+Br
Filt+Cl
Cl_Tab
Cl_Liq
Floc+Cl
Urban Lower: Ideal
Filt_Cer
Filt+Br
Filt+Cl
Cl_Tab
Cl_Liq
Floc+Cl
Rural Low: Ideal
Filt_Cer
Filt+Br
Filt+Cl
Cl_Tab
Cl_Liq
Floc+Cl
Urban Low: Ideal
Score
Acceptability
Availability
Affordability
0% 20% 40% 60% 80% 100%
Filt_Cer
Filt+Br
Filt+Cl
Cl_Tab
Cl_Liq
Floc+Cl
Rural Lower: Ideal
Filt_Cer
Filt+Br
Filt+Cl
Cl_Tab
Cl_Liq
Floc+Cl
Urban Lower: Ideal
Filt_Cer
Filt+Br
Filt+Cl
Cl_Tab
Cl_Liq
Floc+Cl
Rural Low: Ideal
Filt_Cer
Filt+Br
Filt+Cl
Cl_Tab
Cl_Liq
Floc+Cl
Urban Low: Ideal
Score
Acceptability
Availability
Affordability
Non-turbid water Turbid water
Introduction to HWTS| 15
Is water muddy?
NO
Are products from outside the community
available in the market or through humanitarian
response?
NO
Is wood or fuel available?
NO
Promote straining,
SODIS, 3 pot
method, or
filtration with
frequent cleaning.
YES
Promote straining
and boiling. Also
promote
responsible wood
collection and
reforestation
YES
Is water cloudy?
NO
Use a normal
dose of chemical
disinfection
YES
Use a double
dose of chemical
disinfection
YES
Promote
straining,
3 pot
disinfection,
sedimentation,
or filtration
with frequent
cleaning.
Decision trees
Promote safe water storage and handling
Source: after IFRC, 2008
Introduction to HWTS| 16
HWTS Selection is complex

Context-specific

Importance of criteria
Ranking (weighting)

Informal, formal methods

Conclusion
Introduction to HWTS| 17
Conclusion
Introduction to Household Water Treatment and Safe Storage, Module 5.6
Dr. Richard Johnston
Household Water Treatment
and Safe Storage
Strategic Environmental
Sanitation Planning
Water Supply
and Treatment
Municipal Solid
Waste Management
Excreta and Wastewater
Management
WASH in developing countries MOOC series
www.sandec.ch
Introduction to HWTS| 2
Planning & Design of Sanitation
Systems and Technologies
Dr. Christoph Luethi

Affordable and context-specific
sanitation solutions

Recommended:
General background in environmental or civil
engineering, urban planning or geography


WASH in developing countries MOOC II
Introduction to HWTS| 3
WASH in developing countries MOOC II
Sanitation Chain: 5 functional groups
User
Interface
Collection /
Storage
Conveyance Treatment Use/Disposal
j k l m n
Introduction to HWTS| 4
Starting May 26!
www.coursera.org/course/water
Introduction to HWTS| 5
Week 1
Background
Disease
Contamination
Week 2
Water Safety
Sedimentation
Filtration
Week 3
Disinfection
Safe storage
Week 4
Implementation
Strategies
Vulnerable groups
Week 5
Validating
technologies
Monitoring and
evaluation
Health Impacts
Why, What, How
Introduction to HWTS| 6

Thanks!
Introduction to HWTS| 7

Colleagues at Eawag
Fabian Suter, La Zaretti
Sara Marks, Regula Meierhofer, Maryna Peter
Heiko Gebauer, Hans-Joachim Mosler

Peg Fortenberry, Procter & Gamble
Alison Hill, Vestergaard-Frandsen
Rachel Peletz, Aquaya Institute
Ryan Rowe, UNC Water Institute

EPFL
Coursera
Thanks!
Introduction to HWTS| 8