Report 3 of the third workshop of the WHO FAO IDRC … WHO/HSE/WSH/10.03 Report of the THIRD...

Report of the

THIRD CONSULTATIVE WORKSHOP ON THE WHO/FAO/IDRC PROJECT

“NON-TREATMENT OPTIONS FOR SAFE WASTEWATER USE IN POOR

URBAN COMMUNITIES”

Amman, Jordan 7-10 March 2010

World Health Organization Geneva

3

WHO/HSE/WSH/10.03

Report of the THIRD CONSULTATIVE WORKSHOP ON THE WHO/FAO/IDRC PROJECT

“NON-TREATMENT OPTIONS FOR SAFE WASTEWATER USE IN LOW-INCOME URBAN COMMUNITIES”


The workshop was organized jointly by the World Health Organization and the International Development Research Centre (IDRC), in collaboration with the Food and Agriculture

Organization of the United Nations (FAO). Local arrangements were made by the WHO Centre for Environmental Health Activities (CEHA) in Amman, Jordan, in collaboration with the project team of the Royal Scientific

Society of Jordan. CEHA is part of the WHO Regional Office for the Eastern Mediterranean.

World Health Organization

Geneva 2010

4

© World Health Organization 2010

All rights reserved. This health information product may not be reviewed, abstracted, quoted, reproduced, transmitted, distributed, translated or adapted, in part or in whole, in any form or by any means. The designations employed and the presentation of the material in this health information product do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this health information product is complete and correct and shall not be liable for any damages incurred as a result of its use.

5

CONTENTS

Page Executive summary 6 1. Introduction 8 2. Workshop proceedings 11 2.1 Opening 11 2.2 Review of the progress reports 13 2.3 Formulation of lessons learned and recommendations for the future 36 2.4 The STAC meeting 42 2.5 Field trip 42 3. Document review and technical discussions 43 3.1 Draft UN-Water Policy Brief 43 3.2 Guidance document 44 3.3 Information kit second edition 47 3.4 Climate change and wastewater use 49 4. Conclusions and recommendations 50 Annexes Annex 1. Programme of Work 52 Annex 2. List of Participants 55 Annex 3. Minutes of the STAC meeting 59

6

EXECUTIVE SUMMARY

The third and final consultative workshop on the WHO/FAO/IDRC project Non-

treatment options for safe wastewater use in poor urban communities was held in Amman, Jordan 7-10 March 2010. The workshop was attended by six members of three of the four project teams, the four members of the project’s Scientific and Technical Advisory Committee (STAC) and Secretariat members from WHO, FAO and IDRC.

The workshop objectives were: 1. to review the progress reports of the second phase studies in Ghana, Jordan and Senegal; 2. to formulate lessons learned from the field work in the three countries as an input into a

guidance document on sanitation safety plans; 3. to review a draft outline of the sanitation safety plans guidance document; 4. to review materials for the second edition of the WHO/FAO/IDRC/IWMI Information

Kit on the Guidelines for the Safe Use of Wastewater; 5. to review a draft of the UNEP/GRID document on wastewater treatment and use; 6. to discuss challenges for the safe use of wastewater in the face of climate change; 7. to update all participants on recent developments in the field of safe use of wastewater in

agriculture and aquaculture; and, 8. to make direct observations in Jordan through a field visit to the study site of the

Jordanian team.

The workshop reviewed the progress reports received from three of the four teams and the executive summary of the final report received from one team. Two of the four projects had suffered from a disruption in the flow of financial support, and these were reviewed for accomplishments to date as well as for work that still needed to be done.

Members of the STAC made recommendations of the work that remained to be done for each of the three projects to bring them to a satisfactory completion. The overall project will come to completion on 30 April 2010, and any residual work will have to be reported on within four months after the above date, i.e. by 31 August 2010, allowing a conclusive presentation at the 2010 Stockholm World Water Week. The teams were also expected to each prepare a list of articles already published or submitted to peer-reviewed journals and those planned or under preparation.

The team members, STAC members and Secretariat members worked in groups to formulate lessons learned and recommendations for the future. The outcome of this group work was presented and discussed in plenary.

A number of other items were reviewed and/or discussed in plenary: the contents of the second edition of the information kit on the third edition of the WHO Guidelines, format and contents of a Manual for Sanitation Safety Plans as the key output of the project, the draft UN-Water Policy brief on wastewater management and options for research on the links between climate change and water reuse practices.

A field visit to the Jerash Palestinian Refugee camp (20,000 inhabitants) provided the workshop participants with an opportunity to make direct observations on the flow of greywater in the settlement and its use in the surrounding agricultural areas.

The general conclusion at the end of the workshop was that the project had made a valuable contribution to the understanding of the practical application of the third edition of the

7

Guidelines. The results provided a sound basis for more detailed follow-up activities in a further range of settings and for the formulation and piloting of a Manual on Sanitation Safety Plans.

8

1. INTRODUCTION

In November 2006, the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO) and the International Development Research Centre (IDRC) jointly initiated a project entitled non-treatment options for safe wastewater use in

agriculture by low-income urban communities. Based on agreed criteria four different settings were selected and these served as the

context for testing the third edition of the WHO Guidelines for the Safe Use of Wastewater, Excreta and Greywater in Agriculture and Aquaculture (WHO, 2006). The project aimed to test the Guidelines for their applicability and for the feasibility of the methods and procedures they propose, and to explore the constraints and obstacles that may be encountered in their implementation. The final product expected at the point of departure of this project was a guidance document to assist national and municipal authorities and other users of the guidelines in their application.

The project objectives, as defined in the WHO/FAO/IDRC project document, had been defined as follows:

� To identify economically, technically and socially appropriate non-treatment options for health protection such as crop restriction, wastewater, excreta and grey water application techniques that reduce levels of exposure to hazards and exposure control measures such as the use of personal protective equipment, hygiene education, food safety measures etc as promoted by the WHO guidelines.

� To study the feasibility and potential effectiveness of the non-treatment health protection measures in reducing the disease burden associated with the use of wastewater, excreta and greywater.

� To increase awareness of the guidelines in the international development community and among national governments.

� To synthesize research findings into a joint WHO/IDRC document that will help low-income countries adapt the WHO guidelines for effective application in their own unique circumstances.

The selection process that resulted in the four projects implemented is described in detail

in the report of the first consultative workshop (Accra, 4-7 December 2006).

9

The four projects are: � Ghana Kumasi: Evaluation of non-treatment options for maximizing public health

benefits of WHO guidelines governing the use of wastewater in urban vegetable production in Ghana.

� Ghana/Tamale: Minimizing health risks from using excreta and grey water by poor urban and peri-urban farmers in the Tamale municipality, Ghana.

� Jordan: Safe use of greywater for agriculture in Jerash Refugee Camp: focus on technical, institutional and managerial aspects of non-treatment options.

� Senegal: Proposition d’étude en vue de l’intégration et de l’application des normes de la réutilization des eaux usées et excréta dans l’agriculture.

A four-member Scientific and Technical Advisory Committee was established, which

was consulted as part of the selection process and which subsequently accompanied the project from initiation to closure for advice, monitoring and evaluation. The STAC Terms of Reference are presented in an annex to the report of the first workshop.

The studies were divided in two parts, following the structure of the Guidelines. The first

phase addressed issues of risk assessment and the second phase issues of risk management. At the first consultative workshop each team prepared a protocol for the activities under phase 1. All projects got underway in the first half of 2007, with a slight delay in their start-up. Progress reports were submitted in November 2007 and these were reviewed at a second consultative workshop. The detailed discussions of the progress reports and the recommendations made by the STAC members are presented in the report of the second workshop (Dakar, 26-29 November 2007). At this workshop protocols for the second phase of the studies were prepared, with a focus on risk management activities that followed from the risk assessment phase.

At this point a number of administrative constraints created a dichotomy between the

projects. Two projects (Jordan and the FAO-sponsored Ghana Kumasi project) followed the agreed time table which aimed at project completion by May 2009. The other two projects (Ghana Tamale and Senegal), however, suffered serious delays and were interrupted until December 2009. A no-cost extension was agreed with IDRC and the third and final consultative workshop was moved to be held from 7 to 10 March 2010 in Amman, Jordan.

This third workshop, reported on here, concluded the WHO/FAO/IDRC project on non-treatment options for the safe wastewater use in agriculture by low-income urban communities. The workshop’s objectives were:

(1) to review the progress reports of the second phase studies in Ghana, Jordan and Senegal; (2) to formulate lessons learned from the field work in the three countries as an input into a

guidance document on sanitation safety plans; (3) to review a draft outline of the sanitation safety plans guidance document; (4) to review materials for the second edition of the WHO/FAO/IDRC/IWMI Information

Kit on the Guidelines for the Safe Use of Wastewater; (5) to review a draft of the UNEP/GRID document on wastewater treatment and use; (6) to discuss challenges for the safe use of wastewater in the face of climate change; (7) to update all participants on recent developments in the field of safe use of wastewater in

agriculture and aquaculture; and (8) to make direct observations in Jordan through a field visit to the study site of the

Jordanian team.

10

The expected outputs of the workshop were: (1) Final reports from the Ghana, Jordan and Senegal, approved by the Scientific and

Technical Advisory Committee. (2) A report of the Jordan workshop. (3) Recommendations derived from lessons learned and comments on the draft guidance

document. (4) Suggestions and comments concerning materials for the second edition of the

Information Kit. (5) Comments on the draft UNEP/GRID document. (6) Recommendations on further research needs, including on wastewater use and climate

change.

A number of activities in Ghana Tamale and Senegal will need completion beyond the final closing date of 30 April 2010 and these will be reported on in the WHO web-pages on wastewater use.

11

2. WORKSHOP PROCEEDINGS

The workshop was held at the WHO Centre for Environmental Health Activities (CEHA, which is part of the WHO Regional Office for Eastern Mediterranean) in Amman, Jordan from 7 to 10 March 2010. It was attended by six team members of three of the four project teams (i.e. two team members each from Jordan, Ghana/Tamale and Senegal; the team leader of the Ghana/Kumasi was unable to attend for health reasons), the four members of the project’s Scientific and Technical Advisory Committee, Secretariat members from WHO, FAO and IDRC, and a number of observers.

The workshop programme is presented in Annex 1 and the list of participants is presented in Annex 2.

2.1 Opening

2.1.1 Opening statements W HO, FAO and IDRC The Director of the WHO Centre for Environmental Health Activities (CEHA), Dr Basel

Al-Yousfri, welcomed the participants to Amman and reminded them that all countries in this WHO Region were under the water poverty line. In a region with such a level of water scarcity, the use of wastewater was an imperative, in rural and urban settings alike, and the countries of the region had developed laws and regulations to ensure wastewater use was safe. Robert Bos, Coordinator, Water, Sanitation, Hygiene and Health in the Department of Public Health and Environment in WHO headquarters in Geneva expressed his thanks to the Director and staff of CEHA for their support in the preparations for the workshop and for their kind hospitality. He recalled that the last workshop had taken place over two years ago, and during that period problems of water scarcity had become more serious in many parts of the world, against the backdrop of continued urbanization (now, more than 50% of the world population lived in urban settings) and exacerbated by global climate change phenomena. At the same time, efforts to achieve the Millennium Development Goals had continued and were now being stepped up as 2010 marked the milestone of five years to the deadline of 2015. He re-iterated the objectives of the workshop. On behalf of IDRC Mark Redwood informed the participants of recent changes in the IDRC structure and of the greater focus on climate change issues in the new structure. He had reviewed the original proposal document of this project and had noted the need to have concrete deliverables: the information kit on the guidelines, the guidance document for their implementation but also a report on the impact of the use of the guidelines at the country level,

12

and in particular how the project had contributed to the strengthening of capacity in local communities. Javier Mateo-Sagasta had recently joined FAO headquarters in Rome and he informed the participants that Sasha Koo-Oshima, who had led the FAO wastewater use programme for many years, was about to leave the Organization for a new position with the USEPA in Washington DC.

The work on wastewater use in agriculture would be continued with an emphasis on the strengthening the FAO wastewater database, which contained information on wastewater production, treatment, use as well as the economic information provided by Member States, and also: data from peer-reviewed articles, workshop/conference proceedings and related FAO databases such as AQUASTAT and FAOSTAT; the incorporation of water quality and wastewater use in agriculture in the FAO State of Land and Water report, FAO’s new flagship publication of the global status of land and water resources, to be published in June 2011 ahead of the FAO Conference; four field projects on water quality in urban and periurban agriculture (Angola, Guatemala, Nicaragua and Senegal – the one in Senegal addresses treated wastewater use); the production of a farmer field school manual on the safe use of wastewater in agriculture, derived from the Kumasi study within the project under review; the production of a paper on heavy metal interactions in agricultural use of wastewater; and, the continued involvement in the interdisciplinary group on Food for the Cities.

The FAO water report 35: From waste to resource: the economics of wastewater reuse in

agriculture had just been launched at the IWA International Conference on Water Economics, Statistics and Finance, and the FAO publication on laws for water management was about to be published and contained a chapter on wastewater.

2.1.2 Overview of events since November 2007 Robert Bos presented a brief overview of events since the workshop in Dakar in November 2007, where the teams had received feed-back on their reports of the first phase of the study and had formulated protocols for the second phase. The report of that workshop had been published early 2008, and all teams had submitted their updated progress reports of phase 1 and their protocols for phase 2 by the end of January 2008, as had been agreed, with the exception of the Jordan team, which had awaited inputs from Professor Thor-Axel Stenstroem during a visit in March 2008. The WHO Secretariat had confirmed the satisfactory receipt of all reports and protocols and had given the green light for phase 2 to start. At this point in time a sequence of events had led to a serious delay in the funding stream to the Ghana/Tamale and Senegal projects. The retirement of the Libreville, Gabon-based responsible officer of the WHO Regional Office for Africa in Brazzaville caused a gap in the hand-over of files, and next WHO headquarters went through a major administrative change, including an administrative black-out period from 1 June to 31 July 2008, the transfer of all headquarters’ administrative services to a new administrative centre in Kuala Lumpur, Malaysia and the introduction of a Global Management System in a new software package. The general disruption, the confusion over the status of transfers of funds and lack of clarity about payments of installments under the previous contract led to delays that were only fully overcome with the issuance of contracts to the Ghana/Tamale and Senegal teams for the second phase in November 2009.

13

The Jordanian project and the FAO-supported Ghana/Kumasi project did not suffer these delays and were able to proceed with their work as planned in Dakar, be it that the two Jordanian principal investigators went abroad to pursue advanced degrees and a hand-over of their project responsibilities was required. While the project work in Ghana/Tamale and in Senegal had come to a hold, the work on products continued and a first information kit on the WHO Guidelines, containing various fact sheets, guidance briefs and policy documents, was successfully launched at the Stockholm World Water Week in August 2008. The leader of the Ghana/Tamale team attended Stockholm World Water Week in August 2009 and presented her work at a seminar on the safe use of wastewater during the Conference. This seminar generated the idea of the formulation of a Manual on Sanitation Safety Plans. The foreseen training of technicians of the University for Development Studies at the Centre Suisse in Côte d’Ivoire did, on the other hand, not materialize as foreseen by in Dakar, again because of the lack of flow of funds. Finally, an important event that did not fit within the immediate scope of this project, but which benefited from the participation of all those involved in the project (and many others) was the Expert Consultation organized in Accra, Ghana by the International Water Management Institute, the International Development Research Centre and the World Health Organization. This Consultation resulted in the Accra Consensus: an agenda for research, capacity building and action of the safe use of wastewater and excreta in agriculture (see: www.iwmi.cgiar.org/Research_Impacts/Research_Themes/Theme_3/Accra_Consensus.aspx) and in the publication Wastewater Irrigation and Health 1 early 2010. Copies of this publication were presented to all workshop participants, kind courtesy of Dr Pay Drechsel and IWMI.

2.2. Review of the progress reports

2.2.1 Jordan: Safe use of greywater in the Jerash Refugee Camp, with a focus on

technical, institutional and managerial aspects of non-treatment options.

The following account of progress in the Jordan project is based on the PowerPoint presentation prepared for the workshop rather than the progress report received in October 2009. The final reports of this and the three other country projects will be made available on the WHO/WSH web page. Objective and target groups

The objective of this project is to investigate optimal modalities for application of the third edition of the World Health Organization Guidelines on the Safe Use of Greywater in Agriculture, in the specific context of the Jerash refugee camp and the nearby farms. The target groups in this context are found at the farm level (farmers) and at the household level (children).

Ten official Palestinian refugee camps in Jordan accommodate a total of 307 785 refugees for which the United Nations Relief and Works Agency (UNRWA) provides basic services. For this project the Jerash refugee camp was selected based on the specific criterion of poor vulnerable urban areas with relatively high presence of indicators of adverse water-related

health issues.

1 Drechsel, P., Scott, C.A., Raschid-Sally, L., Redwood, M. and Bahri, A. (eds.), 2010. Wastewater

Irrigation and Health: assessing and mitigating risks in low-income countries. Published by Earthscan on behald of the International Water Management Institute (Colombo) and the International Development Research Centre (Ottawa).

14

The camp area of 750,000 m2 is provided with basic infrastructure and services: electricity, water supply and basic sanitation services (indoor latrines). It contains 2050 housing units, all provided with piped water and 1560 housing units provided with latrines from which the wastewater is disposed to cesspools or septic tanks. Greywater is separated in the houses and discharged through small open ditches to large collection points distributed all over the camp.

The basic health problem related to unsafe and contaminated water is bloody diarrhoea; its incidence is significantly higher in Jerash than in other camps with a sewerage system. Inhabitants are exposed to high risk levels associated with raw greywater. The limited area of the Jerash camp makes the construction of a treatment plant within its confines difficult. A plant is currently under construction, however, in the vicinity and is expected to enter into service in the course of 2010.

The project’s specific objectives were:

♦ to assess the current status of greywater use and the associated health issues;

♦ to identify and assess health protection measures in close consultation and with active participation of the community and other stakeholders; and,

♦ to explore and test effective activities to promote health-oriented behaviors and personal hygiene for target groups.

In terms of method, the project was based on a multidisciplinary approach ensuring a coherent framework to achieve integration of different components of the study, including social, technical, economic, institutional, environmental and public participation issues. Close collaboration with NGOs (Non-Governmental Organizations) and CBOs (Community-Based Organizations) was common practice.

The initial steps of work included field visits and community consultation to establish a Local Stakeholders Committee. Next, as part of the first phase of risk assessment, the project team developed observational checklists and structured interview questionnaires, and carried out data collection, risk analysis and evaluation using EpiInfo software. In the next phase of risk management and non-treatment the focus was on health protection measures: health education was carried out at the household level and promotion of proper grey water handling at the farm level.

The widest possible range of stakeholders was invited to formal and informal informative meetings to initiate dialogue and introduce project objectives, activities and anticipated outcomes: local community members, farmers, representatives of NGOs and CBOs, health inspectors, physicians from public and private health centers, school directors and teachers, members of the Camp Development Committee (CDC), UNRWA officers working in the camp and officers of Department of Palestinian Affairs.

A steering committee was established to coordinate efforts among governmental institutions in areas of work targeted by the project and to facilitate policy formulation and recommendation. The steering committee was made up of representatives from different governmental and non-governmental institutions: World Health Organization/CEHA, Department of Palestinian Affairs, the Ministry of Water and Irrigation, the Ministry of Health, the German GTZ and the Ministry of Agriculture. Activities

In the risk assessment phase, information was obtained by qualitative participatory methods: observational checklists (OC) and structured interviews (SI). Both were structured to follow the risk assessment paradigm of WHO guidelines, which includes hazard identification,

15

hazard characterization, exposure assessment and risk characterization. They included the following components: family information, exposure information, epidemiological information and hygiene behaviors and risk perceptions.

The field team consisted of one observer and one interviewer who visited 399 households and 13 farms. Visited households received a sticker for identification. Correspondents were housewives for the households and farmers for the farms. With support from WHO/CEHA EpiInfo software was used to construct a functional database. In the risk management phase, the application of non-treatment health protection measures was carried out. These included public education and awareness programmes on hygiene behaviour (Participatory Hygiene and Sanitation Transformation (PHAST) training programme, lectures to create awareness, posters and other promotional tools), with school students and house wives as target groups and promotion of proper grey water handling (use of protective clothes and boots), with farmers as the target group. The PHAST training programme was deployed through seven workshops:

♦ Introduction: Water and health-water related diseases.

♦ Problem Identification: Health problems in Jerash Camp.

♦ Problem Analysis: Good & bad hygiene behaviors, community practices, how diseases

spread.

♦ Planning for Solution: Blocking of spread of diseases, selecting barriers.

♦ Selecting Options: Improved hygiene behaviors.

♦ Planning for Behavioural Change: Planning for change.

♦ Evaluation

Eighteen awareness lectures were given, covering good and bad hygiene behaviours, health impacts of grey water and hygiene behaviours, and grey water canals.

Some 2000 copies of a specially designed poster were distributed by housewives and

school children throughout the camp to convey messages on how to minimize the risks related to grey water and other pollutants in the camp (see next page).

In accordance with the WHO Guidelines protection measures have to be subject to

rigorous monitoring at three levels: validations of the methods, operational monitoring and verification of their impact.

Impacts of the risk management strategies were appraised directly by measuring the change in behaviours and adoption of health oriented practices. The timeframe of the project did not allow an appraisal of health impacts. The appraisal was done by analyzing the data that had been obtained during post intervention observations, interviews and questionnaires. The project team prepared the questionnaire and distributed among the farmers. The survey was conducted in five farms nearby the refugee camp.

In the following table the parameters (cf. Chapter 6 in the WHO Guidelines) are presented for each control measure adopted in the project.

16

Control measures Validation requirements Operational monitoring

parameters

Verification monitoring

parameters

Health and hygiene promotion

− Testing of promotional materials with relevant stakeholder groups

− Local programs in operation.

− Promotional materials available.

− Promotion included in school.

− Increased awareness of health and hygiene issues in key stakeholder groups.

− Improved practices.

Access control, use of personal protective equipment

− Identifying which personal protective equipment is available at low cost that workers will wear.

− Testing the effectiveness of the personal protective equipment in preventing exposure to hazards.

− Visual inspection of workers to ensure that they are wearing the appropriate personal protective clothing.

− Public health surveillance of workers to document reductions in skin diseases, and hook worm.

Figure 1. The poster prepared by the project and distributed in the camp

17

Research findings (I): risk assessment at the household level.

The situation analysis showed that the camp has electricity and is supplied with piped water. Water delivery is intermittent and each house has a roof tank for drinking-water and other domestic purposes (food preparation, personal hygiene, washing and laundry).The main sanitary facility is the latrine linked to a sub-surface cesspool which allows wastewater to seep into the ground. The hazard identification and characterization work revealed that uncontrolled waste disposal is common in the camp, that greywater from showers, kitchens and washing machines is drained by means of small pipes through the walls of house into ditches running in the centre of streets. This practice results in major health hazards because greywater mixes with other wastewater of faecal material from the uncontrolled disposal of diapers. Another possible route of contamination was that caused by animal manure in the streets. Linked to these hazards, the exposure assessment revealed a number of risk behaviours: children playing in the ditches and having accidental contact with greywater; indirect exposure while playing at home through inhalation; and cleaning of greywater ditches within the confines of the camp. Characterization of the risks showed that the major impact was diarrhoea (both watery and bloody) with an incidence peak of 9.8% at a sample size of 2581 persons. Analysis of the exposure routes and effect (diarrhoea) showed significant causal links with children playing nearby greywater ditches for three hours and more and the lack of hygiene behaviour. At the farm level, the risk assessment showed, first of all, a situation where greywater generated at the households in the camps runs along collections canals and flows down into s stream to the agricultural area. Greywater is either stored in concrete reservoirs or earth pools or transferred directly to the field. Greywater is distributed either manually (buckets), by surface irrigation using moveable pipes or by drip irrigation. The main crops cultivated included tree crops (olives, citrus, almond and cactuses), vegetables (beans, maize, zucchini’s, lady-fingers and capsicum) and ornamental trees. Hazard identification and characterization showed that in the agricultural areas, the sources of fecal contamination were similar to those in the camp: uncontrolled solid waste containing organic matter, pathogens from dead animals, animal waste and exposed dirty diapers. For the same health impacts (watery and bloody diarrhoea) the actual evidence was less compelling: two cases of bloody diarrhoea (out of a sample size of 67) were reported during the olive harvesting time. And five cases (out of 67) of hepatitis were recorded on a single farm where greywater is used for irrigation and vegetables. No statistically significant evidence of enhanced risk could be demonstrated at the farm level as opposed to what was observed in the camp. Three vulnerable groups are exposed to on-farm risks; farmers or farm workers and children who work or visit their families in the farms as well as shepherds who visit farms to feed their animals near the canal. The hypothesis in assessing risk at farm level was that contact during irrigation and during harvest is more likely than contact related to crops. Therefore, the presumed exposure routes included direct contact during pumping activities from the canal to the pool, contact during direct distribution of greywater from canal to the fields for irrigation and microbial contamination during the olive harvest, especially in the fields along the canal.

18

With respect to exposure during irrigation it was found that 75% of the farmer community was exposed to greywater for three months a the year, with exposure frequency ranging from once every day to once every three weeks. With respect to exposure during olive trees harvest: it was found the farmers are likely to have contact with greywater for period of one month every year and for duration of five to nine hours every day. Monitoring of control measures revealed that during the frequent inspection of farm workers, about 20% of farmers were still not wearing the personal protective clothing. Research findings (II): Effectiveness of health protection measures.

The same method was followed as adopted in the risk assessment phase. The datasets on the vulnerable group in the community (children) are still under analysis. The exposure of the farmers was assessed during irrigation and harvest. No single incidence of diarrhoea or hepatitis was recorded during the harvesting season according to the farmers who were interviewed during the survey. The vulnerable groups in this assessment were farmers and their children who helped them in the olive harvesting. The greywater exposure duration for 80% of the farmers is more than three months/year. Only 20% of the farms use mixed water (greywater and rain water). Farmers on farms using mixed water have the greatest exposure to greywater: they stay about four months on the farm to irrigate the crops during the dry season. Furthermore, farmers on such farms have the most exposure to the greywater as the crops are irrigated once every three days while other farmers irrigate once a week at most. And, 80% of the farmers are in contact with greywater for eight hours/day during the olive harvest. It was found that only 33.3% of the farmers were wearing gloves during the agricultural activities; however, almost half of the farmers were wearing boots and 26.70% of them were wearing overalls. During the survey, the farmers who admitted not adopting safety measures while involved in agricultural activities gave the following reasons: some of them are not used to wear safety clothes during their work at farms. Some cannot bear wearing extra clothes especially during the high temperatures of the summer season. Few indicated that they do not have such safety materials. The team also promoted the creation of sub-surface flow, a constructed wetland and the deployment of drip irrigation materials as part of the measures.

With respect to the development of a national safe use of wastewater policy and institutional framework, the following points were discussed and recommended by the steering committee:

♦ Members of the steering committee discussed the importance of implementing the WHO Guidelines in Jordan. However, the committee expressed uncertainty about their immediate implementation since the methods and procedures proposed by the Guidelines are new and untraditional.

♦ The steering committee suggested to consider this project as a baseline for WHO Guidelines. However, it was recommended to prepare a summary of the WHO Guidelines depending on the project outputs.

♦ RSS coordinated with GTZ to review the policy of wastewater treatment and reuse (steering

committee of risk monitoring and management system for the safe use of wastewater).

19

The capacity building component of the project will be important for sustainability. It included:

♦ A four-day training programme on statistical analysis using EpiInfo software at RSS.

♦ A three-day training programme on using Health Mapper Software. The programme was organized CEHA-WHO.

Both were targeted at the project team and other researchers at ERC.

♦ A three-day training course focused on the importance of the OWARE initiative for researchers and the best methods for using the search engines was given by CEHA office and held at RSS. The training targeted the project teams and other researchers from different centers at RSS.

Main conclusions.

The main conclusions of the Jordan project are:

♦ Risk management can be successfully achieved using a combination of technical treatment options and knowledge and awareness programmes.

♦ Risk management activities must rely on the assessment of risk in order to be efficient and valuable.

♦ To achieve health-based targets, three processes should be adopted: system assessment, identification of control measures, and methods of monitoring control methods.

2.2.2 Ghana – Kumasi: Evaluation of non-treatment options for maximizing public health benefits of WHO guidelines governing the use of wastewater in urban vegetable

production in Ghana

For health reasons Professor Robert Abaidoo was unable to attend the workshop in Amman. He submitted the following executive progress report: Background

The KNUST-WHO-FAO-IDRC project continued to make progress but not without certain constraints. Principal investigators and students continued with the implementation activities including participation of two project members in the Second Consultative workshop on the WHO/FAO/IDRC project on ‘Non-treatment Options for the Safe Use of Wastewater in Agriculture in Poor Urban Communities’ and the students are close to submit final draft copies of their theses. The other activities included: completing the draft training handbook on Minimal Health Risk Options for Vegetable Production which now enters the pre-testing stage. The Handbook covers five units. First, it explains the problems of contamination of wastewater and how using such water for production of vegetables poses health risks to the farmers themselves, and to all the people who consume the vegetables. Next, it describes the various options that farmers can choose from to reduce health risks in their vegetable production efforts and how farmers can easily assess the performance of the options they have chosen. The last two topics will help farmers who participated in training in methods of minimizing health risks in vegetable production, to train other farmers in their locality and to effectively disseminate the knowledge

20

and skills acquired from training. In doing so, a large number of farmers will be able to produce vegetables which are safe and will not cause health problems to the community.

Ghanaian vegetable consumers are aware of the health risks associated with vegetables produced by urban and periurban horticulturalists using wastewater and hence are concerned about the health risk posed by the vegetables sold in the markets. The consumers are inclined to accept price mark-ups on vegetables to gain the health benefits and environmental quality improvement from the non-treatment options of wastewater use in UPA. They are willing to pay GH¢ 4.70 ($ 4.61) to move from the current water application methods used, to the improved technologies (non-treatment options of wastewater use) with their associated health and environmental benefits. Gender, income and experience of suffering from vegetable-borne diseases are the determinants of Ghanaian consumers’ willingness to pay. In general, the choice of the non-treatment option (OPTION D) with high percentage reduction of pathogen, soil and groundwater has been shown to have a direct positive impact on individual’s willingness to pay whiles the status quo option (OPTION A) has direct negative impact on the individual’s willingness to pay. Preliminary empirical results of studies on the adoption of improved irrigation practices (non-treatment risk reduction options) and perceptions reveal that age, education and experience of the farmer have a significant positive effect on the probability of adoption of improved practices of managing irrigation water on the vegetable farms.

The project activities have confirmed that irrigation water used in vegetable farming, which is mainly water from shallow hand-dug wells, is contaminated with thermotolerant coliforms and helminth eggs and that the contamination levels are above the recommended level. Therefore cabbages, spring onions and lettuce produced from these irrigation water sources are also contaminated. The study also revealed that cessation of irrigation four (4) days prior to harvesting reduces thermotolerant coliforms and helminth eggs counts significantly. The “multiple barrier approach” where barriers (non-treatment interventions) were placed along the production-consumption pathway and were shown to have an aggregate effect in reducing health risks (as proposed by the WHO guidelines (2006)) is feasible. Significant cumulative reductions were obtained for both thermotolerant coliforms and helminth eggs, when the same batch of cabbage, spring onion, or lettuce produced in fields where cessation of irrigation four days before harvesting at farm was practiced, together with market-based interventions and washing cut cabbage pieces with vinegar (1:5) and salt solution at the street kitchen sites. In all, the outcomes of the study indicated that non-treatment interventions proposed in the WHO guidelines (2006) are effective under actual field conditions in reducing contamination levels on wastewater - irrigated cabbage, spring onion and lettuce.

In addition to this executive summary, Dr Gordana Kranjac presented a PowerPoint

slideshow prepared by Professor Abaidoo, which highlighted the following points: The history of domestic wastewater use for irrigated vegetable production goes back

about five decades, and the practice has been mainly promoted because of the limited access to fresh water resources. There have been justified concerns about the possible crop contamination with pathogens. Four main exposure scenarios can be distinguished in the Ghanaian setting: accidental ingestion of wastewater by the farmer, accidental ingestion of contaminated soil by the farmer, accidental ingestion of wastewater and contaminated soil by the farmer, and consumption of wastewater irrigated vegetables collected from the farm. The basis for these scenarios includes:

21

♦ Farmers’ exposure – vegetable farming in Ghana is labour-intensive and puts farmers into direct contact with irrigation water and contaminated soil. Generally, farmers do not wear any protective clothing (boots, gloves etc).

♦ Consumers’ exposure – mostly through the consumption of vegetables (commonly lettuce served by fast food sellers).

In the context of the WHO/FAO/IDRC project stakeholder perceptions and legislation

were addressed directly or indirectly in the following three thematic areas, with a particular focus on irrigation with polluted water sources: agriculture in the urban vicinity, water and sanitation, and farming and food safety.

In a systematic search and review some 90 legislative documents with a bearing on wastewater use in agriculture were identified. Sources included the national archives, the IWMI-RUAF library and libraries of various other institutions and authorities, and the peer-reviewed literature, institutional web pages and experts. The conclusion of this review was that in Ghana, the objectives of the WHO/FAO/IDRC project were supported by a framework of policies, strategies and regulations, and that the institutionalization of a multiple barrier approach as suggested in the revised WHO guidelines was fully in line with the target of the Ghana Standard Board to establish Food Safety Management (FSM) systems along the food chain.

Promoting best practice in wastewater use in agriculture entails that the study results have to be translated into practical recommendations to be incorporated into the FSM system, and the key institution for institutionalization of the Guidelines was the Ghana Standards Board.

For the institutionalization of safe practices “from farm to fork”, the training schools of

extension officers and food caterers and those on the inspection checklists of the FDB should be targeted. The National Community Water Supply and Sanitation Programme could function as a vehicle for messages addressing hygiene and handwashing.

Interventions

The following interventions were carried out in the context of the project:

Assessment of effectiveness of non-treatment interventions in reducing health risks associated

with consumption of wastewater-irrigated vegetables (cabbage, lettuce and spring onions), with the general objective to evaluate the efficiency of a combination of non-treatment interventions in reducing potential health risk (expressed in the charts a log reduction in E.coli) associated with consumption of wastewater irrigated vegetables along producer consumer pathway (see charts below).

Cabbage

WHO standard

Vinegar

Salt solution

0 2 4 6 8

1

2

3

Pro

du

ce

tre

atm

en

t

Log reduction

Treatment

Cessation

Produce washing

Market removal of outer leaves

Disinfection

22

Lettuce

Spring onions

Joint adoption of safer irrigation options for wastewater vegetable production in Ghana, with the following results: adoption of safer irrigation options is influenced by household characteristics, such as age, gender and education, and farm-level characteristics, such as farm size, distance of vegetable farms to irrigation water sources and extension contact; adoption of the safe irrigation options increased with farmers' perceptions on the ability of the options to increase profit and reduce health-risks to producers and consumers. A number of policy recommendations emerged:

♦ On the short-term: accelerate the pace of human capital development and in particular, institute affordable educational and training programs for the poor.

♦ Direct policy instruments for minimizing the risks to producers and consumers: raising awareness and promoting the use of various health-protection measures during production and marketing.

♦ On the longer term: local stakeholder agencies and governments should enact, strengthen and regulate existing environmental laws.

Finally, the issue of consumers’ willingness to pay for safer vegetables had been addressed, with the following research questions: 1. Are Ghanaiain consumers aware of the health risks associated with vegetables produced by using wastewater? 2. Are Ghanaiain consumers aware of the stages along the food chain where vegetables get contaminated?

WHO standard

Salt solution

Vinegar

0 2 4 6 8

1

2

3

Pro

du

ce

tre

atm

en

t

Log reduction

Treatment

Cessation

Produce washing

Storage over night

Disinfection

WHO standard

Vinegar

Cl solution

Salt solution

0 2 4 6 8

1

2

3

4

Pro

du

ce

tre

atm

en

t

Log reduction

Treatment

Cessation

Produce washing

Disinfection

23

3. Are Ghanaiain consumers willing to pay for improved environmental quality and safer vegetables produced through the application of non-treatment options of wastewater use in urban vegetable production? 4. Do socioeconomic/attitudinal charateristics have an impact on Ghanaian consumers’ willingness to pay for safer vegetables?

The results showed that the majority of vegetable consumers (about 92%) usually consume vegetables at home, about 7% consume vegetables from roadside food vendors while about 1% consume vegetables from restaurants. It also indicated that most vegetables eaten are usually cooked (76%) while 24% of consumers eat vegetables raw. The results also revealed that Ghanaian consumers are willing to pay for “safer” vegetables (managed through the non-treatment options of wastewater use in urban and peri-urban vegetable production). Consumers in Ghana are willing to pay an average of GH¢4.70 ($4.61) per month to improve over the status quo. This translates in a consumers’ willingness to pay at 91.9%. Apart from the already mentioned determinants of willingness to pay, it became apparent that male consumers were more likely to be willing to pay for safer vegetables rather than their female counterparts. This may be attributed to the fact that males in the household are responsible for the health of the entire household and would be willing to give out more of their income in order to keep the household free from any vegetable-borne diseases.

2.2.3 Ghana - Tamale: Minimizing health risks from using excreta and grey water by

poor urban and peri-urban farmers in the Tamale municipality, Ghana.

Tamale is the largest urban center in Northern Ghana with a population of over 300,000 - nearly 80 % of whom live below the poverty line. Although annual rainfall is around 1000 mm, there are 7-8 dry months when farmers have to resort to wastewater for vegetable irrigation as there is no perennial stream passing through Tamale and the groundwater table is low.

Fecal sludge serves as an alternative source of nutrients to many cereal producers, as the cost of chemical fertilizer is more than they can afford. The practice of using raw fecal sludge for peri-urban crop production has been established in the study area for more than 25 years. Application of both waste water (WW) and fecal sludge (FS) by farmers is usually carried out without any accompanying protective measures and therefore results in high contamination levels of the farm produce and also poses serious health risk to both farmers and consumers.

The Tamale project aimed to test non-treatment options for the reduction of farmers’ health risks and analysed their adoption drivers and constraints at the farm and institutional level. It also aimed to increase awareness of farmers, city authorities, relevant groups and agencies, as well as other stakeholders of the need for such measures and the framework within which to implement them, in line with the 2006 WHO Guidelines.

In addition to the use of alternative water sources (mostly open sewerage systems, abandoned small dams and dugouts within city perimeter and hand dug wells), farmers rely on faecal sludge as an alternative source of nutrients due to the high cost of chemical fertilizers. The practice of using raw faecal sludge for periurban crop production has been established for more than 25 years in the study area.

Application of both waste water and/or faecal sludge by farmers is usually carried out without any accompanying protective measures or risk reducing practices and therefore poses

24

serious health risks to farmers and – especially where wastewater is used on vegetables eaten raw – to consumers. City authorities of Tamale have tried to ban the practice on several occasions, but farmers return to them time and again because of poverty and a lack of alternative options.

The target group for this project consisted of low-income urban and periurban farmers. Various activities such as field work, awareness creating stakeholders workshops, preparation of documents for publication, and continued participatory on-farm testing of “safe practices” were carried out over the period under review.

Field work - wastewater

The implementation of the planned activities over the 2008-2010 period was constrained by a paucity in funding, The field work that was carried out over the 2008-09 dry season benefited from the support of the International Water Management Institute (IWMI). Dry season use of imported drip kits for wastewater application for selected vegetables was tested and results were shared. These results showed that imported drip kits, on the whole, were not entirely suitable for use by farmers in the northern Ghana context because of the small size of their plots, large amount of sediments in the water leading to clogging of the drip lines and the high temperatures towards the end of the dry season (February - March). This led to the heating of water in the black drip lines to temperatures that made it unsuitable for vegetable cultivation. A local drip kit originally developed in 2008 was re-designed, produced and tested on farmer’s fields in 2009/2010. The local drip kit is cheap and simple to use, and the colour of the plastic tubes is grey, which helps keeping the temperatures of the water in the pipe lower and the water therefore more suitable for vegetable cultivation.

Most importantly, it was found that the drip system significantly reduced the quantity of both total and faecal coliforms in the wastewater used for irrigation, compared to situations where watering cans with a mesh were used. Results for both local and imported drip systems were about the same. This offers farmers a workable option to use a drip system which they can manufacture and assemble themselves and which at the same time responds to their need for safer options for wastewater application. Some relevant results of on-going experiments are presented in Tables 1 to 3 below. Table 1. Coliform levels found in wastewater used in irrigation of vegetables in Tamale (2009-2010 dry season; location: Gumbehini)

(number/100ml)

Faecal coliforms Total coliforms

First Week 49 000 7 200

Second Week 38 000 6 900

Third Week 16 000 3 400

Forth Week 17 000 2 600

25

Table 2. Performance of local drip system -2009/2010 dry season.

(number/100ml)

Faecal coliforms Total coliforms

Farmer 1 Watering Can 262 277.67

Drip 1 11.33 13.67

Drip 2 10.33 10.43

Drip 3 9.33 9.98

Farmer 2 Watering Can 267 339

Drip 1 12.03 13.42

Drip 2 9.92 10.02

Drip 3 11.3 10.45


Drip 1 10.33 11.95

Drip 2 10.1 11.89

Drip 3 9.23 10.13

Table 3. Performance of imported drip system -2009/2010 dry season.

(number/100ml)

Faecal coliforms Total colifoms


Drip 1 10.24 13.54

Drip 2 10.03 11.83

Drip 3 8.25 9.67


Drip 1 11.14 12.26

Drip 2 10.82 12.03

Drip 3 10.35 11.94


Drip 1 10.43 13.21

Drip 2 9.67 11.32

Drip 3 7.89 10.28

Faecal sludge work

During 2008, perception studies on food stuff produced using faecal sludge as a fertiliser were conducted with a sample of about 200 farmers, market sellers as well as consumers and staff of the municipal authority. The overall picture that emerged was that farmers find nothing wrong with faecal sludge use in agriculture and intend to continue to use it as a cheap source of fertilizer. Consumers and authorities, on the other hand are shy of accepting this practice and propose various measures to ban it.

At this point in the Tamale presentation Professor Thor-Axel Stenström contributed a presentation of preliminary results of research carried out under his supervision. Research conducted by a PhD candidate (Mr Razak Seidu) at the University of Life Sciences, Norway, who worked with farmers using faecal sludge indicated that farmers’ practices are acceptable as they do not contribute significantly to health problems in the community and work as well as low-cost treatment options described elsewhere. Rather, the main health problems are rooted in

26

the overall level of hygiene and once this has been generally improved at the farmer household level then faecal sludge application on the farms can be continued as a safe practice.

The details of this research and its outcomes would be published in the course of 2010.

With the aim of assessing the health hazards and risks associated with the agricultural application of fecal sludge, the research had two specific objectives: to assess the seasonal variation of diarrhoea incidence in communities applying fecal sludge, and to identify the most important risk factors associated with diarrhoea cases in the sludge communities. The study design was that of an open cohort study and involved 2664 individual disaggregated into 1341 belonging to sludge-applying households and 1323 from non-sludge-applying households, all living in periurban farming communities in and around Tamale.

Preliminary findings showed that being a member of a sludge-applying household

increased the risk of diarrhoea, but direct involvement in sludge application was not significantly associated with excess diarrhoea risk. Rainfall and temperature were found to be important determinants of diarrhoea incidence: increased bi-weekly incidence of diarrhoea cases coincided with rainfall events in both sludge and non-sludge households, maximum rainfall events increased the risk of diarrhoea incidence in both sludge and non-sludge households and maximum temperature peaks decreased the risk of diarrhoea incidence in sludge households but increased it in non-sludge households. Application of this seasonality model would allow predictions of diarrhoea incidence in relation to untreated fecal sludge application patterns and weather variations. Further refinement using other socio-demographic risk factors would be an option.

Considering four groupings of risk factors, the research also showed that hygiene factors

accounted for the largest proportion of diarrhoeal diseases, followed by the infrastructural factors (housing, water and sanitation infrastructure), fecal sludge application, and the socioeconomic conditions.

Main conclusions of this research included: improved domestic hygiene practices are key

to overcoming barriers to improving the diarrhoeal disease situation, irrespective of the use of fecal sludge, and in order to reduce the relative effect of sludge application on the number of diarrhoea cases, multiple rather than single interventions, targeting the farm, community and domestic levels should be implemented.

Application of a hierarchical effect decomposition model showed that diarrhoea is

determined by various risk factors, and that the distal factors among these are mediated through causal pathways involving more proximal factors. These factors may act independently or in tandem and it was found that the setting (domestic or public) rendered the impact mechanism on incidence and severity of diarrhoeal disease more complex. Meetings and training programmes

In March 2009 a workshop was organized in Tamale, for farmers, researchers, local media and authorities on use of faecal sludge and wastewater, to share experiences from the 2007-2008 guidelines testing and application of the non-treatment options in the field. Six presentations were made about the project work and future plans were presented.

Frequent field training was conducted to help farmers understand the necessity for protecting themselves when using wastewater for irrigation and also to support them in improving the quality of wastewater used. Some examples can be found in Table 4 below.

27

Table 4. Examples of training programmes for farmers and other stakeholders carried out during 2008-2010.

Date Number of

Farmers Purpose

8 December 2008

25

Participating farmers were from all the four vegetable cultivating sites in the urban area (Zagyuri, Sangani, Buipela and Gumbihini). Health hazards related to waste water use and protective measures to adopt were thoroughly discussed and demonstrated with assistance from extension officers of the Ministry of Agriculture.

1 November 2009

10

Improving waste water quality for vegetable production using locally designed drip system. The principles and operation of drip system, the need to improve the quality of edible vegetables produced from waste water. Sangani and Gumbihini farmers were all discussed. Locally fabricated as well as imported drip system were introduced to farmers.

5 December 2009

10

Training in the use of the imported drip system and the principles governing its operation.

3 March 2009 Male

20

Female 15

Demonstration on the process vegetables movement chain – from farmer to the food vendor. Participants were farmers, fast food restaurant operators and vegetable sellers. Faecal sludge farmers were also a part of this programme

4 January 2010

25

Training in the operation and use of the modified local drip system

The outcomes of these activities included heightened awareness and a more ready acceptance of wastewater use in the municipality. Dissemination activities: Radio programmes, video presentations and publications

A radio discussion was transmitted on a local FM station in Tamale (Radio Justice) twice, on 14 and 20 June 2008. The programme had several segments, such as a jingle, a panel discussion and a phone-in segment. It was about one hour in duration. The panel consisted of a wastewater vegetable farmer, vegetable seller caterers (trained and untrained) and a researcher from the University for Development Studies, discussing problems related to urban vegetable production and use of wastewater. The phone-in segment was designed to involve the general public. Discussions were based on safe use of wastewater for vegetable production applying the WHO Guidelines. This activity was carried out in collaboration with the Knowledge Sharing Project Synopsys. Papers presented at conferences and symposia and other dissemination activities

Some of the project activities and findings were presented at local and international forae and also prepared for publication. Details are presented below.

1. G. Kranjac-Berisavljevic, B. Z. Gandaa, Abdul-Ghanyu, S., 2008. Experiences with design and production of locally manufactured drip system for wastewater irrigation in Tamale

28

Metropolis. Paper presented at the International Conference on Agricultural Engineering, Cape Coast, Ghana, September 2009 (in print).

2. G. Kranjac-Berisavljevic, Abagale, F. K. (in print) Use of Vernacular Radio in WHO guidelines dissemination - experiences from Tamale, Northern Ghana.

3. Owusu Agyeman, F. and G. Kranjac-Berisavljevic, Use of Faecal Sludge for Agriculture in Tamale Metropolis: perception of Farmers, Consumers and Relevant Agencies. Presented at Dry Toilet Conference, 2009, Tampere, Finland. Available from Dry Toilet website.

4. Kranjac-Berisavljevic, G., Perceptions Versus Risks in the Use of Faecal Sludge in Tamale, presented at the Seminar WHO Wastewater Guidelines: A Reality Check on the Ground Seminar, World Water Week 2009, Stockholm.

5. Amoah, P., Drechsel, P., Schuetz, T., Kranjac-Berisavljevic, G., Manning-Thomas, N. 2009, in print. From world cafe’s to road shows: using a mix of knowledge sharing approaches to improve wastewater use in urban agriculture. Knowledge Management for Development Journal, Taylor and Francis, Copyright © 2009 Routledge.

6. Manning-Thomas, N., 2008. IWMI Wastewater KSinR project broadcasts interactive radio program (Blog, posted 15 June, 2008).

Analysis of constraints and unforeseen opportunities

The unexpected and prolonged interruption of funding affected all project activities, resulting in damages to project sustainability and maintenance of networks of partners created in the earlier period. Furthermore, planned activities such as training of technicians in Abidjan, Côte d’Ivoire on methods to use in analysis also could not be accomplished. This situation had repercussions for the farmers, where required field visits by MoFA staff as well as linkages with NGOs could not be sustained, but were conducted patchily. Only a limited number of workshops and meetings at local level was carried out, as presented in Table 4.

Project partners have, however, greatly assisted project activities during this period, in different ways. For example, the Knowledge Sharing project posted project activities on the website and advertised its outputs at worldwide meetings. This, together with help from IWMI, has been a mainstay of the project activities during the period under review (2008-2010) and prior to the release of the final installment of project funds. 2.2.4 Senegal: Application of standards of the WHO for the re-use of wastewater and excreta in

agriculture.

The qualitative results from the first phase are complemented by quantitative results from the second phase. The research has focused on three components : parasitology, lettuce contamination and the links between farmer infection levels and lettuce contamination, and it has continued to provide a framework for the capacity building and promotional activities. These were aimed in particular at the farmers and consumers. The three components and their results are presented in the following sections. Parasitology

The main objective was to achieve general improvements in the health of communities and in particular of women and children, by an enhanced promotion of the standards and norms proposed by WHO for the use of wastewater in agriculture.

29

The specific objectives included:

♦ To estimate the prevalence of environmental health problems associated with the use of wastewater in agriculture, among farmers and their family, marketers, consumers and members of communities adjacent to the sites of cultivation;

♦ To evaluate the quality of the used wastewater in urban agriculture, from the parasitilogical and microbiological perspective:

♦ To test agricultural produce grown with wastewater and consumed raw for microbiological and parasitological contamination.

Parasitological assays have been carried out in three stages, first checking the farmers, marketers and consumers, next lettuces and finally farmers in association with the lettuce they cultivated.

Methods

A population census was the basis for the calculation of the population sample size required, and based on this 42 farmers, 39 market women and 17 household were selected for the study in the Niayes de Pikine area. Stool samples were collected for testing in the Parasitological/mycological Laboratory of Fann. Samples have been checked microscopically directly or diluted using the modified Ritchie method and the Kato method was applied to quantify the number of helminth eggs. These analyses have been done between July 2007 anf September 2008. To determine the impact of different ways of irrigation on the level of contamination of vegetables that are eaten raw, lettuces were collected that had either been irrigated by flooding, by sprinkler/watering can or after a period of no irrigation prior to harvest to allow for microbial die-off. Each lettuce was weighed and kept in a sterile physiological salt solution for 24 hours. The water was then centrifuged and the precipitate was checked microscopically. These analyses were carried out in November and December 2008, using 15, 20 and 5 lettuces for each of the irrigations methods mentioned, respectively. Following awareness creation campaigns by the team, with a focus of parasitic infections linked to urban agriculture, a case control study was done among the farmers of Niayes de Pikine. Twenty-five persons were selected from among those sensitized to the issue, and 15 from among thise that were not. Stool was selected from all and lettuces were collected from their fields. The analyses were carried out as indicated before.

30

Results

Table 1. Levels of parasitosis among farmers, market women and consumers

Farmers Market women Family members

71,4%

74,3%

70,5%

Typology

Farmers: Ascaris lumbricoïdes, Trichiuris trichura, Entamoeba coli,

Entamoeba histolytica/ dispar, Giardia intestinalis.

Market women: Ascaris lumbricoïdes, Trichiuris trichura, hookworm, Entamoeba coli,

Endolimax nana. Family members : Ascaris lumbricoïdes, Trichiuris trichura, Strongyloïdes

stercoralis, Trichomonas intestinalis, Entamoeba histolytica, Entamoeba

coli, Endolimax nana.

Table 2. Specific levels of parasite infections

Parasites

Ascaris

Trichiuris Ankylostoma Strongyloides T.

Intest.

Giardia

E.

hist.

E.

coli

E.

nana

Farmers

50

33,3

2,3

4,7

21,4

Market women

20,5

17,9

2,5

41,0

10,2

Family members

29,4

11,7

5,8

5,8

5,8

47,0

5,8

Table 3. Average parasite load (Number of eggs per gram of faeces)

Farmers Market women Family members

Ascaris

77.0

15.5

41.5

Trichocephalus

3.4

2.1

1

Lettuce : level and type of parasite contamination Samples of lettuce irrigated by flooding (surface irrigation) 45% (9/20) Samples of lettuce irrigated with sprinklers/watering cans 26.6% (4/15) Samples of lettuce subject to a microbial die-off period 80% (4/5) Protozoans identified: Entamoeba histolytica, Entamoeba coli, Trichomonas intestinalis

Helminths identified: Strongyloïdes stercoralis

31

Table 4. Levels and species of parasites

Sprinkler Flooding Sample size sprinkler/flooding

1 Trichomonas intestinalis trophozoites and

3 rhabditoid larvae of S.

stercoralis

37/45

2

6 rhabditoid larvae of S. stercoralis

39/36

3

3 rhabditoid larvae of S. stercoralis

32/34

5 Trichomonas

intestinalis trophozoites 26/29

7 4 rhabditoid larvae of S.

stercoralis 35/26

8 Trichomonas


9 3 rhabditoid larvae of S. stercoralis

35

11 7 rhabditoid larvae of S. stercoralis

27

17 Trichomonas intestinalis trophozoites

Trichomonas


19 Trichomonas


20 Trichomonas


Table 5. The impact of a die-off strategy

Results Weight (grams)

1 Entamoeba histolytica trophozoites

28

2 Trichomonas intestinalis trophozoites

25

3 Entamoeba coli cysts 30

4 nil 27

5 Entamoeba histolytica trophozoites

21

Farmers and lettuces linked

Levels of parasite infection Farmers Lettuce Cases 52% (13/25) 32% (8/25) Controls 53% (8/15) 53.3% (8/15)

32

Parasite species found Farmers Cases: Ascaris lumbricoïdes, Trichiuris trichura, Entamoeba coli, Endolimax nana Controls: Ascaris lumbricoïdes, Entamoeba coli,

Lettuce Cases: Ascaris lumbricoïdes, Trichomonas intestinalis

Controls: Ascaris lumbricoïdes, Trichomonas intestinalis

Table 6. Specific microbial infection rates in farmers

Parasites/bacteria

Ascaris

Trichiuris E. coli E. nana Multiple parasites

Cases 26.6

20

46.6

6.6 2

Controls 50

50

Table 7. Specific parasite contamination rates in lettuces

Parasites

Ascaris

Trichomonas intestinalis

Cases 37.5

62.5

Controls 37.5

62.5

Table 8. Average parasite load, number of eggs per gram in farmers’ stool

Parasites

Ascaris

Trichomonas intestinalis

Cases 9.5

3.7

Controls 12.2

Table 9. Average parasite load in lettuces (eggs per gram)

Parasites

Ascaris

Cases 1.7 / 53.9

Controls 1 / 79.9

DISCUSSION

Farmers, market women and households Microbial prevalence is practically identical in all three categories, with a higher

diversity in parasite and bactrial species at the household level. In the latter group the majority are not pathogenic (Entamoeba coli, E. nana). the bacterial microbes prevail. They represesnt, in fact, over 50% of the microbial load. Transmission takes place by fecal-oral pathways and environmental contamination originate from faeces. These infections are indicators of poor levels of hygiene.

33

Farmers are mainly affected by intestinal helminths. Ascaris infections are predominant and the average parasite load is also higher in farmers, with as a consequence higher levels of morbidity. The loads in farmers are nevertheless lower than the average found in children, which may be as high as 5000 eggs per gram of stool.

Even though microbial infection levels may be the same in all three groups, the health consequences are not. The pathogenicity levels are highest in farmers. It raises the question of occupational health risks and how an effective response to these risks can be mounted. Lettuces

The level of contamination of lettuces was found to be linked to the type of irrgation applied. Surface irrigation through flooding leads to significantly higher levels of contamination than the use of watering cans to sprinkle the crop (45% versus 26.6%). The same microbes are encountered. These findings come from experimental situations where the water quality for both types of irrigation was the same and show that risks linked to flooding are higher than those linked to sprinkling. Questions arising are whether this is linked to different microhabitats or to the way lettuces are washed before consumption.

The die-off studies confirmed the resilience of some microbes under dry conditions and their results raise the question whether the die-off period can be extended without affecting the quality of the crop produced. Farmers and lettuces

The case control study took two groups, one as a control – both groups had the same level of microbial infection at the start ; the target group was given exposure to in formation and subject to awareness creation activities. It was found that helminth burdens were higher in the control group than in the target group. Similarly, it was found that lettuces grown by members of the control group were more contaminated than those produced by farmers belonging to the target group. This would seem to indicate that awareness creation and training in safer methods of irrigation will have a positive impact on contamination levels and infection levels.

Best agricultural practices to reduce the risks of vegetable contamination

Objective

To determine the level of bacteriological contamination of lettuces in relation to different cultivation practices and to the applcation of the ‘die-off’ method. Methods

Sampling method

Lettuces were purchased on the marketplace verifying which irrigation method had been used by the producers. For the testing of ‘die-off’ effectiveness lettuces were collected directly from the field. Lettuces were also collected from fields cultivated by farmers who had been given a de-worming treatment several months earlier and who had been given gloves and boots for their protection. Analytical protocol

Ten gram samples of each lettuce were taken and put in a Stomacher container with 90ml water. The sample was centrifuged (200 RPM) for 10 seconds and incubated for 24 hours at 37°C; the analysis was carried out using the FISH method.

34

Table 10. Results according to different irrigation regimes

Samples (sprinkler)

E.coli/gram

Samples (flooding)

E. coli/gram Samples ‘die-off’

E.

coli/gram

S01 1 635 F01 4 906 D01 0

S02 0 F02 1 635 D02 0

S03 6 543 F03 14 719 D03 0

S04 3 271 F04 4 906 D04 0

S05 0 F05 0 D05 0

S06 0 F06 1 635

S07 3 271 F07 3 271

S08 F08 0

S09 F09 0

S10 F10 1 635

S11 F11 8 177

S12 F12 0

S13 F13 8 177

S14 1 635 F14 0

S15 1 635 F15 6 542

F16 0

F17 0

F18 0

F19 6 542

F20 0

Discussion The results of these analyses indicate that lettuces irrigated by watering cans are less

contaminated than those irrigated by flooding, both in terms of number of positive samples and in terms of the magnitude of the contamination. In this context, the results for the ‘die-off’ samples collected from the fields stand out positively, as no E.coli contamination was found, an important indicator that faecal contamination had been eliminated.

The studies also show that in spite of many years of promotional activities by various government agencies and especially by the National Hygiene Service, to raise the awareness of the need for food hygiene to ensure a reduction in diarrhoeal diseases and cholera, there continue to be significant numbers of household who do not know how to safely prepare vegetable for raw consumption. There is a clear need for the establishment of a national plan for awareness creation of the risks involved in the raw consumption of food produce cultivated using wastewater and the promotion of good kitchen practice to bring water-associated disease cases down. The market women can play an important and effective linking role between producer and consumer and they can deliver important public health messages to the consumer. There is a need to replicate these studies in other parts around Dakar where wastewater is used for agricultural production. Good practice in the safe use of wastewater in urban agriculture

General and specific objectives

To contribute to health improvements for the general population, and for women and children in the town of Pikine in particular, through an improved promotion of the WHO safety norms and standards relating to wastewater use in agriculture.

35

Specifically, To study and disseminate good agricultural and safe food preparation practices to reduce the health risks associated with the use of wastewater in agriculture and the consumption of agricultural produce grown with wastewater To implement a programme to adapt the WHO Guidelines to the local context and to disseminate them. Expected results

Improved agricultural practices aimed at health risk reduction disseminated to the level of farmers, including a better management of scarce water resources, a better understanding and management of the associated health risks and an improved quality of horticultural products. Activities

Carry out demonstration projects to disseminate information about non-treatment options for the safe use of wastewater in agriculture by developing demonstration patches for the different practices with an active follow-up to ensure the adoption of the proved methods and with education and training for farmers on the use of the non-treatment options. Methods

Different demonstration sites were put in place and dialogue with farmers was initiated about the comparison of the two main irrigation practices in the area, i.e. sprinkling using watering cans and surface (flood) irrigation in furrows. In both cases, the studies foresaw that irrigation would be stopped two days before harvesting. The results of the studies and analyses would be communicated to the farmers through an IEC programme. Four capacity building sessions were organized to brief the farmers about the WHO standards and norms. A total of 42 farmers participated in sessions 1, 13, 15 and 19 November 2008. Results

The first session brought to light farmer constraints and through a participatory process came up with the following recommendations : Partners in the research should make an effort to enhance the capacities for drainage and water treatment in the area. Flooding would allow a decrease in frequency of irrigation and therefore lead to a reduction in overall water use. It was strongly recommended to apply a regime of 15 days of sprinkler irrigation (watering cans) followed by 15 days of flooding complete by a ‘die-off’ period which would also contribute to a better produce. Farmers themselves had started to improve their practices and techniques, especially by digging furrows, in recognition of the fact that water distribution without furrows is less homogeneous, and that the system of surface irrigation is accelerated by furrows. During the final session a number of new ideas were added : Better support for tomato plants to prevent the tomatoes from being in direct touch with soil and irrigation water; furrow irrigation for larger plants such as tomatoes; better leveling of the soil to optimize water distribution in the field when using surface irrigation; and, a further investment of time working in the fields could lead to a healthier and therefore better marketable product.

36

Conclusions

♦ The prevalence of parasite contamination among urban populations in Niayes of Pikine (local market gardeners, sale women and households) is greater than the average national prevalence.

♦ Protection tools will be more efficient if there is a long-term monitoring of their use.

♦ Flooding, a gardening technique that normally contributes the reduction of health risks in crops, did not perform well in this study. The technique was either not properly applied or its effectiveness is limited in the local context.

♦ Although ‘die off’ techniques showed a strong effectiveness in the reduction of bacteriological contamination in crops, its effectiveness was less obvious for parasite contamination.

♦ The disinfection strategy deployed at the household level was effective in more than 80% of the cases.

2.3 Formulation of lessons learned and recommendations for the future

The workshop participants were divided over two groups for discussions on lessons learned. The composition of the groups was as follows:

Group 1 Group 2 Mr Bos Dr Cissé Dr Fall Dr Drechsel Mr Gandaa Eng Hamad Dr Seydou Mr Gaye Prof Stenstroem Dr Kranjac Mr Pule Mr Malkawi

Mr Mateo-Sagasta Mr Redwood

The groups were given a framework of talking points structured to reflect the Guidelines contents.

Talking points on lessons learned

RISK ASSESSMENT Setting health-based targets QMRA and other risk assessment approaches Synthesis of risk assessment RISK MANAGEMENT Design of non-treatment options Effectiveness of non-treatment options Calculation of cumulative risk reduction Social acceptability, technical soundness, economic Feasibility

37

Criteria for selection of interventions

ENABLING ENVIRONMENT Policy framework and regulation Conditions favouring community participation Institutional arrangements

OTHER ISSUES

The outcomes of the group discussions were presented in a plenary session on the last day of the workshop and the consolidated conclusions are presented here.

RISK ASSESSMENT 1. Setting Health-based Targets

♦ Already in Accra this was identified as a potentially difficult task. None of the projects fully accomplished to set health-based targets. In all projects, however, proxies were used (e.g. indicator bacteria or disease incidence) with the objective to achieve maximum risk reduction.

♦ In the Senegal project an attempt was made to test health-based targets by establishing a health baseline.

♦ It was recognized that there was an important need to emphasize capacity building in the setting and monitoring of health-based targets.

♦ One practical option might be to set the most conservative target (a DALY reduction of 6 logs) and then aim for the best possible outcome.

Lesson learned

No team had the core experience required to set health-based targets effectively. This reflects the lack of capacity to actually formulate health-based targets, and points to the need for capacity building in this area. Individual observations: Ghana –no expert can do this–; Jordan –capacity is lacking on this–; the whole concept of health-based targets was new to the teams. 2. QMRA and other risk assessment approaches It was considered important to define the system in terms of where the problem starts, what are the exposure routes, what are the elements of the chain and what are the boundaries of the system and critical hazard points? It is equally important to categorize types of people along the chain of risks – e.g. children (coming from schools, playing), farmers, consumers, marketers and a critical step in order to understand the health risks faced by a population is to ask the following five questions:

♦ Who are exposed?

♦ Where are they exposed?

♦ When are they exposed?

♦ How are they exposed?

♦ How often are they exposed?

The system is defined by exposure points – and these, in turn, were largely defined by activities of the target groups. Four different approaches of risk assessment and analysis were used

1. Epidemiological (stool samples e.g. Tamale, Dakar). 2. QMRA (Tamale, Kumasi).

38

3. EpiInfo, ANOVA: software applied to large datasets to try to correct for confounding factors (Jordan).

4. Multiple regression analysis (Tamale) applied to identify the share of diarrhoea cases attributable to bad hygiene –i.e. to determine what is the contribution of wastewater to latent health risks.

The advantages of the Jordanian approach came out clearly – data collection through straightforward household surveys, supported by EpiInfo software as a well-tested tool that could be applied to existing epidemiological data or to data collected in surveys. Hazard identification was easier for farmer and household than it was for consumers and the wider community. For example, children playing in gutters, people swimming at a beach or family members of farmers present more difficult subjects to study as the origin of diseases may be obscured. A related challenge was the actual collection of data and the establishment of a database for larger population sizes. Lesson learned

The Guidelines over-emphasize QMRA while there are many other statistical mainstream options available to researchers. The challenges imposed by QMRA are amplified by language limitations (i.e. most QMRA material is in English limiting its applicability in some contexts). The possibility of considering proxies should not be discarded; hazard identification should be the first step to be linked to disease incidence as a proxy. This then leaves open a more complicated microbiological approach. To do this properly, a multidisciplinary team is required (microbiologists, economists, statisticians). Scoping, i.e. setting boundaries, for the research exercise is critically important to ensure that the planned assessment is feasible and can be followed-up. 3. Synthesis of risk assessment

A key question in the process of synthesizing risk assessment information is: Who is most affected and to what degree are they affected?

♦ The Kumasi team followed the contamination pathway established in the preparatory phase of the project. The team analysed numbers of farmers and consumers affected.

♦ The Tamale team focused on farmers immediately, assuming from the water analysis that they were the most affected.

♦ The Senegal team based itself on previous work which indicated farmers to be the most important risk group; this was corroborated by the water quality information that had also emerged from previous research work. The team also analysed lettuce to assess exposure risks. Women sellers and consumers were included in the exposed groups.

♦ The Jordan team initially looked at farmers, but after the risk assessment, identified children as a priority group at risk.

Lessons learned

Conventional wisdom points to the option of complementing expert knowledge and epidemiological evidence. In this type of studies one cannot, a priori, only focus on one group, but one must consider the entire “system” (i.e. household, links between farmers, their families, how food is prepared, hygiene practices; the market). Often, in the system context a lot of variables can affect risk – and this raises the question why one would not just assume maximum risk, thereby reducing the high costs associated with a full epidemiological study. An alternative would be the approach of using rapid risk assessments, advocated by some epidemiologists.

39

RISK MANAGEMENT

4. Design of non-treatment options If non-treatment options concern systems where no manipulation takes place, then what does this mean in practice? For example is drying of sludge a non-treatment option? The main conceptual innovation would appear to be the system’s approach towards dealing with all critical hazard points along a chain and in this context whether an intervention is of a treatment or non-treatment nature is of secondary importance only. All options for preventive measures related to all critical hazard points must be identified and defined, and they must be considered from their overall impact in a local context. For example, for the often quoted approach of stopping irrigation two to four days prior to harvest in some cases studied in Ghana unacceptable yield losses of around 10% were observed, rendering the method unfeasible. If recommended measures are applied strictly, however, non-treatment options can be very effective, but monitoring is critical and it was recognized that monitoring capacity was lacking in many countries. It was concluded that verification monitoring can provide useful lessons, that assumptions on how waste was traditionally used needed checking, that reliance on surveys was not enough, they should be complemented by direct observations and, importantly, that within the boundaries set, appropriate sample size and representativeness should be ensured. In the four study projects intervention designs focused on farmers and street-food vendors, with the following further specifications:

♦ Kumasi – the focus was on traders and on consumers’ willingness to pay for the additional costs incurred by non-treatment options.

♦ Dakar – the focus was on groups with the potential to participate in risk reduction. A reduction of 1 log was achieved, but this was not particularly successful.

♦ Tamale – farmers were consulted and researched in terms of their interest in and attitudes towards drip irrigation as a safer wastewater irrigation method.

♦ Jordan – a main focus was on awareness raising – for example, on changing practice in collecting olives to reduce exposure. Conventional wisdom had it that non-treatment options were not possible in Jordan, but the project tried to break down barriers to change.

Lessons learned

Having to convince policy makers through examples (science/evidence) is only part of the equation. Better observation (focusing on one group or on a specific irrigation method) helps to increase the likelihood of uptake and clarifies the evidence. This is a long process – for example, it took two years to identify people’s current practices, modifying them, study the economic implications for farmers/traders, study perceptions and then to test the improved practices and verify that risk levels are indeed reduced. Lessons from one country could be transferred to other countries (with similar practices). A perception study would still be required to assess if uptake is realistic. 5. Effectiveness

There were two perspectives to this: Effectiveness per se in the removal of health risks (effectiveness measured in terms of proxy indicators) is straightforward, as exemplified by the experience in Dakar. Cost-effectiveness of risk reduction measures adds an extra dimension (e.g. the use of vinegar as a kitchen practice to disinfect lettuces has proved to be effective (4 log reduction), but it is too

40

expensive since a large amount is required). Another example is that of imported drip irrigation kits as compared to locally produced drip irrigation kits. Lessons learned

On a small scale it is preferred to focus on the unit price per log reduction, as this is a more realistic effectiveness indicator to measure at that scale. The question to be asked is: how much does it cost a household to reduce the risk? On a large scale disability-adjusted life years can be used as an indicator, a feasible approach but one that requires QMRA. Moreover, estimating the dollar value of each DALY reduction requires an economist. 6. Calculation of cumulative risk reduction Kumasi – Identify best practices, find out how effective they are, and then combine different options to increase log reduction in risk. Projects were summing up incremental improvements, but this does not necessarily work. This is a better way to reduce risk, but it can only realistically be done under highly controlled conditions. In addition to the calculation of cumulative risk reduction, there also should be a disaggregation of cumulative risks for each different target groups (farmers, vendors, consumers). Lessons learned One cannot just add up incremental risk reductions. It is preferable to err on the safe side instead. Collecting the relevant information requires a large effort in terms of field trials. 7. Social acceptability, technical soundness, economic issues

Farmer recognition gave more social power to many marginalized farmers. It is important to disaggregate different groups: wastewater farmers, faecal sludge farmers. Research can encourage some forms of acknowledgement and recognition. Economic analysis was not really explicitly addressed in this project. Previous work in Dakar and other cities has noted the economic value of wastewater irrigated crops. The new FAO publication highlights this aspect. The potential for scaling up is an important factor (uptake through social marketing, economic incentives). Effectiveness of the adopted intervention vis-à-vis the health reduction effectiveness as well as compliance (how likely is it that the intervention will be taken up and sustained). Lessons learned

The introduction of interventions of different types should be carried out incrementally, in a step-wise manner; offering whole packages of integrated interventions at once does not work and may be counterproductive. Economic incentives would be the best way to achieve social uptake. Urban farmers have a very high economic return – so, for example, tenure security would be an important incentive for farmers to stay in farming and adopt safe wastewater use practices. With respect to control, monitoring, regulation, institutionalization, education and awareness creation were crucial – no one will change his/her behaviour unless the person knows for what

41

reason they need to change it. The WHO guidelines under-emphasize the mechanisms by which to facilitate the adoption of safer practices. Also, the adoption rate matters in the overall result. Other incentives need to be identified and tested. This requires time. 8. Criteria for the selection of interventions The following criteria had been developed and applied in the studies:

♦ Cost effectiveness and affordability of the interventions.

♦ Identification of traditional practices and capitalizing on these (Tamale – faecal sludge management).

♦ Ownership (linked to social marketing).

♦ Efficacy in terms of improving health.

♦ The intervention must be an improvement over what is already being done. Lessons learned The most important criterion is adoptability (e.g. a 1 log reduction that is used may be considered better than a 5 log reduction that is not). This criterion is not clear in the guidelines and it should be.

ENABLING ENVIRONMENT

9. Policy Framework and regulation The questions that arose repeatedly in the implementation of these studies included: Who monitors? Who regulates? Who is responsible? In Jordan, for example, enforcement of wastewater use legislation is strong. The old guidelines (1989 second edition) are still considered the “current” – there will need to be a period of adoption and the question is how to increase the uptake of the 2006 Guidelines amongst ministries of health. Standards associations are good targets for evidence (Ghana, Jordan, Senegal). The wastewater safety plan could become the kind of framework for monitoring and control (Jordan). Lessons learned It will be difficult to translate the Guidelines into policies and strategies as long as they are hard to explain and implement. Without policy backing, they may not become institutionalized. The logical lesson is therefore: simplify the guidelines to increase their policy acceptance. Clearly, countries where the second edition of the Guidelines has already been incorporated into legislation and regulation will require some innovative thinking on how to link the previous edition of the Guidelines to the third edition. In this connection a small learning module would be extremely helpful – as short as one or two days of training. There are few training courses and IHE might be a good candidate to ask to develop this. Translation of the guidelines into other languages would also be helpful. 10. Conditions favouring community participation

Reference is made to the points raised earlier under social acceptability (above). Also in this case the premise applies: the easier the guidelines can be explained and implemented, the higher the chance of uptake and participation. The credibility of the team encouraging adoption of new practices is a key determinant of success. 11. Institutional arrangements

42

The essential analysis to be done addresses the question: which ministries are in charge? It is critical to minimize jurisdictional overlap in this process. Capacity development is indeed required in this connection. But capacity building needs can be reduced if the guidelines are easier to understand and also if they do not require advanced (QMRA) or expensive (monitoring) analytical capacities.

2.4 STAC meeting Members of the STAC met on the morning prior to the official opening of the workshop and reviewed the programme and expected outcomes. No changes were proposed for the workshop agenda and programme of work. The members read the progress reports and had a round of preliminary discussions. The STAC then convened again on return from the field trip on day three and decided on responses to the progress reports presented. They also formulated recommendations for the proper completion of the project within the remaining time available. The detailed minutes of the meetings are presented in Annex 3.

2.5 Field trip

On the third day of the workshop a field trip, organized by the Royal Scientific Society of Jordan (RSS), gave participants an opportunity for direct observations of the study site of the Jordanian team, the Jerash Palestinian refugee camp. A first stop on the way was at the canal (formerly a river) that transported treated wastewater to the King Talal dam. From there water was released for agriculture in the Jordan Valley – prior to use it was mixed with water from clean sources. The Jerash refugee camp has 20,000 inhabitants and is therefore one of the smaller camps in Jordan. Its economy is mainly based on the service industry, and the accommodation consists of permanent, high density housing with large households of extended families (10 persons per household on the average). Human waste is collected in underground cess pools which, unlike septic tanks, are not closed systems. Therefore, seepage may contaminate ground water as well as urban drains. Greywater flows out of the houses into open drains that collect at the lowest part of the camp and then flow into the surrounding agricultural area, where olive groves and citrus plantations are the main features. There is a serious lack of solid waste management and the greywater gets contaminated as it flows through the drains, including by fecal matter mainly from disposed diapers. The group was received in the so-called knowledge centre by the authorities of the camp, who welcomed the group and stressed the importance of the project for the health status of the camp’s community. Then a walking tour around the camp allowed the inspection of important spots. Subsequently, the agricultural production area was visited to observe the use of the greywater/wastewater. A wastewater treatment plant is under construction and is expected to change the agricultural practices of the local farmers. The field trip was concluded with a visit to the King Talal dam which serves for hydropower generation, but most importantly to store water for irrigation of intensive agriculture in the Jordan Valley.

43

3. Document review and technical discussions 3.1 Draft UN-Water Policy Brief The group was informed about the purpose of and plans for World Water Day 2010 and gave a quick review to a draft UN-Water Policy Brief on Water Quality. The international observance of World Water Day every year on 22 March is an initiative rooted in the 1992 United Nations Conference on Environment and Development. Its designation has been formally confirmed by a United Nations General Assembly Resolutions. UN-Water, which brings together 26 UN entities with the aim to promote coherence and coordination in UN System initiatives within the scope of all aspects of freshwater and sanitation, agreed to dedicate World Water Day 2010 to the theme of water quality (“Communication water quality challenges and opportunities”). The United Nations Environment Programme (UNEP) was the global lead agency for this year’s World Water Day activities. As part of the materials produced by UNEP, a draft UN-Water Policy Brief on Water Quality had been prepared, and this document was reviewed by the workshop participants. It consists of the following sections: (1) Water quality challenges and opportunities; (2) Moving to solutions and actions (with a focus on pollution prevention, treatment of polluted water and restoration and protection of ecosystems); (3) Mechanisms to achieve solutions (with a focus on improving the understanding of water quality issues, improving communication and education and improving financial and economic aspects); and, (4) Moving forward: clean water for today and tomorrow. The following points were made in the discussion of this draft document:

♦ The text falls short in its aspirations to be a policy document, and on the whole it reads more like the abstract of a conference paper, in spite of the guidance given in section (3) which should be strengthened and made more prominent.

44

♦ A policy brief should reflect that its recommendations are made based on solid evidence that either existed or has been generated for the purpose of the new policy guidance. Clear conclusions resulting from this evidence should then lead to the policy guidance proposed. This draft has too many policy statements for which the presentation of evidence and conclusions is vague or lacking. In particular, the paper should present convincing evidence of the positive impacts of recommended interventions and clarify how such interventions can be scaled up.

♦ The current draft does not reflect the power of the UN System to deal with this issue adequately, and it does not sufficiently highlight the importance of the interagency nature of UN-Water and how this provides a model to be replicated as an intersectoral arrangement at national level to deal effectively with the complex and multidisciplinary character of wastewater management challenges.

♦ The drivers behind the wastewater problems need to be more clearly identified, so that policy guidance can be geared towards dealing with the issues at the root of those problems. It was felt that the draft text remained too much at a global level and as a result remained too generic. This could be improved by regional contextualization of some of the issues.

♦ Some members of the group felt that the draft policy brief did not do sufficient justice to the enormous volume of work that had already been done on managing water quality and that a further analysis of that work would lead to a sharper focus on the really critical issues. In order to tackle these issues, the document could be re-formatted into a policy roadmap.

♦ The draft as a whole appeared to reflect the UNEP overtones on ecosystem protection and restoration and also emphasized wastewater treatment. In this connection it would be appropriate to identify the drivers of failure of many wastewater treatment plants in the past, and to take a closer look at the range of conventional and non-conventional treatment approaches, including those at the farm level. The policy brief should capitalize on progress made over the years in non-conventional treatment approaches and in the safe re-use of wastewater in agriculture and aquaculture.

The participants were grateful for the opportunity to review this draft, asked the Secretariat to pass their comments on to those leading the further development of the draft and expressed the hope that their contributions would be helpful in the production of the final UN-Water Policy Brief on Water Quality.

3.2 Guidance document/Manual for Sanitation Safety Plans

As stated on page 9 of this report, the final product expected at the point of departure of this project was a guidance document to assist national and municipal authorities and other users of the WHO guidelines in their application.

Following the Dakar meeting, IDRC produced a profile and table of contents for the

envisaged document. It would be aimed at researchers, municipal and most importantly, national authorities who work on risk reduction with different stakeholder groups: farmers, vendors and consumers. It would present a step-wise approach following the four-step WHO framework: risk analysis, characterization, exposure, and planned management. The aim would be to generate

45

contextual recommendations for optimal Guidelines’ application that follows the logical sequence of implementation events.

The document must be written in an accessible way. The drivers for this product included:

• Most institutions are heavily resource constrained and need quick advice on how to handle essential functions.

• Many policy makers may have limited experience with health risk analysis.

• There is a need to address the viability of various methods in relation to capacity without compromising efficacy and quality of the analysis.

• There is a need not only for cost-effective non-treatment and treatment options, but also for cost-effective measurement and monitoring systems.

• Different stakeholders have different needs - farmers, marketers, consumers, regulators.

• The need for step-by-step guidance in line with the four stages of the WHO Guidelines. Questions that are pertinent to local stakeholders vis-à-vis the WHO Guidelines included:

1. How significant is the health risk? How should the health risk be put into perspective? 2. Who are most affected and who can address the problem? 3. How could the risk(s) be reduced? 4. The intent to reduce the risk(s) implies the need to start with a structured programme (e.g.

outreach, training). What are the costs and requirements of a campaign or risk reduction program?

5. What will be the costs and health benefits of the proposed or favoured interventions compared to other interventions (or non-action)

6. And, for the four case studies: where treatment does not work – essentially, what happens after disaster management?

The proposed table of contents for the guidance document is presented below:

1. Executive Summary.

2. Introduction. What are the key questions? Applying the guidelines by making assumptions and avoiding excessive amounts of

redundant research? What are the baseline assumptions (what we already know and do not need to

replicate research) Ideal option is treatment however what to do when this is not feasible?

3. Outline of the four pilot projects with reference to an annex containing details of the case

studies. 4. Summary guide of methods and how to conduct the four-stage approach as advocated by

the WHO Guidelines.

♦ Examples from cases studies from the WHO/FAO/IDRC project

♦ Need for control group, methods for a “quick and dirty” assessment

♦ Need for a baseline

♦ How to effectively use existing baseline analysis on wastewater

♦ Looking at samples in relation to control groups

46

5. Feasible risk reduction methods and procedures in different contexts.

♦ What are cost-effective measurement approaches that can be employed to implement cost-effective risk reduction approaches?

♦ Questionnaire approach as a cost-effective method of assessing risk.

♦ Training methods (taken from the Farmer Field Schools)

6. Institutional aspects (based largely on the Kumasi project)

♦ Template for policy

♦ Common messages that should be included in various policies on wastewater – municipal, national – also differentiated by ministry and sector (e.g. agriculture, water, environment).

7. Planning and management approaches – this section needs to address the fundamental

weakness that many approaches would seem to add labour cost while sometimes reducing yields…

♦ On-farm options that may be “treatment” or “non-treatment” – long list of feasible options with notes on how to implement them. These would need to be very well illustrated.

♦ Different strategies (there are around seven or more) – including costs associated with implementation, potential benefit etc.

♦ Branching feasible options out from what is included in the guidelines to include options not mentioned in the guidelines…

♦ Consideration for the need to apply framework to implement non-treatment options (market incentives, social marketing, regulations, awareness raising and education)

♦ Addressing behaviour change – what is required for this to be done successfully?

8. Conclusions (epilogue) A seminar on the WHO Guidelines at Stockholm World Water Week in August 2009 considered options for this guidance document and recommended a format similar to that of the training manual for water safety plans. In the discussion over the title (wastewater safety plans or sanitation safety plans) the seminar recommended the latter. The workshop participants discussed this concept and reviewed the outline of the training manual for water safety plans. It was agreed that the title sanitation safety plans appropriately placed the safe use of wastewater in a broader environmental sanitation concept. The manuscript would have to be differently structured than the training manual for water safety plans, which targeted an audience of water utility managers and other decision-makers and regulators in the field of drinking-water quality. The flowchart approach, as presented in Figure 2, was considered desirable for the sanitation safety plan training manual as well, with a clear sub-division in modules reflecting the essential functions required. It was recommended that WHO, FAO and IDRC proceed with the preparation of a first draft manuscript of this training manual, together with other relevant partners, including the International Water Management Institute and the International Water Association. This manual would use information emerging from the case studies as illustrative examples of the technical guidance provided.

47

Figure 2. Flow chart representation of the modular training approach for water safety plans

3.3 Information kit second edition

WHO, FAO, IDRC and IWMI plan to launch a second edition of the information kit on

the third edition of the WHO Guidelines at the 2010 World Water Week in Stockholm. The contents of this kit were discussed at the workshop.

The third edition of the Guidelines for the Safe Use of Wastewater, Excreta and Greywater for Agriculture and Aquaculture was published in 2006, 17 years after the publication of the second edition.

This third edition marked a departure from the previous edition by presenting integrated risk assessment and incremental risk management in the so-called Stockholm framework, which now is generally accepted as the framework to ensure safety for drinking-water, the safe use of wastewater and safety of recreational waters.

Application of the Stockholm framework introduces a number of new concepts, methods and procedures, including the establishment of health-based targets, the application of quantitative microbial risk assessment (QMRA), the comprehensive assessment of risks along the chain of events from source to use, the design of risk management measures along the same chain, adding up risk reduction levels that will result in meeting the health-based targets, and a well-established monitoring package by independent national authorities.

At various occasions, concern had been expressed by national authorities from WHO Member States about the complexities of the framework approach and the need for substantial capacity building so essential functions can be performed at the level required.

48

One response to this concern had been the production of an information kit addressing a

number of concepts, methods and procedures in a succinct way with clear examples, lifting issues destined for specific target audiences out of the mainframe of the Guidelines. The key guidance notes prepared for this information kit included: A numerical guide to Volume 2 of the Guidelines and practical advice on how to transform them

into national standards. Key issues in the safe use of wastewater and excreta in aquaculture The concept of exposure reduction in the use of excreta and greywater in agriculture.

The information kit first edition was jointly produced by WHO, FAO, IDRC and IWMI and it was launched at the Stockholm World Water Week in August 2008. Its materials were also made available on the WHO web page: http://www.who.int/water_sanitation_health/wastewater/usinghumanwaste/en/index.html

The kit had been well-received and continued to be in high demand. It was therefore recommended at a Seminar on the WHO Wastewater Guidelines in Stockholm in 2009 to produce a second edition.

A draft contents for this second edition was discussed at the workshop, after clarification that this kit would contain new materials while the materials of the first kit would remain available on the web.

As a general comment it was proposed to ensure a certain structure to the contents of the kit so it would not create the impression of a miscellaneous collection of papers, with a link to specific target groups addressed by single documents or clusters of documents.

One of the key questions often raised was linked to the reduction of the recommended value of the health-based target in the WHO Drinking-water Quality Guidelines and why this had not been incorporated into the safe use of wastewater guidelines.

The following list of proposed documents was agreed, with the proposed author between brackets: A guidance document on the contextual use of guidelines in different regions and linked to

the sanitation ladder (P. Drechsel, IWMI)

A guidance note explaining and updating the microbial risk assessment information (Duncan Mara, with Andrew Hamilton and Andy Sleigh, Leeds and Melbourne universities) (comment made: should include exposure graph)

A guidance document on health-based targets (Bruce Gordon, WHO; based on a January 2010

meeting in Geneva)

A concept note on water safety plans and sanitation safety plans; the feasibility of using sanitation safety plans as a vehicle to implement the guidelines, including flowchart with essential functions and actors (Th.-A. Stenstroem, SMI Stockholm)

49

A fact sheet on on-farm basic infrastructure as part of the integrated risk management approach in wastewater use for agriculture (P. Drechsel, IWMI)

Summary of the FAO water report 35: From waste to resource: the economics of wastewater

reuse in agriculture (J. Mateo-Sagasta, FAO)

Lessons learned from the WHO/FAO/IDRC project in Ghana, Jordan and Senegal (R. Bos, WHO and M. Redwood, IDRC)

A call for collaboration on the development of a Manual for Sanitation Safety Plans (R. Bos, WHO)

An announcement of the availability of the French version of the guidelines (web-based, to be

published second half of 2010) (R. Bos, WHO)

Order form and flyer for the Earthscan published IWMI/IDRC book (to be submitted by P. Drechsel)

Order form for the third edition of the WHO Guidelines (already available)

The UN-Water Policy brief on wastewater management (tentative, depending on when final

version will be available (see also section 3.1 in this report)).

3.4 Climate change and wastewater use

The workshop took note of a WHO presentation on a recently published joint WHO/DFID study “Vision 2030”, which considered the impact of climate change on drinking-water and sanitation systems and services. Based on official climate change projections for 2020 and 2030, the impact on such systems and services had been assessed. In particular, their resilience in the face of extreme weather conditions had been evaluated. Recommendations for improving this resilience distinguished different types of drinking-water and sanitation systems. The participants considered that there was a need to carry out similar research on the impact of climate change on wastewater use in agriculture and aquaculture, especially because the “Vision 2030” study did not include water quality parameters. It was recommended that WHO, FAO and IDRC prepare a set of priority research questions in this connection. This was in line with new directions of IDRC. It was also recommended opportunities be explored for possible support for such research under the recent call for proposals by the EU SPLASH initiative.

4 CONCLUSIONS AND

RECOMMENDATIONS

4.1 Conclusions

The third consultative workshop on the IDRC/WHO/FAO project in Dakar, Senegal reviewed the final progress reports received from the country teams, based on the protocols agreed at the Dakar workshop in November 2007. All progress reports were accepted, recognizing that the teams from Ghana/Tamale and Senegal had been constrained by the problems to ensure a timely flow of financial support. For those two tams a number of residual activities remained to be done.

The country teams had satisfactorily concluded the risk management phase, and the information the project had yielded would provide an important input into the formulation of a sanitation safety plan training manual. In this second phase the complementarity between the different projects had continued to be an important aspect and added value to the basis provided for generic guidance for the implementation of the WHO Guidelines.

Lessons learned were discussed and this resulted in a useful and practical list of recommendations for future research, for the application of the current research outcomes in the field and for targeted capacity building. The third edition of the WHO Guidelines continue to be experienced as challenging, and this indicated the further need to prepare fact sheets and policy briefs for various user groups highlighting items from the Guidelines of particular interest to them. This need would be addressed by preparing a second edition of the successful Information Kit, and on the longer term a process for the rolling revision of the guidelines should be initiated. Other items were discussed in detail and participants contributed actively to the discussion, so that the workshop also yielded feed back on the proposed UN-Water

51

policy brief on wastewater management, on options for wastewater use research in relation to climate change and the format of the wastewater safety plan training manual 4.2 Recommendations

(1) All teams to submit their final reports to WHO by 15 April 2010, to allow final reporting to IDRC in line with the agreed no-cost extension of the project until 30 April 2010. (2) The Ghana/Tamale and Senegal teams to indicate a schedule for residual work to still be carried out and completed by 31 August 2010. (3) Report of the third workshop to be prepared by WHO and complete draft to be circulated to all participants by 30 April 2010. (4) Second edition of the information kit to be prepared in consultation with the STAC and country team members. (5) First draft of the wastewater sanitation plan training manual to be completed by 31 December 2010. (7) WHO, FAO, IDRC and IWMI to co-convene a side event during the Stockholm World Water Week in September 2010, where the information kit second edition will be launched and a briefing presented on the outcome of the project.

52

Annex 1

THIRD CONSULTATIVE WORKSHOP ON THE WHO/FAO/IDRC PROJECT

“NON-TREATMENT OPTIONS FOR SAFE WASTEWATER USE IN LOW-

INCOME URBAN COMMUNITIES”


Workshop Agenda and Programme of Work

Sunday 7 March 2010

Sunday morning

10:00-12:00 Meeting of the Scientific and Technical Advisory Committee to review the programme of the workshop

Review of objectives and expected outcomes of the workshop General comments on progress Outlook for work beyond the completed project

12:00 Refreshments

Sunday afternoon

13:00 – 17:00 Session 1: opening and report review

13:00 Opening ceremony, with opening statements from FAO and IDRC Official opening by the Director of CEHA Round of introductions workshop participants

Objectives and expected outputs of the workshop Workshop arrangements

13:20 Approval agenda, programme of work 13:30 Overview of events since the Dakar workshop December 2007

Robert Bos, WHO Geneva Discussion

14:15 Review Ghana Kumasi project

Brief introduction and presentation by the Jordanian participants: Progress report and Q&A

15:15 Refreshments

15:45 Review Jordan project


16:45 Re-capitulation of day 1

17:00 Closure Session 1

53

Monday 8 March 2010 Monday morning

09:00 – 12:30 Session 2: Report review 09:00 Review Ghana Tamale project

Brief introduction and presentation by the Ghanaian participants from Tamale: Progress report and Q&A

10:15 Refreshments

10:45 Review Senegal project


12:00 Concluding discussions and instructions for group work Closure Session 2

12:30 Refreshments Monday afternoon

13:30 – 17:00 Session 3 Group Work

13:30 Group work: Formulation of lessons learned and recommendations for future action

15:15 Refreshments

17:00 Closure of Session 3

Tuesday 9 March 2010 All day field visit to the Jerash Palestinian Refugee Camp. Tuesday evening (18:00-19:00): STAC meeting

Wednesday 10 March 2010 Wednesday morning

09:00 Plenary, feedback from the groups

Group 1, presentation and discussion

Group 2, presentation and discussion

10:30 – 11:00 Feedback from the STAC 11:00 Refreshments

54

11:30 – 12:30 Session 4: Document review and technical discussions Presentation draft guidance document on sanitation safety plans Discussion Presentation draft Information kit materials Discussion Draft UNEP document on wastewater treatment Discussion 12:30 Refreshments Wednesday afternoon

13:30 – 15:30 Session 4: Document review and technical discussions (continued) Open discussion on the challenges to safe use of wastewater in agriculture posed by climate change. 15:30 Closure of Session 4 and closure of the workshop

= = =

Annex 2

List of participants

Project team members

Ghana (Tamale)

Ing. Dr. Gordana Kranjac-Berisavljevic, University for Development Studies, P.O.Box TL 1350, Tamale E-mail: [email protected] Tel: +233-71-25257 Tel (mobile): +233 24 446 7142 Mr. Bizoola Zinzoola Gandaa University for Development Studies, P.O.Box TL 1882, University for Development Studies, Tamale, Ghana E-mail: [email protected] Tel: +233(0)7193148 (office) Mobile: +233(0)247649770 and +233(0)266151094 Jordan

Dr. Nisreen Al Hmoud Researcher, Head of the Microbiology Unit (MU) Head of Water Quality Studies Division (WQSD) Environmental Research Centre (ERC) The Royal Scientific Society (RSS) P.O Box 1438 11941 Al-Jubaiha Tel: + 962 6 53 44 701 ext 2435 Fax: +962 6 53 40 373 E-mail: [email protected] Eng. Hamad bani Hamad Royal Scientific Society, Environmental Research Center P.O Box 1438 11941 Al-Jubaiha Fax: + 962 6 53 40 373 E-mail: [email protected] Senegal

Malick Gaye, Coordonnateur ENDA RUP Rue Félix Eboué, Ecopole Ouest Africaine BP 27083 Dakar Malick Sy Tel : 00221 822 09 42 Fax: 00221 821 41 66 E-mail : [email protected] or [email protected]

56

Dr Cheikh Fall Institut de Santé et Développement (ISED) BP 16390 Dakar-Fann Tél : +221 6381403 / +221 824 7898 Fax : +221 825 36 48 E-mail : [email protected]

Members of the Scientific and Technical Advisory Committee Pay Drechsel International Water Management Institute 127 Sunil Mawatha Pelawatta Battaramula 10200 Colombo Sri Lanka Tel: +94 (11) 2 787 404 E-mail: [email protected] Dr Seydou Niang, Responsable du Laboratoire de Traitement des Eaux Usées (LATEU).Chef du Département de Biologie Animale/ IFAN CH. A. Diop UCAD Bp. 206 Dakar Sénégal Tel: +221 77637 63 63/221 33 825 04 11/ 221 33 825 98 90 Fax : +221 33 824 49 18 E-mail: [email protected] ; [email protected] ; [email protected]; [email protected]; [email protected] Dr Guéladio Cissé, Centre Suisse d'Investigation, Abidjan, Côte d'Ivoire Currently at the Swiss Tropical Institute, Socinstrasse 57, Basel, Switzerland E-mail: [email protected] Professor Thor-Axel Stenström Professor, Chief Microbiologist Dept of Parasitology, Mycology, Water and Environmental Microbiology Swedish Institute for Infectious Disease Control Nobels väg 18 171 82 Solna Sweden Tel: +46 8 4572469 Mobile: +46 70 6476047 +46 73 7078556 Fax +46 (8) 730 32 48 E-mail: [email protected]

Secretariat

Robert Bos, Coordinator, Water, Sanitation, Hygiene and Health Department of Public Health and Environment,

57

World Health Organization, Geneva, Switzerland Tel: +41227913555 Fax: +41227914159 E-mail: [email protected] Mr Mazen Malkawi, Senior Technical Officer WHO Regional Office for the Eastern Mediterranean, Centre for Environmental Health Activities, P.O. Box 826769 Amman 11190, Jordan Tel: +962 6 5524655 E-mail: [email protected] Javier Mateo-Sagasta Associate Professional Officer Water Resources, Development and Management Service Food and Agriculture Organization of the United Nations Via delle Terme di Caracalla I-00100 Rome Italy Tel.: +39 06 5705 3798 Fax: +39 06 5705 6275 E-mail: [email protected] Mr Thebe Pule, Regional Advisor Drinking-water and Sanitation WHO Regional Office for Africa, Libreville, Gabon Tel: +47 24 139 238 E-mail: [email protected] Mark Redwood, Senior Program Officer Environment and Natural Resource Management, International Development Research Centre (IDRC) 250 Albert Street PO Box 8500, Ottawa, Canada K1G 3H9 Tel: 613 236-6163 ext. 2050 Fax: 613 567-7749

E-mail: [email protected]

Unable to attend

Sasha Koo-Oshima Senior Technical Officer

58

Water Resources, Development and Management Service Food and Agriculture Organization of the United Nations Via delle Terme di Caracalla I-00100 Rome Italy Tel: +39 06 5705 3798 Fax: +39 06 5705 6275 E-mail: [email protected] Robert C. Abaidoo Department of Environmental Science Kwame Nkrumah University of Science and Technology (KNUST), Kumasi E-mail: [email protected] Tel (mobile): +233 20 8186154

59

Annex 3

Meeting of the Scientific and Technical Advisory Committee

during the Third and Final Consultative Workshop on the WHO/FAO/IDRC Project « non-treatment options for safe wastewater use in poor urban communities

The members of the Scientific and Technical Advisory Committee of the project met twice during the workshop which took place in Amman 7-10 March 2010. In attendance: Dr Pay Drechsel International Water Management Institute, Colombo

Dr Seydou Niang, IFAN CH. A. Diop, Dakar

Dr Guéladio Cissé, Swiss Tropical and Public Health Institute, Basel

Professor Thor-Axel Stenström Swedish Institute for Infectious Disease Control, Stockholm

Robert Bos, World Health Organization, Geneva

Javier Mateo-Sagasta Food and Agriculture Organization of the United Nations, Rome

Mark Redwood, International Development Research Centre, Ottawa,

Thebe Pule, WHO Regional Office for Africa, Brazzaville

Mazen Malkawi, CEHA/WHO Regional Office for the Eastern Mediterranean, Amman

The first meeting took place the morning of 7 March prior to the start of the workshop, the second the evening of 9 March following the presentation of progress reports by the country teams.

First meeting The first meeting reviewed the programme of the workshop and had no specific recommendations to make in this respect. Time was spent on reading the progress reports received from the teams. The idea of a synthesis article to come out of this work for publication in the peer reviewed literature was proposed and agreed. This would not stand in the way of individual teams doing their own papers. The need to discuss the concept of the guidance document and link it to the idea of sanitation safety plans was agreed.

60

Second meeting

Agreed agenda

1. Process of finalization of the project, financial and technical reporting 2. Status of individual projects: what remains to be done 3. Publications, other outputs and follow-up 4. Other business

Project finalization

The contract between WHO and IDRC had been initiated in 2006, with and end-date of 31 March 2009. At the last moment FAO had joined through an exchange of letters between WHO and FAO. Faced with the delays caused by administrative constraints, WHO had request a no-cost extension of the project from IDRC until 30 April 2010, and this request had been granted. This implies that there can be no further expenditures after 30 April 2010 and that the financial and technical reports will have to be submitted by WHO to IDRC in the two weeks following 30 April 2010. There is no problem with the financial reporting: all funds have been committed, and most disbursed. The only remaining “obligated” funds which still have to be disbursed are the second installments under the second APWs (contract) with the Ghana Tamale team and the Senegal team. Mark Redwood explained that the final technical report should summarize the outcomes of the individual projects by the teams and present in a synthesis how these outcomes relate to the original overall objectives, and in particular how the work has contributed to a better understanding of the guidelines. It was pointed out in the discussion that each project had operated in its own specific context and with different capacities and that therefore mainstreaming of the outcomes into a generic result would not be possible. As full coherence between the projects is therefore hard to achieve, the emphasis should be on their complementarity and lessons learned from each situation. It was agreed that sufficient time should be spent on the last day of the workshop on the outcome of the group discussions that had reviewed lessons learned on the second day of the workshop. Mark Redwood offered to provide an IDRC template that would help the reporting on this project – and the outcome could also be the basis for the synthesis paper discussed by the STAC at its first meeting during this workshop. As 30 April was only 6 weeks away, by that date only the technical report and the first detailed outline for a synthesis paper could be expected.

61

It was recognized that because of the delays the Senegal and Ghana teams would need more time than another six weeks to analyse data recently collected, revisit some of the datasets for strengthening of their analysis and final reporting. There were three challenges with three time frames:

getting the final technical report submitted to IDRC by 30 April completing any outstanding field work and analyses shortly after 30 April scientific consolidation of the final reports of the teams into a synthesis paper about

three months down the line.

This brought the discussions to agenda item 2: can the reports presented at the workshop be considered final and if not what remains to be done.

Ghana Kumasi

The Ghana Kumasi report was discussed first. As the team leader had been unable to attend, it was left to FAO (which had funded this project) to verify the status of reporting and share the final report with WHO, IDRC and the STAC as soon as possible.

Jordan

The PowerPoint presentation at the workshop had clarified a number of questions that remained unanswered in the team’s progress report. It was clear that the advocacy and community mobilization part had been much more extensive that what was reflected in the progress report, and the final report should reflect this in detail. Also, the agriculture component needs consolidation. At the time of preparing the progress report (October 2009) the analysis of the agriculture data (risk assessments for farmers) had not been completed, but this had been done meanwhile and needed to be included in the final report. It was also clear from the presentation at the workshop that there had been substantive work on the institutional (policy/regulatory) perspective and this should be highlighted in the report as an important outcome. It was noted that the basic datasets produced in the report rather emphasized the EpiInfo work the team had performed, and the STAC would like to see more basic data of their water quality monitoring data, as it had become clear during the field trip that they had collected substantial data on this aspect as well in a routine manner. This information should lead to a final evaluation of the nature of the wastewater – where are the boundaries between greywater and wastewater and how can water in the camp, at the collection points at the camp boundaries and in the agriculture area be characterized? It would also be helpful if the final results were placed in a system’s context which clarified exposure points. This would put the findings in context, particularly since the initial hypothesis put more emphasis on the exposure risks at the farming level, and the risks related to the greywater drains became more prominent as the study advanced.

62

This team (and indeed all the other teams) should be asked to submit a comprehensive list of articles already submitted or published and articles intended to be prepared for publication on the basis of this work. The STAC offers assistance to all teams in the review of papers they are preparing for publication.

Ghana Tamale

With respect to the progress report it was noted that it consisted at the moment only of five pages of text and that the remainder were annexes. The narrative needs substantial expansion for the final report. It was also clear that the annexes indicate a lot of work of work particularly on perceptions and the social acceptability of certain interventions has been done, but that a lot still remains to be done (for no fault of the team, that is). It was suggested to go back to the protocol that was developed in Dakar and see to what extent intervention studies can be completed in line with that. The team should be asked to prepare a table of contents of outstanding issues and how these will be addressed. Professor Stenstroem offered to assist in the cross-referencing in the final Ghana report to the work done by Razak and presented at this workshop. Razak’s thesis defence was scheduled for the end of May. In addition to completing the work, in the case of Ghana Tamale in particular it would be interesting to receive feed-back on what the team feels the new directions for further research in this area should be. This was true for the other teams as well, and one of the outcomes in the synthesis report should be an updated inventory of research needs and research questions for further studies.

Senegal

The team should submit a final report that pulls together the earlier progress reports and provides a comprehensive insight into all work done and its results. It was felt that the presentation of results needed to be lifted to a more sophisticated level, the way the data were presented now where to simplistic and failed to give an insight into answers to the original research questions asked. Statements made in the report should be properly evidence based, and backed up by a more detailed description of methods applied. One of the problems perceived remained the inadequacy of sample sizes. The report should also be linked back to the guidelines and the issues from the guidelines addressed in the research. It was recognized that there was a problem of languages, but it was felt that asking the Senegal team to write there final report in English would put too much of a burden on them, unless they had a translator in the ENDARUP team at their immediate disposal. Dr Seydou Niang agreed to assist the Senegalese team in the production of their final report, addressing the above issues.

63

Publications and outputs.

The issue of publications and outputs had been discussed in the course of the discussions above and at the first meeting The meeting was concluded with the expression of appreciation and thanks by Robert Bos on behalf of the Secretariat for the excellent and hard work done by the STAC members. It was hoped the collaboration with the members of the STAC in this area of work could be continued in the context of other projects and technical cooperation activities.

= = =

Report 3 of the third workshop of the WHO FAO IDRC … WHO/HSE/WSH/10.03 Report of the THIRD...

Documents

Transcript of Report 3 of the third workshop of the WHO FAO IDRC … WHO/HSE/WSH/10.03 Report of the THIRD...