The Acceptance & Adoption of Household Based Treatment And Safe Storage Of Drinking Water (HWTS)
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The Acceptance & Adoption of Household Based Treatment And Safe Storage Of Drinking Water (HWTS)
Bongi Moyo-MaposaWater & Asset Management GroupCSIR Built Environment
The evidence & learning from field application in the developing world
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Presentation Outline
• Introduction– The safe water challenge & The case for HWTS
• Scaling up HWTS– A review of the field evidence (literature and field
examples)
• Conclusions: – Implications for practice, advocacy and policy– Limitations of the evidence base & further work
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The Safe Water and Health Challenge
Globally, approx 3% of deaths, 4% of DALYs due to unsafe water, sanitation and hygiene
Diarrhoeal illness in Africa, Asia and Latin America 90% due to environmental sanitation
Diarrhoea still a public health issue of concern in South Africa
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The Case for HWTS
• Focus on personal & domestic hygiene in diarrhoeal disease control
• The rise of HWTS:– Early reviews of the efficacy of interventions
(Water Quantity & availability> sanitation>water quality)
– Shift in the paradigm (quality more important): post –collection contamination &HWTS
– Prospects for universal access to safe
water and sanitation
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The Case for HWTS
A cost effective strategy:
Relative risk estimates for diarrhoea Water quality(0.69), sanitation (0.68) and hygiene (0.63) Source water quality (0.89) compared to point of use (0.65)
Independence of HWTS
$1 investment = $60 in reduced DALYs
WHO endorsement- HWTS Network
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Scaling-Up HWTS
What are the factors that have influenced the acceptance and adoption of household based water treatment and safe storage in the target contexts?
Scaling up strategies
Areas for further work
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Review of the field evidence
Querying the evidence
Review of the literature
Inclusion & Exclusion criteria
Data sources
Thematic analysis
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1: Compatibility with existing social and cultural norms
Intervention might interfere
and cause disease
Using disinfectant might
interfere with the cooling
of water in clay pots
Water is culturally
associated with purity
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2: Convenience
Convenient method to use
Easy to use/ ease of use
Preferred bleach to the flocculant disinfectant because the process was simpler
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3: Time
Women already have a heavy workload
Treating water took too much time
Bleach vs flocculant disinfectant
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4:Taste & appeal of the treated water
Volume of treated water
- almost always to little
Taste and smell of
‘WaterGuard’
Visible effects of using
flocculant disinfectant
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5: Cost or Affordability
SODIS economical but
bottles were a problem,
cheaper than boiling
No money to buy
disinfectant etc
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6: Need for water treatment
Source water contaminated
Aware of importance of
treating water
Aware of the link between
water and disease
Water traditionally
associated with purity,
already clean
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7: Self Efficacy & Knowledge
Aware of the link
between water and
disease
Know how to prevent
diarrhoea
Have access to the treatment
technology
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8: Motivation
Cues to action
initiate behaviour change
Trusted and competent
information sources
(social marketing
& motivational interviewing)
Prestige
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9: Access to the technology/ intervention
Intervention not
readily available in
the home
Cheaper locally available
alternatives
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10: Perceived efficacy of the intervention
Know about the
germicidal effects
of the sun and chlorine
Previous experience
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Acceptance
Convenience
Taste & Visual Appeal
Compatibility
Time
Knowledge/Self
Efficacy
Motivation
Perceived Efficacy of
Intervention
Accessibility Affordability
Need for water
treatment
Adoption
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Review of the field evidence(1)
In a community survey of communities around De Hoop Dam (2009)95% of the households interviewed stored drinking water after collecting it
75% storage containers reportedly covered
62% reported treatment
>80% used JIK (a household disinfectant) and soda
Soda only, chlorine and boiling
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Review of the field evidence(2)
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Review of the field evidence(2)
In a community survey of 35 randomly selected households in Tsambonkhulu, Mpumalanga (2012):
Community relies on 3 unprotected wells although there a number of boreholes and a piped water scheme
All collection and storage containers were made of plastic
Most of the collection containers had narrow mouths and were not covered
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Review of the field evidence(2)
Appears most household do some kind of treatment
Only a quarter (23%) did not report treating their drinking water
Range of treatment methods reportedly used
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Review of the field evidence(3)
Potter for Peace Ceramic Water Purifiers were distributed to communities in the E. Cape as part of the ASWSD I project (2010) Community trained in the use of the filters at
distribution
Acceptability to users: Happy to have the filter but dissatisfied with its performance (too little water, too slow, clogs within a few days)
Learnings: Understanding of context is key To deployment of appropriate intervention, Shed light on the relevant elements of context
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Review of the field evidence(3)
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Review of the field evidence (3)
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Review of the field evidence (3)
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Review of the field evidence (3)
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Review of the field evidence (3)
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Review of the field evidence (4)
The AmDrum in the E.Cape (2009)A 50L flocculant- disinfectant system designed by the CSIR, piloted in 2009 and subsequently redesigned
Issues with the original design: Technical problems – loose parts, leaking taps, taps
breaking, smelly sand column
Unavailability of spares and chemical refills
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Review of the field evidence (4)
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Review of the field evidence (5)
The rise and rise of HWTS in urban Harare (2007-2008)
Breakdown in the municipal water supply services
Cholera and diarrhoea outbreak
Boiling previously common, chlorination became the method of choice
Chlorination preferred over SODIS in an informal settlement in peri-urban Harare
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A deep well
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Meanwhile....
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Review of the field evidence (5)
To treat …motivation, resources, knowledge, health concerns, taste and acceptability of treated water,
trust placed in authorities, availability & accuracy of information
Or not to treat….concerns about time, labour constraints, unwillingness to take up the responsibility, religious beliefs, and conviction about the necessity of treatment
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Review of the field evidence (5)
TREAT
MotivationHealth concerns
Knowledge
Taste and acceptability of treated water
Resources
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Conclusion
HWTS is an option to secure access to safe water for households
Available field evidence can provide a framework to understand HWTS implementation:
Implications for practice
Direction of future research
Policy and advocacy
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Conclusion
Limitations and gaps in knowledgeLimitations
Wide geographical coverage Short term nature of the studies
More work on acceptability and adoption Issue addressed as a secondary objective Settings Technologies
chlorination & solar disinfection
The role of the researcher