Overview of Phase II, proposed directions for Phase III Batsi Majuru International Network on Household Water Treatment and Safe Storage Annual Meeting 10 October 2016

Outline Phase II objectives What did we do well What did we do not do well Thoughts on future directions Mention review process WHO/ Maggie Montgomery

Review process Network survey (2015) Discussions at AG/PPG meeting (2015) Telephone discussions with AG, and other participating organizations (2016) Reflections of the Secretariat Mention review process

Phase II objectives Strengthen evidence base of the public health relevance of household water treatment and safe storage; Observe tangible results in the scaling-up of HWTS achieved in countries in all regions of the world; Develop national policies and institutional frameworks to ensure the integration of different environmental health interventions with HWTS at the household level from a broad public health perspective; and Evaluate best practices in HWTS programmes and disseminate for advocacy purposes

QUIZ! When was the Network first established? 2003!

What we did well: Strengthening evidence Relatively little evidence on health impacts of HWTS, prior to 2011 Several rigorous studies in the last 5 years, highlighting : 25-50 % diarrhoeal disease reductions from various HWTS methods (Clasen et al., 2014) WHO (2014) update on burden of disease associated with inadequate WASH highlights diarrhoeal disease reductions of as much 45 %

What we did well: Facilitating national policy development Regional workshops and development of national action plans East Africa 2011: Ethiopia, Kenya, Rwanda, Tanzania and Uganda Southern Africa 2012: Malawi, Mozambique and Zambia West Africa 2013: Gambia, Ghana, Liberia and Sierra Leone South-East Asia 2014: Lao PDR, Viet Nam Mongolia, Cambodia, the Philippines Ethiopia 2016: Ethiopia, Kenya, Ghana New policies on HWTS developed, or in some countries HWTS included in national health policies such as: Maternal and child health HIV/ AIDS and TB Nutrition Emergencies Source: WHO, 2012. Status of national policies on household water treatment and safe storage in select countries. Geneva, Switzerland.

QUIZ! Name two key publications on HWTS that have been developed through the Network’s input

What we did not do well: Evaluating best practice in HWTS programmes, and dissemination Toolkit for monitoring HWTS programmes developed in 2012 However: Extent to which Toolkit has been incorporated into programmes Behaviour change is a key determinant of correct & consistent use, but no evidence-based frameworks have been applied at scale Sustainable markets for HWTS remain a challenge Perception of HWTS as an emergency intervention, free distribution, etc. Weak local markets (African region), high import taxes on HWTS products However, some promising examples of scale up may emerge

What we did not do well: Integration of HWTS with public health efforts WHO taskforce on integration of HWTS and health (2013) Objective: Review health evidence, provide recommendations on what can and should be done to scale-up HWTS Recommendations: Link with HWTS with major int'l and nat'l initiatives (child health, HIV, Dengue, etc) Select HWT options that meet WHO criteria AND most likely to be used Implement within existing health and community channels, monitor and track progress Progress made at global strategy level, but little practical action on integrating HWTS with key public health efforts Participants WHO staff from maternal and child health, nutrition, malaria, neglected tropical diseases, HIV, emergency alert and response

Thoughts on future directions: Strategic focus Addressing HWTS within a package of water safety solutions HWTS as a component of public health programmes HWTS in emergencies Best practices and examples of targeted scale-up

HWTS within water safety solutions ‘Improved’ sources are not necessarily safe; 1.8 billion people globally use a drinking-water that is faecally contaminated HWTS is mitigatory measure within a water safety plan (WSP) framework SDG 6.1 indicator requires data on water quality; WSPs and HWTS can contribute to target Countries such as Ethiopia working to holistically address WSPs and HWTS Not just treatment, but also safe storage, which is important for Diarrhoeal disease reduction Preventing spread of cector-borne disease such as Zika and dengue

HWTS as a component of public health programmes Greater health gains Zambia HIV+ mothers (Peletz, et al.; 2012; Peletz, et al.; 2013) Use of filters 96% among HIV+ mothers Significant reductions in diarrhoea in young children and the household Long-term high use sustained even after intervention ceased Strengthened regulations: Ensuring that only products that meet health-based performance criteria are sold / distributed Classifying HWTS products as health products, to increase awareness of effective HWTS products in the health sector, facilitate tax waivers / reductions WHO/ R Granich

WHO Regional Office for Africa HWTS in emergencies Number of individuals affected by emergencies is the highest it has been in the century Updated short technical guidance required to guide: Selection of products (not only microbial performance) Targeting Implementation; and Monitoring WHO currently updating technical briefs on WASH In emergencies Best practices for sustained use in the phase immediately after crises WHO Regional Office for Africa

Best practices and examples of scale up Uptake is an important issue, and sustainable markets for HWTS are necessary to achieve this Best practices and examples are required on development, testing and implementation of sustainable business models for HWTS Antenna Technologies

Thoughts on modalities There are some gaps that the Secretariat may not be able to fill How can participating organizations in the Network best fill these gaps?

Summary Strengthening evidence What we did well Strengthening evidence Facilitating national policy development What we did not do well Integration of HWTS with public health efforts Scaling up best practice, and dissemination of lessons Thoughts on moving forward HWTS within broader water safety solutions Integration with public health Best practices and examples for targeted scale up HWTS in emergencies Acknowledge AG/PPG