Francesca Bernardini UNECE World Health Organization World Health Organization 15 May, 2018 15 May, 2018 The UNECE/WHO-EURO Protocol on Water and Health: where health, environment and development policies meet Francesca Bernardini UNECE 1 1

Why a treaty to manage water resources and prevent water-related diseases ? In the European Region, poor-quality drinking-water causes over 13 000 deaths from diarrhoea among children aged 0–14 years (5.3% of all deaths in this age group) each year 140 million (16%) do not have a household connection to a drinking-water supply, 85 million (10%) do not have improved sanitation; the situation had not improved in the past 15 years In central and eastern Europe water is safe only in 30—40% of households. Emerging threats: protozoan infestations of drinking-water supply systems, proliferation of Legionella, and potential health problems related to the increasingly complex chemical environment Overuse, pollution, extreme weather events affect water resources A bit of background even if you know the situation These figures are old, nothing has changed in the past 15 years And this is only to talk about the health consequences, a similarly dire pitcure is for the water ressources in the region

The Protocol on Water and Health World Health Organization 15 May, 2018 The world’s only legal treaty designed to reduce water-related deaths and diseases through improved water management The Protocol was negotiated to address these problems 3

Environmental Management Aim: Protect human health and well being by better management of water resources Effective protection of water related ecosystems and sustainable use of water resources Provision of adequate supplies of wholesome drinking water Health outcome Environmental Management Drinking water quality Prevention, control and reduction of water-related diseases Detection, contingency planning and response to outbreaks Legal framework Aim: protect human health and well being by better water management: it’s innovative and unique as it really makes the link between the differen sectors That’s the main added value and biggest strengths of the Protocol: compared to other approaches which are still very sectoral the Protocol brings together the environmental and health sides and offers a holistic and non-piecemeal approach Health Outcomes Environmental quality

Objectives (a) Access to drinking water for everyone and (b) Provision of sanitation for everyone => Focus on sustainable development and MDGs, beyond MDG 7, target 10 => framework for implementing the human right to water and poverty reduction => focus on governance, integration of policies and on cooperation It is closely linked to development issues, that’s why you might be interested in ti and not only medical doctors Sustainable development and MDGs Poverty reduction Policies integration, governance aspects Cooperation between sectors and countries

Status of ratification World Health Organization 15 May, 2018 Status of ratification Adopted in 1999 by 36 countries Entered into force in 2005 Currently ratified by 24 countries Signatories Parties Towards accession What is also interesting is that other countries which did not sign it in 1999 are now in the process of accession . 6

Scope Costal and estuarine waters Surface waters @ MED action plan @ WHO central photo library Costal and estuarine waters Surface waters Water during abstraction, transport, treatment and supply @ UNEP photo collection Wastewater collection, transport, treatment, discharge, reuse @ WHO EURO photo collection

How: the Protocol’s pillars Reinforce each other Ensure continuous progress Some info but more from the following presentations

Art 6 and 7: Targets, measures, review of progress ESTABLISH TARGETS MEASURES REVIEW PROGRESS Within 2 years of becoming a Party, each Party shall set targets and target dates Water supply and sanitation Water management Health protection National coordination mechanism Water management plans Investments Monitoring Enforcement Capacity building Collect and evaluate data Publish results Review progress Submit summary report How does it work? This is the stenght of the Protocol, it forsters a logical approach that support continuous progress Declare targets tailored to country needs and capacity: Water supply and sanitation (quality, Improved access, system performance, discharge of Wastewater and sludge); Water management (resource quality, recreational water, aquaculture); Health protection (Outbreaks, level of disease) Set dates: Parties also 1) establish national coordination mechanisms, 2) develop water management plans, 3) establish framework for enforcing drinking water quality standards Review progress: 1) Parties collect and evaluate data on progress towards target; 2) Parties publish results of data collection and evaluation; 3) Parties review progress; 4) Parties provide summary report through Secretariat to MOP

Progressive and continuous action Within two years set targets and target dates In a certain way the protocol is mostly a tool for integrated planning, for the development of integrated national road maps and strategies which have clear targets and measurable indicators of progress Tailored to the needs and capacity of Parties Not only access to water and access to sanitation but a very holistic approach: targets on water, health and environment Not only access to sanitation but also water treatment and efficiency of the service (added value vis-à-vis MDGS and discussion at the WWW) Not only drinking water as a potential source of disease but also other way of exposure (irrigation, bathing, aquaculture, etc) Need/opportunity for integration of policies and cooperation of sectors: it’s here where it mostly happens, Flexibility: think out of the box. E.g. address social aspects such as minorities, human right to water Not just a bureaucratic exercise: continuous progress: assessment and revision of targets, clear indicators of progress More in Pierre’s presentation

Surveillance and response Public information of threat Preventive and remedial actions Public authorities notified Responsive Health Systems Contingency plans timely prepared Within three years, each Party shall have established systems for surveillance and early warning of water related disease, contingency plans and response capacities. Implementing these provisions requires action in a number of areas. Second pillar: only surveillance can prove that progress has been achieved More in Monica’s presentation Water-related outbreaks or threats identified Capacity strengthened to implement contingency plans

Project Facilitation Mechanism Assistance tools Project Facilitation Mechanism Compliance Committee Carrot and the stick but actually two facilitative mechanism to support Parties in their efforts A procedure of non-judicial, non-confrontational and consultative nature for review of compliance: more in Attila’s presentation Obligation of Parties to assist each other in the implementation of the Protocol: which has been translate into practice in the AHPFM Both very important: Parties are not alone in the implementation of the protocol Non compliance problem that could lead to a an action by the Compliance Committee can then by overcome though assistance by other countries through the AHPFM. Or on the contrary serious non-compliance demonstrated by the CC could be an important indicator of lack of commitment that would make the country found in non-compliance be seen as less reliable for other countries providing assistance though the AHPFM Compliance and implementation are at the centre of the Protocol: it’s not only a piece of paper

Public awareness, education and public participation Parties shall Ensure public participation in decision making (target setting) Take steps to enhance public awareness Promote common understanding between sectors Encourage education and training Ensure that information is available to the public Beside the two main obligations to set targest and develop surveillance systems, the Protocol includes a number of other obligations in particular on public awareness, education and public information

How does the Protocol function? Meeting of the Parties (MOP) Compliance Committee Bureau Task Force Surveillance Task Force on Indicators and Reporting Task Force on Extreme Weather Events The CC and AHPFM are an integral part of the Protocol’s structure whish is also one of it’s assets Continuous progress at the multilateral level through bodies which promote and assess progress and identify challenges and emerging issues SO the Protocol is able to respond to new needs. Eg Task Force on Extreme Weather Events which looks at the additional challenge created by climate change to safe water and adequate sanitation More In Roger’s presentation Mostly through the adoption every three years of a programme of work Working Group on Water and Health Ad Hoc Project Facilitation Mechanism Joint Secretariat WHO – UNECE

In practice… technical guidance From the what to the how for a common approach in the region Theoretical and technical framework for compliance with main obligations Guidelines on setting targets, evaluation of progress and reporting; technical and policy guidance on surveillance Paper, not important, on the contrary it has proven crucial in the implementation of the MD project. Especially in EE countries fundamental to follow a “model”

In practice… emerging(ed) issues Small scale water supplies Water supply and sanitation in extreme weather events Equitable access to water / implementation of the human right to water and sanitation

In practice… capacity building On different aspects of the Protocol’s implementation Focus on South-Eastern Europe and Eastern Europe, Caucasus and Central Asia Supported by other activities and feeds back to work under the Protocol

In practice… country projects Two ongoing in Moldova and in Ukraine Requests for others Link to activities carried out within the National Policy Dialogues on IWRM under the EU Water Initiative

Main advantages Legally binding => ensures long-term commitment and forms a basis for improved regulatory environment Designed to support continuous progress with pace and objectives tailored to countries’ priorities and capacities Programme of work supports implementation and harmonization in the region as well as a framework for dealing with emerging issues Offers a structured environment for government, NGOs and business to develop long-term cooperation at national and international level The bottlenecks in addressing these problems often occur beyond the purview of the water and health sectors. They lie in the formulation and implementation of policies; the effectiveness of institutions and the arrangements between them; the translation of political will into action; the allocation of resources at national and international level; and in the capacity of countries. Legally binding but flexible in nature, define what the ultimate objective is but leave it to countries to chose their pathe

Where do we stand in the rest of the region Results of the first reporting exercise Recognition of the importance of the Protocol is increasing, implementation is progressing Setting targets is a challenge for countries as it confronts governance inadequacies Problems of access to water and sanitation in rural areas Not only access: quality aspects, hygiene, performance In the early years, there was obviously a problem of political recognition of the tool, country had ratified it it was not a political priorities. Probably few of you also knew it before today. All the work carried out in the past 4 years is bringing its fruits, All parties but 3 reported (AL, LUY, SP) plus 4 non-Parties reported (AR, GEO, UZ, CY?) Not an easy instrument to implement, tackles problems at the root.

Challenges Difficulty of the problems => complexity of the solution Integration: the beauty of the Protocol and its curse Win inertia of traditional/sectoral approach=> Still weak recognition of the linkages between environment and public health Difficulties in getting high political attention Financial implications vs underfunding of the water sector As we know the problems that the Protocol wants to tackle are extremely difficult and it is therefore understandable that also the solution is complex and Parties have difficulties to implement the Protocol (we will hear something about the practical example of Romania) The biggest strength but also “weakness” is the need for integration and cooperation between sectors (more in Pierre) Need to catalyze more resources, not only from donors countries but mostly form state budget themselves

Status in Eastern Europe Targets Ratification Country Under development 22 April 2009 Belarus Set and adopted 10 March 2000 Republic of Moldova ? 31 December 1999 Russian Federation Set Adopted? 26 September 2003 Ukraine