© Copyright Medentech 2009 New Technologies & Techniques for Scaling-up Household Water Treatment Ulick Stafford PhD R&D Manager Medentech, Clonard Road, Wexford NUI Maynooth, November

© Copyright Medentech 2009 (C) Copyright Medentech 200  1.1 billion people do not have access to drinking water from improved sources (18% of world’s population)  Up to an estimated 4 billion diarrheal episodes occur per year (1.2b associated with water), with up to 3.5 million deaths  Every day diarrheal diseases kill 5,000 young children Unsafe water kills

© Copyright Medentech 2009 U.N. Millennium Development Goals MDG Goal No 7: to reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation by 2015 (UN World Summit 2002) To reach the MDG for drinking water requires 1.1 billion people to gain access in the next decade: 300,000 people every day!!!!! 84% are in rural areas

© Copyright Medentech 2009 Improved Drinking Water? Gundry et al study: South Africa and Zimbabwe Randomized study – 254 children, aged 1-2 years Dry and wet seasons > 10 CFU/100ml E.coli Improved (standpipe, borehole, protected well) Unimproved (unprotected well/spring, river/canal) At Source12%71% Household Storage41%81% Drinking Cup51%82%

© Copyright Medentech 2009 The burden of unsafe water negatively effects: the healthcare system – at any one time half the world’s hospital beds are occupied by people with water-borne disease1 the income generation of households, community and, therefore, the nation as a whole the education capacity – children not attending school the absorption of nutrients, especially in young children, reduced resistance to infection and, potentially, long-term gut disorders 2 – contributes to malnutrition preventable mortality and morbidity Household water treatment can pay back US$60 for every US$1 invested (3) 1. Water for Life Decade. UN Factsheet 2. T. Clasen et al. Interventions to improve water quality for preventing diarrhoea: review, Water for Life. WHO/Unicef, 2005 Prevention is better than cure

© Copyright Medentech 2009 Simple techniques for disinfecting water at household level are shown to considerably reduce diarrhoea: twice as effective as interventions at source 1) Because household water treatment techniques can be cheap and the impact of improving water quality dramatic, household water treatment and safe storage can produce huge health and economic benefits 2) The most cost-effective strategy evaluated was disinfection of unsafe water at the point of use This is a simple technology, is of very low cost, and would achieve substantial health benefits 3) Chlorination, at the point-of-use, has been shown to reduce diarrhoea by 39% 1. J. Borazzo et al. Scrub a Dub Dub: Is there anything new in Hygiene Improvement. USAID 2. Water for Life, WHO/UNICEF, WHO World Health Report, 2002 Household Water Treatment

© Copyright Medentech 2009 Aquatabs meet all the criteria & sets the quality standards for HWTS products: Safety and consistent quality Biocidal effectiveness – > 15 field evaluations Health-Impact / Water Quality Acceptable by indigenous peoples – > 10 studies Affordable by low-income earners Asia:€0.03 to €0.05 US cents per 20 litre tablet India:€0.01 to €0.02 US cents for 10 litre tablet Africa:€0.02 to €0.05 US cents for 20 litre tablet Social marketing / commercial marketing Availability, Scalability – 2 sites/3 Billion Aquatabs Shelf Life – 5 years Light & Portable – appropriate for rural area distribution, the last mile. Aquatabs – Criteria for HWTS

© Copyright Medentech 2009 Benefits to users in low-income countries Simple to use. No need to measure Can be purchased in amounts to suit available funds Safe. Will not bleach or burn Light to transport & small to store Taste acceptability Cultural (Religious) acceptability (Halal Certified) Quality assured (Active ingredient USEPA & NSF certified) NaDCC is now in WHO drinking water guidelines * Joint Expert Committee on Food Additives

© Copyright Medentech 2009 Target Populations: At the high risk of diarrhoeal diseases from unsafe water Base of the economic Pyramid (BOP) Demand-driven model (Non Subsidised) Commercial Profitable Distribution Channels – 8 times the added value remains in country Sustainable & scalable Social & Commercial Marketing Health Education / Behaviour Change “Above the line” & “Below the line” Aquatabs – Distribution Model Objectives:

© Copyright Medentech 2009 HWTS is the ultimate in education pre-preparedness for crisis situations. The full community is educated/trained for crisis (even if uptake is low). HWTS is the ultimate in deep prepositioning. Stocks readily available in most crisis prone areas. This secondary benefit equates to DALYs averted. Brings down cost of crisis interventions for public sector and NGOs Post event continued use & net savings to the public sector. Recent examples, Haiti, Ethiopia & Vietnam. HWTS products immediately available and population aware to self-dose. Emergencies – the hidden success of HWTS Network

© Copyright Medentech 2009 Immediate availability and commercial sales channels in place result in most rapid deployment to crisis hit areas. Haiti – 50 million tablets shipped in within 10 days due to HWTS program availability. Pakistan 150 million within 3 weeks. Immediate availability of local text promotional / educational materials. A Langtane study has shown an uptake level 9 times greater with proper usage education than simply making product available in a crisis. HWTS is pre-positioning

© Copyright Medentech 2009 Behavioural Change Marketing – techniques Taste improved tablets Long term double blind placebo controlled Health Impact Trial India Schools, Village & town level water disinfection systems Floc tablet New “KISS” system New Medentech Developments

© Copyright Medentech 2009 (C) Copyright Medentech 200  Self Chlorination – activated with flow of water  Attached to end of stand pipes‏ or roof tanks inlets  Robust plastic design – exceptional long life unit  Zero maintenance Example of HWTS related new product developments

© Copyright Medentech 2009  Chlorinates 20 litres per minute  200,000 litres at 1ppm  Ideal for schools – low cost  Active chlorination ceases once flow of water stops.  Can continuously chlorinate  Adaptable to rainwater harvest, standpipes etc.  Adjustable chlorine delivery ppm Aquatabs EZ Ball-cock mounting option Simple adjustable chlorine dose

© Copyright Medentech 2009 The global population is increasing faster than all our combined efforts are reaching The WHO International Network to promote Household Water Treatment and Safe Storage (HWTS) needs your support The mission is to support 750 million people with household water interventions by 2015 Medentech is a Collaborating Organisation within the Network 10 billion litres is not enough!

© Copyright Medentech Medentech Importer Commercial “Retail” Distribution Emergency & Non Commercial Commercial “Community Based” Distribution Wholesalers/ Distributors NGO’s / Government NGO’s/FBO’s, Regional/ District Networks & Micro-Enterprises Kiosks / Pharmacies Health Sales Agents & Direct Sales Social Marketing Organisation Government / National Stakeholder Group International Network Special Risk Groups – Schools, etc.

© Copyright Medentech 2009 Support HWTS products and usage by promoting behavioural marketing Carry out a long term double blind placebo controlled Health Impact Trial Introduce taste improved tablets Schools, Village & town level water disinfection systems Floc tablet New disinfection systems Medentech is Committed to