1. 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

2. 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

3. 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

4. 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

5. QUIZ!
When was the Network first established?
2003!

6. 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 %

7. 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, Status of national policies on household water treatment and safe storage in select countries. Geneva, Switzerland.

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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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?

17. 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