1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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”

16. 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

17. 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

18. 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

19. 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

20. 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.

21. 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

22. 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