1. Edema Ojomo The Water Institute at UNC October 31, 2012 Water and Health Conference 2012

2. Background Objectives Methodology Analysis using IAD Framework Levels of capacity Conclusion

3. Approximately 800 million people lack access to improved drinking water sources 1 An even greater number lack access to safe water 2,3 Ideal solution? Household Water Treatment and Safe Storage (HWTS) an interim solution Relevant to the Millennium Development Goals (MDGs) HWT practiced for centuries Some research has shown HWT to be efficacious in reducing microbial contamination and diarrhea Not yet achieved scale Picture from Missionary Oblates of Mary Immaculate

4. Better understand how to scale up and sustain HWTS practices Map enabling and obstructing factors to scaling up and sustaining HWTS practices Define the enabling environment for HWTS Better understand what countries are ready for HWTS Develop an assessment tool to determine the amenability of countries to HWTS

5. Institutional Analysis and Development (IAD) Framework Interviews, Focus group discussions and E-surveys Literature Review World Bank Doing Business methodology

6. Frameworks Help to identify different elements and the relationships among these elements relevant to understanding a problem Help generate questions that can be easily ignored Help reduce bias toward disproportional weighting of more readily available data Help reduce bias associated with preconceptions of researchers Used the IAD framework to identify actors relevant to scaling up and sustaining HWTS practices

7. Start Figure 1: Pictorial representation of IAD framework

8. Users Retailers/Wholesalers Manufacturers Government Implementers (e.g. NGOs, PS etc.) Donors Figure 2: Actors identified by 300in6 as being needed for making water safe in a scenario of HWTS How many types of people does it take to make a glass of water safe to drink, in a scenario of household water treatment, storage and proximity provision?

9. Product Purchase Investment in HWTS intervention Policies regarding HWTS practices and products/technologies, including import regulations, standards, etc. HWTS practice advocacy Product development Product advocacy/ promotion Product sales Cost recovery Figure 3: Actions identified as vital to bringing effective HWTS products to users

10. The framework sheds some light into the complexity inherent in scaling up HWTS Numerous actors Significance of each of these actors varies Several factors influence the decisions of these actors Interaction among actors is complex

11. Enabling Environment describes the broader system within which individuals and organizations function and one that facilitates or hampers their existence and performance (UNDP, 2008). Organizational/Intervention describes the characteristics of the organization carrying out the intervention and/or the features of the intervention Individual/Household describes the target population and can either be an individual, household, or community

12. ENABLING ENVIRONMENT (A) ORGANIZATIONAL /INTERVENTION (B) INDIVIDUAL/HOU SEHOLD (C) SUPPORT PROVISIONUSE (C) Are affected by technology price and type provided by (B) (B) Are affected by demand and behaviors of (C) (B) Are affected by policies and regulations set by (A) (C) Are affected by policies and subsidies set by (A) (A) Are affected by demand for safe water by (C) (A) Are affected by lobbying done by (B) Figure 4: Relationship between the three levels relevant to scaling up and sustaining HWTS

13. Government advocacy for HWTS Presence of policies and/or strategies A home for HWTS Partnerships and networks that define certain stakeholder relationships (e.g. PPP, networks for collaboration) Certification of HWTS products and technologies Import regulations concerning HWTS products/technologies

14. Partnerships with other organizations and communities An effective supply chain and distribution network Capacity building activities Cost recovery options Awareness raising activities Choice of product/technology Available resources Integration of HWTS into other programs

15. Financial ability to adopt HWTS practice Preferences about technology type Cultural belief about water/water treatment Leaders advocating HWTS Understanding of the relevance of HWTS Perception of diarrhea Aspirational products

16. Can the technology being promoted by your organization be produced locally? Do you plan on producing technology locally? Yes No Can the technology be imported into the country? (Take import barriers and regulations into consideration) No Conditions are not amenable for an HWTS intervention with the proposed technology No Yes Is there an effective and sustainable supply chain for technology and consumables after your organization leaves country/community? Conditions are not amenable for a sustainable HWTS intervention with the proposed technology No Conditions are amenable for a sustainable HWTS intervention with the proposed technology Yes Is there skilled labor available for manufacture (or will this capacity be developed)? Yes Conditions are not amenable for the development of effective/quality HWTS technology in country No Is there a clear supply chain for technology and spare parts? Conditions are not amenable for a sustainable HWTS intervention Conditions are amenable for a sustainable HWTS intervention Yes No Assessment tool that takes all three levels into consideration

17. Achieving successful scale-up and sustainability is a highly complex process There is no silver bullet - the answer is intervention specific However, this study highlighted the following important questions to consider when designing an intervention What actors are relevant to your intervention? What are their roles? How do these actors interact? What are the enabling environment features relevant to your intervention? What intervention characteristics need to be modified to account for country/community context? Who is the target population? What characteristics does this population have and how can these be managed?

18. Photo from WHO HWTS Following emergencies and disasters

19. 1 WHO & UNICEF. (2012). Progress on Drinking Water and Sanitation: 2012 Update. USA: World Health Organization and UNICEF. 2 Bain, R. E., Gundry, S. W., Wright, J. A., Yang, H., Pedley, S., & Bartram, J. K. (2012). Accounting for water quality in monitoring access to safe drinking- water as part of the Millennium Development Goals: lessons from five countries. Bulletin of the World Health Organization, 228-235. 3 Onda, K., LoBuglio, J., & Bartram, J. (2012). Global Access to Safe Water: Accounting for Water Quality and the Resulting Impact on MDG Progress. International Journal of Environmental Research and Public Health, 880-894. 4 UNDP (2008).UNDP Practice Note: Capacity Development New York, New York, USA