1. Point of Use Water Systems: Solutions that meet water quality challenges Solutions that meet water quality challenges Jo Barnes Division of Community Health Faculty of Medicine and Health Sciences University of Stellenbosch Tygerberg Policy Dialogue: DST/EU Sector Budget Support, HSRC and the WRC 2 October 2012

2. Two broad categories of users of POU devices in South Africa - the well-off and the poor:  Well off people only use POU devices to improve water taste (or are neurotic about health)  Poor people use (need?) POU devices to make water safe REALITY - There is wide overlap of reasons for use distributed over many income classes. So-called high income families do not necessarily have access to safe, acceptable wate r 2 Some questionable assumptions

3. "POU's are usually simple, inexpensive technologies which positively affect the health of rural households by reducing the prevalence of water borne diseases". REALITY: POU devices do not necessarily positively affect health simply by delivering cleaner water to households. Correlation between water pollution level and occurrence of diarrhoea in household about 0.3 3 Some questionable assumption s

4. Contamination occurs in two different domains:  Public  Domestic To realise maximum and sustainable benefit, prevention of disease should occur in both domains Assessments often carried out too soon after implementation Hawthorne effect causes initial improvement that does not last 4 Reasons for the mismatch

5. Confounders present in studies announcing reduction of diarrhoea. Such studies did not adequate take into account:  Home hygiene behaviour - recontamination  Domestic sewage disposal  Food storage and preparation practices  Quality of irrigation water used for fresh produce  Availability of soap and drying material for handwashing  Vector transmission (flies, rodents, cockroaches...) In addition, low water sampling frequency gave wrong impression of water quality used in homes. 5 Reasons for the mismatch

6. 40 - 60 persons per toilet

7. Standpipes also disposal points for dirty water

8. No safe place to discard wash water - runs into stormwater drains

9. Animal and human feet bring contamination into homes

10. Poor solid waste removal causes contamination

11. Drains running over due to stormwater intrusion

12. Example of "backyard shacks" 12

13. 58% of RDP type houses in our study had non-operational toilets at time of visit 100% of houses had visible serious structural damage (leaking roofs, leaking walls, broken taps...) 40% of RDP houses had one or more persons who had diarrhoea in the previous two weeks 61% of households dispose of dirty water and wet waste by flushing it down the toilet 100% of inhabitants said they did not know how to maintain their houses Only two households paid for water Problems in low-cost housing settlements:

14. The “kitchen” in many low cost houses 14

15. Improved kitchen in RDP house

16. Tap in toilet with no connection to drain 16

17. No place to discard washing water - runs into storm water drains 17

18. Evidence of alcohol misuse 18

19. The large number persons living with of HIV/AIDS increases the already considerable number of persons who are particularly susceptible to waterborne diseases What is often forgotten is that HIV/AIDS sufferers also secrete millions of pathogens into their environment - they act as 'incubators' 19 The HIV/AIDS complication

20. POU devices are reported to have low uptake in communities needing clean water the most. This occurs even where they are distributed for free. Filter devices are more popular than chemical treatment because of complaints of off-taste. Effective implementation ("marketing") will have to go beyond standard messages about water and health. Active and sustainable teaching of home hygiene will go a long way towards realising the benefits of POUs 20 POU devices have low uptake

22.  The hosts of the meeting for the opportunity to speak  Flemish Government, Water Research Commission, Harry Crossley Foundation, German Academic Exchange (DAAD), National Research Foundation and Stellenbosch University for research assistance  Stellenbosch University for ethical clearance  Stellenbosch University Water Institute Acknowledgements Thank you for your interest 22