1. Elizabeth Medlin, M.PH. Global Water, Sanitation, and Hygiene Team Environmental Health Services Branch U.S. Centers for Disease Control and Prevention Drinking Water from Households to Cities: One Size DOESN’T Fit All National Center for Environmental Health Division of Emergency and Environmental Health Services

2. The Situation  Worldwide 884 million people do not use improved sources of drinking water  ‘Improved’ = Not necessarily microbiologically ‘safe’ at all times

3. Challenges with Community Water Systems  Water quality  Intermittent service  Times of maintenance and repair  Household storage part of everyday life

4. Community Water Systems + Households Source waters and the watershed sources of pollution and their impact Treatment processes efficacy in producing safe water Distribution system infrastructure and integrity Consumer ?

5. Storage – tanks, buckets, drinking containers Handling – cups, hands Treatment – boiling, bleach, filters Other factors – sanitation, hygiene Contamination of Water from Tap to Consumption

6. A Spectrum of Interventions  Spectrum of intervention  Complementary, not competitive  One size DOESN’T fit all

7. Intermittent Piped Continuous Piped Temporary/ Refugee Hauled A Spectrum of Interventions Household Treatment/Storage Disaster Response Water Safety Plans Regulations

8. Water Safety Plan + Household Water Treatment and Safe Storage  Water Safety Plan (WSP)  Catchment to consumer  Does not traditionally identify hazards within household  Household Water Treatment and Safe Storage (HWTS)  Does not focus on risk management at source  No single intervention is the “best”  Misses the point  Often more than one intervention may be needed

9. Positive Samples – Total Coliforms Tap Household Storage Tank Drinking Water Container Positive Samples – E. coli WSP Household Survey: Guyana 11/47 (23%) 8/22 (36%)31/73 (42%) 30/47 (64%) 19/22 (86%)66/73 (90%) Guyana Household Survey

10.  Results  WSP- Inadequate disinfection at treatment plant  WSP- Inconsistent service  HHWTS- Inadequate storage and handling  Recommendations  WSP team works to improve service  WSP team initiated a HHWTS campaign

11. Positive Samples – Total Coliforms Tap Drinking Water Container Positive Samples – Fecal Coliforms WSP Household Survey: Jamaica 2/7 (28.6%)10/20 (50%) 2/7 (28.6%)14/20 (70%) Jamaica Household Survey

12.  Results  WSP- Inconsistent service  WSP- Microbial contamination of piped system  HHWTS- Inadequate storage and handling with decreasing chlorine residual  Recommendations  WSP team works to improve service  CDC recommended an education program on safe storage

13. Spectrum of Interventions is a Necessity  No single intervention is the “best”  Misses the point  Often more than 1 intervention may be needed  Need to promote interaction between approaches and implementing organizations/networks

14. For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Elizabeth Medlin, M.PH. Global Water, Sanitation, and Hygiene Team emedlin@cdc.gov National Center for Environmental Health Division of Emergency and Environmental Health Services