1. Elizabeth Medlin, MPH Global Water, Sanitation, and Hygiene Team Environmental Health Services Branch U.S. Centers for Disease Control and Prevention Rick Gelting, Ph.D., P.E.; Kristin Delea, M.PH., REHS A Conceptual Framework to Evaluate the Outcomes and Impacts of Water Safety Plans National Center for Environmental Health Division of Emergency and Environmental Health Services

2. System Assessment Monitoring Management & Communication Water Safety Plans Health-based targets Surveillance Public health context and health outcomes WHO Framework for Safe Drinking Water

3. System Assessment Monitoring Management & Communication Water Safety Plans Health-based targets Surveillance Public health context and health outcomes

4. Purposes of a WSP Conceptual Framework Varied outcomes and impacts of WSPs Common framework and terminology Basis for the development of indicators Common understanding of the time frames Various benefits of implementing WSPs

5. Logic Models Logic Model Development Guide – WK Kellogg Foundation

6. Logic Models System Assessment Monitoring Management & Communication Water Safety Plans Health-based targets Surveillance Public health context and health outcomes Logic Model

7. WSP Conceptual Framework Inputs Water Supplier Stakeholders Champion Staff / Management Time Commitment Facilities Materials / Equipment Knowledge Political Will / Motivation Funds Water Supply Improvements Health Improvements Water Safety Plan Impacts Socioeconomic Improvements Other Environmental Factors (Sanitation, Hygiene, Food, etc.) Institutional Changes Operational Changes Financial Changes Policy Changes Feedback Activities/Outputs Outcomes Months Years Preparation System Assessment Monitoring & Evaluation Management & Communic ation Feedback & Improvement

8. WSP Conceptual Framework Inputs Water Supplier Stakeholders Champion Staff / Management Time Commitment Facilities Materials / Equipment Knowledge Political Will / Motivation Funds Water Supply Improvements Health Improvements Water Safety Plan Impacts Socioeconomic Improvements Other E nvironmental Factors (Sanitation, Hygiene, Food, etc.) Institutional Changes Operational Changes Financial Changes Policy Changes Feedback Activities/Outputs Outcomes Months Years Preparation System Assessment Monitoring & Evaluation Management & Communic ation Feedback & Improvement

9. WSP Conceptual Framework Inputs  Stakeholders and partners  Water supplier  Institutional partners  Less traditional partners  Champion  Time commitment, Facilities, Equipment  Funds  Motivation

10. WSP Conceptual Framework Inputs Water Supplier Stakeholders Champion Staff / Management Time Commitment Facilities Materials / Equipment Knowledge Political Will / Motivation Funds Water Supply Improvements Health Improvements Water Safety Plan Impacts Socioeconomic Improvements Other Environmental Factors (Sanitation, Hygiene, Food, etc.) Institutional Changes Operational Changes Financial Changes Policy Changes Feedback Activities/Outputs Outcomes Months Years Preparation System Assessment Monitoring & Evaluation Management & Communic ation Feedback & Improvement

11. WSP Conceptual Framework Activities / Outputs Motivation WSP

12. WSP Conceptual Framework Inputs Water Supplier Stakeholders Champion Staff / Management Time Commitment Facilities Materials / Equipment Knowledge Political Will / Motivation Funds Water Supply Improvements Health Improvements Water Safety Plan Impacts Socioeconomic Improvements Other Environmental Factors (Sanitation, Hygiene, Food, etc.) Institutional Changes Operational Changes Financial Changes Policy Changes Feedback Activities/Outputs Outcomes Months Years Preparation System Assessment Monitoring & Evaluation Management & Communic ation Feedback & Improvement

13. WSP Conceptual Framework Outcomes  Four Categories:  Institutional Change  Operational Change  Financial Change  Policy Change  Different time scales Institutional Changes Operational Changes Financial Changes Policy Changes

14.  Increased communication  Increased knowledge  Improved perceptions and attitudes  Increased training Institutional Changes Operational Changes Financial Changes Policy Changes Outcomes Institutional Change Gelting, 2008, unpublished WSP in Guyana brought together the water supplier and the drinking water regulator: Relations Communications Coordination of efforts

15.  Improved system infrastructure  Implementation of improved procedures Institutional Changes Operational Changes Financial Changes Policy Changes Outcomes Operational Change Mahmud et al, 2007 WSP in Bangladesh identified a need for direct ACTION by operators to: -repair damaged water source infrastructure -move sources of contamination -clean the surroundings of the water supplies

16.  Cost savings  Cost recovery  Increased donor support and investment Institutional Changes Operational Changes Financial Changes Policy Changes Outcomes Financial Change Environmental & Engineering Managers, Ltd, 2007 WSP in Jamaica: ”…Utility and government are well- prepared to implement and sustain donor-financed improvements.” “WSPs provide a new stage for funding assistance.”

17.  Informal WSP knowledge-sharing and promotion  WSP model sharing as norms of practice  WSP formal regulatory requirements Institutional Changes Operational Changes Financial Changes Policy Changes Outcomes Policy Change Environmental & Engineering Managers, Ltd, 2007 WSP in Jamaica: WSP Success WSPs as requirement in regulations 8 to 10 years

18. WSP Conceptual Framework Inputs Water Supplier Stakeholders Champion Staff / Management Time Commitment Facilities Materials / Equipment Knowledge Political Will / Motivation Funds Water Supply Improvements Health Improvements Water Safety Plan Impacts Socioeconomic Improvements Other Environmenta l Factors (Sanitation, Hygiene, Food, etc.) Institutional Changes Operational Changes Financial Changes Policy Changes Feedback Activities/Outputs Outcomes Months Years Preparation System Assessment Monitoring & Evaluation Management & Communic ation Feedback & Improvement Other E nvironmental Factors (Sanitation, Hygiene, Food, etc.)

19. WSP Conceptual Framework Inputs Water Supplier Stakeholders Champion Staff / Management Time Commitment Facilities Materials / Equipment Knowledge Political Will / Motivation Funds Water Supply Improvements Health Improvements Water Safety Plan Impacts Socioeconomic Improvements Other Environmental Factors (Sanitation, Hygiene, Food, etc.) Institutional Changes Operational Changes Financial Changes Policy Changes Feedback Activities/Outputs Outcomes Months Years Preparation System Assessment Monitoring & Evaluation Management & Communic ation Feedback & Improvement

20. 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. National Center for Environmental Health Division of Emergency and Environmental Health Services THANK YOU FOR YOUR ATTENTION!

21. Outcomes Institutional Change: Increased Knowledge and Understanding  Increased communication and collaboration  Increased knowledge and understanding  Improved perceptions and attitudes  Increased training Mahmud et al, 2007; Rand Water, 2007 WSPs in South Africa and Bangladesh showed: Increased understanding Improved ability to prevent issues Encouraged staff to share knowledge

22. Outcomes Institutional Change: Improved Perceptions and Attitudes  Increased communication and collaboration  Increased knowledge and understanding  Improved perceptions and attitudes  Increased training Howard et al, 2005; WSP in Uganda showed that initially staff were hesitant of WSP process. -WSP built upon existing practices -WSP formalized existing procedures

23. Outcomes Operational Change: Implementation of Improved Procedures  Improved system infrastructure  Implementation of improved procedures Mullenger et al, 2002 WSP in Australia identified areas for development and change in already- documented SOPs: -greater understanding -new SOPs more effective -sense of ownership

24. Outcomes Financial Change: Cost Recovery  Cost savings  Cost recovery  Increased donor support and investment Rizak, et al 2003; Bhandari, 2007; Casey, 2006; Constance, 2004; Whittington, 2002; Whittington et al, 2002; WSP Cost Recovery: Improved Service (WSP) Increased Customer Satisfaction Increased Willingness to Pay

25. Outcomes Policy Change: Informal Knowledge-sharing and Promotion of WSPs  Informal WSP knowledge-sharing and promotion  WSP model sharing as norms of practice  WSP formal regulatory requirements Howard et al, 2005 WSP in Uganda: Demonstrated Effective WSP Increased Interest from Others

26. Outcomes Policy Change: WSPs as Norms of Practice  Informal WSP knowledge-sharing and promotion  WSP model sharing as norms of practice  WSP formal regulatory requirements Mahmud et al, 2007 WSP in Bangladesh: -WSPs became well-accepted by NGOs -WSP examples and templates developed