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Back To Vidyya World Water Day – 22 March 2001:

Water – Immediate Solutions For Persistent Problems

More than one billion people drink unsafe water and 2.4 billion, 40% of the human race are without adequate sanitation, and 3.4 million people, mostly children, die every year of water-related diseases (more than one million from malaria alone), the majority of them unnecessarily.

But the picture is neither gloomy nor hopeless, says the World Health Organization (WHO) in a report on water and sanitation released here on the eve of World Water Day, Thursday, 22 March.

"Clearly, a problem of this magnitude cannot be solved overnight, but simple, inexpensive measures, both individual and collective, are available that will provide clean water for millions and millions of people in developing countries – now, not in 10 or 20 years," said Dr. Gro Harlem Brundtland, Director-General of WHO. "We do not have the luxury of waiting around for large infrastructure investments to provide water supplies and basic sanitation services for all who need them. It makes no sense, and it is not acceptable, to ignore the immediate priorities of the most needy."

Optimistic but realistic, the WHO report, entitled "Water for Health – Taking Charge", strongly urges several basic measures, including purifying water (chlorination and sodis), and improving hygiene, as immediate means of improving people’s water supply in developing countries.

Chlorination, for example, is "a proven means of ridding water of disease-causing microorganisms in piped water," according to the report.

Moreover, research carried out at the Centers for Disease Control and Prevention in Atlanta, Georgia, and by the Pan American Health Organization, supports chlorination in households without piped water, even though the prevailing wisdom is that chlorination should follow and not precede the creation of water and sanitation services.

"We looked at how chlorinated water could be provided to poor households through a simple, low-cost treatment and secure storage method," says Mark Sobsey, Professor of Environmental Microbiology at the University of North Carolina in Chapel Hill. "One of our findings is that improving water quality alone does work and we can do this without improving sanitation.

"What we know now is that even in conditions of very poor sanitation and hygiene, where people are collecting whatever water is available to use for their household water supply, if the water is chlorinated, the water is improved microbiologically, and you can find statistically significant decreases in diarrhoeal disease."

A good example of successful chlorination is to be found in the Maldives where a national control programme used it in wells and in oral rehydration salts against diarrhoea. Rainwater was also collected for drinking. Twenty years after the programme started, all of the Maldives islands have their own community rainwater collection tanks, and deaths from diarrhoea are virtually unknown.

"Another easy, small-scale, cost-effective, immediate technique for providing safe water, individually or collectively, is a still little-known but highly effective solar thermal technique. It is called SODIS and was promoted by the Swiss Federal Institute for Environmental Science and Technology near Zurich," said Dr Jamie Bartram, Coordinator of WHO’s Water, Sanitation and Health Programme, which issued the report.

"SODIS, or solar water disinfection, is a nearly cost-free system because sunlight costs nothing, and the only other elements are throw-away plastic soft-drink bottles and a black surface," explains Martin Wegelin, a researcher at the Swiss Institute for Environmental Science & Technology.

Transparent bottles are filled with water and placed horizontally on a flat surface for about five hours. The illness-causing microorganisms (pathogens) in the polluted water succumb to the killing effect of the ultraviolet light in solar radiation. The process is enhanced when the solar water disinfection is combined with a "solar thermal water treatment" which makes use of the fact that the colour black absorbs light. This is accomplished by painting the bottom half of the bottle black or placing it on black-painted corrugated iron or plastic sheets.

"Field studies in Bolivia, Burkina Faso, China, Colombia, Indonesia, Thailand and Togo," the report states, "show that the process works."

A third recommendation of the report calls for "changing behaviour."

"Our research shows that washing with hand soap would probably sharply reduce deaths from diarrhoeal disease," asserted Valerie Curtis, a lecturer in hygiene promotion at the London School of Hygiene and Tropical Medicine. "All it requires is soap and motivation. But that’s more easily said than done."

A three-year study in India, West Africa, the UK and The Netherlands proved that the traditional "scolding, moralistic" approach to changing behaviour doesn’t work. People turn off if they are warned, "You’ll get sick or die if you don’t change your filthy ways." Ms. Curtis says that Brazilians refused to cooperate in a cholera prevention programme because they thought they were being accused of being "filthy dogs". "We used a positive motivation approach in a three-year project in Bobo-Dioulasso, Burkina Faso, and at the end they had tripled their use of soap." Studies of diarrhoea show that the simple act of washing one’s hands with soap and water reduces incidence of the disease by 35%.

Elsewhere, good water management has almost eradicated guinea worm, a disfiguring, disabling disease which afflicted 50 million people in Africa and Asia in the mid-1900s. By 1999 that number had fallen to below 100’000.

But poor irrigation water management, in sharp contrast, has led to a huge spread of schistosomiasis (snail fever) to areas of the world where it never existed before. An estimated 200 million people are infected today with schistosomiasis, according to WHO.

What should be done differently to prevent water-related diseases and to ensure that everyone has access to at least some safe water and sanitation?

For one thing, says the WHO report, the health sector must get fully involved in water management. It can no longer be left to water management authorities or to environmental ministries. Just as major development projects always have environmental impact assessment, they should also require health impact assessments. Those involved in water management have to be responsible for its effects on people’s health. During the past 50 years there has been a strong emphasis on medical interventions including for example, drug use and this has tended to reduce the attention and priority given to safe water supply and adequate sanitation into the back seat. With the growing resistance to antibiotics, insecticides and standard drugs, health authorities now understand the limitations of a strictly medical approach. That makes safe water and sanitation more important than ever.

"Society generally looks at the contribution of development to health. The contribution of health to development has been largely ignored. It is time to reverse this way of looking at things. And it is high time to recognize safe water supply and adequate sanitation to protect health are among the basic human rights," said Dr Brundtland.

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Editor: Susan K. Boyer, RN
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