Safer Water, Better Health

(WHO Publication 2008)

Deaths (000) Attributable to Water, Sanitation and Hygiene, By Cause and WHO Member State, 2002

Disease or injury
Population (000)

India
1 049 550

Total deaths
Total WSH-related

10 378.5
782

% of total deaths 7.5% DALYS (000) Attributable to Water, Sanitation and Hygiene, By Cause and WHO Member State, 2002 Total DALYs Total WSH-related % of total DALYs 299 909.8 28 213.3 9.4%

Why we need to review our approach

In India like many other countries waterborne illness still occurs Outbreaks show us that we cannot solely rely on water treatment indicators End-point testing is too-little-too-late

Start Up Activities
Initial meetings/workshops with Ministry of Urban Development, CPHEEO, BWS&SB, HMWS&SB and other partners in 2004 : jointly by USEPA and WHO. September 2004: Workshop for strengthening Drinking Water Quality Surveillance programme involving five Ministries, ten research agencies and ten selected water boards/ PHEDs. March 2005: Workshop to introduce the concept of WSP, Development of Directory of DWQ Labs., Development of Manuals for Lab. Practitioners.

What made Water Safety Plan Acceptable?

Since WSPs are a risk management tool to prevent the contamination of drinking water before it occurs, WS Managers accepted the concept.

Some basic questions to build a WSP

1. What are the hazards to safe drinking water? 2. How will these hazards be controlled? 3. How will the control for the hazard be monitored? 4. What actions must be taken to restore control? 5. How can the effectiveness of the system be verified?

Interrelation of the chapters of the Guidelines for Drinking water Quality in ensuring drinking water safety
Introduction
(Chapter 1)

The guideline requirements (Chapter 2)

SUPPORTING INFORMATION Microbial aspects (Chapters 7 and 11) Chemical aspects (Chapters 8 and 12) Radiological aspects (Chapter 9) Acceptability aspects (Chapter 10)

FRAMEWORK FOR SAFE DRINKING WATER

Health-based targets
(Chapter 3)

Public health context and health outcome

Water Safety Plans

(Chapter 4)
System assessment Monitoring Management and communication

Surveillance
(Chapter 5)

Application of the Guidelines in specific circumstances (Chapter 6)

Large buildings, Emergencies and disasters, Travellers, Desalination systems, Packaged drinking water, Food production, Planes and ships

Water Safety Plan

A WSP comprises, as a minimum, the three essential actions that are the responsibility of the drinking water supplier in order to ensure that drinking water is safe. These are: a system assessment; effective operational monitoring; and management

WHOs Response

Moving away from reliance on output monitoring- i.e. measuring para-metres in final water More input monitoring- i.e. measuring para-metres showing that the system is working Priority focus on microbial hazards Short- term chemical changes and exposures Catchment-to-consumer (farm-to-fork) Multiple barrier approach HACCP Reality check on todays water supply situations

What are the benefits to doing a Water Safety Plan?

Significant cost savings: allows more effective, targeted investments in infrastructure for maximum benefit Health benefits: improved water quality and reduced incidence of illness and disease Cutting edge approach and best practice for securing water safety

Aspects of collaboration
Partnerships amongst GOI, State Water Boards, WHO, USEPA and NEERI Objective of collaboration is to demonstrate riskbased management of urban water supply systems, including following 3 activities:
Laboratory strengthening Water safety plan demonstration Water treatment plant optimization

Laboratory Strengthening
Collaboration between NEERI, NICD, WHO, and Ministry of Health and Family Welfare to develop laboratory manual Manual peer reviewed and published in 2007. Training offered to participants from Hyderabad and Pune based on manual

Development of Directory of Water Quality Testing Laboratories.

Development of Support Documents for DWQ Laboratories

1. Directory of Drinking Water Quality Test Laboratories.

2. Guidance Manual for Drinking Water Quality Monitoring and Assessment.

www.whoindia.org/sde/water_snitation/water/water_quality/

WSP Demonstration Projects in Hyderabad

Three Locations
Adikmet area 24X7 water supply maintained by HMWS&SB. Comparatively new system.

Serilingampally area- Bulk supply by HMWS&SB augmented by ground water sources. Maintained by Local Body.
Moin Bagh area Old city, narrow lanes, intermittent water supply maintained by MHWS&SB. Old system.

Steps adapted for the Development of WSP: Hyderabad

Forming WSP steering group Review of existing data / System / Description / Zoning

Development of tools Analytical training

System Assessment / Validation of Tools

Establish Vulnerability / Hazard Matrix & Map

Development of Risk Maps

Verification and Refinement of WSP

Health-Based Targets for DWS Objectives

The overall objective of the study is to conduct a risk assessment in each of the three project sites that would provide baseline data for establishing health based targets to guide and evaluate the implementation of the WSPs in these sites. Specifically, in each of the project areas, the study aims to:
Estimate incidence of acute gastroenteritis (GE) Estimate intra-household and distribution point prevalence of drinking water contamination Assess relative risk relationship between exposure factors (drinking water and hygiene practices and water quality) and health outcomes Assess socioeconomic determinants influencing exposure to risks and disease burden

Incidence of Acute Gastroenteritis

Area
Adikmet Moinbagh Serilingampally Total

Slum
5 45 27 77 896 1320 796 3012 5.58 34.09 33.92 25.56

Non Slum
5 32 23 60 1511 1343 1493 4347 3.31 23.83 15.41 13.80

Total
10 77 50 137 2407 2663 2289 7359 4.15 28.91 21.84 18.62

GE Cases (Last Seven Days)

Population Covered
Adikmet Moinbagh Serilingampally Total Adikmet Moinbagh Serilingampally Overall

Incidence Rate of GE Per 1000

IRA - WDS
IRA : Integrated Risk Assessment WDS : Water Distribution System IRA-WDS is based on a risk-based modeling approach that assesses the risk associated with contaminant intrusion into water distribution system during non-supply hours. This is a GIS based decision support system that predicts the risk associated with contaminated water entering WDS from surrounding surface foul water bodies, sewer pipes, drains and ditches

Components of IRA - WDS

Contaminant Ingress System Pipe condition Assessment Model Risk Assessment Model

GIS integration

Estimation of seepage envelopes due to pollution sources (contamination zone) Estimation of contaminant zone in water distribution network (intersection of seepage envelopes with distribution network)

Ingress Model
Length of contamination pipe or SPCZ Contaminant concentration along SPCZ

Simulation of contaminant concentration at contaminant zone

Pipe condition assessment model Condition of contaminated pipe

Risk Assessment Model Risk Assessment Model Risk Analysis

 ADD a slide on data to be collected from Abhas slide.

Contaminated Zones in WDS of Adikmet

Risk Mapping of WS Network in Adikmet

Risk Rank 2 3

Risk Classification Very High High

Risk Index 0.3 0.45- 0.54

No. of Pipes 3 17

Percentage (%) 0.32 1.83

4
5

Medium
Low

0.63- 0.82
0.86- 1.0

490
418

52.8
45.04

Findings
Risk Assessment Very High Risk : 3 Pipes (1975) High Risk : 17 Pipes (1975 and 1996) Medium : 490 Pipes (1975, 1978 & 1996) Low : 418 Pipes (1975, 1996 & 2005) Condition of Pipes Very Bad : 3 Pipes (1975) Bad : 15 Pipes (1975) Medium : 293 (1975, 1978, 1996) Good : 327 (1975, 1996) Very Good : 290 (1996 and 2005)

Verification point 1
Back side of Batkama Kunta Sewer Crossing

Water Sample Collected on Feb 13, 08 No Contamination detected

Sewer Line

Water Supply

High Risk due to Bad Pipe Condition

Legend
RISKRANK
2 3 4 5

Road

Risk Rank

Risk Class

PCA Rank

PCA Class

Install ation Year 1975 1996 1996

Materi al

Press ure Kg/c m2) Low Low Low

Leaka ge (lps) 1.2 0.3 0.1

Bedding Conditio n Poor Good Good

Workman ship

Traffic

Contam inant Conc 0 0 0

2 4 5

High Medium Low

1 4 5

V.Bad Good V.Good

RCC CI CI

Poor Good Good

Busy Medium Quiet

Contaminated Pipe at DMA-II

Sewer Crossing WS line

Physical verification required for contamination due to sewer

Sewer Crossing WS Line

Contaminant Ingress 1 : Contaminant Concentration

 Add slide on CCP

Steps completed in Hyderabad

Regional workshop introducing participants to WSPs completed May 2006 Workshop brought together participants from Sri Lanka, Bangladesh, Nepal, in addition to the Chennai, Delhi, and Pune to build a network of regional water safety professionals Formation of Steering Committee and three task forces for three zones. Engagement of NEERI for documentation and provide technical support for Risk assessment. Study for Assessing acute Gastroenteritis risks associated with water quality and sanitation facilities in the three zones. Field level data collection for the water systems, sanitation, drainage, soil, groundwater, contour maps, land use plan etc. in three zones. GIS mapping Completed model treatment plant audit, to be expanded to two additional cities and additional water treatment plants.

Other Uses of WSP

WSP may be used as a tool for better management of water supply systems. This not only helps in identifying the risk areas, it could also be used for:
1. Identifying losses in the system including unaccounted for water/ revenue loss. 2. Investment planning by pinpointing very high risk and moderate risk areas. 3. Focusing the WQ monitoring locations and taking up corrective measures

Agencies Involved in the development of Training Module

Engineering Staff College of India, Hyderabad Hyderabad Metro Water Supply and Sewerage Board (HMWS&SB) NEERI- Nagpur, Mumbai and Hyderabad Department of Health, Government of Andhra Pradesh Institute of Health System, Hyderabad WHO India Country Office

Training Material for Water Safety Plan in Urban Areas Target Group
Participants
Water Supply Managers, Public Health Engineers, Scientist involved in Water Supply Maintenance, Water Supply Policy Makers

Duration
4 Days

Location (present)
Engineering Staff College of India, Gachi Bowli, Hyderabad 500 032

Topics to be covered in the training for WSPUrban Areas

Topics to be covered
Day 1 1st Session 2nd Session 3rd & 4th Sessions Introduction to WSP Risk Analysis Water Sanitation & Health Hazards

Duration Presented By
1 hrs 1 hrs 1 hrs each ESCI WHO IHS (Dr George) Department of Health, Government of A.P. (Dr Sailaja) HMWS&SB (Mr Narsappa)

Day 2

5th Session

Case Studies, Hyderabad

1 hrs

6th Session
7th Session 8th Session Day 3 Field Visit

Data Collection for WSP, CCP Concept

Introduction to GIS Applications in WSP, Data Maping etc. Development of CCP in other areas Adikmet Zone Moin Bagh Serilingampally Development of WSP and its planning Integration and interepretation Feedback and Valedictory

1 hrs
1 hrs 1 hrs day 1 Day

NEERI (Dr Ravinder Kumar)

NEERI (Dr Aabha Sargaokar) NEERI (Dr Rakesh) ESCI/HMWS&SB (GMs) & NEERI HMWS&SB (Mr Narsappa)

Day 4

9th Session 10th Session

1 hrs 1 hrs

Development of Training Material for Water Safety Plan in Urban Areas Day 1
Topics Covered
Introduction to WSP
What is WSP? How this is useful for strengthening water quality surveillance programme? What are the main principles behind WSP?

Presented By
ESCI

Risk Analysis
What is a Risk Factor? How the concept of HACCP applied in WSP? What are the methods of applying the Risk Factors? How to determine the Risk Factor? What are the major Risk Factors? Sanitary Survey

WHO (Mr. A.K.Sengupta)

Water Sanitation & Health Hazards

Water supply and environmental sanitation and its linkages with health. How this was done in case of WSP programme in Hyderabad? What is acute GE diseases and risk associated with it in the three zones? What are environmental factors we are looking for? What are the linkages between inadequate water and sanitation with health and epidemiological studies?

Institute of Health Systems (Dr George) & Department of Health, Govt of A.P (Dr Sailaja)

Development of Training Material for Water Safety Plan in Urban Areas Day 2
Topics Covered Presented By
Case Studies, Hyderabad HMWS&SB Description of Hyderabad Metro Water Supply & Sewerage Board (Mr Narsappa) and Why they have adapted the concept of WSP in the three areas in the city. How the three zones got selected? Special features about the three zones. What we expect to achieve? How WSP was initiated in Hyderabad? Formation of Team Data Collection for WSP, CCP Concept NEERI What data need to be collected for WSP? Significance of these (Mr Ravinder Kumar data. What are the problems in getting this data? Where to get Rao/ Ms. Dhage) these data? How these were collected in the field? Introduction to GIS Applications in WSP, Data Maping etc NEERI How these data gets used in the development of WSP? What is (Dr Aabha Sargaokar) GIS and How this is in use? How this programme gets developed and interpreted? The significance of these results in determining the risks? Interpretation of risks. Solution of the problem Development of CCP in other areas NEERI (Dr Rakesh/ Ms Dhage)

Development of Training Material for Water Safety Plan in Urban Areas Day 3
Topics Covered Presented By
ESCI/HMWS&SB (GMs) & NEERI

Field Visit

Adikmet Zone Moin Bagh Serilingampally

Development of Training Material for Water Safety Plan in Urban Areas Day 4
Topics Covered Development of WSP and its planning Integration and Interpretation
Feedback from the Group on Field visit Certificate distribution and Concluding session

Presented By
HMWS&SB) (Mr Narsappa)

Partners signed on to the Collaborative Effort State Agencies Federal Agencies

MoH&FW/ NICD MoUD/ CPHEEO RGNDWM MoWR/ CGWB MoE&F/ CPCB CSIR/ NEERI
AGENCIES USEPA/ USAID UNICEF World Bank WSP WHO

HMWS&SB DoH, GoAP IPM, GoAP EPTRI, GoAP Institute of Health System Hyderabad Mun. Corp. Serillingampally Mun. Delhi Jal Board Pune Municipal Corp. ASCI NGOs

Opportunities to share lessons

NEERI, as coordinator, will be documenting entire process Opportunity to share lessons learned in other urban systems (expanding risk assessment tools to assist water utilities with management). Opportunity to share guidance documents generated as a result of activity with interested cities. Training Programme for WSP.

 Add States/ Urban Bodies showing interest in WSP

Conclusion
WSPs protect from contamination from catchments to consumer WSPs are comprehensive management strategies to prevent outbreak of disease WSPs assist water boards with making targeted investments for maximum benefit
*picture courtesy HMWS & SB

Thank you.