Water Sanitation Health

Managing water in the home

Accelerated health gains from improved water supply

Social and economic aspects

1 Educational, Behavioral and Related Socio-Cultureal Considerations for Household Water Treatment Systems

A number of studies and considerable field experiences have shown that the introduction of water treatment technology without consideration of the socio-cultural aspects of the community and without behavioral, motivational, educational and participatory activities within the community is unlikely to be successful or sustainable. Therefore, initiatives in water, hygiene and sanitation must include community participation, education and behavior modification. A number of systems have been developed and successfully implemented for this purpose. One of the most widely used and successful of these is termed PHAST, which stands for Participatory Hygiene and Sanitation Transformation (WHO, 1996). It is an adaptation of the SARAR (Self-esteem, Associative strengths, Resourcefulness, Action-planning and Responsibility) method of participatory learning. PHAST promotes health awareness and understanding among all members of a community or society in order to change hygiene and sanitation behaviors. It encourages participation, recognizes and encourages self-awareness and innate abilities, encourages group participation at the grassroots level, promotes concept-based learning as a group process and attempts to link conceptual learning to group decision-making about solutions and plans of action for change and improvement of the current situation. It encourages internally derived decisions and both material and financial investment of the community to affect change.

Current approaches to participatory education and community involvement in water and sanitation interventions apply behavioral theory and other related sciences to successfully implement control measures. The use of water treatment technologies and other water quality control measures that are consistent with prevailing beliefs and cultural practices and local resources are promoted by behavioral theory. Community involvement at all levels is important in achieving community support and sustainability for the technology. Efforts to introduce improved household water treatment and storage systems have employed health education, community mobilization, social marketing, motivational interviewing, focus groups, and other educational, promotional, communication and mobilization techniques to change behaviors, facilitate learning and elicit participation.

Another example of this approach is a program to facilitate support agencies in developing community willingness and capacity to take responsibility for their own water supplies called the MANAGE Dissemination system developed by the International Water and Sanitation Centre (IRC, 1999). The goal of the system is to facilitate achievement of community management of and decision-making for rural water supply supplies. The MANAGE Dissemination program disseminates and shares findings of entities engaged in developing and implementing community participatory action through an information network intended to enhance multi-institutional learning approaches and develop training methods and tools that facilitate and support community management of water supplies. The system employs exchange visits and other communications activities among participants who are stakeholders in the community's water supply ranging from local citizens to NGOs and their national and international partners. The MANAGE Dissemination system has been implemented in many parts of the world, including Africa (Cameroon and Kenya), the Indo-Asian region (Pakistan and Nepal and Latin America (Colombia and Guatemala).

The use of social marketing in the effort to gain acceptance and support for household water treatment and storage systems depends to some extent on the nature of the household water treatment technology and its use of marketable commodities, such as a disinfectant, other water treatment chemicals or an improved household water storage vessel. In the case of household water treatment with liquid chlorine and storage in a narrow-mouth container, social marketing of the chlorine solution became an important activity to change behavior by motivating potential users buy and use the product. (USA CDC, 2000; Thevos et al., 2000). It is likely that some previous efforts to introduce and promote similar practices of household water chlorination and safe storage in an improved vessel failed or achieved poor results because of inadequate participatory education, behavioral modification, motivational communication, social marketing and other community-based participation and responsibility.

Assessing the success of water and sanitation interventions is another important consideration. It not only provides key information about the success of the intervention but also that has been used to assess and improve water sanitation technologies and systems in developing countries is the Knowledge, Attitudes and Practices (KAP) survey. A KAP survey was used to better understand the impacts of the cholera epidemic in the Amazon region of Peru in the early 1990s and to assess the socio-cultural aspects of the cholera preventive measures that were introduced (Quick et al., 1996).

2 Economic Aspects of Household Water Treatment Processes and Systems

The affordability, costs and willingness to pay of household water treatment technologies are important considerations for their implementation, use and sustainability. All systems for household water treatment and storage require an approach for cost recovery in order to be sustainable. Approaches to cost recovery include providing all or some system components free of charge with funding provided by external sources (donors, governments, etc.), partial cost recovery by sales of some system components (e.g., sale of a household water disinfectant), recovery of all costs by sales of all system components. A phased approach to cost recovery also can be employed, with initial subsidies that decrease or stop later on or loans that must be repaid later on. Often, economic analyses reveal that the costs of prevailing water use, treatment and storage practices can be shifted to a new system of improved household water treatment and storage, if communities and consumers are made aware of the substitution, accept that is better than the existing system and thereby become willing to create an economic demand. Some water intervention initiatives have employed pricing schemes and short-term subsidies or price supports to obtain and increase consumer demand, including sales on credit, barter sales and in-kind payments (work in exchange for goods and services of the technology). The various approaches for cost recovery and financial management of household water supply systems are beyond the scope of this review. Many of the principles of financial management for more centralized water supply and sanitation systems have been described elsewhere (Cairncross et al., 1980; WHO, 1994). It is likely that these economic approaches to cost recovery and technology sustainability can be applied or adapted to the more decentralized systems for household treatment and storage of water described in this report.

The costs of various point-of-use or household water treatment and storage systems have been estimated previously. However, the cost estimates for specific technologies by different sources are not always in agreement and for some technologies cost estimates are lacking. Differences in local conditions and availability of materials also contribute to the variability and uncertainty of cost estimates for household water treatment and storage technologies. Table 17 lists the cost estimates of some of the most promising alternative household water treatments, adapted from estimates made by the USA CDC (2000).

Table 17. Cost Estimates per Household for Alternative Household Water Treatment and Storage Systems (US$)*

System Imported Items Initial cost of hardware (per capita; per household) Annual operating cost per capita and household
Boiling None None (assumes use of a cook pot) Varies with fuel price; expensive
Ceramic filter Filter candles $5; $25 $1, $5 for annual replacement
SODIS and SOLAIR (solar disinfection by UV radiation and heat) None (assumes spent bottles available) Cost of black paint for bottles or alternative dark surface (roofing) None
Solar heating (solar disinfection by heat only) Solar cooker or other solar reflector Initial cost of solar cooker or reflector & water exposure and storage vessels Replacement costs of solar reflectors and water exposure and storage vessels
UV Lamp Systems UV lamps and housings Initial cost of UV system: US$100-300), $20-60 Power (energy); lamp replacement ($10-100) every 1-3 years
On-site generated or other chlorine and narrow-mouth storage vessel ("USA CDC Safewater" system) Hypochlorite generator and associated hardware for production and bulk storage $1.60; $8.00 $0.60/$3.00 (estimated by USA CDC); costs may be higher for different sources of chlorine and for different water storage vessels
Combined coagulation-filtration and chlorination systems Chemical coagulant and chlorine mixture, as powder or tablet Use existing storage vessel or buy a special treatment and storage vessels (US$5-10 each) Chemical costs at about $US7-11 per capita per year ($35-55 per household per year, assuming about 2 liters per capita (10 liters per household)/day

*Adapted from estimates by USA CDC (2001)