Health policy and advocacy for water management in development

(Policy and advocacy activities focus on a limited number of targeted issues. These concern areas in which: (i) major policy development is planned or in discussion with potential health impacts arising from water management actions; (ii) a change in policy would yield unusually high health gains; and (iii) health gains are used to justify changes in water sanitation and hygiene actions, which are not substantiated by available evidence. Emphasis is placed on delivering outputs to major policy forums and in collaboration with other international partners, when appropriate.)

• Water for people and health
• Promotion of access to safe water supply and adequate sanitation as a major requirement to ensure a healthy life and enable the social development of the poor and unserved. Activities will focus on evidence-base policy development and are closely aligned with the millennium declaration goals.
• Water for food and health
• Water for food is important for health through food security, nutrition and effects of inappropriate water use practices. Activities will mainly focus on the inter-agency Dialogue on Water, Food and Environment. Emphasis will be on the Dialogue establishing a knowledge base. Other activities will include collaboration with the International Water Management Institute and other centres of the Consultative Group on International Agricultural Research (and, in particular, with the System-wide Initiative on Malaria and Agriculture) on the development and promotion of water management and other agricultural practices for vector-borne disease control, in close conjunction with Roll Back Malaria and the Regional Offices.
• Water and human rights
• Several soft law and hard law instruments refer to rights concerning water, but the "right to water" remains unclear. Ongoing activities aim to clarify the status of this right and to draw attention to this in appropriate forums.
• WHO contribution to Freshwater Year 2003 and the Third World Water Forum
• Planning, preparation and coordination with related institutions of the International Year of Freshwater Year (2003) and the Third World Water Forum (Kyoto, March 2003), which are major policy initiative events in the near future.
• Programme development and support
• Household water management policy analysis
• To develop a policy analysis on household water management, based on the outcome of burden of disease and cost-effectiveness studies. 

(Reliable information provides the basis for informed policy-making and decision-taking. This area of activity concerns collection and dissemination of information, including major database resources. Its objective is to ensure awareness of, and access to, high-quality information relating to: the health burden associated with water, sanitation and health; the impacts of actions in water, sanitation and hygiene upon health; concerning present state of progress and trends; and concerning major areas of activity in health protection, based on water and sanitation management is an important focus of activity.)

• Water supply and sanitation monitoring (JMP project)
• Through the WHO and UNICEF Joint Monitoring Programme (JMP), report on global status and trends in the water supply and sanitation sector; provide water supply and sanitation coverage figures for the UN system; and provide support to monitoring international targets, including millennium declaration goals.
• Sanitation Connection
• Create and manage content for Sanitation Connection. Increase awareness, usefulness and utilization of the inter-agency Sanitation Connection internet resource and oversee its ongoing development.
• Database on legislation and standards
• Development of database on water legislation and water-quality standards. The database is being developed with FAO and is intended to be made available on the internet to be readily accessible.
• Information dissemination
• Planning, coordination and implementation of the programme of information for programme-specific target groups, promoting knowledge about water, sanitation and health and of WHO activity in this; managing and supporting the public information component of Water, Sanitation and Health activities.

(Reliable information provides the basis for informed policy-making and decision-taking. Ensuring availability of high-quality information relating to the health burden associated with water, sanitation and health and the impacts of actions in water sanitation and hygiene upon health is an important focus of activity.)

• Drinking-water disease burden
• Drinking-water disease burden arising from exposure to arsenic, fluoride and nitrate/nitrite in water.
• Evaluate the environmental disease burden of several water-, sanitation- and hygiene-related diseases and assess the effectiveness of interventions concerning flies; and on disease burden arising from sewage pollution of the marine environment.
• Disease burden: vector-borne disease
• Comprehensive literature reviews on burden of disease of four vector-borne diseases in the context of water resources development and the cost-effectiveness of water management interventions (malaria, schistosomiasis, Japanese encephalitis, filariasis). Developing and testing a methodology of fractional attribution of BOD to water resources development components.
• Cost-effectiveness of water and sanitation interventions
• To complete cost-effectiveness analyses for: improved water supply and basic sanitation; disinfection of water at point-of-use; halve population without improved water supply by 2015; halve population without basic sanitation by 2015; provide piped and regulated water supply and full sanitation coverage, with partial treatment of sewage; and improve personal hygiene.
• Preparation of systematic review of the role of global movement of ballast water by ships in long-distance dispersal of viable Vibrio cholera spp.

(Infectious diseases associated with water sanitation and hygiene account for the majority of water-related disease burden and affect developing and developed countries world-wide. While some of the associated diseases are well-described, information concerning causative agents is incomplete and evidence concerning the effectiveness of control approaches and measures continues to emerge.)

• Emerging pathogens in water
• Some of the important pathogens known to be transmitted by water have only been recognized in the last 30 years and new pathogens continue to be recognized. This activity comprises a cluster of actions intended to provide synthesized information on such pathogens as they emerge and adequate information becomes available. The work also includes other "emerging issues" relating to previously unrecognized routes of exposure.
• Microbial risk assessment and management
• Microbial risk assessment provides a basis for understanding the control of a number of important water-related diseases. This activity includes a number of actions intended to foster the development and application of microbial risk assessment to the prevention and control of water-related disease.
• Microbial safety indicator systems
• Important developments have occurred in the use of different parameters and indicators in water-safety management and in detection and quantification methods. This activity seeks to critically review the actual potential applicability of alternative indicator safety systems, with an emphasis on cost-effective health protection.
• Legionella risk assessment and management
• Organize expert working group in control of Legionnaires' disease in collaboration with the PHLS; preparation of normative guidelines on Legionnaires' disease for incorporation into the WHO Guidelines on Drinking-water Quality, the WHO Guidelines for Safe Recreational Water Environments and the WHO Guide to Ship Sanitation.

Capacity building for health-care waste management

• National capacities in health-care waste management
• Conduct health-care waste management assessments, convene national workshops and develop health-care waste management national action plans.
• Pilot projects in regions and countries
• Initiate health-care waste management pilot projects in regions and countries. Develop best practices for the safe management of health-care wastes. Develop regional and national HCWM training centres.
• Cooperation with GAVI
• Collaborate with GAVI to promote safe HCWM and ensure that HCWM is considered as part of any application for GAVI funds.
• Short-term staff

(The frequency of occurrence of natural disasters and those arising from human activity has increased in recent decades. Water supplies may be directly affected (intentionally or accidentally) during emergencies and the rapid provision of minimum basic water and sanitation provision is critical in minimizing the health impacts of disasters and emergencies.) Emergencies may provide opportunity for increased transmission of water-based insect vectors.

• Water and sanitation in emergencies
• To support EHA and WHO Regional Offices matters related to natural disasters and emergencies. Preparation of guidance materials and direct assistance in the normative aspects of prevention, preparedness, relief and rehabilitation.
• Vulnerability reduction and prevention of contamination
• Development of measures for preparedness against intentional or accidental contamination of drinking-water, etc.
• Responses to priority health threats
• Support for projects to mitigate problems associated with hazardous chemical substances in drinking-water, such as arsenic and fluoride.
• Evaluation of toxic cyanobacteria.

Health impact assessment of water resources

• Biodiversity and health
• Main activities come under the Harvard/WHO/UNEP initiative on biodiversity and health, including production of a health chapter. Collaboration with Danish Bilharziasis Laboratory and WHO Regional Offices and Country Offices in the organization of regional workshops on biodiversity and health. Collaboration with IUCN in the development of a comprehensive, country-oriented action plan on wetlands, biodiversity and health.
• WWAP and WWDR report (with UNESCO)
• Inputs into the WWDR process, including a general health section, a section on health indicators in the context of water resources development and management and a health component in WWDR case studies.
• Health impact assessment of water resources development
• Develop and mobilize resources for a comprehensive proposal for the institutionalization in Africa of an HIA capacity-building programme. This will include training of trainers, problem-based training courses and national policy seminars.
• Advocacy for HIA at Regional Office level, including support in HIA guidelines formation.
• Produce and promote the Training Manual on HIA.
• Basic Water Supply and Sanitation with Regional Offices
• Support the WHO Regional Offices in activities dealing with water supply and sanitation for low-income communities. Identification of best practice materials, support to project preparation, fund-raising and project implementation.

(WHO environmental quality "guidelines" are normative products intended to inform the development of efficient and effective disease control by countries at all levels of development. They are intended primarily to assist national development of regulations and standards and are used also by practitioners in various areas.)

• Guidelines for drinking-water quality, 3^rd edition
• WHO Guidelines for Drinking-water Quality are used in countries at all levels of development. The second edition, published in 1993, superseded previous Guidelines and international standards. Actions in hand primarily concern the collation and synthesis of the relevant information base and the development of the third edition of the Guidelines.
• Guidelines for safe recreational water environments
• Guidelines for Safe Recreational-water Environments are in development, for application to coastal and freshwaters and to swimming pools, spas and similar environments. Both areas will be finalized during the 2002-2003 biennium.
• Guidelines for the safe use of wastewater and excreta in aquaculture and agriculture
• Develop guidelines and guidance material for the safe use of wastewater and excreta in agriculture, aquaculture, aquifer recharge, and related areas.
• Guidelines for sanitation on ships and aircraft
• Preparation of revised WHO Guide to Ship Sanitation.
• Preparation of revised WHO Guide to Hygiene and Sanitation in Aviation.
• Guidelines for urban environmental management for vector control; commissioning of guidelines for integrated vector management and for vector control needs assessment. Participation in the inter-cluster working group on DDT, production of a guidance document on alternatives to POPs pesticides.
• Short-term staff

(Drinking-water quality is a concern for health protection in developing and developed countries world-wide. Information on the effectiveness of control measures is not readily available for several priority hazards and for several control measures. This product brings togther a series of activities concerned with critical evaluation of the effectiveness of control measures and its dissemination.)

• Control of hazardous chemicals in drinking-water
• Preparation and publishing of UN-system-wide "synthesis report" on arsenic; monograph on fluoride; and monograph on nitrate/nitrite in drinking-water.
• Protection of source waters
• Protection of source waters is of proven effectiveness in water-quality and health protection. Critical information concerning the efficacy of measures for the protection of water sources is little available in many areas and has been under-evaluated from a health perspective. Preparation of guidance, based on critical review of available evidence, is under way.
• Quality control in drinking-water supplies
• Coordination of preparation of guidance concerning: materials and chemicals used in the production and distribution of drinking-water; desalination; and on monitoring and assessment of drinking-water supply and quality.
• Guidance on household water treatment and storage
• Development of guidance on good practice in household water treatment and storage.
• Short-term staff

Tools and good practice in health-care waste management

• Decision-making guide for primary health-care centres
• Develop a decision-making guide on HCWM for primary health-care centres in less-developed countries. Incorporate comments into draft document and create easy-reference HCW treatment guide.
• Technical guidance on treatment (including blood disposal)
• Develop good practice guidelines for the safe handling and ultimate disposal of blood.
• Support for application of guidance
• Support for application of HCWM guidance, including development and updating of the HCWM website.

General management and administration of WSH programme

• Communications
• To incorporate expenditures for office communications, such as fax and mailing.
• Informatics support and hardware
• For expenditures linked to any information technology/computer services required, as well as purchase of computer software and hardware. Obligations to be raised if and when special purchases/contracts required.
• Miscellaneous support and coded articles
• To cover expenditures for all miscellaneous office purchases, such as coded articles (e.g. transparencies), general books (those not related to specific workplans).
• Programme Support Costs
• Ad hoc cost-shares for previous workplans