WHO/Lars Møller
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Addressing sanitation challenges in the European Region

Sanitation is defined as access to and use of facilities and services for the safe disposal of human urine and faeces. Access to safely managed sanitation plays a crucial role in protecting public health and in reducing the global infectious disease burden.

In the WHO European Region, sanitation still poses various challenges, giving rise to the spread of disease and broader impacts on well-being.

  • More than 300 000 people still practice open defecation.
  • More than 36 million people lack access to basic sanitation services on premises, as well as in institutional settings, such as schools and health care facilities.
  • The release of untreated urban wastewater to the environment damages water ecosystems and exposes local communities to pollution.
  • Inequalities in access to basic sanitation services persist, especially between rural and urban areas, rich and poor communities, and disadvantaged and general populations.

Addressing sanitation challenges remains a high priority in the Region. While closing the sanitation gap in the Region requires significant public investment, this is cost-effective: US$ 1 spent on improving sanitation brings a return of US$ 5 by keeping people healthy and productive.

WHO promotes the sanitation safety plan (SSP) approach in support to country efforts towards achieving Sustainable Development Goal (SDG) target 6.2 on providing access to adequate and equitable sanitation and hygiene for all by 2030. The SSP approach is a means to manage systematically health risks along the entire sanitation chain, from collection of human waste to disposal or reuse of wastewater. It is a tool based on risk-based principles, which aims to ensure safely managed sanitation services. Key steps in SSP development include:

  • description of the sanitation system;
  • identification of hazards and hazardous events, and the assessment of associated health risks;
  • development and implementation of an incremental improvement plan to mitigate the identified risks;
  • establishment of effective control measures and monitoring of their performance;
  • regular review of the risk assessment and management plans.

The SSP approach supports the implementation of WHO’s “Guidelines on sanitation and health” (2018) and “Guidelines for the safe use of wastewater, excreta and greywater” (2006). The Declaration of the Sixth Ministerial Conference on Environment and Health and the Protocol on Water and Health promote the adoption of the SSP approach in policies, regulations and practice across the Region.

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Strengthening drinking-water, wastewater and water-related disease surveillance

Strengthening drinking-water, wastewater and water-related disease surveillance

WHO Charles Ndwiga
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Overview

Surveillance is the ongoing systematic collection, analysis and interpretation of health-related data for planning, implementing and evaluating public health policies and practices. In accordance with the International Health Regulations (IHR), all WHO Member States are required to strengthen and maintain core public health capacities for surveillance and response.

WHO/Europe supports Member States in strengthening their capacity to:

• implement risk-based approaches in surveillance of drinking-water;
• monitor water-related disease incidents and manage outbreaks effectively;
• conduct environmental surveillance of disease agents in wastewater.

WHO/Europe produces technical guidance, tools and training materials on these topics and conducts country-specific sub-regional capacity building. The Protocol on Water and Health, a legally binding instrument for the WHO European Region supported by WHO/Europe and UNECE, provides a key implementation mechanism for these activities. They also strategically align with and support the implementation of IHR requirements, as well as the goals and targets of the 2030 Agenda for Sustainable Development related to water, sanitation and health.

Drinking-water surveillance

Drinking-water surveillance is a core public health function and an integral component of the framework for safe drinking-water recommended by the WHO Guidelines for drinking-water quality. It is fundamental for the delivery of safe drinking-water and protection of public health by promoting the improvement of quality, quantity, accessibility, reliability, affordability and continuity of drinking-water supplies. Risk-based drinking-water surveillance is considered best practice as it supports the development of appropriate and efficient monitoring programmes for individual supplies. It also aids prediction and identification of long-term changes and associated risks for drinking-water supply.

Surveillance and outbreak management of water-related diseases

The Protocol on Water and Health requires its parties to establish, improve or maintain comprehensive surveillance and early warning systems for water-related diseases and prepare comprehensive contingency plans for responses to outbreaks. Building blocks in strengthening such systems include a sound legal and regulatory framework that defines clear responsibilities and procedures for surveillance and outbreak management, adequate resources and infrastructure, and ongoing professional development programmes at all levels.

Environmental surveillance of disease agents in wastewater

Environmental surveillance of pathogens and contaminants in wastewater has proven effective in providing important information on the risks to health at the population level. Wastewater surveillance is not a standalone surveillance approach, but can be employed as a complementary and integral part of public health surveillance. Given its multiple benefits and successful applications in different contexts (e.g. poliovirus, COVID-19 virus, antimicrobial resistance), the development of such monitoring programmes can be of added value in detecting and tracking disease in communities and thus providing important information that facilitates public health decision-making and measures.