Technical Verification for Social Acceptability Testing?

Daniele Lantagne and Rob Quick - Wednesday 17 May 2006

In reading over the great diversity of postings and information that has been sent in through this e-conference so far, there seemed to be one theme that I'd like to discuss and ask a question on.

Many people and groups have talked about the importance of social acceptability of different options, but very few people have talked about the related technical qualifications. While I completely agree that social acceptability is critical, I will argue that technical verification of the technology used is also critical - and that the two must be considered in tandem when conducting studies.

I would propose three minimum technical qualifications necessary to conduct social acceptability testing:

1) The technology must not have the potential to cause harm to the study population.

2) The technology must meet some minimum standards of proof of improvement to water quality in a laboratory setting.

3) Concurrent with social acceptability testing should be the verification that the technology is used effectively by the populations we are serving.

These may seem simple, but I'll give two specific examples of why I think perhaps we need to state them.

The first example is the Lifestraw filter, that has been mentioned in this forum. The ORIGINAL LifeStraw filters had iodine residuals that were high enough to cause health effects in a significant fraction of the population using it over a short term (email DUL4@cdc.gov for report). This is not acceptable. Having said that, several of us have been discussing these issues with LifeStraw management - and they are working on prototypes with lower iodine residuals. Further testing in the lab and the field are necessary before we feel that this technology is ready for social acceptability testing.

The second has to do with the AED study in Nepal that has been referenced here. The ceramic filters were found to be the most acceptable of the four options presented to potential users. However, treated waters in the ceramic arm of the AED study had bacterial contamination (see this e-conference web page for study results) . This leads to a very large question in my mind, which is:

Is it ethical for us to recommend something because people like it even though we don't know how effective it is?

Appropriate testing of the ceramic filters (pore size, microbiological removal efficiencies) prior to implementation in Nepal with the filters would have answered some of the deeper questions, such as: Is the failure of the filter due to its manufacture? Or due to poor hygiene in the home? With the highly quality-controlled Potters for Peace filter in Managua, we found complete removal of bacteria in the laboratory, but recontamination in finished water in the homes due to cleaning the receptacle with unfiltered water. A follow-on study found that if people were taught to clean the receptacle with filtered water, recontamination was drastically reduced.

I would also like to say that I think it's really important as well to consider social acceptability regionally. As Matthias pointed out for Central America, chlorine solution has been given away for free by health clinics for years - and thus there is resistance to paying for chlorine (even when the cost is very low at around 30 cents to treat 1,000 Liters of water) and less resistance to SODIS. I completely agree. However, in Africa and Asia - where chlorine hasn't been given away for free, the situation is very different. People are willing to pay for this technology. Cultural context and experience is key.

Social acceptability is one important piece of a larger verification process that should include laboratory and field water disinfection effectiveness, health impact, and affordability. Ultimately, to make a difference, scalability and sustainability will also need to be addressed. For large scale implementation activities, all of these factors should be considered.

Mark Sobsey and the International Network are currently working on technology verification standards for point-of-use water treatment options. These are much more developed and based on scientific review and information, and meant as an actual certification process.

Here, I am just wondering what we should establish as the minimum technical qualifications for conducting social acceptability testing - what do people think?