Theme 2: NEWAH Case

Theme 2: How do programs promote HWTS and ensure that the government continues to supply improved drinking water sources?

by Ratan Budhathoki, Laxmi Paudyal & Santosh Basnet

Nepal Water for Health (NEWAH)

Kathmandu , Nepal

Introduction

Poor hygiene and sanitation are responsible for 70 percent of diseases among children in Nepal. Annually 10 million episodes of diarrhea occur among children under five resulting in approximately 15,000 child deaths (Unicef 2004).

Nepal Water for Health (NEWAH) is a Nepali NGO headquartered in Kathmandu with offices the five development regions. Through partnership with other Nepali NGOs and CBOs, NEWAH supports the construction of drinking water supply systems and sanitation facilities in the rural areas.

Nepal is located in between the two most populous countries of the world: India to the east, south, west and China to the north. The current population of this land-locked country is estimated at 25.3 million with an annual growth rate of 2.2 percent. Thirty-one percent of the population is below the poverty line. Rural population is currently at about 85 percent, though urban and peri-urban areas are growing quickly, giving rise to slums and urban poor (CBS 2005).

Water and Sanitation services

Safe drinking water is vital to life but is not available for many people in Nepal. According to the Tenth Plan (2003-2007), by 2007, Nepal aims to provide 85 percent of the population with access to basic water supply and 50 percent to sanitation services. People (primarily women) in many rural areas spend 2 to 4 hours a day to collect the required quantity of water for their family.

The target spelled out by the Rural Water Supply and Sanitation National Policy 2004 is to provide a hundred percent coverage of both water supply and sanitation by the year 2017. It plans to renovate, rehabilitate, improve and expand existing water supply systems and to increase the quality of services (Sharma S. & Adhikari P, 2005).

Water quality issues

Arsenic, iron, lime incrustation and presence of coliform in the water are the main contaminants that compromise water quality. Numerous efforts have been made to mitigate the negative impact and improve the water quality standard. However, the poorest groups usually are the last to be served.

People living in hilly areas get water through gravity flow piped water systems, protected springs and rain water harvesting. In the Terai, the plains, communities use shallow tube wells, deep tube wells and hand dug wells to collect groundwater. Piped water is considered a safe water source as it is delivered by improving and protecting the water (spring) source that people trust to be safe. According to Nepal Living Standard Survey report 2003/ 04, 14 percent of households in Nepal have water piped to the house, 30 percent have piped water piped outside the house, and 56 percent of households depend on wells and other sources.

Role of government in safe water supply

Regarding the drinking water supply project implementation, the rural water supply and sanitation policy 2004 mentions that "capacity of the local bodies, user committees and non – governmental organizations will be enhanced to work as per the decentralized approach that will help minimize the government's direct involvement in the implementation of water supply and sanitation projects." It states "HMG and local bodies will play the role of regulating, monitoring and facilitating the implementation of the projects". Regarding water quality aspect, the policy spells out "the system for regular monitoring and evaluation by the users at local level of micro-organisms and chemical and physical elements present in the water distributed to the community will be developed to maintain the quality of water".

Highlight of the issues involved

Community management is key to all rural water supply and sanitation programmes/projects. Most programme implementation requires users or community involvement from scheme selection and planning to implementation and much beyond. The community—not the supporting organization—operates and maintains the water supply schemes.

NEWAH provides health and hygiene promotion as an integral component of water supply and sanitation projects to establish a link in people's minds about disease and unhygienic practices, and to provide information about what constitutes hygienic behaviour. The key subjects are:

• Safe disposal of excreta preferably through construction of household latrine
• Hand washing at 5 critical times
• Disposal and use of waste water (link with kitchen gardening promotion)
• Safe water from source to mouth
• Food hygiene – protection by covering and use of dish drying rack
• Attention to domestic and environmental hygiene – proper disposal of household refuse and housing of domestic animals
• Knowledge of paths of infection and treatment of diarrhea and oral dehydration therapy.

The methods used in delivering the hygiene promotion classes include series of simple pictorial messages about the most effective primary and secondary physical and behavioural barriers to the transmission of pathogens via faeces. Singing, dancing, role-play, puppets show, games, story telling, video show, demonstrations and practical exercises are used to help participants from the community easily understand the information.

Household water treatment and storage (HWTS)

NEWAH does not directly promote household water treatment. It focuses on safe storage and safe handling of water from source to mouth. NEWAH believes that focusing on point of use water treatment alone is not enough. It stresses that HWTS promotion should go together with protecting the source and systems and promoting water handling, proper latrine use and hand washing. Thus NEWAH-supported water supply systems give major priority to making water safe at source.

Drinking water handling starts at the water source and ends when the water enters the mouth. NEWAH encourages users to clean the water vessel before collecting water, to cover water vessels in households, to keep water vessels high enough so that children and animals cannot contaminate it. NEWAH also carries out arsenic and iron testing in tube wells and coli form tests from streams in the hills. It promotes using chlorine at the source and in storage tanks to prevent biological contamination. NEWAH also raises awareness about boiling water as a treatment option, but uptake of this method depends on users’ perceptions and understanding about the importance and effectiveness of boiling.

Examples from experience

Another Nepali organization, ENPHO, has researched, developed and promoted household drinking water treatment techniques.For example, in collaboration with other research institutions, EHPHO has developed and promoted the Kanchan filter, hypochlorite solution (Piyush) and SODIS. http://www.enpho.org/water_treatment.htm

NEWAH promotes Kanchan filters only in arsenic prone areas. These filters are seen as effective to reduce the arsenic concentration, iron content and coliform. As per NEWAH’s experience the practical problem related to this filter is that the community do not maintain the filter properly, since users must change the nails, sand, gravel and maintain the bucket and fittings frequently.

None the less NEWAH is willing to promote the use of Kanchan filter, test colloidal silver filter (promoted by international development enterprises – IDE) and pilot other new products that would assist households to manage their drinking water safely and reduce burdens from diarrheal diseases. NEWAH wants to identify the ways of reducing the cost, ensuring its sustainability and make these products more user-friendly. In addition to this, new products that are cost effective and easily maintained, should be accessible to remote villages.

Stimulating questions to provoke discussion

While donors, governments and implementers work towards the millennium development goal ofproviding access to improved water supply by 2015[1], many households currently depend on water supplies of inadequate quality and limited access. Even households with adequate access to safe drinking water engage in practices that bring about ‘secondary contamination’ of water.

1. Does promoting household water treatment and safe storage allow the government to shift the responsibility to individuals to finance their own safe water?

1. How can implementers promote water treatment and safe storage without reflecting negatively on existing water sources, which may or may not be safe to drink?

1. Can organizations working to improve access to water also promote HWTS without sending a confusing and conflicting message to their communities?

This e-dialogue will address these key questions, and work to identify successful program strategies for advancing on both government provision of safe water and household treatment and safe storage.

[1] The Millennium Development Goals define access as 30 minutes or less to go, collect water and return home.