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Preferences of arsenic mitigation options in Bangladesh: Stakeholder and end user perspectives ABSTRACT Despite access to arsenic mitigation options millions of people drink arsenic-contaminated water. Discrepancies between stakeholders’ and end users’ preferences of mitigation options may be a reason for slow mitigation progress. We aimed at identifying the most preferred options by comparing both stakeholders’ and end users’ preferences. Results suggest installing the most preferred options - deep tubewells, well-sharing and piped water supply - with greater priority. INTRODUCTION Arsenic mitigation in Bangladesh Tubewell screening program (2000-06): tested over half (app. 5 millions) of the wells (Johnston and Sarker, 2007). National policy and implementation plan (2004): Developed variety of arsenic mitigation options 2000- 09: >160’000 arsenic mitigation options were installed (UNICEF, 2010). Arsenic as a public health threat Arsenic contamination of drinking water is a global public health crisis (Naujokas et al., 2013). Bangladesh: >20 million people are still at risk of drinking arsenic-contaminated water (Flanagan et al., 2012). Health effects: arsenicosis Figure 1: Skin lesions Mohammad Mojahidul Hossain a, b , Hans-Joachim Mosler a , Jennifer Inauen c a Eawag: Swiss Federal Institute of Aquatic Science and Technology, Switzerland b Christian Commission for Development in Bangladesh (CCDB), Bangladesh c Department of Psychology, University of Zurich, Switzerland Contact: [email protected] Figure 2: other chronic diseases Figure 3: Death 42,700 - 56,400 deaths per year (Flanagan et al., 2012) Using of arsenic mitigation options Still many installed mitigation options are not maintained or used regularly (Inauen et al., 2013). 0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00% Overall Household filter Piped water… Community filter Well-sharing Deep tubewell Pond sand filter Dug well Rainwater… 62.10% 92.90% 85.60% 73.60% 71.20% 54.00% 51.60% 48.40% 36.60% 37.90% 7.10% 14.40% 26.40% 28.80% 46.00% 48.40% 51.60% 63.40% users non-users Figure 12: using of arsenic mitigation options (Inauen et al., 2013) Preferences of arsenic mitigation options End users preferences influenced by: Technical factor (e.g., water quality) Socio-cultural factors (e.g., religious barriers) National policy and plan: prioritized surface over ground water options. Best mitigation option(s): ongoing debate among stakeholders Slow progress: peoples’ preferences are neglected Research questions (1)Which mitigation option(s) are preferred by both? (2)What advantages and disadvantages do both perceive for each option? END users surveys Two cross-sectional surveys: Study -1: November 2009 Study -2: December 2010 Total sample size 1268 households: Study 1: N=872 Study 2: N=396 Study locations: six arsenic-affected districts of Bangladesh Study participants: Randomly selected households Risk of drinking arsenic-contaminated water Access to arsenic-safe water option(s) Face-to-face interviews: Structured questionnaire, qualitative questions Stakeholder interviews Qualitative interviews: August 2008 Total sample size: N= 22 representatives of stakeholders Study locations: Dhaka and other locations in Bangladesh Selection of stakeholders: purposefully from different levels by their importance, agreement and availability Interviews: Semi-structured personal interviews Most available arsenic mitigation options Figure 4: Household filters Figure 5: Communityfilter Figure 6: Rainwater Harvesting Figure 9: Piped water supply Figure 7: Pond sand filter Figure 8: Dugwell Figure 10: Deep tubewell Figure 11: Arsenic-safe shallow tubewell METHODS RESULTS Preferences of arsenic mitigation options 27.3 22.7 13.6 13.6 9.1 4.5 Piped water supply Deep tubewells Pond sand filters Rainwater harvesting Dug wells Arsenic removal filters Figure 13: Stakeholders’ preferences (%) 26.42 15 10.3 9.2 8.8 8.4 8.2 6.38 Deep tubewells Well-sharing Household filters Community filters Piped water supply Pond sand filters Rainwater harvesting Dug wells Figure 14: End users’ preferences (%) Advantages & disadvantages of arsenic mitigation options 0 5 10 Peoples' WTP Water Monitoring easier Long-term option Less costly 9.1 4.5 4.5 4.5 0 5 10 15 Limited feasibility Maintenance No WTP for using 13.6 4.5 4.5 Figure 15: Stakeholders’ perceived advantages & disadvantages of PWS (%) 0 10 20 30 40 50 Water unavailability Economic problem Use/maintenance No disadvantage 41.6 29.6 28.8 28 Figure 16: End users’ perceived advantages & disadvantages of PWS (%) 0 2 4 6 8 10 Most sustainable Easy use & maintenance Preferred by GoB 9.1 9.1 4.5 0 5 10 15 Groundwater table decline Limited technical… Expensive Risk of as. contamina… 13.6 9.1 9.1 9.1 Figure 17: Stakeholders’ perceived advantages & disadvantages of DTW (%) 0 20 40 60 80 100 Good taste Good temperature Nice to meet people Not effortful & time- consuming 81.8 76.5 15.2 9.1 0 20 40 60 80 Distance/effort/time Water quality concerns Difficult social situations No disadvantage 66.1 14.5 12.9 17.7 Figure 18: End users’ perceived advantages & disadvantages of DTW (%) CONCLUSIONS Most preferred mitigation options: Deep tubewells Piped water supply Well-sharing (only by end users, but not by stakeholders) To advance arsenic mitigation efforts: Most preferred options: install and promote with greater emphasis Poorly preferred options: technological improvement and promote with behavior change interventions Collaboration between stakeholders and prioritize peoples’ preferences is urgently needed Further research required. REFERENCES Flanagan S.V., Johnston R.B., Zheng Y. (2012). Health and economic impact of arsenic in Bangladesh: Implications for mitigation strategy and practice. Bulletin of the World Health Organization, 90, 839–846. doi:10.2471/BLT.11.101253 Inauen J., Hossain M.M., Johnston R.B., Mosler H.J. (2013). Acceptance and use of eight arsenic-safe drinking water options in Bangladesh. PLoS ONE, 8(1), e53640. doi:10.1371/journal.pone.0053640 Johnston R.B., Sarker M.H. (2007). Arsenic mitigation in Bangladesh: National screening data and case studies in three upazilas. Journal of Environmental Science and Health, Part A: Toxic/Hazardous substances and Environmental Engineering, 42, 1889–1896. doi:10.1080/10934520701567155 Naujokas M.F., Anderson B., Ahsan H., Aposhian H.V., Graziano J.H., Thompson C., Suk W.A. (2013). The broad scope of health effects from chronic arsenic exposure: update on a worldwide public health problem. Environmental Health Perspectives, 121(3), 295–302 UNICEF. (2010). Arsenic mitigation in Bangladesh. UNICEF, Dhaka, Bangladesh. Available at: http://www.unicef.org/bangladesh/Arsenic_Mitigation_in_Bangladesh.pdf. Accessed 10 December 2013 For more information: Hossain M.M. and Inauen J. (2014). Differences in stakeholders’ and end users’ preferences of arsenic mitigation options in Bangladesh. Journal of Public Health, 22, 335–350. DOI 10.1007/s10389-014-0625-8 0 50 100 Distance/effort/time Difficult social situations Water quality concerns No disadvantage 64 38.4 12.8 6.4 Figure 19: End users’ perceived advantages & disadvantages of well-sharing (%) Stakeholders did not name well-sharing Past studies identified some major problems: collecting water as more time-consuming normative problems lower confidence and commitment to use (Inauen et al., 2013) 0 2 4 6 8 10 9.1 For emergency response 0 5 10 15 Not sustainable High cost Maintenance 13.6 4.5 4.5 Figure 20: Stakeholders’ perceived advantages & disadvantages of arsenic removal filters (%) 0 20 40 60 80 Arsenic-safe No/less iron Good taste/smell/ color/temperature Good water quality (unspecific) 74.6 65.9 61.9 37.3 0 20 40 60 Use/maintenance dissatisfaction Distance/effort/ time Economic problem No disadvantage 41.3 34.9 11.1 30.2 Figure 21: End users’ perceived advantages & disadvantages of HH filters (%) 0 20 40 60 80 Arsenic-safe No/less iron Good taste/smell/ color/temperature Good water quality (unspecific) 79.2 68.8 47.2 39.2 0 20 40 60 80 Arsenic-safe Good taste/smell/ color/temperature No/less iron No/less illness Good water quality (unspecific) 70.4 56 48 25.6 20.8 0 2 4 6 8 10 9.1 For emergency response 0 5 10 15 Not sustainable High cost Maintenance 13.6 4.5 4.5 Figure 20: Stakeholders’ perceived advantages & disadvantages of arsenic removal filters (%) 0 20 40 60 80 Arsenic-safe No/less iron No/less illness Good taste/smell/ color/temperature Good water quality (unspecific) 79.2 56 41.6 40 40 0 20 40 60 80 Distance/effort/time Economic problem Water unavailability Water quality concerns Difficult social situations No disadvantage 60.8 24 14.4 9.6 9.6 28 Figure 22:End users’ perceived advantages & disadvantages of community filters(%) 0 1 2 3 4 5 4.5 Feasible in the coastal area 0 5 10 Microbial contamination Maintenance problem People prefer simpler solution Unknown to rural people 9.1 4.5 4.5 4.5 Figure 23: Stakeholders’ perceived advantages & disadvantages of PSF (%) 0 20 40 60 80 Arsenic-safe No/less iron Good taste/smell/ color/temperature No/less illness Good water quality… 68.5 43.5 37.9 36.3 31.5 0 50 100 Distance/effort/time Water quality concerns Difficult social situations No disadvantage 66.1 14.5 12.9 17.7 Figure 24: End users’ perceived advantages & disadvantages of PSF (%) 0 1 2 3 4 5 Main safe option for the coastal regions There's enough rain 4.5 4.5 0 5 10 Limited feasibility Unknown to people Only one family can use Not preferred by people 9.1 4.5 4.5 4.5 Figure 25: Stakeholders’ perceived advantages & disadvantages of RWHS (%) 0 50 100 Arsenic-safe No/less iron Good taste/smell/ color/temperature Good water quality… 91.1 90.2 41.5 30.9 0 20 40 Use/maintenance dissatisfaction Water unavailability Distance/effort/time No disadvantage 26.8 23.6 16.3 30.9 Figure 26: End users’ perceived advantages & disadvantages of RWHS (%) 0 2 4 6 Similar in traditional usage culture Require less space Easy maintenance Very sustainable 4.5 4.5 4.5 4.5 0 1 2 3 4 5 4.5 Often contaminated with arsenic Figure 27: Stakeholders’ perceived advantages & disadvantages of dug-wells (%) 0 20 40 60 80 Arsenic-safe No/less iron No/less illness Good taste/smell/ color/temperature 67.7 46 46 37.1 0 20 40 60 Distance/effort/time Bad taste/smell/… Water quality… Difficult social… Water unavailability 55.6 35.5 22.6 12.9 9.7 Figure 28: End users’ perceived advantages & disadvantages of dug-wells (%)
