Safely managed services: transitioning from MDGs to SDGs
RWSN Forum, Abidjan
November 2016
Tom Slaymaker Rick Johnston Robert Bain
Outline Time Topic Presenter
9:00-9:15 Global monitoring of SDG 6 Rick Johnston, WHO
9:15-10:00 Safely Managed Drinking Water and Sanitation Services
Tom Slaymaker, UNICEF Robert Bain, UNICEF
10.00-10:30 Discussion all
10:45-11:15 Coffee
11:15-12:00 Guidelines for Water Safety Planning and Sanitary Inspection in Rural Areas
Rick Johnston, WHO Fiorella Polo, UNICEF
12:00-12:30 Global monitoring of WASH in schools and healthcare facilities
Tom Slaymaker, UNICEF Rick Johnston, WHO
12:30-13:00 Discussion all
2
Goal 6
6.1 Drinking
water 6.2
Sanitation and
hygiene
6.3 Water quality
6.4 Water
scarcity
6.5 Water
resource managem
ent
6.6 Eco-
systems
6.a International cooperation and capacity development
6.b Local
participation
Means of Implementation
Goal 6: Ensure availability and sustainable management of water and sanitation for all
Goal 6
6.1 Drinking
water 6.2
Sanitation and
hygiene
6.3 Water quality
6.4 Water
scarcity
6.5 Water
resource managem
ent
6.6 Eco-
systems
6.a International cooperation and capacity development
6.b Local
participation
Means of Implementation
Goal 6: Global monitoring initiatives
JMP
GLAAS
GEMI
6.1.1
6.2.1
6.a.1
6.3.1
6.3.2
6.4.1 6.4.2
6.5.1
6.5.2
6.6.1
6.b.1
Aspirational global targets
8
55. The Sustainable Development Goals and targets are integrated and indivisible, global in nature and universally applicable, taking into account different national realities, capacities and levels of development and respecting national policies and priorities. Targets are defined as aspirational and global, with each Government setting its own national targets guided by the global level of ambition but taking into account national circumstances. Each Government will also decide how these aspirational and global targets should be incorporated into national planning processes, policies and strategies. It is important to recognize the link between sustainable development and other relevant ongoing processes in the economic, social and environmental fields.
SDG targets 'leave no one behind'
• SDG indicators to be disaggregated where relevant – income,
– sex,
– age,
– race,
– ethnicity,
– migratory status,
– disability and
– geographic location,
– or other characteristics
10
JMP timeline for global SDG baseline
Activity Date
1. Data request via UNICEF/WHO October – November 2016
2. Preliminary estimates November – December 2016
3. Country consultation January – March 2017
4. Final estimates March – June 2017
5. JMP global baseline report June 2017
6. UN SG SDG progress report July 2017
11
Target 6.1: Drinking water
By 2030, achieve universal and equitable access to safe and affordable drinking water for all
6.1.1: Population using safely managed drinking water services
Definition: Pop. using an improved drinking water source which is:
• located on premises,
• available when needed, and
• free of faecal and priority chemical contamination (E. coli/thermotolerant coliforms, arsenic, fluoride)
14
Accessibility
Quality
Availability
MDG/SDG Service ladder Progressive realization
SDG 6.1
Safely managed drinking water
services
Improved source located on premises, available when needed, and free from contamination
Basic service Improved source within 30 minutes round trip collection time
Limited service Improved source over 30 minutes round trip collection time
Unimproved Unimproved source does not protect against contamination
No service Surface water 15
P
rog
res
siv
e R
ea
lis
ati
on
Data sources Criterion Household Surveys Regulatory data
Accessibility Whether or not the main water
source is on premises
Travel time (or distance)
Household connections
(piped supplies)
Maximum distance/
travel time
Availability Availability from main source
In the last month, has there
been any time when you have
been unable to get sufficient
water when needed?
Continuity of (piped)
supplies
Hours of service
Quality Water quality testing at the source
and in the household
Compliance with
national norms
Risk management
16
Accessibility
Household surveys and censuses • On premises (piped water)
• Travel time (or distance)
• Within 30 minutes for basic service
Regulatory data • Household connections
(piped water)
17
Availability
• Household surveys and censuses • Continuity (hours of service) of
piped water supplies
• In the last month, have you been unable to get water from your main drinking water source?
• Regulatory data • Continuity of piped supplies
• Different benchmarks (24/7, 20, 18, 12 hours per day)
18
Quality
• E. coli/thermotolerant coliforms, arsenic, fluoride
• Household surveys and censuses
– New module to test E. coli in household surveys
• Regulatory data
– Many for only formal systems, mainly urban
– Some lack E. coli or thermotolerant coliforms
– Many lack arsenic and fluoride
19
Water Quality Module Experiences
20
Bangladesh (MICS) Ecuador Lebanon Nepal (MICS) Pakistan (MICS) Paraguay (MICS)
Bangladesh global MICS5 pilot
Belize field test
Water quality module has now been included in 11 countries, five in Africa:
Congo (MICS)
Cote d’Ivoire (MICS)
Ethiopia
Ghana
Nigeria (MICS)
10+ more in planning
What to measure?
Top priority is faecal contamination – Source and household
– E. coli testing
– Grow bacteria
22
Not contaminated (“clean”)
Heavily contaminated
Water testing supplies
23
Most items are available from UNICEF Supply Division: • Allow 2-3 months for
delivery
Local procurement needed including for • Hand sanitiser • Marker pen
Optional electric incubator
Resources + support
Resources
Manual for water quality
Questionnaire
Training materials
Global experts for training
Tabulation plan/syntax
Further analysis
24
Water sources can be contaminated
• Intermittent water supply, leaking distribution systems
• Infiltration of surface water into wells
• Leaks in septic tanks and latrine pits
• Agricultural runoff containing chemicals or microbiological contamination
Households can contaminate water
• Touching the water during collection
• Collecting water from the source in dirty containers
• Storing the water at home in open/dirty containers
• Touching the water at home with dirty utensils or hands
Improved sources are designed to protect against contamination, especially fecal contamination, and are less likely to be contaminated than unimproved sources
Improved is not always safe
Target 6.2: Sanitation and hygiene
By 2030, achieve access to adequate and equitable sanitation and hygiene for all, and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations
6.2.1: Population using safely managed sanitation services, including a handwashing facility with soap and water
Definition: Pop. using an improved sanitation facility which is:
• not shared with other households and where
• excreta are safely disposed in situ or
• transported and treated off-site
30
Accessibility
Quality
31
Service ladder Progressive realization
SDG 6.2 Safely managed
sanitation services
Private improved facility where faecal wastes are safely disposed on site or transported and treated off-site
Basic service Private improved facility which separates excreta from human contact
Limited service Improved facility shared with other households
Unimproved Unimproved facility does not separate excreta from human contact
No service Open defecation P
rog
res
siv
e R
ea
lis
ati
on
Universal basic sanitation by 2030
34
1280
946
909
798
277 638
2852
4936
0
2000
4000
6000
8000
10000
Po
pu
lation
by s
an
ita
tio
n fa
cili
ty (
tho
usa
nd
s)
Open defecation Other unimproved Shared Improved
201
5
201
6
201
7
201
8
201
9
202
0
202
1
202
2
202
3
202
4
202
5
202
6
202
7
202
8
202
9
203
0
Universal basic An estimated 3.5 billion people need to gain access between 2015 and 2030 (8.4 billion globally)
1990 2015 2030
SDG global indicator on hygiene
By 2030, achieve access to adequate and equitable sanitation and hygiene for all, and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations
Hygiene is the conditions and practices that help maintain health and prevent spread of disease, including handwashing, menstrual hygiene management and food hygiene
(JMP hygiene working group)
SDG global indicator 6.2.1
Population using safely managed sanitation services, including a handwashing facility with soap and water
35
37
Discussion: implications for rural service provision
• Drinking water – Accessibility: On premises vs within 30 minutes
– Availability: available when needed
– Quality: faecal contamination, arsenic, fluoride
• Sanitation – Emptying of latrines
– Faecal sludge management
• Hygiene – Handwashing with soap and water
Outline Time Topic Presenter
9:00-9:15 Global monitoring of SDG 6 Rick Johnston, WHO
9:15-10:00 Safely Managed Drinking Water and Sanitation Services
Tom Slaymaker, UNICEF Robert Bain, UNICEF
10.00-10:30 Discussion all
10:45-11:15 Coffee
11:15-12:00 Guidelines for Water Safety Planning and Sanitary Inspection in Rural Areas
Rick Johnston, WHO Fiorella Polo, UNICEF
12:00-12:30 Global monitoring of WASH in schools and healthcare facilities
Tom Slaymaker, UNICEF Rick Johnston, WHO
12:30-13:00 Discussion all
39
Water Safety Programming
• Joint advocacy to make water safety a priority
• Water safety frameworks
• Capacity building for regulators and operators to switch to risk management approaches
• Behaviour change programmes at community level
41
Strategic advocacy to shift government and sector priority
42
Entry points
• SDG planning processes in country
• SWA High Level Meetings and country dialogue
Joint voices
• Government, development partners, NGOs, private sector
Water safety frameworks
43
Health-based targets
Water safety planning
Surveillance
Public health contexts
Managing risks is more cost-effective than treating
Risk management
Risks Control/
preventive barriers
Water safety
Should I wait until
an accident happens?
Water safety planning identifies barriers to risks and aims at concrete implementation
Step 1: Engage stakeholders
Step 2: Describe water
systems
Step 3: Identify and rank hazards,
risks, control measures
Step 4: Develop and implement
incremental WS plans
Step 5: Monitor control measures
and effectiveness of plans
Step 6: Review
WS plans
Adapted from WHO guidance
Steps for small
systems
In small systems sanitary inspections can be used as a simplified risk assessment tool
Step 1: Engage stakeholders
Step 2: Describe water
systems
Step 3: Identify and rank hazards,
risks, control measures
Step 4: Develop and implement
incremental WS plans
Step 5: Monitor control measures
and effectiveness of plans
Step 6: Review
WS plans
Adapted from WHO guidance
Steps for small
systems
Sanitary inspections
In community managed systems, barriers’ implementation requires behaviour change
Catchment
Source
Consumer
Barriers
HWTS can be a ‘last
mile’ barrier
We can build on lessons learnt from behaviour change programmes like CLTS…
Step 1: Engage stakeholders
Step 2: Describe water systems
Step 3: Identify and rank hazards,
risks, control measures
Step 4b: Implement WS
plans
Step 5: Monitor control
measures and effectiveness of
plans
Step 6a: Review
WS plans
Step 4a: Develop incremental WS
plans Post-
Triggering
WS
Ce
rtif
icat
ion
Step 6c: Upgrades that require
external support
Visual tools leveraging emotions
RWSN Forum
Abidjan, Côte d’Ivoire
Guidelines for Drinking-water Quality:
Small Water Supplies
An Update
Rick Johnston
Jen DeFrance
2 December 2016
Guidelines for Drinking-water Quality
Need to update the Community
Supplies Guideline
2nd ed, 1993
• Volume 3 (1997): Surveillance and Control of Community Supplies
• Sanitary Inspections (SIs)
3rd ed, 2004
• Framework for Safe Drinking Water introduced
• Shift to risk-management approaches
• Water Safety Plans (WSPs)
Since then
• 4th ed, 2011
• Additional experience with managing small water supply systems, including Sanitary Inspection forms
Risk Assessment/
Risk Management
WSPs and (SIs)
Health-based targets
Surveillance
Public health context
and health outcomes
WHO’s Framework for Safe Drinking-water
Guidelines for Drinking-water Quality:
Surveillance & Control of Community Supplies
The most effective means of consistently ensuring the safety
of a drinking-water supply. “
”
A comprehensive risk assessment and risk
management approach that includes all
steps in the water supply from catchment to
consumer
WATER
SAFETY
PLAN:
Key definition:
WHO Guidelines for Drinking-water Quality
Small Water Supplies Guideline:
Activities to Date
Gap analysis of the Guideline and consultations with experts and stakeholders (2009+)
Updated structure and table of contents of the Guideline (2014)
First draft of updated Guideline (2015)
Literature review and expert interviews on SI forms (2015)
Revision of SI forms and second draft of guideline initiated (2016)
Small Water Supplies Guideline
54
Part 1:
Policy Framework
Part 2:
Field Guide
Purpose Provides the
overarching policy
framework for
managing small
water supplies
Support surveillance
activities (WSPs, SIs
and water quality
testing)
Target
Audience
Decision makers/
planners/managers
at various levels of
government
Field workers
undertaking water
quality surveillance
activities
Small Water Supplies Guideline
55
Part 1: Policy Framework
1 Introduction
2 Policies and regulations
3 Standards and guidelines
4 Water Safety Plans
5 Technical interventions
6 Surveillance
7 Using information and taking action
Small Water Supplies Guideline
56
Part 2: Field Guide
1 Introduction
2 Considerations for field workers
3 Procedures for field work visits and record keeping
4-5 Review of WSP process & SIs
6-7 Water sampling and analysis and QC
8-9 Interpretation of findings and reporting
10 Using surveillance data
Small Water Supplies Guideline
57
Part 2: Field Guide
1 Introduction
2 Considerations for field workers
3 Procedures for field work visits and record keeping
4-5 Review of WSP process & SIs
6-7 Water sampling and analysis and QC
8-9 Interpretation of findings and reporting
10 Using surveillance data
Annexes: examples of small water supply inventory
forms, SI forms, etc.
Small Water Supplies Guideline and
Sanitary Inspection Forms
• SI forms continue to be a
useful tool in their own right to
identify hazardous events and
prioritize management actions
– for both the individual supply
and surveillance agency
• SI forms can be a useful tool
to support WSPs, in particular
to identify hazardous events to
inform risk assessment
Revision of SI forms
• Needs to be informed by evidence base, practical
experience, new technologies/construction materials, etc.
• Can SI forms be updated to better align with WSPs? – Standard ‘Yes’ / ‘No’ method of scoring assumes equal weighting of each
hazardous event while within WSPs each hazardous event should be
ranked (e.g. high, medium, low)
• Can SI forms be made more useful?
• Improve graphics – Figures in earlier WHO guidance (1976) provided more technical detail
Need to ensure SI forms remain to be simple, brief and serve both
surveillance authorities and water suppliers
Revision of SI forms: Evidence Base Review
Method: Literature reviews + expert interviews
Aims: To address and analyse the evidence related to
• experiences, practices, reported benefits and
challenges with SIs
• scientific validity of the questions covered by the SI
forms to support prioritization of hazardous events
• experience with use of SI forms in the current Guideline
versus nationally/locally adapted ones
• any experiences with use of SIs as part of water safety
plans (WSPs)
Part 1:
Technology
fact sheet
• Diagram + description of key elements and protective features
• Drawing depicting risk factors?
Part 2:
SI form
• Yes/No section
• Modify questions and add/delete questions based on review
• Option to assign a risk grade (low, med, high)?
Part 3:
Explanatory
notes
• To support answering the SI questions
Part 4:
Management
advice
• To support remedial actions associated with each question
Revised SI Package
Example SI Form: Assessment
Sanitary inspection questions
(Rainwater Harvesting) Yes No
Is there any visible contamination of the roof
catchment area (plants, dirt, or excreta)?
Water quality is at risk if the roof catchment is unclean.
Water may be contaminated before entering the storage
tank, or contaminants present on the catchment could be
washed into the tank.
☐ ☐
Are the guttering channels that collect water dirty?
Unclean gutters can contaminate the water or introduce dirt
into the storage tank in the same way the roof can.
☐ ☐
Example SI Form: Assessment
Sanitary inspection questions
(Rainwater Harvesting) Yes No
Complete this portion
only for questions
answered ‘YES’.
Grade the risk by
placing a tick over Low,
Medium or High.
Is there any visible contamination of the roof
catchment area (plants, dirt, or excreta)?
Water quality is at risk if the roof catchment is unclean.
Water may be contaminated before entering the storage
tank, or contaminants present on the catchment could be
washed into the tank.
☐ ☐ Low Medium High
Are the guttering channels that collect water dirty?
Unclean gutters can contaminate the water or introduce dirt
into the storage tank in the same way the roof can.
☐ ☐ Low Medium High
Total number of risks
YES LOW MED HIGH
Number of risks Score
LOW X 1 =
MED X 3 =
HIGH X 5 =
YES RISK SCORE =
Are the guttering channels that collect water dirty?
Unclean gutters can contaminate the water or introduce dirt
into the storage tank in the same way the roof can. ☐ Low Medium High
SI form package and Guidelines: Next steps
• Finalize SI package for 3-4 technologies (Q1 2017)
– rainwater harvesting, covered dug-well with handpump,
protected spring source and household storage
• Pilot SI package (Q1 2017)
• Draft updated Guideline (Q1 2017)
• Revise SI package for selected technologies and
develop for other technologies
• Adapt to digital platform?
• Peer review
• Finalize Guideline 2018
Feedback
• Feedback on SI Package
• Feedback on SI form format
–Feasibility of assessing the risk for each individual
question?
–Need for overall risk score?
Looking for volunteers to pilot SI form package and
peer reviewers of Guideline including SI form package
Discussion
• Experiences with sanitary inspections
–What has worked well (or not)?
–How do they link to action?
WASH in Institutions in the SDGs
Target 6.1: achieve universal and equitable access to safe and
affordable drinking water for all
Target 6.2: achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in
vulnerable situations Universal and for all imply all exposures and settings including households, schools, health facilities, workplaces, etc.
Target 4.a: proportion of schools with access to basic WASH services
Basic services
Schools Health care facilities
Basic water
Basic sanitation
Basic hygiene
Basic waste management
70
WASH in Schools in the SDGs
Targets 6.1, 6.2
Universal and for all imply all exposures and settings including households, schools, health facilities, workplaces, etc.
Target 4.a Indicator:
‘Proportion of schools with access to:…
(e) basic drinking water;
(f) single-sex basic sanitation facilities; and
(g) basic handwashing facilities
(as per the WASH indicator definitions)’
Indicator Definitions of Basic Service
Basic drinking water
Drinking water from an improved source is available at the school
Basic sanitation
Improved facilities, which are sex-separated and usable (accessible, functional, prviate) at the school
Basic handwashing
Handwashing facility with water and soap available to students
Basic service
Drinking water from an improved source
is available at the school
No service
No water source or unimproved source
(unprotected well/spring, tanker-truck
surface water source)
Basic service
Improved facilities, which are single-sex
and usable at the school
No service
No toilets or latrines, or unimproved
facilities (pit latrines without a slab or
platform, hanging latrines, bucket
latrines)
Basic service
Handwashing facility with water and soap
available to students
Limited service
Handwashing facility with water, but no
soap
No service
No handwashing facilities at the school or
handwashing facilities with no water
Drinking water Sanitation Hygiene
Limited service
There is an improved source (piped water,
protected well/spring, rainwater, bottled
water), but water not available at time of
survey
Limited service
There are improved facilities (flush/pour
flush, pit latrine with slab, composting
toilet), but not sex-separated or not
usable
Service ladders allow for progressive realization SD
G T
arge
t
Basic service
Drinking water from an improved source
is available at the school
No service
No water source or unimproved source
(unprotected well/spring, tanker-truck
surface water source)
Basic service
Improved facilities, which are single-sex
and usable at the school
No service
No toilets or latrines, or unimproved
facilities (pit latrines without a slab or
platform, hanging latrines, bucket
latrines)
Basic service
Handwashing facility with water and soap
available to students
Limited service
Handwashing facility with water, but no
soap
No service
No handwashing facilities at the school or
handwashing facilities with no water
Drinking water Sanitation Hygiene
Limited service
There is an improved source (piped water,
protected well/spring, rainwater, bottled
water), but water not available at time of
survey
Limited service
There are improved facilities (flush/pour
flush, pit latrine with slab, composting
toilet), but not sex-separated or not
usable
Advanced service
May include: water is available when
needed, accessible to all, and free from
faecal and priority chemical
contamination based on water quality
testing
(to be defined at national level)
Advanced service
May include: facilities are accessible to
all, of sufficient quantity, inspected for
cleanliness & appropriate facilities for
menstrual hygiene management are
provided
(to be defined at national level)
Advanced service
May include: handwashing facilities
available at critical times and accessible
to all; menstrual hygiene education and
products provided
(to be defined at national level)
Service ladders allow for progressive realization and more ambition SD
G T
arge
t
*includes schools with at least one functional boys' and one functional girls' toilet which may or may not be single-sex
WASH in schools coverage considering the new SDG criteria for basic service
Example: Creating baseline SDG estimates in PNG
*Preliminary estimates (analysis still in progress)
Example: Calculating basic water service coverage in PNG
*Preliminary estimates (analysis still in progress)
Example: Calculating basic water service coverage in PNG
*Preliminary estimates (analysis still in progress)
Improved
Limited
Basic
No Service Unimproved/None
Maps to the JMP service ladder
Example: Calculating basic WinS services in PNG**
* Rough estimate of basic sanitation; schools report one functional toilet for boys and one for girls, but may or may not be single-sex
**Preliminary estimates (analysis still in progress)
51
28
10
30
17 47
19
54 43
0%
20%
40%
60%
80%
100%
Water Sanitation Hygiene
Pro
po
rtio
n o
f sc
ho
ols
wit
h W
ASH
se
rvic
e le
vel
Basic Service Limited Service No Service
*
*Preliminary estimates (analysis still in progress)
WASH service coverage is lowest in schools with the youngest children*
WASH in schools coverage disaggregated by school level
Example: Data could be disaggregated by school level
*Preliminary estimates (analysis still in progress)
Water (left), sanitation (middle) and hygiene (right) coverage in schools disaggregated by province
WASH in schools coverage varies by region*
Example: Data could be disaggregated by region
And by urban/rural…
Resources
1. More details & expanded questions: Expert Group Meeting Report
http://www.wssinfo.org/fileadmin/user_upload/resources/WinS-Expert-Group-Meeting-June-2016-Report_FINAL.pdf
2. Guidance Note for monitoring WASH in Schools in the SDGs
http://www.wssinfo.org/fileadmin/user_upload/user_upload/Core_questions_and_indicators_for_monitoring_WinS.pdf
WASH in Health Care Facilities in the SDGs
Target 6.1: achieve universal and equitable access to safe and affordable drinking water for all
Target 6.2: achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations
Universal and for all imply all exposures and settings including households, schools, health facilities, workplaces, etc.
Indicator Definitions of Basic Service
Basic drinking water
Water from an improved source is available on premises
Basic sanitation
Improved sanitation facilities are available and usable, separated for patients and staff, separated for women and allowing menstrual hygiene management, and meeting the needs of people with limited mobility.
Indicator Definitions of Basic Service
Basic health care waste management
Waste is safely segregated into at least three bins in the consultation area and sharps and infectious wastes are treated and disposed of safely.
Basic hand hygiene
Hand hygiene materials, either a basin with water and soap or alcohol hand rub, are available at points of care and toilets.
88
1. What is the main water supply for the facility?
2. Where is the main water supply for the facility located?
3. Is water available from the main supply at the time of the survey?
4. Is there at least one usable improved toilet available for outpatients at the facility?
5. Is there at least one usable improved toilet designated for women and girls, which provides facilities to manage menstrual hygiene needs?
6. Is there at least one usable improved toilet designated for staff?
7. Is there at least one usable improved toilet that meets the needs of people with reduced mobility?
8. Are there functional hand hygiene stations available at the selected point of care on the day of the survey?
9. Are hand washing facilities with soap and water available at toilets on the day of the survey?
10. Is waste safely segregated into at least three labelled bins in the consultation area?
11. How does this facility usually treat/dispose of sharps waste?
12. How does this facility treat/dispose of infectious waste?
Next steps
• Adapt core questions to MIS
• Further develop expanded questions
– Including on cleaning
• Publish guidance note
• Core questions for WASH in birthing settings
89
Resources
1. Expert Group Meeting Report
http://www.wssinfo.org/fileadmin/user_upload/resources/WinS-Expert-Group-Meeting-June-2016-Report_FINAL.pdf
2. Core questions (to be glossy at some point)
http://www.wssinfo.org/fileadmin/user_upload/resources/160825-FINAL-WASH-in-HCF-Core-Questions.pdf