WHO Guidelines for Drinking-water QualityIceland, January 2005

Jamie BartramCoordinator

Water Sanitation and HealthWorld Health Organization

History of the Guidelines

1958, 1963, 1971: International Standards1984 First edition of “Guidelines”: basis for setting standards but standards responsibility of states1993 Second edition: increase in number of chemicals 2003 Third edition systematic safety approach; application to different settings.

WHO Water Guidelines

AimFeatures

Approach

Protection of human healthAdvisory in natureSupport national standard-setting adapted to social, cultural, economic & environmental contextRisk-benefit philosophyBest available evidence - science and practiceScientific consensusExploit global information and experience

Use of WHO Guidelines

Scientific basis for national and supra national norms and standards e.g. Japan, EU, Australia Active participant-users e.g. USA, CanadaTransposition e.g. some developing countries Used in absence of national standards/GL

Guidelines for Drinking-water Quality

ProcessPlan of work from IG meetings and proposalsIndividuals/teams draft documentsWorking groups initial review (and improvement)Public domain review (and improvement)“Final Task Force” meeting of government-nominated experts

Current Volumes of Guidelines for Drinking-water Quality

Volume 1: Summary

(series of monographs on individual chemicals and microbes)

Volume 3: Surveillance and control of community supplies

WHO Guidelines for Drinking-water Quality

Microbes (infectious agents)

Chemicals

Radiological aspects

Acceptability aspects

Application ‘settings’

Guidelines and Regulations for Water-borne Infectious Disease

• > 100 years “success” in outbreak control• reliance on end product testing: too little too late• post-exposure• residual disease burden• unrecognised pathogens• diverse health outcomes

WHO GDWQ 3rd Edition - Response

Moving away from reliance on output monitoring -measuring parameters in final waterMore input monitoring - measuring parameters that show that the system is workingShort-term quality changesCatchment-to-consumerNeeds transparency openness, inter-sectoralRisk-based

Buildings on multiple barrier, HACCP,….

Framework for Water Safety in3rd Edition WHO GDWQ

Health Based TargetsWater Safety Plans1 System Assessment2 Monitoring of control measures 3 Management PlansIndependent Surveillance

Health.-based targets(Chapter 3)

Water safety plans(Chapter 4)

Surveillance(Chapter 5)

Public health context and health outcome

System Monitoring

Management&

CommunicationMonitoring

Framework for Safe Drinking Water

Health-Based Targets

Targets based on public health protection and disease preventionBenchmark for water suppliesPublic health benefitLocal circumstancesQuantitative risk assessmentGuidance developed by WHOFrom simple to complex

WSP part 1: System Assessment

System assessment to determine whether the water supply chain (up to the point of consumption) as a whole can deliver water that meets the targets

Reality check before starting WSPSystem capability to meet Health-based TargetsOutcome identifies system improvementsValidation of processesIdentifying what reduces and prevents contamination

Health based targets

System assessment

Monitoring of control measures

Management Plans

Independent “surveillance”

WSP part 2: Monitoring of control measures

Monitoring of the control measures in the supply chain that are of particular importance in securing water safety

Target barriers identified in system assessmentOperational monitoring - continual effectivenessSimple parameters, from results to action

Health based targets

System assessment

Monitoring of control measures

Management Plans

Independant surveillance

WSP part 3: Management Plans

Management plans describing actions to be undertaken from normal conditions to extreme

events; including documentation and communication

Documented:system assessmentcontrol measure identificationmonitoring planmanagement responsessupporting programmes (SOPs, training …)communication plan

Health based targets

System assessment

Monitoring of control measures and actions

Management Plans

Independent “surveillance”

Independent Surveillance

Systematic independent surveillance that verifiesthat the above are operating properly

Audit of Water Safety Planshows WSP is being adhered to

Verificationend-product final check

Health based targets

System assessment

Monitoring of control measures and actions

Management Plans

Independent surveillance

Guidelines and Regulations for ChemicalsSuccesses and Challenges

very widely used monitoring against GVsscientifical basis clear and soundrefine approach and GVs as new evidence emergesvery many chemicalsrelative disease burden/severityconsistency of approach for ‘materials and chemicals ….’ (“additives”), up to tapshort-term versus long-term exposure

WHO GDWQ 3rd Edition - Response

Mainly “business as usual” - some new or modified GVsmore rigorous assessment of need for GVopportunity for wider commentgroup by source-type (management response)rolling revision and future strategy

Updating the Guidelines

Keeping the Guidelines up-to-date is a major challenge …WHO moving towards a ‘rolling revision’Substantiating the positions and ‘guidance’on good practice makes up most of the work. Recovery of field experience.Around 40 lines of work in the rolling revisionPeer and Public domain review have been ‘built-in’

Rolling Revision of WHO Guidelines for Drinking-water Quality

Application in specific settings

Small community water supplyWater and sanitation on ships and in aviation (linked to IHR)DesalinationTemporary water suppliesWater supply in emergenciesWater supply in large buildings, health care facilities

Origins of the Meeting

Guidelines Volume 3: 1st and 2nd editions

Guidelines 3rd edition, Water Safety Plans

Expression of concerns by countries about "small community" water supply safety

Icelandic and Australian leadership

Driving Forces & Issues

burden of disease, outbreaks and sporadic

80% of "unserved" are rural

water quality data few but show "small community" safety a priority

small/indigenous/peri-urban/remote

Outcomes – an action plan for an international initiative?

Might include:Network development

Develop a dedicated small system networkRegulators networkHousehold water safety network

Evidence base for advocacyBurden of diseaseCost and benefit analysisCountry situationsTechnology verification

Library of resource materials (eg capacity building)Development and dissemination of appropriate tools(physical, software)Lessons learned on organising support systemsOutreach e.g. to professional groups (IWA)Pilot application evaluation and reporting

Finding the Guidelines

Http://www.who.int/water_sanitation_health/GDWQ/index.htm