Transcript Guidelines - Water Voor Ontwikkeling

Water, Sanitation,
Hygiene and Health
in the framework of new
WHO priorities
Robert Bos
Water, Sanitation, Hygiene and Health
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Water, Sanitation and Hygiene in the WHO | October 2009
Overview
 The links between water sanitation, hygiene and health
 The rationale for water and sanitation interventions
 WHO’s comparative advantage in water and sanitation
 Current WHO activities in water and sanitation
 Strengthening WHO’s role
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Water, Sanitation and Hygiene in the WHO | October 2009
Sanitation: the #1 medical milestone
 Dec 2006: BMJ readership votes sanitation as the greatest
medical milestone since 1840
– Sanitation beat the discovery of antibiotics, the creation of the anti-conception
pill, the development of vaccines and the discovery of the structure of DNA.
 Water and sanitation are iconic interventions in public health
history
– Figures like Snow and Chadwick led the way
– Water and sanitation were a key engine in the success of the industrial
revolution
 The margin by which sanitation was voted on top was
substantial
– Of 11,000 votes cast with a choice of 150 topics, some 1700 voted for
sanitation; some 30% of those who voted were MDs.
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Water, Sanitation and Hygiene in the WHO | October 2009
Sanitation: the #1 medical milestone
 Prof Johan Mackenbach (Erasmus University, Rotterdam)
said on the occasion:
I'm delighted that sanitation is recognized by so many people as
such an important milestone. The general lesson which still holds is
that passive protection against health hazards is often the best way
to improve population health.
Did he mean to say passive protection or should he really have said
primary prevention?
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Water, Sanitation and Hygiene in the WHO | October 2009
Why Water, Sanitation and Health?
 Burden of disease: the headlines
– 1.9 million attributable annual deaths from diarrhoea
– 1.2 million malaria deaths each year
 Burden of disease: the details
– 1.4 million preventable child deaths from diarrhoea
– 860 000 preventable child deaths from malnutrition
– One third of the world population (2 billion infections)
affected by intestinal parasitic worms
– 25 million people seriously incapacitated by lymphatic
filariasis
– 200 million people with preventable schistosomiasis
infections
– 5 million people visually impaired by trachoma
– 280 000 prevetable deaths from drowning
– Half a million malaria deaths that could have been prevented
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Water, Sanitation and Hygiene in the WHO | October 2009
Why Water, Sanitation and Health?
 In a more generic way, the old Bradley and
Feachem definitions (1983) lead us to key
interventions:
– Water-borne diseases
(microbial contamination of drinking water)
– Water-washed diseases
(sufficient water quantities )
– Water-based diseases
(infection through contact with water)
– Water-associated vector-borne
diseases
(ecosystems conducive to vector breeding)
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Water, Sanitation and Hygiene in the WHO | October 2009
Diseases with largest environmental
contributions (I)
Diarrhoea
Lower resp. infections
Other unintentional inj.
Malaria
Road traffic injuries
COPD
Perinatal conditions
Ischaemic heart dis.
Childhood cluster
Lead-caused MMR
Drownings
HIV/AIDS
0
Environmental fraction
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1%
2%
3%
Non-environmental
Water, Sanitation and Hygiene in the WHO | October 2009
4%
5%
6%
% of global disease burden in DALYs
Diseases with largest environmental
contributions (II)
Malnutrition
Cerebrovascular dis.
Asthma
Tuberculosis
Suicide
Depression
Poisonings
Falls
Hearing loss
Violence
Lymphatic filariasis
Lung cancer
0
Environmental fraction
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1%
2%
3%
Non-environmental
Water, Sanitation and Hygiene in the WHO | October 2009
4%
5%
6%
% of global disease burden in DALYs
Water, sanitation, hygiene interventions
 Providing sustainable access to safe drinking-water
– Infrastructure improvements, service improvements, strengthened policy and
regulatory frameworks, household water treatment
 Providing access to adequate sanitation
– Infrastructure improvements, community engagement, management of
medical waste, promoting wastewater as a resource for small-scale
agriculture
 Promoting hygiene
– Providing access to sufficient quantities of water, handwashing campaigns,
sanitation in schools, sanitation in health care settings, safe storage of water
 Best practice in water management
– Environmental management: modification of infrastructure, management to
maintain low vector receptivity, incentives and sanctions for water use in
agriculture and energy, improved housing, health impact assessment
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Water, Sanitation and Hygiene in the WHO | October 2009
Water, sanitation, hygiene interventions
 The rationale for primary prevention
– The public health imperative
– The economic argument
– Sustainability and resilience
– Development objectives
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Water, Sanitation and Hygiene in the WHO | October 2009
The rationale for primary prevention
 The public health imperative
– The WHO definition of health
– Principles of public health focus on community health, on
tackling the root causes of ill-health and on evidence-based risk
reduction
– Managing environmental determinants of health is not only
about risk reduction, but also about maximizing health
opportunities
– For some water-associated infections there are no other
interventions than water interventions
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Water, Sanitation and Hygiene in the WHO | October 2009
The rationale for primary prevention
 The economic argument
– WHO and World Bank global estimates of returns on
investments in water and sanitation: upto USD34 per USD
invested
– A return to primary health care (as opposed to selective PHC)
conceives a cross-sectoral approach to health, placing
alternative interventions in a wider economic perspective
– In the context of development, cost-effective opportunities for
preventive action at the planning stage will be substituted by
much less cost-effective curative “after the fact repair” at the
operational stage.
– WHO Commission on Macro-economics and Health – water and
sanitation are highly cost-effective interventions.
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Water, Sanitation and Hygiene in the WHO | October 2009
The rationale for primary prevention
 Sustainability and resilience
– Growing pressures on medical interventions: drug resistance,
insecticide resistance
– The drug dilemma: mass treatment for ever or expensive case
detection and treatment – reduction of the environmental risk
factors provides the answer.
– Resilience of technology and systems in the face of change, for
example climate change
– Resilience of infrastructure at times of civil unrest and
breakdown of services
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Water, Sanitation and Hygiene in the WHO | October 2009
The rationale for primary prevention
 The development objectives
–
–
–
–
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The MDGs – MDG 7 with its water and sanitation targets
The water and sanitation ladders to climb out of poverty
Water and sanitation as engines for development
The intricate relationship between poverty and ill-health
Water, Sanitation and Hygiene in the WHO | October 2009
Water and Sanitation
why at WHO?
 The simple answer:
it is mandated by the Constitution
– CHAPTER II – FUNCTIONS
Article 2 In order to achieve its objective, the functions of the
Organization shall be:
(a) to act as the directing and co-ordinating authority on international
health work;
…
– (i) to promote, in co-operation with other specialized agencies where
necessary, the improvement of nutrition, housing, sanitation, recreation,
economic or working conditions and other aspects of environmental
hygiene;
…
– (u) to develop, establish and promote international standards with
respect to food, biological, pharmaceutical and similar products;
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Water, Sanitation and Hygiene in the WHO | October 2009
Water and Sanitation
why at WHO?
 The comparative advantages of WHO
– Authoritative source of health statistics, incl water-associated diseases
– A long tradition in normative functions related to drinking-water and
sanitation
– Its constitutional link to MoHs in Member States: the possibility to influence
public health legislation in relation to water and sanitation
– The “elderly statesman” position of WHO in the UN system (good
governance, legal authority, solid reputation)
– An effective institutional infrastructure (water advisors at the regional level,
environmental health officers in country offices)
– A broad network of international and national partners in the area of water
and sanitation: collaborating centres, international and national NGOs
– Acclaimed neutrality in interpreting research data
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Water, Sanitation and Hygiene in the WHO | October 2009
Water and Sanitation
why at WHO?
 What is in it for WHO ?
– Work in water and sanitation helps WHO being perceived as fulfilling its
constitutional obligations
– Evidence-based water and sanitation efforts help meet the Organization’s
goal
– As non-contentious issues in public health, involvement in water and
sanitation enhances WHO’s corporate image
– As traditional pillars of Primary Health Care, water and sanitation strengthen
the main WHO strategy of health for all
– Water and sanitation provide an entry point for interagency and intersectoral
collaboration
– The current focus on Africa and women’s health is immediately served by
water and sanitation activities
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Water, Sanitation and Hygiene in the WHO | October 2009
Water, Sanitation and Health (WSH) at WHO
 Two flagship activities
Global Monitoring of Access to Water and Sanitation (JMP)
Normative water quality issues, including rolling revision of
the Guidelines for Drinking Water Quality
 Mainstream issues:
–
–
–
–
–
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Cholera and epidemic diarrhoeal disease
Health impact assessment
Integrated Water Resources Management
WSH in emergencies
WSH / health care waste management in health care facilities
Water, Sanitation and Hygiene in the WHO | October 2009
Global Monitoring:
Headlines from latest Report
 The world is likely to meet the MDG drinking-water target
by 2015
– the number of people using unimproved sources of drinking
water has fallen below 1 billion
– More than half of the world’s households now have piped water
connections in or near their homes
– Progress is slowest in sub-Saharan Africa, home to a third of the
global population using unimproved drinking water sources
 Trends
– Drinking water quality issues not captured
– Disagregation: how far, at what expense?
– Devolving responsibilities
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Water, Sanitation and Hygiene in the WHO | October 2009
Normative role in water quality issues
Maintaining up-to-date Global
Drinking-water Quality Guidelines
Developing, testing and promoting
water safety plans (WSPs) as the
instrument for guidelines
implementation
Rolling revisions
• 4th edition Guidelines
for Drinking-water
Quality (GDWQ) - 50+
items on rolling revision
Promoting health-based
water quality regulations
• Regulators Network
Maintaining up-to-date Guidelines
for the safe use of wastewater in
agriculture
Training in WSPs
Maintaining up-to-date Guidelines
for recreational waters
Research on nontreatment options of
wastewater use
• with AusAID, IWA and
PAHO
• with IDRC and IWMI
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Water, Sanitation and Hygiene in the WHO | October 2009
Rural areas
• Small Community Water
Supply Network
• Volume 3 of the GDWQ
• Water Safety Plans
Urban areas
• O&M network
• Establishment of regional
networks with IWA
• Water Safety Plans
Household level /
vulnerable groups
• Household Water
Treatment and Safe
Storage Network
Priority settings
• WASH standards in
hospitals and schools
Water and Sanitation
Focus on Africa
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Water, Sanitation and Hygiene in the WHO | October 2009
Water and Sanitation
Focus on Africa
 The Libreville Declaration
Establishes a strategic alliance between the health and environment
sectors, which will come to expression
• through integration and harmonization of policies, regulations, national strategies
and institutions, and
• through mechanisms for joint monitoring and evaluation of critical indicators,
and information exchange, and
• Through the promotion of multi-disciplinary research, health impact assessment
and management of development, and fostering of intersectoral negotiation
skills.
In all three categories, Water and Sanitation activities are on-going,
can contribute to the furtherance of the goals set by the Declaration
and can gain benefits from the proposed integration of health and
environment
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Water, Sanitation and Hygiene in the WHO | October 2009
Water and Sanitation
Focus on Africa
 Key interventions for Africa now
– Favour investment and efforts for sanitation improvement and
hygiene over extension of access to safe drinking-water
– Promote a basic package at the household level: household
water treatment, safe storage, hygiene in particular
handwashing
– Strengthen capacities in the safe use of wastewater in periurban areas
– Improve water management and drainage in urban areas for
urban malaria control.
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Water, Sanitation and Hygiene in the WHO | October 2009
Water and Sanitation
Focus on Africa
 Key interventions for Africa tomorrow
– Comprehensively build capacity in health impact assessment of
water resources development (only 10% of Africa’s water
resources have been developed).
– Strengthen policies and institutions so Africans can take the
development of drinking-water infrastructure into their own hand
– Assess resilience of drinking-water and other hydraulic
infrastructure in the light of climate change
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Water, Sanitation and Hygiene in the WHO | October 2009
Working with other agencies
 WHO is a founding member of UN-Water and chaired UN-Water for its first
two years
 WHO has strong bilateral links with sister UN agencies: FAO on water quality,
irrigation water management and wastewater use; UNEP on water quality
and impact assessment
 WHO liaises with major international NGOs: the International Water
Association, the IUCN and WWF, the National Sanitation Foundation in the
USA
 WHO maintains strong links with a number of key bilateral donors on issues
of water and sanitation: USAID, AusAID, DFID, AFD, BMZ
 WHO maintains strong links with a number of health ministries on issues of
water and sanitation: Health Canada, MoHLW of Japan; and with USEPA in
the USA
 WHO has a strong network of collaborating centres in the field of water,
sanitation and hygiene.
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Water, Sanitation and Hygiene in the WHO | October 2009
New challenges
Water scarcity
Climate change
The green
economy
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Water, Sanitation and Hygiene in the WHO | October 2009
Climate change and
water supply/sanitation
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Water, Sanitation and Hygiene in the WHO | October 2009
Water, Sanitation, Hygiene and Health
in the framework of new WHO priorities
Conclusions
 Water, sanitation, hygiene and health is a dynamic and
responsive programme that addresses key public health
issues in line with WHO’s mandate and relevant to the
Organization’s goals.
 Global trends towards a green economy and concerns
over poverty levels that remain too high (especially in
Africa) and over the impact on health of climate change
create new challenges and opportunities for WSH in the
context of WHO’s priorities for the 21st century
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Water, Sanitation and Hygiene in the WHO | October 2009
Water, Sanitation, Hygiene and Health
in the framework of new WHO priorities
Conclusions
 WSH has a proven track record of responding to new
needs of Member States, and its present focus on water
quality and global monitoring is the result. Efforts will be
needed to broaden and diversify its financial resource
base and strengthen its human resource base.
 The Libreville Declaration has created a new context to
push for rapid advance in water and sanitation in the
African context, where it is most needed.
 WHO takes a central position in the UN system on water
activities, with an authoritative voice on health claims and
interventions
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Water, Sanitation and Hygiene in the WHO | October 2009
More information on water,sanitation and
hygiene in WHO
www.who.int/water_sanitation_health
Thank you for your attention
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Water, Sanitation and Hygiene in the WHO | October 2009