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How can we get more people to treat their own water?

Published on: 16/06/2016

Whether you live in the countryside or city in Ethiopia, your water may be unsafe to drink. Household water treatment is one way we can improve its quality.

I spend a lot of my time working on Self-supply, where rural households develop and improve their own supplies through their own investments and actions. This usually involves family wells but household water treatment and storage (HWTS) is similar and related, and can even be part of a package. Similar because the intervention relies on consumer behaviors in the household to invest, improve and use their facility. Related because family wells and HWTS are highly complementary. Typically the water from a family well is likely to be unsafe to drink according to standards, and HWTS is one way to improve it's quality. However, it's not only water from family wells that might be unsafe.

One figure that we remember now is that at the Millennium Development Goal finish line in 2015, water supply coverage in Ethiopia was estimated at 57% (average for urban and rural). These are the people with improved water supply sources including piped water at premises. This implies obviously that still 43% of the country's population was without access to improved water supply sources.

A survey that included Ethiopia (the Rapid Assessment of Drinking Water Quality or RADWQ) is now about to be repeated. Last done over 10 years ago (data collection in 2005) this survey found that 56% of water samples at the point of use did not comply (> 0 TTC) with the WHO standard for fecal coliforms.

So we shouldn't forget that HWTS is needed both by households without and with improved water supplies.

Until recently, we were guided by a target under the Health Sector Development Program IV (2010/11-2014-15) to work towards 77% use of household water treatment and safe storage practices (up from 7%). This looked rather ambitious and wasn't matched by a system to monitor and track improvements. The national target is now 35% by 2019 (Health Sector Transformation Plan, HSTP 2015/16-2019/20) with a revised baseline figure of 10%. If we use round figures for the sake of simplicity and forget about population growth, that means going from 10% of 100 million people (10 million) using HWTS to 35% of the population (35 million). That means at least 25 million people; let us say 5 million households have to be convinced. How can we reach 5 million households? How to build the supply chains for locally manufactured or imported products – chemicals and filters – to reach these consumers?

Apart from locally made filters and chemicals such as bio-sand filters, ceramic filters, and some chlorine products, others filters and chemical-based additives are imported from abroad. The existing availability of imported products is challenged by both availability of foreign currency and taxation. Despite being promoted by national health plans, HWTS products have not been seen as a normal health intervention that enjoys tax exemption. The taxes on such products are borne by the end users which increases the product price. Waiving taxes from such products might encourage more use.

Life Straw Water Treatment

Many HWTS products are currently disseminated through NGOs working on emergency relief or on a project intervention basis. Increasingly both NGOs and government are looking at how local entrepreneurs and private sector could distribute WASH products. But the supply chains to reaching users are not well established. Chlorine products are more available than filters. These can be kept as stock at in local pharmacies or clinics.

Ceramic Filter

Some possible options to get HWTS products to users were raised and discussed during an inter-regional workshop on HWTS held in Addis Ababa from 3- 5 May 2016. These included: distributing through urban water and sewerage utilities, through health centers and health posts, or through sanitation marketing related businesses.

Advantages and limitations of each possible channel were raised and discussed; urban water and sewerage utilities have technical expertise to provide after sales service or support, and also they are semi-business oriented so they may be able to partner well with private manufacturers or suppliers; however it could a cause conflict of interest for a utility to promote HWTS when they should be centrally treating water; and perhaps it may reduce user confidence in the water quality of the utility's supply. The use of the health posts and centers may link well to demand creation as there are health extension workers in every rural kebeles; but a challenge is linking the public sector with private sectors (suppliers and manufacturers) and managing incentives for government staff. The use of the sanitation marketing businesses would have the advantage of linking HWTS products and rather complimentary sanitation products; and these entrepreneurs might need multiple products to be successful. However, such businesses exist only in a few kebeles or woredas so it may be hard to take HWTS products to scale.

I personally believe that the three possible dissemination channels all have their advantages and disadvantages. Important is testing them in different contexts and learning what works.

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