Quality time

Published on: 20/05/2014

Last week, an interesting systematic review was published, that assessed whether water sources classified as "improved" are indeed safe. This review of 319 studies, reporting on 96,737 water samples, found that a significant portion of improved sources contained fecal contamination. The study also found that water sources in low-income countries and rural areas were more likely to be contaminated. The authors conclude "that an improved source provides a measure of sanitary protection but does not ensure water is free of fecal contamination". It confirms also other study findings that if water quality is taken into account, figures of "access to safe water" as per the JMP are highly overestimated. Earlier work of IRC also found that improved communal sources in Ethiopia definitely provided better quality than unimproved family wells; still a significant percentage of the ones classified as improved has bacteriological contamination. We had a bit of quality time at IRC to discuss the implications of these findings for our own work. Should we pay some more attention to water quality in our work on monitoring? Should we work more with those who develop low-cost water quality monitoring devices linked to smart phones (such as this one and this one (in Dutch only))? And most importantly, how can we act upon these data?

Should we work more on low-cost water quality monitoring?

We started by recognizing that anything that can bring down the costs of water quality monitoring and that facilitate more widespread monitoring is more than welcome. But to paraphrase what Patrick Moriarty said at an earlier debate on the death of the handpump, these are" pieces of 21st century technology to monitor a 19th century piece of pumping technology", to which I would add, that are managed by 20th century water committees. To put it differently, if your smartphone indicates that the water from your handpump is contaminated, is there anything the water committee can do about it? Adopting the low cost water quality tests only makes sense if there are service providers with capacity to take some corrective action, however basic it may be. And in many cases, that capacity is not there.

Chlorination, as the most basic form of water quality management, is promoted among piped rural water supplies across much of Latin America, particularly the ones that are gravity-fed. But most rural service providers struggle with that. Surveys indicate that only a small fraction of service providers actually chlorinates the water, and only a fraction of them do that in an adequate manner. I readily admit that for a long time I have been skeptical about these types of efforts to improve water quality or the value that must be attached to a situation where water committees do not chlorinate. During the internal debate in IRC, I found out that many of my colleagues are skeptical too. Many arguments were shared against putting much emphasis on water quality.

• Generally, users have a low demand for high quality water. They want water that is ok-ish, tastes good and isn't mud; but they do not necessarily want high quality water.
• Even if you provide very clean water, much of that gets contaminated between tap or pump and the point of use
• If many of the other aspects of the service are poor (like quantity and continuity), focus on addressing those first, before moving on to water quality

Nobody is advocating for providing dirty water – in the end the human right talks about access to safe water. But the gist of the arguments was that the effort to make water safe needs to be proportionate to the other components of the service level. It is like the game "snakes and ladders": if you climb high up the water quality service ladder, but quantities supplied or accessibility is low, you quickly slide down the stairs again.

I readily admit I am a water quality skeptic

That led us to identify a couple of broad scenarios of water supply and what could pragmatically be done about water quality monitoring and its management:

1. Situations where a large part of the population practices self-supply from unimproved sources. These would be the types of settings found in the earlier mentioned study in Ethiopia. No water quality monitoring is needed to know that water sources are likely to be contaminated. The main focus should be on approaches to improve the sources, by simple protection measures. They will still not be fully safe, but it is a first improvement.
2. Situations where the population relies on basic levels of service – the typical situation of boreholes with handpumps. The main focus should be on hygienic handling of the water. By definition, users will need to fetch and carry the water and store it at their house, increasing the risk of re-contamination along the way. In these settings, water quality testing should be done at least when the water point is installed, also to ensure that these water points don't have chemical contamination. Colleagues shared anecdotal evidence from Uganda and Burkina Faso that even these initial tests are often not happening. The low-cost tools could at least simplify the initial testing and bring down the expenses. But regular water quality monitoring will not make much sense, as typically the capacity of the water committees to address water quality issues is very limited.
3. Same situation as above, but where there is a high probability of presence of fluoride or arsenic. The low-cost monitoring tools may be relevant in doing the studies to assess this, but of course addressing these situations will be complicated and involve major infrastructure works (probably making the budget for monitoring small in comparison).
4. Situations of more complex systems (piped systems with household connections) with higher degrees of professionalization. Here monitoring starts to make most sense as more water quality management measures can be taken. And probably these then need to be part of bigger packages to improve services. For example, if continuity of supply in piped schemes is intermittent, water quality management will be very difficult. This is where the low-cost monitoring tools have probably most value. It is also in these types of settings where approaches like water safety planning, as promoted by the WHO, make most sense.

The kind of data that triggered this internal debate will surely keep on coming in over the years to come. The low-cost quality testing devices will probably even increase that flow. But the quality challenges will remain for a while to come: even many countries in Europe are not actively monitoring water quality in small and private systems. But as important as getting the data, is identifying pragmatic ways to address the water challenges. I hope that the type of scenarios outlined above are of help in that, so that we progressively can tackle the 'safe' part of the human right to water.