Lessons learned from fifteen drinking water treatment program evaluations in Haiti

Providing safe drinking water is a priority in emergencies. The 2010 earthquake in Haiti and subsequent cholera outbreak thus led to the implementation of numerous point-of-collection (PoC) and point-of-use (PoU) water treatment programs. We propose to present a synthesis of lessons learned from fifteen evaluations conducted in Haiti between 2010 and 2016, including four PoC and eleven PoU water treatment programs, to better understand which strategies have helped make programs effective and sustainable. Overall, it appears that PoU water treatment technologies were more effective than PoC water treatment programs in the Haitian context. Additionally, evaluation results suggest that programs achieving sustained effectiveness were those that:1) promoted technologies that were effective and familiar to beneficiaries; 2) had reliable supply chains for water treatment products; 3) worked with local partners; and, 4) included monitoring

Sustained effectiveness of chlorinators installed in community-scale water distribution systems in Haiti

In 2012 and 2013, Child Relief International (CRI) partnered with Haiti Philanthropy to install “Chlorinators” in 79 gravity-fed water distribution systems in Southeast Haiti as an emergency response project, followed by a sustainability plan. We carried out an independent evaluation to assess the extent to which Chlorinators were operational and providing safe water approximately two years after installation. We completed 18 randomly selected site assessments, 180 household surveys, water quality testing for Free Chlorine Residual (FCR) and Escherichia coli on water samples from reservoirs, taps, and household stored water, and 24 key informant interviews. None of the systems were functioning 2 years after installation, 3% of household respondents had received information about the Chlorinators, and no community or household water samples had detectable FCR from Chlorinators. However, key informants were largely supportive of the systems. Reasons for non-operation and challenges associated with achieving sustainability are discussed

WASH interventions in emergencies and outbreaks: two systematic reviews and impact analyses

There is a lack of evidence-base for WASH interventions in emergencies, although many agencies collect various types of evidence that is not formally published or widely shared. The aim of this work is to help provide policy relevant evidence of WASH interventions by summarizing the information collected by NGOs, UN agencies, or local governments responding to humanitarian emergencies and disease outbreaks. A systematic search covered academic databases, agency websites, and direct solicitation of humanitarian actors. Qualitative and quantitative research methodologies, as well as, both published and grey literature were eligible for review. More than 15,000 manuscripts were identified, 1,500 abstracts assessed, and 500 full texts reviewed. Final included manuscripts will be summarized using the GRADE summary of findings around the themes of: use of service; health-related outcomes; non-health related outcomes; barriers and facilitators to implementation; and cost-effectiveness. This work will establish a real-world evidence-base for humanitarian WASH policy

A cross-sectional study on water access within the Healthy Villages and Schools (VEA) program in the DRC

In DRC, the Healthy Villages and Schools (VEA) National Program consists of a community participatory process towards sustainable access to improved water services, hygiene and sanitation where villages and schools are certified “healthy” once they comply with 7 WASH specific norms. Through a mixed-methods survey of household questionnaires, water quality testing of source and stored water samples, mapping of water sources, and discussions with key informants, this study looked at VEA implementation in the Katana health zone, South Kivu province, to ascertain lessons learnt from the program. From 206 household surveys and 71 focus group discussions, it was determined that there are two primary barriers to effective water supply coverage: accessibility to a source within 30 minutes and delivery of water that conforms to WHO guidelines of <1 E. coli CFU/100mL. Additional demographic and WASH knowledge, attitudes, and practices outcomes as well as challenges associated with the VEA are discussed

Evaluation of household drinking water filter distribution programmes in Haiti

Household water treatment can reduce diarrhoeal disease in populations without safe water access. We evaluated five programmes that distributed biosand, ceramic, or Sawyer household water filters in Haiti after the 2010 earthquake. We conducted household surveys, collected water samples, and tested water quality at ~50 houses from each programme. Across programmes, self-reported filter use ranged from 27-78%; confirmed use (met reported use and showed the filter with water in it) ranged from 20-76%; and, effective use (stored water quality was improved to international guideline values using the filter) ranged from 0-54%. More successful programmes: 1) distributed an effective technology; 2) provided safe storage; 3) required cash investment; 4) provided initial training; 5) provided follow-up; 6) provided supply-chain access; 7) targeted households relying on contaminated water sources; and, 8) had experience working in the local context. These findings suggest that well implemented programmes can result in sustained filter use in Haiti

Operational research on water safety plans: implementations in India, DRC, Fiji, and Vanuatu

Despite the promotion of Water Safety Plans (WSPs) as a comprehensive risk assessment and management strategy for water delivery, there is a lack of documented outcomes and impacts from this approach, particularly for community-managed supplies. Through a mixed-methods protocol of household surveys, water quality testing of source and stored water samples, key informant interviews, and focus group discussions, this study looked at WSP implementation in four countries to ascertain lessons learnt from these programs. From 817 household surveys and 256 key informant discussions, it was determined that there was no clear evidence linking WSPs to improvements in water quality. However, interviews indicated improved capacity of local committees in understanding their water supply systems and in identifying key risks to the delivery of safe water. Additional outcomes of WSPs and challenges associated with their implementation are discussed

Setting priorities for humanitarian water, sanitation and hygiene research: a meeting report

Recent systematic reviews have highlighted a paucity of rigorous evidence to guide water, sanitation and hygiene (WASH) interventions in humanitarian crises. In June 2017, the Research for Health in Humanitarian Crises (R2HC) programme of Elhra, convened a meeting of representatives from international response agencies, research institutions and donor organisations active in the field of humanitarian WASH to identify research priorities, discuss challenges conducting research and to establish next steps. Topics including cholera transmission, menstrual hygiene management, and acute undernutrition were identified as research priorities. Several international response agencies have existing research programmes; however, a more cohesive and coordinated effort in the WASH sector would likely advance this field of research. This report shares the conclusions of that meeting and proposes a research agenda with the aim of strengthening humanitarian WASH policy and practice

Approach for the selection of a bacteriophage surrogate for the Ebola virus to evaluate surface disinfection efficacy.

<p>Approach for the selection of a bacteriophage surrogate for the Ebola virus to evaluate surface disinfection efficacy.</p

Characteristics of the Ebola virus and of the selected test organisms.

<p>Characteristics of the Ebola virus and of the selected test organisms.</p

Observed average first-order inactivation constants (k, min^-1) and log inactivation (LI) at 0.1% and 0.5% NaOCl.

<p>Observed average first-order inactivation constants (k, min^-1) and log inactivation (LI) at 0.1% and 0.5% NaOCl.</p