R ig h t w a y t o P r e p a r e d n e s s

H id d e n S u c c e s s o f H W T S in e m e r g e n c ie s

C u r r e n t ly u p t o 2 b i l l io n p e o p le la c k

a c c e s s t o s a f e w a t e r a n d

e m e r g e n c y e v e n t s s ig n i f ic a n t ly

e x a c e r b a t e t h e s e f ig u r e s

K e y is s u e in E m e r g e n c y

Water and sanitation are critical determinants for survival in the initial stages of a disaster.

People affected by disasters are generally much more susceptible to illness and death from disease, which to a large extent can be related to inadequate sanitation, inadequate water supplies

and inability to maintain good hygiene. The most significant of these diseases are diarrhoeal diseases and infectious diseases

transmitted by the faeco-oral route. (1)

W h a t is H o u s e h o ld W a t e r T r e a t m e n t &

S a f e s t o r a g e ( H W T S ) f o r lo w – in c o m e

g r o u p s Household water treatment is any activity to improve water quality undertaken at the

household level. HWTS:

Simple techniques reduce diarrhoeas twice as effective as intervention at source.

Economical with huge health impact. It can be adopted immediately in already

existing system.

H o u s e h o ld W a t e r T r e a t m e n t & S a f e

s t o r a g e ( H W T S ) f o r lo w – in c o m e g r o u p sHousehold chlorination reduces diarrhoea by

almost 40%HWTS interventions contribute to the MDG’sHWTS interventions are affordable and cost effectiveThey can make an immediate impactThey are “need” driven and not “supply” drivenParadigm shift from “Cure” to “Prevention” HWTS interventions are suitable sustainable scale-upHWTS interventions need greater advocacy and adoption by Governments and NGO’s

H W T S Im p a c t A growing body of evidence from the development

context has shown treating water at household level improves the microbial quality of stored household water and reduces the burden of disease in users (Clasen 2007).

Based on this evidence the World Health Organization promotes Point-of-use water treatment as a means of

achieving the Health gains of safe drinking water for the 884 million who lack access to improved water supplies and the millions more whose drinking water in unsafe” Unicef /

WHO 2008: WHO 2005) (2)

It is found that HWTS education can lead to uptake levels up to 9 times greater than simply delivering water treatment products without pre-education in crisis

situations.

H W T S O p t io n s

HWTS options include

Boiling, Sodis (sunlight disinfection), Filters, Sand filters, and chlorination such as Aquatabs or liquid

bleach and combined flocculent & disinfectant.

H W T S & C r is is

Three recent examples of where HWTS programs have made product immediately available in crisis situations have been, Haiti in January 10, Ethiopia

in September 09 and Vietnam in October 09.

H W T S & C r is is In Ethiopia after a recent cholera outbreak,

queues formed outside pharmacies to purchase Aquatabs. HWTS communication and education

programs meant that the communities understood the threat, understood the cure and were able to take immediate action to prevent

further outbreak.

Daniele Langtane in her study on the recent Haiti crisis found uptake levels of Aquatabs to

increase by from 10% to 90% with proper education.

W h y s h o u ld N G O s a n d e m e r g e n c y N G O s e n g a g e

in s u s t a in a b le H W T S p r o g r a m s ?

 Safe drinking water is an immediate priority in

most emergencies.

HWTS is one of the most cost effective methods of reducing Disability Adjusted Life Years (note

graph below).

“50% of malnutrition is not caused by lack of food but by disease associated with unsafe water

and sanitation”(3)

Up to 50% of all people in hospital are there due to unsafe water. HWTS programs reduce

diarrhoea rates in populations resulting in long term population health gains. Population health

gains lead to economic growth.

W h y s h o u ld N G O s a n d e m e r g e n c y N G O s e n g a g e in

s u s t a in a b le H W T S p r o g r a m s ?

 It can be suggested that early initial use of HWTS options during epidemic outbreaks will reduce the potential severity of the outbreak.

Immediate access to HWTS options through commercial channels will ensure earliest possible

usage.

Conversely, distributing HWTS products by NGOs in the midst of a crisis situation is more

expensive, donor dependant and requires education for the end users during stressful

times.

Furthermore, demand surge can lead to a shortage of products when needed most, whereas HWTS programs ensure ongoing

availability and greater ability to meet surge demands.

W h y s h o u ld N G O s a n d e m e r g e n c y N G O s e n g a g e

in s u s t a in a b le H W T S p r o g r a m s ?

  Properly run, HWTS programs are commercially sustainable and do not require ongoing donor support. They deliver development funding to NGOs due to the snowball effect of increased sustained

uptake.

Engaging in HWTS programs will see NGOs moving from reactive models to long term development models. From cure to

prevention.

HWTS techniques such as Sodis or chlorination are ten to 20 times cheaper for the end user than boiling. Chlorination keeps water safe after treatment whereas boiled water is substantially

vulnerable to re-infection.

In a blind trial in Bangladesh, Aquatabs were shown to reduce diarrhoea rates amongst most vulnerable children by 65%. (4)

W h y s h o u ld N G O s a n d e m e r g e n c y N G O s e n g a g e

in s u s t a in a b le H W T S p r o g r a m s ?

  Giving communities the education to self-treat their water empowers the community and helps

break the cycle of dependency on aid.

C o s t e f f e c t iv e n e s s o f H W T S

Household water treatment cuts the primary transmission route for diarrhoeal disease and can

pay back up to US$60 for every US$1 invested

Among all water quality interventions to prevent diarrhoea, chlorination (at household level) is the

most cost effective;

C o s t e f f e c t iv e n e s s o f H W T S

Cost effectiveness

Interventions against diarrhoeal diseaseCost-effectiveness

ratio (US$ per DALY averted)

Cholera immunizations 1,658 to 8,274

Rotavirus immunizations 1,402 to 8,357

Measles immunization 257 to 4,565

Oral rehydration therapy 132 to 2,570

Breastfeeding promotion programs 527 to 2,001

Latrine construction and promotion ≤270.00

House connection water supply 223

Hand pump or stand post 94

Water sector regulation and advocacy 47

Household Water Treatment (Afr-D)* 46

Latrine promotion 11.15

Hygiene promotion (including hand washing) 3.35

Source: Disease Control Priorities in Developing Countries. Jamison et al 2006 chapter 2 p.41

D o e s i t m a k e f in a n c ia l s e n s e ?

“In strictly financial terms, the return on investment in water and sanitation cannot be overestimated. Economic benefits range

from $3 to $34 for each dollar invested” (5)

- HWTS programs generate surplus funding which can be re-invested in supplementary income for NGO volunteers and further

HWTS education programs.

- Investing 100 Rupees in water purification tablets will give a family enough tablets for 3 months whereas investing the same amount in HWTS educational programs will result in one family

committing to use Aquatabs in into the long term future and at no further cost to the NGO.(6)

  There are substantial programs underway internationally

in which NGOs take an active role in the education of communities and the commercial sale of HWTS products.

These programs often take the form of door-to-door education & sales visits. Through these programs staff and part-time staff of the NGOs can incentive while the NGO’s

central offices also get incentive.

Some NGOs train communities in the need to use one of a range of HWTS options available. For example the “Self Help Group Ladies” model in Lucknow sees NGOs training

communities through SHG ladies to use HWTS options. The SHG ladies earn an income from the products that they sell.

H o w d o N G O s g e t in v o lv e d in H W T S p r o g r a m s ?

 

• H W T S i s t h e u l t im a t e in p r e -p r e p a r e d n e s s . T r a in e d p e o p le

• H W T S i s t h e u l t im a t e in p r e p o s i t io n in g . R a p id d e p lo y m e n t

• P o s t e v e n t c o n t in u e d u s e & n e t s a v in g s t o t h e p u b l ic s e c t o r

• Z im b a b w e P S I . S ig n i f i c a n t s u c c e s s a t r e t a i l le v e l

• E t h io p ia – C h o le r a o u t b r e a k = s e l f t r e a t m e n t

E m e r g e n c ie s – t h e h id d e n s u c c e s s

o f H W T S N e t w o r k

B e n e f i t s lo w -in c o m e u s e r s

• S im p le t o u s e . N o c r u s h in g o r s t i r r in g

• C a n b e p u r c h a s e d in a m o u n t s t o s u i t

a v a i la b le f u n d s , e v e n d a i ly

• S a f e . W i l l n o t b le a c h o r b u r n

• L ig h t t o t r a n s p o r t & s m a l l t o s t o r e

• T a s t e a c c e p t a b i l i t y

• C u l t u r a l ( R e l ig io u s ) a c c e p t a b i l i t y

• Q u a l i t y a s s u r e d ( A c t iv e in g r e d ie n t U S E P A

& N S F c e r t i f ie d )

• N a D C C i s n o w in W H O d r in k in g w a t e r

g u id e l in e s

• K e e p s w a t e r s a f e

* Joint Expert Committee on Food Additives

A q u a t a b s me e t a l l t h e c r it e r ia & s e t s t h e q u a l it y s t a n d a r d s f o r HW T S p r o d u c t s : S a f e t y a n d c o n s is t e n t q u a l i t y B io c id a l e f f e c t iv e n e s s – > 15 f ie ld e v a lu a t io n s H e a l t h -Im p a c t / W a t e r Q u a l i t y A c c e p t a b le b y in d ig e n o u s p e o p le s – > 10 s t u d ie s A f f o r d a b le b y lo w -in c o m e e a r n e r s

A s ia : € 0 . 0 3 t o € 0 . 0 5 U S c e n t s p e r 2 0 l i t r e t a b le tIn d ia : € 0 . 0 1 t o € 0 . 0 2 U S c e n t s f o r 10 l i t r e t a b le tA f r ic a : € 0 . 0 2 t o € 0 . 0 5 U S c e n t s f o r 2 0 l i t r e t a b le t

S o c ia l m a r k e t in g / c o m m e r c ia l m a r k e t in g A v a i la b i l i t y , S c a la b i l i t y – 2 s i t e s /3 B i l l io n A q u a t a b s S h e l f L i f e – 5 y e a r s L ig h t & P o r t a b le – a p p r o p r ia t e f o r r u r a l a r e a d is t r ib u t io n , t h e la s t m i le .

A q u a t a b s – C r i t e r ia f o r H W T S

• P h a r m a c e u t ic a l m a n u f a c t u r e r – ( G M P ) -

2 5 y e a r s in b u s in e s s

• IS O 9 0 0 1: 2 0 0 0

• D o c u m e n t e d p r o c e d u r e s a r e in p la c e t o

e n s u r e m a t e r ia ls a n d p r o d u c t s   c o n f o r m

t o In t e r n a t io n a l s p e c i f ic a t io n s

• In t e r n a t io n a l R e g is t r a t io n s

• 10 0 % U S E P A a p p r o v e d & m a n u f a c t u r e d

a c t iv e in g r e d ie n t

• In t e r n a t io n a l N S F c e r t i f ie d t a b le t & a c t iv e

in g r e d ie n t

• C o l la b o r a t e w it h t h e t e c h n ic a l b o d ie s o f

t h e H W T S N e t w o r k

• E f f e r v e s c e n t b a s e u s e s

p h a r m a c e u t ic a l /f o o d g r a d e in g r e d ie n t s –

n o t e c h n ic a l g r a d e s

• 5 y e a r S h e l f - l i f e c e r t i f ie d t o IC H

s t a n d a r d s .

• P r in c ip a l s u p p l ie r s t o m a in in t e r n a t io n a l

A id a g e n c ie s .

Certified to NSF/ANSI

Standard 60

A q u a t a b s – Q u a l i t y & S a f e t yO u r o b je c t i s t o c o n s t a n t ly s e t t h e g o ld -

s t a n d a r d f o r w a t e r p u r i f ic a t io n t a b le t q u a l i t y :

Field trials have been independently undertaken in:

- B a n g la d e s h ( A IT )- B r a z i l ( M in o f M a r in e / A B E S )- D o m . R e p ( D o m . In s t o f In d u s t r ia l T e c h n o lo g y )- E l S a lv a d o r ( C e n t r a l A m e r ic a n U n iv e r s i t y ) F r a n c e ( M in o f D e f e n c e )- H o n d u r a s ( M in o f H e a lt h )- In d ia ( B a y e r )- K e n y a ( M in o f W a t e r )- P a k is t a n ( C i t i la b )- S o u t h A f r ic a ( N g a n g a n e L a b )- S p a in ( P h a r m a c e u t ic a l C o l le g e ) - S w a z i la n d ( M in o f W a t e r ) - T a n z a n ia ( M in o f W a t e r )- V ie t n a m ( In s t M i l i t a r y M e d ic in e )- Z im b a b w e ( P u b H e a lt h L a b )

G r a p h ic u s a g e in s t r u c t io n s

f o r n o n -l i t e r a t e p e o p le

Aquatabs DosageTubs

Aquatabs 8.68g are also available in tubs of 60 tablets to treat larger volumes of water:

1 tub of 60 tablets will disinfect 60,000 litres of water

Tablet Dilution Available Chlorine

Aquatabs 8.68g 1000-1250 litres 4-5 mg/l

Well Disinfection

Aquatabs 8.68g tablets or Aquatabs Granules are also suitable for disinfecting:

Tanks and other storage structures Pipework Wells, tubewells and boreholes Spring Boxes or Silt Traps

Comprehensive guidelines are available

Well Treatment, Zimbabwe

Multi-Purpose Aquatabs

• Water Disinfection:

• One tablet, when added to 200 litres of water, will disinfect the water in 30 minutes, (at 5mg/l available chlorine)

Water CollectionKisumu, Kenya

L o n g t e r m p r ic e c o m m it m e n t• M e d e n t e c h is d e l ig h t e d t o a n n o u n c e i t s

lo n g -t e r m c o m m it m e n t t o B O P a f f o r d a b le r e t a i l p r ic e s o f A q u a t a b s w h i le n e v e r c o m p r o m is in g o n q u a l i t y

• P r e p o s i t io n in g o f f e r f o r le a d in g a id a g e n c ie s , N G O ’ s a n d g o v t . a g e n c ie s .

A d d r e s s in g o u r c h a l le n g e s

t o s c a le -u p o f A q u a t a b s

3535

36

37

38

39

40

43

Day-3(Products distributed on Spot)

©©MedentechMedentech 20072007

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Indian Health Impact Study

• ChloRun health impact study in A.P.

• Initial reports show significant reduction in diarrhea.

• Babies weight in intervention group show significantly improved than control group.

Aquatabs advantages• Efficacy: Proven efficacy as high level broad spectrum disinfectants in critical

care environments. All efficacy claims are supported in our library of independent studies & reports.

• Residual Killing Power: Continue to kill germs after application. This help prevent surfaces becoming re infected.

• Shelf-Life: Long Shelf Life (5 years in foil, 3 in tubs)

• Easy to transport: Classed as non hazardous for transport. They are light & easy to store. The equivalent of 1,000 litres of disinfectant can be held in the palm of your hand

• Safe to Use: Safe to use and will not burn if spilt as liquid bleach may.

• Simple to Use: Simple to use. One tablet in a known volume of water will provide an exact reliable killing solution. Complicated measuring is not needed.

• .

AquatabsAquatabs are self dissolving (effervescent) water purification tablets

can be used in a wide variety of situations.

• Household Water Treatment

• Emergency & Disaster Relief

• Peacekeeping & Defence Forces

• Travel, Camping & Marine

• Number 1 Water Purification tablet in the world

• Over 1 Billion Aquatabs supplied in 2009 = 15 billion litres of water

• Over 13 million daily users in developing countries

• .

HWTS Programs in IndiaHWTS Programs in India

• HWTS program in 500 slums in Lucknow

• Health worker pilot HWTS program in 80 villages in U.P.

• Pilot in Maharashtra with 400 SHG.

• Bicycle model pilot in Partapgarh.

• Unemployed youth/students model in Imphal.

• Health worker model in Dharavi, Mumbai.

Chemical:Chemical: CDB 56. CDB 56. Solid Granules Solid Granules

Dosing Technology:Dosing Technology: State of art dosing State of art dosing machine.machine.

ChloRun- For Community water ChloRun- For Community water disinfection disinfection

• H o u s e h o ld W a t e r T r e a t m e n t h a s b e e n s h o w n t o b e o n e o f t h e m o s t e f f e c t iv e a n d c o s t -e f f e c t iv e m e a n s o f p r e v e n t in g w a t e r b o r n e d is e a s e in d e v e lo p m e n t a n d e m e r g e n c y s e t t in g s .

 • D e e p p r e -p o s i t io n in g o f s t o c k s o f w a t e r

p u r i f ic a t io n p r o d u c t s a n d m o s t im p o r t a n t ly t h e p r e -e d u c a t io n o f v u ln e r a b le c o m m u n it ie s b e in g c a r r ie d o u t b y H W T S p r o g r a m s r e s u l t in e a r l ie s t a v a i la b i l i t y o f p r o d u c t t o t r e a t w a t e r in e m e r g e n c y s i t u a t io n s c o m b in e d w it h p r e -e d u c a t io n o f c o m m u n it ie s t o t h e n e e d t o t r e a t t h e i r w a t e r .

Conclusion

• U p t a k e le v e ls in H W T S p r o g r a m s u n d e r -r e p r e s e n t t h e a c t u a l b e n e f i t s t o t h e w id e r c o m m u n i t y o f t h e e d u c a t io n a l v a lu e g a in e d c o n c e r n in g w a t e r t r e a t m e n t . In v e s t m e n t in H W T S p r o g r a m s e d u c a t e s t h e w id e r c o m m u n i t y a s t o t h e n e e d t o t r e a t w a t e r a t r i s k a n d e s p e c ia l ly d u r in g c r is i s s i t u a t io n s .

• T h e h id d e n s u c c e s s o f H W T S p r o g r a m s is t h e s u r g e u p t a k e t h a t a r is e s in b r o a d e r c o m m u n i t ie s d u r in g c r is i s s i t u a t io n s .

Conclusion

THANKS

V i ja y M a l ik

IC L W A T E R

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W e b s i t e : w w w . a q u a t a b s . c o m