Household water treatment: scaling-up is premature say researchers

A critical review concludes that the widespread promotion of household water treatment (HWT) is premature given the available evidence. Further acceptability studies and large blinded trials or trials with an objective health outcome are needed before HWT can be recommended to policy makers and implementers, say Wolf-Peter Schmidt and Sandy Cairncross of the London School of Hygiene and Tropical Medicine (LSHTM) [1].

Point-of-use water treatment (household water treatment, HWT) has been advocated as a means to substantially decrease the global burden of diarrhea and to contribute to the Millennium Development Goals (MDGs). To determine whether HWT should be scaled up now, the LSHTM researchers reviewed the evidence on acceptability, scalability, adverse effects, and nonhealth benefits as the main criteria to establish how much evidence is needed before scaling up. These aspects are contrasted with the evidence on the effect of HWT on diarrhea. The researchers found that the acceptability and scalability of HWT is still unclear, and that there are substantial barriers making it difficult to identify populations that would benefit most from a potential effect. The nonhealth benefits of HWT are negligible. Health outcome trials suggest that HWT may reduce diarrhea by 30-40%, but current evidence does not exclude that the observed reductions are largely or entirely due to bias.

[1] Schmidt, W. and Cairncross, S. (2009). Household water treatment in poor populations : is there enough evidence for scaling up now? Environmental science & technology ; vol. 43, no. 4 ; p. 986–992. doi:10.1021/es802232w

Read the full review here

IDS Conference discusses scaling up Community Led Total Sanitation

A conference at the Institute for Development Studies (IDS), Brighton, UK, from 16-18 December [2008] brought together professionals from around the world to share research and insights on Community Led Total Sanitation (CLTS).

The conference was the culmination of an IDS-led research project [Going to Scale? The Potential of Community-Led Total Sanitation], funded by DFID.

CLTS is an innovative approach in which communities mobilise themselves to take their own action to end open defecation.

Read Julia Day’s blog and see images from the conference at The Crossing, the blog for the STEPS Centre.

[...] The conference learnt of remarkable progress towards communities becoming open defecation free (ODF) in [...] Bangladesh, Cambodia, Ethiopia, India, Indonesia, Kenya, and Zambia.

[Several problems were identified including]: how to support and verify the inclusion of the poorest and most marginalised; social, physical and ecological sustainability; the safe confinement of children’s faeces; financing, rewards and incentives; and quality and style of training. How to go to scale with quality was an overarching and recurrent theme throughout the conference.

Almost every panellist highlighted that communities are not homogeneous, and that race, gender, ethnicity and class can be significant axes of difference. Achieving ODF conditions requires acceptance and participation by everyone in a community. Care is needed to ensure that CLTS reaches those who are poorest and most marginalised and that these groups don’t become more stigmatised in the process.

[...] Key areas for innovation and learning were identified, among them: how to sustain ODF conditions once they have been achieved; the role of children and schools; integration and collaboration with other approaches to sanitation and hygiene; and policy advocacy in working with donors and governments. Learning alliances of organisations and individuals were agreed to be a promising way forward.

[...] IDS will continue to work on CLTS. Findings from the current research project will be widely disseminated early in 2009. Under a new Irish Aid-funded project, IDS researchers Robert Chambers and Petra Bongartz will work together with Kamal Kar on action learning and networking and Lyla Mehta will explore opportunities for future research. This new project will include continuing to build a global network for sharing and learning to improve practice and policy around CLTS.

For more info on CLTS see the new (under development) and old project web site.

Source : Robert Chambers and Petra Bongartz, IDS, 23 Dec 2008