The weather was lovely, as were the red and yellow colours of the fall trees, for the last day of the conference. A water filter vendor packed up his things and wheeled them to his car. Friends, old and new, took pictures of each other. The hosts served yet another fine lunch when the programme ended at noon. Everyone’s a little weary. It has been an intense week for the many gathered scientific researchers, government representatives, field workers, and others. For me it was a good chance for new learning, right up to the end.

Water Safety Plans (UNICEF-WHO session). SDG target 6.1 is safe and affordable drinking water for all. Safely managed drinking water is a) on premises, b) available when needed, c) and meets water quality standards. This formulation just got approved at the Bangkok meetings this week.

Water Safety Planning is a ‘management tool’ to make this happen: Set a target, make a plan, and check to see if the plan is working. This tool can help to monitor and verify safety at multiple stages of the drinking water production and delivery system, not just at the end. The objectives of a Water Safety Plan (WSP) are to do the following:

1. Look at source water, minimise contamination of it;
2. Reduce or remove contamination by treatment; and
3. Prevent contamination during storage, distribution (leaky pipes) and consumer practice.

The work is done in Source Treatment Plants, in the Distribution System, and at water points or outlets. At the heart of a WSP is a ‘risk matrix’, which is a simple scoring sheet identifying the types and levels of risks. Water quality is one thing checked; but water delivery arrangements and infrastructure also are assessed. Scoring systems, to assess levels of risk, are simple and mostly qualitative. Most important risks are evaluated, priority improvements are identified, and their costs are estimated. (Challenging examples: agricultural fertiliser run-off, leaky pipes.)

Especially since 2004, many countries have been doing WSPs. A 2013 survey of WSP implementation, policies, and regulation in 100 countries found that 91 had implemented them. Policies and regulations are found in lower percentages, which have been increasing since 2004.

The case of Ethiopia’s WSP was described. The process started in 2012 with a Joint Technical Review, in which high-level government officers participated. Water safety issues thus got priority policy attention. In 2013 a WSP was developed, and training was done for some small community supply systems with technical assistance from WHO. Multiple government departments were involved. In March 2014 a national meeting was convened, with the Ministry of Weather in the lead. A publication from that event was Climate Resilient Water Safety, which focused on protecting both the quantity and quality of water resources in years ahead. This document described a national strategic framework defining goals to be reached by 2020.
Water, Health, Environment, Agriculture, meteorology, and Universities were involved in a TOT (Training-of-Trainers) for 26 participants, including five from Tanzania. The training ‘cascaded from there’, and there now are six urban and three rural WSPs serving 500,000 people. By the end of 2015 they will have scaled up to four more water supply systems. Impacts will be measured later on. The advantages of a WSP are these:

• Establish baselines and measure progressive improvement of water supplies and survice reliability. (It’s not just about water quality, also about services.)
• Also looking for changes in knowledge and understanding
• Change in operation, maintenance and management practices
• Help with policies, guidelines and setting standards for development and utilization.

The principal challenges are resources, technical capacity, and coordinating the involvement of institutions from multiple sectors. The Joint Technical Review meetings were a good way to engage the interest of high-level decision makers. Future plans include water resource inventory, vulnerability assessment at basin and catchment levels, and new infrastructure.

Community Health Clubs (CHC) in Urban Areas. Two presentations discussed the WASH and other advantages of forming CHCs in urban areas, especially squatter settlements (slums). The country case studies were from Haiti (by Jason Rosenfeld, Lakou La Santé) and Zimbabwe (by Juliet Waterkeyn & Regis Matimati, Africa AHEAD). 
Presented as an alternative to other, more well-known, rural methods of community mobilisation, CHCs are formed in the generally crowded conditions of urban life, in which most people are migrants from the countryside and somewhat detached from familiar social networks. Their living conditions general involve rental units, so landlords are important stakeholders.

The CHC is a group centred on a training course. Members join and go through a fixed series of classes on specific topics. WASH is the entry point, but broader community development and other health goals can be part of the picture, depending on what people decide to do with their group. Those who go through the full training have public, formal graduation ceremonies and receive certificates entitling them to status as full-fledged CHC members. Both presenters spoke of the CHCs as meeting a need for stronger ‘social capital’ (or supportive social networks) in the urban environment, as group members form strong bonds. Volunteer facilitators, who are CHC members, gain knowledge and experience, but they are not paid for their services.

The Haiti population has 28% improved sanitation and 58% improved water. The January 2010 earthquake demolished almost all infrastructure. Water supplies have recovered more than sanitation systems. Cholera will be endemic in the foreseeable future. There have been almost 9000 cholera deaths since the first cholera outbreak, ten months after the earthquake. Space is hugely important: ‘They are living like sardines’. There isn’t even space for community latrines. There also aren’t any large sanitation service providers in Port au Prince. The demand is there, but no one to respond to it.

The Lakou La Santé is a small organisation supporting CHCs as a ‘programme’, not as a limited-term ‘project’, the presenter emphatically stated. They are in these communities to do whatever it takes to solve development problems by building up viable ‘civic structures’ that will be capable one day of advocating on their own for local improvements. WASH objectives are to improve information and practices related to spread of waterborne diseases.

The programme started with six clubs across the city, including Cité Soleil, a very dangerous place to work. All are underserved areas. The CHCs have positive names and slogans: ‘Each one helps others’, ‘health is more wealth’, ‘my health is yours’, ‘health is victory’. Now there are about 32 new clubs with more than 1000 members. A common saying among them is a twist on a Haitian proverb: ‘The business of the goat is not the business of the sheep’, meaning mind your own business. The new twist is, ‘The business of the goat is the business of the sheep’. Lakou is the Haitian word for a rural family compound. Calling their groups by this name suggests family-like ties, though members in these urban settings mostly are not actual relatives.

In an evaluation study of members and non-members in three (non-dangerous) places 75.3% of club members reported sharing a toilet with a friend or neighbour, if they didn’t have their own toilet. Non-members were still resorting to OD.

The organisation seeks NGO and other working partners in Haiti, because services are so very sparse. They are negotiating with the Ministry of Health to get some services, but health workers are overburdened.

In Zimbabwe after a cholera outbreak in 2008-9, Oxfam sent Africa AHEAD in to do emergency relief. They formed 50 health clubs in Mutare, which is a coastal city, the gateway for entry of cholera from Mozambique. Moved to Chipinge, Chirezdi, Bindura, and finally to Harare. All these different projects taught us different things. They have 331 health clubs now in six cities, with a total of 27,692 members. Facilitation costs are less than $3.00 per person. Large-scale programmes are more cost-effective than small-scale, according to this presenter. Activities are many. They include savings schemes, solid waste management, communication with the town councils. Results include: increased social cohesion, household water treatment, self-initiated clean-up efforts, and an all-important sense of pride. A police official in one of the cities said that the clubs had helped to reduce domestic violence. An open sewer responsible for the cholera outbreak was cleaned up. ‘Perpetrators now know that violence is unacceptable’. We built tippy-taps, latrines’. One old woman said, ‘I expected my next certificate would be my death certificate. Now I’m very proud’. They put their certificates up on the walls of their homes. Another woman in Zimbabwe went to a local mission saying she needed a job. They asked her if she had any certificates. She went through the whole course with us and got her certificate. She did get a job in the mission after six months.

During a panel following the presentations, the moderator, Darren Saywell, head of Plan-USA, said – We need to be adaptable in our approaches. But we should not apply any one approach in one context. His example: attempts to do CLTS in a high-density urban context don’t work. What seems to work better is ‘triggering landlords’. It’s a stop-gap measure, but may improve quality of life. We are trying to ‘experiment at the margins’. Work with local government, make small steps (nudges) forward.

Suzanne Hanchett is a consultant and partner in Planning Alternatives for Change