Promotion of Point of Use Water Treatment in Nepal Challenges and Opportunities of Giving Choice

BackgroundDespite advances made in increased access to water supply during the past two decades—37% in 1990 to 82% by 2001 (Central Bureau of Statistics, 2001), the quality of water remained unacceptably low. In 2006, the Government of Nepal established the Drinking Water Quality Standard, which established the policy framework for addressing the water quality problem with the existing resources and low public awareness about the need for safe water.In collaboration with Department of Water Supply and Sewerage of the Government of Nepal, The U.S. Agency for International Development (USAID) funded UNICEF and its USAID/Hygiene Improvement Project (USAID/HIP) to embark on a pilot project in four districts in Nepal to face the challenge of improving water quality, a challenge even greater than just reaching the population with improved water supply.Formative and Baseline ResearchA baseline survey conducted by UNICEF-USAID/HIP in 2006 showed that 75% of the surveyed households (1800 households and 200 change agents) were unaware of the risk of their poor quality water and assumed that their water was safe for drinking, despite several national studies including those done in the pilot project areas that had shown high microbiological contamination in all water sources of Nepal, including piped water supply provided by the government. Public perception of unsafe water was limited to the physical appearance of water, which brought about the misconception that “clear and cool water is safe water.”To address water quality, the pilot took a comprehensive approach guided by the Hygiene Improvement Framework, built upon three essential “pillars” of focus to achieve hygiene and sanitation improvement: access to necessary supplies and equipment; an enabling environment that includes supportive policy and institutional capacity; and the third pillar of promotion, including social mobilization, marketing and education.Program ApproachThe Nepal Hygiene Improvement Project, under a UNICEF-USAID/HIP joint effort, focused on promotion of basic hygiene practice including safe handling, storage and treatment of household drinking water coupled with hand washing with soap. The approach offered four options for treating water—boiling, chlorination, filtration and solar disinfection (SODIS), giving information and offering a choice of methods based on family preference. The unique decision to offer a range of treatment options rather than focusing on limited options was based on a Consumer Preference Study carried out at the start of the project, which identified the preferred characteristics of water and water treatment based on taste, odor, effort, perceived effectiveness, along with an assessment of the available commercial offerings. The research showed preference for different product attributes under different contexts, and no particular product preference over others. All of the promoted technologies met efficacy criteria to remove/kill disease causing bacteria at the acceptable level, were cost effectiveness in relation to existing socio-economic status of the target population, and there were existing or potential local production facilities for sustained promotion and use.The uniqueness of this project lay in its approach to create demand through various interpersonal communication methods, capacity building, and community mobilization activities using various change agents and demonstrations to reach 500,000 households in four regions of Nepal, 6,000 frontline workers, and 200 schools.Before generating new demand, Nepal HIP planners realized the need to attend to supply issues as well, and set out to improve the affordability and accessibility of point-of-use (POU) products. The programmers' assumption that the products would be readily available through market forces proved spurious, and through a market assessment HIP planners concluded that all producers were in a more or less nascent stage of product marketing and distribution. Limitations in both resources and distribution networks limited product availability. Locally produced hypochlorite products (WaterGuard and Piyush), colloidal silver (CS) filters (Safa filter and Solutions Benefiting Life/SBL Disc filters) were made available to fulfill local demand. Local potters were trained to produce filters locally to reduce transport costs rate of breakage of clay filters.With the effort to expand the network of the product, producers were able to make better links to get additional support from various funding agencies to improve, expand and distribute products, and at the same time expanded promotion of their product, which had been previously limited to confined areas. This brought about improvement in the capacity of existing producers as well as entry of new small-scale producers/entrepreneurs at the district level.At the sector level, a task force comprised of major stakeholders on water and sanitation were involved from the beginning of the project as part of advocacy for the integration of household water treatment and hand washing in regular programs of the stakeholders, including at the policy level . This task force was fully involved in development of sophisticated yet simple communication materials, appealing to a range of ethnic audiences within the volatile political environment of Nepal.At the implementation level, due to constant changes in the government role, and unstable political conditions due to civil war, the project had to adjust to the change from centralized to district level administration, which required a significant amount of the project time and energy, instead of concentrating on project implementation, monitoring and further planning on improvement.With robust focus on supply, promotion and enabling environment (policy and capacity), the stage was set for changing hygiene and water treatment practice, aiming to catalyze significant change in behavior from no use of soap for hand washing to regular use at three critical times, and from no water treatment to the use of a least one household water treatment option on a regular basis. A follow-up survey is underway to quantify the impact of the HIP on changing key behaviors.Expansion and Uptake of Pilot EffortThe effort has expanded from pilot to national level, and household water treatment and hand washing has now been incorporated in several of the water and sanitation programs of major stakeholders. Together, a national commitment to address water quality shortcomings has been formalized with the establishment of a National Water Quality Steering Committee, where household water treatment has been inserted as a prominent component of water quality improvement. Household water treatment is taken as a key approach to prevent and reduce outbreaks in flood prone areas of Nepal by the Epidemiology and Disease Control Division since late 2007. Similarly, these approaches have now been kept as part of School Sanitation Hygiene Education program of UNICEF, which will address schools of more than 18 districts of Nepal.Several entities like UN-Habitat and the Coca-Cola Company have joined hands to bring about change in the quality of water through household water treatment and hygiene practices. Similarly these components have been included in the in post-conflict reconciliation/rehabilitation project in mid and far western regions of Nepal, together with emergency preparedness package. Although it started with a focus on four districts (out of 75 districts) in Nepal, point-of -use promotion has now reached 25 districts from various programs and is expected to reach all districts through various public and private sector network of the country in coming years.