SAFE WATER AND WASTE DISPOSAL FOR RURAL HEALTH: A PROGRAM GUIDE

Item

Title: SAFE WATER AND WASTE
DISPOSAL FOR RURAL HEALTH:
A PROGRAM GUIDE
extracted text: COMMUNITY HEALTH CEL.

EXECUTIVE SUMMARY
SAFE WATER AND WASTE
DISPOSAL FOR RURAL HEALTH:
A PROGRAM GUIDE
COMMUNITY HEALTH CELL
326, V Main, I Block
Koramonpala
Bangalore-560034
India

In 1981, about fifty percent of
the people in developing nations
did not have reasonable access to
a safe water supply. Roughly 75
percent did not have adequate
sanitation facilities.
Improvements in water supply
and sanitation facilities in recent
years have not kept pace with
population growth so that more
people are unserved today than
in 1970. The heaviest
concentrations of unserved
people are in rural areas.
The principal result of
inadequate water supplies and

sanitation facilities is a heavy
burden of diseases, a burden that
is greatest on children. The
developing nations have a high
mortality rate among infants and
young children. Half of all
deaths in developing nations are
among children under five, with
malnutrition and infectious
disease the primary causes. The
disease that is most often
involved is diarrhea—a result of
the lack of clean water and of
poor personal, household and
community sanitation practices.
Many other diseases, unknown
or already eliminated in
developed nations, are
widespread.

Improvements in water supply
and sanitation in developing
countries have many positive
effects. They promote economic
and social, as well as human,
development and are a good
investment for the countries
needing improvements, for other
countries wishing to be of
assistance, and for international
agencies.

Water-Related Diseases

Category

Transmission

Water-site insect carried

Disease-carrying insects
breed in or near water

African trypanosomiasis
Onchocerciasias
Malaria
Arboviruses
Filariasis

Water contact

Disease transmitted by
contact with water

Schistosomiasis

Water quality/microbiological Disease transmitted by
consumption of
microbiologically
contaminated water

Cholera
Typhoid fever
Diarrhea
Dysentery’
Guinea worm

Sanitation-relaled/water
hygiene

Shigellosis
Trachoma and conjunctivitis
Ascariasis
Scabies

Disease transmitted by
inadequate use of water

Environmental interventions to
control water-related diseases
make a health difference, as the
experience of industrialized and
many developing nations shows.
These interventions involve
water supply, more sanitary
methods of excreta disposal,
better hygiene education, or

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I

Examples of
Specific Diseases

some combination of these. In
order to plan such interventions
effectively, there must be an
understanding of the principal
water-related diseases and the
way each is transmitted. Most
interventions can occur at the
transmission stage. The most
important of these diseases may
be classified as shown in the
accompanying table.

3

Water Quality Standards
Efforts at water supply
improvement are usually
directed at achieving at least
minimum adequacy in terms of
both quantity and quality.
Developing nations that want to
attack disease and ill health
through water improvements
must surely develop water
quality standards.
The current methods of
assessing water quality were
fashioned over the past two
hundred years in the urbanizing
areas of Europe and North
America. While these methods
may not be completely and
automatically applicable to the
developing nations, this
experience offers valuable
guidance. At present, the most
widely accepted standards are
those formulated by the World
Health Organization.
Water quality standards
should be applied as a means to
better health, not as an end in
themselves. The test of water

quality standards is their
effectiveness as a tool to evaluate
water supplies as a source of
microbiological diseases.
Indicator organisms, especially
the coliform group, are widely
used as tests to assess the
possibility for these disease
producing pathogens to occur in
a water supply.

Water System Development
Although water has many
beneficial uses, the domestic
uses such as drinking, cooking,
cleaning, and bathing are
especially important because of
their relationship to disease and
health. Improvements in water
supply systems generally occur
through changes in the source of
water and in the means of
distribution to the users.
The steps involved in the
development of a water supply
system are as follows:

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Step 1. Identifying a Water
Source. Potential sources are
surface water and ground water.
Step 2. Retrieving the Water.
This refers to the means used to
retrieve the water from its source
and bring it into the distribution
system. Wells and intake
structures are examples of
retrieval methods. Retrieval also
includes devices for moving the
water, such as windmills and
pumps.
Step 3. Treating the Water.
This may not be necessary if
there are no harmful
contaminants in the water. If
there are such contaminants,
there are a number of treatment
technologies available for dealing
with them.

Step 4. Storing and
Distributing the Water. Water may
be distributed directly from the
source without storage. Since
people do not use water at a
constant rate, however, it is
usually better to have a means
for storing water in quantity so
that high-demand periods may
be accommodated.
All water systems require
repairs from time to time;
complicated systems require
constant monitoring and
maintenance if they are to
function reliably. This aspect of
water supply development
should never be overlooked or
neglected.

COMMUNITY HEALTH CELL
326, V Main, I Block
Koramongala
Bangalore-560034
India

7

Planning Water Supply
and Sanitation Programs

Waste Disposal Systems
Waste disposal includes non
water carried human excreta
disposal, domestic wastewater
disposal, solid waste disposal,
and industrial waste disposal.
The most common non-water
carried human excreta disposal
methods are bury and cover,
overhang toilets, bucket deposit
and collection, pit or vault
privies, bored hole latrines,
water-sealed privies, aqua
privies, compost toilets, chemical
toilets, burn-out or incineration
toilets, and oil-flushed toilets.
These are listed in order of least
to most complex.
Domestic wastewater disposal
methods suitable for use in rural
communities in developing
nations include septic tanks,
cesspools, evapotranspiration
beds, elevated mounds, package
aerobic units, sand filters,
trickling filters, and stabilization
ponds. If certain conditions can
be met, the water-sealed privy is
probably the best non-water
carried excreta disposal method.
The choice of a wastewater
disposal method depends on the

amount of wastewater to be
disposed of, the human,
institutional and capital
resources available, and the type
of soil present.
Urban or town solid waste
disposal on an organized,
community-wide basis is quite an
expensive, labor-intensive
undertaking. In many rural
villages, scavenging and re-use
of waste materials make solid
waste disposal a relatively minor
problem. If a solid waste disposal
system is needed, it should
probably be one such as
composting that allows for re-use
of waste materials or a sanitary
landfill which allows the land to
be used later for another
productive purpose.
Industrial waste disposal is
and will continue to be an
increasingly important problem
in the developing nations. There
is a wide variety of physical,
chemical and biological processes
available to remove particular
types of pollutants from
industrial wastewaters. The
treatment method will depend
on the precise type of industry
and the pollutants which need to
be removed from its wastewater.

Planning water supply and
sanitation programs takes place
within a political situation. This
situation must be realistically
assessed by the planner. The
approach chosen should reflect
political realities. Variations
depend largely on the extent to
which planning approaches are
expert-biased or user-biased.
Generally, the most successful
water and sanitation programs
are user-biased because this
approach is more likely to ensure
community understanding and
support of the program. The
approach that is most likely to
result in an efficient and
successful program is one that
involves the community at every
stage of project planning and
implementation. The planning
process occurs in seven stages:

(1) Recognizing the Problem
(2) Formulating Goals
(3) Collecting and Analyzing
Data
(4) Generating Alternatives
(5) Appraising and Selecting
Programs
(6) Making New Programs
Work in Practice
(7) Evaluating Programs
There are three key factors in
environmental health program
planning: community
participation, human resource
development, and economic
considerations.

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Human Resource
Development

Community Participation
Community participation is
one of the most important factors
in determining the success or
failure of a water supply and
sanitation program. Social and
cultural attitudes toward water
supply and sanitation
technologies will weigh heavily
in determining whether the new
facilities are used or simply sit
idle. To ensure that the facilities
are used, it is essential that
community members be involved
in the planning and execution of
all projects.
Community participation
consists of more than
contributions by community
members of time, money and
labor in building a facility. For it
to be a success, community
participation must allow local
people to be involved in
decision-making. This will be a
valuable asset to the project
designers as well as to the
community. Local people will
have much useful information
and wisdom to contribute to the
project development effort.
Community participation affords
an opportunity for community
education which may be
essential to give villagers the

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information and understanding
they need to make intelligent
decisions and to effectively use
the facilities when they are
completed.
The national water and
sanitation plan must have a
community participation
component that is carefully
designed and scrupulously
carried out. This is not easy and
it will require a community
participation strategy that is
adhered to in all projects
undertaken as part of the water
supply and sanitation program.
There are a number of
techniques that may be used to
achieve effective community
involvement. The community
participation strategy should
make use of those most
appropriate to a given country
and a given community.

Of all the resources needed to
implement water supply and
sanitation programs, human
resources (people) are probably
the most important. Without the
proper mix of human resources,
the program will fail. Human
resource development is a critical
part of water supply and
sanitation program planning and
requires assessing human
resource needs and designing
and implementing a training
program.
There are several options for
types of training methods to be
used. The selection of a training
method depends on the
education and experience of the
trainees, the tasks for which they
must be trained, and the
resources that are available to
devote to training. A method
that depends on task analysis as
the basic training approach is the
most likely to be successful.
Training should be carefully
designed to transfer the precise
information that the trainees
need in the most effective
possible manner. This means
that trainers must be carefully
selected and may themselves
need some training before the
program is undertaken.

Economic Considerations
The third essential aspect of
water supply and sanitation
programming is economic and
financial. This includes providing
for capital investment in design
and construction, paying for
operation and maintenance of
the completed system, as well as
understanding the basic
economic principles which bear
on the feasibility and timing of
the program.
Funds for capital construction
can come from the beneficiary
communities themselves, from
national government and non
government sources, and from
international donor
organizations. Planning the
economics of water and
sanitation programs and projects
involves consideration of four
basic economic principles:
demand, supply, costs and
benefits. Application of these
principles will affect the
economic character of the water
supply and sanitation program
and the individual projects it
entails.

Once the system is
constructed, the users probably
will have to pay for service to
defray operation and
maintenance costs and perhaps
to cover a portion of the
construction costs. It is usually
not practical or desirable for the
operation of water supply and
sanitation systems to be fully
subsidized by government. Rate
establishment and collection are
thus often critical to the on-going
success of a system but are
sometimes very difficult matters
from a social policy viewpoint.
The key considerations in rate
establishment and collection are
adequacy of revenues to meet
operation and maintenance
costs, fairness to the users, and
the ability and willingness of the
community to pay the rates.

If

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c°WuNiTy u
CELL

Editorial Advisory Board

Gordon Alexander*
United Nations Children's Fund

Mary Elmendorf
Consultant

P. A. Stevens*
World Health Organization

R. C. Ballance*
World Health Organization

Leon Jacobs
Consultant

Dennis Warner"
Water and Sanitation for Health Project

John Kalbermatten*
World Bank

Gerald F. Winfield
Consultant

Horst Otterstetter*
Pan-American Health Organization

Robert Worral
Population Reference Bureau

Fred Reiff*
Pan-American Health Organization

Marlin Young*
University of Florida

Ex Officio Members

Project Manager

Photographs

John H. Austin*
Agency for International Development

Mary E. Morgan
Institute for Rural Water

Raymond Victurine
Michelle DeNevers
Michael McQuestion
Noel Pern.’
Christopher Walter

James Bell*
Peace Corps
Martin Beyer
United Nations Children's Fund

David Donaldson
Pan-American Health Organization and
Water and Sanitation for Health Project

Earle Lawrence
Agency for International Development
Victor Wehman*
Agency for International Development
Edwin L. Cobb
National Demonstration Water Project

*Did not serve for full duration of project
Prepared by
National Demonstration Water Project
for
U.S. Agency for International Development
under
Contract Number A1D/DSAN-C-0063
Knowledge Synthesis Project
Environmental Health Information Activity

This document is a summary of a book entitled Safe Water and Waste Disposal for Rural Health: A Program Guide published as a part of
"Water for the World" materials prepared under contract to the U.S. Agency for International Development. Other parts of "Water for
the World" include about 160 technical notes on narrowly-defined technical topics and two documents similar in length to this one
entitled Program Planning for the Decade for Water and Program Implementation for the Decade for Water.

The views expressed in this document are the responsibility of National Demonstration Water Project and do not in anv wav represent
the policy of the U.S. Agency for International Development. Information on this and other "Water for the World" materials may be
obtained from the Development Information Center, Agency for International Development, Washington. D.C.. 20523, U.S.A.
July, 19S2

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