The Safe Drinking Water Partnerships aim to address the critical public health issue of unsafe water, sanitation, and hygiene, which results in over 1.8 million deaths annually due to diarrhea, primarily among children under 5. USAID is engaged in a range of partnerships to improve water quality and hygiene, focusing on household-level water treatment and safe storage interventions.
Household-level, or point-of-use (POU), chlorination is a tested approach that has demonstrated public health impact on diarrhea at a low cost, allowing for wide coverage. USAID is promoting two approaches to POU chlorination: the Safe Water System developed by the U.S. Centers for Disease Control and Prevention (CDC) and PuR developed by Procter and Gamble. The CDC’s Safe Water System includes three components: treatment of water at the point-of-use using locally-produced sodium hypochlorite solution, safe water storage in containers with a narrow mouth, and behavior change promotion to sustain safe treatment and storage practices.
The Safe Water System has been implemented through PSI in several countries, including Ethiopia, India, Kenya, Madagascar, Mozambique, Nigeria, and Zambia. Procter & Gamble has developed a POU water treatment product, PuR Purifier of Water, which is made available to non-profit organizations at P&G’s production cost. PuR is effective in treating turbid water with high levels of suspended solids, but has a higher unit cost per liter of water treated.
More than 1.1 billion people worldwide lack access to an improved source for their drinking water, and many more lack access to water that is safe to drink. Household chlorination is an effective means of making water safe to drink using products such as hypochlorite solution and P&G’s PuR product. USAID has used several partnership models to promote POU chlorination, including public-private partnerships, integration into other health activities, and support networks.
The Safe Drinking Water Alliance, a public-private collaboration, has been established to develop innovative program approaches for ensuring the safety of household drinking water. The alliance includes USAID, Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs, CARE, PSI, and Procter & Gamble, which have joined forces to leverage their respective expertise and resources to better understand the behaviors and motivations for choosing particular technologies for treating household water. The focus has been on working with the PuR product with three program approaches: a commercial approach relying on P&G’s marketing and distribution channels, a “social” approach relying on marketing and distribution through not-for-profit NGOs, and distribution during emergency and humanitarian crises.
USAID has also awarded contracts to two different consortia to promote both household water treatment and the use of zinc for diarrhea treatment. The program led by Abt Associates builds on existing USAID-supported social marketing activities at country level, while the program led by the Academy for Educational Development focuses on a public-private partnership model that engages the public sector and manufacturers, NGOs, and civil society. Both contracts have the capacity to develop commercial partnerships for product development, marketing, and distribution, useful for both POU and zinc.
The Hygiene Improvement Project, implemented by a consortium led by the Academy for Educational Development (AED), builds on USAID’s thirty years of investments in water, sanitation, and hygiene. HIP focuses on improvements at large scale in three key hygiene practices: safe feces disposal, proper handwashing with soap, and point-of-use water treatment and safe storage. Each of these interventions typically results in a 30-40% reduction in diarrheal prevalence in children under five. HIP’s approach is to strengthen partnerships, coordinate efforts between the various actors involved in health and hygiene, integrate hygiene into health and non-health platforms, and engage the private and commercial sectors to ensure products and services are available.
USAID has been an active member of the International Network to Promote Household Water Treatment and Safe Storage since its formation in 2003, with the Secretariat housed at the World Health Organization in Geneva. The Network’s mission is to contribute to a significant reduction in waterborne disease, especially among vulnerable populations, by promoting household water treatment and safe storage as a key component of water, sanitation, and hygiene programs. Members include government offices or ministries working in health and water quality, local governments considering household-level pilot projects, NGOs carrying out projects in communities or training implementers, universities, companies developing products, and other stakeholders.
USAID provides technical assistance on the Safe Water System and related activities through CDC. While USAID is focusing on household chlorination approaches, there are other technologies that show promise, including ceramics or biosand household filters and solar disinfection.