Integrating Household Water Treatment and Storage into Health Services: Rationale, Examples from the Field, and Lessons Learned

Transcription

1 Integrating Household Water Treatment and Storage into Health Services: Rationale, Examples from the Field, and Lessons Learned Rob Quick, MD, MPH Waterborne Diseases Prevention Branch Centers for Disease Control and Prevention

2 Definition Rationale Examples from the field Social entrepreneurs Maternal and Child Health HIV care and support Perinatal care Primary schools Lessons learned Outline

3 Definition The management and delivery of health services so that clients receive a continuum of preventive and curative services, according to their needs over time and across different levels of the health system

4 Rationale Combine preventive and curative services Improve continuity of care Increase equity of access to services Share costs Influence health behavior during teachable moments Facilitate local program ownership

5 Examples of HWTS Integration from the Field Kenya: social entrepreneur program Kenya and Zambia: maternal and child health (MCH) services Uganda: HIV care and support services Malawi and Kenya: perinatal services Kenya: primary schools

6 Social Entrepreneur Program: Kenya Safe Water and AIDS Project (SWAP) Social marketing extenders in communities of greatest need Avon Ladies Train local women s groups as health educators and product vendors Provide basket of health products at wholesale to groups Groups sell at retail and keep profit as incentive Provide access to microcredit

7 Waterguard Dilute bleach PUR Coagulation / Disinfection Aquatab Disinfection Tablet Safe Water Storage Vessels Soap Supanet Mosquito nets Mosqbar Mosquito repellent Condoms Family Planning Pills Skin Infection Treatment High Protein Flour Economical Stoves Sanitary Pads Diapers SWAP Products

8 Number of SWAP Groups, Savings Accounts, and Loans No. of accounts No. of groups

9 Annual WaterGuard Sales

10 Maternal and Child Health Services: Kenya and Zambia Pilot: Homa Bay, Kenya RNs trained in water treatment, hygiene Drinking water and handwashing stations placed in clinic RNs teach mothers in waiting and exam rooms Solution sold at hospital

11 Evaluation Household surveys at 2 weeks and one year Results: 68% with detectable chlorine residual at 2 weeks 71% with detectable chlorine residual at 1 year

12 Program Expansion Kenya: 300 health facilities since 2004 Zambia: 150 health facilities in

13 HIV Care and Support Services: Objectives Provide interventions that prevent HIV-related disease and death Attract clients to VCT and HIV prevention and care services Conditions targeted PCP Malaria Diarrhea Prevention of HIV transmission Uganda

14 Basic Care Package (BCP) Safe water systems Filter Cloth Condoms Bednets Cotrimoxazole IEC materials

15 BCP Evaluation Survey of clients from 3 health facilities Results: 93% reported ever using WaterGuard 65% reported using it the day of interview 36% with chlorine residual in stored water

16 Perinatal Services: Malawi and Pilot 1: Two districts in Malawi 15,000 hygiene kits (improved storage container, WaterGuard, soap, and ORS sachets) distributed to pregnant mothers at clinic visits 45,000 refills (WaterGuard and soap) provided at return visits or delivery Kenya

17 Malawi Program Evaluation Baseline and follow-up household surveys of: 389 pregnant mothers 386 relatives or friends Results: Confirmed WaterGuard use increased from 2% at baseline to 61% at follow-up among mothers 32% reported purchase after free distribution Confirmed WaterGuard use increased from 2% at baseline to 25% at follow-up among relatives/friends Greatest use among rural, less educated, lower SES

18 Program Expansion Malawi HWTS integrated with PMTCT Partner participation required (for VCT and couple disclosure) Provider training (emergency OB, neonatal resuscitation) Kenya HWTS integrated with PMTCT, rapid syphilis screening and treatment Incentives include protein fortified flour and clean delivery kits Provider training Kenya HWTS integrated with immunization visits

19 Primary Schools: Kenya The Intervention Drinking/handwashing stations Starter supply : water treatment products and soap Education 2003: First pilot (one school) 2006: Second pilot (45 schools) : Third pilot: 17 schools with earth pans PUR and WaterGuard for water treatment

20 Evaluation: Third Pilot Baseline and follow-up surveys of students and parents Results: Increase in household water treatment: 6 to 21% Decrease in absenteeism: 26% Sustained over one year period

21 Lessons Increases in HWT observed Increases in take-home knowledge of water treatment and hygiene observed (schools, clinics) Increased HWT among friends/relatives of program participants noted (ANC) Use of trusted personnel (nurse, teacher, local vendor) enhanced programs

22 Lessons Equity of access to HWTS products improved Low implementation costs (<$100 per school or clinic, <$10 per person) Effective distribution model for commodities (clinics, entrepreneurs) Economic incentives for some implementers (entrepreneurs)

23 Lessons Scale achieved in some cases (BCPs) Policy support obtained for BCPs (PEPFAR) HWTS expansion in institutions (clinics, schools) accomplished at modest cost Social marketing facilitated programs Local access to products High level of product awareness

24 Lessons Regression in water treatment behavior observed over time (ANC) Personnel changes can cause programs to regress (esp schools) Donor support required, which affects potential sustainability and scalability Policy support still needed (schools, ANC and other clinic programs)

25 HWTS integration is: Bottom Line A promising approach to increasing adoption, equity of access, and scale of HWTS An incentive that can increase use of health services HWTS integration is not: A cure for inadequate resources A substitute for needed water and sanitation infrastructure Implementation of promising models at larger scale is needed to measure health impact, examine economies of scale, and inform policy discussions

26 Thank You