Workshop on Household Water Treatment and Safe Storage (HWTS), Siem Reap, Cambodia, 10-12 October 2006 : report

(WP)EHElICPIPHE/2.l!001

English only

Report series number: RS/2006/GE/30(CAM)

REPORT WORKSHOP ON HOUSEHOLD WATER TREATMENT AND SAFE STORAGE (HWTS)

Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC and WATER AND SANITATION PROGRAM OF THE WORLD BANK.

Siem Reap, Cambodia 10-12 October 2006

Not for sale Printed and distributed by: WorId Health Organization Regional Office for the Western Pacific Manila, Philippines November 2007

WHO/WPRO LIBRARY MANILA. PHILIPPINES

2 0 FER?GOB

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NOTE The views expressed in the report are those of the participants in the Workshop on Household Water Treatment and Safe Storage and do not necessarily reflect the policies of the Organization.

This report has been prepared by the Wodd Health Organization Regional Office for the Western Pacific for governments of Members States in the Region and for those who participated in the Workshop on Household Water Treatment and Safe Storage, which was held in Siem Reap, Cambodia, from 10 to 12 October 2006.

SL"MMARY

The Workshop on Household Water Treatment and Safe Storage (HWTS) was held in Slem Reap, Cambodia, from 10 to 12 October 2006. It was convened jointly by the World Health Organization (\\,HO) and the Water and Sanitation Program (WSP) of the World Bank. It was attended by 56 participants, seven resource people, three WHO staff, two WSP staff, and 20 observers from international, governmental and nongovernmental organizations. The objectives of the workshop were: (1)

to share experiences on ongoing HWTS projects and initiatives and the role of government and national policies in promoting HWTS; to discuss the new WHO protocol on HWTS technology verification and other ongoing HWTS technology verification initiatives supported by the World Bank Water and Sanitation Program and others; and to identify the next steps to promote HWTS in selected countries.

(2)

(3)

The workshop consisted of country presentations, technical presentations and group discussions. The workshop noted that household water treatment and safe storage (HWTS) technology choices exist and are effective. Cost effectiveness and culrural acceptance of HWTS technologies are becoming better understood, and it was encouraging to see that srudies are under way to look into the technical and socioeconomic aspects ofHWTS. The workshop also noted that each country seems to have a partial or limited selection of HWTS devices and approaches, but they seem to be influenced more by donor choices and not related to consumer choice. This is a potential problem that needs to be resolved taking into account the roles of national governments and of the implementing and technical agencies. It is also important to involve users to make wise choices about the point of use (POll). :\"ational governments should be actively involved to help evaluate, regulate, and promote appropriate choices in HWTS. Donors and implementing and technical agencies are needed to help inform and support government decision-makers and to bring information to consumers. The WHO effort to introduce technical protocols to evaluate POD approaches is an encouraging and welcome step. The workshop encouraged all countries to participate in the review of the draft protocol, to include each country's thoughts and experiences, and make the protocols more meaningful and useful.

CONTENTS Page 1. INTRODUCTION ................................................................................................................. 1 1.1 Objectives ..................................................................................................................... 1 1.2 Opening remarks ........................................................................................................... 1 1.3 Organization of the meeting .......................................................................................... 1 2. PROCEEDINGS .................................................................................................................... 2 2.1. 2.2 2.3 2.4 2.5 3. Filter Technology and Performance .............................................................................. 2 Behaviour Change, Interventions and Marketing ......................................................... 6 Environmental Technology Verification .................................................................... 10 Summary of group discussions ................................................................................... 14 Environmental Technology Verification on HWTS ................................................... 17

CONCLUSIONS ................................................................................................................. 17 3.1 General ........................................................................................................................ 17 3.2. Household water treatment and safe storage devices and approaches ........................ 18 3.3 Technical protocols ..................................................................................................... 18 ANNEXES ANNEX 1 ANNEX 2 OPENING ADDRESSES LIST OF PARTICIPANTS, ADVISERS/RESOURCE PEOPLE, REPRESENTATIVES AND SECRETARIAT WORKSHOP PROGRAMME SUMMARY OF COUNTRY REPORTS LIST OF DOCUMENTS CD OF THE WORKSHOP PRESENTATIONS

ANNEX 3 ANNEX 4 ANNEX 5

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ANNEX 6 -

1.

INTRODUCTION

The Workshop on Household Water Treatment and Safe Storage (HWTS) was held in Siem Reap, Cambodia, from 10 to 12 October 2006. It was convened jointly by the World Health Organization (WHO) and the Water and Sanitation Program (WSP) of the World Bank. The local organizers of the workshop were the Ministry of Rural Development (MRD) and the Ministry of Health (MOH). 1.1 Objectives (I)

To share experiences on ongoing HWTS projects and initiatives and the role of government and national policies in promoting HWTS; to discuss the new WHO protocol on HWTS technology verification and other ongoing HWTS technology verification initiatives supported by WSP and others; and to identify the next steps to promote HWTS in selected countries.

(2)

(3) 1.2

Opening remarks

In his opening remarks, the WHO Representative for Cambodia welcomed the participants and emphasized the importance of Member States to continue striving to attain the Millennium Development Goal (MDG) targets for water supply and sanitation and the role ofHWTS as a low-cost strategy for reducing health risks associated with unsafe drinking water. In his opening remarks, the WSP-East Asia and Pacific Representative mentioned that this was the second workshop after the 2005 Symposium on HWTS in Bangkok. However, he stressed that even after the Bangkok meeting, there are many technical and socioeconomic issues that need to be considered. These include: development and testing of household water treatment technologies; analysis of cost effectiveness of household water treatment; evaluation of the role of household-based water treatment technologies in emergency response; improving uptake and sustainability; and taking proven technologies to scale through commercial and quasi-commercial deployment.

The text of the WHO and the WSP representatives' speeches are provided in Annex 1. 1.3 Organization of the meeting

The meeting was attended by 56 participants and observers, including participants from the five countries in the Region, seven resource people, 20 representatives from international, governmental and nongovernmental organizations, one staff representing the WHO Western Pacific Regional Office in Manila and two staff representing the WHO Cambodia Office, and two WSP staff representing the WSP Cambodia Office. Annex 2 contains the list of participants, and Annex 3 shows the timetable of the meeting.

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2.

PROCEEDINGS

2.1.

Filter Technology and Perfonnance

2.1.1 Independent appraisal of ceramic water filters in Cambodia

Mr 1.M. Brown, University of North Carolina, presented the results of an independent appraisal study of ceramic water purifiers (CWP) which are manufactured and supplied at the household level in Cambodia. The nongovernmental organization International Development Enterprises (IDE) started production in 2002, with a factory in Kampong Chhnang province. Two more factories were constructed later, one operated by the Resource Development International (RDD and one by the Cambodian Red Cross. In October 2003, IDE completed a field study of the CWPs after one year in use, yielding promising results. The study used bacterial analysis of water samples and user surveys to measure the performance, acceptance and use ofCWPs in 12 rural villages. The field study also assessed health improvements, time and costs savings of using CWP. The study conducted by Mr Brown was designed as the first independent assessment of CWP performance and use. It was also the first study that attempted to quantify health impacts from filter use. The study was carried out in two parts: (I) a cross-sectional study of households that originally received a filter to determine uptake and use rates and associated factors; and (2) a nested longitudinal prospective cohort study of 80 households using filters and 80 control households to detennine the microbiological effectiveness and health impacts of the filters in household use. Brown evaluated the following aspects: (1) the continued use of the filters over time as the proportion of filters still in use since introduction, and factors potentially associated with filter uptake and long-term use; (2) the microbiological effectiveness in situ of the filters still being used, as determined by the 10glO reduction values (LRVs) of the indicator bacterium E. coli; and (3) the health impacts of the filters as determined by a prospective cohort study using data on diarrhoeal disease prevalence proportions among filter users versus non-users. They also collected a variety of other data intended to shed light on successes and challenges facing the long-tenn sustainability of this intervention in Cambodia. Stratified analyses, logistic regression, and log-risk regression with Poisson extension of generalized estimating equations (GEE) were employed in analysis of cross-sectional and longitudinal data to determine factors associated with long-tenn filter use and effectiveness of filters currently in use. The study found that CWPs have significantly improved water quality irrespective of period of use of the filter; filter breakage is the main reason for discontinued use; recontamination can be a big problem; CWPs are able to reduce the incidence of diarrhoeal disease by almost 50%; availability of parts is important; software is needed to improve usage skill; knowledge of usage and replacement at the household level is important; and finally CWPs should be sold to users rather than given free. User behaviour also affects filter performance and it is important to incorporate educational programmes.

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2.1.2 Sand Filter Development in Viet Nam Mr Tran Quang Toan, National Institute of Occupational and Environmental Health (NIOEH), Ha Noi, Viet Nam, presented the technical performance and users' satisfaction survey of arsenic removal systems using sand filters. The presentation concerned the fact that many tube wells in Red River Delta contain elevated level of arsenic in excess of 10 parts per billion (ppb). Although there was no detailed assessment on the number of people exposed to arsenic, UNICEF and the World Bank reported that about 10 million people are at risk of exposure to excessive levels of arsenic in drinking water. In 2003, the National Institute of Occupational and Environmental Health (NIOEH) Viet Nam studied arsenic concelltration in tube wells in three villages in Ha Nam. The study found 94.4% of the tube wells have arsenic concentration exceeding 10 ppb and eight patients were suspected to have arsenicosis. The use of household iron reduction plants (IRPs) has been well accepted since the 1990s, and many households were using IRP to treat their water. The study found that there was no standard design for IRPs and the designs were not related to water requirements of the households. However, bricks and black sand were used as filters but their dimensions varied. An electric pump costing about US$ 20 per unit was the most common way of pumping water from the source to IRP for treatment. The study found that the efficiency of iron removal using IRPs decreases rapidly over time and that flow rate also reduces rapidly because of clogging. Cleaning of the IRP was difficult because it requires the sand to be taken out of the filter. The filtered water was not clear and still retained smell and taste of iron. The arsenic concentration in the filtered water is still higher than the WHO guidelines of 10 ppb. The study also found out that community acceptance would increase if the filtration efficiency increased, better iron and arsenic removal was achieved, and filters were easier to maintain. Mr Tran presented the technical efficiency and acceptability of modified and improved IRPs. The modified versions featured standard designs; spraying systems of raw water on a filter-bed; the use of yellow sands; washing valves; and the use of electric pump. The modified and improved IRPs were installed in 50 households for trial; the filters were built by workers in the village with the involvement of households. The study showed that the efficiency of iron removal increased significantly. The efficiency of arsenic removal also increased. On user satisfaction, 80% ofthe households agreed that water has improved in terms of transparency and taste; 68% found it easier to operate; 99% found that washing the sand bed is easy; and 91 % non-improved households would like to switch to the improved version. However, in the improved IRP version, recontamination of the environment by arsenic sludge is a potential problem. 2.1.3 Video Presentation The video shown by Dr Mickey Sampson, director of the nongovernmental organization Resource Development International (RDI), was a preliminary release of a documentary commissioned by WSP Cambodia in an attempt to disseminate widely the findings of the CWP evaluation results. The documentary presents the main findings of the CWP evaluation, preceded by footage on filter production, testing and marketing. The video is included on the CD accompanying this report.

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2.1.4 Household Arsenic Removal: The Bangladesh Experience Professor Feroze Ahmed, University of Engineering and Technology, Bangladesh, discussed basic arsenic removal processes, household arsenic removal technologies, costs of arsenic removal technologies, and advantages and disadvantages of different processes. There are four major processes to remove arsenic: oxidation and sedimentation; coagulation and filtration (i.e. use of alum, iron salts or naturally occurring iron); sorptive filtration (i.e. activated alumina, granulated ferric hydroxide/oxide, metallic iron or iron ore, synthetic composite active materials, and ion exchange); and membrane filtration (i.e. nano filtration and reverse osmosis). The chemical and physical aspects of each process were explained. Various designs of household or small community arsenic removal technologies and designs were presented. Each has its own technical and economic advantages and disadvantages. The cheapest method is still air oxidation and filtration, but the process is slow and not fully efficient. The chemical oxidation process also kills microbes and is relatively simple and rapid. However, there are still many options that need to be researched further. 2.1.5 Assessment of ground water conditions and suitability for household treatment to remove arsenIc Dr Davin Uy, Institute of Technology, Cambodia, reported that tube wells in central Cambodia were found to have high levels of arsenic with 52% of wells tested exceeding the Cambodian National Drinking Water Quality Standards of 50 ppb.

Tube wells have significantly higher levels of arsenic, iron and phosphorous than open wells and have near neutral pH. The chemical composition of water in tube wells and open wells is consistent with redox controlled dissolution of iron oxyhydroxides in groundwater and their subsequent re-precipitation when exposed to the atmosphere in open wells. Arsenic, iron and phosphorus concentrations are weakly correlated in both tube wells and open wells, but arsenic contamination is strongly associated with high iron (54% of wells with more than Img/l iron are contaminated with arsenic). Concentrations of dissolved iron reach levels as high as 10 mg/l and dissolved phosphorus reaches levels as high as 1.8 ppm. While high levels of dissolved iron may facilitate natural oxidation, they are likely to cause problems in the operation of any household filtration system. Levels of dissolved phosphorus approach 2 ppm in some samples but this is unlikely to cause significant problems with household treatments. The arsenic concentration in the open-well water has a maximum recorded concentration of 50 ppb. However, arsenic concentrations at the bottom of open wells were found to be significantly higher and in some cases exceeded national guidelines. The number of microorganisms in open wells (as measured by thermotolerant and total coliform counts per 100 ml) is higher than in tube wells. Though the arsenic concentration in the open wells is not more than 50 ppb, in the opinion of Dr Uy, open wells are not a suitable alternative source of drinking water because of high levels of bacteriological contamination. The consistent use of household treatments technologies can address this drawback.

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2.1.6 Preliminary Assessment of Local Media for Removing Arsenic in Ground Water in Cambodia Ms Va Dany, Department of Environmental Sciences, Royal University of Phnom Penh, Cambodia, reported preliminary findings of experiments to identify local materials that may be used in the construction of arsenic removal filters. Results found in this study are limited in terms of the number of filter replicates constructed, filter designs, the number of parameters measured and analytical accuracy. Nevertheless, some important insights were obtained for the development of household filters in Cambodia. The data suggested that it may be difficult to reduce the arsenic concentration to the national drinking water standard using natural and locally available media (fine river sand, marine sand, crushed rock and charcoal) without addition of sorptive material or chemical oxidants to enhance filter performance. The limited data obtained in this experiment indicate that the addition of a layer of iron nails at the surface of the filter increased arsenic removal efficiency. However, the arsenic removal efficiency decreased over time. It should be stressed that these filters do not replicate the Kanchan filter which is substantially larger and uses Skg of iron nails. It is possible that the use of a larger iron nail layer may improve performance significantly. The trend of decreasing filter efficiency with time highlights the general problem of durability in arsenic removal filters when operated in the field. All filters have a limited lifespan before replacement or rehabilitation of the filter material is required. In Cambodia and other developing countries, villagers will not be able to tell if the filter they are using is still lowering arsenic to an acceptable level without access to arsenic test kits. The results of the "do nothing" option also indicated that natural oxidation, while it is known to be effective in some instances, cannot be relied on to effectively remove arsenic. It should be noted that further laboratory and field trials of household treatment methods will be necessary before any widespread promotion in Cambodia. Future studies should consider the following: investigating performance of other locally available media; improving the quality oflocal media by adding available and low-cost chemicals and iron nails to enhance their adsorption capacity; testing the chlorine compounds in the forms of bleach, chloramine tablets and free chlorine in oxidizing arsenic; and conducting an independent rapid assessment of existing filters, such as the Kanchan filter, in removing arsenic and pathogenic organisms in drinking water. 2.1.7 Challenges Facing Arsenic Removal Technologies in Cambodia Dr Mickey Sampson, Research Development International, Cambodia, highlighted that the highest concentration of arsenic in groundwater could be found near the TonIe Bassac and Tonie SliP rivers. Flooding and arsenic levels are potentially linked because high levels of arsenic could be found in flood-plain areas. However, high levels of arsenic could also be found in southwest Cambodia during the dry season. In high arsenic areas, iron levels in concentrations ofO.S to more than 30 mgll have been found. Hence, arsenic removal technologies should also look at iron levels. In addition, manganese levels were also high and some wells have a manganese concentration of more than

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30 mg/l. Manganese is a neurotoxin at high doses and it also affects the performance of certain filters. In areas where water hardness is highly variable and pH ranges from 4.2 to 8.3, high levels of arsenic were found. The large range of chemical and physical variability has important implications for the functioning of arsenic removal technologies. The paper also reported that arsenic concentration in shallow open wells can be as low as 10 ppb. This was found in Prek Russey Village in Kanda!. Studies were also done on the arsenic removal efficiency of Kanchan filters (consisting of a bio-sand filter [BSF] with a mechanism to add iron-oxide to the influent water). The experiments involved six filters, each loaded with 5.5 kg of small size nails. Water samples used were from both wells and surface water from three sources, and the loading rate was 40 litres/day. The average concentration of arsenic from source water No. I was 194 ppb; source water No.2 was 403 ppb; and source water No.3 was less than 10 ppb. The results showed that for the fIrst two months of filtration, arsenic removal was relatively good, producing filtered water with arsenic concentrations lower than 10 ppb. However, after two months, the removal rates declined signifIcantly. Lessons learnt from the experiments are that more studies are required on the effectiveness ofKanchan filters in Cambodia. Hydro geochemical conditions in Cambodia should be considered and hence all waters should be tested and understood. It is risky to introduce technologies when their performance is poorly understood. Longevity of filters is important for use in the fIeld. The expectations that rural residents use filter media correctly must be backed up with good information and instructions. Finally, for any filtration system to be introduced, the following factors should be considered: willingness to use and maintain it; educational materials to ensure users understand how to maintain it; sustainability and affordability for long-term use; availability of replacement components; and evaluation of risk reduction versus costs. 2.2 Behaviour Change Interventions and Marketing

2.2.1 Behaviour change in HWTS Mr Robert Ainslie, Center for Communication Programs, Bloomberg School of Public Health, Johns Hopkins University, reported that lately more emphasis and attention are given to behaviour change in the water and sanitation sector. However, similar to technologies, there is no universal behaviour change solution to every household water treatment technology. Behaviour change may lead to healthier people and to cheaper, easier and safer technologies, which are better for the environment. There are four elements to sustained behaviour change: supportive environment and programmes (for example the influence of religious leaders); effIcient delivery systems (services and products need to be available, easily accessible and affordable); nurturing communities (the community must accept water treatment so that they can create norms for behaviour); and promotion of ownership.

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The rate of adoption of new technology by a community is influenced by many factors including relative advantage, compatibility, complexity and observability. Individuals, households and communities all play important roles in influencing behaviours around household water treatment and safe storage. Three models on behaviour change were presented: predictive model of communication and change; model of communication and hygiene behaviour; and a conceptual framework for improving hygiene behaviour. In these models, the more we understand the factors that influence behaviours, the better we can develop programmes to promote new behaviours and technologies in HWTS. 2.2.2 Influencing behaviour-large scale point-of-use (POU) programme in Indonesia-Air Rahmat Mr Robert Ainslie, Center for Communication Programs, Bloomberg School of Public Health, John Hopkins University, started the presentation started with the information that 30%--40% of water treated by boiling at the household level is still contaminated with E. coli by the time it is consumed. He reported that in Indonesia boiling of drinking water is an accepted practice. However, after subsidies for kerosene were abolished by the Government, households came under pressure to find a cheaper means of treating water. The "air rahmat" programme ("air" being the Indonesian word for "water") offered a successful approach to cheaper and easier treatment of drinking water in Indonesia. The programme is based on commercially marketing small bottles with a chlorine solution for drinking water treatment. The programme benefited 10 million people in two provinces. Air Rahmat uses an attractively shaped bottle and distinctive labels. The retail price for a bottle with enough chlorine to last one to one-and-a-half months is only US$ 0.44. There has been active involvement of the media, printed promotional materials, billboards and participation by nongovernmental organizations. The Air Rahmat project faces many challenges including: consumer rejection due to the smell and taste of chlorine; the fact that there is no visible change in the water when treated; the difficulty for consumers to accept unboiled water; and difficulties getting retailers to become interested in the product. 2.2.3 Household water treatment-social marketing approach Mr Nguyen Dinh Dzung, Population Service International (PSI), Viet Nam, presented a successful marketing project of household chlorination in Viet Nam called SafeWat. SafeWat is a weak chlorine solution in a bottle of 150 ml and is capable of treating drinking water at a household level for one month or 1000 litres of raw water. When applied, SafeWat is claimed to be effective within 30 minutes. The retail price is only 4,000 dong or US$ 0.25 per bottle. The product is on sale at many retail outlets, such as pharmacies and shops. Active promotion in the media also has contributed to success. The challenge is that some users are unhappy with the smell and taste of chlorine. Other challenges are that SafeWat is a new produce and hence it is difficult to convince users; changing behaviour is difficult; SafeWat does not reduce turbidity and turbid water is seen as "unclean"; distributors were expecting large and quick profits; and the product is relatively heavy to carry.

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2.2.4 Awareness Raising and Behavioural Change Dr Mickey Sampson, Resource Development Institute, Cambodia, contrasted two approaches to communication on household water treatment and safe storage (HWTS): oral and written. Given the low literacy rates in Cambodia, most people appreciate oral more than written communication. There are many methods of oral communication. These include pictorial explanation, music, videos, storytelling, traditional chants, kinaesthetics, and arts and colouring. In addition, famous people can help reinforce messages. These include artists and athletes. Factors like beauty can also attract attention. For example, arsenic water causes black spots on the skin and this information could dissuade people from drinking water with arsenic. Another example is that hand washing promotes beauty and improves sex appeal. It is also important to mix interesting stories in television or movies with health messages. Karaoke for example is a popular entertainment in Cambodia, and it could introduce moral and health messages. To ensure karaoke songs reach the general public, it would be a good idea to provide master copies free to karaoke outlets so that they can reproduce copies and sell them over the counter. Another innovative method is the use of puppet shows. The target audience is children, but they are also enjoyed by adults. The characters for the puppets are animals such as dogs and frogs, and they can deliver messages that could be sensitive if provided by people. In summary, the use of oral communication methods can be more effective than the use of written materials because they involve personal interaction about the subject to be addressed. 2.2.5 Marketing research and approaches Mr Michael Roberts, International Development Enterprises (IDE), Cambodia, discussed experiences gained from the different approaches to distribution of ceramic water purifiers in Cambodia. Of particular interest to IDE is the contrast between the use of market-based and subsidy-based distribution systems. The biggest potential disadvantage of the market-based distribution system is that the products may not reach the poorest. However, the challenge of the subsidized system is that there are limited resources to supply products to a large group of people, which makes the approach unsustainable in the long term. In addition, there is some evidence that investment by the household leads to products being valued and used more, and maintained better. A mixed distribution method, taking into account some degree of market segmentation (providing increasing levels of subsidy with increasing levels of poverty) would seem to address the shortcomings, but such approaches have their own challenges. They would create price confusion, undermine market systems, and consumers might delay the purchase hoping for prices to drop. There have also been examples of households selling their subsidized products to others willing and able to pay more for them. However, IDE Viet Nam sold pumps at full cost and 64 000 were sold, at a total consumer investment ofUS$ 2.7 million. The amount invested by the donor for promotion and market development was almost US$ 2 million, or US$ 30 per pump sold. Installing the same number of pumps with 100% subsidy would have cost US$ 5.8 million, or almost three times as much. For marketing approaches to be successful, it is also important to have good supply chain and marketing mechanisms as well as promotion campaigns for better market penetration.

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The ceramic water purifier national roll-out plan has as objectives sustainable private sector production and sales; creation of awareness and demand for filters; and quality control to ensure purchasers receive a quality product. The challenges to the plan are copying of the filters by non-authorized manufacturers leading to poor quality filters. There is no consumer protection in Cambodia; a working filter would be indistinguishable from a non-working filter. These factors, coupled with the decentralized manufacturing of the filters, make quality control a challenge. The promotional strategy is split into three phases. The introductory phase is within the first three years; the growth phase is between years four and five; and the maturity phase is from six to 10 years. In the early stage, filters should be promoted as a convenient way to treat water. In the growth stage, emphasis should be given to health and cost savings. Between February 2004 and September 2006, IDE and the Cambodian Red Cross distributed about 63 000 CWPs. Most of the filters were bought by nongovernmental organizations although the proportion of filters bought privately is increasing. A survey of 60 filter purchasers in Kampong Cham province showed that the majority had purchased their filters at full price, paying an average ofUS$ 8.25. The average age of the CWPs was about two years. The survey results also revealed that 100% of the respondents cleaned the filters and receptacles at least once per month and the average cleaning rates were 3 times per month; 85%-95% of them reported proper handling and cleaning of the filter elements, but only 50% knew not to touch the spigot (and that the filter elements should be l replaced after 2 years ). The survey also showed that 73% of users reported a noticeable decrease in diarrhoea; 100% reported time savings; and 98% reported expense savings. The preliminary results revealed positive responses from purchasers in terms of benefits they gained from CWP usage. However, follow-up market research is needed that involves true random sampling of larger user groups; observational confirmation of proper cleaning and handling techniques; and selection of control groups for comparison. The biggest challenge for market-based approaches is the ability to reach the hard-core poor. Although the CWP is relatively cheap, to many they are still unaffordable. The majority of CWP purchasers belong to medium- to low-income levels but do not include the poorest and most vulnerable groups. Two strategies are suggested: the first is to influence affordability; and second is through "smart" subsidies. Affordability is a function of willingness and ability to pay, neither of which are static. Marketing can increase the willingness to pay, by increasing understanding, trust and value consumers place on the benefits of using a CWP.

Information on the need to replace the filter element is superseded by the research done by Brown et. ai, reported earlier in these proceedings. Filters continue to work, but breakage is a problem.

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Smart subsidies could be carried out through nongovernmental organizations with community-based programmes to reach the poorest. Capitalizing on nongovernmental organizations' local knowledge and goodwill could help to build trust in the technology and identify those who really need a subsidy. However, this effort should not undermine the private sector distribution network, and a supply chain should be operational before subsidies come into play. Smart subsidies can be in the form of vouchers, credit or instalment mechanisms which avoid the "free handout" approach which distorts perceptions of actual price and value.

In summary, issues remain to be worked out in both the market-based approach and the subsidy-based approach. The delivery of "software" in the market-based approach needs further attention because the private sector is limited in its ability to deliver health and hygiene education together with a product. The question of how to keep promotion up after the initial marketing push is over has also not yet been answered. Consistent and reliable funding will be required to address some of those and other outstanding issues. 2.2.6 Behaviour change and HWTS Mr Robert Aisnlie, Johns Hopkins University, emphasized that in the planning of behaviour change for HWTS, it is crucial to have a clear understanding of the audience. The strategic design should have clear and achievable objectives and activities, development of messages and materials, implementation and monitoring, and finally evaluation and re-planning. Behaviour change communication (BCC) requires interpersonal communications, credibility of source, knowledge transfer and community mobilization. Events such as theatre, puppets, singing, contests, etc. can be effective mechanisms for BCC. Others may include mobile promotional systems like buses and vans, visits, parades, etc. The mass media approach may reach a wider audience but it is expensive, especially for rural areas. Use of religious tracts and leaders can be an effective means for communication. 2.3 Environmental Technology Verification

2.3.1 What is Environmental Technology Verification (ETV) and how can it be applied: Examples from Bangladesh Professor Feroze Ahmed, Bangladesh University of Engineering and Technology, discussed ETV practices for household and community level water treatment technologies with special emphasis on Bangladesh. Environmental Technology Verification may be defined as a process for confirmation of an environmental technology performance claim through evaluation, while evaluation of a technology is defined as a detailed, independent third-party assessment and validation of a process performance claim of a technology, using a rigorous protocol. The objectives of ETV in Bangladesh are: to verify and validate an environmental technology against the performance claims of the proponent through independent third-party evaluation; to verify and validate a technology against the requirements of national standards or guidelines; and to provide government, implementing agencies, development partners, users and consultants objective and quality assured data for decision-making.

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ETV is done in three steps; first is the technical evaluation and verification; second is social evaluation; and third is fiscal evaluation. The steps for Technical Verification are: preparation, review and approval of Technology Specific Test Plan (TSTP); technology submission by the proponent; mobilization of field equipment and supplies; training of personnel; source selection and.characterization; technology installation and operation; sample collection and testing; data acquisition, analysis and compilation; quality assurance and quality control; verification of technologies; and preparation of documents. The Technology Specific Test Plan covers eight areas: procedures related to testing activities specific to the technology; the experimental design required for the technology; data analysis and control, as well as quality assurance and quality control (QNQC) procedures for safeguarding the quality of data; the evaluation of residues and contamination; health and safety relating to electrical, mechanical and physical hazards; health and environmental concerns relating to chemicals used in the normal operation of the technology; and health and environmental concerns relating to the disposal of chemical and/or biological wastes and by-products. In Bangladesh, the ETV programme for arsenic removal at household and community levels was funded by the Canadian International Development Agency (CIDA). Field testing of technologies was considered appropriate as none of the proponents had sufficient scientific test data to allow verification of their performance claims and because of the fact that natural groundwater cannot be synthesized in the laboratory. Five hydro-geologically different and challenging regions were chosen for testing the technologies. Technology Specific Test Plans were prepared and agreed upon by signing of the document by the technology proponent and the Verifying Organization (VO). Wells were selected that closely met the proponent's performance claims in respect of water quality. Field testing was continued until the desired number of tests was completed or media breakthrough occurred, or proponent's claims were met. Influent and effluent samples were analyzed in the field, in selected laboratories and in a reference laboratory in Canada. The volume of treated water produced was recorded. The presence of specific technology-related substances in water was analysed. Leaching of arsenic was determined by the United States Environmental Protection Agency (USEPA) Toxicity Characteristic Leaching Procedure (TCLP) and Dutch Total Available Leaching Procedure (TALP). Metal scans for US EPA-regulated metals in TCLP and T ALP extracts were performed. Independent laboratories were selected by experienced professionals to carry out quality assurance and quality control. A Laboratory Quality Assurance Plan was developed and implemented. The personnel of testing agencies hired to collect samples in the field were trained by the Environmental Technology Verification-Arsenic Mitigation (ETV-AM) staff and their work WaS monitored. An established chain of custody ensured sample integrity from field to laboratory. Frequent inter-laboratory comparison of split samples was conducted. One of the important stages in the verification process is to estimate the cumulative volume of water that can be safely treated by the technology. A curve showing effluent arsenic concentration versus cumulative volume of water was constructed and analysis was done using

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empirical non-linear regression models. The performance of the technology is determined statistically, at the 95% confidence level, and compared with the proponents' claim. Lifespan for ~ach technology was determined based on average daily water consumption. Based on expert Judgement, and the field test data, additional performance characteristics are stated. An independent expert committee reviews the sample collection, data analysis and validates verification results. The general conditions for the deployment of technologies are that each technology was allowed to be deployed at wells of a similar type of water quality to the tested wells, where the technologies performed well. The well (water) where a technology will be deployed needs to be tested by an approved laboratory for arsenic and other relevant water quality parameters no later than six months prior to the deployment. The well water quality data, information regarding the well location, well ownership/technology ownership and the date of installation/sale must be submitted to the VO within 30 days of sale or installation of the technology and also kept on file by the proponent for five years. Post-deployment performance monitOring of the technology is a necessary condition for its deployment. In addition, the technology proponent must comply with the National Waste Management Protocol approved by the Government of Bangladesh regarding safe disposal of the waste generated by technologies. The proponent also must supply an installation, operation and maintenance manual of the technology to the user and must train at least one member of the family at the time of installation. The proponent shall also provide the purchaser with accurate and safe operational instructions regarding frequency of media replacement. Following the successful completion of an ETV process, the proponents have to sign a legal agreement with the VO before they can receive their provisional verification certificates. In addition, deployment guidelines have been developed which are cited in the legal agreement. All terms and conditions that form part of the verification certificate must be adhered to. The proponent bears all liabilities related to consumer protection, any failure ofthe technology and any environmentally adverse effects. If the technology is ever modified in any way, VO must be notified in writing. VO will reserve the right to re-test and verify the altered technology, prior to allowing its sale. IfVO decides at its sole discretion that the proponent breached any terms, it can order the proponent to cease to sell, advertise, distribute, promote or install the technology in Bangladesh. In short, the general findings from ETV process in Bangladesh are: most of the technologies could not meet the .performance claims of the proponents that were set in laboratory tests on synthetic water; quality of natural groundwater greatly affected the performance of the technologies; one region with high levels of phosphate, pH, silicate and dissolved organics severely affected the performance of all the technologies; the cost-effectiveness ("value for money") of the technologies and social acceptability appears to vary widely; and the data indicate that microbial contamination was occasionally introduced to the treatment units as a result of handling ("secondary contamination"). This means that user education on basic hygienic operation of units is important. 2.3.2 The WHO ETV protocol for household water treatment: an overview of proposed protocol Mr Joe Brown, University of North Carolina, started his presentation with the fact that the goal for household water treatment technologies is to provide safe water. The paper discussed the proposed WHO protocol for Environmental Technology Verification of household water treatment technologies.

- 13-

The development of the WHO ETV protocol was sparked by the absence of standard criteria for comparing different household water treatment technologies and options. Many methods have been used to evaluate technologies and various effectiveness claims from manufacturers or implementers were reported and the different approaches could be confusing to users. Some protocols already exist in richer countries but a flexible framework is needed for developing countries. The basic question is "what is safe water and can these devices or technologies provide it"? The goal is to provide safe water to people. ETV is the basis for making an infonned choice since users cannot evaluate performance themselves. ETV also encourages research and technology development. However, we have to recognize that some trade-offs are needed between acceptability, appropriateness, availability and cost effectiveness. The proposed WHO protocol is intended to facilitate and encourage development, improvement, promotion and purchasing of small-scale water treatment devices appropriate to health improvements through an international point of reference on technology assessment and health-based benchmarking. WHO protocols are applied to all small-scale water treatment devices. "Safe storage" devices are not included unless these are part of the water treatment device. The intended audiences are the national-level certification organizations, regulatory authorities, HWTS research and development organizations, manufacturers, implementers and technology specifiers. The criteria of the protocols/guidelines are based on the tolerable risk: IxIO·6 disability-adjusted life years (DAL Ys) per person per year due to disease. The WHO protocols are not prescriptive but provide guidance to other entities to create national certification programmes. The WHO protocols are based on risk-assessment models rather than epidemiological assessment. The measurement and methodology for risk asSessment is described in the WHO Guidelines fOr Drinking Water Ouality, 3rd Ed. (2003). Risk assessment modelling is an imperfect tool since there is much we do not know about concentrations of microbes in water and dose-response models. However, we need a logical basis for perfonnance testing of the technology. Where gaps exist, best possible assumptions are made based on the precautionary principle. . The proposed WHO protocols are based on laboratory performance of technologies against three classes of pathogens (or surrogates): bacteria, viruses and parasites. Based on representative local data or assumptions for BACKGROUND water quality, technologies must be able to provide safe water as defined by WHO. Incremental improvement is encouraged as most technologies wiJI not meet this high level in the beginning. A three-star system may be used to classify technologies, but this is still under discussion. Minimum criteria are that technologies reduce all three classes of pathogens and results in a minimum cumulative DALY level which remains to be set. Safe water targets require the following removal efficiencies: 5 loglo for bacteria, 8 10glO for viruses and 4 10glO for protozoa.

- 14-

A three-star technology must meet safe water levels for all classes of pathogens. The intermediate or improved technology meets the safe water level for one or more pathogens and some reduction (0.5 10gIO) in all classes and meets a minimum composite DALY. A minimum one-star technology reduces all classes of pathogens (0.5 10gIO) and meets a minimum composite DALY. For example, the bio-sand filter reduces bacteriophages up to 1 10gIO (90%) under both specified test waters and under actual use conditions including water volume to be treated; reduces E. coli bacteria up to 3 10gIO, reduces C. perfringens up to 6 10gIO and hence it achieves a two-star level. Another example is the ceramic water filter. It could reduce bacteriophages up to 2 10glO (99%) under both specified test waters and under actual use conditions, reduces E. coli bacteria up to 6 10gIO, reduces C. perfringens up to 8 10gIO and so achieves a two-star rating. Most technologies in current use will be two-star or one-star devices and multiple-barrier approaches could be an option. The protocols would establish a ranking system based on performance and hence it is useful in technology selection. ETV encourages incremental improvement and rigorous testing of technologies to protect users. Based on the proposed ETV countries may choose to develop their own criteria with locally relevant modifications.

In summary, the WHO protocols are developed based on a health based risk-assessment approach as outlined in the WHO Guidelines for Drinking Water Quality (3rd edition). It establishes methods for calculating the 10gIO reduction values (LRVs) corresponding to WHO-recommended risk level of 1 micro DALY/personiyear. The WHO ETV protocols allow for flexibility and encourage incremental improvement in water quality and risk reduction. Some trade-offs may still be needed between the effectiveness and practical considerations of the technologies. 2.4 Summary of group discussions

There were three sessions of group discussion. Topics discussed in each session were related to the technical presentations made on that particular day. 2.4.1 Filter Technology and Performance The group deliberated extensively on country experiences with water quality testing. Questions asked in the group included: Is there a standard or guidelines for water quality testing? What are minimum water quality parameters to be tested? Are there procedures for testing of chemicals in biological samples such as fish? How to improve water quality surveillance? What could be learnt from World Water Management Day? On the issue of setting the research agenda, the following suggestions were made: • • • • Research should be used to assist in decision-making processes. Research activities should incorporate all stakeholders. Emphasis should increasingly be given to behavioural, cost and cultural aspects. There should be close working relationships in research between nongovernmental organizations and researchers.

- 15 -

• • • •

Input from communities are needed to engage in "needs-based research". Research efforts are often more donor driven and hence may not necessarily touch priority issues, for example, pathogens versus arsenic. Comparison of research approaches and results among research projects within and between countries. Standardization of definition used for research, for example, how to measure diarrhoeal disease.

It was also suggested that research activities at the governmental level are still weak or even non-existent. There are also issues of territoriality among government departments in sharing research facilities and research results.

On the question of how to share research, the group suggested the utilization of existing mechanisms such as the HWTS network at the global level. However, this has to be brought down to the individual country level. It is important to establish a good network between researchers and other stakeholders. A web-based communication mechanism would be more useful in this sharing process. The network should include research institutions of each country and some regional network should also be established. However, the group expressed caution about the barriers to information sharing which are created through established rights to use of proprietary information. Member States are also encouraged to organize regular workshops on specific topics. Finally, it is important that research findings on HWTS be channelled to senior people in government. Other issues discussed by the group were: water quality standards and methods; country specific parameters; limiting factors for water quality surveillance, especially the capacity of laboratories; vehicles to carry out water quality surveillance, including the involvement of the private sector; and innovation in water quality testing. 2.4.2 Behaviour Change Interventions and Marketing The group recommended that market interventions through either subsidized or unsubsidized approaches should ensure better usage of HWTS technologies. It was agreed that there should not be a 100% subsidized system. This requires creating awareness of the need for water treatment, creating demand, providing choices, and the ability for people to weigh between household water treatment costs and health benefits gained. In addition factors like availability, affordability, safety, effectiveness and ease of use should be considered. Research is required to find individuals' ability and willingness to pay to find the appropriate level of subsidies. Software should also be developed and delivered in advance of distribution and separate software for purchasers and beneficiaries may be needed. Testing and surveillance should be carried continuously with different channels and they should be repeated with different methodologies.

- 16 -

We also need a mUlti-pronged approach from the community level to media, follow-up with vendors, and materials such as VCDs for vendors to rent or distribute. At the village level, it is important to improve knowledge of village health workers and use word of mouth as an effective means of promotion. Manufacturers should be involved from the beginning to ensure proper use of the technologies. The biggest challenge is how to reach the poorest. Ways to accomplish this include: development of different technologies for different income groups; and developing innovative financing approaches (lease, credit programmes, sponsorship, payment plans). For schools, HWTS should be incorporated into their health and hygiene programmes. The group noted that research needs in Behaviour Change Interventions (BCI) and marketing should be at the global and country levels. However, a framework for behaviour change should be developed that should focus on sustained behaviour as well as safe storage because of the risk of recontamination. The research should cover a wide age range and cover people with different socioeconomic backgrounds to determine positive and negative deviants. It is also important to find agents of change and innovators that could be students or factory workers and not necessarily people of higher authority. Other important factors that need to be addressed in behaviour change for HWTS are:

• • •

The pros and cons of subsidies and impacts on behaviour change. Which behaviours are learnt for life and which are temporary? How do behaviours combine/affect each other? What behaviours can lead to other behaviours? What are the associated factors? Priority behaviour change in the context of refugees. How do behaviours change when people relocate, especially from resource-rich areas to resource-poor areas? What interventions are best? How do people communicate? What are influences on their behaviours? Geographical influence on behaviours? Lessons from marketing/drivers for creating need and desires. Proper levels of sophistication: Some media are too high tech or low tech. We need to find the right balance for target popUlations; visual media are often too advanced for people. Change agents: Effectiveness of children as change agents; messages from school community. Religious, political and class cohesion; influence on power structures. How to get private sector engaged/teach lessons.

• •

•

• •

• •

•

- 17 -

The group emphasized that decision-making processes by government including formulation of strategies and action would be more effective if based on solid research. The group felt that this experience is still lacking. However in the Philippines, the Ministry of Health formulated policies on technology verification and the development of standards based on research results. Through this the Government can control unauthorized distribution of unproven technologies. Another important role of government is to facilitate coordination among stakeholders. In Viet Nam, government facilitates intersectoral coordination and formulates guidelines. Government should share policies and plans with interested agencies. However, the role of external support agencies is to strengthen government to control and enforce policies. All members should support the government technically, flllancially. The group also noted that there is no single ministry totally responsible for safe water. Hence an umbrella organization or working group is needed to improve coordination. Lack of funding can be an obstacle to effective coordination. However, this coordination should be led by senior government officials as they are capable of establishing links with various stakeholders. Legislation should also be considered that could promote cohesiveness in all concerned ministries. 2.5 Environmental Technology Verification on HWTS

The theme of the group discussion was Environmental Technology Verification (ETV) on household water treatment technologies. The participants were divided according to countries and these included the national government officials and nongovernmental officials who work in that country. Each country was asked to discuss the subject of ETV, and taking into account the workshop presentations to answer the following questions: • Is ETV already established in your country? IfETV is not yet established, does your country need it? How would you promote ETV in your country? .

•

The results of the group discussions are summarized in Annex 4.

3.

CONCLUSIONS

The main conclusions of the workshop were: 3.1 General

3.1.1 The workshop noted that it is clear that household water treatment and safe storage (HWTS) technology choices do exist and are effective, but the performance of the technologies to varying degrees depends on local conditions.

- 18 -

3.1.2 Cost effectiveness and cultural acceptance of HWTS technologies are becoming better understood, but much more information is needed. It was encouraging to see that studies are under way to look into technical and socioeconomic aspects of HWTS, and the workshop was an encouraging step to help disseminate this infonnation and to promote further debate and research. 3.1.3 The chief accomplishment ofthe workshop was infonnation exchange, although the scope was limited by time constraints. The participants recommended that similar event should be carried out on regular basis, perhaps annually, and with a similar mix of countries, agencies and experts from different fields. 3.2. Household water treatment and safe storage devices and approaches

3.2.1 The workshop noted that each country seems to have a partial or limited selection of all of HWTS devices and approaches. However, they seem sometimes to be influenced more by donor choices and not related to consumer choice. This is a potential problem to be resolved, taking into account the roles of national governments as well as roles of implementing and technical agencies. It is also important to involve all to make wise choices about these point-of-use approaches. 3.2.2 National governments need to be actively involved to help evaluate, regulate and promote appropriate choices in HWTS. 3.2.3 Donors, as well as implementing and technical agencies, are needed to help inform and support government decision-makers and to help bring infonnation to consumers. 3.3 Technical protocols

3.3.1 The WHO effort to introduce technical protocols to evaluate point-of-use approaches is an encouraging and welcome step, and the model presented in the workshop looks promising. However, the workshop encouraged all countries to participate in the review of the draft protocol to include country thoughts and experiences in order to make the protocols more meaningful and useful. 3.3.2 In the future, the WHO technology evaluation protocols could be extended to include chemicals of concerns such as arsenic and fluoride. 3.3.3 The workshop participants learned of Bangladesh's model on ETV. However, the Bangladesh model may have to be adapted and adjusted to suit other country contexts.

ANNEX 1

OPENING ADDRESSES 1.

Opening Remarks - WSP Cambodia

Excellency Sou Phirin, Excellency Sim Son, Dr. Prak Piseth Raingsey, Dr. Nasir Hassan, colleagues and friends:

On behalf of the World Bank Water and Sanitation Program in Cambodia a very warm welcome to this workshop on Household Water Treatment and Safe Storage in Siem Reap. The meeting on HWTS this week is the second in this region, following the 2005 Bangkok HWTS Symposium which many of you here today also attended. Even then, we could say that "Household water treatment works"; a message I would like to emphatically repeat and stress in the days ahead. A number {)f suggestions for further work were made at that workshop a year and a half ago: • • • • Development and testing of novel technologies Analysis of cost effectiveness of household water treatment Evaluation of the role of household-based water treatment technologies in emergency response Improving uptake and sustainability: taking proven technologies to scale through commercial and quasi-commercial deployment

At the same time, a number of papers concluded that "more research is needed". We have had 18 months, and a lot of progress has been made in that short period. Some of the further research which was carried out, and some of the practical experience gained will be presented in the coming days, although some of the subjects have had more attention than others. Clearly, HWTS is on the agenda and "things are happening"; there are a lot of reasons for optimism. Yet diarrhoea continues to kill indiscriminately, chemical water quality remains a growing cause for concern -the first arsenicosis cases were confirmed in Cambodia not more than one week ago-and our successes in establishing comprehensive water quality surveillance programmes remain few and far between. The debate over the role of household water treatment in attaining the MDG goals is not at all resolved. So let us not think for one moment that we are done. We are merely getting started. In the coming days, we will exchange information and make recommendations and suggestions in 3 areas; 1. Filter hardware, dealing with microbial quality improvement as well as arsenic removal

2.

"Programming" of filter implementation (behaviour change interventions, marketing) Country efforts to verify technology performance, and WHO's efforts to propose an ETV protocol

3.

While we have a number of presentations on each of these subjects, we will also ask you to engage in discussion, and help develop our thinking on how to move the subject forward. To that end there will be participatory discussion and group work sessions on all three days. WSP's support for HWTS is focused on carrying out field based performance assessments and the dissemination of fmdings to the user communities, to enable families as well as NGOs, government and others to make informed investment and programming decisions. I am looking forward to sharing results as well as future plans with you in the days ahead. On a personal note, I am excited to see so many people representing so many different organisations here, and look forward to a week that is productive as well as enjoyable.

Our special thanks go to the Ministry of Rural Development and the Ministry of Health, for organising much of the workshop. We are happy to work together with WHO and UNICEF in our efforts to promote HWTS, and look forward to continuing our cooperation.

2.

Opening Remarks by WHO Representative Cambodia

Thank you Chair Person; His Excellency Sim Son, Secretary of State, Ministry of Rural Development; His Excellency Nou Phalla, Vice Governor of Siem Reap; Mr Jan Willem Rosenboom, Country Team Leader, World Bank Water and Sanitation Program; distinguished speakers and resource persons, ladies and gentlemen. It is my great pleasure to say a few words at this important workshop. On behalf of the organizing committee, I like to inform everyone here that this workshop is able to bring together more than 50 participants from this Region to discuss and exchange experiences, ideas and information on household water treatment and safe storage. Countries represented in this workshop are Lao PDR, Mongolia, Vietnam, Philippines, Bangladesh, USA, Myanmar and the host country, Cambodia. This workshop has covered many aspects with the themes including technology, hardware and production, software and implementation and technology verification. I hope all have benefited from this workshop. Target 10 of the Millennium Development Goals (MDGs) calls for reducing by one half the proportion of people unserved by safe drinking water by 2015. In 1990, the baseline year for the MDGs, 476 million persons were unserved in the East and Southeast Asia. Even if the MDG Target 10 is met, hundreds of millions will remain without access to safe drinking water. For the foreseeable future, therefore, innovative strategies are needed to promote low-cost, home-based treatment of drinking water and safe storage of treated water. In recognition of this fact, WHO established in 2002 the International Network to Promote Household Water Treatment and Safe Storage (HWTS). Annual meetings of the Network were held in Washington, DC (2003), Nairobi (2004) and Bangkok (2005) and recommendations emerged from the annual meetings that regional initiatives and regional forums for information sharing should be supported to more effectively promote household water treatment and safe storage as a strategy for reducing health risks associated with unsafe drinking water.

The WHO Western Pacific Regional Office has promoted household water treatment and safe storage since before the establishment of the International Network and up to the present time. Support has been given for demonstration projects in the Lao People's Democratic Republic and the Philippines, for project development in Cambodia and Mongolia, for research on household level technologies for arsenic mitigation in Cambodia and Viet Nam, and for training activities in these and other countries. Countries of the WHO South-East Asia Region, notably Indonesia, are also engaged in pilot or research activities on household water treatment and safe storage with support from WHO and others. Many international nongovernmental organizations and several international organizations and donors are also actively supporting HWTS in countries of the Region. Chief among these is the World Bank Water and Sanitation Program with which WHO is pleased to be co-sponsoring this workshop. The workshop that begins here today provides an opportunity for exchange of experiences and information on household water treatment and safe storage projects and initiatives and the role of government and national policies in promoting HWTS. Participants will also have the opportunity to hear and discuss the new WHO protocol on HWTS technology verification and other ongoing HWTS technology verification initiatives. An important output of the workshop will be the identification of next steps to be taken to promote HWTS in the Region. Ladies and Gentlemen, Finally, I would like to thank Ministry of Rural Development and Ministry of Health as the organizers to this Workshop. I am extending our deepest thanks to speakers and resource persons of this workshop who will contribute information and knowledge on recent aspects of household water treatment and safe storage. To all of you in this workshop, I wish you all a successful workshop.

ANNEX 2

LIST OF PARTICIPANTS, ADVISORSIRESOURCE PERSONS, REPRESENTATIVES, AND SECRETARIAT

1. PARTICIPANTS WSP-sponsored Participants CAMBODIA

Mr Michael Roberts, Country Director, International Development Enterprises, PO Box 1577, Phnom Penh. Fax: (855 23) 223540. Tel: (855 23) 223541. Mobile: (855) 012 629 069. E-mail: mroberts@online.com.kh Dr Mickey Sampson, Country Director, RDI, P.O. Box 494, Phnom Penh. Tel: (855 023) 369 577. Mobile: (855) 012822526. E-mail: mroberts@online.com.kh Ms Sao Sokha, Technical Staff, Department of Rural Water Supply, Ministry of Rural Development, Phnom Penh, Cambodia. Tel: (855 012) 836 306. Mr Yiin Viriya, Senior Manager, Rural Programs, HAGAR, House 53 D, Street 242, Phnom Penh. Fax: (855 23) 213 375. Tel: (855 23) 219 045. Mobile: (855) 012 822470. E-mail: waterfilter@hagamroject.org

Mr Sent Eam Hor, Arsenic Task Force, Department of Rural Water Supply, Ministry of Rural Development. Corner Road 169 and Soviet Blvd., Phnom Penh. LAO PEOPLE'S DEMOCRATIC REPUBLIC Ms Sengphet Thammavong, Laboratory Technician, National Center for Environmental Health and Water Supply, Group 9, House 114, Ban Nongbone, Saysetha District, Vientiane. E-mail: soutch(tillaotel.com Mr Anouluck Khamphilom, National Center for Environmental Health and Water Supply, Group 9, House 114, Ban Nongbone, Saysetha District, Vientiane. E-mail: anouluckkh@hotmail.com; soutch@laote1.com PHILIPPINES Engineer Joselito Riego de Dios, Chief Health Program Officer, National Center for Disease Prevention and Control, Department of Health, San Lazaro Compound, Rizal Avenue, Sta. Cruz, Manila. Tel: (632) 732 9966. Mobile: (63) 927 514 7568. E-mail: litoriego@yahoo.com

Dr Antonio Yasania, Provincial Health Officer, Ground Floor, Provincial Capitol, Sarangani Province. Fax: (63 083) 508 2285. Tel: (63 083) 508 2167. Mobile: (63) 9156201185. E-mail: cpc6sarangani@yahoo.com VIETNAM Mr Nguyen Dinh Dzung (Dzung), Sales and Distribution Manager, Safe Water Program Manager, Population Services International, Viet Nam. Tel: (844) 772 3620. Mobile: (84) 915128668. E-mail: dzungnguyen@psi.org.vn

WHO-sponsored Participants CAMBODIA Dr Prak Pi seth Raingsey, Director, Preventive Medicine Department, Ministry of Health, 151-153, Avenue Kampuchea Krom, Phnom Penh. Fax: (855 23) 880 407. Tel: (855 12) 862 022. E-mail: pisethseyCiilhotmail.com Dr Lim Thai Pheang, Director, National Centre for Health Promotion 612 Blvd Sihanouk, Phnom Penh. Fax: (855 23) 213 608. Tel: (855 23) 213 608. E-mail: nchp@camshin.com.kh Dr Khuon Eng Mony, Deputy Director, Preventive Medicine Department, Ministry of Health, 151-153, Kampuchea Krom, Phnom Penh. Fax: (85523) 880407. Tel: (855 12) 862 022. E-mail: monykhemasa@yahoo.com Dr Chim Sopharo, Deputy Director, National Centre for Health Promotion, 612 Blvd. Sihanouk, Phnom Penh. Fax: (855 23) 213 608. Tel: (855 23) 213 608. E-mail: esopharo me@yahoo.com WHO-sponsored International Partcipants LAO PEOPLE'S DEMOCRATIC REPUBLIC Mr Soutsakhone Chanthaphone, Deputy Director, National Center for Environmental Health, Group 9, House #14, Ban Nongbone, Saysothe District, Vientiane. Fax: (856) 21413 310. Tel: (856) 21413 310. E-mail: soutch@laotel.com Dr Byambasuren Zolboo, Environmental Health Inspector, State Specialized Inspection Agency, Builder's Square 13, Chingeltei District, Ulaanbaatar. Tel: (976) 11 260 668. E-mail: bzok@yahoo.com Dr Bavuujav Baigalmaa, Officer, Health Promotion Department, Peace Avenue 13B, Post Box 187, Ulaanbaatar. Fax: (976) 11 320663. Tel: (976) 11 321 093. E-mail: bbaigaI2003@yahoo.com PHILIPPINES Engineer John Foz, Licensing Officer III, Department of Health, Region 1, San Fernando City, La Union. Tel: (077) 722 3811. E-mail: jfcI964@yahoo.com

MONGOLIA

VIETNAM

Dr Tran Dac Phu, Deputy Director, Viet Nam Administration of Preventive Medicine, Ministry of Health, 138A Giang Vo Street, Ha Noi. Fax: (844) 736 6241. Tel: (844) 843 0040. E-mail: tdpmoh@yahoo.com Dr Vu Trong Thien, Head of Environmental Health Division, Institute of Hygiene-Public Health, Ministry of Health, 159 Hung Phu street, District 8, Ho Chi Minh City. Fax: (848) 856 3164. Tel: (84 8) 859 6158. E-mail: vutrongthien@yahoo.com ADVISERSIRESOURCE PERSONS

WSP-Sponsored AdviserslResource Persons Professor Feroze Ahmed, Professor of Civil Engineering, Bangladesh University of Engineering and Technology, Civil Engineering Building, 3rd Floor, Dhaka - 1000, Bangladesh. Fax: (882-2) 966 3695. E-mail: fahmed@ce.buet.ac.bd Mr Joseph Mark Brown, University of North Carolina at Chapel Hill, 1714 Jo Mac Road, Chapel Hill NC 27516, USA. Tel: (1 919) 360 8752. E-mail: joebrown@email.unc.edu Ms Kaida Liang, Co-Principal Investigator BSF, CB# 7431, McGavran-Greenberg Hall, Room 3206, Chapel Hill, NC 27599-7431, USA. E-mail: kliang@email.unc.edu WHO-sponsored AdvisorslResource Persons Dr Robert Ainslie, Chief of Party, Safe Water Project, Indonesia, Cipek Utara, Jakarta. Fax: (6221) 7202075. Tel: (62,21) 720 7776. E-mail: Robert.ainslie@Jhuccp.or.id Mr Tran Quang Toan, Head of Laboratory of Water Analysis on Chemistry, National Institute of Occupational and Environmental Health, 1B Yersin Street, Ha Noi, Viet Nam .. Fax: (844) 821 2894. Tel: (844) 971 7329. E-mail: gtoan@FPT.vn Ms Dany Va, RUPP, Phnom Penh, Cambodia. E-mail: danyenvironment@yahoo.com Dr Davin Uy, Director of Research and Development, Institute of Technology of Cambodia, Pochentong Boulevard 86, Phnom Penh, Cambodia. Fax: (855 23) 880369. Tel: (855 12) 213 982. E-mail: DavinuV@itc.edu.kh OBSERVERS WSP-invited Observers Rainwater, Cambodia Ms Lyn McLennan, Technical Adviser, Rainwater Cambodia, #48B Street 99, Beng Trabek, Phnom Penh, Cambodia. Mobile: (855-92) 981 747. E-mail: rainwatercambodia@yahoo.com Mr Edgar Viterbo, WES Adviser, PLAN International, Philippines. E-mail: Edgar.viterbo@plan-international.org

PLAN International

Mr John Collett, Water & Sanitation Adviser, PLAN International, Viet Nam. Fax: (844) 822 004. Tel: (844) 822 0661 Ext. 35. E-mail: John.Collett@plan-international.org Mr Tofik Rochman, Water and Sanitation Specialist, PLAN International, Indonesia. Fax: (62 21) 522 9571. Tel: (62-21)5229566. Mobile: (62) 81310850507. E-mail: Tofik.rochman@plan-international.org Mr Peter Feldman, Water and Environmental Sanitation Advisor, PLAN International, Sangkat Tonie Bassac, Phnom Penh, Cambodia. E-Mail: Peter.feldman@Plan-international.org Mr Ab Koster, Chief Technical Adviser, PLAN International Cambodia. E-mail: a.koster@online.com.kh ADB Mr Wan Maung, ADB TSWSS Project, PO Box 953, Cambodiana Office No.6, 313 Sisowath Quai, Phnom Penh, Cambodia. E-mail: 012996333@mobitel.com.kh Ms Julia Rees, Chief Seth Koma Section, UNICEF, P.O. Box 176/ No. 11, Street 75, Srachark Quartier, Phnom Penh. Fax: (855 23) 426 284. Tel: (85523) 426 215 E-mail: jrees@unicef.org Ms Sophary Phan, Assistant P.O., UNICEF, P.O. Box 176/ No. 11, Street 75, Srachark Quartier, Phnom Penh, Cambodia. Fax: (855 23) 426 284. Tel: (855 23) 426 215. E-mail: sphanCci{unicef.org ADRA Mr Ben Davis, Watsan Projects Technical Coordinator, ADRA, PO Box, Phnom Penh, Cambodia. Mobile: (855 12) 765 136. E-mail: marks@adracambodia.org; bend@adracambodia.org Ms Mary Weir, Health Delegate, International Federation of Red Crossnted Crescent Societies, # 17, Cambodian Red Cross Street (180), Phnom Penh, Cambodia. Mobile: (855) 012 222 609. E-mail: marv.weir@ifrc.org Mr Lem Varidh, Marketing Coordinator, International Development Enterprises, PO Box 1577, Phnom Penh, Cambodia. Fax: (855 23) 223540. Tel: (855 23) 223 541. Quang Van Nguyen, Country Director, International Development Enterprises, Nha so 6, Ngo 161, Thai Ha St., Dong Da, Hanoi, Vietnam. Fax: (844) 514 7802. Tel: (844) 514 7800. E-mail: guang@idevn.org. Web: www.idevn.org Samaritan's Purse Ms Marianne Maertens, Water and Sanitation Program Developer, Samaritan's Purse, Phnom Penh, Cambodia. Mobile: (855) 092 717 857. E-mail: mmaertens@samaritan.org

UNICEF

Internatonal Federation of Red CrossntedCrescent Societies International Development Enterprises

WHO-invited Observers CAWST Ms Millie Adams, CAWST, Bay 12,2916 5th Avenue NE, Calgary, AB T2A6K4, Canada. Fax: (1403) 2436199. Tel.: (1 403) 2433285 ext 222. E-mail: Madam@cawst.org Mr Oun Syvibola, National Water and Environmental Sanitation Adviser, PLAN International, #99-100, Preah Sothearos Tonie Bassac, Chamkamom, Phnom Penh, Cambodia. Fax: (855 23) 210 971. Tel: (855 23) 217 214. E-mail: Oun.Syyibola@plan-intemational.org Mr Chan Borima, Marketing Manager, Population Services International, Phnom Penh, Cambodia. Tel: (855 12) 943 168; (85523) 210 814. E-mail: borima@psi.org.kh Dr Mom Sichan, Safe Water Manager, Cambodian Red Cross, #17 Croix Rouge Khmere (St. 180), Phnom Penh, Cambodia. Fax: (855 23) 212875. Tel: (855 12) 976 805.

PLAN International

Populations Services International

Cambodian Red Cross

Mr Tommy Ka Kit Ngai Ph.D. Student, University of Cambridge, Engineering Department, Center for Sustainable Development, Clare Hall, Herschel Road, Cambridge, CB3 9 AL, England. Fax: (1-416) 284 6185. Tel.: (1-416) 284 6185. E-mail: tommy.ngai@alum.mit.edu Rainwater Cambodia Mr Aun Hengly, Project Coordinator, Rainwater Cambodia, Sangkat Boeung Kak 1, Khan Toul Kork, Phnom Penh, Cambodia. E-mail: rainwatercambodia@camshin.com.kh

SECRETARIAT WSP-sponsored Organizers Dr Chea Samnang, Director of Rural Health Care, Ministry of Rural Development, Comer Road 169 and Soviet Blvd., Phnom Penh, Cambodia. cheasamnang@online.com.kh

Mr Jan Willem Rosenboom, Country Team Leader, Water and Sanitation Program, 70 Blvd. Norodom, Phnom Penh, Cambodia. Mobile: (855 12) 464 360. E-mail: jrosenboom@worldbank.org Ms Phalla Yin, Program Assistant, Water and Sanitation Program, 70 Blvd. Norodom, Phnom Penh, Cambodia. E-mail: pyin@ifc.org WHO-sponsored Organizers

pr flero l<.ol, Vice Director, Department of Preventive Medicine, Ministry of Health, 151-153, Avenue Kampuchea Krom, Phnom Penh, Cambodia.

Mr Terrence Thompson, Regional Adviser in Environmental Health, WHO Regional Office for the Western Pacific, United Nations Avenue, Manila Philippines. Fax: (632) 521 1036. Tel: (632) 528 9890. E-mail: thompsont@wpro.who.int

Dr Nasir Hassan, Environmental Engineer, WHO Representative Office, P.O. Box 1217, Sangkat Chaktomouk, Khan Daun Pehn, Phnom Penh, Cambodia. Fax: (855 23) 216 211. Tel: (855 23) 216 610; (855 23)216 942. E-mail: hassann@cam.wpro.who.int Mr Kong Sovann, Programme Assistant, WHO Representative Office, P.O. Box 1217, Khan Da. Tel: (855 23) 216 610; (855 23) 216 942. E-mail: sovannk@cam.wpro.who.int WSP-Sponsored VIP Attendee H E Sim Son, Secretary of State, Ministry of Rural Development, Comer Road 169 and Soviet Blvd., Phnom Penh, Cambodia. WHO-sponsored VIP Attendee Professor Dr Eng Huot, Secretary of State, Ministry of Health, 151-153, Avenue Kampuchea Krom, Phnom Penh, Cambodia.

ANNEX 3

WORKSHOP PROGRAMME Day 1, Tuesday 10 October

Time 8:00-8:30

Format

Subject Registration (continued from Monday evening)

Opening Session 8:30-8:40 8:40-8:50 8:50-9:10 Plenary Plenary Plenary Welcome by the organizers (MRD) Welcome by Governor of Siem Reap Introduction of Programme and Objectives (WSP and WHO) Official opening by H.E. Sim Son, Secretary of State for Rural Development, Cambodia

9:10-9:30

Plenary

9:30-10:00

Coffee Break and Group Photo

Technical Session I: Filter Technology and Performance 10:00-10:30 Lead Paper Ceramic Water Purifier Evaluation Results: Mr Joe Brown, University of North Carolina Sand Filter Development in Viet Nam: Mr Tran Quang Toan, National Institute of Occupational and Environmental Health Production and Marketing of Ceramic Water Purifiers Questions to presenters Discussion questions: What research still needs to be done? How can we improve research methods/results?

10:30-10:50

Presentation

10:50-11:15 11:15-12:00

Video Presentation Panel Discussion I

12:00-13:15 13: 15-13 :45 Lead Paper

Lunch Household Arsenic Removal: The Bangladesh Experience: ProfFeroze Ahmed, Bangladesh University of Engineering and Technology Arsenic in Cambodia: Prof Davin UY,lnstihM of·· Technology, Cambodia Research of sanl> filters in Cambodia: Dr Dany Va, Royal University of Phnom Penh .

P:45"H:O? 14:05-14:25

rres~~tii:m

Presentation

14:25-14:50 14:50-15:10 Presentation

Tea Break Arsenic Removal Effectiveness of Local Filters: Dr Mickey Sampson, Resource Development International Questions to presenters Discussion question: The suitability of arsenic removal filters for household use

15:10-15:30

Panel Discussion II

15:30-16:30

Working Groups

Group 1: How to improve publishing and sharing of experience? Group 2: Using research results-what can be done to improve filter performance? Group 3: [Selection by participants]

16:30-17:00 17:00

Plenary Plenary

Group result sharing; dot voting Closing announcements

19:00-20:00

Participant dinner and traditional dance performance

Day 2. Wednesday 11 October Time Format Subject

Technical Session D: Bel1aviour Change Interventions and Marketing 8:00-11 :00 or 11 :30 (inc!. break) Presentations, exercises and group work Understanding HWTS behaviours Identifying factors that affect behaviour change for HWTS Developing a model for HWTS behaviour change Facilitated by Dr Robert Ainslie, Johns Hopkins University 11 :00-11 :30 Presentation Social marketing of Sodium hypochlorite in Viet Nam: Mr Nguyen Dinh Dzung, PSI Viet Nam (tbc). Awareness Raising and BCI Approaches: Dr Mickey Sampson, RDI.

11 :30-12:00

Presentation

12:00-13:15 13:15-14:30 Discussion and Presentation

Lunch Identifying approaches to Behaviour Change Interventions (BCl): Dr Robert Ainslie

14:30-15:00 15:00-15:45

Tea Break Lead Paper Marketing Research and Approaches: Mr Michael Roberts, International Development Enterprises, Cambodia Group I: Advantages and disadvantages of subsidies Group 2: What are current research needs in BCI and marketing? Group 3: [Selection by participants]

15 :45-16:30

Working Groups

16:30-17:00 17:00

Plenary Plenary

Group result sharing Closing announcements

Day 3. Thursday 12 October Time Format Subject

Technical Session HI: Environmental Technology Verification for HWTS 8:00-8:30 Lead Paper What is Environmental Technology Verification and how can it be applied: Examples from Bangladesh: ProfFeroze Ahmed. The WHO Protocol for Household Treatment ETV: An Introduction: Mr Joe Brown Questions to presenters Discussion on workable approaches to ETV in individual countries

8:30-9:00

Lead Paper

9:00-9:30

Panel Discussion III

9:30-10:00 10:00-11 :00 Country Groups

Coffee Break Group work: Building on foregoing presentations and discussion, propose steps and timing to start verification work in country Report out on group work: Cambodia, Indonesia, Laos, Mongolia, Myanmar, Philippines, Viet Nam

11:00-11:30

Moving Plenary

Closing Session 11 :30-11 :40 11:30-11:45 11:45-11:50 11:50-12:00 Plenary Plenary Plenary Plenary Summary outcomes Remarks by Convenors, WHO and WSP Final remarks by the Governor of Siem Reap Official closing, by H.E. Prof Eng Huot, Secretary of State for Health, Cambodia

12:00

Lunch

SUMMARY OF COUNTRY REPORTS (Household Water Treatment Technologies Environmental Verification (ETV) for Each Country)

Cambodia Is ETV already established in your country?

Indonesia No No

Lao PDR No

Mongolia

Philippines Yes

Vietnam Yes • Three ministries involved in ETV Consumer promotion

No

•

Only technical

verification

• Countries with NO Yes:

association

ETV, do you need ETV in your

•

increasing number of household .water treatment

Yes: many new

Yes:

•

technologies coming into the country

•

promoting Borne household water treatment technologies

Not sure: • Lack of

-

-

country?

capacity to undertake ETV

tectmologies i1nrI:nlduced in the

•

acm:mtry ETV is required for verification

· · •

process

good time to start

(chlorination, biosand

filters, CWP etc)

• Practical steps

need to verify the above

to develop ETV

•

Ministry of Rural D~<>pDent

Present WHO

d~_nt

•

shlmld lead IlTV in the 'COWlt: ry Ilstablish a Technical Task

Draft ETV Protocol to Ministry of

•

technologies Establish ETV Review Panel to

•

To consult

-

-

relevant government

Health and WHOIndonesia Meeting of

be lead by Ministry of Health and panel members to include representative from Science J

ministries i.e. Ministry of Nature,

Force for IlTV deft!lop"I<m t . Task force members are from government,

stakeholders on HWTS constituting government agencies, NGOs etc to discuss verification process

Technology and Environment

•

Ministry of Health etc. Ilstablish a committee to

NGOs, and other

•

concern parties Task Force also to collect existing ETV documents such as

Agency (STIlAl and other concern agencies

study the need of IlTV in the country

• •

Ilstablish an ETV Steering Conmittee to review available ETVs

•

Carry out IlTV at pilot scale Incorporate

from Bangladesh

•

•

•

Establish a formal IlTV

•

with the ongoing field

•

I "'"

•

Committee constituting relevant stakeholders. Above committee

in other countries and

methodology for RWSS

draft country ETV

•

Incorporate ETV in community

should be approved by the Government

•

Identification of verification

dialogue on IIWTS technology options

• • •

agency Adopt National ETV Protocol Implement protocol Dissemination

of Protocol and process to all relevant agencies No time set

Expected time to start ETV process

•

November/December 2006

•

•

As soon as possible

•

No indication

-

yet until proper consultation is made Improve coordination Improve coordination Improve training and capacity

Success efforts

•

!lTV

should not

disrupt existing implementation efforts on household water treatment

•

Who will pay for ETV i.e. government, producers etc?

•

Needs financial

and technical assistance to

•

-

•

start ETV development process

• •

Improve coordination between the three ministries involved in ETV

technology implementation

• Challenges of ETV development

building ETV with certification

would be better

•

Laboratory capacity is a major concern

•

Laboratory capacity is major concern

• •

Laboratory capacity is a major concern

•

Capacity to test specific microbes

Lack of coordination between government and

proposed in WHO Draft Protocol

for Star System

nongovernmental agencies

•

Limited expertise and facilities

Other comments

•

To consider whether ETV is

•

Who tests

-

technology, private

•

legally binded or

· •

not or just a guideline To consider separate ETV licensing for urban and rural Interim ETV

• •

labs/cost Identify minimum standards Indonesia Who approves test results

•

should be considered before

• •

•

Who/what needs certification Producer of

full ETV is developed

Information sharing between government and non-government agencies is a major concern Development. of national database Collaboration from academicians and experts are

•

• •

Need to review current ETV to consider WHO'S Protocol To also include social and fiscal evaluation Continue field testing or conduct action research involving NGOs

•

Improve coordination between the

three ministries

•

Should find a good balance between technical, social and fiscal verification

•

Countrywide water supply assessment is required

• • • • •

technology (each pr,oducer) Project agency implement of

needed

and other institutions for overall ETV process

•

Strengthen capacity for water quality monitoring at province and district levels using low-cost and easy to use

during ETV

•

development Use own data to

the technology (cost, agency) Monitoring protocols in

replace WHO values. Should adopt WHO guidelines where necessary and relevant Consider

methods

the field Revivification when

Who pays government, producer, p,

•

political structure

applying How to enforce

• •

policy Use of verification,

branding, promotion Dissemination

of policy to public

ANNEX 5 LIST OF DOCUMENTS Title Draft meeting notes of the third annual meeting of the international network to promote HWTS and 2005 International Symposium on Household Water Management Information Bulletin No. 1 List of participants Workshop programme No Soft copy on CD

No Yes Yes

Workshop objectives .

No yes, as PPT .

Independent appraisal of ceramic water filters in Cambodia, 20022006 (PPT show) Extended field trial of Household Iron Removal Plants to remove arsenic from groundwater (pPT show) Household arsenic removal: The Bangladesh experience (pPT show) Assessment of groundwater conditions and suitability for household treatment to remove arsenic (PPT show) Preliminary Assessment of Local Media for Removing Arsenic in Ground Water in Cambodia (pPT show and final report with same title) Challenges Facing Arsenic Removal Technologies In Cambodia (PPT show) Understanding Behaviour Change for HWTS (PPT show) Influencing Behaviour: Initiating large scale POU treatment programme in Indonesia "Air Rahmat" (PPT show) Household Water Treatment: a social marketing approach (PPTshow) Awareness Raising and Behavioural Change (pPT show)

yes, asPPT

yes, as PPT

yes, asPPT

yes, as PPT show and PDF file

yes, asPPT

yes, as PPT yes, as PPT and video clips yes, as PPT and video clips yes, as PPT and video clips yes, as PPT and video clip

Marketing approaches to promote ceramic water filters in Cambodia: a report on field experience since 2004 (pPT show)

Behaviour Change Interventions (PPT show) Environmental Technology Verification (ETV) - Example from Bangladesh (PPT show) WHO household water treatment technology verification: overview of proposed protocols (PPT show)

yes, asPPT yes, as PPT

yes, asPPT